Proceedings - 19th International Conference - IEEE/EMBS Oct. 30 - Nov. 2, 1997 Chicago, IL. USA

INTEGRATED CLINICAL ENGINEERING AND INFORMATION SYSTEMS

Bertram N. Ezenwa, Ph.D. Assistant Professor, Departments of Mechanical Engineering and Physical

Medicine and Rehabilitation, Wayne State University Manager, Rehabilitation Engineering Department, Detroit Medical Center, Rehabilitation

Institute of Michigan, 261 Mack Blvd., Detroit Michigan 48201 E-mail: Bertram-Nworah@msn.com

ABSTRACT

Healthcare systems are experiencing wide-scale consolidation and absorbing smaller healthcare operations. This move is driven by the current healthcare market forces, regulation and legislation, and the desire to shape healthcare service delivery for the next century. Patients demand quality and speed of service, reimbursement agencies seek volume at reduced cost, and clinicians want to know how they can satisfy reimbursement agencies and patents. Technology and dynamic process implementation provide the opportunity for one of the multi- dimensional solutions necessary to satisfy patients, reimbursement agencies and clinicians. This presentation discusses a method to lealize this opportunity through innovative and structured Clinical Engineering implementation.

Key Words: clinical engineering, dynamic process

INTRODUCTION

The traditional clinical engineering service environment is limited to maintaining existing patient care equipment. New equipment is occasionally purchased without first considering the impact on the hospital environment. This may adversely impact the quality of patient care or waste precious resources. Clinical Engineering organizations such as the AHA-ASHE, ACCE and the Clinical Engineering track of the IEEE are making significant strides to minimize the negative impact of the clinical engineering current practices through strategies for equipment management and process improvement. At the healthcare system level, clinical engineers should also assume the responsibility for patient care equipment acquisition to improve the overall onsite clinical equipment performance.

The high cost of medical care delivery is driving reimbursement agencies to ask more questions than

before. Consequently, today’s healthcare scene is moving in the direction of discounted fee for service, shared risk, and full risk contractual and population based models. Suboptimal quality of care is driving customers to break their traditional loyalty to a particular healthcare system, resulting in empty hospital beds and loss of revenue.

In the effort to reduce cost, healthcare administrators have considered outsourcing some hospital services including clinical engineering. While outsourcing alone may be cost-effectve in some areas, for clinical engineering services, this may not be the case. This is because the performance of clinical equipment directly affects the quality of patient care. Equipment malhction and patient data degradation could increase the length of procedure, a consequence not viewed favorably by reimbursement agencies, nor healthcare administrators in today’s fixed fee for service model. It may shake customer confidence, and cause loss of loyalty.

This chain of event is not surprising because, in system identification, unless a sufficient and persistent excitation is applied to a system, it is impossible to characterize the system dynamics completely. Inability to do this makes it impossible to achieve the desired target output. A more involved role of clinical engineers is essential to determine all aspects of the problem, and to implement appropriate solution/s which in some cases may include outsourcing.

With the surge of modem technology, hardware and software, healthcare consumers in the near future will be able to receive various healthcare procedures within their community at low cost. Healthcare systems willing and capable to adapt to the changing market demands stand the best chance to prosper in today’s and hture healthcare scenes. This presentation considers the clinical engineering service environment, in a multi- dimensional medical service delivery arena. The new

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Proceedings - 19th International Conference - IEEE/EMBS Oct. 30 - Nov. 2, 1997 Chicago, IL. USA

clinical engineering practice will be discussed in relation to healthcare administration, information systems, medical equipment manufacturers, and clinical service delivery.

DISCUSSION

Healthcare Administration One vital step to the multi-dimensional solutions necessary to satisfy the patient, reimbursement agencies and the clinician is the seamless integration of clinical engineering with information services and clinical service delivery providers, and an active professional link with medical equipment manufacturers. Healthcare administrators should implement management responsibility for clinical engineering in order to facilitate direct link of clinical engineering services with information systems, and other clinical services providers. This level of responsibility is necessary to facilitate the provision of clinical information on demand from anywhere in the healthcare system.

In today’s healthcare climate, reimbursement agencies are asking more questions related to length of stay, treatment, and procedure. While increased length of stayheatment are necessary for some hospital procedures, it is inexcusable as a result of inefficiency, and degradation of information crucial for medical decision making. Upper level administrators should demand and obtain from clinical engineering administration robust plans and data relating to service delivery and the projected impact on the healthcare market.

Information Systems New technology provides the promise of access to medical treatment closer to patients’ neighborhood than before. In the near future, patients may not have to go to the hospital for every procedure. If they have to, hospital systems which are capable of responding to their needs without delay will prosper. Patients will demand to know how good a treatment they received before continuing to patronize a healthcare system. This demand will present great challenges to healthcare systems. The opportunities to satisfy the demand lies in integrated clinical engineering-information services in healthcare systems. Physicians want easy to use information in a usable format. Integrating clinical engineering and informations systems is necessary in order to present patient data to physicians in real-time, and at distant places. With usable information, physicians can present and interpret the results of procedures to patients in real-time. It will require paper-less, film-less patient data through computer local and wide area networks. These opportunities and the existing systems will be reviewed in the context of a

combined clinical engineering and information services approach.

The Manufacturer Opportunities to phase new equipment into clinical practice lies in smooth and functional integration of the new with the existing. It also lies on cooperative arrangements between onsite clinical engineers and the manufacturer, especially with respect to proprietary and confidential technologies. Models of cooperation between the manufacturer and hospital clinical engineers will be discussed.

The Clinical Engineer Patients are demanding high quality of service, and physicians are desperate for real-time patient information in a reliable and easy-to-use format. Physicians are seeking information from emerging technology, ongoing research, databases, archives, and systems in virtual space for experimenting before actual practice. How can clinical engineers satisfy the physician and the patient at a reasonable cost? The answer lies in the relationship between clinical engineering, information systems, the manufacturer, and healthcare system administration. A sample future work environment for patient data archiving and rapid information dissemination is illustrated in Figure 1.

CONCLUSION

Integrating Clinical Engineering and hospital Information Systems is a necessary start for on-line, on- time delivery of clinical services in the healthcare systems of the future. With this model and emerging technology hard copies of various hospital imaging information will become obsolete. The waiting period of patients can be dramatically reduced by implementing real-time processes. Physicians can order and change procedures in real-time. Physicians can access patient data on demand and at all locations within their organization. Manufacturers can phase their new systems into existing hospital systems more efficiently. The key to successful implementation lies in a structured role of clinical engineering within the information systems and clinical service delivery.

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