The other day someone asked me what a connectologist was. In short, a connectologist is someone with a proficiency in medical connectivity who uses that knowledge to integrate medical devices with clinical information systems to automate workflow. This begs the question, “what is medical connectivity?”
Medical devices have followed a general life cycle, whether a heart/lung machine or diagnostic ultrasound. Their life starts with an idea revolving around a clinical need and the technology to be applied to that need. In the beginning it’s all about the data, optimizing the device for its intended purpose. Others enter the market and compete on the quality of their data — data on efficacy in the case of perfusion and image quality in the case of a diagnostic modality. During this phase customers grapple with fitting this new technology into clinical practice and hospital operations. As the technology matures, products become undifferentiated; all remaining competitor's products produce good data, and have (more or less) equivalent features. Competition starts to revolve around price, which is bad news for vendors.
Customer needs shift as well. The new device isn't new any more, and is well integrated into clinical practice. Customers become less interested in the quality of data produced by the devices and much more interested in finding help in managing the data that's created. They want “connected” devices, connected to a network of PCs, servers and perhaps an archive. By this time, the device vendors have been in business for 10 or 20 years. Their cowboy days of innovation are but a dim memory. The successful vendors have established world class core competencies critical to their standalone device business: embedded software development, mechanical and electrical engineering, operator workflow relating to device use, and device service and support (basically board or unit swapping, parts depots, loaner pools, etc.).
Now someone steps up to meet these new market needs, typically some young upstart competitor (trouble makers or saviors, depending on your point of view). Customers understand their needs only partially because they've never bought or used the kind of connected solution they've envisioned. Customers know they want something new, but aren't sure exactly what. Vendors are presented with the option of steping out of the box that they've become so comfortable with over the last 10+ years, or not. They can tell that the world outside the box is different. Because they've never developed, manufactured, sold, serviced or supported a product of that type, they can't really conceive what is required of them.
My first medical connectivity experience was in the early 1980s, working for a software vendor. Trinity Computing Systems was writing software on Apple II and IBM PCs for the cath lab. A computer connected to the printer port on cath lab recorders, emulating a printer. The computer also had a graphics tablet for calculating ejection fractions, valve areas, and other values from cine films and the pressure recordings. All of this went into a database and was used to create custom diagnostic reports and a cross patient database. By far the largest recorder vendor at that time, E for M, decided they liked the box business and would not be offering a connected product. Trinity grew rapidly, evolving from a cath reporting product to a broad diagnostic cardiology information system called CardioNet. This was a great niche for a software company like Trinity, but the eventual winners were medical device companies liker Marquette who embraced connectivity and launched integrated solutions. Over the next several years, E for M faded away as demand for standalone recorders dwindled.
For vendors who commit to making the change from a standalone box company to a connected systems company, the way is long, arduous and expensive. Vendors must identify the “whole product” solution; you can't sell just do the parts you want and leave the rest up to the customer to figure out. Then new core competencies required for systems need to be identified and secured. Many vendors fail to recognize that connectivity is a basic requirement and consider it as a big new revenue opportunity, almost like a new business.
Buyers face mirror image challenges. What is the whole product solution, and can the vendor provide one? Does the vendor have the required core competencies to develop, sell, install, service, and support the system I want? Does my total solution require some portion that the vendor has not released? If I buy “futures,” will the vendor deliver in a timely fashion? What about coexistence and interoperability with other systems in my hospital? These are all essential questions.
The sad truth is that in most cases neither the vendor nor the buyer knows what they don’t know. They end up backing into solutions after trail and error. From a standalone box perspective, little about connectivity is either intuitively obvious or as easy as it looks. The good news is that with experience, effective planning and decision making processes can be used to take much of the risk and unnecessary cost out of connectivity. That is the job of the connectologist.
There are a number of key device markets presently going through some variation of this evolution. A whole group of devices have not been previously connected because they were too mobile and poorly suited to wired local area network connectivity. These devices are now getting wireless connectivity: infusion pumps, patient monitors, vital signs capture devices, and ventilators. Many of these devices have been connected in the ICU for some time, but the use model there is significantly different from the new target markets outside the ICU. But hey, that just entails putting a radio in the device, right? Hmmm, maybe…Read More