What Are We Doing Here?

Since January, this site has had over 3,600 visits and almost 10,000 page views, average visit length is at 3:29. Thanks to everyone who's visited, and especially those of you who've called or emailed me with feedback, suggestions and corrections.

Yes, even though I am a connectologist, I do make mistakes and I encourage everyone to keep me on the up and up. Take advantage of the comments link at the bottom of each post to share your knowledge and experience, your outrage, or provide corrections when I get things wrong. While compliments are always appreciated, it is the corrections that I think are the most important. Every comment left generates an email notification so I am sure to read every one, and will update any post accordingly. Comments can be either anonymous or you may identify yourself. Abusive comments will be deleted.

Here's my corrections policy: any erroneous post will have an update at the bottom of the post noting the correction. The original error (unless its egregious) will remain so that a chronology is maintained that reflects changes over time. (Otherwise, I could just change the post and republish, but readers who had seen the post before the correction might be confused — and besides, I'm not pretending to be infallible.)

Let me also encourage you to email me with news about your experiences, rumors, or other things concerning connectivity that might interest the rest of us. I will keep identities anonymous unless requested otherwise.

This is probably a good time to talk about ethics. Like many of you, I sign confidentiality agreements from time to time. I take these NDAs very seriously and do not discuss anything covered by those agreements. The same goes for consulting engagements with both hospitals and vendors. Nothing is disclosed in any way without prior permission from the client. I will be glad to disclose current clients upon request, and entertain certain limited non compete restrictions. My reputation is based largely on ethical behavior, and along with my knoweldge and techniques, forms the bedrock of my consulting practice.

You should know that all web sites generate server logs that tell me about visitors to my site. Rest assured I can't tell what you're wearing or whether you brushed your teeth this morning (thankfully). I'm proud of my readers, and I know where many of you come from and how often you visit. You can see much of this info yourself, by clicking on the Site Meter logo below the Google Search box on the right site of this web page.

Finally, what do you think of the photos? Its been fun adding them, and visiting NTI was a great opportunity to get some interesting shots.

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Vendor Problems with Connectivity: An Overview

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Medical device vendors are like everyone else, they tend to resist change. It's rarely very pretty when technology and market requirements force a successful box company to add connectivity features. Over the years I've seen a range of outcomes and reactions, from denial (E for M cath lab recorders) to easy embrace (Sarns/3M). Fundamentally, connectivity is a transition from a homogeneous environment controlled by the manufacturer to a heterogeneous environment that feels completely out of control.

When I started out some 20 odd years ago, connectivity meant a PC with some data analysis and reporting software plugged into the serial port on the back of device. Connectivity today means a bidirectional network connection that is wireless (unless it's a CT that's bolted to the floor). Now devices have to talk to (or interoperate with) third party systems that work within a general purpose IT network environment populated by other devices. None of this is rocket science, just an interrelated complex mess that benefits from specialized planning, process and expertise.

Root causes for connectivity problems are based in human nature. First is the desire to apply current thinking and processes to new problems. If most things in life were intuitively obvious we would all be rich, driving flying cars or living in space colonies. Much about connectivity is not intuitively obvious. The next root cause is resistance to change. When a device vendor is faced with connectivity, they've typically been doing business the same way for 10 or more years (and if not the company, then certainly the employees). Successful vendors have world-class execution that creates a narcotic like comfort zone that's hard to leave. Finally, most device companies aren't very strategic. Their strategy (like their business model) was refined years ago, they've become tactically focused, strategic “muscles” have atrophied.

Linear common sense thinking leads vendors to apply their current business model to connectivity. This creates problems in product development, sales, installation, service and support. The components in an embedded medical device have a life cycle of years, the life cycle of connectivity components is measured in months; applying the same design and product testing processes don't work.

An ultrasound system that records to film looks almost identical to an ultrasound system connected to a PACS. The first is bought solely on image quality; the second is bought on workflow first, then image quality. Installing the standalone ultrasound is as simple as uncrating it, plugging it in and turning it on. However, a connected ultrasound system is not “installed” until it talks to a PACS properly. The skill set and pay scale for a field service rep who swaps boards is significantly different from someone who does network integration and DICOM configuration. Time and again vendors have learned these lessons the hard way, and both the vendor and their customers have suffered.

Using a device business model with connectivity has financial implications as well. Product offerings that include third party components (like computers and network gear) will never return the factory margins of core device products. The gross margin device vendors ranges from high thirties into the fifties. A well executed turnkey software business model will deliver nine to twelve percent to the bottom line. It is unavoidable that the more a vendor's revenue comes from connectivity, the lower their gross margin. This presents an interesting financial management problem for device vendors that is usually dealt with after the fact rather than in planning.

All of these differences bring us to resistance to change. I've seen resistance to change in the refusal to hire network engineers because of the difference in pay vs. existing field service engineers; the 40 to 60 percent sales force turn over because of a refusal to change from selling boxes to the solution selling required to sell connectivity enabled devices; and a refusal to expand product test and verification capabilities to match the heterogeneous environment in which connectivity products exist. Corometrics' first generation fetal monitor surveillance system was built just like they made devices, from scratch (they even wrote their own operating system) while competitors were fielding lower cost PC-based surveillance systems with the same or better features. Because resistance to change is an emotional response, there is little logic at work and can result in “business insanity.”

Finally we come to an absence of strategic planning. Device vendors typically have device strategy down cold, but given the preceding root causes, strategic planning is seldom applied to connectivity. The natural device vendor inclination to do everything themselves so little thought is given to existing and new core competencies required by connectivity. Questions about intellectual property, where a vendor adds real value to a broader solution, strategic alliances, and long term market development often go unasked. There is a definite tendancy to try to do too much and become seduced by the beauty that is connectivity.

All of these problems can manifest themselves in physical symptoms that impact customers and can provide competitive intelligence to other vendors. Internally, connectivity can suck up an inordinate portion of R&D budgets and engineering time. The most prevalent symptoms are in product availability, either delays or products that never make it to market. A variation of this is the first generation connectivity product with minimal features that is followed by the “real” product that customers want. The first generation is hardly worth buying, and the follow on product takes forever to come to market.  A related symptom is the buggy release; this is where a major product release with many new features and capabilities is found to have, ahem, problems once installed in customer sites (but it tested great in the lab). 

Wireless radio selection is an area ripe for these problems because vendors aren't as familiar with market and technical requirements or the nature of these types of component products. (It's just a WLAN card right? How hard can that be?) More than one vendor is faced with replacing a radio they just came out with.

Finally, we have the edge condition customer who experiences problems. These customers push the envelop in either scale or complexity in their use of the product, and as an outlier, testing proves inadequate resulting in problems.

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Welch Allyn Introduces Propaq LT at AACN/NTI

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As mentioned earlier, Welch Allyn introduced the Propaq LT at NTI earlier this week. Their sales force has been showing pre release demo units for the past few months. This unit continues the Propaq tradition of easy to use, rugged, transportable patient monitors. The Propaq LT is almost half the cost of the Propaq CS.

At right, the Propaq LT (mounted in its self-charging cradle) is pictured with a Welch Allyn Micropaq (on the left) and a pen (for scale). It weights less than 2 pounds and is drop tested up to 75 g's, equal to a 6 foot drop on linoleum. Monitored parameters include 3 and 5 lead ECG, SpO2, respiration and NIBP for adult, pediatric and neonates. Battery life is similar to the Propaq, and because the bed rail cradle also charges the monitor it's always ready to go.

The Propaq LT has some pretty interesting features. The small rugged monitor is ideal for monitoring in non traditional areas, in addition to EMT, transport, and procedure areas. This is the only multi parameter monitor that can be mounted on a regular IV pole. It also comes with an “opera purse” carrying handle for ambulating patients.

The charging cradle has an integral bed rail hook. You can see that because the monitor is small, so is the screen. For situations where greater visibility is a requirement, they created a charging cradle that includes an SVGA output for driving off-the-shelf external flat panel displays.

The Propaq LT is highly configurable via a software utility supplied with the device. The display (parameters, waveforms, numerics and size), parameters, default alarm limits, trending and “snap-shots” can all be configured via a PC and USB cable.  Putting the configuration into a separate utility greatly simplifies the user interface. The monitor can be configured specifically for the level of staff expertise and clinical area in which it's used.

The unit is available either standalone or wireless. The wireless version works with Welch Allyn's central surveillance system Acuity, and can integrate with EMRs and other clinical systems.

The low cost, form factor, ruggedness and simplicity make this an ideal device for the variable acuity care model.

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