Interoperability Analysis: Meeting Meaningful Use (MU) Stage I Criteria for Medical Device Connectivity
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1 Interoperability Analysis: Meeting Meaningful Use (MU) Stage I Criteria for Medical Device Connectivity Bridget A. Moorman CCE June 2011 BMoorman Consulting, LLC AAMI Conference, San Antonio, TX, USA 25 June 2011 BMoorman Consulting, LLC 1
2 Overview Meaningful Use Stage I Costs and ARRA Reimburse Generic Device Interface Design Network Characteristics Data Characteristics CE perspective Sample Interoperability Table Use for Data Summary Interoperability Statistics Device Replacement Costs for MU Stage I Summary Rollup Interoperability Costs Things to keep in mind 25 June 2011 BMoorman Consulting, LLC 2
3 Meaningful Use Stage I ARRA EMR certification for meaningful use (2011) stage 1 electronic charting of vital signs (blood pressure, height and weight) Does not specify electronic device connection 2015 is expected date for requirement of medical device interoperability No specific definition of medical device interoperability Currently IS77 specifies standards to be used for remote monitoring At the data level is based on IEEE standards TN905 is a technical note and not a specification Good information, not easily enforceable 25 June 2011 BMoorman Consulting, LLC 3
4 Meaningful Use Stage I From medical device perspective, aimed at lower acuity services (basic vital signs) Did not specify data standards Even though not required to have physiological information flow electronically, affords an opportunity to start slowly with device integration Caveat: very mobile clinical workflow and therefore difficult to align data requirements, specifically patient ID affiliation with physiological data 25 June 2011 BMoorman Consulting, LLC 4
5 Costs and ARRA Reimburse EMR Costs Congressional Budget Office estimated at $14.5 K per bed with $2.7K/bed for operations/maintenance Does not include medical device connectivity McKinsey Quarterly estimates $80-$100K per bed Device Connectivity Costs Critical Care Bridget Moorman, Kaiser - $6.75K-$10K per bed; Linda Chan, Virtua AAMI - $6K per bed; Medical device replacement costs due to inability to connect to network cost not well defined Virtua spent $1.5M very quickly ARRA reality if meet eligibility and meaningful use criteria $44K per eligible professional in 2011/12; $39K per EP in 2013; $24K per EP in 2014; $0 in 2015 and beyond 2010 McKinsey Quarterly only cover 20% of costs 25 June 2011 BMoorman Consulting, LLC 5
6 Generic Device Interface Design Generic Medical Device Interface to Clinical Information System Diagram Patient Monitor Dedicated Network Central Station Dedicated Network Aggregator TCP/IP LAN HL7 Possible Super - Aggregator TCP/IP one message HL7 Clinical Information Systetm Patient Ancillary Medical Device RS232 Serial TCP/IP Serial LAN Possible 5 separate physical devices: Ramp to network HL7/xML Aggregator TCP/IP one message HL7 Patient ID System Bar-Code RF-ID Biometrics RS232 9 pin to RS pin to Device ID adpator to RS pin to RJ45 or Wireless Adaptor RJ45 or RS232 DBP to Wireless Dongle ADT System Ancillary Medical Device 25 June 2011 BMoorman Consulting, LLC 6
7 Network Characteristics Physical to Network Transformation Device Identification Traditional Dongle Transduction Transmission Medical Device Ramp to Network Integrator Server/Interface To CIS/EMR Wired Wireless Bluetooth ZigBee Collapsed/Combined with Ramp Wired Wireless Ethernet WiFi TCP/IP 25 June 2011 BMoorman Consulting, LLC 7
8 Data Characteristics Data sent at device interface Transduction Transmission Medical Device Ramp to Network Integrator Server/Interface To CIS/EMR -Proprietary -Standard IEEE HL7 POCT -Continua Certified (includes networking protocol) -IHE profile Conformance (networking Protocol agnostic) 25 June 2011 BMoorman Consulting, LLC 8
9 CE perspective: Device information in MEMS Network capability: Y-N Wired - Wireless Wired Physical: DB9, DB22, RJ45 Wireless: Bluetooth, ZigBee, Z, other Transport: RS232, TCP/IP, Serial Data: Proprietary, general, ZZ Other: Continua Certified, IHE conformance to specific use case (PCD-01), part of medical network (monitor connected to central station) 25 June 2011 BMoorman Consulting, LLC 9
10 Sample Interoperability Table 25 June 2011 BMoorman Consulting, LLC 10
11 Uses for Data Interoperability Score Networkability Age Driver available from third party vendor Part of integrated system which has EMR interface capability Summarize Department Facility Device Type 25 June 2011 BMoorman Consulting, LLC 11
12 Summary Interoperability Statistics Four multi-facility healthcare organizations Interoperability scoring was a component of a Strategic Technology Plan Done as work for Premier Healthcare Consulting Solutions Data has been anonymized, collated and normalized 25 June 2011 BMoorman Consulting, LLC 12
13 Summary Interoperability Statistics Interoperability Scoring Networking Capability Age of Equipment Part of a larger system Readily available Device Driver in third party medical device integration system Ranges from none to excellent Excellent assumes direct patient id affiliation Not available as yet Therefore, scoring is from none to good 25 June 2011 BMoorman Consulting, LLC 13
14 Device Replacement Costs From ECRI or Market on-line General Vital Signs Monitor (VSM) $3500 BP monitor A&D Costco/Walmart (Continua certified) - $70-$145 Scale/Rod EMR interface-able - $750 Scale (Continua certified) Bluetooth - $360 Cabled - $120 Issue - need patient ID affiliation mechanism Through workflow with EMR Separate system (RFID-Barcode) 25 June 2011 BMoorman Consulting, LLC 14
15 Summary Interop Statistics- Raw Scales Scales < <x<500 >500 Clinics Clinics < <x<500 >500 Good Avg Poor None June 2011 BMoorman Consulting, LLC 15
16 Summary Interop Statistics- Raw VSM < <x<500 >500 Clinics VSM Clinics < <x<500 >500 Good Avg Poor None June 2011 BMoorman Consulting, LLC 16
17 Summary Interop Statistics- Normalized Scales Clinics < <x<500 >500 Good Avg Poor None June 2011 BMoorman Consulting, LLC 17
18 Summary Interop Statistics- Normalized VSM Clinics < <x<500 >500 Good Avg Poor None June 2011 BMoorman Consulting, LLC 18
19 Summary Interop Statistics- Cost for Replacement Clinics < <x<500 >500 Scales Low $4,170 $2,112 $5,920 $12,750 High $26,063 $13,200 $37,000 $79,688 VSM Low $2,954 $1,798 $3,939 $14,935 High $71,313 $43,400 $95,083 $360, June 2011 BMoorman Consulting, LLC 19
20 Device Replacement Costs Does not include Patient ID affiliation system Does not include 3 rd party integration system if used Assumes Average to None Interoperability Device scoring must be replaced 25 June 2011 BMoorman Consulting, LLC 20
21 Summary Interop Rollup Costs Clinics < <x<500 >500 Low $180,000 $150,000 $350,000 $1,735,000 High $272,000 $202,000 $472,000 $2,147,000 Assumptions: a) Number of VSMs determines number of ramps to network b) Cost for ramp to network is $6000 per c) Total Rollup Cost is number of devices replaced summed with cost of ramps to network d) Does not include patient ID binding mechanism/system costs e) Above rollup costs rounded to nearest $ June 2011 BMoorman Consulting, LLC 21
22 Things to keep in mind Strive for decoupling of medical device and EMR acquisition decisions Specify standards in acquisition documents IEEE data standards, specific networking standards, security standards, IHE profile conformance Patient ID binding at the time/place of physiological data measurement may necessitate another system/process Early tracking of interoperability characteristics of existing device inventory assists provider in making prudent medical device integration decisions 25 June 2011 BMoorman Consulting, LLC 22
23 Questions? 25 June 2011 BMoorman Consulting, LLC 23
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