An HIT Moment with … Dave Dyell

An HIT Moment with ... is a quick interview with someone we find interesting. David Dyell is founder and CEO of iSirona of Panama City, FL.

Everybody’s talking about EMRs. Should they be talking more about integrating device data with them?

In a lot of ways the conversation should be one and the same. When you consider the HIMSS EMR Adoption Model, it shows that any Stage 3 hospital or above has implemented electronic nursing documentation. What it doesn’t show is that much of the data, including device data, is still written on paper to be transcribed into that electronic chart later. Meaning that a physician could be looking at physiological data that is 3-4 hours old by the time it is available in the EMR. I believe the latest data shows over 70% of the market has reached Stage 3, yet most facilities we speak with are still writing vitals on paper and transcribing them later.

We believe that part of the EMR adoption model should be to automate as much of the point of care workflow as possible and thereby truly create a paperless EMR. Its also important to note that device integration is not exclusive to the EMR. Many departmental systems have nursing documentation modules and integrating devices to those can provide a similar value proposition to integrating to the EMR. Examples are ED, Critical Care, OR, Anesthesia, OB, etc.

You’ve worked with integration engines for many years. Those tools opened up entirely new product possibilities for hospitals without requiring major internal or external IT resources. How is that like and unlike tools like iSirona’s that integrate devices?

While there is an aspect of what we do that provides interface engine-like functionality, device integration is really about automating the workflow at the point of care. The bits and bytes of managing data from the device and translating to a format needed by the EMR is engine-like, but interface engines never really touched the workflow directly. They were and still are for the most part a back-end, lights-out kind of tool that only interacts with other IT systems.

In order for a device integration solution to truly impact the workflow it must provide integration points to the end user, the clinician. Whether that be positive patient ID functionality to tie the patient to the devices being integrated or an authentication system that allows the caregiver to review all the collected data prior to delivery to the EMR, it must integrate to the workflow.

Let’s say a hospital’s chief medical officer wants 2-3 examples of real-life major care improvements made possible by your products. What examples would you cite?

A great example is the ability to help reduce in-house codes. More accurate and timely information clearly enables the physician to make on-the-spot decisions and better identify those patients trending towards a code. The average length of stay in the ICU to recover from a code is 14 days and the daily cost per patient is over $5,000.

Another example would be supporting fall prevention protocols. By integrating smart beds to nurse call systems, caregivers can be made aware when a patient that should be stationary is attempting to exit the bed. Along the same lines, the bed can tell us when a ventilated patient’s bed has been lowered below the recommend 30-45 degrees, thereby alerting a caregiver to help prevent ventilator-associated pneumonia.

Considering that these types of incidents are being considered for inclusion in the CMS “never-event” list and thereby would not be eligible for reimbursement, this can have a definite impact financially on the organization.

How fast growing is the volume of electronic data sent by medical devices, how can it be used, and what changes should clinical systems vendors be considering to use that information effectively?

Traditionally the amount of data captured by clinicians related to what the devices can actually output was very small. Some of the data is not necessarily clinically relevant, but the larger issue is there is just not enough time for a single person to collect all of the data potentially available from the devices. A single medical device may be capable of generating 300+ pieces of discreet data, while a given EMR flowsheet may only require 8-10 of those to be typed in.

When you remove the manual data entry task, which is so time consuming, you can then expand that data set to something that is much richer and can have a very positive impact on patient care. As the acuity of our patient population has grown, so has the use of medical devices and the sheer amount of data our caregivers are required to capture. A recent study showed nurses having spend an average of 147 minutes per nurse per shift on documentation, much of that from devices.

Many of the EMR and CIS vendors have decision support algorithms that analyze this data to help provide guidance to caregivers. Having that data set automated ensures the accuracy and timeliness of the data and gives the algorithm a richer set of data to work from. Using solutions like ours that provide positive patient ID ensures the data is charted to the correct patient, giving the caregiver comfort that the guidance being provided is for the correct patient. Clinical staff are then better able to predict and prevent adverse outcomes such as in-house codes, sepsis, and ventilator-associated pneumonia. We have multiple clients and other industry experts that tell us repeatedly that one of the problems with failure to rescue or recognize deterioration of patient conditions is poor quality of data.

Over my years of working with interfaces, we watched the laboratory industry push CIS and EMR vendors to the point now that we can see lab results even from outside reference labs back into our systems within seconds of the analysis on the specimen being completed. That gives our physicians great access to the chemistry of their patients. As we have discussed today, much of the physiology is still written down and typed in later, meaning that a physician logging into CPOE is faced with current chemistry, but potentially 3-4 hour old physiology. This forces a call to the floor to request current vitals, etc. and thereby devalues the CPOE experience to the physician. It is important that IS and EMR vendors recognize the workflow around device data capture and ensure their systems support the automation of this important part of the care process.

iSirona is a small company with at least one well-known competitor. How will you differentiate your offerings and compete with an established player?

I am glad you finally asked a sales question. Product, product, product. We built our product with the help of clinicians to ensure that we solved their needs. Just automating a clinical step was only going to bring marginal value to our customers. Automation alone saves time and allows for greater accuracy, but that has to be countered by associating the device to the correct patient to insure data is documented to the correct patient. Also, iSirona was built with a patient’s mobility in mind. iSirona’s system architecture ensures continuous data capture across multiple care environments and even through ‘cold spots’ in the hospital’s wireless network.

Additionally, we want the caregivers, regardless of EMR, to have the ability to view, select, and comment on the data they are charting. Our clients have the choice between using iSirona or the core clinical system for data authentication and charting additional required documentation. For clients choosing to use the core clinical system, iSirona provides and embedded solution for minimal impact to clinical workflow.

Our goal is to assist our clients in simplifying patient data collection while improving the quality of care and patient safely. We will continue to listen to our customers and prospects and ensure that we remain the visionary in this space.