Health System Adopts Remote ICU System
Kansas based Via Christi is the latest health care delivery system to adopt a remote ICU patient management system. Their $7 million system, dubbed “eCare-ICU” will go live April 4, 2006. They will be serving outlying hospitals in their own system initially, but are also targeting other hospitals. They estimate they will be monitoring 173 ICU beds by January of 2007, including their hospital in Pittsburg.
Via Christi officials say the potential to save lives is tremendous.
They estimate as many as one in four ICU patients' lives will be saved
at its four participating hospitals — more than 150 people in the
first year alone.
Via Christi is the first hospital in Kansas to hook up to an
off-site electronic monitoring system and one of only about 150
hospitals nationwide that have installed the technology.
Via Christi plans to sell monitoring service to other hospitals
throughout Kansas. It already has had several hospitals express
interest, said Janell Moerer, vice president for business development.
There is no mention of which vendor is providing the system. And yes, the picture at right is a VisICU eICU site, but the e-Care ICU must have a similar set up.
UPDATE: It's been confirmed, that this is a Visicu installation.
FDA Aims to Speed New Products to Market
The FDA has a program, called The Critical Path to New Medical Products, that will modernize the processes used to take products from “proof of concept” to a released and approved product. The latest step in this project is to identify specific areas or opportunities where improvements can be made (story here).
gap between the quick pace of new biomedical discoveries and the slower
pace at which those discoveries are currently developed into therapies.
The release of the list marks a starting point in identifying
priorities to be accomplished under the Critical Path Initiative.
Government, industry and academic experts estimate that, if
accomplished, the new tests and tools developed under the Critical Path
Initiative will modernize the drug development process by 2010 and help
to get new medical discoveries to patients faster and at a lower cost.
The Critical Path Opportunities Report is organized into six broad
topic areas: development of biomarkers; clinical trial designs,
bioinformatics, manufacturing, public health needs and pediatrics.
FDA's outreach efforts uncovered a consensus that the two most
important areas for improving medical product development are biomarker
development (Topic 1 ) and streamlining clinical trials (Topic 2).
Note that bioinformatics is third on the list. As software becomes more tightly integrated into the diagnosis and care of patients, regulatory focus is expected to increase. The configuration, implementation and use of clinical software is what's getting most of the prospective regulatory focus currently, but I would not rule out the eventual application of the Quality System regulation (QSR) to software development.
UK Hospital Adopts Passive RFID for Patient Identification
This story describes a patient idenfication system implemented to reduce the incidence of operating on the wrong patient.
patient tracking system in its ear, nose and throat ward. Developed by
Safe Surgery Systems, the system uses radio frequency identification
(RFiD) tags in plastic wristbands to monitor patients' progress through
the ward. Patients are tagged on arrival and given an RFID-equipped
wristband. A digital photograph is taken and attached to the electronic
patient record to help confirm identification. The tags are passive -
they have no battery, making them slim and light, and are only
activated when they pass through an electronic point emitted from
antennae placed around the ward. Each tag can hold 170 pages of data
and is discarded after use to prevent the transfer of hospital
infections such as MRSA.
It seems that bar codes would accomplish the same thing at significantly lower cost. The one advantage this system has is that the RFID tags are automatically read when they pass through choke points – but human intervention is still required to establish context so that the system can determine if the scanned patient is the one scheduled for surgery.
If You Can't Measure It, You Can't Manage It
This management truism is placed squarely in a hospital context in this column by Tina Foster, in Health Care's Most Wired Magazine (am I the only one who thinks that's a pretty silly name for a magazine?). In my hospital practice, the biggest barrier to operational improvements is the lack of operational data. This lack of data also represents the greatest sink of my time when working with hospitals. Amazingly, some hospitals spend hundreds of thousands to more than a million dollars having consultants gather operational data – a cost that many times exceeds the price of software systems that can provide just the kind of data that Foster talks about. This is the need and what Foster defines as a dashboard.
sources, enabling decision-makers to develop and adopt appropriate
plans to support the overall strategic vision. Additionally,
benchmarking performance indicators against an external market
dashboard–one that contains data from peers–can validate the
organization’s targets or raise important questions.
Within any organization, there are varying
and conflicting ideas about how to achieve strategic objectives. In the
absence of focused and reliable data or a defined strategy for using
it, the most vocal opinions will determine how to meet objectives,
which may not be the best route for the organization or the majority of
the stakeholders. This is where a dashboard can be valuable.
There are two general categories of products targeting this need, cluster apps targeting high acuity patient care areas and hospital-wide patient flow and logistics apps. Cluster apps target critical care, the emergency department (ED) and surgery. House wide patient flow apps track and support bed management and the logistics around care delivery across all types of patient beds. Here is Foster's description of the surgery need.
lion’s share going to achieving optimal patient outcomes and meeting
staffing demands. At the same time, their limited business training and
minimal support may not equip them for taking advantage of the abundant
raw data available. Traditional management methodologies can’t keep all
necessary imperatives on the typical OR director’s radar.
The surgical services department is a
primary revenue and cost driver for the vast majority of hospitals.
However, its leadership may not be prepared for the job, making it an
ideal area for a dashboard. According to AHA’s 2006 Hospital Statistics,
surgery typically represents 40 percent to 50 percent of all hospital
revenue and 45 percent to 60 percent of hospital expenses. The OR
director of an average community hospital manages an operating budget
of $14.2 million, according to the OR Manager 2005 annual
survey, but only 17 percent of those directors are supported by a
business manager. And of the OR directors in this group, 34 percent
have graduate-level education and 34 percent have bachelor’s degrees.
Improving the operational efficiency of care delivery does more than just reduce staff overtime or ambulance diversions, patient outcomes and satisfaction are also impacted.
hospitals, especially in the OR, where every 5 percent increase in
surgical volume represents an average 1 percent increase to the
operating margin, according to the Health Care Advisory Board Future of General Surgery 2004
report. For most hospitals, an additional surgical case a day yields an
additional $1 million to $3 million of net revenue per year. In results
from the OR Manager 2005 annual survey, 52 percent of
directors reported an average volume growth of 7 percent. When
decision-makers have access to performance indicators that can be
compared with similar providers, they are better able to manage this
capacity and its impact on the organization as a whole.
In fairness to the cluster and patient flow software vendors alluded to above, there is a lot more entailed than dropping a piece of dashboard software on top of a department – you have to actually have, you know, data. Consultants can provide significant value to their clients, but they can also waste huge budgets while delivering little return. Rather than engaging consultants for expensive manual data gathering efforts, leverage their expertise to select and implement an information system that will provide operational data every day – those kind of engagements are less expensive, and deliver value for the life of the software system you purchase.
At right is a sample dashboard from patient flow logistics vendor, StatCom.
UPDATE: A thoughtful reader leaves this comment:
as the data that is put into it. It seems like this is where data input
technology such as RFID tags or StatCom's WiBut (from your 2/14 blog
entry) become so crucial.
Certainly a product should have the proper data collection tools (you know, tools people will actually use). Just as important is the implementation, training and ongoing management of the system. Even with good data collection tools, bad habits can compromise data integrity.
Can State Medicaid Programs Drive Remote Monitoring Reimbursement?
The state of Indiana will begin providing Medicaid reimbursement for telemedicine consultations starting May 1, 2006.
long way toward increasing adoption among providers,” said Greg Beck,
director of the telemedicine department at Clarian Health Partners.
“Providers will begin to realize this is actually a technology they can
incorporate into their business practice.”
Beck said Clarian has been expanding its
telemedicine offerings, which began with experts from Riley Hospital
for Children in Indianapolis meeting with patients and parents at
Deaconess Hospital in Evansville. The Clarian program now includes
hospitals in Bedford, Fort Wayne, Terre Haute and South Bend.
of the telemedicine services have involved pediatrics in areas such as
urology, dermatology and diabetes education, said Beck, adding that
telemedicine meetings also have involved adult oncology and pulmonology.
The current sweet spot for telemedicine is in consultations with specialists.
One of the biggest barriers to remote monitoring adoption is reimbursement. Since most changes in reimbursement are driven by CMS/Medicare, the traditional approach lobbying for expanding reimbursement has centered in Washington DC. The other side of CMS is Medicaid, which is run by the states. The pressure between health care needs and budgets is arguably felt more keenly at the state level. And this change in Indiana shows that states will extend reimbursement when proven to reduce costs. It might even foster private payor reimbursement.
instance, Anthem Blue Cross and Blue Shield, which is part of
Indianapolis-based WellPoint, said it has a limited pilot program to
provide reimbursement for telemedicine meetings. Anthem spokesman Tony
Felts said the program has involved pediatric services at Clarian
Health Partners and psychiatric services at St. Vincent Health.
