Progress in patient safety and quality has been slow, despite increasing recognition of risk across the healthcare system. Efforts to reduce harm to patients or to improve quality of care often focus on a single, local intervention or a collection of local interventions, usually seeking to improve a single care process. Although valuable, this approach is incremental, resulting in modest, though needed, improvements. Most quality improvement efforts miss a larger opportunity to improve and redesign the fabric of healthcare. It appears that a systems integration approach that incorporates the fundamental building blocks of healthcare, from equipment and technology to clinical insight and workflow processes, is needed to take the next major leap in improving quality and safety. More specifically, a systems integrator in healthcare, the equivalent of Boeing th aviation, is needed to make significant progress.
Modern day intensive care units (ICUs) and operating rooms (ORs) each can contain easily 50 to more than 100 different pieces of electronic equipment. Yet, this equipment and these technologies do not communicate or work efficiently in an integrated fashion, posing a safety risk. The limitations also reduce the ability of new technology to improve productivity and to reduce cost in medicine.. Additionally, clinicians often feel burdened rather than supported by technology, as if vendors needs are setting the agenda. As a result, workarounds are common and solutions meant to help often directly conflict with one another.
The lack of an integrated system results in diagnostic errors, failures to identify deteriorating patients, communication errors, and inefficient work, all of which contribute to worker stress and burnout. For example, despite the increasing understanding that clinicians routinely ignore alarms due to noise fatigue and their perceived nuisance, most vendors of monitoring equipment have responded by making their alarms louder or more irksome, hoping to out-compete related equipment by ensuring their alarm gets at-tention. Yet equipment alarms are not equally important and there is currently no system that prioritize disparate alarms. Additionally, there is no incentive for a given vendor to work with its peers on this problem. The result is an “arms race “mentality that is fundamentally detrimental to the quality of patient care.
Although there are promising efforts, such as Health Level Seven (HL7) to support interoperability and standardization of equipment, true integation of disparate data streams and clinical workflows into a single smart system, although technically possible, does not exist. Accordingly, clinicians are presented with ever increasing amounts of raw data, often in chaotic environments, with the expectation of filtethig data, prioritizing risks, and making informed treatment decisions. Consequently, safety has not improved. Ironically, the overall signal-to-noise ratio in complex healthcare settings may be worsening despite advances in technology and computing power.
The broader fragmentation of medicine extends to hospital units and even to individual patient rooms. Industry vendors depend on and promote this fragmentation with each vendor workting alone trying to maximize market share. Al-though single-solution equipment providers exist, they still reside within isolated domains (eg, radiology and imaging, physician-order entry, and electronic patient record) and don’t integrate with other technologies. Hospitals have largely stood on the sidelines in shaping the landscape of technology, equipment, and infrastructure in healthcare. They are perceived as the battleground in which vendors claim victories and admit defeats, but not as a driving force behind integration to which the market responds. This needs to change.
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