EBME Leadership
as late as you can,” advised Consultant Clinical Engineer, Francis Hegarty.
The digital void and connectivity Professor John Sandham further invited discussion on the ‘digital void’. The forum highlighted that there is a significant gap between enterprise ICT (focused on EHRs like Epic/Cerner) and the clinical reality of medical device integration. He warned that connectivity in any new hospital must be a top priority. “At last year’s EBME Expo, we had our first connectivity conference,” noted Professor John Sandham. “Although it’s our newest conference, it was the second most attended, which was very telling. It shows that there is a huge amount of interest in connectivity and a huge lack of knowledge in how we get from A to B.” The group identified a need for interoperability
standards (such as the international ISO/ IEEE 11073 standard) and the importance of SDC (Service-oriented Device Connectivity). While industry adoption is growing, it is not mandatory, leading to fragmented “little eco- systems” from different suppliers. One thought leader argued that healthcare must mirror the military/automotive sectors by adopting the equivalent of a “Generic Vehicle Architecture.” Devices should be “plug and play” on a standardised hospital data bus. The room raised a pivotal concern: “Who is currently influencing the Government on these technical standards?” There is a lack of a unified technical voice at the DHSC’s “top table” to mandate these architectures. When it comes to connectivity, another thought leader pointed out that, “You need somebody in ‘a helicopter’ to say, ‘this is what a digital hospital looks like. This is what a connected hospital looks like – and the benefits are…’ There needs to be very clear understanding that if you’re building future hospitals, medical device connectivity must be part of it – it needs to be funded in the business case. You need people who understand that, and you need to develop a new workforce to deliver it.” They added that there are companies who
create interfaces as their specialty and build relationships with the leading medical device manufacturers. However, when a hospital’s EHR project is being implemented, the people driving it forward are not always aware of this and do not budget for it. “The right people are not at the table to drive that discussion,” one of the delegates warned. While the NHS leaders are saying that hospitals must be digitally ready for what the future might hold, budget constraints are still an overriding factor. For example, a UK Trust scheduled
400 smart beds at £15,000 each, but budget constraints forced replacement with standard beds at £1,700 each. Nevertheless, the group agreed that if doctors can justify a need, often Trusts will find the money. Business cases need to emphasise the clinical benefits, as well as cost savings and efficiency savings.
User training and safety Another key consideration for the NHP going forward is user training. Professor John Sandham revealed that the data shows that, each year, over 12,000 people experience medical device related harm. EBME departments are increasingly being asked to take responsibility for user training, but there are significant challenges. “When I looked into it, I found that 98% of harm occurred due to issues around the use of equipment, rather than maintenance issues.
Yet there are still issues around user training… If you take a nurse, doctor or surgeon out of their place of work, to train them properly, there’s a cost attached to that, as they need to be replaced in their absence,” Professor John Sandham commented. “I undertook a cost calculation, when I was conducting research about 15 years ago, and it was a huge cost – just on the nursing side. This means that they tend to have buddy-to-buddy training instead. However, this is may be insufficient or poor.” The forum suggested that training varies
according to the type of equipment. For example, in the case of surgical robots, surgeons are required to undertake a proctorship programme and must demonstrate competency before being allowed to use the technology in theatres. Some of the most high-risk equipment causes the least amount of harm, therefore
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