Clinical Engineering Fills Gap Between Technology & Clinical Disciplines

With technology rapidly impacting healthcare, those who can bridge understanding between the clinical and IT sides are in big demand.

Clinical engineers (CEs) are in a unique position to fill the chasm between the two disciplines. “Clinical engineering is a merger of those two professions,” says Paul Sherman, CCE, president-elect of the American College of Clinical Engineering (ACCE). “We’ve often been that human interface between technical and clinical people.”

The CE field has undergone a lot of change over the past 20 years, according to Tom Judd, national project director of clinical technology for Kaiser Permanente and a founding member of ACCE. With all the data and historical information coming into play, CEs are tasked with lifecycle management of medical devices and they can help redefine clinical workflow.

Data & interoperability

Clinical workflows need redefining because of the increasing data coming from all these medical devices. ICU patients, for example, have several parameters monitored around-the-clock. “Those data can be shoved into the record but do they need to be and how much? Without somebody who knows that part, [providers] run the risk of losing vital information because it’s buried under data,” Judd says.

Another challenge is interoperability. “Getting things connected to other things is a very poorly organized, poorly orchestrated, poorly understood task” in healthcare, says Elliot B. Sloane, PhD, CCE, president and founder of the Center for Healthcare Information Research & Policy (CHIRP).

Other fields have been doing this for a long time, so there is science, engagement and experience that has greatly improved the rate of error and failure. However, modern computer technology goes back to the 1970s and iPhones only go back five years, he points out. “We don’t have a lot of experience in healthcare. We’re trying to catch up.”

Part of the problem, Sloane says, is user requirements for interoperability are not at all clear. If everyone adopted Integrating the Healthcare Enterprise (IHE) standards, that “would take much of the variability out.” It wouldn’t solve all the problems but it would be a good start. For example, there is not a legal or financial framework for the telemedicine services insurance companies will reimburse.

Efforts to improve interoperability are starting to impact the sharing of lab results. Estimates of waste in healthcare point to up to 40 percent due to repeat studies, such as lab tests, Sloane says. He worked on a project in Saudi Arabia to set up shared lab results. The country was in the unique position of being able to build an efficient system from the start, rather than being stuck with competing retail chains, lab services providers and clinicians as in the U.S.

Saudi Arabia is using IHE, a finite number of tests providers can order and certain parameters, such as a deadline. The information is broadcast to affected parties and the results are posted to a central repository that is primed with notification rules.

A similar system in the U.S. would be a vast improvement over the current set up. “We can reserve a DVD at any of 20 nearby Redbox locations but we can’t do the same with our lab results.”

Sloane does see improvement for U.S. lab results on the horizon, however. About 10,000 volunteers are participating in the development of standards and he just began a new lab order project with the Office of the National Coordinator for Health IT.

‘Natural extension’

Another aspect the CE field must address is training. “We have to learn more. Courses and curriculum have to be expanded,” says Sloane. He anticipates rapid rates of change. “Bioengineered medications, customized cocktails of medications based on my DNA and my particular type of cancer, for example, are wonderful frontiers but big challenges. We’re still hard pressed to get a tablet of aspirin to the right patient at the right time on the right day.”

Increasing their expertise in EHRs is one way CEs can effectively expand their knowledge, he says, seeing it as a natural extension to what a lot of biomedical engineers already do. Advancing technology means more and more systems and tools are connecting and expanding. The equipment CEs have been managing for decades are now sending information out into the world, Sherman says. “CEs are going to need some kind of background in EHRs to stay viable in the field.”

To help move that from idea to practice, CHIRP developed EMR System Training Access & Resources (EMR-STAR), an open source training module. The module is designed to enrich a wide range of existing health IT courses by giving students hands-on access to EMR systems, says Sloane, who oversees the project.

“Students can read about the tools, but they haven’t had an easy way to use the tools and understand all the nuances,” Sherman says. In 2012, CHIRP began a three-year contract with the Department of Labor’s Health eWorkforce Consortium to design, develop, implement and provide EMR-STAR training for more than 2,000 new healthcare workforce employees through online and college courses.

The access to EMR systems is designed to improve students’ confidence, competence and flexibility in working with different EMR systems since they will probably work with multiple systems through the course of a career. Now, CHIRP is working to transition the educational material to clinical engineering.

“We’re hoping we can provide a path for them to really jump in and become the experts,” says Sherman. “It’s yet another opportunity for our field to expand and help more people.”