5 reasons medical device data is vital to the success of EHRs

Shahid,

All agree manual entry of patient data collected from medical devices is labor intensive, inefficient and error prone and RNs are expensive resources under scrutiny with cost savings initiatives. But you seem to be saying that numbers reflected on patient monitors are always - or even reliably - accurate and reflective of the patient values.

With physiologic monitors, dozens of factors cause monitors to display "inaccurate" reading (artifact) or outlier data that would not normally be entered into patient's paper or EHR, or responded to much less used for data analysis and research. These range from canula or tube placement, to flailing movements, to monitor lead issues. How will technology recognize these and filter out?

Today, in paper and EHRs/MDI in critical care, RNs use critical thinking to determine which values best reflect patient's condition. These values are combined, as appropriate, with characteristics of indicator such as pulse thready or respirations stertuous and other related observations (e.g. skin turgor) that together comprise a patient assessment. Vital signs are critical but often late stage indicators of patient change in status.

We agree, there is a clear role and proven value for remote surveillance and monitoring - at nurses station and/or remote eICU. However there are parts of assessments that must still be made at the bedside by RN and we need to consider the impact of innacurate data entered into IT systems.

In observing patient or a visual display of a continuous monitor (locally or remotely) clinicians often discard errant or questioable values. (Because monitor reads zero does not mean the patient is dead and every nurse knows impact of teeth brushing, turning, etc. on monitor "readings").

However, once values are entered in EHR and "integrated" systems they can set off a series of events ranging from inappropriate (potentially dangerous) actions by a remote MD and warnings and alerts from EHR CDS and BI systems (e.g. out of range values), or firing off conditional orders (e.g. for pulse >X, give Y). All nurses need is more false alarms, error corrections and phone calls and opportunity for med errors.

How would systems know which value to discard? Are MDs aware they are liable if decision made on med dosing or treatment based on errant values? Whose e-signature is attached / accountable for data (clinically and legally)?

RNs entering 1000s of data elements a shift is a flawed process, but they are not mindlessless transcibing numbers from "infallable' monitors. Before we eliminate critical QA step (not just data entry process) in a life critical process, I suggest a healthy public debate of impact, expected and potential unexpected consequences, and experience of those who've done this in live settings.

If by "automatic charting" you and others assume RN QA step (critical care) and you recognize numbers shown on monitors do not always reflect patient values regardless of how they're derived, then it would be important to highlight this.

I again welcome you to participate in a interdisciplinary public discussion and present your position and research on how these issues are addressed.

Ann Farrell,BSN, Pricipal Farrell Associates, LLC