Last week Frost & Sullivan announced that they're kicking off an "exciting new study" on the state of centralized patient monitoring in the U.S. They're going to go department by department to analyze centralized patient monitoring in hospitals and ambulatory care. Their goal is to "elucidate key drivers and trends that are transforming the concept of central monitoring."

The market is indeed changing, although the glacial rate of change typical to health care makes change hard to recognize. Here's the hypothesis for Frost's study:

"The future of hospital patient monitoring is being decided at the central stations," notes Frost & Sullivan research analyst Nathan Cohen. "The entire concept of centralized patient monitoring is evolving as clinical information systems are integrated with patient monitoring networks."

Certainly data acquisition from patient monitors into paperless charting systems (EMRs) is the biggest driver for spending in the patient monitoring market. Imagine dealing with the scenario a 500+ bed east coast hospital is facing:

  • Most of their data generating medical devices are 5 to 10 years old and predate any connectivity features like HL7 interfaces;
  • 12 central stations supporting 4 different models of patient monitors of various vintages;
  • 29 different networks (private subnets) some as old as 15 years - they have Thick-Net, Thin-Net and twisted pair cabling;
  • Two separate telemetry systems supporting a total of 300 transmitters;
  • Wireless monitors using 2,400-2,484GHz 802.11FH, channelized 608-614MHz WMTS and 174-216MHz VHF (the discontinued telemetry band, now unprotected);
  • About 200 spot vital signs monitors; and
  • A bunch of stand alone IV pumps and ventilators (i.e., without any connectivity).

The fact that they've standardized on one patient monitoring vendor doesn't really help here, since the vendor's proprietary solution is for the hospital to "upgrade," i.e., buy all new equipment that supports connectivity. They're probably looking at around $20 million for their EMR software - I doubt they've got another $10 to $15 million for all new monitors, pumps, etc. - a different solution beyond upgrades will be needed to fix these problems at most hospitals.

While the EMR is the be-all end-all for IT, the clinical side of the house is focused on automation at the point of care (POC) to improve patient safety and staff productivity. Patient monitoring (both continuous and spot) and central stations are key players at the point of care. In addition to monitors though, you have other medical devices (pumps, vents, enteral feeding pumps, dialysis machines, and point of care diagnostics), nurse call systems, wireless phones, and overhead pages. Caregivers now receive life-critical alarms though all of these devices and systems - located behind closed doors in patient rooms, at the central station, or carried by the nurse. All these alarms and alerts are annunciated differently, with different alarm types. Since most of these alerts and alarms are broadcast throughout the nursing unit, caregivers rarely know when an alarm is intended for them (is generated from one of their patients), or one of their peers. A common result of this mish-mash is alarm fatigue, sometimes resulting in failure to rescue and sentinel events. The human factors environment on nursing units is arguably hostile to caregivers and unsafe for patients.

Senior management also has their priorities that impact the delivery of patient care. Most hospitals experience patient flow bottlenecks in their critical care areas: ICUs, step down units and telemetry. An increasingly popular mitigation strategy is the adoption of variable acuity units where certain ventilator patients and monitored patients are kept on their general care units, avoiding admission (or readmission) to critical care units. The concept here is to deliver the appropriate level of care in the lowest cost setting. The effective implementation of this care delivery model can have a significant impact on hospital revenue and operating costs, not to mention staff and patient satisfaction. As more aggressive therapies - and associated surveillance - is delivered outside of critical care areas, the cost of having monitoring techs watch central stations can be significant. Whether the approach is to put one monitor tech per nursing unit to watch patients or centralizing the function and putting all the monitoring techs in one room with a bunch of screens, the cost can be significant. I know of another east coast hospital, this one with almost 800 beds that spends $1 million annually on their central monitoring surveillance.

Now the driving force of medical device data acquisition in support of EMR adoption is properly re-cast as one of several factors driving change at the point of care. It should also be clear that hospitals have to deal with more than just their patient monitoring vendor(s) to respond to the many competing priorities and initiatives around the point of care.

UPDATE: Frost analyst Nathan Cohen commented that he agrees that, "One-vendor solutions have proven insufficient to meet the needs of complex clinical IT/application environments." He goes on to describe a recent site where he saw things pulled together by Emergin.