Is it acceptable not to make dramatic improvements in patient safety? Should medical devices notify doctors if patients are having a critical event? If medical devices are connected all together, do they speak the same electronic languages?
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A 32-year-old woman was on the operating table for routine gall bladder surgery, and doctors needed a quick X-ray. To keep her chest still while the image was shot, her ventilator was switched off. But the anesthesiologist, distracted by another problem, forgot to turn the breathing machine back on. The woman died.
The case is an extreme example of the kind of error that could be prevented if medical devices were designed to talk to each other, says Dr. Julian Goldman, a Massachusetts General Hospital anesthesiologist who has compiled such instances from across the United States to highlight the need for medical device “connectivity.” In this case, he says, synchronizing the X-ray machine with the ventilator, so the image was automatically timed to a natural pause in breathing, would have made it unnecessary to turn it off.
As technology moves forward, people expect the electronic devices of everyday life to work together, from cellphones that can call or text-message other phones, to computers that interconnect with a slew of gadgets. But in the medical world, where the stakes are higher, such flexible interconnection is rare. Each device operates in its own silo…
Now the push for greater connectedness in hospital electronics is gaining momentum. The goal is devices that can not only plug into one another, but can also “understand” each other and automatically identify potential life-threatening problems sooner than they would have been caught by busy nurses and doctors.
In October, a task force – including Partners HealthCare, Mass. General, Johns Hopkins Medicine, Kaiser Permanente, and the Boston-based Center for Integration of Medicine and Innovative
Technology – released sample language that hospitals can incorporate into contracts with vendors of medical devices, requiring that manufacturers create products capable of communicating with other devices using agreed-upon standards…
The administration of pain medication is one area where the ability to connect could save lives, advocates say.
A case reported in the Canadian Journal of Anesthesia, for example, describes a 19-year-old patient who accidentally received too much pain medication through an IV pump and died. Such pumps have safety features intended to guard against overdoses, but in most cases they are not hooked up to the monitors tracking the patient’s vital signs.
That means a dosage error or unexpected reaction that causes the patient to decline could escape notice.
A study published this month in the Joint Commission Journal of Quality and Patient Safety looked at the safety of patient-administered pain medication and found that it is four times more likely to result in patient harm than other medication errors.
At a recent conference, Goldman’s Medical Device Plug and Play Interoperability Program demonstrated how problems with such medication systems could be addressed. It presented a series of circuits that could patch together monitors and, when needed, automatically shut off the pump administering pain medication, and call the nurses station.
Dr. Marc J. Bloom, director of perioperative technology at New York University’s Langone Medical Center, calls the clutter of wires and cords in operating rooms “malignant spaghetti…
Ehrenfeld pointed out another danger: increased costs. He’s seen a patient come in with an MRI scan saved on a CD, but in a proprietary file format that can’t be easily viewed, meaning that another MRI is ordered at considerable cost. So why hasn’t greater connectivity in medical devices been developed before now? There are a variety of reasons…
And medical device companies have been slow to change so far, according to Tim Gee, a principal at Medical Connectivity Consulting. Adding interconnectivity could increase companies’ liability and costs, and open them up to new competition from other companies, he said…
The turning point may be the arrival of the first truly revolutionary application, such as a medical version of an iPod, that changes people’s expectations of their devices…