Clinical Engineering & Device Integration (CEDI)

Highly Integrated Clinical Engineering for Highly

Integrated Healthcare

Jennifer L Jackson, MBA, CCE

June 1, 2013

Clinical Engineering Symposium, presented by ACCE

AAMI 2013, Long Beach, CA
Overview Of Cedars-Sinai

3% General Acute
 Established in 1902 and located in Los Angeles, 5% Med/Surg (466)
5% 3%
California
Monitored Beds
 947 licensed beds, Level I Trauma Center (141)
7%
 Primary service area includes 3.3 million people 49%
Intensive Care
13%
 Community support groups representing (120)
more than 16,000 individuals
15% Perinatal (64)

On average, every day we serve:

 233 Emergency Department Patients

 76 Emergency Department  Inpatient
Admissions
 >735 Inpatients
 18 OB Deliveries
 120 Operative Procedures
 44 CVIC/E.P. procedures
 4 Level 1 Trauma Patients
 25 Acute Rehab patients
 >1400 Outpatients Visits and Procedures

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Caring for Our Technology

• 14,784 + Computers on the network

• 34 Physical Locations

• 2,588 servers in our 40,000 sq. ft. data center

• 412 clinical applications

• 2,828 TB of Tier 1 and 2 storage

• 112 systems are real-time synchronized to each other

• 10,437,932 interface transactions a day

• 29,000 medical devices managed by Clinical Engineering

• CS-Link launched in August 2007

• CS-Link CPMO launched in March 2012

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The Clinical Engineering Department
May 2013
Mission Statement

In close collaboration with

clinicians, administrators, and
other technology groups, Clinical
Engineering and Device Integration
promotes quality patient care
through the appropriate and safe
use of medical device technology.
Clinical Engineering and Anesthesiologists meeting
to discuss the hardware mounting related to CS-
Link Anesthesia Record implementation.

We strive to be a center of
excellence for innovative and
robust solutions that promote
leadership in delivering
healthcare related services.
Clinical Engineering and nursing working together to plan out unit
closures for the nurse call replacement.
Who We Are

•Biomedical Equipment
Technicians
•Image Guided Systems
Technicians
•Clinical Systems
Specialists
•Clinical Systems
Engineers
•Project Specialists
•Administrative Staff
Who We Are
• Staff re-organized into 4 teams.
• Total new FTEs created: 3
One Project
Management/Implementation
• Device Integration
Clinical Engineering
•23 FTEs
•Sample technologies supported
•EKG carts and EKG archive
•physio monitoring
•device integration terminal
servers
•fetal monitors
•defibrillators
Three Support and Optimization Teams
• Clinical Engineering
• OR Clinical Engineering
• Integrated Device Systems
Integrated Device OR Clinical Engineering Device Integration
Systems •8 FTEs •6 FTEs
•6 FTEs •Sample technologies supported •Sample Projects
•Sample technologies supported •Scope Mgmt •Device <-> CS-Link Integration
•Airstrip •Anesthesia Machines •Voalte implementation
•Emergin •OR AV integration •Alaris integration
•OBIX •Image-guided systems •Nurse Call replacement
•Nurse Call/Call Light
 CSMC Clinical Engineering
a brief history

• HP’s PDMS installed at

Late 1980’s

July 2011
CSMC Clinical Engineering and
• Ventilators, Urimeters, Device Integration

Aug 2007
and Blood Gas Analyzers New EHR vendor selected Department is formed

Apr 2013
are integrated • One requirement is to Cardiology Applications
• Clinical Engineers do this keep current device Team joins CEDI
work integration

• Clinical Engineering moves

1978

out from Cardiology • PDMS replaced with

Early 1990’s

• Merges with Laboratory CareVue

Feb 2012
Service • HP 200LX ‘smart’ OR Imaged Guided
calculators can receive Systems team joins
alerts from system Oct 2010 Device integration with CEDI
Clinical Engineering • Integration engineer new EHR goes live
1976

Departments from Lebanon moves to IT Clinical Engineering and

and Sinai hospitals merge, Device Integration are
still under Cardiology separate departments
under different VPs
Medical device integration fundamentals

Three key features of any • Examples

medical device  ‘Simple’ data measurement
 The type of device and
devices to more complex
the complexity of the  stethoscope -> ICU
measurements it monitor -> MRI
produces, and  One or two parameters ->
analysis and alarms ->
 The data it measures and
remote control
transmits externally,
 Simple to complex

 The method by which it connectivity technology

communicates to external  Point to point serial
systems.  Fixed IP network enabled
 Secure wireless network
compliant

Source: Zaleski, JR. Integrating Device Data into the Electronic Medical Record. Publicis
Publishing. Erlangen, Germany. 2009.
Medical Device Domain with ever increasing complexity

Source: Zaleski, JR. Integrating Device Data into the Electronic Medical Record.
Publicis Publishing. Erlangen, Germany. 2009.
Snapshot of CSMC Medical Device
Connectivity
Infusion Pumps
• 924 Infusion pump brains wirelessly communicate
 Currently used to push datasets and download logs

 2014, bidirectional interfaces go into production (test environment live August)

Patient Monitoring
• ~255 telemetry patients’ data imported to EHR (288 max – will increase in 2015)
• 690 multi-parameter monitoring devices imported to EHR
• 120 terminal servers in critical care areas for connection to ventilators, urimeters
 85 anesthesia machine ‘systems’ in production Nov 2013

 Expands to ED and 60 med-surg beds in 2014-2015

 Mobile vital signs collection live Sept 2013

Cardiology
• 35 EKG carts are wireless
• Orders/results for cath lab hemodynamic systems
• Orders/results for EKG archive to EHR live July 2013, incorporated with carts
Alarms/Alerts
• Bed exit/Chair exit alarms – sent to smartphones
• Medical Device (“aux”) jack in each room
• Tele monitor based alarms managed through central monitoring, filtered
What Makes Us Different
in the way we manage medical device systems

• Unique organizational structure

 Independent department within IT

 Work side-by-side with applications and

technical teams
• Unique job roles
 Image Guided Systems Technicians

 Much more clinical than a ‘typical’ BMET,

working side by side with surgeon during
procedures to ensure the technology is
properly aligned and functioning
 Clinical Systems Specialists

 Stronger IT skill set than a ‘typical’ BMET

• More of the technical lifecycle within one
department
 Building device records in the EHR

 Testing and maintaining orders/results

interfaces
 Project management

 Technical support

 System optimization
Current Projects
External

• Leading role
 Bidirectional pump interface
 Nurse Call replacement

 Mobile Vital Signs rollout

 EKG orders/results interfaces

 Digital OR implementation

 Voalte phone implementation

 Voalte/Rover co-existence testing

 Part of Rover trial

 Central Monitoring Center renovation

 Pediatric reporting from cardiology PACS

 Advanced Health Sciences Pavilion equipment

planning, including Training Center

• Strong supporting role
 Anesthesia Record (anesthesia machine
integration)
 Fetal monitoring expansion

 EHR expansion to PPOs (integrated medical

device strategy)
 SEA 50/Alarms NPSG Task Force
Current Projects
Internal

• Equipment Management Committee

 Reviewing and revising equipment management policies

 Overseeing equipment audit

• Training plans/Career paths

 Developed career paths for BMET, CSE, CSS, and DBA job families

 Corresponding training plans

• Recruit/retain the best staff

• Total Cost of Ownership/Cost of Service
 Bring all service contracts into CEDI

 Identify opportunities for improvement

• Prepare for Robot Wars 2013!

Our formula for success:

We work hard.

We play hard.

We’re flexible and curious.

We know Elvis.
THANK YOU!