Why Information Management Standards Matter to Biomeds

Abstract

We are all aware that The Joint Commission (JC) has standards for information management. Most of us probably aren't aware of what they are, however. We should be for two reasons.One is that, increasingly, the medical equipment for which we are responsible is dependent upon software, networks, and servers for which information technology (IT) departments are responsible. I have heard comments and complaints about IT not being aware of, or sensitive to, the needs of medical equipment or our responsibilities for it. Well, it's a two-way street. We must be aware of, and sensitive to, the needs of information systems, and IT's responsibilities.The other reason is that these standards apply directly to our computerized maintenance management systems (CMMS). I do not consider it too much of a stretch to include the clinical engineering CMMS when considering the hospital's compliance with the JC's information management standards. In fact, in the introduction to its “Information Management” chapter, the JC states that, “Requirements in this chapter apply to all types of information managed by the organization, unless the requirement specifically limits the type of information to health information.” I have heard many complaints about the use and performance of CMMS. I believe we could go a long way towards improving the use and performance of CMMS if we paid attention to the JC's information management standards.The “Information Management” chapter in the JC's hospital accreditation manual has four sections and a total of eight standards. The four sections pertain to planning, health information, knowledge-based information, and monitoring information management processes. The planning section has two standards. IM.01.01.01 requires hospitals to plan for managing information. In its description of this requirement, the JC points out that planning must be for “the full spectrum of data generated and used by the organization.” The second standard in the planning section is IM.01.01.03, which requires the hospital to plan for information management continuity. The JC explains that this pertains to paper-based systems as well as electronic systems, and includes knowledge-based as well as health information. Both of these standards pertain to information originating in medical equipment and connected to a network. The value of planning should be obvious: know what information is needed; know where the information comes from and goes to; write the plan in enough detail that it can be explained to users and justified to administration. Part of the plan should cover the continuity standard: how the system is designed to assure continuity; what backup system is provided; what to do if the system does go down. For information systems that involve medical equipment, the clinical engineering (CE) department must obviously be an integral part of the planning process.The health information section has four standards. They pertain to the privacy, security, integrity, collection, and usefulness of health information. This section covers the implementation and use of health information systems. This is an area where there is increasing overlap between IT and CE. More and more medical equipment is being connected to networks. Data that medical equipment transmits and receives is health information, so these standards are applicable to medical equipment that is networked. Again, when these systems involve medical equipment, clinical engineering has to be part of the process.The section on knowledge-based information has only one standard, and it requires that information resources be available, current, and authoritative. The JC separates information systems into two broad categories: health information and knowledge-based information. Information from medical equipment would be in the health information category, while a CMMS is a knowledge-based information resource. The application of JC information management standards to CMMS's is covered in the next section.The fourth section, monitoring information management processes, also has only one standard. This standard requires that health information be accurate. Just as with the health information standards above, this standard applies to networked medical equipment. Clinical engineering has always been involved with the accuracy of medical equipment. The standard on health information accuracy is one more facet of the performance of medical equipment, when that equipment is connected to a network.IT departments have standards that are similar to CE department standards. Information management standards pertain primarily to the safety and performance of data, while medical equipment management standards pertain primarily to the safety and performance of equipment. Because of this similarity, it should be relatively easy for CE to understand, respect, and assist with the priorities of IT. If we take the initial steps, and meet IT just a little bit more than halfway, they will become willing partners with us whenever our duties overlap. I speak from experience.Let's have a show of hands: Who among us is more pleased than displeased with their CMMS? Hopefully, that would be most of us. Now, keep your hands up if and only if you have never cursed the day that you became involved with a CMMS. There may well be no hands left aloft. But, have we taken the time to really analyze our issues with our CMMS? More often than not, at the root of our problems is the garbage that we feed our CMMS. In the inimitable words of the great Pogo possum, “We have met the enemy, and he is us.”Bad habits are not the only reason that we all have such difficulty with the quality of our CMMSs. One other factor is that significant administrative support is necessary to enter and maintain data. We are always under pressure to do more with less. We are often required to reduce our operating budgets. Administrative support staff are prime targets for budget cuts. It might seem easy to transfer their functions to technical staff, but that invariably means that these functions are given lower priority by folks who were hired for other duties.Yet another factor is that CMMSs cannot meet the needs of the vast majority of CE departments. These departments are almost proud of the fact that they are so different from each other. How can we realistically expect a commercial CMMS to satisfy any more than perhaps 80% of the needs of a given department? The only alternative is to create one's own CMMS, but how can we realistically expect very many departments to tackle writing and maintaining their own CMMS? We must, at the very least, plan properly. What do we do, how do we do it, and what data do we need to support what we do? If we can't even get a decent match when evaluating a CMMS, there isn't a snowball's chance in the solar corona that it will meet our needs.In this case, recognizing the problems does not get us halfway to the solution. But I think that applying the JC's information management standards to our CMMS would get us well past halfway to a solution. To be more specific, what can we do with information management standards to help us with our CMMS? Step 1 is to read the standards, the elements of performance (EP) for each standard, and the explanatory material. Sections I and III are directly applicable to a CMMS (knowledge-based information). It is beyond the scope of this article to provide a detailed description of the response to each EP. Very generally, however:For years, I have believed, and stressed, that a realistic way to look at most standards is that they get us to do the right thing for the wrong reason. Good standards are clearly written descriptions of minimum performance practices. They aren't best practices. They are the minimum level of performance that we should accept.The JC's accreditation standards are different from most standards because they cover such a wide range of performance practices. Then they require that different functions within the organization not only use standards that, at first blush, might not seem applicable, but they expect that these different functions actually cooperate with each other just to meet minimum performance practices. This is certainly the case with the JC's information management standards. Besides the IT department, virtually every other department in a hospital needs to comply with at least some of these standards. I don't want to give the JC any ideas, but if they wanted to catch any hospital in the country not complying with their standards, they need look no further than the application of information management standards in any department other than IT.Too often, clinical engineering and information technology departments are at odds with each other over areas of responsibility and authority when it comes to implementing and maintaining medical equipment networks. The JC's standards describe the rudiments of how these networks should be planned, implemented, and maintained. It is up to users to recognize that they won't even achieve minimum performance standards without cooperation between CE and IT.Too often, clinical engineering departments do not properly implement and maintain their CMMSs. The JC's standards describe how knowledge-based information systems should be planned, implemented and maintained. It is up to users to recognize that they won't even achieve minimum performance standards without having staff dedicated to the use of their CMMSs.Using the JC's information management standards can, one, improve patient care and safety by improving cooperation between CE and IT, and two, improve the performance of your CMMS by improving how it is planned and implemented. This gives new meaning to the old expression, “kill two birds with one stone.”