Hospital Network Management
Health Management Technology has a story on network management best practices. Applications that demand this kind of management include point of care apps like CPOE, high bandwidth hogs like PACS, and technically demanding apps like wireless VoIP. If you add networked and wireless medical devices to the mix, especially for surveillance or alarm notification, and effective network management becomes a patient safety issue.
The author, Eileen Haggerty of NetScout, divides things into 3 phases: pre-deployment audit, decision and planning, rollout and ongoing management. Here’s an excerpt from the first phase:
Create an inventory of the applications running over the network. This includes key details for optimizing the use of network resources, such as distinguishing business versus recreational use of the network,
identifying applications that have been or will be retired, and pinpointing processes being performed at less than optimal times of the
day. Value: This data will reveal bandwidth-consuming recreational use of the network, such as online gaming and streaming radio or video, as well as business activities such as downloads of security patches to desktops or server updates during peak times of the day that may be performed at a different time.
Evaluate bandwidth to ensure capacity availability for PACS or EMR services. Rank most and least utilized network segments, both in the campus LAN as well as over remote office WAN connections; trend activity and look for patterns in traffic behavior. Value: This information will be invaluable in “right-sizing” network segments to comfortably support the new services. (Note: If your hospital is charged by your service providers for WAN change orders, this takes on an even more important role in ordering the right bandwidth the first time.)
Create response time baselines of the hospital’s essential applications. Measure typical application response times for key applications. For instance, baseline the application nurses use to track schedules and hours worked, which may measure overall response time at 300 milliseconds, 220 milliseconds for network flight time, and 80 milliseconds for server think time. Value: This will help you understand your users’ perception of these applications’ performance prior to the introduction of PACS or EMR. If the reality is different post-implementation, you will know precisely by how much and where it is occurring—in the network or the application server.
Identify ancillary performance issues. No network is perfect—use this opportunity to do a little house cleaning. Look for packet loss, high application retransmits, previously undetected worms or viruses, or router misconfigurations. Value: Network anomalies may negatively impact service delivery of existing or new applications. Identifying them in the audit phase of the project gives you time to remediate them and avoid losing confidence in the PACS or EMR project during introduction and rollout. As an example, a medical center based in the northeast United States performed a network audit in advance of a PACS deployment and found eight workstations infected with a virus that were thought to have been removed from the network.
You’ve done all of these things, right? And your vendors know all the performance parameters required for their applications in addition to their impact on your network infrastructure, right? The fact that most medical device vendors want to run on private networks does not build confidence in their network management acumen. Most hospital IT departments should take a page out of the clinical engineering department’s book when it comes to documentation and tracking. According to Eileen, ” We won a new account because we provided them visibility into their network so they could find the reason their new VoIP implementation had some of the phones deregistering without warning – we saw an asynchronos QoS assignment in the RTP voice which was at fault.”
Medical devices need network monitoring too – actually more than just network monitoring. Startup company Nuvon was founded in 2003 to extend network management to the special purpose medical devices used in hospitals. Their solution combines remote service capabilities (device monitoring, reflashing EPROMs, and remote diagnostics) along with more traditional network monitoring to provide end to end performance monitoring for devices and their networks.
If you’ve read the FDA’s recent guidance document on wireless medical devices, it’s pretty clear that integrated medical device and IT infrastructure monitoring will be required to ensure safety and effectiveness.
EMR Adoption and Medical Device Connectivity
Associate Brad Sokol sent me a link to a paper on Health Affairs, How Common Are Electronic Health Records In The United States? (abstract)(full pdf). It turns out there are many answers to this question. (The terms EHR and EMR are interchangeable in this post.)
Based on the surveys reviewed in this study, the EMR adoption rate for physician offices in the U.S. is a whopping 24 percent. The following table is excerpted from the study.
| Range from medium- or high-quality surveys (%) | Best estimates based on high-quality surveys (%) | |
| EHRs in physician offices Solo practitioners Large physician offices |
17 – 25 13 – 16 19 – 57 |
24 16 39 |
| EHRs in hospitals CPOE |
Not available 4 – 21 |
None 5 |
There are no publicly available studies on hospital EHR adoption. That's such an active commercial market; there are private market research firms who provide their studies to vendors for a fee. Perhaps a reader can share with us some hospital EMR adoption numbers. Large practices are defined in one study as having 20 or more physicians and 39 % adoption; another study defined large practices as 50 or more docs with an estimated 57% adoption.
Physician practice size is an obvious variable, with adoption going higher the larger the practice. The other big variable is the extent of adoption. According to the IOM, there are 8 key capabilities of an EHR. If adoption were limited to physicians who had implemented at least 4 of the key capabilities of an EHR, adoption rates would fall to only 9 percent. As with many new markets with extensive solutions, features are being implemented gradually.
Growing EMR adoption means that medical device connectivity is
becoming a bigger issue for medical device vendors who sell into the
physician practice market. When physicians adopt an EMR, they want the data produced by their devices to automatically flow into their electronic records. Manually entering data is inefficient and error prone. Just as in hospitals, data manually read or copied off medical devices can be entered into the wrong patient's record, the data can be transposed, or in some cases never entered at all. Common devices include spot vital signs monitors, SpO2 monitors, ECG, holter, ultrasound, spirometry, point of care diagnostics, and other categories of devices.
Before EMRs, physician decisions regarding the point of care revolved around medical devices – the diagnostic confidence of data, ease of use, and cost were chief considerations. Practices who have adopted (or realize they will eventually adopt) an EMR consider connectivity with their EMR a new key criteria for device selection. Physicians in the process of adopting an EMR frequently replace existing devices that cannot be integrated into their EMR. To device vendors it seems that EMRs have replaced devices as the new king of the hill in physican's minds – and they're right.
Pictured right is the Burdick Sensaire spirometer, which sports serial connectivity out of the docking station. (That's not an antenna on the right, it's a stylus for the device's touch screen.)
HIMSS Tips for Vendors – Closing Sales
Vendors
with a large presence at HIMSS start planning for the next year almost as soon
as the current year’s event is complete, so my posts on vendor planning will focus
on things you can pull off between now and February. The first topic we’ll look
at is moving existing sales prospects to the close.
How many sales would you have to close to justify the marketing investment in HIMSS? If you're like most companies exhibiting at HIMSS, it would not take very many incremental sales to get a huge return on HIMSS. Creating a plan to move prospects towards a sale – and documenting the results – can make anyone look like a marketing star.
The
key advantage of an event like HIMSS is the availability of many prospect’s key
decision makers along with many of your company’s resources. At HIMSS you will
have demonstration systems combined with access to senior management, R&D
and product management folks, in addition to sales and marketing.
Getting
good results from attending a conference like HIMSS is all about good
execution. Like many marketing projects, this one is iterative – digging in to
each of the following tasks will provide additional information to refine
previous tasks.
First,
determine which resources will be available at the show. This includes demo
systems (noting features, versions, hardware and software), prototypes, and
human resources (both who and when). Coopitition – collaborative alliances with
sometime competitors – has become pervasive in health care. The HIMSS
conference provides a unique opportunity for partners to work together,
leveraging both sets of resources for integrated demonstrations and meetings
with customers.
Now
in conjunction with sales management, look at your sales pipeline and identify
key accounts to target at HIMSS. You will want to go back to the field to
confirm who will be attending HIMSS – you might even encourage their attendance
so they can get the equivalent of a corporate visit without making a special
trip (and allowing you to save that corporate visit for the close).
Once
you know which target accounts are attending, dig into the sales strategy for
each account. Are there common themes across accounts or will each meeting be a
one-off? Work with sales to determine what will be most effective in moving
each account forward in the sales process, and revise your demo capabilities
and meeting resources accordingly. Don’t forget to consider how you might leverage alliance partners
who will also be in New Orleans.
Once
you’ve identified your internal and alliance resources, identified your target
accounts, and refined your resources in response to sales strategies and
meeting objectives, it is time to start executing.
Working
with sales, invite and schedule each target account in accordance with your
resource availability. Consider ways you might increase the importance of these
meetings in the minds of your prospects: a special invitation, follow up calls,
and customized pre-meeting briefs can improve the attendance and effectiveness
of your meetings at HIMSS. And don’t forget post-meeting things like thank you
notes, and written summary of the meeting.
One
of the nice things about special meetings like these is that you can leverage
the HIMSS planning work you’ve been doing for months. It does not take closing
many sales opportunities that you’ve identified to justify your entire
company’s attendance at HIMSS, let alone justifying the extra cost and effort
these meetings require.
My
next post will look at the wonderful competitive intelligence gathering opportunity
that HIMSS provides. Until then.
Pictured right is GE Healthcare's NDA-only exhibit area from HIMSS 2006. This was a very cool way to demonstrate technology leadership. Entering
the enclosed exhibit required your name, title, company and
address (either scanned off a business card or typed) and a click to
accept a 3 line NDA – all done pretty quickly on a laptop. Inside was… well, I can't really say. But it's a great way to create
buzz and leverage some of your R&D feasibility work.
