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

Assess technologies 

With regard to technologies, perhaps the first task is to evaluate the hospital’s and vendors’ readiness. Are current or potential vendor partners—CPOE, BCMA, infusion systems, and EMR—ready for interoperability with regard to their technology, track record, implementation team, change-agent expertise, and infrastructure to provide ongoing support? What is the vendor’s track record and knowledge base for optimizing implementation?

Software and hardware

The hospital’s current infusion fleet needs to be assessed to determine the potential complexity of connecting all pumps to the EMR. From an IT, pharmacy, nursing, and biomed perspective, how will the resulting system be maintained? Do systems or software need to be upgraded or replaced? Having a different platform for different types of infusions (e.g. large-volume, syringe) along with different servers, integration engines, and drug libraries exponentially increases the complexity of managing and monitoring the system. Hospitals standardize their EMR capabilities; does it make sense to standardize infusion therapies to a single platform?

A major consideration is whether software, hardware, or infrastructure needs to be upgraded. If a major version change is needed for the infusion system or the EMR, these projects should be kept separate from implementing interoperability. Nursing adoption is likely to be greater if nurses do not have a negative experience with interoperability because of challenges from a concurrent upgrade. Issues that prevent the use of interoperability can make it much more difficult to achieve high compliance levels later.

Wireless infrastructure

Interoperability has to function seamlessly in every part of the hospital where patient care may occur. The connectivity demands are much higher than for smart pumps alone. Robust heat mapping (evaluation of wireless connectivity throughout the facility) needs to be done for every patient care area where an infusion pump would be used. If any gaps in coverage are identified, plans must be made for a wireless infrastructure upgrade.

Scanners

A thorough assessment also includes simple things such as making sure all bar code scanners work. Whoever manages the scanners needs to round on the floors, checking the workstations on wheels to make sure they are fully functional. The importance of this became readily apparent in the midst of one hospital’s go-live: A nurse commented that she had to hold the USB cable to use the bar code scanner. IT had to be called to come to the room to replace all the scanners with ones that worked, unnecessarily disrupting the implementation.

Ergonomics

The ergonomics of the care areas also need to be assessed. Do the room layout, location of the work station, and bar code scanner allow for bedside use? Are nurses using handheld or tethered scanners? Is the tether close enough to the infusion device? Would placing a lead-lined portable x-ray machine in the room disrupt bar code scanning? If nurses are scanning medications in the hall, how will they scan medications for a patient in isolation?

Good compliance with the use of BCMA suggests that the equipment is working and the nurses are happy with it. If compliance is bad, there could be many reasons, including poorly functioning equipment or an insufficient number of scanners.