Respironics was showing Respi-Link, remote monitoring capabilities through an RS232 serial port. The biomed must take the device down to their shop and connect it to a computer that runs a special Respironics client. Through this connection, users can download firmware updates and do run some diagnostics. Respironics is using Axeda for this feature, and support the Esprit, NICO and new vents. No word on wireless network connectivity.
Walking down the aisles, I came across the IMT Medical booth. The Viasys Vela ventilator they were using to demonstrate their test fixture sported an RJ45 connector for what is apparently an Ethernet connection. The product page only mentions “data output port for graphic and information systems” – which sounds suspiciously like a serial port to me. Perhaps a reader can enlighten us further.
The Tyco booth was dominated by Nellcor – and a rep sporting an attractive forehead worn SpO2 sensor. I was going to get a photo of him, but I'm really not that mean. Nellcor wasn't showing the wireless SpO2 monitor they displayed at the Rapid Response Systems conference last month in Pittsburgh. In the back of the booth was a Puritan Bennett ventilator – no connectivity really, just an RS232 serial port.
Radianse showed a new real time location system (RTLS) receiver. Unlike the previous boring rectangle, the new receiver sports a modern wave-like shape. Referred to by some as the “Captain Cruch hat,” the wider form factor supports a new antenna with a horizontal egg shaped receiving area. This new antenna reduces sensitivity to tags on adjacent floors, but maintains excellent coverage for the floor on which it is locationed. The back of the new receiver sports both power over Ethernet (POE) and a plug for a DC power supply. There is also a slot for a WiFi card so the receivers can be configured to talk to a wireless network rather than a wired Ethernet.
Radianse mentioned that there's a new patient worn single-use tag in the works, due later this year. This tag will be 40% smaller and less expensive.
At Draeger's booth, they showed their new telemetry system. This is the same system they showed last year as a “pre approval” system. They have received their 510(k) and will be shipping in the next few months. You can see a quick demo of this unique telemetry system here.
Draeger also showed a new “clinical PC,” the Infinity C700. This device sports a wide-screen display that shows a few more seconds of waveform. Like previous versions, there is an Ethernet connection between the patient monitor (in this case an Infinity Delta patient monitor).
Spacelabs was showing their Flexport. It was not really clear whether this was a new product or not. The module interfaces third party devices (they had an Edwards cardiac output monitor hooked up in the booth) to Spacelab patient monitors. A serial D-connector goes to the third party device, and an RJ45 connection goes to the Spacelabs monitor – it was not clear whether the RJ45 was an Ethernet link or what, but the module is configurable (by Spacelabs only). The module integrates both numeric and waveform data from third party devices, and supports alarms and alarm notification through Spaclabs' central station. It was not clear if the third party device data could also be passed to the EMR via a Spacelabs HL7 interface.
After the initial flurry of new RFID vendors, I was surprised to come across a brand new vendor. RadarFind has been in development for a number of years and offers a unique approach to indoor positioning – an approach they assured me was vastly superior to anything else on the market.
This system uses 900 Mhz, so it's not a WiFi based system like Ekahau or AeroScout. Here's the good part – the receivers are built into wall outlets and use the electrical wiring to transmit positioning data to a collector that aggregates data from multiple readers. This reduces installation costs considerably. Collectors are connected to the positioning engine (the software that determines location) via Ethernet.
Another difference with RadarFind is that the readers initiate communications with the tags, rather than the other way around. Tags run about $50 or less, depending on features. Their top dollar tag has a 3 position sliding switch that can be used to indicate status – so a caregiver or tech could indicate a specific status, like room occupied, dirty, or clean. Readers go for $200-$300 each.
The real secret sauce in any positioning system is how they determine position. RadarFind uses highly engineered MIMO (multi in/multi out) antennas in both the receivers and tags. The math used in the positioning engine utilizes both signal timing and strength in what they called “windowed RSSI.” They use “active null-busting” to minimize the effect of multipath interference, which is common in hospitals. Positioning accuracy was claimed to be between 8 and 9 feet. The system is installed in their first beta site, so they don't have data on percent of room level accuracy readings, etc. The company is VC funded, has raised about $5.5 million in 2 rounds, has 11 employees (they contract a lot of their engineering), and sells direct.
I stopped by Physio Control – their booth was sort of slow, what with the FDA stopping product shipments and all. Most of us from the vendor side for any length of time have lived through a similar experience; it is not fun. Physio does have some interesting things in development, and the first is released but had a “soft launch.”
They've got a solution that uses an ambulance gateway to link their monitor/defibs to a server farm on the Internet. These servers will serve up a web application for the review of “STEMI” patients – that's ST elevated myocardial infarction patients, those who benefit most from rapid therapy administration. The application will be community focused providing access to multiple hospitals so any diversion issues can be quickly resolved. The system is already in use in two communities, one in the tri-cities in Eastern Washington state and the other in the North East.
One unresolved product feature question is whether they will open up the system and allow other vendor's monitor/defibs connect to the servers on the Internet. I predict that if they keep the system closed (for a misguided competitive advantage) the system will see very limited adoption. If they open up the the system, many more communities will buy because they have devices from multiple vendors – either it's too expensive to replace all their monitor/defibs at once, or they're owned by separate entities. In this latter scenario, Physio will still have a competitive advantage against every vendor who has yet to integrate with the solution – integration for Zoll, CardiacScience or Welch Allyn could easily take 12 to 24 months, and some may even be foolish enough to refuse the opportunity to participate. Tendencies towards proprietary systems strategies run deep – I don't expect Physio to open the system, but time will tell. A couple of Physio's devices include Bluetooth and they are looking at WiFi connectivity.
Zoll showed a new R-Series monitor/defib intended for hospital crash cart use. The device will soon sport an 802.11b radio – when I teased them about their “primitive” radio, they noted that a follow-on radio will support 802.11b/g. What's really weird is that the radio will only work peer-to-peer, talking to a PDA used to capture data and document code events in Zoll's PC-based CodeNet application. A future version of the radio will connect to the infrastructure (the hospital's access points) to provide an enterprise-wide defib dashboard. This device maintenance and readiness application will indicate test results, devices that require servicing, and in a future version download firmware updates, provide network clock sync, distribute the hospital's standard defib configuration, and provide access for remote diagnostics from the Zoll mothership.
The Anritsu RF analyzer is the preferred tool for RF trouble shooting and identifying sources of interference. At $14,000 this tool is not as widely available as it should be. Current barriers to adoption include price, complexity, and the perceived skill level required of users. With the rapid uptake of wireless technologies in hospitals, some improved marketing could make this device part of the standard kit in every hospital's clinical engineering shop. Hopefully they'll start to think outside the box and get this important tool into a greater number of sites.
Pictured right is the Anritsu Spectrum Master.
UPDATE: Word has it that Physio Control will open their STEMI Internet-based information system to third party monitor/defibs. This is driven by the fragmented market where a community may have multiple EMS agencies, referring hospitals and PCI centers.