HHS connects bedside data to the EHR and its early warning system

Hamilton Health Sciences (HHS) has partnered with Philips Capsule to integrate a wide range of critical-care bedside devices – such as patient monitors, ventilators and other lifesaving devices – with the hospital’s Epic electronic medical record (EMR) system.

This enterprise-wide deployment of the Capsule Medical Device Integration (MDI) system has transformed the way patient data from bedside devices in HHS Intensive Care Units, Emergency Departments, Post-Anesthesia Care Units and other specialty areas under the critical care umbrella are captured, stored and shared with doctors, nurses and other key team members.

This initiative highlights HHS’s national leadership in seamlessly integrating data collected from various monitoring and therapy devices connected to the hospital’s sickest patients into the EMR, ensuring safer patient care and improved clinical workflows.

Examples of bedside devices in this integrated system include ventilators to help patients breathe; intra-aortic balloon pumps to support the heart when it’s not pumping effectively; cardiac monitors that continuously track heart activity; continuous renal replacement therapy to support patients with severe kidney failure; and ECMO artificial heart-lung bypass machines for patients in severe cardiac or respiratory failure.

“As technology advances, we as a hospital need to be able to pivot in order to provide the very best, leading-edge care,” said Jennifer Lounsbury, chief nursing information officer for HHS.

Key players in integrating these systems included the hospital’s health information technology services team and biomedical technology team, collaborating with critical care teams.

The inner workings: The Capsule Medical Device Integration software platform acts as a universal translator of sorts between bedside equipment and Epic EMR system – the world-class, fully digital hospital information system launched at HHS three years ago and used internationally by many top-ranked hospitals.

This allows for collecting data from various medical devices and systems, then aggregating that data for use in clinical workflows.

The aggregation allows clinicians to access and analyze a comprehensive view of patient information from a single source, rather than needing to consult multiple devices or systems.

Epic replaced several different electronic and paper systems, eliminating the time that doctors, nurses and other key team members spent tracking down patient information from various sources. With Epic, every patient’s medical information is instantly available in one secure place online.

Capsule Neuron hardware, the connectivity hub, was installed at critical care bedsides at Hamilton Health Science’s four acute sites – Hamilton General Hospital (HGH), Juravinski Hospital, West Lincoln Memorial Hospital and McMaster Children’s Hospital.

“Anywhere there’s a critical care bed, you’ll find a Capsule Neuron device,” said Adam DeMeester, the HHS biomedical technologist who helped lead the 18-month-long project to integrate the technology.

To integrate with the Capsule MDI system, each variable from the monitoring device must be individually mapped in Epic so the system can recognize and accept the data. Before Epic went live, HHS’ clinical informatics inpatient documentation team and the biomedical team tested every variable to make sure the data flowed correctly and accurately into Epic.

Jenny Deaves, the lead clinical informatics specialist for integration setup, worked closely with DeMeester to add new devices, like HHS’ new continuous renal replacement therapy machines and ECMO devices.

Capsule Neuron’s custom plug-and-play cable sets work with patient monitoring devices, regardless of brand, transferring the continuous flow of data into Epic. This seamless process ensures that physicians, nurses and other key team members have a constantly updated and steady stream of accurate, comprehensive patient information for timely, data-driven decisions.

“Even the slightest change in vital signs can be detected very early, for prompt medical intervention,” said Lounsbury.

High praise from nurses: The system frees up nurses to spend more time on direct patient care because the technology does the charting for them. Charting involves documenting key information from bedside devices, like vital signs, and regularly updating the patient’s chart.

“Our integrated system has made such a positive difference in our practice,” said Stefanie Gasse, a registered nurse at HGH’s ICU. “We’re so forever grateful for this system.”

Prior to the Capsule Medical Device Integration with Epic, the hospital could only transfer data from patient monitors to an earlier electronic health record system. However, other critical care devices, such as continuous renal replacement therapy, ECMO or anesthesia machines were not integrated. This limitation forced clinicians to manually transcribe data into patients’ electronic charts or onto paper, which was not only time consuming but also prone to human error.

In contrast, the Capsule Medical Device Integration System enables seamless connections with any bedside devices, regardless of brand, in a truly vendor-neutral way.

“This technology integration is a big win for nurses, because it removes the risk of transcription errors that can happen with charting. Data from patient monitoring equipment is sent in real-time and it’s available for integration to the patient record, once the nurse validates the data,” said Leslie Cicero, manager of clinical informatics and solution delivery.

Hamilton Early Warning Score: When the new HHS West Lincoln Memorial Hospital opens, non-critical care area teams will be able to enter vital signs into new bedside monitors which will allow for all variables that make up the Hamilton Early Warning Score (HEWS).

HEWS was developed and championed at HHS to identify patients who were showing early signs of deterioration. With the new devices, the bedside clinician will receive an alert on the machine based on an algorithm in real time and the variables will flow directly to Epic.

The alert on the bedside screen will inform them of a change in patient condition and direct the team to the next course of action – which may include monitoring only and/or notifying a physician.

This additional feature is possible because the new, modern build can support the latest technology, said Nick Popratnjak, director of business support solutions delivery for HHS.

Data in the eye of the storm: Where the integrated Capsule MDI system/Epic EMR technology really shines through is in the continuous collection of data during a crisis.

For example, doctors and nurses can fully focus on helping the patient knowing critical information like heart rate, blood pressure and respiratory rate are continuously being streamed to Epic for review later, once the crisis is under control.

“Helping the patient is always our number one priority, but this system provides the data to help us understand what happened,” said Dr. Alison Fox-Robichaud, a critical care physician at HGH. “It gives a wealth of data to help us know, retrospectively, what went wrong.”

This also means better decision making, since it’s easier to spot and compare trends using this data.

Lise Diebel is a communications advisor at Hamilton Health Sciences.