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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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.

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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.

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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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