Convergence of Medical Devices with Clinical Information Systems: Innovative Health Information Technology Pilot Projects with a Focus on Patient Medication Safety

4.6.2010  PRESENTERS: Nathaniel Sims, MD Clinician, Teacher, Cardiac Anesthesiologist, and Medical Advisor to Biomedical Engineering, Massachusetts General Hospital; Assistant Professor of Anesthesia, Harvard Medical School Rick Hampton Wireless Communications Manager, Partners HealthCare MODERATOR: Steven Flammini Chief Technology Officer and Corporate Director, Application Development, Partners HealthCare Video not available.

Forum Abstract

In the late 1990s, the MGH transformed patient intravenous (IV) medication safety by conceptualizing and developing the "smart" drug infusion pump -- an invention that was first deployed at the MGH and has since proven highly useful in clinical care worldwide. Nathaniel Sims, MD, anesthesiologist and innovator at the MGH Department of Biomedical Engineering led the research that resulted in patented inventions owned by the MGH on the original smart pump prototype.

Motivated by an awareness of continuing tragic events involving the complexity of drug dosing calculation errors and mis-programmed drug infusion pumps at hospitals, a multidisciplinary Partners HealthCare team has created a roadmap for further advancing IV medication safety. A highlight of this plan is a proposal to pilot closed-loop IV medication administration at MGH using software that compares data from a patient's drug infusion pump with the specific order in the pharmacy profile and generates alerts if necessary.

The original smart pump technology was considered revolutionary because it housed customized clinical decision support within FDA-regulated patient care devices.  As the next step in smart pump enhancement, a 12-person PHS team recently authored an in-depth report outlining the transition of technology from stand-alone smart infusion pumps to networked Intelligent Infusion Devices (IIDs).  The new IIDs are wirelessly networked, and can be associated with a particular patient, based on a scan of the pump's front-panel barcode by a bedside caregiver. Since all MGH drug pumps will soon have capable radios, they will be constantly 'tweeting' drug name, concentration and dose-rate settings to a pump server. With this in place, the team proposed that MGH-written software could provide a nearly-real-time comparison between what's happening at the bedside and what should be happening, and look for variances. This critical next step amounts to a second safety check of the pump's programming against an actual medication order, augmenting the vision of 'making the right thing, easier to do’. The team considered multiple complex issues during the year-long effort, which included visits to hospitals piloting prototypes of automated pump programming directly from pharmacy information systems. Numerous challenging requirements issues are present, some of them unique to Partners Healthcare.  These include Partners' high standards for authentication and the security of medical devices on wireless networks. The team realized that the new software module will likely permit closing the loop in a way that is consistent with proposed new regulations.  However, it will take time and resources to move a successful software module pilot from a controlled setting, such as a lab, to the bedside. Many challenging issues about medical device connectivity and interoperability will remain, as the all-electronic inpatient medical record -- with numerous connected patient care devices -- moves closer to reality at the MGH.

 Dr. Sims and co-presenter, Rick Hampton, PHS Wireless Communications Manager, will summarize the findings and Technology Roadmap developed by the Partners Task Force on “Infusion Pump Connectivity to Clinical Systems”, which was finalized in March, 2010.

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