Dräger Medical’s Infinity Patient Monitoring System™
integrates ventilation, patient monitoring, and charting
data at the point of care

"It’s all about size, power and connectivity," said Chris Jones, vice president of marketing at Tyco Healthcare’s Nellcor unit (Pleasanton, CA). "Companies are making things to be compatible with [Microsoft] Windows. Everybody can see the direction in which the technology is going but the challenge is how to make it work."

Mix in such terms as affordability, compatibility, portability, versatility, along with modular components, remote monitoring and touch-screen capabilities, as well as user friendliness, and you begin to see a convergence of concepts familiar in the computer environment, too.

Frost & Sullivan, the Mountain View, CA-based market research, consulting and training firm, identified 12 segments that comprise the $6.4-billion patient monitoring market in the United States, which account for nearly half of the global market. Those 12 segments, which the firm tracks, are anesthesia monitoring; blood pressure monitoring; cardiovascular monitoring; diabetes glucose self-monitoring; EEG diagnostics and monitoring; external defibrillators; fetal and neonatal monitoring; multiparameter equipment; pulse oximetry, capnography and anesthesia agent monitoring; sleep apnea monitoring; telemetry and temperature monitoring.

One of the hottest new opportunities resides out on the floors responding to ambulatory patients, according to Jones, and not tethered to bedrails, computers or equipment stands. It’s ambulatory telemetry that can be read on a device that resembles a personal digital assistant, if not a PDA itself. Telemetry today remains as close as we’ve gotten so far to those "tricorders" used on the "Star Trek" television and movie series.

"It’s low-end remote monitoring," Jones noted. "Clinicians want to get useful information and use that information where they need it."

Frost & Sullivan pegs telemetry as the segment to watch within the next year or so, forecasting considerable growth in the area of 30% to 42%.

Fired up about wireless

Capitalizing on this new trend is GMP Wireless Medicine Inc., which launched its LifeSync Wireless ECG System in March and debuted it at the annual American Association of Critical-Care Nurses show in Orlando in late May.

GMP bills LifeSync as "the first monitoring system that eliminates lead wires and trunk cables between patients and bedside, 12-lead or transport ECG monitors." Two-way radios transmit and receive patient ECG and respiration data to existing ECG monitors, and the disposable LeadWear System replaces the need for lead wires. GMP acquired the worldwide, exclusive rights to use this proprietary wireless technology for medical applications from Motorola Inc. and worked with that company’s engineers to design and develop LifeSync.

GMP designed the system to save nurses time by eliminating the need to detach and reattach lead wires during patient transport, and by facilitating patient mobility (e.g., positioning and turning). Another potential benefit is that it may reduce the risk of cross contamination stemming from the reuse of lead wires, according to the company.
Philips SPO2 Sensor

The transition to wireless for telemetry hasn’t been without its challenges. Clinicians using older telemetry systems transmitted and received medical physiologic data via the UHF and VHF bands, which are typically used by television broadcasters. Unfortunately, the advent of digital TV reduced available bandwidth. The Federal Communications Commission gave healthcare providers access to the Industrial, Scientific and Medical (ISM) band, which also is used by various communication devices, such as pagers, PDAs and mobile telephones, as well as microwave ovens. In short, medical users of the VHF, UHF and ISM bands were susceptible to outside electromagnetic interference from a host of other devices.

That’s why most manufacturers are working with Wireless Medical Telemetry Services (WMTS), established specifically for healthcare by the FCC to enable clinicians to transmit and receive patient data bidirectionally (meaning that data could be resent if needed) without interference.

"All of the majors use WMTS," said Scott Sbihli, marketing manager of wireless systems in the clinical systems area of GE Healthcare, about the leading manufacturers. "That’s the strongest indication that [providers] should be there, too."

Although Sbihli recognizes that more devices are going wireless these days – computers, phones, pumps – he acknowledged that providers have been slow to respond in terms of their spending when measured against their interest. Certainly, wireless telemetry beds are pushing the boundaries of flexible monitoring, and the capability of remote, multi-parameter modules pumping more data through the pipeline is no longer so far-fetched. "We’re wiring facilities today with the goal of working with telemetry beds in the future," he noted, adding that wireless towers are being erected to satisfy expected demand spikes.

A hard look at software

Earlier this year GE Healthcare launched a new telemetry system under its ApexPro banner. Joining the ApexPro CH (which stands for channel hopping) is the new ApexPro FH (which stands for frequency hopping). ApexPro FH uses a bi-directional communication infrastructure that hops around the frequency spectrum to prevent interference, signal loss or dropout, so that data are transmitted clearly to the central workstation. Both ApexPro systems connect to the company’s Unity Network Patient Data Server (PDS), which continuously collects and stores monitoring data as patients move from one monitor to another, regardless of location. When clinicians connect to the Unity Network Patient Viewer system they can access monitoring data from anywhere in "near" real time.

The PDA-based Voyager from Dolphin Medical, Inc.

GE Healthcare expects the ApexPro FH to gain a solid foothold in the U.S. even as the rest of the world relies on the ISM-oriented and channelized ApexPro CH system, according to Sbihli.

"Adoption has been slow," said Kristin Yakimow, general manager of market for GE Healthcare’s Clinical Systems & Diagnostic ECG Americas unit. "Hospitals always ask for return-on-investment estimates. But what’s the average life cycle on monitoring equipment? You just can’t keep these units for seven years and maintain them. You have to upgrade. Unfortunately, most hospitals are using them for 10 to 12 years and don’t feel they need to upgrade the software."

Indeed, patient monitoring is more of a software game than hardware, noted GE Healthcare’s Ruben Salinas. "Clinicians want access to information either remotely or centrally with a common user interface."

One example is GE Healthcare’s Solar line, which includes an array of options for modular flexibility, including the Tram modules for multiparameter data acquisition that also can function as a transport monitor when combined with the Smartpac Transport Display. User interface options include the company’s Trim Knob, touchscreen, remote keypad, mouse or keyboard.

Doing more with less

Philips Medical Systems expanded its Intellivue line of patient monitors beyond the high-end intensive care units that use its MP90, MP70 and MP60 monitors. In February, Philips rolled out its mid-range MP50 and MP40 models for lower acuity areas, such as surgery centers, emergency departments and intermediate care environments. More recently it introduced its portable MP30 and MP20 models, which can be wireless and are geared toward ambulatory surgery, post-operative care and patient transport.

"The trend we see in acute care critical care units is that staff under a lot of stress simply wants to accurately measure the care they provide to patients while moving those patients through the continuum faster," said Ken Ferry, senior vice president and general manager of patient monitoring. "That’s why we develop products that provide world-class measurements and help clinicians analyze outcomes."

Nellcor’s Chris Jones echoed that trend. "The cost of ICU beds is expensive so critical care nurses want to move those patients down quickly to the general nursing care floors," he said. "They want to get patients out of the ICU beds faster."

Dräger Medical Inc. emphasizes flexibility and portability through its modular Infinity System, which spans patient monitoring, central and bedside workstations, telemetry monitoring, wireless monitoring, cardiology information management and Web-enabled enterprise-wide marketing. When attached to an Infinity Docking Station, the modular Infinity monitor can adapt to the specific care setting for which it is being used, including alarm settings, waveform and parameter organization and relevant software access. For example, the new Infinity Delta and Delta XL models weigh less, have a longer battery life (three hours) and are adaptable to anesthesia. When undocked, the Delta, Delta XL and Gamma XL also facilitate wireless networking.

The pulse of oximetry

Big changes also have emerged in the pulse oximetry segment, historically a staple of the perioperative and critical care areas of the hospital used to measure oxygen saturation in the blood (SpO2). Among the changes are size, power (including performance) and compatibility, which also affects price.

It’s not uncommon today to see fingertip and handheld pulse oximeters in use, alongside tabletop and higher end units. Dolphin Medical Inc., for example, makes a PDA-based pulse oximeter called Voyager; Nonin Medical Inc. makes and markets a wrist-worn pulse oximeter called Wrist Ox. Nellcor even makes a sensor that can be affixed to your forehead.

The measurement accuracy of older pulse oximeters was limited by motion artifact until companies, such as Nellcor, developed motion tolerant algorithms to compensate. Masimo Corp.’s Signal Extraction Technology (SET) distinguished surrounding noise from motion artifact. In the past, ambient light also interfered with readings, and the devices tended to perform rather poorly under low perfusion conditions.

Yet as many pulse oximetry manufacturers improved monitor technologies, companies like Nellcor also improved their sensors. For example, the company’s OxiMax sensor contains a digital chip that sends a signal to the oximetry monitor when a patient’s SpO2 levels drop to an alarm level. The monitor then records that data into the sensor chip so that data follows the patient around and can be uploaded to another monitor, according to Jones. "What we’ve done is take the intelligence of pulse oximetry out of the monitor and just put it into the sensor," he said.

But at the same time, Nellcor saw the patent for its resistor calibration feature expire late last year, opening up the market to other brand-name compatible or generic sensors. In fact, Masimo formed a new division within its company, SpO2.com, to focus on developing and manufacturing Nellcor-compatible sensors. Not surprisingly, Nellcor’s Jones urged caution because the leading pulse oximetry companies tend to sell monitors and sensors as systems. "Let the buyer beware," he said. "You just have to educate yourself. One key area to focus on is how the company did their testing. Did they test their products on actual patients or healthy persons?" HPN