Smart Pump Technology – An Overview
I noticed a strange referrer in my servier logs today that lead me to this paper (pdf here) published in the AAMI Biomedical Instrumentation & Technology journal. In this paper, Ron Snodgrass presents an overview of smart pumps, with a focus on drug errors reduction systems (DERS).
The general purpose pumps of today have served the healthcare industry well because they offer clinicians broad range programming flexibility for dose rate and volume parameters that can treat the entire hospital population from infants to adults. For example, the infusion rate on most infusion pumps can be programmed to deliver as little as one drop per hour to as much as 1 liter per hour. At the same time, the volume to be infused settings can also be programmed to deliver in the wide range of 0.1 ml to 9,999 ml. Unfortunately, this combination of broad range programming and the flexibility of serving patients in all age groups exposes the potential for user programming errors and also opens the door to lethal doses or adverse drug events.
Ron goes on to lay out the drug errors reduction system value proposition.
Since today’s pumps rely heavily on human intelligence for programming without limits or restrictions, medication delivery errors are going to happen. To combat this problem, infusion pumps must be designed with the capability to place dose limitations on IV medications and provide clinicians the opportunity to double check their delivery settings before administering to their patients. Let me introduce you to the next generation of infusion pumps that offers these unique safety features known as “smart pumps.”
Smart pump is a term that was adopted by the Institute for Safe Medical Practices (ISMP) because these new infusion pumps are designed to significantly reduce medication errors (ME) and also because they provide pertinent data to support continuous quality improvement initiatives for increasing patient safety. Smart pumps incorporate software programs known as a dose error reduction system (DERS). Keep in mind, each manufacturer of smart pumps has its own unique name for their specific DERS program. Most DERS on the market today provide the following primary medication management safety features:
What caught my eye was the fact that this site was listed in a “For More Information” sidebar as a source for the latest on “Smart IV Pumps and Safety.” Thank you, Ron, for including this site.
Update on Spacelabs New Wireless Patient Monitors
One of the product managers at Spacelabs was kind enough to call me up the other day and fill me in on their new wireless patient monitors. I've written in the past about their new SL 2400 wireless monitor, and since then, Spacelabs has released the new SL 2600.
First let's talk about the radio. Spacelabs is using an off the shelf radio as I speculated before – they're using the Symbol CF (Compact Flash) 802.11b radio that's designed for embedded systems applications. This embedded radio card has a 5 year life cycle, rather than the 6 to 18 month life cycle that commercial radio cards have. This sounds like the same radio that GE is using in their new Dash.
Next let's look at encryption. Yes, all that stuff I said in my previous post about WEP was true; WEP is wimpy encryption. But, Spacelabs' implementation of security (the reason for encryption ) on their new monitors are good. First, Spacelabs applies their own application layer encryption to everything that comes out of the monitor and over the network. And like most monitoring vendors, they don't send waveform data with patient identifiers. Once patient context is established, waveform data is associated to the patient using internal codes. Finally, Spacelabs has validated their monitors with BlueSocket network security appliances for the truly paranoid among us.
When it comes to connectivity, Spacelabs has an advantage. Back when Carl Lombardi ran the company, he split it in two and created a medical device division and clinical information systems division, in the same company. I guess Carl was a visionary Connectologist. Now, Spacelabs finds itself a medical device vendor once more, but their history, along with some pretty intense training, has given Spacelabs an understanding of wireless connectivity that is arguably better than everyone else. Evidence of this knowledge can be seen in their approach to network integration – i.e., getting their medical devices to work on a hospital's network. Spacelabs has a detailed site survey they use, but beyond that every network is unique. They don't require a private subnet or a VPN, although VPNs are a common network design tool used to deliver performance for critical applications like medical devices or VoIP. Most medical device vendors do everything they can to keep their networks separate in order to reduce (to zero, hopefully) common variables found in general purpose computing environments.
The new SL 2600 sounds like a more feature-rich version of the 2400.
The UltraviewSL2600 is well-suited to a broad range of
environments, including perioperative, emergency and neonatal care
applications. The monitor's compact size and larger display, coupled
with advanced monitoring features, provide a flexible solution that
enables hospitals to augment their existing installation of Spacelabs
monitoring, as the new monitor has full network compatibility with all
existing Spacelabs UltraviewSL Ultraview® and PCMSTM centrals and bedside monitors.
Additionally, a wireless networking option supports central
surveillance during patient transport, when patients are often under
greater stress and risk, enhancing patient safety and improving
emergency response time. Together with Spacelabs' new Clinical Event
Interface to pagers and other handheld devices, these capabilities
serve to accelerate the flow of critical, time-sensitive patient
information to caregivers, regardless of patient or caregiver location.
UPDATE: I forgot to mention that Spacelabs has service menues on their wireless monitors that RF and network performance data that's sufficient to do a manual site survey. I also got this additional bolus of information:
When a “live” hardwired network connection is established, no wireless signal
strength indicator is displayed. (The radio turns itself off). However, unplug
the network cable and the wireless radio turns on automatically, and the signal
strength indicator is displayed.
This is
a useful feature that allows clinicians to determine what mode of networking (HW
or WLAN) the monitor is working off of. As well, the monitor allows for
separate IP network addressing for both hardwired and wireless networking
modes.
The signal strength indicator mentioned is the classic “chicken foot” with a multi bar signal strength meter that also indicates whether the radio is associated with an access point through color coding,
Why Are We Here?
This website is intended to be a conversation – between me and all of you (and amongst yourselves, too. What I put here is not “published” or set in stone, it's not a newsletter, it's a blog. You might read something here that you won't find elsewhere (not for lack of trying – you should see some of the search engine queries that bring people to this site). Something might be funny or another one of my harebrained opinions, or just incoherent ramblings – like right now. Sadly, I possess incomplete knowledge and, on rare occasions, make mistakes. That's when it's your turn.
When I'm misinformed, incompletely informed or just plain wrong, correct me, enlighten all of us. And do it right now, don't wait to make a call or set up a meeting at an upcoming show (unless you're really pissed, then take your time). Click the comments link at the end of the post, or rip off a quick email, or pick up the phone.
Don't get me wrong, I'm not complaining. Over the past several months, comments, emails and phone calls have increased. We've learned some good things, things that enrich us, our industry, and the patients that we ultimately serve. Thank you.
It bothers me toI learn that I've gotten something wrong in a blog post, I squirm inwardly and feel like I've let you all down. The longer you wait to tell me, the worse I feel. Let's just get it over with, make it quick – that way we all win.
New Remote Monitoring Market Study Released
Spyglass Consulting has released a new market study on remote monitoring called, Trends in Remote Patient Monitoring. Spyglass creates great market studies that illuminate markets just as they're getting hot. It seems that so many market reports either focus on markets that are too early and undeveloped or markets that are mature and well, boring. Director, Gregg Malkary, is lucky; as a boutique consulting firm, he can select dynamic topics and do them when his report will have the greatest value for both vendors and early adoptors.
I talked with Gregg a while ago to get some of the high points from this latest study. This assessment of remote patient monitoring really highlighted for Gregg how our health care system is optimized for complex acute care rather than preventive or chronic care. Hospital frequent flyer patients (those patients who are repeatedly admitted for poorly managed chronic diseases) are one of the most expensive patient types in health care today. Gregg found that providers are most interested in applying remote monitoring to patients with congestive heart failure, diabetes, chronic obstructive pulmonary disease, and asthma.
One of the biggest barriers to broad remote patient monitoring adoption are state licensure laws. Think Kansas City, St Louis, Spokane/Coeur D'Alene, Duluth/Superior – there are lots of metro areas that straddle state lines. Without a common set of federal requirements or reciprocity (and data reporting) between states, much of the location independence provided by remote monitoring will go to waste. Pricing is another huge barrier to adoption – remote monitoring products currently run from $3,000 to $5,000, yet you can bluy a personal computer for $500. In Gregg's research most organizations felt that sub $1,000 pricing was neccessary to spur adoption. Other key barriers to adoption were connectivity to elderly patient's homes, the current lack of reimbursement, and (surprisingly) physicians who can't imagine remote monitoring as a duty on par with office visits.
Here's more from a Healthcare IT News story:
diseases, such as coronary heart disease and diabetes – will become
widespread over the next four to five years, especially after Medicare
adopts telemedicine as a way to provide better care and reduce costs.
“This will take place much quicker than we think,” Malkary said.
Spyglass interviewed more than 100 healthcare
organizations involved in telehealth including home health agencies,
academic medical centers, regional hospitals, government agencies and
disease management companies.
Sixty-five percent of organizations interviewed
were making limited investments in remote patient monitoring solutions
focusing on high-risk, high-cost patients with multiple chronic
diseases. Organizations are resistant to further investments until RPM
[remote patient monitoring] solutions can be proven clinically and financially effective, the study
found.
Boomers aside, the major impetus for physicians,
hospitals and home health organizations to focus on monitoring their
patients is cost. They need to keep patients out of the emergency room
and out of the hospitals.
Reimbursement for remote monitoring is slowly becoming a reality.
government grants to subsidize deployments, and most interviewees said
their organizations would probably not recoup money spent to install
remote patient monitoring.
Though patients like the remote monitoring systems, they are
unwilling to pay the estimated $150-per-month for them. Nor, for the
most part, are Medicare or health insurance companies willing to pay.
Extrapolating from observed results with a telehealth network
in Tennessee, Burgiss, a professor at the University of Tennessee
Graduate School of Medicine, published estimates
that remote monitoring could bring national costs of caring for
congestive heart failure patients down from $8 billion a year to $4.2
billion, including costs of providing remote monitoring.
There seems to be a fundimental disconnect between providers, payors and patients.
Though companies like Health Hero
have services that both collect information and professionals that
monitor it, patients' personal doctors are often not part of the
monitoring system.
Doctors and nurses need to be able to use the information to
help patients take better care of themselves and avoid trips to the
hospital, said Malkary.
But until the service is covered, clinicians are reluctant to
participate. Doctors usually don't get paid for interpreting data
collected remotely, but they can still get sued if they make a mistake,
said Malkary.
Pictured right is Cardiocom's Carestar chronic disease telemonitoring device.
