title: Capturing Essential Information to Achieve Safe Interoperability.
abstract: In this article, we describe the role of "clinical scenario" information to assure the safety of interoperable systems, as well as the system's ability to deliver the requisite clinical functionality to improve clinical care. Described are methods and rationale for capturing the clinical needs, workflow, hazards, and device interactions in the clinical environment. Key user (clinician and clinical engineer) needs and system requirements can be derived from this information, therefore, improving the communication from clinicians to medical device and information technology system developers. This methodology is intended to assist the health care community, including researchers, standards developers, regulators, and manufacturers, by providing clinical definition to support requirements in the systems engineering process, particularly those focusing on development of Integrated Clinical Environments described in standard ASTM F2761. Our focus is on identifying and documenting relevant interactions and medical device capabilities within the system using a documentation tool called medical device interface data sheets and mitigating hazardous situations related to workflow, product usability, data integration, and the lack of effective medical device-health information technology system integration to achieve safe interoperability. Portions of the analysis of a clinical scenario for a "patient-controlled analgesia safety interlock" are provided to illustrate the method. Collecting better clinical adverse event information and proposed solutions can help identify opportunities to improve current device capabilities and interoperability and support a learning health system to improve health care delivery. Developing and analyzing clinical scenarios are the first steps in creating solutions to address vexing patient safety problems and enable clinical innovation. A Web-based research tool for implementing a means of acquiring and managing this information, the Clinical Scenario Repository™ (MD PnP Program), is described.
authors.affiliation: From the *Office of Science and Engineering Laboratories, Food and Drug Administration/Center for Devices and Radiological Health, Silver Spring, Maryland; †MD PnP Program, Massachusetts General Hospital, Boston, Massachusetts; ‡DocBox, Newton, Massachusetts; §Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; and ‖Partners HealthCare System, Boston, Massachusetts.
authors.forename: Sandy
authors.initials: S
authors.lastname: Weininger
authors.forename: Michael B
authors.initials: MB
authors.lastname: Jaffe
authors.forename: Tracy
authors.initials: T
authors.lastname: Rausch
authors.forename: Julian M
authors.initials: JM
authors.lastname: Goldman
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D056902:Clinical Alarms; D003299:Cooperative Behavior; D003625:Data Collection / Q000379:methods*; D004282:Documentation; D004867:Equipment Design; D004868:Equipment Failure; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D007260:Infusion Pumps; D033183:Interdisciplinary Communication; D010348:Patient Care Team; D061214:Patient Safety; D018570:Risk Assessment; D012307:Risk Factors; D013673:Technology Assessment, Biomedical / Q000379:methods*; D057188:Workflow
chemical_list: D000700:Analgesics