TECHNOLOGY
(medical equipment and medical software), and many different types of information technology systems. There are real benefits that can come from linking the medical equipment to the IT system and allowing the patient data to be ‘pushed’ into the patient record. For example, EPMA systems can ensure that the prescribed medication for each patient is allocated to the right patient record. Modern infusion delivery systems can facilitate ‘drug library’ software in which all concentrations of drugs are held in the memory of the pump, and by linking the pump to the patient via a barcode, the patient prescription can be uploaded directly to the pump. Time of entering data and checking is reduced, with the removal of the risk of human transcription errors. Furthermore, the actual medication delivered is automatically uploaded into the Electronic Patient Record. Such systems were not practicable prior to networking of devices; large hospitals may have thousands of infusion pumps, and drug libraries will require regular updating so the only way to manage this is by sending the data over the hospital network so that all devices can be harmonised to the same configurations. While the technology is available now to do this, there is sometimes a misconception that it can happen simply by implementing a large IT system. Healthcare institutions need to make strategic decisions about which devices they wish to connect in to the hospital network, and plan investment so that in addition to the IT
network, the thousands of medical devices are specified so as to work with the network. WiFi connectivity does not come as standard on most medical devices, so strategic decisions are needed to ensure that once we have our EPR or EPMA, the thousands of portable devices that need to talk to it can do so. This in turn requires that the hospital has a policy to manage technology, and is standardising on devices that it requires to connect in to the central system. Re-usable electronic medical devices typically last for between 5-15 years, with perhaps 8-10 years being most common. However, technological developments may now be rendering devices obsolete due to a lack of connectivity. It is not only devices such as infusion pumps and patient monitors that need to connect in to the Electronic Patient Record (EPR); most devices from weighing scales to diagnostic scanners are becoming available with WiFi options. However, connection to the hospital network is not the only reason to think carefully about how devices are specified.
Hospital at home services
Once we turn our thoughts to hospital at home services, we need to consider whether the devices that are used by trained professionals in our hospitals are suitable for use in a home setting. Official figures show that more than 8,000 drug errors cause serious harm or death in the UK each year, even when used by professional users. Once we move medical devices into the home environment, how does
a non-professional patient or carer deal with problems or unexpected issues? ANSI/AAMI HE 75 defines the process for human factors engineering process for medical devices as starting with ‘define intended use, users and environment’. Up and down the country, however, the urgency to create more capacity is leading to patients being sent home with inappropriate devices that were never designed for use in the home.
Planning investment in healthcare technology
Guidance from the MHRA in England states that all hospitals should have a Board Member with responsibility for medical devices, and that there should be an organisation-wide medical devices group at which policy and investment decisions are made.5
The guidance stops short of saying that the group should report directly to the hospital board. However, with the level of reliance now placed on healthcare technology, it is hard to see how responsible organisations would fail to ensure that there is a direct reporting route. For clarity, this group should have membership that understands the strategic objectives of the organisation, and should be charged with determining the long-term investment in medical technology to deliver those objectives. This requires that there is good understanding of current technological capabilities, and of emerging technologies and developments.
OCTOBER 2016
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