Cisco's Medical Grade Network Provides New Connectivity
On October 11th, Cisco broadcast a live webinar to introduce their Clinical Connection Suite (press release).
Of course Cisco makes the same network boxes for health care as they do for every other vertical market, but they create a vertical market spin with alliances, marketing and distribution. Cisco has done a service to the industry by highlighting solutions to important problems in health care and growing the overall connectivity market.
The Clinical Connection Suite is made up of four components:
- Nurse Call: enables real-time alerts, such as patient or caregiver locations, to engage in direct communications with their patients and mobile colleagues. No longer do clinicians have to be contacted on overhead paging systems or dedicated pagers; instead, they can now use wired or wireless devices, including Cisco IP phones, to access Nurse Call Systems such as Rauland-Borg and middleware from Emergin.
- Patient Monitoring: provides nurses with mobile real-time alerts and patient status by delivering demographic data and key patient information via text and wave form transmission to any wired or wireless IP device. With the realities of healthcare as a
wireless profession, caregivers cannot be tethered to nursing stations or remain in the same clinical area for any length of time. Enabled by Cisco communications capabilities connecting patient monitoring devices from leading monitoring device manufacturers, Patient Monitoring enables clinicians to deliver faster customer response. - Location-Based Services: improves patient care by allowing hospitals to locate and track key assets. Today, valuable time is spent by nurses and clinicians in searching for critical equipment and other hospital resources. By reducing asset tracking time, patients don’t wait unnecessarily for equipment or devices or other hospital resources. Additionally, healthcare facilities prevent equipment loss and replacement costs. Location-Based Services leverages the Cisco Medical-Grade Network and real-time location services for IEEE 802.11 (Wi-Fi) and Radio Frequency Identification Systems (RFID) tracking technology, in conjunction with the Cisco Wireless Location Appliance, asset tracking applications provider PanGo Networks, and active RFID tags from both PanGo Networks and AeroScout.
- Collaborative Care: enables ad hoc collaboration between staff and clinicians to speed the time to diagnosis and treatment, bringing the right caregiver together with patient data in real-time using on-demand audio and videoconferencing capabilities. Using Cisco MeetingPlace and Tandberg’s visual communication technology, Collaborative Care enables hospitals and clinics to provide new services, such as real-time video-based translation capabilities for non-English speaking patients.
The critical piece of Cisco’s solution is the connectivity middleware from Emergin that integrates patient monitors (and other medical devices), nurse call systems, location-based services, and nurse carried communications devices. Without this middleware, there would be no enterprise connectivity solution to replace the proliferating point solutions that have been available for some time. It is interesting that vendors like Rauland-Borg and PanGo have differentiated themselves by integrating with Emergin.
You can see a replay of the webinar at your convenience. During the webinar, there were two questions that caught my attention. First Arthur Gasch asked about network latency and guaranteed delivery. Answer: a standard method of message acknowledgement is provided acrossvendors and products. Wrong answer; life critical data requires minimal latency to ensure that data is analyzed and alarms generated and delivered within specific (and reliable) time frames — this is the excuse medical device vendors frequently use when the say they require private networks for their devices. Later Arthur took another run at the question of maximum latency for life threatening alarms (LTAs) from monitor to phone. This time he got a more technical answer about network management.
The crux of these questions is whether wired and wireless alarm notification that is extended beyond what’s provided by the device vendor is covered by 510k and can serve as primary alarm notification. The difference between primary and secondary alarm notification was the elephant in the webinar living room (more on this here and here). After some bad experiences in the past with pagers, medical device vendors are extremely careful to differentiate between primary and secondary alarm notification (the first being regulated by the FDA and accepted for use in the treatment of patients, the second is neither regulated nor accepted in any legal or liability sense). From Cisco’s wording in their brochure, I would not be surprised if they got a visit by their friendly FDA officer. Oh, and nurse call systems are regulated by the FDA as well via 510k. But for some reason extending nurse call via secondary meansdoes not receive the same focus as medical device alarms.
Another question from Arthur during the webinar: how will this move industry to open systems and standards and drive adoption. Another great question. I think this will raise visibility for both vendors and providers on the importance of improved caregiver communications and the fact that the technology to provide a significant improvement over current approaches does indeed exist.
Someone asked one of the hospitals participating in the webinar about barriers to RFID adoption: the hospital rep (from IT) remarked that RFID is still new technology, currently in Gartner’s “trough of disillusionment”, but advancing quickly. He felt the market is still in the pilot phase, with most institutions lacking the ubiquitous wireless coverage to move RFID beyond specific areas and applications. There seems to be an innate appeal in WiFi based RFID over RFID with dedicated receivers. This seems due to the perceived cost savings of using WLAN infrastructure. It was also apparent that WiFi RFID projects count on the WiFi infrastructure investment justified via other applications. Of course active WiFi RFID tags are much more expensive than “proprietary” active tags and so must avoid infrastructure costs if they’re to show a competitive ROI.
From ExtremeNano story on Cisco’s announcement:
Within three years, RFID tags will be viewed as just another networked device, predicted Kent Grey, global lead for Healthcare Solutions at Cisco Systems. “Because the tags are just another device on the network, the ability to manage the tag comes with the ability to manage the network.”
Finally, an IDC analyst asked how important standardization and enterprise solutions vs point solutions were to the customer. Answer: very, I would guess every CIO wants to leverage network convergence and implement enterprise solutions. One hospital IT person on the webinar stated that IT wanted to get “in front” of medical device purchase by using Emergin and connecting future devices to that rather than “silo based” solutions.
Day Two at AACN/NTI
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.
Day One at AACN/NTI
It is hot and sultry here in New Orleans. Heard some great blues last night. But I really have been working. Here’s what I came across today. Hospira released their MedNet system — I’d tell you more, but the press release didn’t stay out too late last night.
Emergin was once again the vendor who was everywhere, but had no booth. They were in the Spacelabs, Alaris and Philips booths providing the software for alarm management and communications. As an aside, Philips introduced two new monitors at this show; I’ll go by tomorrow and check them out.
Welch Allyn introduced a new monitor, the Propaq LT. Here’s part of their 510k submission. More on this later.
B Braun wasn’t at HIMSS so I haven’t done a write up of their smart pump yet. They’ve wirelessly enabled their 100, 200 and (at this show) their 300 pumps. They will complete the line with the 400 by the end of this year. Here’s a story from 2002 on both Alaris and B Braun smart pumps — you will get a feel for how long they’ve been at this (since 2001) and how well they’ve delivered on their promises.
It’s almost time for dinner. Welch Allyn, the sponsor of our Sunrise Session tomorrow, is talking my co-presenter Cheryl Batchelor and I out tonight. The good news it’s a good creole restaurant, the bad news is I can’t wear shorts.
Health Care Technology Reality Check
Robert Scoble, Microsoft’s technical evangelist, wrote recently about a recent hospital visit. In this post, he describes what he saw at Overlake Hospital (he does not mention the hospital, Overlake’s just a guess). He’s got some great observations. One is the need for medical device connectivity, another is the highly mobile nature of patients and hospital workers.
Connectivity has been transforming medical devices for more than 20 years — most vendors started with the advent of the personal computer, HP started out using their trusty mini computer. Devices presently getting the connectivity treatment are infusion pumps. A broader integration trend is evolving around medical device alarm management and surviellance. Device and nurse call vendors are working with companies like Emergin, Vocera and Radianse to provide the kind of automation and surveillance that Scoble talks about. Some vendors, like Sensitron, are tying together disparet devices into coherent systems that deliver better care and improved staff productivity.
It’s good to be reminded of all the opportunities we have as an industry for further improvement.
Alaris Wireless Pump
Alaris currently has 200 Medley customers (with Guardrails, their smart pump/formulary/anonymous CQI database). At four of them, nurses enter the patient ID through a bubble keypad on the pump so they can pull pump data into their EMR via HL7.
This summer, Alaris will release the ability to establish patient context in the pump via barcodes — no more bubble button pushing. The care giver scans the patient, themselves and IV meds with a barcode reader attached to the pump. At some point I would expect Alaris to leverage Cardinal/Pyxis meds delivery in some kind of value-added bundle.
This release announced at HIMSS includes a patient identifiable database and client apps for surveillance and therapy viewing. In addition to indicating alarm conditions, therapy viewing shows the caregiver the volume administered and the status of the pump. Therapy views also help the pharmacy to minimize waste because they can see when meds have been discontinued, perhaps before the change is reflected through Order Entry.
In addition to remote alarms at the nursing unit, Alaris will have the ability to push alarms out to nurse worn devices. Using Emergin middleware, they can “talk” to Vocera pendants, pagers, and phones. Primary alarm notification still comes from the Medley pump.
With their SPO2 module, Alaris also has limited physiological monitoring capabilities. This has significant potential for improving patient safety. Depending on the area in which the pumps are used and what equipment (and parameters) you may already have will determine the imprtance of this capability. This is of less value in an ICU, but of greater value in lower acuity areas that don’t already have monitors.
With this new version of their system, Alaris adds patient context to their pump and CQI database, adds surveillance, and alarms.
Their WLAN link is 802.11 b, using an Alaris developed component radio.
