Operating Room

Connectivity, interoperability signal top system priorities, technology trends

by Julie E. Williamson

During a time when hospitals are working harder than ever to increase efficiencies, improve care decision-making and patient outcomes, and aid the capture and communication of critical patient data, it stands to reason that medical technologies that can meet each of these requirements has become a top purchasing priority. And that trend is sure to continue now that the Supreme Court has upheld the Patient Protection and Affordable Care Act, which will require healthcare organizations to rely on technology to increase efficiency, curb redundancy and improve outcomes.

Patient monitoring is one technology segment, in particular, that healthcare organizations are eying to drive quality, cost-effective care throughout a patient’s stay — from admission to discharge — while complying with healthcare reform’s information technology and electronic medical record requirements. Indeed, the technology is living up to hospitals’ increasingly high demands and expectations. Portable, flexible and more intuitive monitors that give caregivers the freedom to capture and track critical patient data in a more meaningful way — whether remotely, at a centralized station or at the bedside, and beyond — are the new norm. What’s more, solutions that allow for greater connectivity and interoperability are anything but a mere blip on the monitoring trend screen.

All this adds up to ease of use, effective and efficient use of data, less redundancy, and when used to its fullest, better patient care, sources told Healthcare Purchasing News.

"Monitors are an essential investment for hospitals and their efficient use directly impacts the success of patient care," noted Erik Denny, communications program manager for Physio-Control Inc., Redmond, WA. "With external factors like declining reimbursement and changing payer mix causing tighter budgets, hospitals are seeking ways to become more efficient, reduce ongoing equipment and training costs, and use performance feedback to drive quality improvement."

Baxter’s SIGMA Spectrum Infusion System

Put simply, monitoring solutions must fulfill a broad range of needs, from the C-suite and IT professionals that must ensure that all the patient data is making its way to the patient’s medical record, to the clinicians who must not only have ready, reliable access to patient data, but also have the ability to put that data in a meaningful context to provide the most timely, appropriate care.

Because different care areas require different levels of monitoring and functionality, scalable, flexible solutions are a must.

"Monitoring solutions span the care continuum and there are multiple different uses in which clinicians are seeking, so the need for connectivity and interoperability becomes very important," reasoned Julia Strandberg, vice president of global marketing, patient monitoring, Covidien, Mansfield, MA. The operating room and intensive care unit, for example, rely on their monitoring solutions to clearly communicate as much pertinent patient information as possible to make either real-time care decisions or pinpoint trends and stay one step ahead of potential risks or setbacks. On general care floors and even subacute care settings, monitoring should offer clinicians an at-a-glance snapshot of the patient’s vital sign status, in a flexible way that doesn’t require caregivers to be right at the patient’s side.

"Monitoring aids the road to recovery," she continued, adding that the proliferation of today’s wireless solutions allow caregivers to safely and effectively monitor patients, even as they’re transported to different care settings and units.

Pushing the parameters

As hospitals seek more advanced monitoring solutions and focus on value-based purchasing, they’re relying heavily on vendors to demonstrate their solutions’ far-reaching benefits. It’s both a challenge and an opportunity that vendors are eagerly embracing.

Assuring customers that the monitoring systems provide clinically viable and economically attractive solutions and parameters is a must, Strandberg stressed. "Our customers want to know how the parameters are meaningful and how they support good clinical decision-making," she said, adding that clinical studies are one key way to help articulate that clinical and economic value.

More than ever, solutions are delivering more monitoring parameters in one unit, allowing caregivers to maximize the amount of critical patient data captured, and analyze and trend that data in a more beneficial way, without the need for multiple standalone systems.

"The number of monitoring parameters integrated into a single device continues to grow," confirmed Denny. "However, integration with data systems for both clinical and operational efficiencies is where we’re seeing great advances in monitoring technology." Physio-Control’s LIFEPAK 15 records compression and ventilation data, defibrillation shocks and capnography, and, most recently, continuous temperature monitoring was incorporated for the monitoring of therapeutic hypothermia patients.

GE Healthcare's CARESCAPE Monitor B850

In March, Covidien announced that GE Healthcare will incorporate Covidien measurement technologies into GE Healthcare patient monitors; the Nellcor Respiratory Function portfolio, which includes Nellcor pulse oximetry with OxiMax Technology, and the BIS Brain Monitoring System, are now available on many GE Healthcare monitors. The collaboration brings together streams of patient data that can be used in a more useful way by clinicians at the point of care, Covidien notes. The GE CARESCAPE Monitor B850, for example, now provides access to Covidien measurements, bi-directional information flows between the monitor and hospital information systems, such as EMR, and electrocardiogram measurements — without requiring a separate monitor. In June, Covidien announced the launch of the Nellcor SpO2 module for the Philips IntelliVue patient monitoring platform. The Nellcor SpO2 module incorporates Nellcor OxiMax pulse oximetry technology, providing a cost-effective way for clinicians to detect and treat potentially life-threatening events by creating a more complete picture of a patient’s respiratory function status.

"Combining the Nellcor OxiMax pulse oximetry technology with Philips monitoring platforms can lead to enhanced patient care by providing clinicians with cardiac-based readings of SpO2 and pulse rate — two important vital signs that can serve as an early warning of serious respiratory complications," Covidien reports.

In 2011, GE Healthcare formed its Life Care division in response to the industry’s growing need for device connectivity and data convergence across various devices.

GE is committed to providing an open interface that allows data to be shared between GE’s existing and future devices and third parties’ devices. "We understand that no customer uses just one vendor’s equipment," said Charlie Giordano, chief technical officer of Life Care Solutions, GE Healthcare.

Draeger’s Infinity M300

Telford, PA-based Draeger has also deepened its parameter and integration offerings. The company offers the Infinity Acute Care System, a monitoring solution that provides continuous surveillance, interoperability with Draeger’s ventilation systems, comprehensive patient information at the bedside, and the full suite of Masimo’s rainbow SET non-invasive Pulse CO-Oximetry measurements. The Masimo rainbow SET technology continuously measures multiple blood components and hemodynamic parameters that previously required invasive procedures. The Infinity M300 monitor is a patient-worn telemetry monitor that may be worn around a patient’s neck to monitor both heart rate and oxygen saturation in one device. The bi-directional communication capabilities minimize the need to go back and forth to the Central Station to address issues.

"Waveforms and patient information are viewable on the color display, which also prevents multiple trips by the nurse to the Central Station when visualizing waveforms/quality of signal/battery life, as this can all be addressed at the bedside," Draeger states.

Connectivity aids data capture

The GlySure System comprises two main parts, a monitor and a sterile disposable set which includes a fibre-optic sensor and integrated calibration module.

While parameter offerings are undoubtedly a key factor in healthcare organizations’ monitor purchasing decisions, experts agree that the way that data is captured and managed is the most critical component in effective monitoring. Put simply, all the patient data in the world will be of little value if it’s not organized and managed effectively, stressed Chris Jones, CEO of GlySure Limited, a glucose monitoring solutions provider based in Oxfordshire, UK.
Vendors and their healthcare customers are bridging these gaps with enhanced connectivity through HL7 gateways and wireless infrastructures.

"This connectivity enables the automation of vital sign data from the monitors to the EMR, eliminating the need for constant updating on paper records that must then be manually transferred to each patient’s electronic record," explained Stuart Long, president, North America, Capsule Tech Inc., Andover, MA. "Because more and more monitors have built in the HL7 feed, documentation is now automated for these devices, allowing caregivers to focus on patient care."

Increasingly, healthcare customers are looking for providers with an open approach to wireless networks, added William Fox, Welch Allyn’s marketing director. Wireless connectivity and EMR system integration are key functions of Welch Allyn Inc.’s monitoring solutions. The Welch Allyn Connex Electronic Vitals Documentation System, for example, includes the wireless Connex Vital Signs Monitor, accessory cable management stand, and Connect Vital Management Software, which serves as the backbone for the Connex EVD System and allows complete point-of-care documentation. Two-way communication capability allows users to transmit vitals data, manual parameters and modifiers from the device directly into the EMR system. Bi-directional wireless technology also allows data to be effectively and efficiently pulled out of the EMR, as needed, to improve patient care and clinical decision-making, said Fox.

Draeger utilizes a shared 802.11 b/g wireless infrastructure for its wireless monitoring devices, allowing the hospital to leverage the investment in the wireless infrastructure that is being built for medical and non-medical related devices. "When a hospital can use a shared 801.11 infrastructure for devices like patient monitors, telemetry, voice-over IP phones, computers on wheels, etc., it can literally save an institution millions of dollars that might have been spent on separate single device wireless systems on proprietary network systems," said Mary Kreder Robinson, marketing director, patient monitoring and IT, Draeger Medical Inc.

Draeger’s Infinity Acute Care System monitoring solution includes the handheld Infinity M540 monitor and the Draeger Medical Cockpit that integrates diverse clinical information at the point of care. This fully networked solution allows a single monitor to follow the patient during the entire care pathway to minimize undetected events. "At the same time, it opens the flow of patient information throughout the hospital and beyond to support time-critical decision-making."

Chicago’s Rush University Medical Center is the first US hospital to fully incorporate the new Infinity Acute Care System monitoring solution. When the M540 monitor is undocked it automatically switches to wireless mode, eliminating the need to change monitors or cables. The Medical Cockpit integrates vital signs data from the M540 with networked information, such as patient history, diagnostic images, lab results, and other relevant networked clinical data into one widescreen display at the point of care. The system also enables ventilation parameters from Draeger ventilators to be displayed on the Medical Cockpit and sent over the network.

Improved connectivity is a growing trend in the infusion therapy segment, as well — both in terms of EMR system integration standpoint and Dose Error Reduction Software functionality and compliance. "Both are critical to increasing the safety and efficiency around infusion therapy," said Eric Sato, senior director of Baxter’s US Infusion Systems marketing team. "With bi-directional wireless connectivity and aEMR connectivity, fully integrated systems will enable hospitals to share real-time electronic information with nurses and clinicians to enhance patient safety at the point of care."

Captured patient data can have a direct and positive impact on healthcare organizations’ quality and performance improvement initiatives. Through Physio-Control’s LIFENET System data network, ventilation status, resuscitation effort results and vital signs data captured on Physio-Control’s LIFEPAK 15 is sent to the code review QI team, who then analyzes it using CODE-STAT 9.0 data review software to evaluate chest compression hands-on time, according to Denny. "The result is a strengthened feedback loop with code teams."

Sunnex's M9000 multi-parameter monitor features a 12.1-inch, high-resolution TFT LCD display.

Hospitals aren’t the only institutions setting their sights on connectivity and interoperability. Ambulatory surgery centers are also turning a keen eye to advanced monitoring solutions to drive quality of care and operational efficiencies. EMR-capable devices are becoming a greater priority, according to Scott Patneaude, medical sales manager, SUNNEX Inc., St. Petersburg, FL. It is important that ASCs confirm that the monitor is able to work with or communicate with an EMR — or is EMR capable," he reasoned, adding that it’s also important to confirm if a central station or some kind of "switch" is required for the monitor to communicate with the EMR. "If this is the case, the ASC should confirm not only the cost of the central station/switch, but how many they will need to purchase, as they can be rather expensive."

Emergency medical transport professionals are tapping into more sophisticated monitoring data capture, as well, thanks to solutions that let them acquire and transmit critical vitals to and from hospital providers. Physio-Control recently introduced the ReadyLink 12-Lead ECG device for basic life support EMS systems requiring remote decision support for chest pain patients. ReadyLink enables BLS EMS providers to send and receive a patient’s 12-lead ECG to hospitals using the LIFENET System. "This provides earlier insight into a chest pain patient’s condition, especially in rural areas with limited access to advanced life support providers, and helps enable the most efficient routing for patient treatment," Denny explained, adding the ReadyLink can also be used for hospital walk-ins to send patient 12-lead ECG data to referral hospitals.

Even if a brand or type of device has its own HL7 gateway and feed, which can lead to multiple points of integration for IT to manage, middleware providers can remove that challenge from the equation, according to Stuart. "There are many more devices in the hospital, such as ventilators and IV pumps that also need connectivity. This is where a middleware provider like Capsule can help because middleware solutions enable connectivity of virtually any type of device, including monitors, to any information system." Capsule’s Connectivity Suite offers a variety of deployment options so hospitals can connect any device to any system in any care area — and in a way that fits the clinical workflow and IT infrastructure.

Enhanced connectivity is also coming in the way of remote monitoring solutions and applications that allow real-time access to patient data from tablet computers and other smart devices. This mobile access is allowing caregivers to keep a finger on the pulse of pertinent patient data, which assists in care of high-acuity patients while making monitoring a more efficient task for today’s busy caregivers. In February, GE Healthcare and AirStrip Technologies announced the availability of AirStrip Patient Monitoring, which securely delivers patient monitoring information to critical-care physicians’ iPhones and iPads. AirStrip helps physicians interact with, manipulate and zoom in on more than 100 clinical measurements, and access physiologic data and monitoring waveforms, anytime and anywhere.

"With this application, a physician can be at home and, if needed, can still monitor a patient’s real-time waveforms," explained Giordano.

Remote monitoring will further gain momentum now that the Federal Communications Commission ruled in favor of a vendor-neutral, dedicated wireless spectrum for Medical Body Area Networks. MBANs will eliminate restrictive cables and the need to keep patients tethered to a bedside monitor. Instead, patients will wear the small wireless sensors to capture vital signs, thereby allowing patients to ambulate more quickly and hasten recovery.

As Giordano noted, such wireless medical devices will allow for a continuity of measurements as the patient moves through different care areas. "It’s also a benefit in terms of infection control," he said, adding that wires draped across the patient — and on wounds — pose an infection risk. "If you remove the wires, you reduce those risks."

Systems getting smarter

Today’s monitoring solutions are more intuitive that ever, allowing caregivers to set customizable limits and alarms that help them deliver more personalized, focused patient care.

Smart infusion therapy systems, for example, are being designed to reduce drug errors and improve patient care. Baxter’s SIGMA Spectrum Infusion System automatically defaults to using the drug library when an infusion is programmed. "This has enabled a 93 percent compliance rate with drug library use amongst hospitals using the system," Sato said.

Enhanced customization and flexibility that lets users adjust monitoring and alarm settings to different care areas is another perk that’s allowing facilities to milk the most economic and clinical value. Welch Allyn offers built-in profiles that allow certain users to set alarm limits according to the patient’s unique monitoring requirements.

Such flexibility can go a long way toward ensuring that patient data capture remains meaningful, while also reducing alarm fatigue — an all too common caregiver complaint when facilities implement more and more monitors and parameters. It’s a problem further underscored by ECRI Institute’s Top 10 Health Technology Hazards for 2012, which placed alarm hazards in the number one spot.

"With every new parameter comes another alarm, so the question becomes how do we become smarter with those alarms?" said Jones. Predictive alerts that allow the caregiver to tailor alerts in a more personalized way and manage the workflow effectively instead of having to constantly address potentially disruptive alarms are an effective solution that’s growing in availability and popularity, he said. GlySure’s continuous intravascular glucose monitoring system, which will undergo FDA trials early next year, provides continuous glucose readings throughout the length of stay in the ICU. "Continuous glucose monitoring gives information on where the patient is right now, but it also allows caregivers to do predictive trending, so they know when to take action before a patient falls out of safe range."

Indeed, the presence of smart alarms can significantly enhance a facility’s ability to monitor and care for patients in a more meaningful, timely and truly customizable way.

"It’s important to make alarms smart, responsible and integrated with other parameters so the alarm itself helps with clinical decision-making," reasoned Strandberg. The Covidien Alarm Management System (AMS) for the Nellcor OxiMax N-600x pulse oximeter alerts staff to ongoing oxygenation developments, so clinicians can quickly identify potentially harmful patterns of desaturation, as well as differentiate between serious desaturations and minor transient events.

The Alarm Management System is comprised of four key features, including the SatSeconds alarm management, which reduced nuisance alarms; the OxiMax SPD alert that detects desaturation patterns indicative of repetitive reductions in airflow; New Trend View, which offers historical information with highlighted alerts; and the New General Care Format View that allows at-a-glance evaluation of patient condition. SatSeconds is a clinician-controlled feature that is based on a combination of the magnitude and the time by which a patient goes outside SpO2 thresholds. The result is that clinicians can put brief desaturation events into context with their depth and put shallow desaturations into context with their duration. The Alarm Management System can allow staff to pinpoint worrisome patterns, even if patients aren’t crossing the SpO2 threshold, and give caregivers a clearer picture of the patient’s oxygenation, as opposed to a simple snapshot in time. Put simply, clinicians get alarms that are meaningful.

"When you can normalize and determine between transient events and things that are clinically relevant, you are able to make better care decisions," said Strandberg. "Providing data — and then delivering it to the user in a way that is truly meaningful and easy to understand — is the most important thing we [monitoring solutions providers] can do for our customers. And that’s what customers expect."