John Zaleski over at MedicInfoTech has an interesting post on the design for a central surveillance system that supports ventilators from multiple vendors. Referred to as the Remote Mechanical Ventilation Manager, the system is a rather conventional affair similar to systems for patient monitoring. The system assumes RS232 interfaces on the ventilators.

Changes in hospitals over the past few years have heightened the market requirement for ventilator connectivity. Once limited to critical care areas, ventilated patients who don't require the 1:1 nurse to patient ratio of an ICU have increasingly been transferred to lower acuity on-service units or general care wards. Patients that were once found in highly concentrated locations are now all over the hospital, presenting challenges for respiratory techs and the busy nurses that provide their immediate care.

RTs typically have no visibility into the status of their ventilated patients, until they receive a page or are at the patient's bedside. This lack of data - real time performance, ventilator settings, alarms, and orders for therapy or care - creates an environment in which human error can flourish.

An increasing burden has also fallen on the staff nurse who must juggle the care and vigilance for 5 to 8 patients and keep track of a ventilated patient. The lack of alarm notification beyond local alarms on the device places a special burden on the unit to place ventilated patients where alarms can heard. Coordinating care with respiratory therapy and consulting pulmonologists represents additional complexity. Finally, documentation of ventilator settings, therapies and any resulting clinically significant alarms adds to RT and caregiver documentation responsibilities.

CMS' recent IPPS draft rules for 2008 include provisions for no longer reimbursing hospitals for preventable adverse events. On this list of 13 "hospital-acquired conditions" is ventilator acquired pneumonia (number 7 on the list). As hospitals realize that they will be at greater risk financially with ventilated patients, the need to automate care, surveillance, and alarm notification will increase dramatically.

All this unmet market need creates both opportunity and risk for ventilator vendors. The opportunity revolves around leveraging connectivity features to differentiate and offer unique capabilities. The risk is that competitors may field connectivity features first and lock you out of and increasing number of sales situations. Basic connectivity features fall into a few categories:

  • Surveillance: the ability to remotely view ventilator settings, performance, alarms from locations like RT areas and nursing stations.
  • Alarm notification: alarm annunciation communicated to the caregiver.
  • Event review: the ability to look at past changes in patient condition and response to various therapies, alarms and other pertinent events.
  • HL7 interface: used to export ventilator data to the patient chart and pull in patient demographics for patient identification.
  • Remote access: a web server that provides clinicians the ability to view near real time patient data anywhere there is network connectivity, event across the Internet.
  • Wireless: since RTs and caregivers are almost continuously mobile, you get extra points for wireless enablement of ventilators and the above connectivity features.

The ventilator market is one of the few medical device markets that has avoided "standardization" - where hospitals standardize on just one vendor's products. Proprietary end-to-end connectivity systems could drive hospitals to standardize, possibly squeezing out niche vendors. Note that John's paper shows an installation made up of both Puritan-Bennett and Siemens vents.