There is an obvious tug-of-war in progress between HIT suppliers and medical
device suppliers. For example, the infusion device suppliers are wandering into the IT space
with server-based systems, gateways that are a proxy for the infusion device at
the bedside. HIT suppliers are getting more serious about the infusion device
business as well because it represents a piece of the care process they don't
own.

From my vantage point this is driven by several
factors. Infusion pumps themselves are becoming a commodity and the size of the market
is tending toward shrinkage. As infusion pumps get smarter they increasingly
become part of the medication administration process and less like passive
purveyors of medical data. Programmable infusion pumps create a special case
in the connectivity space because they represent a combination of servers and
systems with interdependencies that are not passive and can do real, direct harm
to a patient.

The above cause a degree of panic among infusion system
suppliers who see the handwriting on the wall, “…how do we grow when we don't own
the medication process, and how do we manage the liability of introducing a
programmable device into the medication process driven by orders in another
system?”

There is a tendency for issues like this to put up walls between
HIT and infusion system suppliers. Device suppliers can creep just so far
into care delivery before they run into two major issues: how do you manage
care process and workflow across dissimilar systems, and how do you decide who gets to be in control?

But some say this will all be solved by interoperability. It
may be solved eventually but today device suppliers and to some extent HIT
suppliers are disincented to implement interoperability because it immediately
draws a line in the sand around their market.

So what is the solution? I
guess I'm altruistic enough to think that a group of device suppliers could get
together with a group of HIT suppliers and decide to “do the right thing” based
on what is in the interest of safe and effective care. There are attempts from
the device side in the form of IEEE 11073 and attempts from the care delivery side in
the form of CIMIT…..with the FDA trying to shove them together. But this is
another case of government having to force an issue because industry can't get
their act together.

Government mandates are a handy explanation for
stock analysts worried by a charge against earnings ostensibly due to government
regulations….charges that are really due to shrinking market and failure to
act.

If you think about it, the big guys like GE, Siemens and Phillips have their fingers in both the HIT and the device industries. And as a rule,
even they can't integrate within their own product lines. All that opportunity,
and they can't get it together. There has always been, in my mind, an oil and
water relationship between software and hardware folks even within the same
company. Fundamentally they see the world differently. Companies that try to
do both tend to be good only at one….and the other struggles. The hardware
guys tend to be king of the mountain.

Point is it may take the government to
disrupt things…..but as is usual with government mandates, no one will like
the outcome…..and the patient is lost in the dust.