Integration of Technology in the Health Care Sector - Essay Example

?Health professionals are confronted with problems on how best to resolve medical emergencies that face their The response accorded to a patient at the time of need directly affects the chances of survival. In this regard, the health professional require relevant and sophisticated interventions in order to assist amicably in medical emergencies. Interventions relied upon are based on the successful adoption and integration of technology in the health care sector. Biomedical engineering is the field charged with the development of medical devices that are aimed at increasing efficiency in the delivery of health care services. Per the European Union legal framework, a medical device is an apparatus that is used in diagnosis, prevention, or treatment of diseased conditions where its mode of action is not through chemical action in a patient’s body. Medical devices consist of enormous variations with regard to their sophistication and scope of use, which ranges from tongue depressors to medical robots and cardiac pacemakers. Biomedical engineering involves fundamental aspects of the device production including designing, system analysis, and practical application. This is in line with ensuring that quality and reliable devices. This paper seeks to highlight defibrillators as medical devices with regard to their history, scope of application and safety aspects of the device in terms of human factors engineering. It is estimated that about 30,000 people in the United Kingdom experience cardiac arrest away from the hospital annually and they are assisted by medical emergency response units (Resuscitation Council, 2010). Such assistance is facilitated by the availability of portable medical devices, which prove essential in the delivery of the critically required services. Among the crucial devices required in relieving the effects of cardiac arrest is the defibrillator. Defibrillators are apparatus, external or implanted, that deliver an electric shock to the heart via the chest cavity in order to restore normal heart rhythms. Defibrillators function by delivering a joust of electric current to the heart in order to polarise the muscles and nerve cells, allowing them resume a normal rhythm (Street, 2012). Implanted Cardioverter Defibrillator (ICD) constantly monitors the heartbeat rate as well as its rhythm to detect abnormal and life threatening rhythms, which on detection an electric shock is sent to the heart to restore a normal rhythm (Defibrillation, n.d). The device also works as a pacemaker to curb the effects of the electric shock, which slows down the rate of the heartbeat. The above is illustrative of a monitoring and feedback mechanism, where the defibrillators function based on signals taken from the patient after its analysis. Among the external defibrillator units are automated external defibrillators (AED), which automate the patient’s heartbeat rhythms for monitoring as electric shock is administered to normalise the rhythm. AEDs consist of in-built computer systems that examine the patient’s heartbeat in order to assess the need to administer defibrillation (Sciammarella, n.d.). One of the common causes of cardiac arrest is ventricular fibrillation, which is characterised by chaotic, unorganised electrical malfunction of the heart resulting in a less effective heartbeat (Khandpur, 2003). This chaotic electrical activity can be stopped and its effects reversed by the application of an electrical counter shock where heart assumes a normal and organised rhythm. Disorders in the generation of a normal pulse by the heart results irregular heartbeats manifested in arrhythmias. Abnormal automaticity and triggered activity are characteristic of conduction abnormalities that trigger ventricular tachycardia. In addition to the use of medication and surgical procedures in the management of arrhythmias, defibrillation comes in handy in resolution of ventricular tachyarrhythmia and atrial fibrillation. This is especially so for medical emergencies that occurs away from healthcare facilities. Defibrillation describes the process of delivering such electric shock to the heart with the aim of halting ventricular fibrillation (British Heart Foundation, n.d.). History of Defibrillators Early attempts by humans to manipulate electricity have been a success with discoveries and inventions that have proved critical for the wellbeing of the society. In the 18th century, a Danish veterinarian demonstrated that chicken could be revived through the administration of electric shock to the head and heart following the discovery of the first capacitor. Abdilgaard focused on fibrillation, which remained a mystery following its previous documentation. It was observed that the chicken died following the induction of fibrillation and they could be revived when limited charge was applied (Akselrod et al., 2009). In 1802, the Royal Humane Society indicated in their report the possible applications of monitored electricity in resuscitation and differentiating genuine death from the apparent. Further studies indicated that ventricular fibrillation could be alleviated by electrical shock as evidenced by Batel’s experiments on dogs (Paradis and Halperin, 2007). It was illustrated that ever though weak electrical currents caused fibrillation, when stronger currents were applied fibrillation was reversed. However, despite the advances made and the research done at the time, the defibrillator was successfully used in 1947 to restore the fibrillating heart of a young patient during surgery. Dr Beck administered electrical shock directly to the exposed pericardium of the patient while in the operating room, paving way for widespread acceptance of the procedure for clinical practice. Researchers dedicated their time and resources towards developing a portable external defibrillator, a process marred difficulties owing to technological hitches. The researchers lacked a portable power source to produce the require voltage during defibrillation. Nevertheless, a closed chest defibrillator was developed by 1957, which had the capacity to deliver repeated electrical shock of 480V to an adult patient without damaging the myocardium. However, the device was bulky weighing about 100 kilograms. By this time, other live-saving emergency methods were established that did not involve surgical procedures, but worked hand-in-hand with defibrillation. One such method is the external cardiac compression, which formed the basis of today’s cardiopulmonary resuscitation (CPR) procedures. Advances in technology have seen defibrillators compressed and miniaturised to range from portable to implantable devices. Functional Components Three critical components require sufficiently calibration in order to facilitate the functions of a defibrillator, and include capacitor, inductor, and power source. The highly specialised interactions between these components afford defibrillators the capacity to restore normal cardiac rhythms. Conductors are the functional units in the capacitors and are a pair, dis-joined by insulation. Since conductors lose and gain electrons with ease, they facilitate current flow on demand and especially with regard to defibrillator. Capacitors store an enormous amount of energy in form of electric charge, which released when the defibrillator is activated. In other words, a charged capacitor acts provides storage for potential energy, which is discharged on to a patient experiencing arrhythmias in order to reverse the fibrillation. This is evidenced by the application of paddles to a patient’s chest and moving the switch in position to complete the circuit, which allow passage of electrons stored in the capacitor through the patient. As such, the rate of discharge declines owing to the reduction in potential across the capacitor. For defibrillation effort to be a success, the current administered should be maintained for a given period, a task charged to inductors. This is owing to the rapid discharging effect observed by capacitors in defibrillators. Inductors function to prolong the time taken during discharge by maintaining the flow of current. This process is governed by Faraday’s law of electronic induction, which indicates that inductors generate electricity that opposes the motion of passing current (Williams et al., 2003). Most defibrillators are fitted with rechargeable batteries either as the main source of power or as a backup. In addition, presents are a step-up transformer and a rectifier, which amplify the voltage before converting the amplified AC power to DC as, desired by the health professional. In addition to these components, others essential in the functioning of defibrillators include controls, electrodes, paddles, a monitor among others. Automated external defibrillators (AEDs) run on battery, thus portable to the field or in public areas for easy access. The electrodes are equipped with sensors that are attached on specific regions of the patient’s chest during defibrillation. The sensors function by picking up the heart rhythm of a victim based on the electrical activity of the heart, and relay the signal to a computer system within the AED. The microprocessor within the computer system analyses the various aspects of the relayed signal including frequency, amplitude and the wave morphology (ECRI institute, 2009). The computer assess for signals similar to normal QRS in order to determine whether a viable rhythm is available. The system also checks for interference that is associated with radio transmission and poor contact by electrodes, which may give incorrect analysis of the signal obtained. AEDs do not administer shock on patients with a stopped heart or in the event that the heart rhythm is not recognised. It is following comprehensive analysis that the computer, through voice prompts, guides on the delivery of electric shock to the patient. The shock may be delivered through the attached electrodes or via paddles that require placing on the patient during defibrillation (National Institutes of Health, n.d.). Adopted from http://faculty.ksu.edu.sa/elsarnagawy/Documents/handout1.pdf The measure is the heartbeat rhythm, which is picked up by the electrodes through the sensors for analysis, the signal is received is transmitted to the conditioner for amplification before being analysed. Signal processing entails analysing the patient’s signal and comparing it with predetermined standards before recommending a course of action. Following analysis, information is displayed on a mounted monitor and the same is stored on in-built memory for future reference. If a viable rhythm is available, a feedback mechanism is activated and an electric shock is administered via the paddles before assessing the patient for response (Staff, 2010). Safety Medical devices are regarded as the basis on which healthcare and clinical research are dependent on, for efficient delivery of medical services. As such, their importance cannot be overemphasised as the levels of innovation involved are proportional to medical advances and consequently, patient safety. Despite the technological advances made in recent years, there numerous risks involved with the application of medical devices. These range from malfunctioning of the device to patient intolerances for its application. It is such risks are should be evaluated and mitigated during the initial designing and development of medical devices as of the part of risk management process. It is critical to have a full understanding of how the medical device, in this case the defibrillator, works in order to understand hazards associated with its application. This lies squarely on the human factor engineering, whose considerations are crucial to the development of medical devices. Such considerations include the device technology, users, benefits to the patient, environment surrounding its use, and the potential dangers associated with the device. Human factor engineering also referred to as usability engineering entails an evaluating the interaction between humans and sophisticated machine systems, a process that is continuous during development (DeVita et al., 2011). The process coordinates the device designs, systems, and environmental working conditions with capabilities and requirements demanded from the user. Such techniques as above date back to the Second World War where engineers and efficiency experts worked to streamline the manufacturing of equipment and operations, which saw revisions in aircraft designs for enhanced accuracy. This highlights the importance of usability testing and human factor engineering as the success of the product is dependent on its ease during application. Similarly, it is critical that medical devices meet regulations under the European Union stipulations that demand for detailed records of the products, designing and construction is limited to qualified personnel, and comprehensive risk assessment should be done (Jacobson and Murray, 2007). The International Organisation for Standardisation (ISO) is a widely acclaimed institution for the development and evaluation of quality systems within various economic sectors including health care. It is essential to establish standards that govern the development and production of medical devices in order to guarantee safety, efficiency, reliance, and value of the products. The organisation has grown to widen its scope for standardisation to include not only the manufacturing industries, but also the ability to address customer satisfaction (Sandom and Harvey, 2004). Industries that have been awarded ISO certification are required to adhere to stipulated regulations during development of their products by meeting all aspects of efficiency. This is achieved through the evaluation of risks associated with their products in order to minimise potential errors and user-related hazards (Edwards, n.d). For instance, in the development of medical devices, the manufacturer should utilise the risk management process to assess the effectiveness of initial designs in order to recognise user-related hazards. It is for the benefit of the company that their product is easy to use and equally sufficient in as a tool during medical intervention procedures. As such, manufacturers, particularly biomedical engineers need to understand the principles of user-related hazards and risk management in order to ensure the safety and efficiency of their product. There various human factors to be considered by engineers during the development of a medical device including potential hazards, device technology, prospective users and the environment in which the device is to be used. Biomedical engineers need to identify effectively potential hazards and risks associated with the medical device. This is a key aspect of risk management as faults can be recognised and resolved during trial runs. Hazards with regard to medical devices may occur when devices are used for purposes other than the intended or are inadequately controlled during application. Similarly, the environment may not be conducive for operating the device or the user’s cognitive capabilities are below par in a given situation. These are scenarios that engineers should identify and create solutions for during the development of their product. Solutions may include but limited to changes in design of the product or prompts to fulfil the particular aspects before using the device. In relation to defibrillators, electrocution is the most prevalent hazard while reviving patients and may cause more harm than good to the parties involved. It is, therefore, imperative that the manufacturer recognises the threat and works on the best method to protect the parties involved. Another error arising from defibrillator is the electrodes connectors that may cause equipment failure due to poor contact with the patient. As a safety measure, manufacturers of AEDs incorporate microprocessors that analyse patient signals before administering shock, which come in handy when heart rhythms are not recognised due to poor connections (American Heart Association, n.d.). In addition, manufacturers should examine the need for the technology that they hope to develop as well as its viability and sustainability. A new product should strive to resolve issues affecting similar products in the market while enhancing efficiency to yield better results. This requires research in existing hazards and safety concerns associated available products in order to develop strategies to mitigate the risks when designing the new technology (Kaye and Crowley, 2000).A common hurdle among medical devices is the incorporation of a complex user interface that often proves confusing and difficult to navigate. However, in the development of new devices, manufacturer should strive to create comprehensible user interface that caters for all persons at any given situation. Studies indicate that medical devices with less complex interfaces are preferred during emergencies as the user is normally under strain to process cognitively numerous knobs, switches, and activation mechanisms that may be involved in complex interfaces. Automated external defibrillators are characterised by the incorporation of voice prompts that guide the user on what to do while reviving a patient (University of Notre Dame, 2011). This is relatively simple to comprehend as it involves systematic procedures that are similar to a checklist in order to ensure the device works efficiently. Most medical devices are usually reserved for emergency purposes and as such, the user can be anyone from the public. In such events, the users may lack the capacity to handle them amicably, an aspect that may affect the efficiency of the device. This is owing to the fact that the users are usually under a great deal of strain and shock as a life may be dependent on their action. Similarly, others may lack the knowledge to operate the device or have impairments such as vision, hearing, or touch. As such, manufacturers should provide solutions in order to accommodate such inadequacies and create designs that compensate across all impairments, which form the basis of usability testing (Dumas and Redish, 1999). In this regard, the incorporation of voice prompts as well as visual aids provides a viable solution to most challenges facing medical devices. The environment in which a medical device is used can grossly affect how effectively the one uses the device and ultimately affects the outcome (Edwards, n.d.). Medical engineers should evaluate possible environments where their devices may be used and equally accommodate it as optimal. Physical environments may hinder equipment visibility, an aspect that can be effectively catered for by incorporation of viable compensatory mechanisms such as in-built lighting and auditory feedback. By designing products capable of adapting different environments, user-related hazards are reduced as the efficiency of the device is increased. References Akselrod, H., Kroll, M and Orlov, M. (2009). History of De?brillation. [Online] Available from http://www.bms.miet.ru/russdefihist/download/Cardiac_Bioelectric_Therapy,Springer,2009,015-040.pdf [Accessed 25/03/2013]. American Heart Association. (n.d.). Questions and Answers about AEDs and Defibrillation. [Online] Available from http://www.tvfr.com/safetytips/docs/AHA_aedqa.pdf [Accessed 25/03/2013]. British Heart Foundation. (n.d.). Defibrillators. 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