Munesh Makhija, general manager of systems and wireless for GE Healthcare’s monitoring solutions business, talked with Digital HealthCare & Productivity about trends in patient monitoring and how GE’s Carescape product portfolio attempts to meet those needs.
DHP: What’s GE Healthcare’s view of patient monitoring?
Makhija:Traditionally patient monitoring is really the medical devices that track the patients and continuously measure a variety of patient information -- you know, vital signs, etc. We have electrodes and sensors that are connected to the patient. Then we measure things like the electrical activity of the heart, the rate of breathing, blood pressure -- really for the purpose of monitoring how the condition of the patient is changing over time, and alerting and providing the right kind of information to caregivers. That, in a nutshell, is what patient monitoring is.
We've been engaged in a dialogue for the last 18 months or so with customers asking what they see as the key trends today where patient monitoring could help and if patient monitoring technologies and products have kept pace.
DHP: What’s the feedback been?
Makhija: Three trends have come out clear, and I don't think they are limited to patient monitoring. One is patients are getting sicker. So, for example, one of our doctors tells us that the patients he discharges from his ICUs today are actually sicker than the patients he used to admit into his ICUs ten years ago. [That’s an] indication that not only is patient population getting sicker, but hospitals are required to have more sophisticated monitoring as a result.
DHP: What does sicker actually mean?
Makhija: How you quantify [severity] is through severity of illness scoring that hospitals use based on symptoms and on diagnosis. It's a scale. But predominantly it also points to a demographic trend around people surviving longer and medical technology being available that wasn't ten years ago, [so the pool of patients they see is growing larger and older, and the older among them are sicker.]
DHP: And the other two trends?
Makhija: Scarcity of skilled healthcare workers and really the shortage of nursing and clinical staff [was one]. That's not only here in the U.S., but also globally. It's a huge problem right now.
The third is that regulatory demands are greater than ever. So there's more need for reporting, there's more need to measure, quantify, pay for performance initiatives, [etc.]
DHP: Not surprising really. Perhaps we could turn to the Carescape product line.
Makhija: GE Healthcare's approach is to offer a portfolio of products, several products that we have today and several that will be coming, to integrate medical devices, communication networks, and IT systems. [The idea is] to take this unorganized patient data and make it more accessible and more meaningful.
DHP: So is it somewhat similar to what Microsoft is doing with Azyxxi?
Makhija: I would say Azyxxi and other [similar] systems are positioned as clinical information systems which bring data together.
DHP: But not necessarily device data?
Makhija: Right. We've got two things. One is the closeness to the patient, because we're literally on the patient's body, and second, we're very real-time. So I think you have to look at this as being extremely real-time and extremely integrated with the clinical workflow around the patient's bed.
[T]hat's the difference between the two (Azyxxi et. al.). We talk about partnering very strongly with clinical information systems, but what we are talking about is much more real-time, much closer to the patient, and much more within the clinical workflow.
DHP: Is the Carescape portfolio the IT infrastructure to collect this data or the monitoring devices themselves?
Makhija: It's actually both. Today we have five products that are part of the portfolio. One is the Clinical Information Center (CIC). It’s a product that a nurse or a nurse manager or a physician could be using to view second-by-second real-time data for multiple patients. So think about an entire ICU, 16 beds or whatever, and you want to have the vigilance for every patient on a single screen -- real-time access to waveforms, alarms, changing patient conditions, et cetera, and the CIC provides that kind of view.
Another Carescape product is iPanel. Hospitals are, of course, 24x7 environments. As nurses or other staff arrive for shift changes, they need to know to what transpired with that patient over the last 12 hours or however long they've been away. It could be procedures that were performed, dietary restrictions that have changed, radiological images that were scanned, [etc]. There are many systems in hospitals that already provide some way to electronically track these things. What we've done with iPanel is create an efficient patient-centric search engine.
It’s a single screen, touch-screen interface. You can program this to list the patients you're interested in. And by simply touching the next tab, what iPanel does is seamlessly collects the right information from all these disparate systems and bring them together at the patient's bedside where the nurse is or the nursing station or a physician office, and in a way that is dynamic and interactive
DHP: How is that different than from any electronic medical record system?
Makhija: One difference is it's technology-agnostic. Often these disparate systems don’t talk to each other well and you have to go to multiple computers or at least multiple programs on one computer and then log in and get the right information, search for your patient, whereas the iPanel is very seamlessly integrated. We'll integrate with whatever the hospital has chosen.
There're a few more products. Another one that’s been pretty successful is the Mobile Viewers product. We've taken live patient monitoring data with the waveforms, the vital signs data, et cetera, and made it available on cell phone, PDAs, and web interfaces so that when a nurse has a critical situation with a patient and calls the attending physician or pages someone to talk to them about it, this doctor can actually see on their cell phone what the nurse is seeing on the patient monitor.
DHP: Is most of the data collection -- the patient monitoring we're talking about now -- done in the hospital?
Makhija: Yes. The Carescape portfolio today is focused around in-hospital monitoring. As a GE Healthcare company, we are [also] doing things around remote and home and other areas, but that's not what the focus of the Carescape.
One of the most recent product launches is the Patient Data Module. We have a whole suite of products that do patient measurements. The thing about PDM is that it's much smaller than other offerings in the marketplace today. It's mobile and portable. It can stay with the patient as the patient moves or transfers from one care unit to the next or goes down for x-ray or a radiology procedure. It records the data while the patient's moving and synchronizes back to the network once the patient's connected.
PDM also has the latest set of parameters that we measure, so the latest algorithms, and the most advanced parameter detection algorithms. One problem customers will tell you about within the patient monitoring industry is sometimes the measurements are not accurate and we alarm falsely. This is true for anybody in the industry. Customers want to get rid of false alarms. One of the advances we've made with the Patient Data Module is we've put in an algorithm called IntelliRate, so for heart rate we will actually look at two or three different ways that we can get heart rate for a patient -- from an EKG signal, pulse oximetry signal, from a pressure if that's been measured -- and it will intelligently decide what the most accurate heart rate is and provide that information back to the caregiver.
DHP: Does PDM have to interface with a GE device, or can it be with other devices?
Makhija: The Patient Data Module works only with GE devices.
DHP: You said there was a fifth product.
Makhija: It’s something we launched in the last year or so, called Enterprise Access product. You might have seen a recent press release we did around a collaboration with Sprint. It's really a recognition of the hospital environment being the most mobile and dynamic workforce that operates 24x7, and the need for wireless communication technology in that environment is something that our customers have been telling us about.
Enterprise Access is a product that a hospital installs one time in their network, and it provides a unifying wireless infrastructure with a multi-use antenna. What it really does is puts one antenna on the ceiling, or one type of antenna in the entire hospital, that can then bring back and provide a unified way to deploy almost any wireless service in the hospital. This includes cell phone or voice communication, data communication, WiFi for laptops, PDAs, also paging or mobile radio communications in hospitals, as well as RFID location technology.
We've also integrated our telemetry systems that are life-critical monitoring for mobile patients right onto this network. It eliminates the need for hospitals to keep going back into their ceiling, ripping out infrastructure or upgrading infrastructure as they need to deploy more services. We work with several service providers and all kinds of services, Sprint being one that we recently formalized.
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