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.