Nadia Ayoubzadeh, Director, Information Services and Clinical Engineering Services (CES), Allina Health
One of the most ubiquitous drug delivery devices in any clinical setting is the infusion pump, an external medical device used to deliver medications and other fluids to a patient intravenously, subcutaneously or as an epidural. Approximately 90 percent of patients admitted to a hospital in the United States receive IV therapy. In order to provide high levels of accuracy, control, and precision to drug delivery, the majority of these patients are placed on an infusion pump. This article explores the innovation journey of this drug delivery technology and its future within a smart hospital ecosystem.
The earliest record of intravenous medicine dates back to the 15th century, although this medical phenomenon did not gain much traction until 1658 when Christopher Wren invented the first working IV infusion device. This revolutionary invention spurred more experimentations of administrating drugs and fluids intravenously. By the 20th century, this branch of medicine experienced huge advancements as needles were refined, rubber materials were replaced by plastic tubing, and vacuum-sealed glass bottles were swapped out for plastic bags which greatly reduced the risk of an embolism. By the 1970’s, the first ambulatory pump was invented which gave patients the ability to move while receiving an infusion. “Smart” or computerized intravenous infusion pumps hit the market in 2001 and signaled yet another major advance in medication administration and safety. For the first time in its history, safety software would automatically alert clinicians when programming errors were initiated resulting in the prevention of potentially fatal outcomes.
Today, the need for the stand-alone infusion smart pumps to operate with greater safety and quality features within the context of a networked, multi-site health system is driving further considerations for technological innovation. With the global infusion pump market projected to exhibit a CAGR growth of over 6.3 percent by 2025, infusion pump manufacturers are taking notice. Top trends include interoperability, cybersecurity, real-time location systems, and digital consumer experiences.
With government incentive programs motivating adoption of the electronic health record (EHR) across the country, health systems are now focusing their attention on interoperability. IV-EHR interoperability involves a wireless, bi-directional connection where infusion information is transmitted by the EHR to the infusion pump. Following the initiation of the infusion, the pump transmits time-stamped infusion data to the EHR creating an accurate documentation trail. This automation leads to the more frequent use of dose-error reduction software by the clinicians, thereby reducing keystrokes and the likelihood of errors related to manual programming.
"As ‘smart’ pumps become ‘intelligent’ pumps, these drug delivery devices are continuing to transform IV medication administration"
Medical device cybersecurity is becoming a growing concern with this increase in connectivity. As pumps become more interoperability in the healthcare setting, there is increased pressure on manufacturers to build greater security features into their design. Medical device organizations are creating vulnerability disclosure documents while governmental agencies and industry associations are providing risk information into the public domain to help healthcare delivery organization reduce or even eliminate potential cyber risks. Additionally, upgrades, updates and firmware patches are becoming the norm as manufactures work to stay current with new security vulnerability risks.
With these technological advances comes a wider range of data that can be utilized to drive meaningful business and clinical analytics. With accurate and nearly real-time infusion information, actionable dashboards can visually display trends that were previously not available. With health systems having hundreds if not thousands of infusion pumps in their inventory, opportunities for improved decision making such as medication management and accurate billing becomes highly valuable.
Another driver to innovate products comes from the pressure health systems are placing on manufacturers to lower the economic burden for ownership. Infusion pump manufacturers are providing new offerings such as pumps with real-time location systems with bi-directional communication. By providing information on where a pump is located and its use status, they can alleviate the ever growing issue of tracking down pumps by healthcare technology management teams, also known as biomed departments. This feature helps address the climbing cost of looking for pumps to perform the increasing number of support activities including preventative maintenance, updates, patches, and repairs.
As ‘smart’ pumps become ‘intelligent’ pumps, these drug delivery devices are continuing to transform IV medication administration. With new features continuing to roll out into the infusion pump drug delivery market, it is not far-fetched to anticipate patients and caregivers continuing to demanding even more functionality. Building predictive artificial intelligence that can anticipate the drug dose and rate of infusion that can optimize care is one possibility. Alternatively, as we move into a more consumer driven healthcare environment, patients using apps to understand information on medication being delivered, its implications and side effects, and cost estimates for usage, could be around the corner. Regardless of what is next, there is a strong likelihood that there will be more innovation that builds over time when it comes to the infusion pump.
Hesham Abboud, MD, PhD, Director of the Multiple Sclerosis and Neuroimmunology Program and staff neurologist at the Parkinson’s and Movement Disorder Center at University Hospitals of Cleveland, Case Western Reserve University School of Medicine