Daylight Savings Is This Weekend
In an effort to reduce energy consumption, the government has moved the start of Daylight Savings Time from April 1 to March 11 and the ending from October 28 to November 4 (the day after my birthday). This change will save untold millions of barrels of oil, and impoverish or enrich Bush's friends in the oil industry (depending on your political persuasion), and potentially risk patient safety. This from the FDA:
Dear Healthcare Practitioner, Hospital Director and Safety Manager:
This is to alert you to the possibility that some medical devices
(equipment), hospital networks and associated information technology
systems may generate adverse events because of the upcoming change in
the start and end dates for Daylight Savings Time (DST), and to suggest
actions you can take to prevent such occurrences.
While we do not know which specific devices might be affected, FDA
is concerned about medical devices or medical device networks that
operate together or interact with other networked devices, e.g. where a
synchronization of clocks may be necessary.
If a medical device or medical device network is adversely affected
by the new DST date changes, a patient treatment or diagnostic result
could be:
- incorrectly prescribed
- provided at the wrong time
- missed
- given more than once
- given for longer or shorter durations than intended
- incorrectly recorded
Any of these unpredictable events could harm patients and not be obvious to clinicians responsible for their care.
Here's the FDA's notice for consumers. Fellow blogger Shahid Shah and I wrote about this a while back (here and here). The topic has also been very popular on the Biomed Listserv. Earlier this week I received my third notice from AT&T Wireless Cingular AT&T – this time a computer generated voicemail. GE Healthcare sent out this notice yesterday.
Not to be outdone, the mainstream media has stories, this from the Philadelphia Inquirer and another from the Boston Globe. We've put up our food and water and bought a few extra cases of ammunition – just in case there's a total breakdown of social order. Hopefully we'll all be on line come Monday.
Defibtech AEDs Recalled by Company
According to the FDA:
Lifeline Semi-automatic External Defibrillators (AEDs) and ReviveR
Semi-automatic External Defibrillators (AEDs). This recall affects all
Lifeline and ReviveR AEDs with software versions 2.002 and earlier.
The self-test software for these devices may allow a self-test to clear
a previously detected low battery condition. If this situation occurs,
the operator may be unaware of the low battery, and the device may be
unable to deliver a defibrillation shock, which could result in failure
to resuscitate a patient.
This is a Class I recall, the most safety-critical recall as defined by the FDA. You can read my profile of Defibtech, “Medical Device Commoditization Hits Health Care” from February, 2006.
Pictured right is their new Lifeline AED.
Richmond (Va) Ambulance Authority Deploys Wireless Tech
Another emergency medical service is deploying wireless technology to support workflow automation, improve pre-hospital care, and better communicate patient data to waiting hospital Emergency Departments. From Information Week (press release):
In an announcement Tuesday, the RAA said the In Motion technology,
which can access different wireless networks while ambulances race to
their destinations, had not only improved pre-hospital patient care by
improving dispatch times, but had also brought about a 50 percent
reduction in mobile data communications costs.
A spokeswoman for In Motion said the firm's “little black box”
has been fitted with communications cards that enable ambulances to
access a variety of wireless networks from satellite links and WiFi hot spots to cell phone and UMTS networks. The system can even connect with some private IP networks operated by companies.
[...]
In setting up the system, the RAA was confronted with a series of
challenges — the exact location of ambulances was needed for rapid
dispatching, drivers were expending valuable seconds studying paper
maps, and response time had to be shortened to seconds. The RAA also
asked for a system that would supply up-to-date patent records and the
records must be HIPAA-compliant and encrypted.
In Motion's onBoard Mobile Gateway
Manager pinpoints vehicle location while it monitors the status of
different wireless networks. The technology has enabled new features to
be introduced including Computer-Aided Dispatch (CAD) and Automatic
Vehicle Location (AVL).
As I've mentioned before (here, here and here), what's described above takes a lot more than just a “little black box” – there are information sytsems at the RAA and local hospitals that must be supported. And multi-site and multi-enterprise implications extend to medical device connectivity as well. Currently adoption in this area is progressing slowly.
Emano Tec Lauches Medical Tablet PC
Okay, it’s not an off-the-shelf PC as like the Motion C5 or Philips ProScribe. But this is one very interesting device. Developed by Emano Tec in conjunction with CareGroup’s Beth Israel Deaconess Hospital, the MedTab hits the following point of care requirements:
- Droppable (tested to 30g impact)
- Pocketable (5.5 x 7.5 x 0.5 will fit in a lab coat pocket)
- Can be wiped with disinfectants
- Water resistant
- 12 hour battery life (with larger capacity battery)
- Wireless – 802.11g and Bluetooth
- 1024 x 768 touch screen display
- Optional bar code, RFID, magnetic card, and fingerprint readers
- $2,000 each with volumes of 50 or more
Did I mention it has a 12 hour battery life? Wow, I’m impressed. We have yet to reach perfection, but this device comes close for a clinician carried use model. This is a very, dare I say, sexy device.
Unfortunately the target market is physicians. There are several large institutions that could spring for a device like this, but nothing like a majority of the hospital market. Another bit of a miss is targeting EMR applications – actual EMR adoption is quite a bit behind all the hype – although the early adopters will probably be the large institutions who might actually buy something like this for their physicians (places like Kaiser, Cleveland Clinic, Mayo and large university teaching hospitals come to mind).
Sorry doctors, but the user population in hospitals that has the biggest impact on patient safety and outcomes is nursing. It is nursing that must deal with the sad state of medical device alarms, high nurse to patient ratios, and would greatly benefit from nurse carried alarm notification. Of course this device could also be used for meds admin and other point of care workflow automation. (Please no charting – use COWs for that.)
Nursing represents the largest category of unfilled positions in hospitals (almost 120,000 according to the AHA) – the nurses we do have working in hospitals could really use a break. But like the physician EMR rounding market, I must sadly admit there’s not much of an existing market for nurse carried computing devices. There is however a long standing (and unmet) market requirement representing substantial demand – recall the adoption VitalCom had with their paper-based solution (until it was proven to be unsafe), and just wait to see hospitals snap up Welch Allyn’s alarm notification system announced at HIMSS.
Okay, let’s get a grip and look at the MedTab’s short comings. The display is an innovative “E-Ink high contrast, low power “digital paper” display.” As you can see in the picture on the right, the display is very readable. Unfortunately, here is no backlight so using this on the night shift will be kind of hard – maybe the night shift could wear LED headlights.
The display size itself is sort of a “tweener” – bigger than a PDA (by a long shot) and smaller than a desktop display. Consequently, applications will have to be tweaked to be readable on the MedTab by the average 40-something nurse – slapping a desktop app normally deployed on a 17 inch display will not work. Here are some more product details:
MedTab provides Microsoft Internet Explorer (IE) which has been modified to be an OS shell and presents itself in kiosk mode. Thus, the device is secure from user tampering and the entire screen is available to the backend system. MedTab uses WinCE as its OS which most vendors support if they have a custom client. The most common customer client is Citrix which supports WinCE.
Unlike PDA or Ultra PCs, MedTab offers the screen size and resolution necessary to view and update EMRs. Unlike Tablet PCs, MedTab is small and light enough to carry in a lab coat pocket.
Beyond this, MedTab will last a whole shift (12 hours) without recharging, is rugged and can be disinfected. MedTab offers the possibility of a single sign-on system since its software configuration and provisioning are controlled by the IT department and not the end user.
MedTab is lockdown and as such, the end user can not configure or modify its software or use it for any purpose other than what the IT department has configured it for. MedTab is easily provisioned remotely over a secure, wired LAN line or wirelessly over state of the art 802.11 security protocols which is configure remotely.
A stolen device represents little risk to security since the system is locked down, and it’s possible to monitor its position and know if it’s leaving a designated area.
Unlike a UMPC (ultra mobile PC) running Windows XP, getting applications to run on the MedTab will take a bit more effort due to the Win CE OS, browser configuration and “lock-down” features.
A device with battery life that will cover a 12 hour shift is fantastic. To work on a nursing unit, you’ll need one MedTab per RN, and 2 batteries for each device. On a big unit you could have 12 or 15 nurses on the day shift, for a maximum of 30 batteries. One of my pet peeves is battery charging systems, and nothing is mentioned about what you do with your 15 spares that have to be charged for the next shift.
There’s plenty of business development work to be done on Emano Tec’s part before they’re ready for prime time. Just imagine though, loading a wireless VoIP client on the MedTab (with a Jawbone Bluetooth headset) along with alarm notification, messaging, worklists, and an RTLS (real time location system) that shows the location of your patients and the closest unused (clean and operational) infusion pump on a floor plan? And that’s just the tip of the iceberg. Sweet.
