10 things you need to know about Integrated Clinical Environments (ICE)
An Integrated Clinical Environment (ICE) is a platform to create a medical ‘Internet of Things’ around the care of a single patient. It brings together all relevant medical devices, connecting network nodes. These might include those in an ICU, data logging devices, applications that support clinical decision making, and external interfaces to other healthcare IT systems and devices. It is rather like an ecosystem, connecting devices with applications that can then use the data and/or direct the devices.
The introduction of ICEs has huge potential to improve patient safety by improving communication between devices. They will allow devices to work together instantaneously, without having to alert a person to a potential problem first. This could have huge benefits in clinical environments where devices may affect each other’s operation, and where the effects can take a while to become obvious, or in avoiding common mistakes such as administering medicine using the wrong system.
ICEs could also help to improve efficiency in hospitals, as well as patient care. By feeding data collection systems, including patient records, automatically, they could save staff time spent on recording data. By bringing all the information together in one place, they should also make it easier to spot patterns and trends in a particular patient’s condition, and ensure that decisions are made quickly and effectively before problems develop.
Lack of interoperability standards, or development of multiple sets of standards, could really hold back the development, use and usefulness of ICEs. The current situation, where devices use different proprietary systems, and are unable to communicate, hampers good patient care. It is crucial that developers of both devices and applications can work to common standards, so that systems are future-proofed, and all devices will be able to connect. The development of open standards, such as OpenICE, is likely to be really important in delivering on the potential of ICEs.
Getting devices to talk to computers is not difficult. What’s hard is to make sure that they can do so securely. There are issues about both patient data confidentiality and safety of operations. The security of connections has been highlighted as a real problem in the IoT more generally, and it is even more of an issue when lives may depend on it. This is probably best addressed through the development of standards.
Delivering on the potential for ICEs will take collaborative working by all those involved. It is impossible for any one organisation, whether hospital, device manufacturer or application developer, to deliver an integrated environment, or even standards on which all can build. There are a number of co-working initiatives already in place, including OpenICE, and also Boston’s CIMIT programme, which are designed to support ICE development.
ICE development really needs to look beyond what is currently possible, and examine ways to improve efficiency and effectiveness. This is potentially a once-in-a-generation opportunity to bring together all those involved in delivering care and make improvements. If it only focuses on connecting what is currently available, that is a huge missed opportunity to examine workflows and patient care, and optimise both.
There is a danger of focusing on technical requirements at the expense of engagement and involvement of clinicians. Technical requirements and standards are important, but they must not come at the expense of non-technical expertise and engagement of caregivers. It will be caregivers who have to use the integrated systems, and change management literature tells us that they must therefore be involved in their development.
ICEs must be a bridge between patient and clinician, not a barrier. They could, and should, be a way of supporting clinicians to deliver better care. They are not a substitute for clinician-directed, patient-focused care. This has been recognised in several ICE projects, including the Medical Device Plug’n’Play (MDPnP) project, which has focused on developing standards for what is described as the ‘Patient-Centric Integrated Clinical Environment’.
Users need to be able to operate ICEs effectively. Without that ability, ICEs will not only not improve patient care, but may be actively dangerous. Developers and standard-setters have a role to play in ensuring that demos and information are available to facilitate this. OpenICE, for example, provides demos and explanations of its ‘Supervisor’, and also demos of sample apps to show what to do with the data. But clinicians also have a part to play in ensuring that they are open to change and improving the way in which care is delivered, rather than resisting passively or actively.