The Importance of Interoperability in Nursing

Communication of all kinds is especially important in nursing. But this isn’t limited to conversations between nurses and patients, family, or staff. Another crucial form of communication is interoperability—when different technologies can communicate with each other.

Susan Niemeier, MHA, BSN, RN, is the Chief Nursing Officer (CNO) with Ivenix, Inc., a new infusion pump company whose vision is to eliminate infusion-related patient harm. “I guide our overall clinical direction and oversee its marketing and product efforts, working closely with the research and development teams,” Niemeier explains.

Niemeier, who has more than 25 years of experience in health care, took time to answer our questions about interoperability.

Please explain what interoperability is.

In its truest—and broadest—definition, interoperability is the ability to share information across multiple technologies. By ensuring that technologies work together, data is able to flow throughout and across the health system. When information flows freely and functions seamlessly, nurses are equipped to make smart decisions and achieve the best outcome for their patients. When done well, interoperability can lead to a new level of health care—a crucial step in optimizing quality of care.

How does interoperability matter in health care?

When health systems, devices, and applications seamlessly share information, nurses can make smart decisions about a patient’s care. Having a holistic view of this information provides insights to make crucial—and sometimes lifesaving—clinical decisions and adjustments earlier in the treatment process.

Interoperability also brings together critical patient information (i.e., medical and medication history, comorbidities, lab evaluations, etc.) from various sources. Nurses do not have to synthesize the information themselves, which is inefficient, error-prone, and limiting. Instead, they can spend more of their time caring for patients.

What are the various products (including EHR) that are used in interoperability?

Devices that are traditionally known to be interoperable include electronic medical records (EMR), department systems (i.e., labs, radiology, pharmacies), specialty focus systems (e.g., cardiology, pulmonary, etc.) and ancillary systems (i.e., billing, insurance, etc.).

I’m passionate about the interoperability of medical devices with other systems. Medical devices contain real-time data that is powerful for nurses when making decisions for patients. Whether it’s a patient monitoring device or a smart infusion pump, interoperable medical devices can elevate patient care practices.

Today’s infusion pumps are an example of a medical device that is capable of interoperability, but has not yet realized its true potential. Currently, many infusion pumps rely on nurses to manually program data into the pump. This may lead to errors and ultimately, adverse drug events. In fact, of the estimated 1.5 million adverse drug events reported to the FDA each year, 54% are related to infusion-pump errors, and 61% of those events are serious or life-threatening.

According to a 2018 Health Information and Management Systems Society’s (HIMSS) survey, 87% of HIMSS survey respondents considered interoperability as extremely or moderately important to what infusion pump they may use. A majority of respondents also considered the automation of programming and documentation efforts—facilitated by interoperability—extremely important for improving patient safety. Yet, less than 20% of respondents indicated actually having implemented EMR/infusion pump interoperability. Unfortunately, the greatest perceived barrier was projected cost with upgrading and connecting pumps with the EMR. We need to do a better job demonstrating that the cost is worth the effort in the form of patient safety, better outcomes, and overall efficiency. 

Infusion pump interoperability enables auto-pump programming and documentation of clinical workflows. Automatically programming the pump from providers’ orders reduces manual steps and variability in the medication administration process. Having the data flow seamlessly into the patient’s medical record reduces time spent in documentation and potential for transcription and/or omission errors. Clinicians are empowered and ultimately satisfied knowing the right drug is administered in the right dose, to the right patient.

However, infusion interoperability can do more to optimize workflows and support smart decision making. Infusion pumps can communicate with alarm management systems to help prioritize alarms and eliminate nuisance interruptions. It can also unlock timely data to advance analytics, ultimately, build insight to enable high quality, safe care.

 What roles do nurses play regarding interoperability? Why should nurses advocate for interoperability?

Imagine safer, simpler, and less stressful infusion delivery for nurses and their patients. To achieve this, the infusion pump should have a meaningful conversation with your EMR—as well as other clinical information systems. 

When an infusion pump and EMR are interoperable, pharmacy-verified physician orders are transmitted directly from the patient record to the infusion pump—no need for error-prone, time-consuming manual input. Moreover, the pump can send accurate, time-stamped infusion data to the patient record, reducing clinician documentation time and the potential for errors.

This year, nurses are working through unprecedented times, dealing with a global pandemic. As an industry, those who answer the “call to care,” need support from the technologies and devices they use regularly, including interoperable infusion pumps, to ensure they continue to improve care despite challenges.

Because of their important role in patient care, nurses have a critical voice in decision-making for technologies and medical devices. It is vital that decisions regarding interoperability include the voice of the nurse. Their perspective can shed light on what is really needed to help them be more effective in improving care and creating efficiencies.

Is there anything else you think is important for our readers to know?

It’s critical for the health care community and industry to understand that interoperability is not a destination, it’s a journey. We need to continue to work together to achieve seamless interoperability, especially with the help of nurses. Health technologies need to engage with and support nurses in decision-making based on the most comprehensive information. The 2018 HIMSS survey shared an estimated 70% of health systems plan to implement interoperable infusion pumps within the next four years. And, this is just one of the devices and systems that are being considered for interoperability use.

Ideally, we would already have these interoperable devices up and running, and integrated in every health system, we’re not there yet. But I believe we’re making great strides to ensure stronger patient safety practices and better care.