The New Enterprise Application – Medical Devices

Cadd-Sentry-Pro

One of my favorite Clinical Engineers called today, prompted by last week’s post on the Emergin acquisition by Philips. Like many that I’ve talked to, this person was surprised that Emergin was not snapped up sooner. A list of potential bidders were mentioned, but my lips were sealed. I will say this about potential suitors for Emergin – the lines are blurring between conventional categories of vendors, on both the health care IT and device sides.

Also discussed were two continuing problems with medical device connectivity, alarm notification and point of care automation (we’ll just call it “middleware” for this post). The first deals with hidden costs – on both the device side and infrastructure side. As you work through the details of plumbing everything together, you tend to uncover situations where to get feature X you have to upgrade your medical device system to version Y. If this happens more than a time or two, the cost of your upgrades quickly eclipses the cost of your middleware.

On the infrastructure side few enterprise networks, wired or wireless, were designed to support the life critical applications of medical devices. Providing surveillance and alarm notification are more than mission critical, and require proper management, monitoring and documentation. Historically, device vendors installed their own physically separate networks so these issues were not apparent to hospital IT departments (and IT departments didn’t mess up device vendor’s networks).

Medical devices are becoming enterprise applications, and no longer justify isolated networks. Hospitals looking to benefit from the features of a system like Emergin’s are looking at rejiggering and upgrading their network (and maybe a lot more). So after you’ve upgraded your medical device systems and network, your total middleware costs have perhaps tripled from original estimates. Ouch.

Medical device vendors continue to push device integration issues off on hospitals. Sure they’ll install a server and manage it (apply upgrades, diagnose problems and get it running again when needed), but they won’t take any responsibility for the actual operation of device connectivity. What clinical engineers need is a software app that actually monitors medical device connectivity and interoperability – sort of like an HP OpenView for medical devices.

As things stand, the biomeds responsible for medical device integration can’t even tell if a disconnected serial cable is the cause of an interruption in data from a medical device. This is way outside the core competencies of medical device vendors. But there are solutions to this kind of problem, Nuvon for one. Presently hospitals are left to their own devices to solve this problem, unless they know to insist that device vendors fill this gap.

Most alarm notification, point of care automation and medical device connectivity solutions continue to be difficult to buy solutions, mainly because everything out there is a partial solution, with gaps and overlap everywhere. In marketing-speak, this is still an early adopter market. The early majority of the market is sitting on the sidelines until someone can field a whole product solution.

Pictured right is Smiths Medical’s Cadd System Pro meds administration software.

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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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PanGo in the News

PanGo-bed

PanGo continues to execute a strategy of business development and integration with solution providers. (See previous post RFID is not a product.)

First, PanGo has teamed up with the ubiquitous Emergin to enable nurse call systems to send location data to nurses’ mobile devices. Emergin, who already supports other RFID vendor’s software, has integrated with PanGo’s indoor positioning software.

Nurses are highly mobile, given today’s nurse shortage and resulting high nurse to patient ratios. The trend towards private rooms in hospitals has increased nurses mobility and increased the need to improve in-room alarm notification.

Next in the news is PanGo’s integration with HIT vendor Eclipsys. This is a straight ahead asset tracking application, first installed at early adopter site El Camino Hospital. Most RFID systems being adopted (piloted, really) by hospitals are part of specialized workflow and patient tracking applications like, infant security, OR and ED departmental management systems, and hospital wide patient flow software. But even a straightforward application like asset tracking needs a user interface, and some integration with other hospital apps and databases.

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Emergin to Dominate Connectivity Software at HIMSS

At last year’s HIMSS it seemed that Emergin was everywhere. Every time I turned around there they were, providing the connectivity middleware for both medical device vendors and others. This year will be no exception, with Emergin appearing in 16 different booths.

It has also been announced that Johnson Controls (who is making a big push to broaden their health care presence) has made a minority investment in Emergin. I’m still waiting for Johnson Controls to actually list health care as one of their vertical markets on their web site. Emergin also plays a critical piece in Cisco’s Clinical Connectivity Suite offering.

UPDATE: Someone from Johnson Controls was nice enough to provide me with a link to the health care section of their web site today. Thanks!

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Kingston General Hospital Goes Wireless

Canadian Healthcare Technology reports that Kingston General Hospital, Kingston Ontario, has implemented a, “fully integrated wireless communications solution.” Sounds sexy and exciting, doesn’t it? It seems they’ve deployed WiFi house-wide:

KGH is the first teaching hospital in Canada to integrate wireless applications with a point-of-care computer that accommodates intravenous infusion, patient monitoring and clinical best practice guidelines in a single platform through an advanced infusion pump system. This means additional support is available to ensure patient safety. These new infusion pumps provide the care team with the most up-to-date drug information through the wireless network while also communicating with other devices to alert caregivers when a problem arises.

Interestingly, no vendor names were mentioned in the writing of this article unless they’re Canadian. So the above vendor(s) shall remain cloaked in mystery. I will however guess the pump vendor above is Cardinal with the Alaris Medley smart pump – they’re the only vendor to offer a patient monitoring module with their pumps.

So, in addition to wireless medical devices, KGH as also deployed (or actually extended an existing deployment) voice over IP (VoIP) wireless phones. They also have, “wireless access to their medical records system,” and a “safety alerting system.” The former I assume is paperless charting with computers on wheels (COWs), the latter I can only guess is an integration between their VoIP phones and infusion pumps using Emergin middle ware (besides the fact that Alaris uses Emergin for this capability, they mention that they have the option of integrating their nurse call system with their VoIP phones, another Emergin capability).

TravelNet Technologies comes in for a mention and quote (along with Bell Canada who designed and installed the network) about their ability to offer patients and visitors Internet access through the WLAN. This is no great shakes as there are numerous network appliances that provide this network service – unless TravelNet is helping the hospital charge for Internet access, which takes all sorts of backend infrastructure.

All in all a pretty cool deployment, if scandalously shy of, you know, facts and details and stuff.

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