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Medical Device System Network Install Issues

Tim Gee — Tue, 22 Sep 2009 16:37:19 +0000

Last week there was an interesting discussion on the Biomed Listserv about network installation for patient monitoring systems. Emphasis highlighting key issues and best practices are mine. The discussion started with a question from Scott Skinner:

I’m curious if anyone has been successful using their own vendors to pull cables for monitoring installations. With the monitoring OEM we work with, they simply get a local subcontractor to do the cable pulls.

So this would involve breaking future monitoring packages up into two quotes: one for the actual technology itself (and associated installation and implementation), and then one for just the cable pull work. The latter would get bid out, and the OEM could compete against other vendors.

Of course, the OEM can just take the profit they would have made on the cable pull and add that to the cost of the equipment bid. One would need to find a way to watch that carefully.

Which lead to a critical observation from Craig Muehling:

We have started pulling our own cable for monitoring installations. I have one happening now and I’m not exactly pleased how it’s working out. I won’t mention and names, [vendor name removed] but they make their equipment charges per drop whether you have any drops or not.

I would still like our [networking] vendor to do the networking, ie: install and configure switches and physically plug patch cables into the switches. Seems easy, but the way they [the patient monitoring vendor] charge it’s really not much less than if they did the whole job. I think from now on, we will have to take on the entire networking job.

I have learned a lesson from this last installation and will scrutinize the quotes closer from now on, but with their charging structure
(supposedly) there’s not a lot of options. Either we do the entire job, or they make lots and lots of money for relatively little work.

Here’s how they do it at the Mayo Clinic, from Steve May:

We have our own low voltage and high voltage contractors for all in-house cable pulling, to include data pulls and all project related work, so cable pulling and wiring costs are never part of an installation package, but an infrastructure cost which we earmark as Capital expenditures and plan/budget annually. Bids & labor costs are renewed by Purchasing every 2 years and our preferred contractors are all able to bid on both project services & time & material services. (more…)

Market Trends Series: Wireless Connectivity

Brian McAlpine — Thu, 17 Sep 2009 22:34:45 +0000

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.
(more…)

The Connectologist is Out

Tim Gee — Mon, 25 Aug 2008 04:03:08 +0000

I will be on vacation for the next 8 days, returning September 2nd.

Connectivity - The Book

Tim Gee — Tue, 04 Mar 2008 04:07:52 +0000

Last October I was asked if I’d ever written a book. The answer was, and remains, that I have not. But then I’m not aware of any else having written a book on medical connectivity. After some thought, it seems that the market may be ready for such a literary epic. (I’m going to have to start wearing turtlenecks or ascots and smoking a pipe.)

The past few weeks I’ve been talking to people asking about publishers and such. I’ve got a few leads, but if you can suggest anyone to contact please let me know.

Here’s what I’ve been able to noodle out: (more…)

Tuesday Morning at HIMSS

Tim Gee — Tue, 26 Feb 2008 13:05:12 +0000

A bleary eyed day 3 of HIMSS. There’s a lot of energy at the show this year - the exhibit hall is full with both attendees and exhibitors. Many write about the theme or hot topics at events. HIMSS has gotten so big, with such depth, that its easy to find that your interests are the hot topic at HIMSS. There have been some interesting announcements, which I’ll post on in the coming days. Many vendors have refined or shifted their strategies in ways that will impact their future products and customers.Yesterday I caught up with a very old friend. We started attending HIMSS over 20 years ago. He observed that some things never change.

There’s still a tremendous amount of spin and vapor ware. Sure there are new vendors and fresh faces but an alarming number of vendors still can’t describe their product in understandable language or articulate their value proposition beyond an alphabet soup of acronyms, “glamor words” and jargon. In meeting with one vendor yesterday, I asked repeatedly, “what is this?” In frustration I asked, “how would your marketing guy describe this?” His reply, “I am the marketing guy.” Uh, open mouth, insert foot…

Pictured at top is the only mobile device at HIMSS (or anywhere else) purpose built for health care from Intellidot.

HIMSS Pre-show

Tim Gee — Fri, 22 Feb 2008 18:48:46 +0000

I’m on my way to HIMSS today, and really looking forward to this year’s conference and exhibits.There’s lots of interesting rumblings among the market segments that I follow.

There will be big news among RTLS/RFID vendors and I’m expecting some announcements from a number of connectivity companies.

As in years past, I’m attending as a contributing editor for MX Magazine. As such I’ve been inundated by PR folks for appointments. For the first time, I’ve used an online schedule to coordinate things. HIMSS only comes once a year, and I always try to make the most of it.

Meet the Bloggers

I’m very late with a post this year, but there will be a meet the bloggers gathering during the HIMSS opening reception - that’s Sunday between 5 and 8 pm (here’s a link). Look for the big blue and orange sign with “Meet the Bloggers” and come by and say hi.

Greetings

Tim Gee — Wed, 20 Feb 2008 14:57:46 +0000

What you see today is the new design for the site. I’ve been contemplating this for some time. The biggest issue was getting the 1,100+ previous posts created using the old software into this system. That should be done in the next few hours.

Enjoy!

Patient Flow Recommendations and Predictions

Tim Gee — Tue, 09 Oct 2007 03:28:39 +0000

Research firm Arketi sent me a survey on hospital patient flow. Sponsored by patient flow software vendor StatCom, the survey sought to quantify the patient flow problem (how many ED boarders, hours on divert, room turn over times, etc.) and identify the departments contributing to, or ameliorating hospital patient throughput. This will all be good marketing data once the study is compiled.

Lack of Data
I was struck by a couple things missing from the study. From my experience, the biggest challenge facing hospitals seeking to improve patient throughput is the near total absence of performance data. Unless an effort is made to manually log performance data - with the oversight to ensure it is accurate and complete - hospitals have little data available to them. Such manual data gathering operations are expensive, time consuming and hard to sustain on a broad basis or for an extended period of time.

As the canary in the coal mine, the Emergency Department is the most common source for any detailed data, and often the squeaky wheel pushing for patient flow improvements. Consequently, data about hours on diversion, ED patient flow metrics, patient boarding, and reasons for boarding frequently represent the best patient flow data in hospitals. Once you get beyond the ED, available data drops off quickly.

Frequently, the best data available is aggregate ADT data that shows length of stay (LOS), transfers and discharges among individual departments and the hospital as a whole. Have you looked at your ADT data lately? Found all those duplicate transaction codes for decommissioned units (still in use)? Does everyone who enters ADT transactions or uses the data have the same understanding of what all those codes and locations really mean and when to use them? If you;ve not addressed this issue (cleaning up your tables, training users, auditing data) in the past year or two, or don’t want to ruin your day (it is Monday after all) let sleeping dogs lie.

The paucity of detailed reliable data to gage patient throughput is a significant hospital need, and I think a key justification for buying a system like StatCom’s, that is not addressed in the survey. Having some quantitative market research as proof to this need would be something I’d want if I was a patient flow software product manager.

Patient Care Methodologies
The other thing that struck me was the lack of any questions about patient care methodologies that create patient flow bottlenecks. Most hospitals are structured and managed based on industrial principles from 30 or 40 years ago. Back in the 1980s before DRGs and prospective reimbursement when hospitals had excess capacity, setting aside a fixed number of beds (and equipment) for specific categories of patients worked pretty well - excess capacity hid a multitude of sins.

As falling reimbursement wrung out excess capacity, the fundamental weaknesses of allocating fixed resources on the expectation that a certain consistent number of patients will utilize those resources became evident. In manufacturing, just-in-time management tools were used to lower costs. The fact is there are no just-in-time patients. Just like manufacturers learned that market demand can’t be reliably forecasted, and implemented flexible manufacturing concepts, hospitals must move beyond rigid patient care strategies. Besides creating patient flow bottlenecks in units like critical care and telemetry, conventional care methodologies can result in unnecessary patient transfers (something else the survey didn’t explore).

The most common example of a patient care methodology analogous to modern manufacturing processes goes by various names: variable acuity units, flexible monitoring, or universal beds. Whatever you call it, it means providing patient care in one on-service unit and not transferring the patient every time their acuity changes. Patient transfers are bad; each transfer adds a day to the patients LOS, and represents an opportunity for adverse events resulting from less than perfect patient hand-offs. Manufacturing has developed many techniques to be more flexible, like cellular manufacturing, kaizen, the Toyota Way, LEAN and Six Sigma - and many of these tools have been adopted by innovative hospitals.

The best way to minimize critical care and telemetry as patient flow bottlenecks is through variable acuity units, where patients receive the most appropriate level of care in the lowest cost setting. You will never be able to match the number of critical care and telemetry beds to the exact number of patients who need them. You can waste money building too many of these high acuity beds - and don’t forget that about 15% of the patients in your critical care and tele beds right now don’t meet admit criteria and should be in other units. Or you can continue to go on ambulance diversion. A patient flow system like StatCom’s can be a useful tool in implementing variable acuity care. Good acuity scoring tools like ClairVia are also helpful.

Prognostications and Prevarications
Let me close by offering some predictions. Thankfully, most of these predictions are perfectly safe because any outcome can’t be verified. First off, the StatCom survey will show that the two departments representing the biggest patient flow bottlenecks are critical care and telemetry.

I see solid growth and adoption for the patient flow application market. McKesson’s acquisition of Awarix is further validation of anticipated growth. The most important justification for a solution like StatCom’s is that you can’t manage what isn’t measured. The market right now is still an early adopter market (that’s marketing-speak for those wild eyed innovators who will try anything). The generation of products coming to market now represents a big improvement over earlier solutions. These systems still require certain enabling technologies to work effectively in hospitals run by anyone but Jack Welch. These applications will provide a plethora of useful data, across the enterprise. As the market matures, hospitals will better learn to pick the good patient flow applications and get better at wringing the most value from them.

Oh, and donâ€™t throw six or seven figure consulting contracts at the problem. The 80/20 rule says that youâ€™ll get 80% of the value from only 20% of the patient flow issues excruciatingly documented by the hoard of fresh MBA graduates who descend on your hapless staff. Empower an internal champion and find someone (maybe even a vendor) who can quickly find the bottlenecks with the biggest impact. Buy a patient flow application, and converge your patient flow findings with your software implementation targeting the “big bang” opportunities. You’ll still spend six or seven figures, but most if it will be on a software application that will deliver real value for years - as opposed to the one-time shot of a big consulting gig.

As patient flow problems increase, hospitals will transition from boarding patients awaiting an inpatient room in the ED to placing them up on their on-service unit. There’s lots of rational patient safety and financial reasons to do this, and the outrage and consternation evoked by such a change will eventually give way to reason. And don’t get snowed by the “fire codes don’t allow us to leave patients in hallways” excuse. They’re in hallways in the ED, aren’t they?

Finally, the federal government’s double edged strategy for transforming health care (reduced reimbursement to drive change, and increased visibility of provider performance to increase quality) will eventually include public disclosure of ED waiting times, reporting of time on ambulance diversion, and statistics on the number of patients boarded. This will probably occur after vendors “cross the chasm” and the early majority of the hospital market starts to implement patient flow solutions. This visibility will eventually drive the market laggards to adopt.

Pictured above is the hospital illustration from StatCom’s home page - I like the 8-bit retro graphic design.

Reference Website: bmesource.org

Tim Gee — Tue, 02 Oct 2007 01:07:42 +0000

The site bmesource.org is a compendium of web sites with the stated goal of, “sharing knowledge across the biomedical technology design community.” The site was started at Stanford University. In 2003 they opened it up to additional university contributors.

I stumbled across the sites via my server logs that showed a visitor who came from bemesource.org. The sight is pretty cool, check it out.

Home Use of Medical Devices Challenges FDA

Tim Gee — Fri, 28 Sep 2007 01:34:43 +0000

Medical Devices Today has a good post on potential safety and effectiveness issues surrounding medical devices where home use by patients is outside the scope if intended use. “Although manufacturers need FDA approval to market a device
over-the-counter directly to a patient or specifically for home use,
there are few restrictions on whether a physician can send a patient
home with a device that is not specifically labeled for use in the home.”

One of the biggest issues revolves around older devices that have been replaced and become hand-me-downs for home health. Concerns include:

Neither devices or directions for use not designed for patient use
Hand-me-down devices frequently missing directions for use
Patient purchased devices, e.g., after the reimbursed rental period, end up getting “recycled” through eBay - with no safeguards for proper maintenance, operation or directions for use
Proper distribution channel safeguards to ensure safety and effectiveness when sold retail or through other resellers

Besides contemplating new regulations or legislation, the FDA is making the following responses:

Meanwhile, in the next six months FDA hopes to invite manufacturers
to participate in its new online labeling repository for home-use
devices. The voluntary repository, which will initially focus on
infusion pumps, will give consumers access to the most up-to-date
instructions for specific models.

The agency is also preparing to launch a sub-network of its MedSun
adverse event reporting program called HomeNet. Participating home
health agencies will be encouraged to report to FDA adverse events,
including close-calls, related to devices used in the home setting.

Be sure to read the whole thing. Pictured right is a Baxter Syndeo pump - perhaps something that might be used in the home?