This piece was originally published in the May 2016 issue of ei, the magazine of the electroindustry.
By Dan DeHanes, Global Product Compliance, Codes, and Standards Leader, Ascom Wireless Solutions
With the increase in patient care needs, clinical staffing challenges, and rising costs of care delivery, there is pressure on healthcare delivery organizations to rely on technology solutions to help efficiently deliver care. In the modern healthcare environment, an optimized workflow allows caregivers to respond faster to dynamic demands at the point of care and to make decisions more efficiently.
Figure 1 depicts a simplified perspective of the various systems that are typically found in today’s healthcare delivery organization (HDO) ecosphere. These and other systems can be integrated to operate with each other to varying degrees. Some systems can be provided by a single-source manufacturer (e.g., nurse call, wireless communicators, and middleware), or all systems can be provided individually and then integrated by either HDO IT staff or by a contracted third-party systems integrator.
Whichever way the system is delivered and integrated, the challenges of eliminating or significantly reducing the risks associated with interoperability hazards reside primarily with the interfaces between all systems and the cooperation among source providers, including those who provide integration services. Therefore, to achieve and implement the most effective and optimized healthcare delivery environment, the HDO must be an educated consumer and user of all IT technologies with which they are investing.
To optimize workflow at the point of care, the HDO must naturally look into maximizing the potential of all healthcare delivery resources and investments. It begins with input from a cross-section of HDO staff, whose feedback forms a critical part of the process. Their feedback can drive innovations to nurse call system functionality, messaging middleware, and wireless voice and messaging devices where product design can be focused on creating efficient workflows. The overall goal is to provide the safest and most effective patient care solution possible.
From a nurse call, middleware, and wireless communications perspective, simplifying the healthcare delivery process means that nurse staff stations, staff consoles, and wireless devices need to perform in unison and have a consistent user interface. A system with a common look and feel across the entire nurse call communications and middleware portfolio allows for quicker adoption by HDO users and satisfaction by patients.
To optimize workflow at the point of care, here are some specific areas that the HDO needs to consider:
- Linking mission critical systems with mobile communication: A few minutes can be all the difference for the chance of survival, recovery time, and length of stay in an acute care setting.
- Connecting the patient to the caregiver: Enterprise-class, onsite wireless communication and messaging systems are widely known to effectively optimize staff workflow and enhance staff/patient communications and satisfaction.
- Clinical systems integration: Wireless communications enable automatically notification when lab results are ready.
- Medical technical alarms: Nurse-call systems that are combined with wireless communication solutions can speed up response times to alarms from medical monitoring equipment.
- Personal safety: With a fully implemented distributed alarm system, the initiator of a personal safety alarm can even know that somebody has received it and will respond.
- Systems and facility technical alarms: For staff involved with facilities management or maintenance, a wireless communication system enables quicker response to technical alarms such as low or faulted battery at medical electrical equipment.
All of these concerns have one common denominator: an alarm event or workflow request can be directed to a specific point of care attendant, while effectively addressing and eliminating the ever-present and growing problem of alarm fatigue.
In addition to being an educated consumer and user of IT technologies, the HDO must also be compliant with all governing regulations and codes. While a large number of standards exists that effectively address user and electrical safety hazards and risks, there is no single standard that pulls together all safety concerns or defines a singular consensus method for compliance. Nevertheless, it remains the responsibility of the HDO to effectively implement, manage, and place into service all systems that are integrated to interoperate with each other.
A good place for the HDO to start is with ANSI/AAMI/IEC 80001-1 Application of risk management for IT Networks incorporating medical devices —Part 1: Roles, responsibilities and activities. This standard addresses the risk management practices that need to be followed by the HDO to ensure clinical IT ecosphere safety, effectiveness, and data and system security.
NFPA 99 Health Care Facilities Code defines requirements for a listed nurse call system and integrated wireless communications system. This code is most often referred to in state codes, either in whole or in part, or may even be extrapolated or adopted directly into code legislation. An installed nurse call system in Category 1 and 2 facilities (i.e., acute care and nursing homes, respectively) must be NRTL-listed to ANSI/UL 1069 Safety Standard for Hospital Signaling and Nurse Call Equipment.
ANSI/IEC 80001-2-5 Guidance on Distributed Alarm Systems provides insight about the implementation and interface risks associated with interoperable hospital communication systems. An effective healthcare communication system that employs wireless communication technology should provide the architecture and operational capabilities described in this document. The HDO is well advised to apply its risk management requirements, especially those that apply to the interfaces between the described architectural elements.
The ANSI/IEC 60601 Medical Electrical Equipment and Systems family of standards addresses the safety requirements for medical electrical equipment and medical electrical systems that can be connected to patients, while the ANSI/IEC 60950 standard addresses the electrical safety requirements for information technology equipment that can be used for additional interoperable purposes.
Collectively, all of these codes, standards, and regulations serve to provide a highly effective structure toward guaranteeing safe and effective implementation and use of interoperable medical electrical systems and healthcare communication technologies.
Mr. DeHanes, Technical Committee Chair for the NEMA Hospital Communications Section, is also NEMA’s representative on the NFPA 99 Electrical Systems Technical Committee and a member of the ANSI/UL 1069 Standards Technical Panel.