Healthcare administrators and professional caregivers have a lot on their minds right now. Both legislators and members of the general public have begun to demand more-open reporting of patient safety and clinical outcomes data, creating an environment in which healthcare professionals are rightly nervous about their every care decision. At the same time, government officials are continuing to call for reductions in reimbursement and are demanding greater transparency with regard to healthcare costs. Taken together, these forces are exerting new pressures that are reshaping when, where, and how healthcare is being delivered.
For many healthcare providers, this combination of outside forces has brought about a renewed focus on direct patient care, and a search for novel approaches to improve safety and efficiency. And throughout the healthcare systemfrom government agencies to neighborhood clinicsthe favored approaches increasingly rely on the implementation of information technologies (IT).
In recent years, healthcare facilities' biggest budget commitments have swung away from the purchase of diagnostic and therapeutic devices in favor of the implementation of wireless networks, electronic medical records (EMRs), and other information technologies. Simultaneously, the purchasing influence of clinical buyers and biomedical engineering departments has been eclipsed by that of the chief information officer (CIO), who often has control over an IT budget that is growing rapidly. In the United States, 48% of hospitals report a definite increase in their IT budgets, and 65% report an increase in IT staff.1 The healthcare IT staff position in greatest demand is the clinical informaticist, the professional who is in charge of automating work flow at the point of care.
Members of the manufacturing communityincluding traditional healthcare IT vendors as well as medical device manufacturers--are also working hard to equip healthcare providers with the tools they need. Manufacturers are responding to user demands for more-flexible point-of-care technologies, 'whole-product solutions' for EMRs, and the ability to integrate data from medical devices directly into the patient's recordto mention just a few areas of current interest. And every day, new technologies are being developed and released to help healthcare professionals capture transactional data at the point of care, coordinate patient care, improve work flow, and enhance communications. And along the way, manufacturers are also watching the growing healthcare IT environment carefully for emerging needs that could represent both market growth and potential business growth opportunities.
In this annual installment of its IT showcase, MX looks at changes in the healthcare IT environment over the past year and into the future. Observations from the 2007 annual meeting of the Health Information and Management Systems Society (HIMSS) help to illustrate the market's evolution.
In spite of a growing focus on the use of information technologies, healthcare administrators haven't lost sight of the core needs of their institutions. According to the 2007 HIMSS Leadership Survey, the top three issues currently facing healthcare providers are: improving the quality of care, increasing patient satisfaction, and dealing with Medicare cutbacks.1
Such interests frequently carry over to or influence the way that healthcare organizations view their needs for IT systems. The 2007 HIMSS survey reports that hospitals named the following as their IT priorities for the coming year.
- Reduce medical errors and promote patient safety.
- Replace or upgrade clinical systems.
- Implement EMR systems.
Last year, the hospital adoption rate for EMRs was a robust 17%, with 69% of U.S. hospitals either installing or already using a fully functional EMR. Mostly on the strength of this brisk EMR adoption rate, the healthcare IT market is forecast to grow at a 13% compound annual growth rate between 2006 and 2011.2
In acute-care environments, there are two basic models for point-of-care computing. The portable-use model supports tasks that are repeated as the caregiver moves from patient to patient. The mobile-use model supports continuous applications regardless of location. To be useful, mobile devices must be with the caregiver at all times.
Portable Use. The dominant approach to supporting the portable-use model is provided by computers and other devices that can be moved on carts, often referred to as computers on wheels (COWs). Historically, the dearth of such products that met hospital requirements has limited adoption of this model, but cart manufacturers have developed designs that minimize such limitations. The latest advance is the incorporation of vital-signs monitors for electronic data collection.
At this year's HIMSS meeting, all of the companies active in the computer-on-wheels market displayed at least one cart sporting a spot vital-signs monitor. Flo Healthcare (Norcross, GA) was showing the Spot Vital Signs LXi monitor by Welch Allyn (Skaneateles Falls, NY) on its carts. Stinger Medical (Murfreesboro,TN) displayed several carts with its own embedded spot monitor. And in Welch Allyn's booth, the company was showing its VSM vital-signs monitor on a cart.
Meanwhile, GE Healthcare (Chalfont St. Giles, UK) was displaying the anticart: a pole-mounted Dynamap vital-signs monitor combined with a C5 Tablet by Motion Computing (Austin, TX), creating a very compact computer-on-wheels assembly.
In the past, point-of-care (POC) computing vendors have generally sold products into the healthcare market that had been designed for commercial or industrial markets. But no more.
At this year's HIMSS meeting, Motion Computing launched its C5 Tablet, the first product to implement the Intel specification for a POC tablet specifically for the healthcare marketplace. Launch of the C5 represents a milestone in the delivery of healthcare-specific features, making it the obvious choice for most portable POC applications. Even before the formal launch of the C5, the UK's National Health Service expressed interest in buying more than 100,000 units.3
Nevertheless, the C5 is far from being a perfect device, and it is uncertain how the tablet will fare against other products designed for POC use.
Mobile Use. A new solution to POC mobility is the MedTab by Emano Tec (Waban, MA). This device weighs 12 oz, has a monochrome 1024 X 768 display, boasts a 12-hour battery life, and offers Wi-Fi 802.11g wireless connectivity. Like the C5 Tablet, the MedTab meets most hospital use requirements. But its greatest accomplishment is its battery life, which makes MedTab the only device of its size that can operate for an entire 12-hour shift.
On the conventional personal data assistant (PDA) front, Hand Held Products (Skaneateles Falls, NY) was the only POC computing device vendor to demonstrate its products using actual clinical work flows. At HIMSS, the Hand Held 9500, 7900, and 7600 were run through their paces using applications for specimen collection, medication administration, and surgical instrument tracking. Of note is the 11- to 12-hour battery life provided by the 9500 and 7900 PDAs (the 7600 has a 6- to 8-hour battery life). The 7900 was also used in the Welch Allyn booth to demonstrate that company's new nurse-carried alarm notification and near-real-time surveillance feature.
Connectivity and Interoperability
At this year's HIMSS meeting there was lots of talk about interoperability, but company displays showed only limited progress since last year. The Integrating the Healthcare Enterprise (IHE) work group on patient care devices held its first Connectathon and Interoperability Showcase. There was also a demonstration project using the CANopen network protocol to automatically recalibrate an invasive pressure when the patient's bed elevation changes.
Connectivity vendor Capsule Technologie (Paris) introduced wireless connectivity using the DPAC Wi-Fi radio module. HCTSi (Panama City, FL) launched a new suite of connectivity products, including Bluetooth and Wi-Fi wireless support. And Cardiopulmonary Corp. (Milford, CT) showcased its surveillance and alarm notification system for ventilators and other devices.
Meanwhile, two healthcare IT vendors showed off their own proprietary 'open connectivity' systems. Cerner demonstrated its MDBus USB configuration standard for serial connectivity, and AllScripts talked about its Universal Application Integrator. Such efforts to provide plug-and-play connectivity highlight the limitations of the HL7 standard, which requires configuration for each installation. But most important, so long as each vendor wants everyone else to integrate its 'universal' software, adoption of such systems will remain limited.
In 2000, the U.S. Federal Communications Commission allocated certain communications frequencies for use as a defined wireless medical telemetry service (WMTS). Although use of the WMTS is a reasonable product strategy, WMTS lacks the bandwidth, monitoring tools, and industry standards that ensure coexistence with other vendors' products.
At this year's HIMSS meeting, Philips Medical Systems (Bothell, WA) signaled that it is moving away from using WMTS for its patient monitors in the United States. Instead, the company intends to provide the same Wi-Fi 802.11a/b/g connectivity it currently provides outside the United States. Initial indications are that Philips will support the wireless local-area network (LAN) by Symbol Technologies Inc. (Holtsville, NY), now a business unit of Motorola. The move will make it necessary for hospitals to install a separate network infrastructure to support Philips medical devices.
Over the past year, vendors such as Capsule Technologie, HCTSi, and Sensitron (San Mateo, CA) have continued their efforts to bring wireless connectivity to legacy devices. Wireless enablement is also coming to new POC diagnostic devices and ventilators. Such increased adoption will create challenges for device and wireless-infrastructure vendors as well as healthcare providers. For instance, facilities will likely need to deal with issues related to the capacity of their wireless LANs, and their need to monitor and manage those networks will also increase. Earlier this year, FDA offered manufacturers some help by issuing a draft guidance about how to apply the quality system regulation to the development of wireless devices.4
Other companies contributing to the momentum in favor of the Wi-Fi standard include Welch Allyn and Hospira (Lake Forest, IL), both of which used the HIMSS meeting to announce new 802.11a/b/g radios for their medical devices. Previously, Welch Allyn had used 802.11 FH radios by Symbol Technologies and Hospira had provided an 802.11b radio. Welch Allyn will release its radio with support for a wireless LAN by Aruba Wireless Networks Inc. (Sunnyvale, CA) and will add support for a wireless LAN by Cisco Systems Inc. (San Jose) shortly after release. Hospira will support its wireless pumps on hospitals' wireless infrastructure.
The connectivity of POC diagnostics has advanced to the point of using wired network connections and docking stations to transfer data. However, use of this docking-station model is limited; today, only about 30% of POC test results are integrated with EMRs, and only about half of POC test results ever make it into the patient's chart.
At this year's HIMSS meeting, LifeScan Inc. (Milpitas, CA), a Johnson & Johnson company, showed the OneTouch Flexx, the first wireless POC glucose meter. Using a Wi-Fi radio module by Lantronix (Irvine, CA), test results from the meter are transmitted wirelessly to the OneTouch DataLink server, eliminating the need to return to a docking station to download data.
Another POC demonstration at HIMSS came from Cardinal Health (Dublin, OH), which last year acquired Care Fusion (Reston, VA). At HIMSS, this acquisition was reflected in the demonstration of an end-to-end medications administration solution. Incorporating the Care Fusion system, the updated Cardinal solution integrates the company's Pyxis MedStation and Alaris infusion pumps to automate the administration of all types of medications.
Although hospital CIOs have long preferred monolithic single-vendor solutions, the past year has witnessed what may be the beginning of a breakdown in the market dominance of this approach. As healthcare IT expands to embrace ever-new applications, implementation of monolithic systems is becoming increasingly complex, more time-consuming, and expensive. Moreover, many single-vendor solutions are merely sets of stand-alone applications that have been loosely cobbled together through acquisitions, and offer few benefits beyond the proverbial 'one throat to choke.'
Out of this struggling product strategy, middleware is emerging as the new best-of-breed application. Vendors have incorporated service-oriented architecture and Web services into their products, paving the way for middleware applications. While conventional best-of-breed applications have a narrow focus and limited integration with the rest of the enterprise, middleware applications are enterprisewide in scope and can deliver specialized features that are tightly integrated with the rest of the hospital's IT infrastructure.
The past year has also highlighted the 'enginification' of healthcare IT through the release of many new applications that are loaded with software engines. There have long been interface engines, and now it seems that every new application from healthcare IT or device vendors has engines for logic and decision support (rules engines), messaging, and, frequently, location. With proper needs assessment and planning, both buyers and vendors can benefit from this trend. Otherwise, caveat emptor.
A final trendbut one that overshadows all othersis the increased emphasis on patient safety in virtually every corner of the healthcare sector. Where past purchasing decisions might have required justification on the basis of a hard-dollar return on investment, such concerns are now being eclipsed by the drive to identify and implement potential patient safety improvements.
Increasingly, case studies from IT vendors are focusing on reductions in adverse events and improved clinical outcomes rather than on lower operating costs or improved staff productivity. When it is done right, improved patient safety returns both greater patient satisfaction and improved financial performance.
- Eighteenth Annual 2007 HIMSS Leadership Survey: CIO Results Final Report (Chicago: Healthcare Information and Management Systems Society, 2007).
- Healthcare Information Systems (Norwalk, CT: BCC Research, 2006).
- "Hospitals Pick Hi-Tech Clipboard," in BBC News [home page online] (21 February 2007 [cited 8 May 2007]); available from Internet: http://news.bbc.co.uk/2/hi/technology/6383035.stm.
- Radio-Frequency Wireless Technology in Medical Devices, Draft Guidance for Industry and FDA Staff (Rockville, MD: Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, FDA, 2007).
Tim Gee is the principal of Medical Connectivity Consulting (Beaverton, OR). For more information, visit www.medicalconnectivity.com.