Interoperability Preparedness: What Hospitals Can Do to Be Ready for Smart Pump-EMR Interoperability

Interoperability implementation shines a spotlight on all aspects of medication ordering, pharmacy review, and nursing administration of IV infusion medications. For example, a hospital may assume compliance with medication safety technologies is good, but preparing for interoperability reveals exactly how CPOE, BCMA, and the smart pump drug libraries are being used. Interoperability will also bring nursing practice into sharp focus—are nurses all following policy and procedure, or is there immense variability? The more that can be done to standardize practice and procedures ahead of time, the easier the implementation will be.

In a previous article in PSQH (Vanderveen & Husch, 2015), we discussed the top 10 lessons learned from early implementations, with a goal of helping hospitals better understand the complexity involved and how to work with vendors most effectively from kickoff through go-live and continuing use. In this article, our purpose is to help hospitals optimally prepare before the implementation teams arrive. Planning, assessing the current state, and standardizing practice and technologies can enable hospital and vendor staffs to focus on interoperability during implementation, without having preventable challenges arise.



A multidisciplinary team that will oversee interoperability preparation must be assembled. Interoperability implementation is a far more intensive process than smart pump implementation and will likely require different resources than the staff that rolled out the stand-alone, yet wirelessly connected, infusion devices.

Interoperability requires bidirectional communication in which the infusion pumps and EMR “talk” and “listen” to each other, which is far more complex than one-way communication. Moreover, communication occurs throughout the infusion process for the thousands or even tens of thousands of pumps connected to hospital networks. Just as interoperability involves multiple systems, the preparedness team needs to involve multiple disciplines within the hospital or integrated delivery network and, as needed, from one or both of the vendors.

Depending on the staff support available, various hospitals have included representatives from pharmacy, nursing, physicians, executive sponsorship, quality, clinical informatics, information technology (IT), IT/clinical applications analysts, biomedical/clinical engineering, project management, data analysts, and clinical education specialists. Not all team members will need to be intensively involved at the initial stages, but early involvement can help build understanding, improve collaboration, and reinforce a culture of safety right from the start.

Ultimately, everyone whose day-to-day work will be affected by interoperability needs to be represented on the team. Vendor representatives may also need to be involved: perhaps as consultants during preparation, and later as entire intensively engaged teams once implementation gets underway.


An initial budget will need to cover staff time for the members of the interoperability-preparedness team and any necessary hardware and software to support various EMR environments, smart infusion device upgrades, additional smart infusion devices for testing/training, BCMA equipment for testing/training, label printers for bar codes to be placed on smart infusion devices, and label printers for pharmacy labels used in testing.


The team also needs to put interoperability on the hospital calendar, after seeing how it fits with the hospital’s other projects. As mentioned above, this often is done two or more years before the desired installation date. Planning for necessary upgrades to the systems involved—CPOE, BCMA, infusion devices, EMR, and wireless infrastructure—should ensure nurses have enough time to become accustomed to using the upgrade and are not burdened or overwhelmed with too many changes at once.


Another task is to determine which metrics will be used pre- and post-implementation to measure success. Examples include the number of manual keystrokes needed to program the pump, compliance with BCMA, compliance with interoperability, compliance with dose-error-reduction software and patient identification usage; infusion system alerts; alert overrides; reprogrammed and cancelled infusions; and lost charges due to missing documentation.