A knotty problem

Lorin David Kalisky
Marketing Manager, Capsule Technologie

Over the past decade, healthcare information systems have advanced dramatically. The computer-based patient record has become less of an elusive goal than it once was. The benefits of clinical information systems (CISs) are clear; they enable healthcare providers to raise the standards of care, institutions to optimise costs, and patients to experience a comprehensive and integrated care delivery process.

But one of the most critical elements of any patient data environment – connectivity with bedside medical devices – remains a significant challenge for CIS providers, device manufacturers, and healthcare providers alike.

Increasingly, CIS providers, medical device manufacturers and end-users are working with third-party medical device connectivity specialists to solve the problem. Third-party connectivity specialists offer middleware systems and software that, when integrated with the clinical or hospital information system, translate medical device data into industry standard XML or HL7 formats and then pass the data to the CIS.

Outsourcing to a third-party specialist can offer several key advantages over other interfacing strategies including greater cost-efficiency, connectivity to a wider array of devices, and much faster implementation.

Islands of information

In most healthcare environments there exists a diverse patchwork of systems and platforms that has evolved over time. Specialized systems and devices are available for radiology, cardiology, pharmacy and acute care – among other care arenas – and most bedside medical devices were designed as stand-alone systems.

Generally, each system or device handles data specific to the area of care, and uses specific data formats that are difficult to integrate. This creates "islands of information" in healthcare, rather than a cohesive information environment; and so connecting bedside medical devices and passing their data to a CIS is not as simple as it may seem.

For the link to work, the device have both a physical (or wireless) connection to the CIS as well as a means of transferring the device data in a format that the CIS can understand —in most cases XML or HL7. The quantity and diversity of devices on the market, their age and lifespan, a lack of industry-wide data standards and the prevalence of proprietary data protocols, all combine to make medical device connectivity a major challenge and a growing point of pain for healthcare.

Creating device interfaces is expensive and time-consuming, and diverts key resources from vendors. Additionally, many device manufacturers do not have the resources or expertise to adapt their products to CIS’s and other networked information systems, and if they do, it remains a slow process. Many manufacturers are small and medium-sized companies that focus on a specific area of patient care, and their products are designed as stand-alone devices. Many devices on the market today (and many more that remain in use) do not have network-ready COM ports such as parallel or Ethernet ports.

Different protocols

All over the world, there are more than 1,000 bedside device manufacturers worldwide offering a staggering diversity of monitors, infusion pumps, ventilators and dialysis machines, among other varied devices. Integrating data from a wide variety of medical devices can be a huge challenge. Not only do clinical information systems need to be able to connect to them, but they also need to connect to legacy devices that are in use in acute care environments.

In the US, the average lifespan for bedside medical devices is usually not more than four or five years, while hospitals and healthcare organizations in Europe generally use devices for 10 years or longer. Many of these devices are no longer available and many CIS providers often find that communication protocols are difficult or impossible to obtain. There are almost as many different data protocols in use today as there are different medical devices.

However, third-party connectivity providers often offer extensive libraries of these device drivers, ensuring high levels of devices connectivity in virtually any care environment. One major strength of third-party connectivity providers is that they specialize in device firmware, low-level data translation, and offer drivers designed specifically for the unique requirements of individual devices.

Hospitals and healthcare providers need to ensure seamless connectivity, even when device manufacturers upgrade their devices, add features or functions, or upgrade the device firmware. Healthcare providers often find themselves in the unfortunate situation of losing connectivity to a specific device after such changes or upgrades take place. In these cases, CIS providers are not always ready or able to solve the problem. Since third-party connectivity specialists focus uniquely on this arena, CIS providers and their customers can be more confident that consistent levels of connectivity are maintained while devices are upgraded or changed.

The future

Clinical information systems were once loss leaders for medium and large device manufacturers. But now they are becoming profitable, the CIS providers are facing increasing connectivity requirements from their customers. Hospitals and healthcare organisations implementing these systems are demanding high levels of connectivity in order to realise the care-level promises of their investments. CIS vendors are scrambling to meet this demand.

As hospitals and healthcare providers increasingly deploy sophisticated information systems to improve and streamline patient care, third-party connectivity specialists offer key business, technology, and regulatory advantages over other strategies. Device connectivity from these specialists enables improved clinical decision-support, helping to reduce the potential for medical error, as well as improve clinician productivity.

Lorin David Kalisky
Marketing Manager, Capsule Technologie 

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