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

Since data set alignment is critical to the project’s successful completion, a hospital may want to bring on a vendor’s pharmacy consultant and nurse consultant to help the hospital’s preparedness team standardize a common data set and clinical workflow for interoperability. Throughout preparation, implementation, and ongoing use, pharmacy and nurses need to meet on a regular basis to review infusion data and make adjustments to ensure the current drug library matches nursing practice and reduces use of basic infusion.

Before implementation begins, compliance with CPOE, BCMA, and the drug libraries on the pump needs to be at the hospital’s established best-practice level. It is important to identify and understand the reasons for noncompliance, with an interdisciplinary team making any changes needed to support best practice.


Drug library stewardship often does not get the attention it deserves, and prolonged delays in updating all pumps is a frequently unrecognized issue. With interoperability, any change in CPOE orders requires a simultaneous change in the drug library released to the smart pumps. Pharmacy should communicate with the clinical staff the name of the new drug library, what changes occurred, and a reminder of the steps required to activate the new drug library on the device. Pharmacy and clinical engineering can work together to monitor library version uptakes to ensure the most current drug library is in use.

Strengthen culture of safety

Finally, the interoperability preparedness team can work with other hospital staff to strengthen a culture of safety. The first step is to work with educators—not just nursing—to create awareness of what is coming and how it fits with the hospital’s mission. Everyone needs to move from what the Institute for Safe Medication Practices (ISMP) calls “first-order” problem solving (working around it to get the job done) to “second-order” (trust, reporting, improvement, and feedback) (ISMP, 2016).

Using second-order problem solving to identify and correct mismatches between drug libraries and actual practice can help increase understanding, collaboration, and compliance between pharmacy and nursing. Robust process improvement can be used not only to continuously improve the drug library data set, but also to increase trust and staff engagement, and to strengthen the culture of safety. As with data set alignment, change management is challenging, and the hospital may want to draw on consultants with expertise in this area.


As noted in an earlier report, “Smart pump–EMR interoperability is more than worth it for safe and efficient medication management—it is a requirement. In both critical and non-critical care areas, interoperability helps reduce error-prone manual infusion programming, streamline nursing workflow, and ensure accurate and timely capture of infusion data. Smart pump–EMR interoperability encompasses the patient in full-loop IV medication management that improves both safety and quality” (Pettus & Vanderveen, 2013).

Preparing for interoperability accomplishes two goals at once. First, even before the smart pump and EMR vendors’ implementation teams arrive, hospital staff can work to reduce the complexity, difficulty, and cost of implementation. Second, by thoroughly reviewing and optimizing the hospital’s technology and practices, hospital staff immediately improve current practice and quality of care. The effective pharmacy-nursing collaboration that implementation requires also improves interdepartmental understanding and communication. Strengthening the culture of safety benefits everyone.

Tim Vanderveen was vice president of the BD (formerly CareFusion) Center for Safety and Clinical Excellence in San Diego, California. He may be contacted at Nicole Wilson is manager, clinical marketing at BD. Katie Moatsos is director of professional services at BD. Monica Obsheatz is senior pharmacy consultant on the BD Clinical Operations Project Management team for connectivity projects.



ECRI Institute (2013). Infusion pump integration. Health Devices, July 2013, 210–221.

Hicks, R. W., Cousins, D. D., & Williams, R. L. (2003). Summary of information submitted to MEDMARX in the year 2002: The quest for quality. Rockville, MD: USP Center for the Advancement of Patient Safety. See more at

Husch, M., Sullivan, C., Rooney, D., Barnard, C., Fotis, M, Clarke, J., Noskin, G. (2005). Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Qual Saf Health Care, 14(2), 80–86.

Institute for Safe Medication Practices (2016, May 19). Reporting and second-order problem solving can turn short-term fixes into long-term remedies. ISMP Medication Safety Alert!, 21(10), 1-4.

Pettus, D.C., & Vanderveen, T. (2013). Closed-loop infusion pump integration with the EMR. Biomed Instrumentation Tech, Nov/Dec 2013, 467–477.

Russell, R., Murkowski, K., & Scanlon, M. (2010). Discrepancies between medication orders and infusion pump programming in a pediatric intensive care unit. Quality & Safety in Health Care, 19i31-5. doi:10.1136/qshc.2009.036384

Schnock, K., Dykes, P., Albert, J., Ariosto, D., Call, R., Cameron, C., … Bates, D. W. (2016, February 23). The frequency of intravenous medication administration errors related to smart infusion pumps: A multihospital observational study. BMJ Qual Saf. doi:10.1136/bmjqs-2015-004465.

Vanderveen, T., & Husch, M. (2015, June 15). Smart pumps, BCMA, and EMRs: Lessons learned about interoperability. Pt Safety Qual Healthcare. Retrieved October 19, 2015 from