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Author: Tim Gee

Secure Messaging Middleware Market Defined

What do secure communications, care team coordination, patient engagement various workflow automation solutions and alarm notification have in common? They’re all examples of messaging middleware solutions found in health care. Which begs the question, what the heck is messaging middleware? This label is a term of art that was first coined by Emergin in the early to mid 2000s. As the name of a product category, it’s descriptive of the underlying technical functions of the product, but has nothing to with how the products are actually used – which can vary considerably. All of this said, the term messaging middleware...

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HIMSS 2014 in Review

The HIMSS conference is so big, with so many different kinds of attendees and exhibitors that it’s almost impossible to have one big theme for any given year. Yet the question of theme for any given HIMSS is something we all talk about. The themes one perceives are at least partially defined by our own interests and area of focus. Consequently, the #HIMSS14 themes for me were: The shifting product and value proposition focus of many of the vendors I track, The tension between spot solutions and enterprise solutions, and The big buzz word of the show, population health....

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Defining the Point of Care Market

It’s useful to segment and analyze markets for developing company and product strategy or analyzing competitor’s actions. Such an exercise helps illuminate why companies and markets do what they do – and what they might do in the future. In getting ready for this year’s HIMSS in Orlando, I’ve been thinking about the point of care (PoC) market. At the first Medical Device Connectivity conference in 2009, I defined the PoC market as the workflow and data associated with direct patient care in nursing units, the ED, surgery and related areas. This contrasts with EMRs managing orders, diagnostics, capturing...

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Role of Montoring Techs in Alarm Notification

Challenges with alarm notification and fatigue have plagued the health care industry for decades. Long before alarm notification systems like Emergin (now Philips IntelliSpace Event Management) and GlobeStar Systems (ConnexAll) appeared, some hospitals addressed alarm issues with the original alarm notification system, monitoring techs. Monitoring techs remain an accepted and effective tool in the constant battle to reduce alarm fatigue and avoid failure-to-rescue events. With the growing adoption of electronic alarm notification systems, is there still a role for monitoring techs? Are electronic alarm notification systems superior to flesh and bone monitoring techs? This blog post will explore monitoring techs...

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Guidelines for Using Wi-Fi for Medical Devices

On a recent LinkedIn group discussion, the following question was posed by Taimoore (Tim) Rajah of the NIH: We are encountering many hospital which are still based on wired LAN technology for medical device connectivity. Many have mentioned their gripes and major concerns about using Wi-Fi technology for patient monitoring and drug delivery monitoring in the OR as well as ICU departments. Many hospitals are still using WMTS telemetry in their more critical patient monitoring areas. This is very expensive and maintenance for such a system is costly. Can you tell us what are the major criteria to ensure...

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Order Workflows

Except for emergent situations, no medical device is used without an order. And if not an order written to accomplish a certain clinical task for a specific patient, then “standing” orders captured in written policies and procedures to handle frequent, routine situations. Consequently, orders are one of the first workflow steps in medical device connectivity. Orders are pervasive, used in all health care delivery environments from acute care hospitals to patient’s homes. Principal ways connectivity can add value to medical device are enhancing patient safety, improving clinical efficacy and productivity. That the inappropriate use or misuse of medical devices can result in patient injury or death is not news. Proper use or misuse can start with the order. Well designed and implemented order workflow automation in a connectivity solution can impact patient safety, the efficacy and utilization of the medical device, and staff/unit productivity. Besides their own unique considerations, order workflows share many of the risks and potential benefits of other types of connectivity workflows. Diagnostic vs Patient Care Devices The nature or characteristics of order workflows is highly variable. When analyzing order workflows, it can be useful to consider the similarities and differences between how orders are used with diagnostic and patient care devices. Diagnostic modalities, be they interventional radiology suites, endoscopy labs or EKG carts, tend to be procedure volume oriented operations. Typically, what’s being ordered comes right...

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Scheduling Workflow

Scheduling is not a workflow one normally associates with medical device connectivity. In some applications, scheduling is handled by software separate from the connectivity solution. Sometimes, scheduling is not done at all. In other applications, as we shall see, scheduling is so much a part of the broader workflow, that it’s hard to recognize as a scheduling task. Two illustrative aspects of scheduling will be discussed, scheduling for diagnostic modalities and scheduling for routine patient care tasks. Because it’s less understood (and frankly more interesting) we will look at scheduling for routine patient care tasks first. Patient Care Task Scheduling Patient care tasks encompass routine activities carried out by caregivers and/or aids. Examples of these routine tasks include vital signs collection, medication administration, bed turns (to avoid hospital acquired pressure ulcers, or HAPU), and respiratory circuit flushing (to avoid ventilator acquired pneumonia, VAP). These tasks must be completed at a predetermined frequency on a reliable basis or adverse events – including patient death – can result. While the scheduling workflow diagnostic tests is very medical device centric (getting the patient to the device), patient care task scheduling is more patient centric (as in ensuring that certain patient care tasks are completed). The order for these routine tasks come from the ordering physician in numerous ways. Often the actual patient care task is implied by the physician order and must...

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Patient Context Workflow

Connectivity enabled medical devices send patient data right out of the medical device to a network, be it a body area network, cellular broadband network, home or enterprise network. The network then conveys this medical device data to databases and applications that store, display and manipulate the data. When a medical device is directly attached to a patient, there is no question as to which patient the device data belongs. As soon as the data leaves the actual medical device via the serial port or a network connection, the association of that data with a particular patient is no longer obvious. Much of the data used in establishing and maintaining patient association or patient context comes from, or is stored in, the patient management database. Patient management workflow is an important enabling component in the overall connectivity solution and key to patient context management. It is critical to reliably know that the data from a medical device belongs to a particular patient. If the data is not associated with any patient it’s worthless; should the data be associated with the wrong patient it could be deadly. When patient data from patient A is misidentified as belonging to patient B, patient A can miss out on a life saving clinical intervention that is mistakenly applied to patient B. In this example, patient A may die due to a lack of...

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TCBI Medical Device Connectivity Conference 2013

In a few short weeks, TCBI will be holding their 5th annual Medical Device Connectivity Conference in Herndon, VA (the Washington DC metro area), November 21-22. It seems like the first conference was only a year or two ago. Medical device connectivity, or the more fashionable (and some might say, more descriptive) term interoperability, has both changed significantly and remained the same over these past 5 years. Lots has changed on the regulatory and HIT governance front. The FDA has issued guidance on mobile medical apps, wireless medical devices, and cyber security – just this year. The FDASIA report on regulating HIT was presented to the ONC, FDA and FCC. Almost in tandem with regulatory advances, there is a growing awareness of the need to improve hospital IT governance to accommodate the safety-critical medical device systems that are increasingly supported by enterprise IT infrastructure. Examples start with the promulgation of IEC 80001 in 2010 and more recently to include an article I wrote last year, The IT/Clinical Engineering Governance Gap, and this year, the ONC’s grant for the SAFER project on best practices and risk management for HIT (reference article here), and ECRI Institute’s Health IT Hazard Manager and their overall focus on patient safety and HIT. The creation of alliances to promote connectivity and interoperability grew this year as well. Both the CommonWell Health Alliance and the West...

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Patient Management Workflow

A key feature of all connectivity solutions is a database that includes all of the patients associated with the system’s medical devices. This is called a “patient census” or ADT (admission, transfer and discharge), much like the way a hospital’s ADT system manages patient demographics for the hospital information system or EMR. Also referred to as patient management data, these data often include: patient name and ID number (permanent medical record number, episode of care number, or both), current assigned location of the patient, and the device associated with the patient. Depending on the application, these data can also include more operational or clinical things like assigned caregivers, admitting and/or attending physician, admitting diagnosis and service unit. It is also possible that this operational or clinical data may be stored in a different file, separate from patient management. Some workflows or systems queue up patient information prior to arrival or application of the medical device, while others capture or generate patient demographics when the medical device is first applied to the patient. In any event, the connectivity solution must capture patient demographics that are sufficient to ensure correct patient identification and possibly additional information that relates to the use of the medical device (e.g., body surface area – or the data to calculate it, weight, etc.) Common methods to capture patient demographics are an ADT interface and a method...

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