New Studies Dispel Misconceptions at Point of Care
I spoke with founder and managing director of Spyglass Consulting,
Gregg Malkary yesterday about two of his most recent studies. The latest is
Point of Care Computing for Nursing (press
release – pdf), and released this October, the same topic targeting physicians (press
release – pdf). Gregg did his first study on mobile computing
in 2003, with follow on studies targeting nurses and physicians in 2004
and 2005. Two years down the road, it was time to take another look -
with some surprising results. The bottom line: significant progress in many areas, but overall there’s still a long way to go.
This latest study provides a nationwide perspective that reveals both product
shortcomings and pitfalls for deploying technologies. In further support of the adage, “you don’t know what you
don’t know,” some of the findings are counter intuitive. According to
Gregg, a lot of the findings are actually misconceptions. Impressions created by trade publications and vendor sales and marketing creates most of these
misconceptions – held by providers and vendors who have drunk their own (or others) Kool-Aide. Let’s start with
networks.
The study found that 64% of nurses in more than
half of the hospitals
believe their wireless network is not reliable enough to support point
of care computing solutions. That’s a frightening majority of the hospitals with poorly
designed, installed and/or managed wireless LANs. This contrasts with
the perception that wireless LANs are pervasively deployed, with great
coverage and solid performance. The study describes a
hospital in the Chicago area where nurses have taped X’s on the floor
were they can get a good network connection. With the
exception of the leading edge hospitals – the magnet or “most
wired” hospitals – wireless network deployments in patient care areas
have a long way to go.
Another misconception includes
computers on wheels (COWs) that are intended to be rolled up to the bedside for meds
administration and paperless charting. Barcoded patient
wristbands are read by the scanner mounted on the COW. The
survey found that the majority of COWs remain in the hallway and
are rarely (if ever) pushed to the bedside. And those barcodes are
frequently hard to scan (especially depending on the selection of
barcode, printers and wristband material). Hospitals were found to make extra
copies of wristband barcodes (or to cut them off patient wrists) and scanned at the nursing
station – apparently where it’s more convenient to scan the darn things
several times each. Perhaps if the cable on the barcode scanner were
long enough to reach the patient from the hallway…
One of the conclusions from the report is that many point of care devices are not well integrated
with applications and workflow. Many applications are not tuned for
clinicians and are hard to use. There are few examples where point of care device and application vendors get together to, you know, make their stuff work well together.
Most point of care devices (with the exception of Motion’s C5, the Emano Tec, and a very few others) are really intended for corporate applications, your stock broker or the UPS gal. These devices lack key features for clinical environments. And it seems that neither device or software vendors want to optimize applications for specific devices.
Security was another common complaint. The
way many IT departments have implemented security it takes 1 to 3
minutes to log in. And of course every time the caregiver has to leave
the keyboard – and they’re constantly interrupted – they have to log
back in. Many caregivers end up making notes on paper and then typing them into the EMR later in the shift when they have more time.
The integration of technologies, training, and user acceptance were found to be key to successful deployments. This is no secret, but the frequency at which these things are poorly executed may surprise you. Sites with active nursing informatics departments had the best implementations. The farther down the scale in nursing involvement, the worse the implementation. Conclusion: IT (and many vendors) just don’t understand clinical workflows.
From the Physician study, it seems vendors are still in love with the physician market – not that there’s been a lot of adoption to encourage such interest. The inclination to “follow the money” does not fit this market segment. While physicians account for almost all the revenue generated in a hospital, the vast majority of these docs do not work for the hospitals. In fact, in most community hospitals there is this an unhealthy co-dependent relationship between physicians and hospital administration that works against consistent IT usage.
Few hospitals have any reason to buy technology for physicians, nor to expect physicians to actually use what the hospital may buy for them. These studies show a hopeful trend. Hospitals are increasingly enforcing IT usage among attending and consulting physicians. Some hospitals are even suspending physician privileges for non compliance. Older docs are getting more comfortable with technology, through cell phones, the Internet, and email. The big are of contention uncovered by the study is private practice, and whether the physician wants to change or invest in technology like a practice EMR.
Surprisingly, 75% of physicians use smart phones. Usage though is limited to communications, personal productivity, and the occasional reference tool (if no other reference is available). There’s lots of vendor hype around smart phones and similar devices. For most uses the screens are too small, and vendors aren’t optimizing their user interface for these kinds of devices.
Here’s an except of data from the studies published by iHealthBeat:
Forty percent of nurses surveyed in September said health care IT
vendors were delivering high-quality solutions targeting nursing
workflow, up from 28% in June 2004, according to a survey by Spyglass
Consulting Group.The September survey also found that 64% of
nurses surveyed said they were concerned that their facilities lacked
the appropriate infrastructure to support point-of-care technology,
including reliable networks, interoperability and security
requirements.
About one-third of nurses surveyed in September
said they were ready to adopt computing applications at point of care.
This represents a 325% increase from June 2004, when just 8% of nurse
surveyed said they were ready. However, just 34% of nurses said their
organizations are investing in point-of-care computing technology, down
from 35% who said the same in June 2004.
The need to improve patient safety and reduce the risk of medical errors drive investments in point of care automation. The market has made progress, but little or nothing has been done to improve clinician workflow. Effective solutions must provide
timely access to the right information to support better and more timely
decisions at the point of care – that means good workflow.
Current deployments of meds administration and nursing documentation apps show increased utilization, but also that they are not being used as intended. The hardware to support these apps are both
fixed location devices (nursing stations, COWs) and mobile devices.
Based on findings from both studies, it is clear that there is no one killer device. The best device depends on the environment, personal preference, tasks to be performed, urgency of the situation, and how well the complexity of the application is matched with the device – you’re not going to do patient charting on a Blackberry.
You can read about some other Spyglass studies here and here. Pictured right is the Emano Tech tablet computer – not perfect, but getting close.
Philips to Acquire VisICU
Philips announced yesterday that they reached a merger agreement to acquire VisICU for $12 per share, $3 over the current share price. From HIStalk, “Visicu earned $9 million on sales of $36 million over the past year. In
the 20 months since its IPO, Visicu shares have dropped from nearly $25
to below $9. Its board has approved the acquisition and recommends that
its shareholders approve it.” VisICU also had $130 million in cash on their balance sheet at the time of the agreement. The value of Philips’ offer totals around $300 million.
The Philips’ press release describes their rationale for the purchase.
By integrating VISICU’s remote patient monitoring and clinical
decision support technology with Philips’ patient monitors, both
companies expect to accelerate growth by offering products that provide
more effective clinical decision support to hospital staff, while
allowing them to monitor far greater numbers of critically ill patients.
Sounds like an extension to the old “proprietary end-to-end solution” strategy. The VisICU service would seem a natural extension for their ICU monitoring business. Tighter integration could probably improve performance and usability. Whether that would translate into better patient outcomes is questionable.
Rumor has it that Philips has one more acquisition to announce before the end of the year.
Medical Device Interoperability Lags Behind Technological Capacity
Yours truly was quoted in an article in FDC Reports’ newsletter The Gray Sheet (subscription only) last week about connectivity. The story was inspired by a comment from Bill Crounse, the director of Worldwide Health at Microsoft, during the World Healthcare Innovation and Technology Congress held in Washington, D.C., earlier this month. He said, “”I no longer believe that technology is really the issue that prevents us from getting things done. We have the technology … We’ve cracked the code on things like mobility and wireless devices and broadband. The remaining barriers are really all-around barriers to adoption.”
The story provides an overview of connectivity in both acute care and remote monitoring, from both vendor and customer perspectives. The story closes with this observation:
“The medical device companies are becoming chimeras, where they’re part IT company, and they’re part embedded system company,” Gee noted. But, as long as their mindset remains that of an embedded system company trying to protect the “black box” of proprietary system design, it will be difficult to move forward, he said.
Jason Williams expresses a similar lament about the lack of connectivity in a great post on NeoTool’s blog titled, Bridging the Device Divide. In a comment to the post, standards guru Todd Cooper observes:
Bottom line is that medical device vendors make more money with either proprietary connectivity or strategic partnerships, and end users – provider orgs – do not demand open standards-based connectivity. It is often called out in RFPs – but gets dropped in the decision making process. K-P [Kaiser Permanente] is one of the few org’s drawing a line in the sand on PnP med dev connectivity. “Collaborative partnerships” are the status quo and have been the basis of controlling and limiting device connectivity both at the PoC and to the enterprise.
Todd’s referring to Kaiser’s new purchase contract language that specifies medical device vendor responsibilities for supporting connectivity. You can read an except of the contract language in this post. Rumor has it that Philips has recently declined to meet some of those requirements; it will be interesting see if Kaiser sticks to their guns and drops Philips as their patient monitoring vendor going forward.
In Jason’s blog post he quotes Robert Nadler who says, “…our business is building medical devices, not EMR solutions.” I don’t think medical device vendors will have the luxury of maintaining that point of view for much longer. I spoke with David Freeman and Munesh Makhija of GE Healthcare’s patient monitoring group a few weeks ago. They attended the CMEF and saw an exhibit floor filled with vendors who are doing the same color displays with waveforms that GE is doing – at 30% lower cost. Rather than playing the manufacturing cost game, GE is looking to software to add clinical value and differentiate from low price competitors. Philips seems to be taking a similar approach with their acquisitions of Emergin and VisICU.
The days of staying in that nice familiar embedded device comfort zone are limited. This has always been the case as connectivity transforms medical device product categories. Remember E for M? They were once the market leader in cath lab recorders. They too decided they didn’t want to do software. They contrast nicely with Marquette Electronics who saw connectivity as an opportunity and redefined the product category – driving E for M out of business and capturing a major share of the cath lab market. (Another great example of leveraging connectivity is Alaris.)
You can access both Jason’s and Bob’s excellent blogs from the Blog Roll in the right hand column of this web page.
LiveData Advances Medical Device Interoperability
Great news in Healthcare IT News:
LiveData has been awarded a $70,000 Small Business Innovation grant in order to
develop a plug-and-play feature to implement standards for OR workflow
and medical device interoperability. The plug-and-play feature will enable devices to work together, to
create safety interlocks, and help ensure that clinicians make
decisions based upon all available information.
LiveData’s provides data integration, mostly in the surgical suite. Unlike video systems from Stryker and many others, LiveData combines real time medical device data with IT systems (EMR, PACS, etc.) and video.
LiveData will team with Draper Labs, Massachusetts General Hospital and CIMIT to do feasibility work in the medical device plug-and-play architecture called the Integrated Clinical Environment or ICE. LiveData will provide the software foundation for the grant project.
Awarepoint RTLS Installed at UCSF
Awarepoint was chosen for asset tracking at University of California San Francisco Medical Center (UCSF). The vendor selection team looked at 6 different systems and selected Awarepoint. The story in Healthcare IT News highlights the technology’s use for improving productivity in the surgery department.
Here’s what jumped out at me:
Installation and the tagging of 700 assets throughout UCSF Medical Center took under 48 hours.
Whoa. The 700 tags is not much for a 500+ bed hospital; what got my attention was the 48 hour installation time. A brief blurb on the product explains:
Awarepoint’s RTLS needs no hardwiring or fixed infrastructure due to
wireless sensors, which plug into electrical outlets. Assets are
attached with small, battery-powered tags, which are tracked using the
Web-based Searchpoint search engine.
Pictured at right is an Awarepoint ZigBee receiver, shot in the wild.
