Integrating medical devices in general practice
Electronic medical records, document scanning, email, secure messaging and computer-based faxing have all served to put downward pressure on the amount of paper modern medical practices have to handle on a day to day basis. However while nearly all general practices are able to receive and process pathology reports sent from geographically distant laboratories using purely digital workflows, many practices still rely on paper as a means of viewing the data produced by medical devices situated in their own treatment rooms.
This article outlines some of the options that are available to general practices, some of whom may already possess all the necessary hardware and software to digitise and streamline the record keeping associated with medical device related diagnostic tests.
Which medical devices will work with my clinical software?
For the majority of Australia’s general practices including those running Medical Director and Zedmed clinical software, the opportunity to connect a range of medical devices to their computers has existed for some time. The developers of these clinical software packages have supplied Pulse+IT with the following information outlining their products’ current compatibility with various medical devices.
Readers are advised to contact both their clinical software developer and the relevant medical device distributor before making a purchasing decision to ensure that any recent clinical software updates, operating system changes or hardware revisions have not resulted in a loss of compatibility.
Medical Director users can view a comprehensive list of compatible devices from within the HCN Maintenance Device List. As well as highlighting any currently installed devices, this area of the program contains the contact details of the relevant device vendors. Amongst the devices listed as compatible are the Norav PC-ECG, Biolog CV3000 ECG, Cube ECG, QRS Diagnostics’ devices, Welch Allyn’s CardioPerfect and Spot Vital Signs software, encompassing ECG, oximetry, pulse, blood pressure and spirometry devices, to name a few.
Zedmed users are able to connect their computers to Welch Allyn CardioPerfect and SpiroPerfect devices, the Norav PC-ECG, the Biolog 3000 ECG, the Easyone Spirometer, and the Micro Medical (now Care Fusion) MicroLoop Spirometer.
While the requisite update has not yet been released, Best Practice Software announced their intention to make their clinical software compatible with a range of popular devices at their inaugural conference in March this year. The company has advised Pulse+IT that Welch Allyn ECG and spirometer devices, spirometers that interface with the WinSpiro Pro software, and PC-based ECGs, spirometers, blood pressure monitors and pulse oximeters from QRS Diagnostics will be compatible with Best Practice within a few months.
Workflows and benefits
As practices that are not using hardware and software combinations that permit seamless medical device integration would be well aware, the scanning of diagramatic data generated by ECGs and spirometry devices can be both time consuming and problematic. The presence of coloured backing paper and the need to scan at high resolution to preserve the quality of graphs dramatically increases the scanned image size when compared to most other scanned documents. In addition, the non-A4 shaped paper sizes utilised by many ECG and spirometry devices can reduce scanning efficiency as extra human intervention is often required during the process to ensure acceptable results.
Even when scanned, ECG and spirometry images cannot be manipulated or intelligently processed using specialised software in the ways that modern technology permits.
Dr Milton Sales, a GP from Newcastle and Medical Director user has had his clinical software configured to interface with his practice’s ECG and spirometry devices for some time — as many as eight years for the ECG and around two years for the spirometer. His practice currently utilises an ECG manufactured by Micro Medical, and an Easyone Spirometer.
Recalling the issues associated with the equipment that preceded his current ‘computer-connected’ medical devices, Dr Sales states: "We found particularly with ECGs, scanning them never gave a good picture. The ECG software allows you to make diagrams bigger or more spread out, and you can run filters on it. Depending on which version of the software you have you can also get the system to provide you with a suggested diagnosis. The old fashion paper-producing ECGs that generated a long roll of paper required secretaries to cut it up, paste it onto paper and photocopy it. The doctor would then report on it and finally it would be scanned. Even then it was stored in a different section of the notes meaning it wasn’t obvious that it was an ECG."
Whereas older medical devices were required to house their own purpose-built computer to interpret the data collected, the majority of PC-connected medical devices jettison most of the in-built circuitry and utilise the processing power of a nearby computer, typically connected via a USB cable or a serial connection in some cases.
Dr Sales describes his practice’s ECG as being "quite a small device, basically four to five inches in diameter and all the leads come off that."
Most medical device manufacturers either bundle their devices with their own drivers and device software, or with device software licensed from a third party developer. Integration work undertaken by the developers of Medical Director and Zedmed allows the user to trigger the device software from within their own clinical software, perform the necessary tests, and then import the information collected back into the patient’s clinical record.
Elaborating on this process as it pertains to Medical Director, Dr Sales explained: "As far as the ECG side of things is concerned, there’s a toolbox within the individual patient’s Medical Director record. If you click on the ECG button, it then launches the bundled software for the ECG device. But it’s seamless, it’s like it’s happening within Medical Director with a new window displaying the ECG. If you close that window, you’re back into the medical record again where you would make your comments or report on the ECG. The image can be called up again in the ECG software, but this process is triggered from within Medical Director.
"With the spirometry side of things, there’s a lung function module within Medical Director, and the numbers and a graph are populated from the spriometry device into the respiratory tab of the Medical Director notes. Again, the user doesn’t have to specifically go external to Medical Director, it’s populated from within the program via its integration with the software provided with the spirometry device."
Posted in Australian eHealth