HIMSS 06 Wrap Up

Arnaud-Houette-Brian-McAlpine

Yesterday I was asked for some quick impressions of this year’s HIMSS. Now that I’ve had a bit of time to digest the event, here’s what I came up with. First, this show was much more of a business development/business alliance oriented show. Many vendors were openly partnering and had products in each other’s booths, brought together by their efforts to bring to market broader solutions that meet market requirements. These alliances frequently revolved around connectivity.

  • First Vocera came to market (a few years ago) on the strength of a health care targeted wireless communicator, and has done well. This year Ascom was the first established phone company to take that step with an almost full blown point of care system integrating wireless phones with nurse call, medical devices and more. Ascom now represents a competitor to both Emergin and their wireless phone competitors.
  • Two new wireless patient monitors were introduced at HIMSS using 802.11b (the GE Dash and Spacelabs SL2400). The adoption of ISM/Wi-Fi over WMTS for wireless patient monitoring is significant, and reinforces the trend away from that proprietary narrow band.
  • GE showed near real time fetal monitor surveillance (AirStrip OB) on smart phones – with a 510(k), no less! (check this photo)
  • PDAs and tablets lost much of their cache this year – there were lots of laptops and integrated computers on COWs (computers on wheels), AirStrip OB on smart phones, and while not an exhibitor, there was buzz about the OQO handheld computer. (check this photo)
  • Welch Allyn was the first major vital signs monitor vendor to release a wireless vital signs monitor for data integration into EMRs (the new Spot) – a couple years behind Stinger Medical. Also of note, Welch Allyn licensed Wellogic’s server software for their wireless vital signs monitor. Clinical servers are neither rocket science nor a trivial effort, what with role based access support, CCOW, RADIUS/LDAP integration, HL7, remote access (i.e., a web server), data storage and high availability. So far, not a single medical device vendor has launched a decent server – until now.
  • Integration middleware vendor Emergin was in over a dozen booths – most of the smart pump vendors, patient monitoring, nurse call and wireless phone vendors, and a few HIT vendors.
  • This was also a year for refining product strategies for patient flow application vendors – in particular, StatCom and Awarix have moved beyond (and in different directions from) bed management to help out more broadly with hospital care delivery.
  • On the imaging front, this was (if not the first) the largest presence of cardiovascular information systems (CVIS) shown at HIMSS. Agfa/Heartlab, Witt Biomedical, McKesson/Medcon, ScImage were all there – and maybe a couple I missed.
  • All the smart pump vendors (Cardinal/Alaris, Hospira, Baxter, B Braun) showed progress in moving past the first generation of wireless features.
  • RFID was hot hot hot at HIMSS this year. In apparent agreement with my post that RFID is not a product, many RFID vendors introduced software applications – mostly basic patient flow apps. RFID also presents an interesting issue for device vendors – for the slackers who don’t embed a Wi-Fi radio into their device, should they embed some kind of tag technology?
  • Finally on a related topic, wireless network infrastructure also got some buzz. GE formally introduced their deal with MobileAccess, InnerWireless repositioned themselves at the show (rolling out their RFID solution and dropping the “leaky coax” part of their solution), and lots of wireless LAN vendors – Cisco, Aruba, Trapeze, Symbol and Meru.

Whew. Pictured above right are two of the Godfathers of Connectivity: Arnaud Houette of Capsule Technologie, and Brian McAlpine with Emergin.

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Day Two at AACN/NTI

Lifesync

More interesting news dug up at the show today. Ventilator vendors don’t seem to get the whole connectivity thing yet. I think they’re spoiled by only having to serve up a serial interface to monitoring vendors in the ICU. Even a non invasive vent for use outside the ICU had no more than a serial port.

I went by the LifeSync booth today. They’ve gotten some adoption for their wireless ECG electrode system. They have a very interesting implementation that shows the basic requirements for wireless sensor based monitoring. You can see the electrode harness that provides reduced noise and false positive alarms, and the patient transceiver (on the right arm). This wireless rig connects over Bluetooth (1.1, class 2) with a monitor transceiver that is connected to the monitor. As I took his photo, one of the many female bystanders told him to smile. I cut his head off, to which he said, “I’m used to that.”

I saw some pretty cool examples of device and software integration today. At the Philips booth, I got two very interesting demos. First was an alarm management and notification demo (using Emergin again). There was a software client that managed caregiver-patient assignments (with 3 levels of escalation). Patient alarms were distributed to VoIP wireless phones from Cisco. And here’s the cool part, the handset displayed a 6 second ECG waveform (along with patient name, room number, and type of alarm). The caregiver can also accept or refuse an alarm, causing the system to escalate to the next caregiver. Later I saw a Philips/Baxter prototype integrating the Colleague infusion pump with a Philips MP 70 patient monitor. The integration supported establishing patient context and the 5 rights for meds administration, using the patient monitor as the workstation. All the resulting data is sent into the EMR. The Baxter pumps talk to their server, which talks to the Philips server. On the Philips side, the Portal feature is required, using a Citrix server. Philips plans to release some version of this as a future product. There are some very interesting comparisons and contrasts between the Emergin/Cisco/Philips alarm notification product (which is released) and the Philips/Baxter project.

With all the hoopla about WMTS, it is interesting to note that both GE and Philips use 802.11 FH (frequency hopping) for their wireless multi parameter patient monitors. I asked them both if they were going to switch to WMTS, and they both said no. You should know that 802.11 FH has been discontinued; Proxim discontinued their product last year, and Symbol’s last buy is this year. All the vendors using this technology have made “last time buys” from their vendors, and as one said, the question is how much of their last time buy inventory they’ll have to write off when they go to a new radio.

Could Handheld Products’ Dolphin 7900 beat out Symbol’s PDAs for clinical use? I heard one user that was getting 11 hours of continuous use out of their 7900 (that’s with WLAN and bar code use) vs. 2 hours from a Symbol device. Both devices are ruggedized and water resistant (conforming to IP54).

UPDATE: It seems that the alarm notification on the Cisco phone shown in the Philips booth is not released. They are going next to clinicals and shooting for a release before year end.

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Day Three at HIMSS

Well, that’s it for me. I’m back in my room, enjoying a Shiner Bock (a fabulous Texas micro brew) in my jammies writing this post — I’ll forgive just about anything during a hotel stay if they have broadband Internet. I’m leaving tomorrow on a character-building 6am flight. All in all it was a great show — saw many old friends, made some new ones, and learned a lot. One of the new friends was Neil Versel, who has an interesting web log on clinical IT.

Today’s favorite session was presented by John Glaser and Jeff Cooper of Partners HealthCare titled, Clinical Engineering and IT — Partners for Patient Safety and Technology Effectiveness. They provided great insights into both fields and the collaboration required by new wireless medical devices, patient flow optimization and how human error can impact patient safety.

The medical device vendor that really stood out was Spacelabs. They had a full compliment of both devices and knowledgeable folks to talk about them (thanks to Chris and Monica). They had some pretty cool things which I’ll expand on in a later post. The largest vendors were the worst, with very limited demo capabilities and no real product specialists that could answer my “secret sauce” kinds of questions. All three major IV pump vendors were represented, showing their wireless pumps with reasonable demos and knowledgeable folks.

I visited all the patient flow software vendors, and got insights into strategy and direction and some vibes that this is becoming a considerably more competitive market. A couple of the vendors mentioned competitive responses to Tele-Tracking, who is by far the oldest and most established vendor in the field. Like most markets, its interesting to see how the vendors pursue various competitive strategies to differentiate and out-compete one another.

The vendor with the biggest presence at the show that wasn’t an exhibitor was Emergin. Many vendors were leveraging their messaging middle wear for alarm notification and patient flow messaging. Moving alarm notification beyond a local audible alarm on the device is a huge need, and Emergin offers a relatively easy way to add this option. So far, everyone’s implementation of Emergin for alarms is lacking one serious capability (Baxter did it on their own with their wireless pump system). It will be interesting to see who steps up first to do it right.

Was it just me, or was Vocera everywhere?

The networking and security market segments were well represented. I found Innerwireless and Airespace most interesting. Indoor positioning systems were also investigated, with interesting results. Drager Medical (Siemen’s new patient monitoring solution) also had a very interesting wireless security story.

A cute college kid won the BMW convertible in the NextGen booth this afternoon. Siemens had the “rock star” booth of the show, a double-decker sheathed in white scrim printed with graphics and lit by racks of lights you’d normally see at a rock concert; very hot, but like the numerous Soarian bill boards I saw around town coming from the airport and riding the shuttle buses, probably a poor ROI. My favorite booth was a large island booth set up like a sports bar — it seemed they were most interested in creating an atmosphere in which their sales reps would be comfortable.

More cogent and informative posts to follow as soon as I’m recovered.

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