Infrastructural considerations for supporting POC devices: healthcare executives must focus on creating integration-friendly environments for the most effective use of mobile devices

Health Management Technology, Jan, 2003 by Ahmad Hashem, Roberto Ruggeri

There are plenty of reasons to be excited about the advent of point-of-care (POC) devices that enhance patient safety and streamline healthcare delivery by giving physicians and other healthcare workers anytime/ anywhere access to heterogeneous stores of patient information. But the huge promise of POC devices creates new challenges for healthcare IT executives--creating a secure, integration-friendly environment that easily facilitates the deployment of these devices.

Mobile and wireless POC devices--ranging from e-prescription pads to electronic stethoscopes to tablet PCs that display everything from patient records to radiology images--have already begun appearing in clinical settings. All indications are that this is just the first wave of what should be ever-richer generations of clinical information capture and delivery systems.

The benefits of POC devices out-weigh just about any complaint the most traditionalist clinician might raise against them. Typical first reactions we have encountered, and logical responses, include:

"My prescription pad never needs rebooting." Yes, but it also won't tell you whether the patient is allergic to the medication you are prescribing, or whether the drug will have an adverse reaction with another medication, has formulary restrictions on the patient's healthcare plan, or was just re called--nor will it guarantee the pharmacist can read what you've written.

"My pen is faster than a keyboard for updating patient records." Yes, but how fast can you search a 2-pound stack of paper to gather past glucose tests for a diabetic patient? While your own handwriting might be perfect, how well can you read the handwriting of other contributors to the record?

"The patient file gathers what I need in one simple place." Not unless you have gathered images from radiology; all records from the patient's previous medical encounters, which could be spread across multiple cities, states and countries; and the file is immediately at hand whether you are in the hospital, your office or conferring with a crosstown or cross-country colleague.

POC devices are coming. Here are considerations to keep in mind as you gear up to provide the infrastructure to support their deployment.

Standards-Based Approach

There's nothing new about the need for integration, especially within the realm of healthcare, where IT professionals have long known the value, and the difficulty, of exchanging data between disparate systems ranging from hospital information systems to imaging storage systems to clinical patient repositories, electronic medical records and health plan information systems. Even with HL7, data exchange between two implementations of the standard can require tweaking.

This is why we believe the first step toward creating an integration-friendly environment is taking a standards-based approach to POC device evaluation and deployment. Healthcare IT can benefit from the strong momentum within the greater computer industry toward using standard communication protocols and technology.

HL7, IEEE 1073 and CCOW

It should be a given that a POC device proposed for deployment supports HL7 messaging, the IEEE 1073 Standard for Medical Device Communications, and the CCOW standard for context management.

The IEEE 1073 family of standards has evolved as an important adjunct to HL7, defining communication standards between POC medical devices (such as vital signs monitors, electrocardiographs, infusion devices and pulse oximeters) and the devices or systems that monitor and manage their operation. Adherence to the IEEE 1073 standard helps achieve plug-and-play operations, in which systems automatically negotiate and configure their connections.

CCOW, which complements HL7's foundation for data interchange and enterprise workflow, is important for integrating data from multiple devices and data stores for a seamless user display. CCOW can be used, for example, to populate separate windows on a tablet PC with information from separate sources.

XML and Web Services

Although the POC display devices will be credited with harnessing patient information from disparate sources, behind the scenes, much of the work will be accomplished using open standards such as Extensible Markup Language (XML), Simple Object Access Protocol, the Universal Description, Discovery and Integration specification, and Web Service Description Language.

These Internet-based standards are revolutionizing how information is exchanged. Approximately 70 percent of healthcare transactions today are paper-based, resulting in administrative costs of up to 20 percent of each dollar spent. It was the need to reduce these costs that, at least in part, led to HIPAA. In the U.S. marketplace alone, the yearly cost of processing and administering claims is about $90 billion. Some healthcare industry analysts believe the $90 billion in administrative costs could be slashed to $5 billion or less by moving from a paper-based system to a coordinated and integrated digital system. POC devices will play a key role in this.