Medical Device Integration Blog

Michelle Grate, RN MSN CPHIMS

Role at Capsule: Senior Project Manager Degrees & Certifications: MSN, CPHIMS Hospitals / Organizations Worked At: University of Kentucky HealthCare, Holy Cross Hospital, Central Baptist Hospital, Ephraim McDowell Hospital, Synapticore LLC, Capsule Tech, Inc. Areas of the hospital you have worked: Women’s Care, Mother/Baby, Labor & Delivery, Home Care, Surgery, IT Who/what inspired you to become a nurse? Actually, I did not have a noble calling to be a nurse. Fresh out of high school I knew I could be a RN in 2 years and make decent money in rural Eastern Kentucky. Ironically, I moved away from the location as soon as I got my degree. But the profession has always been good to me and I am grateful to be where I am now in nursing. Which care environment(s) of the hospital did you most enjoy working? Labor and delivery, it was usually a great experience and the families remembered me for years to come. If you had one superpower, what would it be? I would love to just pass by any location and it would instantly become clean and beautiful again, I would just travel the world making it beautiful everywhere and wave to the crowds.

Recent Posts

Oh, how times have changed… or have they?

Posted by Michelle Grate, RN MSN CPHIMS on Sep 19, 2014 @ 09:00 AM

I stumbled upon an interesting statement recently, "The immediate availability of a patient's chart record means greater convenience to the nurse, the attending physician, the intern and the hospital administrator. Not only is there a marked saving in time, but greater accuracy is secured in clinical records when the chart and chart holder are easily accessible." Sounds like many of the conversations we hear today about electronic documentation. But the source of this statement may surprise you: it is from a series of articles in The Modern Hospital, circa October, 19221! Looks like the theme of immediate availability of a patient's record has been around for a long time and for the same reasons.

This has put me in a bit of a nostalgic mood. Recently I was doing some work at a hospital and I glanced fondly at the good ol' chart rack. It has always been an integral piece in our arsenal of nursing tools. Although they may be a little different from one hospital to another – some are square, some are round, some have wheels, and some sit on a desk – they are all basically the same. Even today with all the electronic documentation and EHRs, they can still be seen doing their humble job on the nursing units, albeit a little thinner than they used to be. I have many memories of pulling up the chart rack to my spot at the nursing desk and doing my documentation for the day, hour, shift or whenever I got the chance.

But I digress, so back to the subject of immediate availability. If you have been a reader of our blog posts, you are already aware that we are advocates of immediate availability of patient's vital signs in the electronic record. Our goal is to help make that possible for any med/surg environment.   We can help you collect vitals directly from most spot check monitors and transmit them along with additional documentation to the electronic record in near real time. This isn't future availability, it is available now. And apparently it still helps with the age old theme of "immediate availability of a patient's chart record".

Does your facility still have chart racks?
What is in them?
Do you think they will ever go completely away?

[1] The Modern Hospital (Vol. XIX, p. Adv. 105). (1922). Chicago: The Modern Hospital Publishing.

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Tags: Nurses, Clinical Documentation, ThrowBack

Timing is Everything - Especially with Vital Signs!

Posted by Michelle Grate, RN MSN CPHIMS on Aug 08, 2014 @ 12:25 PM

The age old saying, “timing is everything,” still rings true today with Clinical Decision Support (CDS). The most effective time to present a CDS alert is immediately at the point-of-care. But how effective is an alert if the data triggering it is entered hours after the actual event?

To achieve the greatest benefit from CDS, data needs to be entered in near real-time. This is why automated documentation of vital signs is essential, even with periodic vitals collection.

We have long tried to achieve the ideal scenario of real-time bedside documentation, but incorporating the necessary workflow is difficult. While many facilities have deployed auto documentation for continuous monitoring in the ICU or the OR, the med/surg environment, or any location where periodic vital signs collection is performed, is often overlooked or not evaluated for automating documentation.

But why? This is an important environment that can benefit by enhancing CDS with automated periodic vital signs collection.

For example, early detection of a patient’s declining condition in the med/surg environment can lead to early intervention and prevent untoward events. CDS is an essential element in early detection and vital signs are a key component of many CDS rules. When vital signs are not entered into the electronic record for minutes or even hours after they are taken, the opportunity to maximize the benefits of early detection is lost.

It is as simple as this: the sooner data is entered, the sooner the CDS rule can trigger an alert and the sooner the patient can benefit. All of this will help lead to better outcomes.

The med/surg environment should be the patient's next stop in a hospital before going home, not back to the ICU or to another critical care area. Maximize the benefits of CDS with automated vital signs documentation at the point-of-care. Capsule's SmartLinx Chart Xpress™ works with a variety of spot check monitors and sends validated vital signs to information systems in near real-time.


Do you have automated vital signs documentation with your periodic monitoring locations?
What are some other benefits you see to automating this workflow?
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Tags: Medical Device Integration, Alarms and Alerts, Medical Device Information System, Medical Device Data, Med-Surg, Low Acuity

Maximizing the Benefits of Your Medical Device Integration Strategy

Posted by Michelle Grate, RN MSN CPHIMS on Jul 01, 2014 @ 10:00 AM

A successful strategy is crucial to helping guide decisions throughout an organization, making it critical that it be in alignment with the organizational goals that it is designed to support.  If the strategy is developed without a clear understanding of those goals, then resources, effort, and money can easily be misappropriated. 

When it comes to information technology, a strategy would not be complete without a thorough architecture covering all aspects of an enterprise. However, one of the challenges for developing that strategy is to look into the future and make plans for current infrastructures as well as potential emerging technologies.  A good enterprise architecture will assist in keeping the focus on growth and the necessary predecessors to get there.

With respect to integrating medical device data with the electronic health record (EHR), the strategy needs to look at the current and long term needs of the organization in order to maximize the investment of the medical device information system (MDIS).  Gone are the days when the ICU is considered the only location for integration of medical devices. 

The vast amount of patient data that can be collected and analyzed for real-time clinical decision support can lead to better outcomes. The more medical devices that are connected to the EHR and other information systems, the greater the amount of patient data that can be evaluated for clinical decisions.  Developing a MDIS strategy will help guide the organization's goals and plans over a long term period and keep the organization focused on their patients as they pursue expanding their use of medical device data.


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Tags: Medical Device Connectivity, Medical Device Integration, Implementation, Medical Device Information System, CONNECT, Medical Device Infrastructure

Healthcare as a Complex Adaptive System

Posted by Michelle Grate, RN MSN CPHIMS on May 01, 2014 @ 09:00 AM

For decades, complex systems have been a topic of study in natural sciences like physics, chemistry, mathematics, and engineering. The concept of complex systems has been used to explain phenomena such as immune system functions and weather patterns.  Complex adaptive systems evolve in response to the changing environment; the need to adapt in order to survive. Tremendous progress has been made in applying Complex Adaptive Systems (CAS) modeling to other disciplines with a more social nature.

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Tags: Informatics, Complex Adaptive Systems (CAS), Workaround

What Language Do Your Devices Speak?

Posted by Michelle Grate, RN MSN CPHIMS on Apr 02, 2014 @ 01:00 PM


Having recently graduated from DUKE's School of Nursing with an MSN in Informatics, there was one topic that far outweighed any other: Standardization in Healthcare Language.   The common theme being everyone knows we need it and everyone is working on it. But are we really making any progress?  

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Tags: Medical Device Connectivity, Medical Device Integration, Clinical, Language Standardization