Hospira and Cerner finally announce
the availability of their integrated smart pump/clinical information
system offering targeting the 5 Rights of IV drug administration.
Hospira's product strategy has been to let HIT vendors establish
patient context; Cerner uses their bar code meds administration system
(a CareGuard module) to identify the patient for both their meds admin
software and the Hospira pump. This is a similar approach that they
took to Bridge Medical, now part of Cerner. Baxter
and Cardinal/Alaris take a different approach by providing their own
bar code readers (Cardinal's is built into their Medley pump, Baxter
uses a reader built into a PDA) to establish patient context.
Additional interoperability (the secret sauce, so to speak)
automatically sets pump parameters based on orders in CareGuard rather
than the caregiver setting them manually. The last but not least smart
pump vendor, B Braun, takes an approach closer to Hospira's.

Cardinal just announced
the day before a new release of its "Alaris System with Guardrails
Suite MX," incorporating the bar code reader and a patient-controlled
analgesia (PCA) Pause Protocol to minimize the risk of patient
respiratory depression during pain management therapy. Here are some
highlights from the press release:

  • For chemotherapy and other intermittent infusions, the Alaris(R)
    System has two new Guardrails(R) limits -- one for the total dose of the
    infusion and another for the duration of delivery -- providing
    significantly increased protection for these types of
    high-risk infusions. In addition, hospitals can customize an IV
    fluid library for each profile, establishing rate limits that help
    ensure accurate delivery of fluids to patients throughout the duration
    of therapy.
  • For patients receiving PCA, the PCA Pause Protocol offers the
    clinician the unique ability to automatically pause a PCA infusion if a
    patient's respiratory rate falls below hospital-defined monitoring
    limits, making the Alaris(R) System the only one available to offer
    individual patient protection throughout the duration of pain therapy.
  • In order to address the specific requirements for IV medication
    administration, the Alaris(R) Auto-ID system provides bar
    coding functionality, which adds an additional check in the
    IV-medication verification process. The system allows hospitals
    with or without a wireless network or bar coding system to benefit from
    the added safety of bar coding for IV therapy and helps reduce
    IV-programming errors. This new Alaris(R) System module enables the
    inclusion of patient and clinician identification in continuous quality
    improvement (CQI) data captured at the point of care. Hospitals
    with the Alaris(R) Gateway are then able to relay
    patient-specific infusion and alarms data to third-party electronic
    medication administration record (eMAR) and other hospital
    information systems.
  • Each hospital defines its rules for IV medication use.
    Changes in these rules can now be maintained continuously through
    a wireless network or with the new Alaris(R) Mobile Systems
    Manager, which has the ability to transfer IV medication rules in
    non-wireless and partly-wireless network environments with no
    interruption in clinical care. Equipped with a wireless access
    point, the Alaris(R) Mobile Systems Manager is a computer on
    wheels that makes WiFi technology and efficient IV medication
    rules transfer available to all Alaris(R) System customers.

Smart pumps are a great connectivity case study. The new connectivity
features have forced all the vendors out of their comfort zone and to
varying degrees driven them to hire in folks with new skill sets. The
evolution of IV pump "smartness" has caused some vendors to have to
go back and redo features due to evolving requirements (a common
connectivity pitfall).I can only imagine the impact that smart pumps
have wrought on vendor's sales forces. What was once a simple "buy my
box" sale has become a mish mash of new buyers (especially IT), longer
sales cycles and uncertainly on the part of hospitals (who've never
bought smart pumps before). Through all of this we witnessed the
brilliant repositioning of second tier pump vendor Alaris into a market
leading patient safety vendor - largely by leveraging connectivity. The
resulting run up in company valuation culminated in the sale of Alaris
to Cardinal at a sweet premium. Alaris' CEO Dave Schlotterbeck
is the envy of many medical device executives, and rightly so. The next
round of challenges for vendors will be escalating R&D costs for
connectivity applications (RADIUS/LDAP integration and interoperability
with HIT vendor's systems) and the complexity of meeting point of care
requirements (especially improved alarm notification).

Hospitals have also been impacted by the advent of smart pumps. As in
most markets before they were changed by connectivity, buyers knew
exactly what they were getting with old fashioned IV pumps. Hospital
buyers had been purchasing "yet to be enlightened" pumps for years;
Nursing and Biomed already knew the answers to most of the questions
they put to IV pump vendor's reps - and the reps knew all the answers
because they'd heard them all before. Smart pumps have dramatically
changed the clinical applications and usability of pumps, and added
considerations for expanded workflow (embracing once manual meds
administration), systems integration (ADT, Rx, and point of care
systems), and infrastructure (WLANs). Now hospitals struggle to find
the "right" questions and vendors scramble to find the answers.

The good news (not just for me) is that help is available.