An ICU patient setting with
a GE CARESCAPE B850 Monitor.

Special report: Integration key to ending "communication chaos"

July 23, 2012
by Diana Bradley, Staff Writer
This article originally appeared in the July 2012 edition of DOTmed Business News

Alarm management would improve if monitoring systems were integrated with pagers, mobile phones and other wireless devices. At June’s Association for the Advancement of Medical Instrumentation (AAMI) conference, the results of a 2011 nationwide survey on alarm management revealed that more than half of those surveyed agreed with this statement.

So, could integration be the solution to the growing “communication chaos” being witnessed in health care? Constantly generating updates, alerts and key pieces of information, a plethora of patient monitoring and other emergency management systems are inundating health care staff with hundreds of notifications every day. Unless this data is gathered and delivered to the right person at the right time on the proper communications device, experts agree it is useless. Hospitals are now working out ways to connect these disparate systems and rein in this communication cacophony, making life easier for clinicians and allowing for improved patient care and satisfaction.

“I wouldn’t call [communication chaos] a trend, I would just call it a reality given the amount of information systems, devices and technologies that come into play in patient care right now,” says Greg Rathmell, director of product marketing for patient monitoring systems and enterprise patient informatics at Philips Healthcare.

With the advancement of networking, wireless solutions and all the disparate technologies hospitals are trying to implement, a technology convergence is slowly but surely taking place. Integrating other sources of patient data with physiological monitors and alarm systems would help clinicians to better understand patient conditions and make sense of alarm signals. These sources include: electronic health records, lab data from multiple sources, combined data from different hospital units and data from other systems. But getting all of these systems to work and play nicely together can at times be challenging for hospitals, according to Allen Enebo, Spacelabs Healthcare’s global product manager for information management solutions.

“It’s just not a simple box solution any longer,” he explains. “You don’t just buy a monitor and use it. You buy a system and that alone is more complex by nature. Then, taking into account the needs of various stakeholders throughout the hospital – IT Clinical, biomed, finance – and how to integrate these to maximize your efficiency, adds to the equation.”

According to Amcom Software’s president, Chris Heim, more and more people are going to treat the patient monitoring system less as its own “island of information” and more as an integrated part of patient care.

“In the past 15 years, there has been a much bigger focus on connecting patient monitoring with other things in the hospital,” he says. “It used to be kind of connected to a central monitor. Now it’s a big change in connecting patient monitoring to mobile clinicians on whatever device they are carrying. This goes along with the rise of the smartphone.”

Connecting the dots
In November 2009, the Spyglass Consulting Group conducted a study, “Point of Care Communications for Nursing,” which found that incompatible hospital communications systems make it difficult for nurses to connect effectively with patients and to wirelessly collaborate with care team members.

In essence, doctors and nurses don a communications “tool belt,” consisting of at least one cell phone, smartphone, in-building wireless phone and a pager. So various messages from various machines must then reach health care workers’ various communications devices.

One popular solution is middleware, which integrates with a variety of input systems, acting as a hub for information, transforming these systems into a single device for communicating with other doctors, nurses, and patients, as well as clinical alerts, including nurse call requests and one-button patient callback.

A doctor receives an alert
from a patient monitoring
system on her smartphone.
(image courtesy of Amcom Software)

A partnership between GE Healthcare and Ascom Wireless Solutions unites wireless hardware and middleware with patient monitoring devices, offering hospitals a “one-stop” solution for wireless secondary alarm management. This enables workflow enhancements by providing clinicians with information anywhere in the hospital through automated paging or text messaging.

“It’s really important, as we have multiple pieces of technology, that technologies converge,” says Dr. David Barash, GE’s chief medical officer, Life Care Solutions. “By converging technologies, we can get all of this data put together into a sophisticated format or into an environment where we can do sophisticated analytics with it. We are going to converge data, technologies and devices, so we can do analytics on large volumes of data.”

Meanwhile, integrating consumer technologies like smartphones with patient monitors presents an entirely different challenge.

“Health care is not quick to adopt new or consumer technologies, which makes sense from a patient risk and a product development perspective,” says Enebo. “It takes time to get through the FDA process for those types of things.”

While the uptake of consumer technologies creeps at a sluggish pace, the technology itself evolves tremendously fast. Companies like Spacelabs are developing ways for health care providers to adopt and integrate this technology earlier and more efficiently.

Last July, Spacelabs created ICS XPREZZ - a mobile application for the iPad. This provides clinicians with the ability to view their patients’ comprehensive monitoring information anywhere they have mobile access. Patients’ information remains secure under ICS Xprezz, because information is processed within the hospital’s secure infrastructure. Further to this, patient data is never saved on the iPad.

Spacelabs’ ICS Xprezz
mobile app for iPad.

“If, as a doctor, I am at the beach or the golf course or simply at home with my kids and I get an urgent call about one of my patients, the ICS XPREZZ enables me to see my patient’s information,” says Enebo. “I am not having a nurse at the bedside trying to describe a waveform to me; I can actually see it and make a better assessment of the patient’s condition or what’s happening with him or her.”

Philips is also working toward integrating patient monitoring systems across multiple modalities, equipping health care facilities with a “one-pipe connection” to share data with enterprise systems such as the hospital EHR.

“There is more of a focus on interoperability; Philips certainly has a large focus on this,” says Greg Eckstein, director of solutions marketing, patient care and clinical informatics at Philips. “Some of our interoperability focus is across devices and departmental level systems, and some of it is interoperability with EHRs, which in turn gives the clinicians better information.”

Filtering and focusing messages
Further to converging systems, information still needs to be filtered to the appropriate person. But determining who has the final say on what alerts are important and whom they are going to is another riddle to solve. For medical device manufacturers, it is difficult to systematically reach these decisions, since they would be largely presumption based, according to Enebo.

“We can’t make any particular assumptions, because doing so could put the patient at risk,” he says. “So the industry has defaulted to sending everything, which makes the clinicians say, ‘Wait a minute, I don’t want everything.’ As a result, we can put filters into place, but the final conscious decisions have to be made by the facilities themselves.”

Minnesota-based Maple Grove Hospital’s senior project manager for information technology and new business development, Craig Wolgemuth, was hired to define the technology to support an effective care model. One of his primary objectives: create focused messaging.

“We took a kind of surgical approach to message delivery, as opposed to what I would call a ‘shotgun’ approach, whereby in the traditional model, [hospitals] would overhead page to everybody hoping that the right people would hear,” he explains. “That creates a lot of ambient noise and distraction to a healing environment.”

However, patient monitor alerts aren’t necessarily the primary communication chaos driver.

“If you are looking at your sicker patients, oftentimes the drivers to the chaos are monitor related,” says Wolgemuth. “If you’re looking at less sick patients like moms who have just given birth or someone who has just had a surgery, a lot of what drives communication is nurse calls, patient requests and interactions.”

To manage these issues, Wolgemuth and his team looked at the entire spectrum of patients and their individual needs – from simple requests to life-or-death scenarios. For example, if a patient’s wireless cardiac monitor (or telemetry pack) indicates the heart has stopped beating, the entire unit must receive that message and the patient must be responded to immediately. On the other end of the spectrum, that same device may merely have a low battery warning. A message like this would go to an aid or tech that has the task of tending to that alert. If that person is not available or the issue doesn’t get resolved in a certain period of time, the message is escalated to someone else until it gets dealt with.

“What we are trying to do is target communications to the right person so nurses are doing nurse work, aids are doing aid work, the chargers are only responding to things that are otherwise unfulfilled by other folks, all the while trying never to create a dead-end for a request from a patient,” Wolgemuth says.

Maple Grove uses Amcom Messenger middleware to send critical secondary notifications from patient monitoring and other alert systems to staff carrying wireless communication devices, including smartphones, pagers, and Wi-Fi phones. Walgemuth was able to use this system to create rules for the routing he wanted for certain events. “[It has] allowed us to achieve quietness of hospital scores in the top two percent of the country,” he says. “We have very high nursing satisfaction given the tools in the environment we have placed them in.”

It is becoming commonplace for end users to not only request, but expect more intelligent filtering capabilities and direction of messages when it comes to patient monitoring systems. GE has implemented a multi-pronged approach to address this issue. The company’s main focus is taking that communication chaos and making it “communication sensibility,” according to Barash.

“A lot of our work around the communication chaos is educating our users around how best to use the technology and make sure it’s most effective,” he notes.

Future forecasting: Monitoring the monitors
If you get garbage in, it’s pretty much garbage out. And trying to match the garbage on the other side will be more difficult than just getting to the root cause of the problem, says Besher Tabbara, market manager for Siemens Healthcare’s Soarian Clinicals, a workflow management solution.

“Fix patient monitor communication upfront, get an accurate measurement, try to minimize user errors you can control, get a nice lead attachment to the patient, get a good signal on the monitor and try to eliminate or get rid of the noise you can control upfront,” he advises.

Fortunately, a number of guidelines and initiatives are underway to help manufacturers and care workers answer the call for improved interoperability in alarm systems. For example, Integrating the Healthcare Enterprise (IHE), a campaign by health care professionals and industry to improve the way computer systems in health care share information, has set up the IHE Patient Care Device Technical Framework Supplement on Alarm Communication Management. The framework, which was released for trial implementation last July, provides a uniform way of representing common alarm conditions in HL7 (Health Level Seven International) messages to facilitate interoperability of systems from different vendors.

Initiatives and idealism aside, Spacelabs’ Enebo sees this as an ongoing problem that health care facilities and manufacturers are going to have to continuously monitor to keep under control.

“Developing new solutions that optimize workflow is the nature of the business,” he says. “You constantly have new devices, new technologies, new data integrations between devices and new information with new clinical data.”

DOTmed Registered 2012 - July DMBN: Patient Monitors Companies

Names in boldface are Premium Listings.
Ryan McGinty, Medical Device Pro's, CA
Roberto Martinez, Mart Medical Equipment and Services, Inc., FL
Ronald Tarr, MEDELCO, FL
Lilly Echazabal , TH. Medical Equipment, FL
DOTmed Certified
DOTmed 100
Todd McCuaig, LS Inc, IL
Brad Rumph, Heartland Medical, KY
Alda Clemmey, Saffire Medical, MA
DOTmed Certified
DOTmed 100
Robert Schirano, Finger Lakes Medical Supply LLC, NY
Lawrence Maroney, Integris Equipment, NY
DOTmed Certified
Joe Harper, Sage Services Group, SC
DOTmed Certified

Liz Nie, Kantech International (Jiangxi) Co., Ltd, China
Liming Xue, SinaCan Exchange Co.,, Canada
Reno Itzhaki, Eltec Eng. Medical Systems Ltd. , Israel