HIMSS Monday – New Orleans 2007
When attending these shows I feel compelled to try to decipher the “buzz,” to name the hot issues or key trends that characterize the event. This show has gotten so large and so diverse that, like the elephant and the blind men, buzz is perceived through your own perspective and interests. So, HIMSS this year is all about connectivity – not really, but that's what it seems to me. I was talking to Matthew Holt last night and the buzz for him was more around broader health care policy (EHRs and consumer health). In the end, whatever you're interested in, you can find plenty of buzz around it at this year's show.
Since patient flow interests me, all of the patient flow and bed management vendors are on my list to visit. I started with StatCom who officially introduced their new product at this year's show. Their new release is a combination of new architecture upon which they're running current and new applications. According to StatCom CEO Eric Morgan and EVP Ben Sawyer, the new release takes StatCom from a departmental orientation to supporting patient flow and the delivery of care on a new enterprise-level scope. Automation in support of the efficient movement of patients through the care delivery process is the health care equivalent of industrial logistics management – health care may lag 10-15 years in this area, but we can take advantage of concepts, software application design and architecture that have been refined over many years. Obviously, we can't just apply industrial management techniques to health care, but the concepts and processes are readily transferable to the delivery of care. StatCom is keenly aware of this and is drawing heavily on industrial logistics to guide and inform their approach to automating the care delivery process to increase patient velocity through the hospital.
Ken Kiser MD, CEO of MedSphere, is probably the most visible proponent for bringing the open source software model to health care. MedSphere is using the VA's VISTA EMR as the code base for their EMR. Last week MedSphere had two big open source releases. They released server and clinical information system services under a GPL license and another release under a Mozilla variation that they call an MPL license. This is their first big contribution of new features to the code base, that's available to the public. They've reserved some rights like attribution, but there are no license fees. Their business model is based on providing implementation services and ongoing software support and enhancement around their code base.
Ken believes the open source business model is well suited for health care. There are many applications and capabilities that providers would like to have. In a market dominated by large health care IT vendors, new software (what little they actually develop rather than acquire) must be justified by large market opportunities, leaving many market requirements unmet. Open source efforts can fill this gap by providing complete applications or software components that meet those needs that lack the big market potential conventional vendors need to justify new product development. The challenge for the open source business model is to come together into an effective organizing structure to facilitate interoperability, consistency and quality. With this most recent code release, MedSphere hopes to contribute to advancing the open source model. Rusty Lewis, MedSphere's CTO, is leading this effort and MedSphere plans to add dedicated resources to advancing open source software in health care.
Later I came across an RFID vendor I'd never heard of called RadiantWave. Business models in the RTLS space are presently going through considerable transition. Some vendors are moving to become enterprise infrastructure providers, others are moving into the application space. Some RTLS vendors have developed their own technology, while others have OEM'd their technology. RadiantWave is an unusual chimera – they are tag agnostic through an “edgeware” positioning engine that they developed and an enterprise mobile resource management system licensed from Red Prairie. RadiantWave has been working with large health care delivery providers (multi site providers is their sweet spot) by providing an enterprise logistics system and configuring specific applications for providers on top of that enterprise architecture. The result strikes me of an enterprise oriented custom application development business model. I can't decide whether this is an oxymoron or a brilliant business strategy.
HIMSS Sunday
I made it – a lot of people didn't (or came in really late). Sadly, my bag didn't make it. It's midnight and they still haven't delivered it yet.
Picking up my registration packet, I ran into Neil Versel and Susan Carr. And while waiting for the Emergin Customer event, I caught up with an old friend from about 15 years ago – we both have a lot more gray hair.
The Emergin event was interesting for the attendees. There were many notable clinical engineers (Yadin David, Izabella Gierras, Steve Grimes, Paul, Sherman, Elliot Sloane, Ray Zambuto) – as someone suggested, “the Godfathers” of clinical engineering. Arthur Gasch was also in attendance. I also noticed a couple of representatives from Cardinal. There was a lot more focus on medical devices and patient safety than you'd expect at a software vendor meeting at HIMSS. More late.
The Meet the Blogger event was a success. This place was more crowded than last year in San Diego, and a lot less crowded than the event we tried to pull off at RSNA. I guess I'll have to break down and come up with some sort of sign so our group is more visible. Check out the photos from the event down the left hand column.
Pictured right are two official HIMSS greeters at the airport.
Philips Launches Wireless Monitor/Defibrillator
Philips does it again, with an announcement that is sure to cause consternation among their competitors (press release). Philips has launched a wireless version of their HeartStart MRx monitor/defibrillator. The device will run on 802.11a/g wireless LANs, “with [the] capability to network with the Philips IntelliVue Clinical Network.” The press release starts off talking about workflow and clinical benefits:
Using the HeartStart MRx, hospitals will be able to transport patients who require cardiac monitoring or therapy between departments or within the same unit without changing equipment. The MRx can also be used at the bedside in departments that would benefit from having both centralized surveillance and cardiac therapy at their fingertips.
There are two big markets for monitor/defibrillators, hospitals and ambulances. While wireless connectivity in the EMS (emergency medical services) world has been around for some time, adoption is severely hampered because hospitals and EMS providers are separate entities. Given the propensity for vendors to create proprietary end-to-end solutions, pre-hospital connectivity necessitates that numerous independent hospitals, and the EMS providers who serve them, must use monitor/defibs and hospital based clinical information systems from the same vendor. Sadly, the structure of the pre-hospital EMS market, and the proprietary strategies of device vendors, has resulted in just a few high profile beta site/trials (that demonstrated meaningful improvements in patient outcomes) and a smattering of adoptions. The return for vendors on their R&D costs for developing this connectivity has been less than poor – not that they can blame anyone but themselves.
In the hospital, monitor/defibs have been standalone devices used in emergency situations. Of course there’s been a need for connectivity (data capture, surveillance and alarm notification) all along. The absence of connectivity has made it possible for a standalone company like Zoll to grab a piece of the hospital market. With the advent of wireless connectivity for the HeartStart MRx, Philips has a powerful new competitive differentiator. Philips is now the only vendor with both full line patient monitors and defibrillators integrated via connectivity into one system – this will be a big deal. GE now has a reason to go buy a defibrillator company. (Maybe Physio-Control, I hear they’re for sale.) Patient monitoring vendors without defibrillators will have another lock-out spec to fight. And defib companies, like Zoll and CardiacScience, will slowly and irretrievably lose hospital market share. Could there be a whole round of defib company acquisitions in the near future?
This tactical move by Philips is shaping up to be an example of leveraging connectivity for competitive advantage. Unfortunately there are few such examples – a hesitancy to adopt connectivity and poor strategies and execution have plagued many vendors. The words, “you don’t know what you don’t know” were never truer then when referring to medical device connectivity.
Pictured right is the Philips HeartStart MRx.
Point of Care Computing Device Review
Yours truly was quoted in this story on point of care computing devices by Neil Versel. In this review, Neil looks at all the various devices used at the point of care and more generally in care delivery areas like nursing stations. After talking with providers and vendors, the conclusion is there is no “one size fits all” solution. Here's what I took away from the story:
- Don't get locked in to any one solution, stay open systems and standards based.
- Healthcare delivery is inherently mobile, don't tie users to a limited number of locations. And don't forget your WLAN – coverage is important, but so too are capapcity (the number of devices per AP) and latency. If users are truly mobile, make sure hand-offs between APs and subnets works well.
- The choice between device deployment types (alcoves, COWs, bedside) should be driven by your situation – and remember situations vary among clinical areas.
- The market is transitioning from paper to paperless and both workflows must be supported. Don't forget things like the ability to print to the closest printer from a wireless device.
- Don't forget the basic health care requirements: water resistance, qualified for harsh disinfectants (find out which ones), ruggedized (1 meter drop on linoleum covered concrete), supports 8 and 12 hour shifts (battery life, swap and recharging), display and input devices must be consistent with applications – both now and during the expected life of the computing device.
- Technology roadmap – these are general purpose devices, so plan ahead (5 years at least) and consider all the different point of care automation and patient safety initiatives planed in your hospital. Otherwise, you'll be replacing more than you need to in the future.
- Consider infection control implications and develop policies and procedures to minimize risk and measure performance.
- Don't forget to consider these applications: point of care charting, meds administration, vital signs data acquisition, alarm notification and surveillance for patient monitors, smart pumps, and ventilators.
Read the whole thing.
USB Drives Pose Security Threat
The Universal Serial Bus (USB) as rapidly replacing RS-232 connections on medical devices. As more device vendors adopt general purpose operating systems like Windows CE, it becomes very easy to leverage USB for connectivity.
When faced with complex connectivity requirements, it is very tempting to just push those requirements off on the user by providing a USB port and thumb drive. Besides the fact that reading and writing data to a USB drive only just barely qualifies as “connectivity” (resulting in manual error-prone workflows),USB drives pose a substantial security threat. Standard USB drives have no built in security.
Anyone can bring a widely available USB drive to a device and download or upload data. Also there is no way to tell if the USB has executable code that will push a Trojan horse or other malicious code onto the target device. This is especially worrisome if your device is running a general purpose operating system like Windows – but even Linux would not be immune to this.
All of this came to mind after reading this brief paper by Adam Wright and Dean Sittig, both of OHSU, in the current issue of Annals of Internal Medicine. Their paper describes the security threats posed by USB drive based personal health records. If you don't have a subscription, you can read the PDF file here.
We modified the programs on the devices so that, when connected to a computer, they gave the appearance of normal operation but surreptitiously searched for and copied data from the computer to a hidden location on the USB device.
USB drives have become so ubiquitous that there are now many novelty drives such as the shuumai (a steamed wasabi pork dumpling) pictured right.
