© FOR THE RECORD /OCTOBER 24, 2005 100 E Michigan St, #200, Saline, MI 48176 tel 888-577-2797 · fax 734-527-6145 info@latitudecg.com · www.latitudecg.com © FOR THE RECORD /OCTOBER 24, 2005 Wireless is one type of technology that is having an impact on healthcare by enhancing data capture and physician mobility. Wirelees applications have the potential to assist in greatly reducing the 50,000 accidental deaths that occur each year from medical errors. Wireless connectivity in all its varieties is becoming increasingly important for accessing data, and the wireless medical device is an imporrtan part of this technological trend. Physiccian armed with PDAs can replace manual paperwork by wirelessly automating data entrry Th e same RFID technology used to track inventory of products and parts in the retail supply chain can be used to track hospital inventtory Emergency room physicians can use mobile ultrasound devices to perform diagnosse at the point of care and capture the images for later reference. Future applications may allow clinical professionals to collect medical information in ambulances and Medi Vac helicoopter to provide better care and speed reacttio times upon arrival at the hospital. While wireless technologies automate many processes and enhance data capture, a lack of information technology (IT) integratiio makes it diffi cult for providers to access a comprehensive view of this data in a meaningffu way. However, using information technoloog to consolidate device data and integrate devices with centralized health information systems can yield even greater benefi ts to healthcare delivery. Some of these applicatiion can and are being implemented now; others require the continued development of healthcare technologies. CURRENT APPLICATIONS Traditional, stand-alone medical devices display information locally on a printout or screen. Monitoring patient physiology informattio with these devices requires frequent bedside visits to observe key data and manualll creating paper records. Two changes are having a profound eff ect on the healthcare industry. First, medical equipment manufacturers have gone digital. Medical devices such as IVs and blood pressuur monitors, which were once analog, have been switched over to a digital format, allowiin data to be gathered, stored and transferred to computer systems. Second, the increased use of mobile medicca devices allows medical practitioners arms length access to the equipment they use on a regular basis. Everything from laptops to blood pressure monitors can be wheeled straight to the patient. Th is combination of digital information and mobility improves operational effi ciency and data accuracy. Mobiile digital medical devices can take patient information automatically, automating and eliminating errors in data collection. Although mobile devices have increased the effi ciency of service delivery, their point-ofcaar connectivity is often limited to wired netwoor access through a mobile docking system. Interoperability with other hospital systems is often limited and interfacing with those systeem through the docking system can be dif-fi cult. Th e device must be disconnected and reconnected to each network equipped room. Some devices may not even connect directly to the network but may require that the data be manually uploaded to a PC. Wireless devices enable more robust pointoofcare connectivity and hospital system interoperrabilit by providing seamless roaminng allowing network connections to change without interaction or knowledge of users. Laboratory and emergency service applicatiion are also impacted by changes in medical device technology. Similar to devices used for bedside patient monitoring, laboratory deviice for performing patient tests have been stand-alone, requiring an operator to perform tests and then manually record the results. Testing devices connected to a network could make the data immediately available to both patients and caregivers. Medical devices used in the fi eld by emergeenc medical technicians and nurses are isolated at the point of care. Information colleccte by these devices is recorded by the fi eld staff and then reported back to the hospital when the patient is admitted. Mobile, netwoorkconnected devices for automated and remote data collection would eliminate the many potential sources of recording error, from the technician’s reading of the device to the hospital staff entering the data in the hospital system. For these types of applicatioons wireless connectivity through a cellular or satellite network can transmit critical data directly into the hospital system so that the patient vitals can be analyzed quickly before the patient arrives. In addition, information about the patient could be transmitted back to the fi eld worker, who can then make more informed, potentially life or death decisions to stabilize the patient. ISLANDS OF DIGITAL INFORMATION In numerous ways the healthcare industry is just beginning to grapple with many of the information technology issues that the manufactturin industry has been wrestling with for the past decade. In the manufacturing industry, Six Sigma and Just-in-Time ( JIT) production were two developing concepts to improve quality (Six Sigma) and reduce costs ( JIT). JIT in the supply chain strives to eliminaat wasteful activities that add cost but not value to the end product. One of JIT’s focus in manufacturing is maintaining minimal inventory to produce just enough product to meet immediate demand. Six Sigma is a measurement of process quality using statisticca procedure control to continually improve manufacturing processes. Both Six Sigma and JIT continue to signifi cantly impact the automotive industry – an industry featuring a highly-engineered product involving 10,000 parts needing to meet demand for many differren models, each with their own inventory requirements. Six Sigma and JIT are supported in part by centralized real-time information from differren points in the supply chain that could be accessed by diff erent decision makers throughout the supply chain. While technoloog advances increased the amount and type Wireless Devices enable more robust point-of-care connectivity and hospital system interoperability by providing seamless roaming.© FOR THE RECORD /OCTOBER 24, 2005 of useful information that could be captured and stored in real-time, the proprietary nature of factory fl oor devices created compatibiliit problems that prevented the effi cient exchaang and use of information on the factory fl oor and throughout the company. Over time, adoption of Six Sigma-and JIT-type productiio increased with advances in factory fl oor technology. Devices began working on open platforms, using a PC-based architecture to exchange information. Th e open, PC-based platform provided a foundation for more sophistticate IT applications that increased procurement effi ciency, inventory control and assembly processes supporting Six Sigma and lean manufacturing. Similarly, immediate access to up-to-date patient and inventory information can reduce costs in procurement and increase the quality of healthcare delivery. Th e healthcare industry can leverage the experience of the manufacturrin industry in implementing value-added IT solutions. Much like the plant fl oor, the healthcare industry also has digital islands of information created by devices that lack standardization and common communication protocols. Healthcare has its own complexities and challenges unique to the industry. A caregiver must consider an enormous number of possibillitie to both diagnose and treat a patient. Each patient’s medical history can dramaticaall aff ect the interpretation of the symptoms observed by the caregiver and vital data measuure by the medical device. Health Insurance Portability and Accountability Act (HIPAA) requirements place additional demands on how information technology must be implemennted Healthcare facilities that can meet these challenges by harnessing disparate data sets and leveraging them through electronic health information systems will support great advancements in the quality of patient care and fi nancial effi ciency, much like the cost reducctio and quality advances the manufacturiin industry has been able to accomplish. CONNECTING ISLANDS OF INFORMATION AT THE FACILITY LEVEL Eff ort in connecting islands of information at the facility level has focused on connectiin caregivers to centralized data repositories. Less attention has been on automated, realtiim collection of vital bedside or laboratory data by a medical device through a common facility-level network that communicates with other healthcare applications and devices. Focusing on connected medical device netwoork can provide great benefi ts. Special terminnal or computers for each medical device are no longer required, as PDAs can provide the means to access data at the bedside. In a wireless environment, caregivers can collect and view remotely accessed data from many diff erent devices and analyze a full set of data, thereby providing the patient with better care. A networked system of medical devices also enhances real-time access, since data does not need to be manually transferred from the medical device to the network. Remote, realtiim data allows nurses and physicians to resppon rapidly to preset alarm conditions. Since they don’t require cabling and proviid mobility advantages, wireless networks provide both cost and benefi t advantages over wired networks. However, security is one concern regarding wireless networks in medicca applications that require compliance with HIPAA privacy standards. Th e act’s 802.11x standards address this issue through WPA and other security protocols. Unfortunately, not all devices use 802.11x protocols (either 802.11b or 802.11g) and not all 802.11x deviice are all compatible with each other. In addittion embedded devices that must operate on lower power requirements often use anotthe protocol, Bluetooth, for wireless communiccation Standardization issues exist on several levels. Lack of standardization among medicca devices means diff erent devices used for the same medical application are not always interoperable. Not all medical devices have a direct interface to the hospital’s IT network, which is further complicated since no standaar communication protocols exist in the medical device industry. Some of these standardiizatio issues are being addressed by standards-developing organizations, such as Health Level 7 (HL7) [www.hl7.org]. Device-level systems provide a potential IT solution addressing the competing technoloogie and standards issues. Th ese systeem could act as network servers connecting medical devices for archiving, printing and forwarding data to hospital-wide systems and applications. One component of a device-level system would be middleware that operated as a translator for the diff erent standards and data formats used by devices. Data could be converted to a common format, such as XML or another format according to the relevant standards established by H7 and other standaard organizations. Th e conversion process makes the data compatible with the healthcaar system and resolves any issues associated with variations in native data formats used by devices from diff erent vendors. Th ese device-level servers would operate in a distributed architecture, connecting the diff erent islands of information. Th e server hardware would operate on an open, PC platfoor to connect, either wired or wireless, to the hospital network through the standard TCP/IP protocol. Th ey would have preinstaalle interface cards that provide necessary connectivity to devices according to any proprieetar communications protocol that might be required to support a set of specifi c devices. An alternative to interface cards on the server would be adapters on the medical devices that converted the device’s communications protocco to the one used by the device-level server. Each server might host several diff erent middleware applications. Each application would translate device data for specifi c vendoor or types of medical devices. For example, one server might include a middleware appliccatio that would transfer recorded images from several diff erent devices that adhered to the DICOM standard and then attach the imagge to a patient’s health record. Middleware applications could be developpe internally by the facilities IT departmeent but it would be more likely that medical device companies themselves would develop bundled systems or other third parties would develop middleware that could be installed on standard PC servers. Many middleware develoopmen tools exist, including IBM’s Websphher and Apache software, but it would not be necessary to use any existing vendor’s softwaare Sun’s Java or Microsoft’s C# programmiin languages would work just as well. LEVERAGING ELECTRONIC HEALTH RECORDS For years there has been skepticism on the touted benefi ts of electronic health records. Th ere has been more optimism with the increease use of the Internet to access medical data. Th e department of Health and Human Services has been searching to establishing a © FOR THE RECORD /OCTOBER 24, 2005 national infrastructure for electronic health records. Th e department recently issued a Response for Proposal (RFP) to design protottype for a national healthcare information network, requiring vendors to consider applicaation that exchanged data across a wide range of providers and vendors. Potentially, medical devices with a real-time connection to a health system network could automatically access and update medical recoord stored in a central database server for access by authorized users across the entire institution, possibly even remotely. Such automattio would provide the most complete and up-to-date patient information at any given moment. Whether it was a nurse responding to bedside alarm, a fi eld technician providing emergency care, or a physician evaluating a patient, the caregiver would have vital informattio from the patient’s history that can affeec the successful interpretation of the curreen real-time data. Combining wireless technologies with a global electronic health information network would exponentially increase the effi ciencies of centralized data by consolidating vital patiien information across multiple health systeems Patient histories confi ned to a single health system might have gaps when they were traveling out of their health network or if paper records from a previous health systte were not transferred to the new system. By closing those gaps, the caregiver is more likely to identify test results that might aff ect a diagnosis and the appropriate prescribed treatment. With access to the results of tests performed out of network, the caregiver can also eliminate redundant testing that adds cost to the healthcare system. CONCLUSION By connecting the digital islands of informattio fl oating around in a wireless environmeent healthcare systems can deliver a higher quality of care and reduce costs. Automation reduces the time, eff ort and cost of administraatin patient treatment. Leveraging this informmatio through electronic health informatiio systems arms caregivers with important information that can improve their ability to diagnose and treat patients. As proved by the manufacturing industry, information and wireless technologies are the glue that can bind these pockets of healthcare information together into a more effi cient system. -Jeff Walter is the president of Latitude Consulting Group, an e-business and technology consulting firm based in Saliine Mich. that helps clients use informatiio technology to increase productivity and reduce costs. 100 E Main St, #200, Saline, MI 48176 tel 888-577-2797 · fax 734-527-6145 info@latitudecg.com · www.latitudecg.com