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The benefits of interfacing computers to medical devices.
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By Nicholas Cain
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Most medical devices in intensive care units (ICU) such aspatient monitors, respirators, and infusion pumps are used asstand-alone devices, they are used in isolation from otherdevices. The patients measurements are often recorded on papercharts with diagnosis being made from interpreting that chart.Many clinical staff feel this is quite adequate to their needs,and the traditional approach is easy to adapt, easy to train,and entirely within their control. I'd like to discuss ways tobring more technology to medical devices and bring benefits tothe clinicians. Traditionally, each patient in intensive care ismonitored with a chart on an A3 sized piece of paper, with eachchart corresponding to 24 hours. At regular intervals (everyfifteen minutes or half an hour), measurements from the patientmonitor, respirator, fluid monitors etc are taken and written onthe chart. The expert eye will recognize trends from the chart,determining whether the patient is reacting appropriately tocare, and therefore determining the correct procedure. At theend of the day the charts are sent to the records department,and usually turned into microfiche or scanned prior to storage.
So what are the areas that technology can provide benefits?Let's assume the paper charts are replaced by a computer, andthe computer retrieves data from the medical devices on eachpatient automatically. Initially we'll assume that the computeradds nothing extra to the practices, in other words it recreatesthe A3 chart exactly, and displays the readings as thoughwritten in by the staff. From here we can see two basicadvantages; Time saving Intensive care departments are the mostexpensive departments in a hospital, often requiring morefinancing than the rest of the hospital combined. The largestsource of the costs is staff. An ICU requires many highlytrained staff. Consequently ICU staff's time is a highlyprecious commodity, and any time spent doing menial tasks istime that should be spent utilizing the staff's expertise.Instead of looking at each medical device and writing the valuesonto the chart, the nurse can look at the chart and validate theresults that the computer displays. At the end of the day thecharts are automatically stored. There's no trip to the recordsdepartment, no manual scanning or transferring to microfiche.Finally, retrieving earlier records, show even greater timesavings. Although retrieving the ICU charts isn't oftenrequired, retrieving patients records often are. With papercharts this can be time consuming and frustrating to staff,while retrieving computer records is usually instant.
Transcription errors Since charts are usually analyzed fortrends, rather than looking at individual figures, entering avalue incorrectly is usually noticed as an anomaly. However, whytake the risk automated collection of the patient measurementsreduces this risk to near zero. Expanding the traditionalapproach
Assuming that we want to do more than just reproduce thecurrent practices in ICU, we can utilize the other benefits thata computerized system brings. All the benefits I'm about todescribe are already available on the market. Diagnosis support
Currently the clinician, assesses the patients data coming fromthe medical devices, the patient history and current state, andcombines this with their training and experience. From thiscomes the diagnosis, and resulting patient care. To some extenta computer can do a similar action by cross referencing datafrom the patient, databases on drugs and procedures, and providethe clinician with more information to base their decisions on.This can give the clinician more options, reassure them in theirdecisions, or even alert them to unforeseen consequences. Theclinician can not only consider the diagnosis support from thecomputer, but also inform the computer to actively monitor thepatient for certain conditions. For instance, the clinician hasadministered a drug which they know will affect the patient in acertain way (e.g. lower the temperature or blood pressure). Theclinician can instruct the computer to monitor for specificphysiological changes in the patient, and if these don't occurthe computer would issue an alert. Medical devices can onlymonitor the specific subset of parameters they were designedfor. The computer on the other hand can use the data from allthe devices, and create more intelligent alerts.
Remote monitoring
Remote monitoring of patients allows the clinician to check thepatient while away from the unit. Giving clinicians the abilityto remotely monitor the patients condition can alert the staffto potential problems earlier. This can also be linked to thealerting mechanisms mentioned in the previous section, andalerts can be sent by many methods such as pagers, email or evenSMS texts. Technology has also allowed a completely innovativeapproach to added to intensive care the remote intensive monitorcenter (such as eICU by VISICU). This allows intensive carespecialists to monitor patients from many hospitals from asingle remote location. While not intending to replace the staffon the ground, the eICU uses a variety of remote monitoringmethods coupled with diagnosis tools. User interfaces Theergonomics of medical devices is now a mature science, and mostmodern devices are extremely clear to read and use. They arestill separate components though. If all the data from eachdevice is brought together to a single point, then the entirephysiological state of the patient can be displayed on a singlescreen. If integrated properly, then this screen can beindependent of the make or model of the devices, and even ifdifferent models are used on various beds, the display willalways be the same. Technology and medical devices are tools forthe clinician, and should primarily adapt to their needs ratherthan staff to extensively change their practices. If staff canrely on a standard display then they can concentrate on usingthe information rather than searching for it. Add to this theremote monitoring and diagnosis support, and you have a singlepowerful tool for the clinician. The display can be dynamic,e.g. the patients stats no longer need to be a string ofnumerical characters, but transformed into graphs as theclinician requires. The diagnosis support can provide baselinegraphs to compare whether the patients state is changing asexpected, and an alert level can move in synchronization toprovide tighter alarm controls (which reduces the number offalse alerts that are all too present in current ICU's).Finally, this can be linked to the patient's stored records, andeach chart is no longer limited to the last 24 hours, but forany time during the patients stay.
I hope this article shows some of the advantages of bringingmore technology to the ICU. Everything I have described iscurrently available. However, the benefit shouldn't be blindlyaccepted. Technology for technology's sake will always be a poorchoice. The greatest barriers to implementing these systems iscost and staff resistance to new practices. Cost is a fact oflife, and only time will bring the costs down as ITinfrastructure matures in hospitals and electronic medicalrecords become widespread. Staff resistance however should beseen as a good thing. It is up to the vendors to demonstratesystems that work with the staff while clearly demonstratingbenefits. Generally this seems to be the case, and the future ofa more technological ICU is looking bright.
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