As clinical engineers (CE) and biomedical equipment technicians (BMETs), we have had our own clinical networks for years. Initially, with literally nothing else to connect to, these networks stood by themselves. Now you can call me a little parochial, but I still firmly believe that live clinical data networks like an intensive care unit monitoring or telemetry system should still be on its own network. You can use a gateway to send information to the hospital enterprise network; but otherwise, it should be its own, isolated entity.
But what about other devices? If we used this paradigm for every device we managed, the hospital’s wiring closets would not be large enough to hold all the miles of wires, fibers, switches, and routers that would be needed to accommodate the infrastructure. Take a look in your existing wiring closets in your own facility. Do you see much room for growth and expansion?
The ability to connect just about anything to the hospital network is growing quickly. Standard protocols available allow the ease of communication and interface with a wide variety of devices and systems. The two primary protocols you will likely see are:
• Health Level Seven (HL7), one of several American National Standards Institute standards. HL7’s domain is clinical and administrative data for a particular health care application, such as medical devices, pharmacy, imaging, or insurance (claims processing) transactions. HL7 is an international community of health care subject matter experts and information scientists collaborating to create standards for the exchange, management, and integration of electronic health care information.
• DICOM, or Digital Imaging and Communications in Medicine, is the standard developed by the American College of Radiology and the National Electrical Manufacturers Association for transferring images and associated information between devices manufactured by different vendors. Theses standards specify a hardware interface, a minimum set of commands, and a consistent set of data formats.
These protocols form the basis for the ability to easily communicate data and images to a wide variety of systems. With this ability, we can connect devices to the hospital network. Both wired and wireless devices can now easily communicate to feed data, images, alarms, alerts, calls, etc to a variety of devices and applications. Let’s look at what is currently available:
• Plug and Play integration software like Emergin allows various devices and systems to link together and to pass information to one another. This software can link devices like phones, pagers, and electronic medical records; and nurse call, building, bed-management, and lab and radiology information systems. And it can enable them to seamlessly communicate with one another.
• Infusion pumps with wireless cards, like the Alaris® Medely™ series of pumps, can communicate with the network to allow data to be uploaded, such as new data sets for dose error reduction; download quality-control data; or send alarms to other devices or systems.
• Device locating/tracking and radio frequency identification (RFID) systems, like those made by AeroScout®, can send real-time equipment-location data on your wireless Wi-Fi network to display on any desktop and interface with your maintenance-management system. (No more not being able to locate items at preventive maintenance time!)
• Communication devices allow staff to communicate directly with one another, interface with nurse call systems to connect the patient directly to his or her caregiver, or pass alarms from patient-monitoring systems to the assigned nurse over your wireless network.
• Wireless electrocardiogram monitoring for patients can be done on your wireless network using a system like LIFESync®, increasing your hospital’s ability to expand monitoring without an investment in additional infrastructure.
• Patient vital signs data can be collected and distributed to the patient’s electronic medical record using a system like the integriti®, made by Stinger Medical. Data can be directly fed by the local area network or wirelessly.
This is not an all-inclusive list, but it does give you a general idea of the possibilities. I truly believe we are at point where nearly every device will need to be able to send or communicate its data somewhere on the hospital’s network. The continued evolution of integration and electronic medial records becoming a standard in every hospital will drive the change. This could virtually eliminate the need for charting data by hand and could eliminate transcription errors altogether, improving the quality and safety of health care.
Managing the Spectrum
As the airwaves continue to get more congested with RF signals, managing the proliferation of devices will increase in importance. Every facility should have someone, whether from biomed or IT, managing the spectrum of frequencies present in his or her hospital. This seems to be a common discussion at several conferences I have attended during the past year. Having a manager and a process to identify and monitor frequencies in use can be a huge benefit in preventing disparate systems from interfering with one another. Here are a few examples of current devices that need to be considered as we generate more RF signals:
• pH monitoring systems to monitor gastric reflux, like the Medtronic Bravo™ System, where a miniature RF capsule is attached in the patient’s esophagus and transmits information to a receiver.
• Wireless urodynamic monitoring, like the Laborie Triton™, which uses a Bluetooth transmitter to send data to a tablet or PC for flexibility.
• Real-time glucose monitoring, like the Medtronic Guardian® RT system, which transmits glucose readings from a tiny sensor to a receiving unit.
These are just a few examples of wireless devices already available for use in hospitals. Considerations need to be made as to possible interference sources for these devices as you plan their location. As you can see, with today’s technology, the only limitation is your imagination.
Next month, I will discuss how CEs and BMETs can prepare themselves for the future of our profession.
Dennis Minsent, MSBE, CCE, CBET, is the director of clinical technology services at Oregon Health & Science University, Portland, Ore.