Medical Device Link.

Wireless Devices

A New Role for Medical Electronics in Health Resource Management

Health resource management can solve some key issues in the healthcare industry, but its success requires the development of wireless-based medical devices.

Ashok Kapoor

In the past 10 years, the intelligent use of data has been a driving force behind advances in productivity. As the information age hits its stride, organizing and transmitting information efficiently has made databases an indispensable resource.

The need to effectively track and manage resources brought about enterprise resource management (ERM) technology. Effectively managing relationships with customers created a need for customer relations management (CRM) systems. The use of such resource management tools has grown rapidly as the benefits of resource management have become clear.

An emerging concept, called health resource management (HRM), is an extension of resource management technology to the healthcare industry. By combining ERM tools with patient-monitoring devices, HRM builds a system-level

The medical device industry still needs to overcome some of the technical challenges required to implement HRM, but the technology presents many opportunities, especially in relation to patient-monitoring equipment.

HRM changes the role of electronic medical instruments by automating data transfer from the instrument over a network to a central location for every unit used for patient monitoring. The ability to connect to a network and automate data transfer brings tremendous flexibility in the deployment model of the medical devices.

Taking full advantage of the control functions available in the current data-transfer protocols, such as the RS-232 interface, the external networks can perform device identity and status check prior to validating data transfer. In addition, the automation of data transfer over the network and the real-time data analysis allow not only the elimination of data transcription error but also the real-time review of patient data by the system.

Background: The Healthcare Industry

As an industry, healthcare accounted for 1.3 trillion dollars in the past year. It is an extremely diverse, highly regulated industry. It is also extremely controversial because the cost of medical care continues to increase by more than 6% every year, nearly three times the consumer price index. Major changes are needed to curtail costs and improve the quality of medical service.

A well-developed HRM system can resolve some key issues by reducing inefficiencies and raising the standard of patient care. These issues include a near-critical shortage of qualified nurses and ever-increasing medical errors. HRM can also address rising costs and the lack of centralized databases necessary for consistent care.

Shortage of Nurses. The medical industry revolves around the patients seeking medical care and the care providers, that is, nurses, physicians, and the supporting staff. In all settings, patients almost always have contact with a nurse.

There are more than 126,000 unfilled nursing positions, and the situation is unlikely to change soon. The detrimental effect of this shortage has been well reported. The shortage has affected the working conditions of nurses who are being asked to care for increasing numbers of patients. Advances in technology have contributed little to alleviate this critical issue.

Medical Errors. With increasing pressure on care providers, medical errors also increase. Errors range from incorrect drug delivery to errors in instructions or patient vital signs.

According to a 1999 report from the Institute of Medicine (Washington, DC), between 44,000 and 98,000 deaths in the United States each year can be attributed to medical errors.

So far, the greatest amount of attention, and thus the greatest corrective action, has focused on medication-related errors such as delivery of incorrect medication or inaccurate dosage to patients. Medical errors such as incorrect transcription of patient vital signs are equally important, but such errors have not received nearly as much attention. Information errors require a technological solution that ensures the accuracy of patient vital signs, as well as the date and time vital signs are recorded. Such patient data should be available in an electronic format that can be accessed by healthcare providers wherever they are.

Rising Costs. Rising medical costs have been thoroughly documented. Expenditures in the healthcare industry are dominated by personnel costs. Tools that can bring efficiency and reduce costs are greatly needed.

Consistent Care. Most hospitals still lack a centralized database to store patient vital signs, notes, and other records electronically. Patient records are archived on paper and are often misplaced and difficult to track. Unfortunately, current standards are focused on addressing scheduling, staffing, billing, and reimbursement issues rather than on patient data.

Current Approaches

Resource management systems are often developed in isolation and seldom communicate with each other. This means that charge captures, patient records, drug information, and other data are not interlinked, minimizing a system's benefits. Patient clinical information is usually available in an electronic format, but often ends up in a printout. In addition to the lack of a central clinical data repository, few systems collect and connect information from multiple devices. The most significant patient information continues to be stored in bedside charts. Vital signs, therefore, are subject to misinterpretation errors during transcription.

An obvious solution is to replace limited paper systems with advanced technologies. However, this is more complicated than it seems. Hospitals generally have a sizable investment in their legacy systems, and so they often cannot justify the cost of retrofitting with new technology.

Technologies to automate clinical vital signs have generally proven to be extremely expensive. Such systems are therefore limited to intensive care units. In most hospitals, monitors attached to patients are usually hardwired to display devices at nurses' stations. The cost of wiring automated systems is viewed as prohibitively high. However, automated systems can be cost-effective and improve the quality of care.

The high rate of medical errors has prompted the federal government to develop legislation to solve some of the industry's problems. Federal law has mandated every hospital to implement systems to reduce medical errors. Federal funds have been earmarked for this process.

For many issues, though, a simpler solution would be to implement HRM systems. Such systems provide patient information to those who need it—when they need it. Therefore, nurse workloads would become lighter, and efficiency in general would improve work flow. In addition, errors caused by misunderstandings or unclear information would be reduced.

Medical Electronics and the Wireless Phenomenon

Medical electronics developers stand to gain tremendously from wireless technology as they find ways to deploy the technology for various devices and procedures. In the past, wireless technology was associated with high cost, poor reliability (with transmission subject to interference), and dropped connections. Deployment was difficult because of very high power consumption. Recent advances in digital wireless technology with noise-suppression techniques have overcome these objections.

Combining low-cost, reliable wireless technology with medical instruments and a cohesive data-transfer protocol holds the key to addressing the major issues in patient care. Using wireless technologies for automated transfer of information from medical instruments enables low-cost installation in hospitals. Wireless connectivity is a step toward building and developing electronic medical records based on a patient's clinical information gathered over time.

With multiple wireless technologies available, it may seem difficult to determine which is best suited for collecting medical instrumentation data. Table I presents a simplified explanation for various forms of wireless communication.

The Federal Communications Commission has assigned spectrum in the 2.40–2.84 GHz band for use in industrial, scientific, and medical (ISM) purposes. Although Bluetooth and 802.11b operate in the same frequency band, they are shown to coexist without significant impact on performance.1 It is quite evident from Table I that Bluetooth is the optimal wireless technology for transferring data into and out of medical monitors. The cost of deploying Bluetooth-based wireless systems continues to decrease. It is now a viable option for medical equipment manufacturers to include wireless connectivity in their equipment. It is extremely important, however, for manufacturers to use a stable communication standard that is backed by a large number of users and is therefore likely to be supported over a long period. The Bluetooth wireless standard meets these requirements. Currently, every major semiconductor manufacturer is building wireless integrated circuits based on the Bluetooth standard.

By using a well-supported standard for seamless connectivity, manufacturers can leverage industry research and development and can easily integrate such data exchange capabilities into their products. In addition, such devices will support next-generation wireless HRM systems.

Wireless Connectivity in HRM Systems

Wireless systems such as Bluetooth help make the HRM concept possible. For example, the HRM implementation developed by Sensitron Inc. (San Mateo, CA) uses a combination of wireless and hardwired technologies to minimize installation costs. The system allows for a dedicated instrument set for each patient bed, and the design of the data network is customizable.

The system uses a well-defined wireless communication protocol to allow the medical instruments to communicate with the network. This protocol is designed to address some of the unique requirements of medical instruments. For example, by reading and qualifying the status of the device, the protocol traps invalid data that may be generated even when the instrument is not ready for operation.

The protocol simplifies data exchange between an instrument and the HRM system. Using a complete data-transfer protocol such as RS-232, RS-422, or RS-485, or using wireless protocols such as Bluetooth, significant functionality can be built into medical devices that enables them to upload some of the manual tasks to the server. This functionality allows the network to monitor the device condition with automated control features, resulting in the most accurate reading possible. HRM interfaces with the instruments through these standard interfaces.

The system automatically collects patient vital sign data from a medical instrument such as an electronic thermometer. Traditional patient charts are replaced by the data delivered to a central processing station. These data are then analyzed and time-stamped by a knowledge-based engine and delivered to a nursing station in real time, along with an at-a-glance summary. Such a system eliminates delays between the gathering and the delivery of the information to the clinician. The system is also designed to prevent manipulation of the database, ensuring the validity of the data.

HRM simplifies clinicians' work flow by delivering patient information to them anywhere. A complete patient history is available using a handheld device. By reducing paperwork, HRM systems can enable significant efficiency improvement, especially for nursing staff.

This protocol enables original equipment manufacturers (OEMs) to establish a common platform for the exchange of data with a particular medical instrument. The underlying theme behind this protocol is to use basic medical electronics instruments in a wireless data-exchange network to allow dedicated vital signs monitors at patient bedsides. Although such technologies will likely increase initial unit costs to OEMs, the improved technology should increase long-term revenue potential.

The Medical Wireless Infrastructure

At the most basic level, a successful HRM system must provide a smooth link between the monitoring systems now in place in most hospitals and the wireless technology of HRM. This is mainly a matter of creating a link between the industry-standard RS-232 interfaces and the Bluetooth systems. Modules have been developed for most common sensors, including blood pressure and pulse measurement devices, pulse oximeters, thermometers, blood glucose units, and weight scales; interface module units for electrocardiographs are in development. The system's flexibility allows it to accommodate any medical device with a well-defined data interface, including legacy system units.

Data from medical devices are sent to a small access-point device that controls communication between the device and the existing local-area network (802.11b wireless or 10/100-based wired). The access point sends the data to a gateway computer that manages data traffic between the access points and the monitoring system.

The information from the sensors is channeled through a gateway to the monitoring system, which stores and analyzes the data. Monitoring system software handles data verification and analysis, data archival, and data presentation. System software is designed to ensure the security of patient data. When the monitoring system determines that an alarm condition has occurred, it routes the alarm information to the appropriate nurse's station.

This infrastructure enables a continuous information flow throughout a hospital. Because the instruments are linked via Bluetooth, deployment costs are minimal. The centralization of key patient data in a robust monitoring system server makes future access to the data easier.

Conclusion

Because of the complex nature of the medical industry, experts often seek traditional solutions. New pressures clearly demonstrate the need for an improved solution such as HRM to address modern issues.

Wireless technology is now proving its viability as a robust, affordable, and useful option for the medical market. Technological advances in gathering, storing, and transmitting information from patient bedsides directly address the issues facing the healthcare industry. Implementing HRM enables patient vital signs to be monitored and tracked efficiently.

Connecting devices such as pulse oximeters and thermometers to a central database is the key to HRM success. Moreover, such technology has room to grow. With additional capabilities, HRM could also be used to wirelessly connect more-complex instruments as well.

Reducing paperwork and making key patient information accessible instantly saves time. In addition, a centralized storage system makes it easy for care providers to access information whenever it is needed. A well-constructed HRM system can minimize mistakes.

An HRM-equipped digital hospital can provide a higher quality of care at a greater level of efficiency. However, such systems require medical equipment that is capable of providing data to the system. With the development of such advanced medical electronics, HRM can help the healthcare industry overcome its information-handling problems.

Reference

1. J Lansford, R Nevo, and B Monello, "Wi-Fi and Bluetooth: Enabling Coexistence," Compliance Engineering 18, no. 4 (2001): 30–45.

Ashok Kapoor, PhD, is chief technology officer for Sensitron Inc. (San Mateo, CA). He can be reached at 650-358-0244, ext.103, or via e-mail at ashok@sensitron.net.

Copyright © 2002 Medical Electronics Manufacturing