Market Trends Series #3: Shift from Dept to Enterprise Focus

From what I have observed over many years, Hospitals have historically approached medical device connectivity projects as a tactical issue to be dealt with. Up until relatively recently, technology alone could be used to solve the connectivity issue (i.e. getting data from point A to point B) with little to no negative impact on clinical workflow. Further, the scope of connectivity projects has been mainly departmentally focused and deployments have been relatively basic. By basic, I refer to projects that have focused on connecting one or two bedside medical devices to a single CIS application or EMR.

Evidence of all of this can be found by looking back at the past 10 or more years and examining typical implementations of biomedical device connectivity to information systems.

•    Most implementations up to now have been in very specific care areas such as the ICU and OR.

•    Most implementations are relatively small in scope, often in the area of about 20 to 50 beds. Incidentally, for most US hospitals this happens to be about the same number of ICU beds per facility.

•    In the ICU, the key devices that are interfaced are typically multi-parameter patient monitors and sometimes ventilators – but vents to a much lesser degree than monitors.

•    In the OR, the key devices are typically patient monitors and anesthesia/gas machines.

•    Outside of high-acuity care areas, in the general ward there are some limited niche interface solutions for mobile vital signs data capture. Many of these are only semi-automated in terms of truly automating both the data capture and the clinical workflow.

•    For virtually all of these implementations, the data collected from the devices is identified though a mapping of the medical device’s location – that is a bed or room location identifier is used to associate the data and alarms.

•    The device workflow – that is the steps clinicians are required to perform at the bedside to interact with devices to establish connectivity – has been limited. This is because most of the devices are actually fixed to the location – i.e. the monitors in ICU are mounted to the wall and data is interface via a networked gateway with outbound HL7.  Therefore few if any steps are required by clinicians because the devices are permanently tethered to a local PC or terminal server that facilitates the data collection.

But as discussed in some of my previous market trends postings – requirements for connectivity have been changing and in some not so subtle ways. Many hospitals are

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Market Trends Series #2: Patient Safety

This is the second post as part of an ongoing series that discusses the market trends that are affecting the evolution of medical device connectivity (MDC) technology. I received some good comments from my previous post – please consider sharing your thoughts, ideas, and experiences.

The second trend I’d like to discuss is the shift towards patient safety as one of the key market drivers for connectivity. It is probably not news to anyone that patient safety has become one of the key drivers for many healthcare IT initiatives. But what is the relationship between patient safety and MDC? Ever since the often referenced IOM report, To Err is Human: Building A Safer Health System, hospitals and vendors alike have increased their focus on driving towards significant reductions in medical errors. The industry as a whole has made great strides, but still lots of work remains.

With device connectivity, my experience has been that for at least the past 15+ years, the key driver has been making the nurse more efficient by eliminating the manual transcription of device data into the patient’s chart. One of the related benefits is a more come complete and legible patient record. However, one could argue that the more legible patient record could be achieved if the vital signs from medical devices were simply typed into the charting application manually (something that many hospitals are actually doing today). So I believe that the nursing efficiency argument holds as the primary driver – but that is starting to be challenged by the focus on patient safety as it relates to connectivity.

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Market Trends Series: Wireless Connectivity

Fresh back from the MDC Conference in Boston last week – great inaugural event and a perfect venue at Harvard Medical School. Thanks to Tim and the conference organizers — I personally heard many very positive comments from a number of attendees.

As the healthcare market continues to evolve, so do solutions related to medical device connectivity. I would like to invite you to join me in a dialog over the next several weeks – perhaps even on an ongoing basis – that will explore the trends that are affecting the market of medical device connectivity.  The idea is to have an open and interactive discussion on where the technology is today, where it needs to go, and what is driving the market.  Remember that this is just my viewpoint as I see things based on my experiences. Perhaps your experiences and perspective are similar or maybe they are completely different.

So, let’s begin.  The first trend I’d like to talk about is wireless medical devices and the impact on connectivity.  We all know that more and more medical devices are becoming wireless and therefore more mobile, for example more and more smart IV pumps (smart pumps) are being implemented every day. One key aspect of wireless technology is the fact that wireless enables devices to become untethered, and therefore a mobile use case is enabled. Wireless medical devices such as smart IV pumps and patient monitors add to the list of connectivity challenges because, from a pure connectivity perspective, they have basically eliminated one problem (the use of a serial data cable) and often create others. Once a medical device is no longer connected to something that facilitates data integration (like a bedside terminal server for example), then part of the connectivity and integration problem often shifts onto the manufacturer of the medical device.

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Managing Patient Context for Bedside Medical Devices – Today’s Situation

Clinical users have been managing patient context in various ways with medical devices for many years. With some classes of medical devices, this is nothing new.  So you might ask — what is the big deal here with patient context and what has changed that makes this topic relevant today?

As I stated in a previous post, managing patient context is all about the clinical workflow.  My working definition of patient context for medical devices is the linking of any information produced by a medical device (including data parameters, alarms, control settings, waveforms, etc.) with a specific patient identifier.

From a patient safety perspective, the best way to establish patient context is to tag data leaving a medical device with a unique patient identifier. And ideally this should be performed at the patient’s bedside where devices can come and go. There is clinician workflow associated with managing patient context – and this is perhaps the most important aspect.

We live in a dynamic world where technologies, products, and user requirements are constantly evolving. Take wireless medical devices for example. Wireless has evolved over the past few years and adoption will increase for the foreseeable future. When connectivity is wireless, patient context becomes even more challenging.  Another example is with the evolving requirements for automatically integrating device data in to an EMR. The EMR market is moving beyond relatively simple patient monitoring vital signs interfaces and is now looking to integrate all bedside device data including smart pumps.

If you look at what is quickly evolving at the point of care today, patient context is becoming more of a challenge for vendors that manufacture the medical devices and as a result, end users (clinicians) are being asked to perform the task of establishing patient context at the point of care. So let’s look at how patient context is currently managed (if at all) and the impact on workflow.

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Why Wireless Connectivity is Different

Wireless changes everything …

I have been watching the evolution of wireless bedside medical device connectivity for several years now. It is now fairly common for medical devices to communicate wirelessly and most hospitals now have the requisite Wi-Fi networks installed and operational. In fact, the saturation point of WLAN adoption in US hospitals has been reached as the numbers are quickly approaching 90% of all US hospitals.

But this posting is not about Wi-Fi or other wireless technologies used in medical devices. Rather it is about additional connectivity considerations beyond the actual wireless connection of the device to a network. Regardless of the wireless connection technology or standard used, wireless changes everything when it comes to connectivity.

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