January / February 2012

Device Integration

EMR Adoption and the Roles of the CMIO and CNO



U.S. hospitals have been focused on achieving criteria outlined in meaningful use since the passage of the American Recovery and Reinvestment Act (ARRA). According to the 22nd Annual HIMSS Leadership Survey, half of respondents identified meeting meaningful use criteria as their organization’s top IT priority, and two-thirds of respondents reported that their organization has already made additional IT investments to position themselves to qualify for the incentives associated with achieving meaningful use. In addition, approximately 40% of respondents reported that IT can have the most impact on patient care by improving clinical and quality outcomes.

As healthcare organizations move toward achieving meaningful use and implementing electronic medical records (EMRs), the integration of medical device data into clinical systems will play a key role.  Medical devices automatically collect patient data, such as vital signs information, on an ongoing and automated basis. However, clinicians collect the vital signs from these devices and then manually key them into the EMR. This required activity, unfortunately, takes clinicians away from patient care. Moreover, it’s an inefficient use of time, often resulting in double charting, once from the device and then in the patient’s electronic record. As a result, clinicians become frustrated and challenge the value of the EMR.

Medical device connectivity alleviates these challenges by automatically capturing that data directly from devices and sending it to the EMR. Charting errors are nearly eliminated, nursing time is recovered, and more time is spent on direct patient care.  Ultimately clinical satisfaction improves as well as EMR adoption. And, as an added benefit, the implementation of medical device connectivity also helps hospitals qualify for meaningful use in all three phases including recording vital signs and charting changes (2011 objective), recording clinical documentation in the EHR (2013 objective), and medical device interoperability (2015 objective). In order to test these assumptions regarding the benefits of medical device integration, Capsule Tech and HIMSS Analytics conducted research with chief medical informatics officer (CMIOs) and chief nursing officers (CNOs or senior nurse executives) as they represent two primary groups that will be impacted by its adoption. The results that came out of the study can be divided into two groups: 1) how the roles of the CMIO and CNO have evolved, their roles in the technology decision-making process, and especially how their roles affect clinical success and patient care; and 2) the role they see medical device connectivity playing within their organizations, in particular to aid in EMR adoption, managing the influx of device data, and improving patient care and outcomes.

The Evolution of the CMIO and CNO
The roles of both positions continue to evolve and change, with both groups reporting increased responsibility overall. Key findings include:

CMIOs indicated that their most basic job function is to bridge the gap between clinical needs and IT; CNOs and senior nursing executives cited that their roles have evolved to be more inclusive of departments outside of nursing.

Senior nursing executives also cite that they are involved in more strategic organizational meetings, which provide them with the opportunity for input at a higher level, however, it also impacts their ability to accomplish day-to-day tasks.

CMIOs recognized the important connection with senior nursing executives and physicians and indicated that they have frequent contact with other C-level executives within the hospital.

Goals, Priorities and the Impact of Medical Device Integration
Many respondents noted that medical device integration is a key solution on the road to achieving a fully functional, integrated EMR environment and a major priority in the next several years. Other priorities and goals, as well as opinions on medical device integration, include:

  • When it comes to medical device integration, both groups of executives cite the important role of the technology in driving EMR adoption and effectiveness. Executives noted that EMR implementations without device integration are “foolish” because increasing workload among nurses can result in decreased adoption of the EMR.
  • Some CMIOs suggested that in addition to implementing EMR solutions, their goals and priorities in the next one to four years will shift to include device integration.  The general feeling among CMIOs is that attaining a complete electronic record is not possible unless data generated from devices is included.  
  • All executives cited the explosion of data—highlighting that when it comes to EMRs, it is no longer only about data collection and management, but also about how to synthesize the data into useable information.
  • Medical devices play an important role in meeting nurses’ priorities of improving patient care.  Medical device integration can help with proper data validation, improved data accuracy, and data collection, which in turn will allow more time for frontline nurses to interact with patients and more positively impact the overall patient care experience.
  • Respondents reported that integrating medical devices is a priority in order to ensure that documentation is more comprehensive and to reduce the likelihood of errors.
  • CMIOs in particular recognized the pressing need of medical device integration and the value it will have on improved patient care (and patient care experience, which can impact overall patient satisfaction scores), clinical data collection, increased patient safety, and improved EMR adoption.

As the feedback to this study highlights, ARRA will continue to be a significant factor for hospitals formalizing EMR strategies with the use of integrated medical devices, and we can expect that capital and operating budgets will be adjusted accordingly. This will be especially true after hospitals have achieved Stage One of the meaningful use criteria and the desired EMR data collection and management levels to receive ARRA funding; device integration facilitates the accuracy and faster delivery of clinical data and therefore should help in meeting this criteria. As the roles of both the CMIO and CNO continue to evolve on different paths, one thing they have in common is very clear: both are vested in using technology to improve patient care. As the study found, medical device integration will be a key solution on the road to achieving a fully functional, integrated EMR environment and helping healthcare organizations increase quality and safety when it comes to patient care.

Susan Niemeier is chief nursing officer and clinical product manager for Capsule Technologies in Andover, Massachusetts. She may be contacted at 978-482-2300 or follow her on Twitter at www.twitter.com/susanniemeierRN.

The full report, Medical Device Integration: CMIO and CNO Perspectives, is available for download at www.capsuletech.com.

SPONSORS

ABQAURP American Society for Quality American Society for Quality Healthcare Division Consumers Advancing Patient Safety
EMPSF Institute for Safe Medical Practices
           
Medically Induced Trauma Support Services (MITSS) Medication Safety Officers Society NPSF Partnership for Patient Safety Society to Improve Diagnosis in Medicine