USB Implementers Forum Creates Healthcare Working Group
The industry group responsible for the advancement and adoption of USB technology (warning: obnoxious sound track) has created a health care working group. Apparently patterned on the Continua Health Alliance approach, the group is targeting health and wellness, disease management and aging independently market segments. Noted members are also all Continua members: Cisco, Intel, Nonin, and Welch Allyn. From the press release (pdf).
In a previous post, the security threats posed by USB devices to personal health records (PHRs) were described. Many medical devices today are based on Windows CE because of the many communications services built into the operating system. A USB drive can carry executable code that could install a Trojan horse program or corrupt data. How (or if) medical devices will mitigate this risk will be interesting to see.
The good news is that USB connectivity is pretty crude and poorly suited for most medical device connectivity applications and should be eclipsed by Ethernet and wireless LANs.
Pictured right is a kanitume USB drive.
[Hat tip: Health Data Management]
Disruptive Continuous EEG Monitor for ICU
Continuous EEG monitoring is a useful diagnostic tool for identifying a number of important neurological problems and to guide therapy. The problem with continuous EEG monitoring is that it requires specialized techs and consulting neurologists. Last November (2006) Stellate introduced a continuous EEG monitor for the ICU with an impressive array of connectivity features (press release). From an MD Buyline write up:
for operation by ICU staff, while incorporating advanced EEG analysis and
display options. Mindful of space limitations in the ICU environment, the
platform features a small form factor panel PC with touch screen controls.
Vita ICU provides several customizable trending options including Cerebral
Function Monitor display, automatic quantification of Burst Suppression
activity and Color Density Spectral Array that each facilitate quick
identification and review of critical events. Sophisticated seizure detection
programs help capture seizure information that would otherwise be difficult to
identify by physical observation. E-mail and pager alerts can be programmed
for notification of attending physicians while they are away from the ICU. The
networking and remote access feature enables review and intervention when
needed by EEG technologists or clinicians without the need for them to be
physically present in the ICU.
In addition to alarm management, the system provides remote alarm notification via email or pager. Alerts can be defined based on trended values, and all data is stored in a SQL database. The system also supports a webcam video camera for streaming video synchronized to the EEG signal to consulting physicians.
Let's summarize. A continuous EEG monitor designed to be set up and operated by ICU staff rather than a specialized tech, with connectivity to provide immediate remote access to retrospective and near real time patient data for consults. Sounds promising, although it seems they may have made a few newbie connectivity mistakes. Pictured right is the Vita ICU system.
FDA Lifts Warning on Guidant ICDs
The FDA has lifted the December 2005 warning letter on Guidant implantable cardioverter defibrillators (ICDs) that suspended Boston Scientific's introduction of new Guidant products. It took Boston Scientific a full year to retool their quality systems and backfill required documentation. The FDA reinspected the Guidant facilities last November and December, rending their decision almost 4 months later. From the Boston Globe story:
Scientific received from the FDA in January 2006. That letter applies
to its drug-coated stent business and the rest of the pre-Guidant areas
of the company. Executives have said they do not expect the warning
issue to be resolved until the second half of this year. Until then,
the company will be prevented from receiving agency approval of any new
models of drug-coated stents.
Congrats to Boston Scientific. Pictured right is the Guidant Contak Renewal ICD.
Are Discharge Systems the Next Patient Flow Application
Doing a good job of getting patients discharged is key to good patient flow. There are many reasons why patients may not get discharged as soon as they could. Attending physicians at many hospitals don’t seem to get around to writing discharge orders until late afternoon or early evening of the day of discharge. Patients sometimes have a hard time getting a ride home. For patients who can’t be discharged to home, finding a SNF (skilled nursing facility) or nursing home that can take the patient can delay discharge.
The need to automate discharge workflows is self evident, with vendors and academics focusing on this area. The key is to replace phone tag and a flurry of faxing with an application that spans multiple health care enterprises.
“Before we actually looked at a variety of systems, we were making our referrals to skilled-care facilities and nursing homes by phone,” said Dee Mann Aust, director of care coordination for Swedish Medical Center in Seattle, which operates three acute-care hospitals and a free-standing emergency-care facility.”It was not efficient,” Aust said. “The facility or agency couldn’t see a lot clinically about the patient and it was not standard in any way.
We get a lot of patients from Alaska who come here for specialty surgery. They may not have a lot of needs; they just want a local place for their care.”
Under the old paper-based system, “Let’s say a family picked a geographical area; we’d have to call three nursing homes in the area and give them the (patient) information and see if they could handle the patient,” Aust said. “You’d spend five or 10 minutes on the phone for each one. That was just the initial referral.”
To address the problem, Aust said Swedish implemented in March 2006 a discharge planning system from ECIN, a developer of a suite of Web-based applications to assist hospitals in discharge planning and care management. Formerly Extended Care Information Network, the company claims installations at more than 300 hospitals and, as subscribers to its Web-based communications service, about 4,200 nursing homes, home health agencies and other long-term-care facilities, according to Charlie Jolie, an ECIN spokesman. In addition, the company maintains an online database of more than 80,000 providers of extended-care services.
The ECIN communication service provides a two-way link between the hospitals and subscribing care facilities. Hospitals typically recruit their local nursing homes to join them on the ECIN network, Jolie said.
The system works well facilitating routine placements and shines when it comes to hard-to-place patients with multiple conditions.
“We know we have some patients who are tough to place, and certainly it’s very efficient to create one referral and to send it out to
multiple facilities,” Aust said. “We have one patient this week we sent out (referral requests) to 35 nursing homes, and three said they want to look into more information for that patient. So you can do searches within ECIN and their provider database to search if someone has an Alzheimer’s unit. That’s a big time-saver. You’re not depending on what was in last year’s entry in a guide. It’s more up to date.”
In addition to the solution from ECIN, this E-Health Insider story describes what they’re doing in the UK. And here’s a paper from last year about automating communications between inpatient and outpatient physicians.
Private Equity Will Hasten Health Care's Transformation
Tony Chen at the Hospital Impact blog has a great post on the tsunami of recent deals in health care. These deals are changing the health care industry. Outsiders in the form of private equity investors and insider hospital M&A are gobbling up failing organizations or those weakened by market changes for which they have ineffective responses. Newly recast ventures that are successful will reward effective change which will drive additional change.
The change required is not the simple head count reduction, and trying to figure out how to do the same old thing with fewer people. What is needed are fundamental changes to the way that care is delivered. These are the changes that will reduce length of stay and improve both patient safety and outcomes. Hospitals today are stuck between a rock and hard place – the rock is the inexorable reduction in reimbursement, and the hard place is the increased visibility and transparency surrounding patient safety and outcomes.
Here are a couple quick examples of the change I'm referring to. Almost every hospital boards patients in the emergency department (ED) to a greater or lesser degree. These patients, shuffled off to out of the way halls awaiting admission, are cared for by off-service nurses (ED nurses) at ever worsening – and sometimes hair raising – nurse to patient ratios. A few heretical hospitals have started boarding those patients awaiting beds up on the floors, on their service. Consequently, each nursing unit could have 1 or 2 extra patients – receiving appropriate care (because they're in the appropriate unit) and at a nurse to patient ratio that is only slightly impacted by a couple extra patients. To someone from another industry this makes admirable sense. From my peers, I've heard excuses ranging from “it's jut not done” to “we can't do it because of fire codes (or department of health regs, etc.)”.
The other example is variable acuity care delivery. Hospitals are organized into units that are specialized based on the level of care, nursing vigilance, therapies that can be delivered, and staff training. This regimented organization was used in manufacturing 20 years ago. Like manufacturing in general, manufacturing healthy patients is not a steady state process. Consequently, census in units varies wildly from unit to unit and day to day. Some units are habitually over capacity, and represent the most common patient flow bottleneck found in hospitals – those over capacity units are critical care units with patient monitoring. Variable acuity units are an analog to manufacturing clusters or pods where the physical environment is quickly modified to adjust to new requirements. Rather than transferring patients because of needed patient monitoring, or a more sophisticated therapy, those patients are kept in their unit and those resources are brought to them. Monitoring patients outside traditional monitored units is a growing trend – half of the telemetry transmitters in hospitals are used on non-cardiology patients. Implementing variable acuity care units is not easy; it requires some pretty fundamental changes.
So, how do you accommodate falling reimbursement and demands to improve patient safety and outcomes? The opportunities to improve operations are many, almost as many as the excuses used to avoid substantive change. As private equity and M&A roils the health care industry, smart people will ask the hard questions with increasing fequency, and change will come.
Pictured right, “resistance is futile.”
