MX:There
seems to be a disconnect between companies that design and develop IT
systems, medical device manufacturers, and end-users. Is this problem
real or perceived? Do the differing views and goals of healthcare's
various stakeholders represent a problem in their own right?

Rod Piechowski:
It is a huge problem, and people are just beginning to grasp the nature
and size of the problem. Whenever we talk about who the stakeholders
are in healthcare relative to any particular issue, it is easy to come
up with a handful of them. But then healthcare people have a natural
tendency to segment themselves, and you start getting substakeholder
groups, each of which believes that it has a unique way of doing
things. That makes it far more complex when you try to integrate all of
this and find some method of implementing IT in such a way that
everybody benefits equally.

Tim Gee:
Medical device companies have always thought in terms of embedded
systems, and now they are faced with this whole new area of
general-purpose computing technology. They aren't fully aware of it
yet, and they haven't yet figured out how to interface with it. One of
my hospital clients had to send back about eight wireless
electrocardiogram (ECG) carts because the manufacturer did not build-in
the right kind of wireless local area network (LAN) security. Using
those devices would have compromised the hospital's entire wireless LAN
security scheme, so the hospital had to pass on them.

Lori Hack:
We certainly have heard stories to that effect as well. Taking a
systemwide perspective is really the key. From the level of the chief
financial officer throughout the whole system, it is critical that the
delivery system and the manufacturers understand that innovatively
solving the health delivery system's business problem may require fresh
thinking. They have to look at a device that typically was used in a
single department and think about its use across the system. That leads
to the issues of connectivity, performance, and integration, which have
never been considered either by the manufacturer or by the end-user.

Gee:
For both medical device manufacturers and for hospitals, it comes down
to making wise investments in existing technology. There are many
opportunities for medical device companies to add value and
differentiate their products by adding connectivity today without
having to worry about reimbursement and all of these other longer-term
structural issues. There are a lot of opportunities for hospitals to
accrue benefits by investing in technologies that give them operating
advantages and increase patient safety and satisfaction—even if they
don't reduce full-time equivalents or other hard-dollar costs.

You could use point-of-care work flow automation as a model of what is
going on in the market. The caregiver and the patient are in the
middle, and they are surrounded by all of these different devices,
ranging from infusion pumps, patient monitors, and nurse-call systems
to order-entry systems, results-reporting systems, and the EHR. The
customer wants one solution, and obviously there is no single vendor
that supplies all of those products.

This
is not a situation that is going to be solved by top-down standards
being imposed on the industry. It will require a lot of business
development and alliances among vendors that are not necessarily direct
competitors, but that have never worked together before.