RFID for Healthcare
This web site was listed in a Healthcare Design Magazine e-newsletter as an RFID information web site for healthcare facilities. I love the URL – www.rfidhealthcare.com – I'm sure there are lots of folks kicking themselves because they didn't think of this URL themselves. Perhaps www.healthcarerfid.com is available? Sadly, no – it just serves up ads based on search terms.
The recommended site (www.rfidhealthcare.com) isn't so cheesy as to simply serve up ads, but the site is decidedly short on actual content. There are brief descriptions of various location based health care applications. It took me less than 5 minutes to review the entire site. As a marketing vehicle for what appears to be a consulting firm, BlueBean LLC. I wonder just how effective it is.
Welch Allyn OEMs EtCO2 from Oridion
Welch Allyn has joined a list of leading patient monitoring vendors offering Oridion’s miniMedi EtCO2 capnography module (press release). About the only vendor who doesn’t OEM Oridion is GE Healthcare – even some OEM vendors, like Analogic – use Oridion for EtCO2. Since Welch Allyn does not sell high acuity patient monitors (for the ICU and OR) this module may end up in a new monitor targeting outpatient surgery or a replacement for the aging Propaq monitor line. Besides mentioning ventilation patient monitoring (something that’s done outside of critical care areas with increasing frequency), the press release mentions this:
Microstream® makes EtCO2 monitoring feasible with both intubated and non-intubated patients and broadens the applications for capnography beyond the more traditional functions. For example, capnography can alert clinicians to episodes of hypoventilation as well as help them assess ventilation and treatment of asthma and chronic obstructive pulmonary disease (COPD). It also provides safety monitoring during procedural sedation, keeping with current American Society of Anesthesiologists (ASA) standards that recommend CO2 monitoring for all anesthetized patients, whether they are intubated or not.
What impact this agreement will have on Welch Allyn’s own EtCO2 OEM modules is not clear. In OEM circles, Welch Allyn is best known for their temperature and motion tolerant NIBP modules.
Pictured right is Oridion’s EtCO2 OEM module.
UPDATE: Word is that the Oridion EtCO2 module will go in a new generation of Welch Allyn monitors.
Medical Devices and Electromagnetic Interference
The delivery of health care is an inherently mobile activity, with patients moving though the care delivery process and almost all health care workers in constant motion. So it's no wonder that wireless technologies have been adopted with gusto.
Electromagnetic interference (EMI) has been a concern with medical devices since their inception. This EMI can be divided into intentional and unintentional interference. Intentional interference typically comes from radio frequency (RF) radiators like walkie-talkies, wireless phones, WiFi radios, and cell phones that use frequencies and specified power levels that may interfere with the operation of other radios or electronic devices. Unintentional interference is caused by things like paper shredders, bad florescent light ballasts, and noisy electric motors (from blow dryers to elevators).
Any electronic device can be affected by EMI, including medical devices. The wireless features of medical devices (or any other wireless device, for that matter) can also be affected. The larger medical device vendors have dedicated engineers and techs who do EMI testing and troubleshoot interference problems at customer sites.
In an effort to promote best practices regarding the use of mobile wireless communications and computing technologies in health care facilities, standards committees TC 215 and ISO 35.240.80 have created recommendations for
electromagnetic compatibility (management of unintentional
electromagnetic interference) with medical devices. Here's the abstract:
guidance for the deployment, use and management of mobile wireless
communication and computing equipment in healthcare facilities in a way
that promotes effective electromagnetic compatibility (EMC) among the
wireless technology and active medical devices through mitigation of
potential hazards due to electromagnetic interference (EMI). The
recommendations given recognize the different resources, needs,
concerns and environments of healthcare organizations around the world,
and provide detailed management guidelines for healthcare organizations
that desire full deployment of mobile wireless communication and
computing technology throughout their facilities. In addition,
suggestions are included for selective restrictions in cases where
healthcare organizations have decided that comprehensive management
procedures are not feasible, practical or desirable at the present
time. The recommendations herein distinguish between wireless
technology controlled by the facility and used by doctors and staff for
healthcare-specific communication and health informatics transport
versus non-controlled (personal) mobile wireless equipment randomly
brought into the facility by visitors, patients or the healthcare
organization workforce.
You can buy your copy of the standard for a mere 132.00 Swiss Francs here. The Medicines and Healthcare products Regulatory Agency (the Brit's equivalent to the FDA) has free recommendations based on the standard here. And you can read a paper on cell phone use in hospitals from last fall here.
2007 HIMSS Leadership Survey Released
I sat in on the conference call this afternoon on the new HIMSS Leadership Survey for 2007. The survey this year was based on a larger sample (360 respondents) and had some interesting findings. Of course most all the focus of the conference call was on EMR adoption. After about 1% adoption annually between 2002 and 2004, the current adoption rate has grown to a very respectable 17% – hey, EMRs may actually happen. I can only sigh to think of all the hospitals replacing all their spot vital signs monitors or other needless crazy things soaking up their budgets. Don't get me wrong – medical device data should be electronically acquired and integrated into EMRS – getting good workflow and not spending an arm and a leg is what's hard. The survey reports that 69% of hospitals are either installing or already have a fully functional EMR.
Good news for many of my clients: the current priorities for IT (for the next 12 months) are “reduce medical errors/promote patient safety” (54%, up from 50% last year), “replace/upgrade clinical systems” (a big increase from 29% in 2006 to 48%), and of course the seemingly ubiquitous “implement an EMR” (almost unchanged at 48% this year). “Process/workflow redesign” also got a 5% bump up to 35% in this year's survey. That process/workflow redesign would get separate mention is interesting, given that almost any new automation requires changing the way you do things. Of course hospital folks (being just like the rest of us) are notorious for resisting change, so it's encouraging to see this get special recognition.
Along with the emphasis on reducing medical errors and improving patient safety IT priorities, the top issue facing health care was reported as “improving the quality of care” – a whopping 69%, compared to 36% in 2006. Second was “patient satisfaction” at 55%, almost unchanged from last year's 51%. A new entry on the list this year is “Medicare cutbacks” at 52%. When you troll the Health Affairs blog, or visit The Healthcare Blog, they're all about transforming health care. The elephant in the living room is the fact that the feds have been transforming health care since the introduction of DRGs in the 1980s and their continued reductions in reimbursement rates. Nothing transforms an industry like falling revenue, well except for the big mill steel industry… oh, and airlines after deregulation, hmm, the record industry… and how about those US car manufacturers? Not surprisingly, “demand for capital” almost doubled from 18% to 31% this year – it seems the list of potential capital expenditures with an attractive ROI just keeps getting longer. In fact, under Most Significant Barriers to Implementing IT was “lack of financial support”, up slightly over last year to 20%.
Under Most Important Applications (next 2 years) both CPOE and EMRs dropped several points to 47% each. “Clinical information systems” jumped from 17% in 2006 to 46%. The 15 point drop for “bar coded meds management” (from 58% to 43% this year) elicited a question from one of the callers. With point of care meds admin applications at a market penetration of around 18%, why does the importance seem to be dropping. The short answer was they don't know, followed by supposition that not enough budget chasing too many projects was to blame. It was noted that bar coding for patient identification and other applications are seeing continued adoption in hospitals. In fact, Technology Adoption (next 2 years) is lead by “bar code technology”, raising from 69% to 74% this year. I think “bar coded meds management” dropped because the market is fractured between systems from HIT vendors who focus on pills and infusion pump vendors who focus on the pump. Whats needed is a system that encompasses all meds administration (that doesn't cost twice as much as today's systems).
One of two new entries under Most Important Applications was “point of care data collection” at 29%. This group must be made up of hospitals that tried to get nurses to type medical device data into their EMR, or they know that over half of all point of care diagnostics test results never make it into the patient's chart (not to mention nurse's complaints about docking stations and workflow with point of care diagnostics connectivity). The other new entry under this category was “evidence based medicine at point of care”, also at 29%.
Some point of care computing devices were mentioned under Technology Adoption. “Tablet computers” and “handheld PDAs” (aren't all PDAs handheld?) made the list at 62% and 59% respectively. Interestingly there is no mention of either computers on wheels (COWs) or wireless phones. There are two predominate use models at the point of care for computing devices, occasional and constant use. Charting, meds admin, vital signs collection are all examples of occasional use. Most hospitals employ COWs or prepositioned computers at or near the point of care for these apps. I would guess most all tablet computers would be mounted on a COW – they're certainly too heavy to carry around. Some vendors use PDAs for their occasional use applications. The nurse-carried use model supports applications that require continual accessibility, things like surveillance, alarm notification, voice communications, other event/message management, and worklists. (Yes, wireless phones are a point of care computing device.) These mostly nascent applications require immediate and highly reliable response from the caregiver, and thus must be with them at all times. So I'm surprised COWs and wireless phones didn't make the list – it's not like they're not being bought by a lot of hospitals.
Finally, the survey ends with Satisfaction with Vendor Performance, which was decidedly down. The “very satisfied” category evaporated from a not very high 8% last year to zero. “Satisfied” fell 10 points to 60%. The largest growing category was “dissatisfied” which went from 4% last year to 14%, followed by “neutral” which increased 8 points to 26%. Like meds admin, this trend also elicited questions from the media. HIMSS chair, Buddy Hickman, attributed this falling from grace raising customer expectations, and a notable gap between vendor marketing and their ability to deliver.
The industry is going through a transformation that is challenging both vendors and buyers. On the technical side, the emergence of middleware solutions and what I call the “enginification” of applications is causing waves and lots of new areas are seeing automation for the first time. The single vendor solution model is braking down, both because the level of automation in hospitals is starting to exceed the ability of any “single application” to address it (not to mention the ability of a vendor to cobble one together through acquisitions), and IT architectures like SOA and web services are making middleware a natural solution for enterprise-wide services (think Emergin and event management). Likewise it seems that every new application has an engine for this and an engine for that – rules engines, messaging engines, interface engines, positioning engines – geez, they're everywhere. All these engines must be tailored and/or configured on a per enterprise basis – a significant undertaking. The promise of these new technologies (the marketing) is tremendous, but the lack of experience with them (on both sides of the table) leaves the delivery and utilization of those promises wanting. We'll get through it.
More on Monitoring Unmonitored Patients
After reading a previous blog post, Susan Carr, editor for Patient Safety and Quality Healthcare magazine, asked me to write a feature article on monitoring unmonitored patients. The story will focus on increased patient monitoring to reduce adverse events.
I'm shooting for a feature length story, but I need your help. I've got plenty of references from the literature, but if you know someone who has a pre publication paper that I could quote, let me know. I'm also looking for folks to interview. So if you have a point of view on patient safety related adverse events, and how increased (or improved) patient monitoring could help, give me a call.
You can read about my previous article for PSQH on patient alarms here.
