D-Link Ships Mobile Router
Another mobile router hits the market. The D-Link unit provides a WiFi hotspot by using an EV-DO network card from Verizon or Sprint.
The new DIR-450 is
designed to accept an EVDO card from carriers such as Sprint, Verizon
or Alltel. To make it work, you plug the device into a source of
12-volt power (including from an external AC power supply) and insert
the wireless data card.
Once that happens, you'll have a mobile Wi-Fi network.
A second version, the DIR-451, due out later this quarter, will support
UMTS and HSDPA devices from Cingular, T-Mobile and others. The DIR-451
is designed to work globally.
The DIR-450 and DIR-451 will also work as a wired router
if a wireless data card is not inserted. The router includes a 4-port
full duplex 10/100 switch to support wired Ethernet devices in addition
to Wi-Fi devices.
You can read about other mobile routers here, here, and here.
Remote Service Infrastructure – Day One
The first presenter was Harald Fiedler with Philips Medical Systems,
from my old stomping grounds in Bothell, Washington. His focus was on
lessons that he's learned from remote service implementation. Harald lead off with a truism: you don't know what you don't know. That is so true any time your business takes you outside of your traditional core competencies. Adding connectivity to a medical device – whether for workflow automation or remote service – takes your organization outside established core competencies.
He
presented some IMV survey data on what customers value most, and by far
service speed was number one. Remote service also provides better
control and management of your installed base. It's easy to know what
you've shipped, but without remote service, you have a hard time
determining what's still in use and the degree of utilization. Philips
has 22,000 systems online at 3,500 customer sites (almost all big-iron imaging modalities). Philips connects to
their devices over the Internet doing proactive monitoring, collects
utilization stats, application training and support, and pushing out software
updates. For example, one of the parameters they track on MRIs is He+
boil off (that's to coolant used in the magnet).
He next hit on what he called the “messy network problem” – getting information from your product
on the customer's network into your enterprise. He sees the remote product monitoring market
starting to transition from early adopters to a more mainstream market.
One indicator of this is the spate of recent acquisitions among remote monitoring software vendors (nPhase, Questra, etc.)
Harald also
mentioned
crossing organizational silos as an important issue – and was a theme from yesterday. C-level buy-in is
critical in getting the organizational focus required to move an
initiative that crosses silos. Security was another topic that was
highlighted, especially understanding requirements. It is also
important to have a marketing guy who understand the remote service
technology and can package the service and create service product
positioning and sales tools – remote service is a product, much like
the devices you're going to monitor remotely, so a product development
and marketing process is necessary for success.
On the topic of security Harald mentioned call obfuscation – security products that hide the actual kind of operating system the system is running – as an important technology. He also took the position of “no analog modems!” Analog modems represent an open port with access to your customer's network; the lack of strong authentication means you don't know who's calling in; analog models don't provide the ability to monitor or see what data is going out, and modems have more reliability issues than network/VPN connections. ISDN modems are prevalent in Europe and don't have the problems of analog modems, and the same holds true with cellular modems used to access wireless wide area networks.
World wide security regs that Philips must comply with includes:
- HIPAA – USA
- BC 73 – CDN-BC
- Bundesdatenschutzgesetz
- EU 95/46 – EMEA
- Various APAC regs
He also mentioned cross border PHI (patient health information)
requirements, some of which limit access to patient identifyable data
from outside the country where the data resides. Philips avoids
accessing any PHI through remote service. The scrub PHI from devices
and data entering the data center for legacy devices. New products
include an enforceable product security policy that cleanses the PHI
data on the device. No PHI is logged for service, and PHI is always
encrypted when it is removed from the device/customer site whether it's on a CD, or a technician's laptop.
Great question about using the customer's VPN solution. The reality is that field service reps could end up with numerous VPN tokens from various hospital's VPN appliances. Because the tokens are “owned” and managed by the hospital (or more importantly not managed by the service vendor)
Next up – a panel discussion on analyzing connectivity options in remote service. On the panel are Winslow Soule, CTO of Integration Display Systems; Jenny Coleman, manager service tool development at Invensys Process Systems, and yours truly. Negotiating network access wiith customer IT departments for remote service is a challenge in every industry. The consensus of the panel was that the best way to overcome IT resistance is education – the quicker you can get ahead of IT's objections with facts and analysis, the quicker and easier it is to gain IT buy-in
After the break, David Geltner, director of engineering at nPhase, and Bill Wark of Siemens talked about “untangling the messy network of cellular wireless.” Wireless wide area networks are an ideal connectivity vehicle for some remote service applications. Field service workflow automation is probably the biggest cellular application. Deploying devices with cellular modems comes with a heavy administrative burden – provisioning, tracking SIMS, consolidating bills, etc. nPhase provides an infrastructure for managing the logistics of deploying and managing a large number of geographically distributed cellular modems. If you're embedding your radio into your device, you must get it certified by the carrier(s) for running on their network.
Pictured right is a Zonar tracking unit utilizing a Siemens GSM/GPRS cellular radio module with integrated GPS receiver.
Optimizing and Securing Remote Service Infrastructure
This must be the height of conference season – I'm at another conference this week. Yesterday I presented a 3 hour workshop titled “Understanding How the Introduction of New Equipment Impacts the Networked Customer Environment: Lessons in Connectivity and Security.” Whew! Medical device vendor attendees are well represented here. My interest in the remote service topic is the considerable relationship between medical device connectivity and connectivity for remote service.
The first workshop yesterday was “What Data Do We Need to Collect? Data Architecture for Remote Service” presented by Yousif Hassan and Asad Jobanputra, both of Esprida Corp. They presented an inward focus on the issues to consider when creating and implementing a remote service system in your company. Identifying data elements, workflow automation, new procedures that are required were all discussed.
My workshop was a nice complement to the first one because my focus was external – gathering requirements from customers, especially for network connectivity, remote service “productization”, and security. Specific processes were presented that describe how to gather network and security requirements from your customers, a review of HIPAA requirements, and a deep dive into Business Associate agreements and resulting operational requirements Business Associate agreements place on vendors. Networking rocket scientist Dave Hoglund, of Integra Systems, collaborated on the creation of the presentation especially around specific methods, techniques and vendors offering remote IT monitoring capabilities for wired and wireless networks, SNMP, etc.
The last workshop (we went until 8pm!) was “Wireless Connectivity Options for Remote Monitoring and Management.” John Canosa and Richard Hecht gave a great overview of the whole alphabet soup of wireless technologies. In addition to reviewing the various characteristics of each different wireless technology (range, bandwidth, cost, etc.) they presented a process for determining which technology is best for your application. Great stuff.
Pictured right (at the front of the room) is Aurora Santiago, event producer, introducing the keynote Steve Pazol, VP & GM of NPhase and fellow blogger – check out his site.
AirStrip OB Users Profiled
GE Healthcare introduced AirStrip OB, their wireless fetal monitoring surveillance product at HIMSS 2006 in San Diego. Here’s a story about the system and some early users in the San Antonio Express News. The 510(k) approved system transmits near real-time waveforms from GE fetal monitors for obstetrician’s to use in diagnosis and treatment decisions during labor. The system took 2 years to develop by software vendor MP4, and is sold by GE exclusively into the labor and delivery market.
The first facility in the country to install AirStrip was Fairview Hospital, part of the Cleveland Clinic in Ohio.
“Our chairman saw a demo and said, ‘We have to have it,’” said Terry McDaniel, system administrator for CentriCity Perinatal at Fairview.
It launched in September with 10 doctors. Through word of mouth, two or three more ask to be added each month, McDaniel said.
She said some of the doctors are heavy users of the new technology for everything from looking at readings that an on-site nurse may find troubling to viewing test results immediately.
AirStrip OB will be in eight hospitals and used by 191 doctors by February, and MP4 executives expect usage to grow quickly. It has just been approved by hospital giant HCA Corp. for installation in any of their 200 hospitals that want it.
And GE is marketing to the 1,500 hospitals around the country that already have GE labor and delivery monitoring equipment compatible with AirStrip.
It costs about $60,000 for a hospital to install the software that lets GE Healthcare’s obstetrics monitoring equipment in the hospital communicate with the doctors’ hand-held devices. Physicians then pay an annual subscription fee of $299.
Pictured right is fetal monitoring data being streamed to a Nokia smartphone via AirStrip at HIMSS 2006.
Philips Launches New Spot Check Vitial Signs Monitor – VS3
Targeting both acute care and alternate care markets, Philips introduced the SureSigns VS3 vital signs monitor today (press release). The new monitor builds on their new line of low acuity patient monitors, the VM 4, 6 and 8.
The SureSigns VS3 provides easy access to patient information
using innovative pop-up screens, fixed keys and icon-based menus. The
full-color, back-lit screen displays large, easy-to-read numerals that
are especially helpful when viewing from a distance or in low light
situations. The screen also provides clinicians with the choice of
viewing scrollable stored patient records and an optional Sp02
waveform. SureSigns VS3 measurements include non-invasive blood
pressure, pulse oximetry, pulse rate and temperature. With
programmable non-invasive blood pressure capabilities, users can
create up to five different programs to monitor non-invasive blood
pressure at particular intervals based on unit-specific protocols.
The SureSigns VS3's standard lithium ion battery and AC power cord
clip enhance battery operation and charging performance. Software
upgrades are remarkably quick and easy via the USB port and patient
data transfer is enabled with HL7 data output through an Ethernet
connection. In addition, an optional bar code scanner capable of
reading both one and two-dimensional bar codes makes patient ID entry
fast and accurate. The innovative design also makes the SureSigns VS3
monitor easy to support. Replacement parts are compatible with the
SureSigns VM monitors to help streamline parts inventory management
and repair.
The press release brags on the new 8.4″ color LCD, compared to the much smaller and purpose-built user interfaces found on spot vital signs monitors from, well, everyone else (GE Dynamap, Datascope Accutorr and Duo, Welch Allyn Spot, and Philips VS1). My guess is that Philips was tired of selling a vital signs monitor they OEM'd from someone else – the VS1 is from Colin. That plus the VS1 lacked network connectivity which was probably hurting competitively.
The VS3 sports an Ethernet port and has HL7 output from the device – another feature shared with the VM product line. Spot vital signs capture entails pushing the monitor from patient to patient several times a day to take readings. Given the inherently mobile nature of the task (compared to an ICU patient connected to a wall mounted patient monitor), it's disappointing there is no wireless capability on the VS3. Rolling the VS3 into a corner to recharge while you download data over a hardwired Ethernet connection will work, but will be a source of frustration for many customers. I can just imagine were staff grabs the pole mounted VS3 and takes off for their first reading, ripping the Ethernet cable and wall plate out of the wall (not to mention possibly damaging the VS3). The unit can store an impressive 400 readings in batch mode. And the onboard barcode reader is also pretty cool.
The features described imply a continuous spot monitoring use case, where a patient is hooked up “to monitor non-invasive blood
pressure at particular intervals based on unit-specific protocols.” Given this device's heritage and the continuous monitoring use case, I would expect the device to have local alarm annunciation. To capture this data into an electronic medical record would require an available Ethernet port in each patient room.
CMS Issues Guidance on Securing Remotely Accessed Health Data
According to AHA News:
to help organizations comply with the Health Insurance Portability and
Accountability Act’s security standards when they allow remote access
to electronic protected health information through portable devices or
external systems or hardware. In general, CMS said HIPAA-covered
entities should be “extremely cautious” about allowing offsite use of
or access to EPHI, and must implement policies and procedures to
protect EPHI that is stored on remote or portable devices/media or
transmitted over an electronic communications network. The agency said
it may rely on the guidance in determining whether actions by a
HIPAA-covered entity are reasonable and appropriate for safeguarding
the confidentiality, integrity and availability of EPHI.
This is not rocket science, but the guidance document provides a good roadmap to make sure all your bases are covered.
[Hat tip: iHealthBeat]
