EVERY NURSE, physician, or other healthcare team member will tell you that we all just want technology to work and support us as we care for our patients. I have yet to meet a fellow clinician who doesn't want to be more informed and efficient while providing better patient care. We want healthcare technology to be easy to use and reliably anticipate our needs, just as our smartphones do in almost every other aspect of our personal lives. Yet even though certain Internet sites can show me 10 different kinds of low-phosphorus dog food based on my last search for “aging bulldog,” I still don't have a reliable and efficient way of knowing which medications are incompatible with my patient's treatment plans.
The missing link
When I started my healthcare career more than 35 years ago, I didn't realize that a large part of my job as a critical care nurse would be facilitating communication between various medical devices, technologies, and people at the patient's bedside. As the nurse, I was my patient's “interoperability.” Not only did I manage multiple infusion pumps, a mechanical ventilator, and numerous other devices, but I was also responsible for transmitting the information outputs of each of these machines to the appropriate places and people at precisely the right moment.
Like all good clinicians, I did my best to understand the patient's health history, make evidence-based decisions, and coordinate my efforts with others. What I really needed was a computerized system to connect the dots for me, to do the simple things like relaying messages from the ECG to the infusion pump to the medical record so that I could do the critical work of heading off a secondary complication or even saving my patient's life.
Many radical treatment breakthroughs and advances in technology have been made in the years since I entered nursing practice. We now can do telemedicine-enabled consults in real time, which is why it's confusing that we still have nurses transcribing vital signs, weights, and other patient data into the medical record. Although technologies operating with digital information can do more than ever before, they're limited by the simple fact that they can't connect to each other: With hundreds of different device manufacturers and over 10,000 different medical devices, they literally speak different languages. Not only does each device require its own unique setup and maintenance, which requires time and specialized labor, but each device also requires its own proprietary software interface needed for basic operation. This leaves most medical devices, electronic health records (EHRs), and other information technology (IT) systems unable to exchange information easily and at an affordable cost.
Without even a basic level of interoperability between medical devices and technologies, how can we ever hope to realize a health system that harnesses the power of data, data liquidity, and precision medicine?
How we can help
Nurses play a critical role in driving change. Who better to help the system learn where interoperability is needed than those who've been facilitating it for all these years? Medical device interoperability is the ability to safely, securely, and effectively exchange and use information among one or more devices, products, technologies, or systems.1 I see three main ways that we can help advance medical device interoperability: be a voice at the table, partner with IT departments on usability issues, and build strategic roadmaps.
Be a voice at the table. Sharing your opinion and expertise on how technology can improve the care environment can provide the clarity and direction that's often missing from improvement efforts. You know the opportunities—and the deficiencies—better than most. Speak up about existing solution tools you work with every day. Are your technology tools meeting the mental model for ideal care delivery? What are your workarounds for providing safe, quality, and efficient care? Do your medical devices connect, and stay connected, with each use? I'm going to guess they don't. And I'm also going to guess you don't have time to open a new ticket each time they don't connect.
Digital devices and mobile health technology are only going to become more prevalent as time goes on, and the problems of today will only be amplified tomorrow unless we address them now. You have a unique opportunity, as someone who's intimately familiar with these processes, to identify transformative solutions for the many issues that frustrate nurses, healthcare providers, and patients.
Partner with IT departments on usability issues. Clinical teams partnering with informatics and IT teams must continue to evolve and move beyond a limited approach that prioritizes EHR screen optimization. We need to explore other solutions within the care environment. Interoperability should blend useful, safe, and satisfying foundations based on frameworks supported by the Institute for Safe Medication Practices and other safety experts that focus on safety and reliability.
The system that we should all aspire to is the cockpit of the smartest and most sophisticated fighter jet in the world. This jet has built-in and completely integrated avionics, advanced sensor fusion, interoperable and data exchange, large liquid displays, the ability to change displays with one-finger touch, and multifunction display to reconfigure and reprioritize with active systems. Imagine if we had the equivalent of that kind of cockpit to coordinate care. Would we still be addressing alarm fatigue?
Empowered frontline clinicians should define and lead the technology requirements that are implemented in their own care environments. This will be critical in crafting a thoughtful design for enhancing usability and workflows to reduce clinician burden from point-of-care solutions. Eventually, this approach could lead to the development of interactive systems of care tools that seamlessly exchange information to improve the care environment.
Build strategic roadmaps. Use your voice to support and implement strategy delivery. As we all focus collaboratively to improve patient engagement and reduce risk of patient harm, a roadmap to properly advance interoperability beyond infrastructure requirements is an excellent starting point.
Let the data tell the story. No one knows the opportunities for improvement within your patient population and care environments like you do. Work with nursing students, new graduate nurses, or your unit staff to collect data supporting a quality improvement project, such as dead spots for wireless connectivity or observations that monitor for noise. These useful data describe the current situation and identify areas of improvement that need to be prioritized in both the short and long term, at the point of care and across the system. Working alongside leadership, offering your input as new processes are designed will only lead to more effective solutions in the long term. That includes being more specific and clear about requirements for what technology should do for us and for our patients.
Your voice matters
We should continue to partner with informatics and IT teams to leverage technology for advancing the safety of the complex care environment. Don't stop advocating until our goal of safe, useful, and satisfying care is achieved. I encourage you to invite IT partners within your system to join you for a day of shadowing. If they walk in your shoes, they'll be better able to partner and advocate for practical solutions. Join the technology and caregivers committee to jointly define and monitor success of roadmaps. If you don't have one, create one. If we want to evaluate care delivery in real time, we'll need to behave differently and address the specific sources of frustration behind open tickets.