Caregiver Use of PDAs at Point of Care
This story describes one hospital system's efforts at point of care workflow automation. They have decided on the adoption of Dell PDAs using MercuryMD software to access hospital information systems. The software provides data access (results reporting, electronic meds administration records (MAR), and reference data like drug dosages and interactions) over a wireless network. It seems they were going to trial various technologies – both software and hardware – but since their first trial went well…
initial pilot last spring of 10 nurses went so well hospital executives
decided to do a rollout to 256 nurses in the summer, [Theresa] Brodrick [R.N., vice president of patient services] says.
“For nurses who did not have a lot of tools or technology it has given
them the ability to pull up patient information at the bedside,”
Brodrick says.
The article goes on to state the many benefits of providing caregivers with wireless automation. Some of the challenges are also noted.
Where to start? Point of care automation is considerable challenge because there are so many variables.. Three categories of data and vendors make up point of care systems, voice/messaging (nurse call, papers, over head paging, phones), medical devices (alarm notification from patient monitors, infusion pumps, ventilators), and clinical information systems (what Voorhees hospital is doing above). Different applications, different vendors, (at least for now) different devices.
The real struggle here is properly assessing needs, designing a system with a believable ROI, and charting a vendor selection and acquisition strategy that delivers long term benefits – all of which must be synced up with new and existing equipment, and care delivery strategies. Fun fun fun. If you're thinking about taking the plunge, give me a call.
HIMSS 06 Wrap Up
Yesterday I was asked for some quick impressions of this year’s HIMSS. Now that I’ve had a bit of time to digest the event, here’s what I came up with. First, this show was much more of a business development/business alliance oriented show. Many vendors were openly partnering and had products in each other’s booths, brought together by their efforts to bring to market broader solutions that meet market requirements. These alliances frequently revolved around connectivity.
- First Vocera came to market (a few years ago) on the strength of a health care targeted wireless communicator, and has done well. This year Ascom was the first established phone company to take that step with an almost full blown point of care system integrating wireless phones with nurse call, medical devices and more. Ascom now represents a competitor to both Emergin and their wireless phone competitors.
- Two new wireless patient monitors were introduced at HIMSS using 802.11b (the GE Dash and Spacelabs SL2400). The adoption of ISM/Wi-Fi over WMTS for wireless patient monitoring is significant, and reinforces the trend away from that proprietary narrow band.
- GE showed near real time fetal monitor surveillance (AirStrip OB) on smart phones – with a 510(k), no less! (check this photo)
- PDAs and tablets lost much of their cache this year – there were lots of laptops and integrated computers on COWs (computers on wheels), AirStrip OB on smart phones, and while not an exhibitor, there was buzz about the OQO handheld computer. (check this photo)
- Welch Allyn was the first major vital signs monitor vendor to release a wireless vital signs monitor for data integration into EMRs (the new Spot) – a couple years behind Stinger Medical. Also of note, Welch Allyn licensed Wellogic’s server software for their wireless vital signs monitor. Clinical servers are neither rocket science nor a trivial effort, what with role based access support, CCOW, RADIUS/LDAP integration, HL7, remote access (i.e., a web server), data storage and high availability. So far, not a single medical device vendor has launched a decent server – until now.
- Integration middleware vendor Emergin was in over a dozen booths – most of the smart pump vendors, patient monitoring, nurse call and wireless phone vendors, and a few HIT vendors.
- This was also a year for refining product strategies for patient flow application vendors – in particular, StatCom and Awarix have moved beyond (and in different directions from) bed management to help out more broadly with hospital care delivery.
- On the imaging front, this was (if not the first) the largest presence of cardiovascular information systems (CVIS) shown at HIMSS. Agfa/Heartlab, Witt Biomedical, McKesson/Medcon, ScImage were all there – and maybe a couple I missed.
- All the smart pump vendors (Cardinal/Alaris, Hospira, Baxter, B Braun) showed progress in moving past the first generation of wireless features.
- RFID was hot hot hot at HIMSS this year. In apparent agreement with my post that RFID is not a product, many RFID vendors introduced software applications – mostly basic patient flow apps. RFID also presents an interesting issue for device vendors – for the slackers who don’t embed a Wi-Fi radio into their device, should they embed some kind of tag technology?
- Finally on a related topic, wireless network infrastructure also got some buzz. GE formally introduced their deal with MobileAccess, InnerWireless repositioned themselves at the show (rolling out their RFID solution and dropping the “leaky coax” part of their solution), and lots of wireless LAN vendors – Cisco, Aruba, Trapeze, Symbol and Meru.
Whew. Pictured above right are two of the Godfathers of Connectivity: Arnaud Houette of Capsule Technologie, and Brian McAlpine with Emergin.
Market Opportunities and Non Health Care Companies in Health Care
IBM blogger Jack Mason nudged me this morning to provide some feedback on IBM's perception amongst those of us in health care – and well, I sort of went off on this rabbit trail…
After years of reinforcement (by other large corporations who've tried and left health care) I have to admit that I see IBM as an outsider. Health care exists on the Wonderland side of the looking glass, and non-health care companies tend to think health care is probably a lot like most other markets – it is not. They tend to lack fundamental knowledge of the market and what it takes to be successful. This knowledge gap is reflected in the apparent lack of a business plan – something beyond, “we'll transfer/hire X people, create a division, build some stuff and figure it out.” Can you take concepts and models from other industries and apply them to health care? Certainly, if you do so from an internal health care perspective – to do otherwise is to court disaster. Here are some common mistakes:
- Underestimating product and market development costs and over estimating market adoption rates (AT&T and PACS)
- Buying a health care company without knowing anything about the market or viability of the acquiree (PPG and E for M)
- Developing products for which there is a substantial market need, but no reimbursement (most everyone in remote monitoring)
Very few large corporations have come into health care and succeeded; most of those that did (like GE or Tyco), did so through acquisitions. Hewlett Packard was one exception that comes to mind; they did it the hard way, product by product. Success takes bringing in people from health care, actually listening to them, a willingness to fundamental change, and realistic investment and pay-off expectations.
There are lots of companies whose horizontal market products are used in health care, like Cisco and Microsoft. While they invest plenty to support the health care vertical market, you have to provide health care specific solutions to really be a health care company. Marketing efforts like the Clinical Connection Suite are rather like dressing in health care drag.
All this is not to discount the exceptional opportunities present in the current health care market. Many market segments in health care are facing considerable change through commoditization and technology advancements, the merging of traditional markets, and the creation of new markets. Here are 3 hotspots.
- Medical device connectivity is eyed by both HIT vendors who think they should own the central station market, and medical device vendors who want to extend their central station solutions into HIT applications (think EMR Lite);
- The point of care market is contested by nurse call, wireless phone, medical device (from beds to pumps to patient monitors) and software companies – given the market's maturity, they must take any growth out of someone else's hide;
- Remote monitoring is a potentially juicy target coveted by outsiders (see this post about Intel, and this one on a burglar alarm company), implantable vendors (Biotronik, Guidant, Medtronic so far), not to mention remote monitoring startups.
Each of these examples (and there are many more) represent unique situations driven by relative market/product maturity, changes in technology and especially changing market requirements – a strategy that works for one probably won't work in another.
UPDATE: And with this post I've added another post category, strategy. This category will be used to track business and product strategies (or the lack there of) that catch my eye.
UPDATE: Reader “Galt” (a heroic literary character) suggests that vendor's resistance to standards is a significant driver to higher health care costs. Experience in numerous industries has show that standards grow markets at a faster rate, giving winners and even reasonably competent losers a bigger piece of the pie. Unfortunately, health care is not near as dynamic as most other industries; buyers and sellers both are more conservative and parochial. I think resistance to standards is a significant barrier to adoption in health care, and a barrier to cost reduction, but not a major contributor to costs. The radiology PACS market would have never taken off without DICOM (and as it is, it still took 10+ years to reach our current market penetration).
The best way to manage health care costs is to improve quality, outcomes and operating efficiency. For hospitals to realize the same levels of automation as other industries prices must fall – we need the Big C (commoditization). Fortunately, a number of market segments are ripe for commoditization.
UPDATE: In the comments below, Jim Maughan makes some great observations on the many faces and configurations of IBM across the world, with a focus on their past involvement with health care. Check it out.
Illinois Considers Mandated Nurse-to-Patient Ratios
The current nursing shortage sometimes results in less than ideal staffing levels and nurse-to-patient ratios. But, are hospitals are trying to save money on the backs of overworked nurses (not to mention their patients) by regularly scheduling insufficient staff? Democrats in the Illinois state legislature are working to pass mandatory nurse-to-patient ratios to “ensure patient safety.” The union points to a 2002 JAMA study that found patients faced a 7% greater likelihood of death for every patient above 4 assigned to a registered nurse.
Most hospitals rely on the charge nurses' judgment for determining staffing
levels. These systems are neither quantitative nor documented. The biggest challenge I see in hospitals trying to improve quality and operational efficiency is the lack of data – and if you can't measure it, you can't manage it. If state legislators must tell hospitals how they should be managed, it would be better to mandate the implementation of a system for measuring caregiver workloads (or patient acuity) than fixed nurse-to-patient ratios.
There is also no doubt that mandated staffing results in temporary emergency room closings (aka ambulance diversions), closed in patient units and entire hospitals. Mandated staffing has also resulted in increased labor costs (23% in California).
ratios also haven't been shown to improve patient care, [Beth] Brooks said. A
2005 study of 268 hospital units at 68 hospitals in California found
that required minimum nurse staff ratios didn't reveal significant
reductions in the incidence of patient falls or pressure ulcers, she
said.
More on mandated ratios here.
Health Spending Projections Through 2015
With all the mind numbing detail a marketing person could wish for, Health Affairs publishes a new study estimating health care spending through 2015. Bottom line: “Health
spending is expected to consistently outpace gross domestic product
(GDP) over the coming decade, accounting for 20 percent of GDP by 2015.”
