COMMENTARY -- The sometimes-contentious relationship between IT and Biomedical Engineering is quickly becoming a cliché. These two groups are quite different, and market forces are conspiring to throw them together with greater frequency. In an effort to make this relationship work, some hospitals are changing biomed's reporting structure and placing them under IT. While "rearranging the deck chairs" may help, there are simpler and more immediate ways to make the IT and biomed relationship work.
When describing the differences between biomeds and IT, Rick Hampton, corporate manager of wireless communications at Massachusetts General Hospital (MGH), Boston, notes that, "the people we work with are both our strength and greatest difference." Biomeds work with clinicians. Especially in hard-core patient care areas like critical care and surgery, this principal relationship gives biomeds their 24/7 responsiveness and focus on patient safety. Biomeds also work under a considerable regulatory burden; JCAHO, FDA, and local codes have made biomeds very policy and procedure driven, with a predilection to document everything.
Biomeds work mostly with line clinicians, rather than staff management, focusing on patient safety, product quality, and maintainability. Issues arising in the selection and use of medical device systems are intertwined with factors such as clinical efficacy, caregiver productivity, and patient comfort. In contrast with IT, medical device budgets rarely lie with biomedical engineering, and the project teams for selecting and implementing medical devices are lead by the department that holds the budget.
The IT focus starts with major a presence in the executive suite, the chief information officer. This staff orientation extends to their relationships with department managers. Information system budgets lie within the IT department, and IT holds most of a hospital's project management resources and is on the hook for multimillion-dollar projects. The mindset in IT is "get it done" and "keep it going" with the business continuity impact of mission critical applications and project completion always in mind.
External factors are conspiring to push IT and biomeds together. As technology advances, and computing power becomes commoditized, medical devices have taken on many information system characteristics. The use of general-purpose computing platforms, networking, and systems integration with hospital information systems have turned what were once standalone boxes into "life critical" information systems regulated by the FDA. Most medical devices are shifting away from private networks as wireless medical devices adopt 802.11a/b/g for wireless connectivity, causing many IT shops to get more involved in medical device systems. Besides this computerization of medical devices, information systems are extending into the point of care with applications such as EMRs and CPOE. Decisions surrounding data integration between medical devices and EMRs can create conflict between IT and biomeds (and bad decisions), when both parties' interests are not considered.
The confluence of IT and biomeds in clinical decisions also impacts vendors. According to Spacelabs patient monitoring product manager, Allen Enebo, "Most biomedical engineering departments do not have the expertise necessary to evaluate the IT portion of many medical device systems, so now IT is a critical component, in addition to the usual clinical decision makers -- it's a real challenge for sales to bridge these two groups and satisfy both." Challenges don't end with the sale, as deploying medical device systems across a hospital's IT infrastructure can create customer service headaches for clinical users and medical device vendors when IT shops are not fully aware of "life critical" requirements and create unintended outages. These dynamics frequently result in ongoing friction -- if not outright hostility -- between biomeds and IT.
Best practices for IT and biomed collaboration are just emerging. The key, according to Hampton, is to, "get IT and biomeds in the same room, working on the same project -- after a while they realize they're on the same team." Biomedical engineering departments have traditionally reported into purchasing or the facilities management department. As they say, familiarity breeds contempt, and moving biomeds under IT without any other changes will do just that. At MGH, they created a wireless coordinator role in IT and filled it with a biomed, Rick Hampton. Clinical IT project teams include both IT and biomeds, leveraging each group's strengths. It is this true collaboration and acceptance of each other's point of view that delivers the best outcomes.Connectologist Tim Gee has spent 20 years in healthcare automating workflow through the integration of medical devices and clinical information systems. You can read his health-tech blog or reach him by e-mail at email@example.com.