BBI Contributing Editor
ORLANDO, Florida More than 19,200 persons from around the world attended the 2004 Healthcare Information and Management Systems Society (HIMSS; Chicago, Illinois) annual conference, held here in late February. HIMSS representatives were touting it as the largest attendance in the organization's history. And there were more than 715 exhibitors, an increase of 15% from 2003. Of the total attendees, less than half were in some sense provider "prospects" and only around 2,800 of these were health network chief information officers (CIOs).
While the largest companies remain, different mid-sized and smaller vendors come and go each year. Some well-known and healthy electronic health record (EHR) and practice management system (PMS) companies find that the conference does not generate enough prospect leads to justify the investment required. But the exhibitor numbers nonetheless grow each year, testifying to the number of new medical IT companies that come seeking viable customers.
HIMSS also is a helpful conference for those seeking a high-level view of the healthcare IT market. It is used by the Department of Defense (DOD; Washington), Centers for Disease Control and Prevention (CDC; Atlanta, Georgia) and Department of Health & Human Services (HHS; Washington), along with private organizations such as Health Level Seven (HL7; Ann Arbor, Michigan), as a showcase for interoperability between systems that adhere to industry standards. HIMSS also is a good place to learn what is happening in the IT space, as evidenced by its keynote speakers and 200+ educational sessions. Some smaller companies register personnel as attendees to cover these aspects of the conference without incurring the expense of exhibiting.
Much of the growth in the medical IT sector (see sidebar, page 90) is driven by external regulatory factors or constraints, rather than any industry groundswell of support for the basic healthcare IT. Coming into compliance with the Health Insurance Portability and Accountability Act (HIPAA) is driving changes among providers, payers and employers alike, who are struggling to implement the standardization of the most basic healthcare transactions now mandated by HIPAA. In spite of all the projected IT spending, most providers are playing a game of "catch-up" on IT infrastructure compared to other industries, as healthcare tries to apply IT solutions to reduce medical errors that result in the death of hundreds of thousands of American each year and contribute to the injury and morbidity of additional hundreds of thousands.
Newt Gingrich, the opening keynote speaker at this year's conference, addressed the U.S. budget crisis by saying that until healthcare costs are reined in, there will be no balanced budget. The former Georgia congressman and Speaker of the House, speaking in his present role of leading the Center for Health Transformation (Washington), portrayed healthcare as a moral issue and suggested that the government could take a more effective role in reducing paperwork and solving healthcare problems, particularly in fostering choice among healthcare consumers. He stated his belief that the widespread use of healthcare savings accounts, which enable healthcare consumers to make decisions and control their healthcare spending directly, would encourage better healthcare responsibility.
Gingrich also advocated increased use of technology and encouraged the IT sector and the vendors present to get involved and to advocate to the state and federal governments that lives and money can be saved through quality technology. Using the airline industry and airline disasters as illustrative of the discrepancy between what needs to be and what has been done, he said that if there were five airline disasters in one year that resulted in the loss of 100,000 lives, changes would be made quickly. Gingrich cited the Institute of Medicine (Washington) report of the 100,000 lives lost annually due to medication errors and how the U.S. public seems unconcerned. More to the point, he also advocated instituting the electronic health record within the year at least as it is tied to Medicare initiatives. He said that the technology to put an EHR in place is available and that it should greatly reduce the time delays to payment due to electronic transfer of payments, with the result being a reduction in the cost of healthcare. With the majority of the HIPPA compliance deadlines now past, the EHR has been the topic of focus.
There is continued confusion regarding the use of the terms electronic health record, computerized patient record (CPR) and EMR. The concept of the electronic health record is a central technology where all of a person's pertinent health information is gathered a one person/one record, cradle-to-grave technology. This could be in a "smart card" or some other technology. The EHR does not yet exist in the U.S., but there is increased activity in that direction, especially now that computer security is improving. The EMR is a record that includes a person's pertinent health information, gathered at a specific facility or physician's office. An EMR is "owned" by the facility or physician, in which the patient has little input or control. The HL7 Standards Group also has been focusing on what the EHR consists of its functional model. The HL7 organization is cooperating with HIMSS to arrive at this functional definition. After failure to ratify the group's first definition and following a period of comment, the HL7 group has revamped its definition and hopes for approval on an upcoming second ballot later this spring. A computerized patient record is a comprehensive database system used to store and access patients' healthcare information, akin to the EHR. But some of the confusion arises because individuals, the media and the industry in general use these terms interchangeably.
UK clearly leads EHR effort
Britain is far ahead of the U.S. in instituting an EHR, as the British have decided that the traditional paper-based records have long ceased to meet National Health Service (NHS) needs for efficiency and effectiveness. Although many general practices and hospitals already have installed their own electronic patient records, these records usually cannot be shared outside the practice or hospital and the NHS has now mandated the EHR for all of Britain.
The numbers are staggering and the goals extensive for the NHS in its plan:
50 million patients.
300 million primary care consultations/year.
624 million prescriptions/year.
5.3 million hospital admissions/year.
13 million outpatient consultations/year.
13 million visits to Accident and Emergency/ year.
A 6 billion ($10 billion) investment.
A key goal of this program is to give clinicians ready access to patient information whenever and wherever it is needed. This is to be achieved by creating a central service to improve the sharing of patient records, by improving the efficiency of primary care physicians by simplifying making appointments with specialists for their patients, by enabling electronic transmission of prescriptions, and by providing for future growth.
The NHS started the process of establishing the National Program for IT in 1998 when the UK Department of Health produced the first strategy document, Information for Health. That plan committed the NHS to lifelong electronic health records for everyone, with around-the-clock, on-line access to patient records and information about best clinical practice for all NHS clinicians. This initial plan was built on and expanded in January 2001 in the document Building the Information Core: Implementing the NHS Plan. This more detailed plan outlined the information and IT systems that would be needed to implement the NHS plan.
In March 2001, Derek Wanless, a commissioner with the Statistics Commission, was asked to examine future trends affecting the health service in the UK over the next two decades. The Wanless Report was published in April 2002 and further expanded on the key role that IT would need to play if the NHS was to keep up with increased demand for healthcare services: "Without a major advance in the effective use of information and communications technology, the health service will find it increasingly difficult to deliver the efficient, high-quality service which the public will demand. This is a major priority, which will have a crucial impact on the health service over future years."
Another NHS document, Delivering the NHS Plan, published at the same time as the Wanless report, further expanded on goals and implementation strategy. The goals set for the timeframe commence in 2005 with electronic booking of appointments, and a full array of clinical applications and functionality from electronic records available in all primary care locations by 2008. One of the first key steps was to recruit a director general, together with assembling a Ministerial Taskforce and Clinical Care Advisory Group. The national program was formally established in October 2002, and Richard Granger was recruited as director general of NHS IT. One of the main recommendations from the Clinical Care Advisory Group was to create an NHS Care Record for each patient, with core information held in a national data repository.
Granger described the National Program for IT during a presentation at HIMSS. One of the practical problems he described is the current system for setting up appointments with specialists after referral by a general practitioner (GP). Due largely to resource limitations where it is not possible to call each patient to set an appointment, cards are mailed to patients with their appointment date. Since the appointment is not confirmed with the patient in advance, the result is a high percentage of no-shows, undermining the current system's efficiency and effectiveness.
One of the early steps in setting the National Program is to create the NHS Care Record. This will comprise a mix of national and local IT services designed to provide a cradle-to-grave NHS Care Record for each patient, which will cross traditional care organization's boundaries. Essential information will be held at local levels, where most care is provided. A summary of care encounters and clinical events will be held in a national data repository.
BT (British Telecom; London) has been awarded the contract to be the national application service provider for the NHS Care Records Service (CRS). SeeBeyond (Monrovia, California) has announced a $28 million contract with British Telecom as part of the National Program for IT, using SeeBeyond's ICAN 5.0 suite to design, deliver and manage a national patient record database and transactional messaging service. Local service provider contracts have been awarded to Accenture (London), Computer Sciences (El Segundo, California) and the Fujitsu Alliance, consisting of IDX Systems (Burlington, Vermont), Fujitsu Services, Tata Consulting Services and PriceWaterhouseCoopers. The first phase of the Care Records Service is due to go live in June, providing clinicians with basic functionality, including the ability to view and communicate an initial set of patient information and to be able to book appointments. More services will be added in 2005, including more detailed patient records, electronic referrals, requests and orders. From 2006 to 2008, more advanced features will be added, with full integration planned by the end of 2010.
Each patient record will have a unique identifying NHS number, which also will form the link between personal health information and demographic data. Access to a patient's healthcare record will be strictly limited to healthcare professionals with a legitimate relationship with the patient, and then limited only to data that is relevant to their role. Further security standards and technologies will be incorporated to ensure compliance with the Data Protection Act of 1998 and the Human Rights Act of 1998, and the common law duty of confidence and professional ethics.
Another early goal is to enable the GP to make an appointment electronically with a mutually selected specialist during the patient's visit. The patient can modify or change the appointment later if needed, either electronically or by phone. Atos Origin, together with Cerner (Kansas City, Missouri), has been selected to design, develop and manage the National Electronic Booking Service. The plan is to introduce this service in six phases, with the first due for release this summer and completion by the end of 2005.
The Electronic Transmission of Prescriptions (ETP) program is already well on the way, with three pilot projects completed. The goals of this program are not only to improve efficiency, but to reduce prescription errors, improving safety, improve convenience for the patient, and to ensure that the prescription information becomes part of the patient's NHS Care Record. Currently, information must be entered on three occasions: by the prescriber, by the pharmacist and by the Prescription Pricing Authority. With ETP in place, information will only have to be entered once. Currently, 624 million prescriptions are written each year, growing at 4% to 5% per year. The efficiency savings alone should be major. The goal is to have 50% of prescriptions transmitted electronically by 2005, with full implementation by 2007.
Another key element of the program is to set up a nationwide secure broadband network, called N3. It aims to deliver continuity of the current NHSnet system as well as meeting increased bandwidth requirements. A National Infrastructure Service Provider is currently being selected.
Key to implementation is communication with the many stakeholders involved, notably the clinical community. A number of groups have been formed to explain the program to stakeholders, identify and address their concerns, and to ensure that intelligence gained from interactions with stakeholders is used to best effect.
Granger also provided some insight into the procurement process. The pricing models used by a number of potential suppliers were found to be inadequate for a procurement of this scale, with pricing proposals, which, if accepted would have resulted in a much higher overall cost. Aggressive negotiations took place with pricing being reduced by as much as 10 times in a number of cases.
The NHS has placed contracts with a number of U.S. companies with operations in Britain. IT services and technology are being procured from IDX Systems, Cerner and Computer Sciences. In addition, Health Language (Aurora, Colorado) will provide language engine technology for implementing terminology services, concept-based indexing and SNOMED-CT support. Also, First DataBank (San Bruno, California) has been awarded a mapping validation contract for the NHS dictionary of medicines and devices.
The NHS's National Program for IT is one of the truly interesting case studies currently under way, for its huge size, scope and potential benefits. The results will be watched worldwide by many other national health services considering similar action to deal with steadily increasing demand for their services, by the clinical community, by industry and by patients.
In the U.S., financing the EHR is key
The issue of adoption of the electronic health record in the U.S. is no longer whether it offers benefits to an organization, or even if it is cost-effective in the long-term, but rather how to finance the deployment of such technologies among providers that are struggling to remain profitable under current reimbursement policy. It seems clear that if adoption of the EHR is to become a national reality, federal policy and incentives, in the form of tax incentives, will be required. Because the under-reimbursement practiced by the Centers for Medicare & Medicaid Services (CMS; Baltimore, Maryland) over the past several years has drained pretty much all of the possibility for profits out of the system, existing healthcare providers simply do not have the capital to make the EHR a reality on anything approaching a universal scale. Without widespread acceptance and deployment, the average selling prices for software licenses will remain higher than they need be. So it's not the value of the EHR that is the question, but rather who will pay for its deployment. The fates of many of the exhibitors at HIMSS rest squarely on the answer to that question. Currently, there is much discussion among Democrats and the Bush Administration about the EHR and more general healthcare policies as well.
Among the proven benefits of implementing the EHR are:
Allows access to medical information by more than one provider at the same time.
Allows ready access to health information by physicians and especially to allergies and adverse occurrences of a patient.
Allows emergency access to personal health information by providers that may not be familiar with a patient.
Reduces transcription errors; there is no handwriting in the EHR.
Speeds up of the delivery of medicine and moves it in a preventive direction because the EHR generates reminders automatically and eliminates the need to continually re-enter a patient's medical history.
Enables permanent records of immunizations and other key health information.
Allows health education to be focused on potential problems a patient may have that can be addressed at the initial physician encounter.
But in spite of the increased emphasis on the EHR, one of the interesting facts noted in the preliminary annual HIMSS survey of CIOs was that some 40% said their institutions would be looking to implement voice recognition in the next two years. This was their No. 1 future issue. The electronic health record was the No. 5 answer, and patient safety ranked even lower. Dave Garets, chairman of HIMSS, interpreted that to mean that patient safety and the EHR still are deemed important, but that voice recognition technology was improving to the point that more areas in hospitals were looking in that direction. He did admit, however, that the result surprised even the HIMSS organization.
A less well-known survey, but one that in some ways is more important, is the Nursing Informatics survey. Data from the 2004 survey of more than 500 informatics nurses, half of whom work in intensive care units or medical/surgical nursing and have more than 16 years of experience, revealed many barriers to nurses becoming informatics specialists. In addition to financial barriers, lack of formal informatics training and having to abandon clinical duties were all key problems in expanding the ranks of nursing informatics.
Other survey results unveiled at HIMSS included the Quarterly HIPAA compliance report, which showed some disturbing results. After the passage of the October 2003 deadline for compliance, fewer than half of the respondents indicated that they were ready to implement all HIPAA standard transactions. As a result, 85% of payers still were accepting non-compliant transactions in January, as was CMS under its contingency plan. Most providers and payers were hoping that CMS would extend its contingency plan for at least another three to six months. Technical obstacles and poor communications were blamed on the slow rate of adoption of the new standards. Beyond the transaction set, 20% of providers were not in compliance with HIPAA privacy rules nine months after their effective dates. Regarding data security, more than 50% of providers and payers indicated that their organizations would not be in compliance with HIPAA security until sometime in 2005. More than 24% acknowledged that their organizations already had security breaches between October and December 2003, when the survey was conducted.
The HIPAA mandates have opened up a whole new market for interface engine and legacy portal companies, one which major providers such as SeeBeyond and Orion International (Auckland, New Zealand) have been quick to announce products to fill. Orion has enhanced its Concerto medical application portal to support such integration on the provider side. SeeBeyond provides a framework for application integration, dynamic business-to-business connectivity and process optimization for more than 1,200 healthcare organizations worldwide to solve challenges such as HIPAA-EDI, patient safety, quality management and enterprise indexing. Of the independent interface engine companies we interviewed at HIMSS, SeeBeyond was clearly the most experienced and stood out from other independent companies and larger firms such as Cerner, which have absorbed previously independent IE vendors.
In the U.S., the integration issue is how back-end insurance payers burdened with some old legacy computer systems can change systems to comply with the standardized format of the mandated HIPAA transaction. The answer is that many simply cannot, so they have adopted a different strategy; through the use of an interface engine between the HIPAA-compliant input format (from providers) to translate it into the format required by their legacy systems and transactions. Then they take the output from the legacy systems and use the same interface engine or portal technology to translate that non-HIPAA-compliant information into HIPAA-compliant EDI that can be sent back to providers. While this introduces two extra steps (one on the input side and one on the output side), it is much easier than making changes to the actual legacy software code that the payers' systems use. The problem with modifying the actual system is that in many cases they are so complex and poorly documented (and written in archaic languages), that introducing a small change in format ripples through to hundreds of changes in interfaced modules and tends to blow the entire system apart. Doing the format conversion from the standard HIPAA to the proprietary format required by the individual systems is a much safer and more expedient solution to achieving HIPAA compliance. It also is a robust driver for the interface engine companies who now have new work on the payer side to complement their work on the hospital and physician provider sides. Meanwhile, companies such as Quovadx and its Rogue Wave Software division (Boulder, Colorado) offer a suite of business repurposing and development tools designed to help organizations streamline overall business process. At HIMSS it was showing its impressive QDX Platform V toolset.
There are two keys to getting expedited reimbursement of medical claims. The first is to make sure the claims are properly coded and will not be rejected. The second is to make sure they adhere to the mandated HIPAA-compliant transaction formats. CodeCorrect (Yakima, Washington) and other companies exhibiting at HIMSS were showing products that helped providers meet the first condition. Most of the practice management software systems vendors were showing updated software versions or had announced partnerships with clearinghouse interface companies to make sure the second objective was achieved. CodeCorrect was showing its suite of four applications Knowledgesource, CDM Manager, ABN Manager and RevenueDashboard which assist coding level to administrative level personnel in managing the charge submission and tracking activities of their enterprise.
New products improve infrastructure
On the improved-infrastructure front, Microsoft (Redmond, Washington) used HIMSS to announce its newest release of its Biztalk HL7 accelerator, not a completely Microsoft solution, and its InfoPath 2003 product, a combination form generator and database product useful for gathering forms-based data into a structured repository. This product was a work-in-progress, scheduled for June release. Included in this product was increased support for handwriting recognition for tablet PC users. This product also has enhanced links to Microsoft's Biztalk 2004 Server and adds support for human workflow service. Some adopters of Biztalk include Amicore (Andover, Massachusetts), which reported plans to incorporate it into its next software versions.
Microsoft also was touting InfoPath 2003, the newest work-in-progress of the Office 2003 suite, which allows forms to be scanned, and data fields to be easily defined and then mapped into back-end Access or SQLServer databases. Microsoft is presenting it as a rapid implementation tool to empower healthcare, form-based applications across the provider space.
With all the emphasis on electronic physician order enter (CPOE) systems to reduce adverse drug events (ADEs), it is important to detect and keep track of ADEs in the first place. CGR Medical (Houston, Texas) showcased its newest advanced incident management system (AIMS) software to do just that. The AIMS product was mentioned by the Institute of Medicine in its 2003 patient safety report as a potential tool to standardize reporting of ADEs.
New medical devices previewed at HIMSS included a PC card-based blood pressure device, shown by QRS Technologies (Plymouth, Minnesota), which has received FDA clearance and will become available later this year. At HIMSS, QRS had a software developer's kit available for this device for third parties who wished to integrate with it. Spacelabs Medical (Issaquah. Washington) the newly acquired subsidiary of OSI Systems (Hawthorne, California), was showing its monitoring system interfaced with two EHR vendors, which underscored its open-systems connectivity. In the Cerner booth, a Spacelabs workstation was being used in a bidirectional, real-time telelink with a similar system at the Society of Critical Care Medicine (SCCM; Des Plaines, Illinois) meeting, being held simultaneously at a location across town in Orlando. The solution was impressive for its real-time performance without the need for a lot of additional components and minimal additional interaction required to make this continuous, real-time networking occur on the Spacelabs' network workstations located at HIMSS and SCCM, respectively. Spacelabs obviously is a company with expertise in real-time physiological networking, something that some bigger competitors talk about but seem to have difficulty delivering.
The HIMSS meeting also provided a good opportunity to learn more about VISICU (Baltimore, Maryland), an innovative company that can provide real-time monitoring and alerts from remote locations to patients hospitalized in an ICU or other monitored acute-care settings. These two companies are leaders in remote communications and real-time surveillance.
New imaging displays also were being shown at HIMSS. Barco (Duluth, Georgia) was showing its 3 megapixel dual-display viewer and N10 video subsystem that retails for around $17,000 and its Coronis higher-end 5 Megapixel model that features its I-Guard that automatically adjusts picture as ambient lighting conditions change or with changes in display orientation from portrait to landscape viewing. This unit costs around $21,000. Features of the Coronis go well beyond what's available from competitors, according to company officials.
There was a whole host of new tablet platforms at HIMSS, most of which suffered from the same problems as their predecessors shown a year earlier limited operating time. Most new tablets still could operate for only three to five hours, far less than the eight to 10 hours required for just one nursing shift. Enthusiasm for nurses having to change battery packs in the middle of a shift has not grown, so adoption in the medical vertical market remains less than it will be when a competitive tablet with a reasonable operating time becomes available. That may not be too far away either.
A breakthrough in battery technology developed for the zero emission project was shown by Electrovaya (Mississauga, Ontario). The company's advance is a patented Lithium Ion Superpolymer battery that provides the highest-energy-density rechargeable battery currently available. The company showed this technology scaled down to laptop size in its new Scribbler SC2000 Tablet PC. Scribbler achieved an operating time on one battery in a high-speed Intel Centrino tablet PC ranging from five to more than nine hours. While a typical low-energy tablet PC consumes between 15 to 35 watts, the Scribbler battery provides either 80 or 140 (optional battery) watts of power, enough for operating times between eight and 16 hours in its 3.1-pound PC with a built-in 60 GB hard drive and 512 Mbytes of RAM, according to Dr. Sankar Das Gupta, chairman, president and chief executive officer of Electrovaya. Coupled with a low-power consuming microprocessor, like the Intel Centrino processor, battery time could probably be stretched to a 12-hour nursing shift. The company's battery technology has been adopted by the National Aeronautics and Space Administration to supply batteries for portable power systems in future space missions.
Another prominent tablet PC vendor at HIMSS was Motion Computing (Austin, Texas), which was showing its latest M1300 Tablet PC, an Intel Centrino configuration. This tablet offers a bright, 12.1" display running on an Windows Tablet PC operating system and is generally well-designed specifically for the needs of the healthcare vertical market, providing excellent hardware support for such medical applications as SRT (speech recognition), physician electronic order entry (CPOE), charge capture at point of care and PACS or DICOM image review. Battery life, however, did not approach that offered in the Electrovaya unit we saw. Dell (Round Rock, Texas) was showing two tablets in its booth, both of which had some limitations in screen size, processor speed or battery life compared to the new Motion Computing or Electrovaya Scribbler tablets.
Rounding out the new computer offerings was the Pelham Sloane (Southport, Connecticut) PS1500, a computer integrated with a flat panel color display. The combination measured a mere 2 " deep, providing a very space-efficient design for medical applications. Users could choose one of three processors that optimized either speed or power consumption. There was a 2.4 GHz. Pentium 4 for speed, a Celeron 1.8 GHz. or a VIAC3 for those who did not require as much speed. The PS1500 could be configured up to 1 GB of memory with up to 80 GB of disk storage. There also was a choice of 802.11b or g wireless networking and a TV compatible video mode. The user interface was touch-screen or conventional keyboard. Both Windows XP Professional and Home operating systems were offered on this interesting new unit. The unit is ideal for situations where running all the cables required by a conventional PC would be a problem or where relocation of the PC needs to be accomplished frequently.
NEC Solutions America (Santa Clara, California) showed its MobilePro 900 Handheld PC. This new unit employs Intel's X-scale processor, with a large keyboard and a bright 8.1" half VGA display. This larger hand-held device weighs in at 1.8 pounds, making it definitely portable and offers an extended life, 4-cell Li-ion battery that provides extended operating time.
There were many new products at HIMSS in addition to computing platforms. One of the more interesting and expected was the new Vocera Nurse Call Integration Module. Vocera (Cupertino, California) is the innovative little company that offers wearable 802.11b voice communication badges (essentially telephones) that provide provider-to-provider communication within the hospital (or nursing home) setting. Its miniature, voice-activated devices coupled with creative software, made for an interesting alternative to traditional in-hospital phone suppliers, many of whom have been very slow to change their products. The missing and logical element of the Vocera approach has been the automation of the patient-to-provider voice link that traditional nurse call systems represent. This limitation has been overcome with the announcement of the new nurse call system that works over traditional WiFi networks using a voice-over IP (VoIP) approach with Vocera's communication badges. By integrating with leading nurse call systems, Vocera expands the utility of its innovation products in the healthcare space, allowing patients requesting assistance to have their request initiated by the nurse call button, directly forwarded to their assigned care provider. For those nurse call systems that offer it, the nurse receiving the call for assistance can now speak directly back to the patients in their rooms, no matter where they are and what they are doing. They also can forward the request to a secondary caregiver if they are involved with another patient or otherwise unable to respond. Vocera also has added a new "push to talk" function to its communication badges, as well as voice-initiated paging, text-to-speech message playback and other new administrative features to its products. All in all, Vocera was showing several very significant new capabilities at HIMSS, which differentiates the company even more as the technological market leader and "Star Trek" preferred solution for in-hospital voice communications. All that are missing are William Shatner and Leonard Nimoy, who apparently are still engaged with Priceline.
As healthcare become more wireless, concerns about the security of wireless networks becomes more intense. While vendors strive for an industry-standard approach to wireless security and hammer out 802.11x and 802.11i standards, many companies offering security infrastructure are emerging on the healthcare scene. One of these, Blue Socket (Burlington, Massachusetts) was showing a range of infrastructure for wireless communications at HIMSS.
ClearCube (Austin, Texas) represents a new paradigm of medical hardware implementation. The ClearCube paradigm is that of a centralized array of computerized integrated in one place. The computers are stripped down to the core memory, CPU and disk resources, called "blades" that are installed in a multi-blade rack that uses a blade-switching communications processor on the front-end to connect individual users to the "blade" resources their applications run on. The hardware easily extends to provide one or more "hot" spare blades, so that switching a user from a failed or failing blade to a hot good one can be accomplished in a couple of minutes which results in 99%+ uptime. Indeed, because of background diagnostics that can be run across all blades, failures can be anticipated and hot swapping occur in a user-transparent manner.
As might be expected, several large commercial companies and the U.S. military already are ClearCube customers, but technology is now available to the medical community that has all of the same security, scalability and manageability issues. This is the logic of back-to-back symmetrical processors used for many years by such leading EMR suppliers as Clinicomp (San Diego, California). ClearCube may quickly become a solution of choice for large integrated delivery networks or ISPs that are serving as application service providers for the medical clients who need secure, HIPAA-compliant solutions.
Mergers, alliances much in evidence
Corporate mergers and marketing alignments also were readily apparent at HIMSS. The largest alignment was the deal between Philips Medical Systems (Andover, Massachusetts) and Epic Systems (Madison, Wisconsin) in which Philips will begin marketing a derivative of Epic's inpatient and ambulatory software system to hospitals and other customers that are smaller than those to which Epic is currently selling. Epic has become very successful selling to providers with more than 150 physicians or more than 500,000 patient visits per year. It has resisted selling to smaller accounts that have approached them in the past. The deal with Philips, which planned to initially concentrate on mid-sized hospital-based networks in the 80-bed to 250-bed range, extends Epic's reach down to these smaller providers. Philips, which has adopted the same rigorous personnel training approach as Epic in having sales personnel work in the installation and customer support mode for up to a year, is about a year away from actually marketing the latter's system to the general market. Meanwhile, Epic is busy stripping out some functionality needed only by the largest groups, to streamline the system configuration that Philips will be offering. The two corporate cultures are well-matched, and this is a relationship that has the potential to be both a strong force in the market and a long-lasting and mutually beneficial relationship.
Philips also was showing new products to its sizeable cardiology and picture archiving and communications systems (PACS) installed base, which now numbers over 1,300 in cardiology and 300 in radiology. For cardiologist IT needs, Philips showed Xcelera, a new cardiac imaging and information management solution based on the Inturis Suite cardiology image management system. It also was showing the Xcelera cath lab management module, a solution that will be enhanced with software supplied by Epic to provide patient logging and POC clinical documentation using "pick lists" to speed reporting and documentation. With extensive device interfaces to patient monitors and charge capture and forwarding to hospital administrative systems, Philips will have a complete and competitive, open system approach to cath lab data management.
MobiHealth (Arlington, Virginia) used HIMSS as a venue to publicize its new alliance with RxHub (St. Paul, Minnesota), a company specializing in electronic drug orders. The idea is to improve drug safety and expedite physician prescription orders. The combination of products offered by the two companies allows mobile PDA physicians to look up drug data and interactions and then order prescriptions directly from the exam room, according to Jim Bradley, RxHub chief executive officer. This provides direct electronic communication between physician and pharmacy.
Given the importance of Internet-based solutions in the healthcare IT space, the major telecommunication companies also were at HIMSS to showcase their broadband solutions. Sprint (Overland Park, Kansas) showcased several novel applications of its broad voice, Internet and wireless networking capability at HIMSS for the healthcare industry, sharing its booth with some partners. Sprint also is prototyping wireless networking solutions for EMS applications, including remote image transmission, patient admission, and patient monitoring information. Cerner and Sprint, geographic neighbors, have jointly developed a remote ICU providing remote patient monitoring. The system is highly scalable, enabling ICU patients from many hospitals to be monitored. Data monitored includes not only the patients' vital signs and clinical data, but also real-time video images.
InSite One (Wallingford, Connecticut) showed its digital storage service provider (SSP) secure archive offering a cost-effective, one-time-fee-per-study model for radiology, cardiology and mammography images. This service adheres to the DICOM standard and uses the Internet, on-site RAID and off-site DVDs in mirrored data centers for immediate, long-term and disaster recovery storage. There is no up-front capital expense, service contracts or ongoing maintenance needed. Meeting HIPAA requirements, the stored images (along with the associated reports) can be retrieved from a web-hosted server allowing viewing by referring physicians and radiologists on call. Pyxis Cardinal Health (San Diego, California) showed a multi-function patient viewing station, the Pyxis Patient Station. This is a networked flat-screen PC by the bedside and can be used both by the patient and by clinical staff for multiple uses. Functions demonstrated included Internet, e-mail, Intranet for patient education support, TV, movies and music for the patient, and patient monitoring and clinical information systems for the clinician. Sprint provides the connectivity backbone. The system is undergoing clinical trials at Detroit Medical Center (Detroit, Michigan).
palmOne (Milpitas, California) showed a PDA using a Treo 600-based solution for patient records, e-prescribing, drug information using Sprint's internal and external wireless networks. This solution is intended to improve efficiency by permitting data access and entry at the point of care.
Canyon Ranch Spa (Tucson, Arizona) showed a novel use of cellphones for nutrition support. Data sent from a patient's cellphone to the spa can include pictures, video, data from home-based monitors and voice. A counselor can then respond with guidance and encouragement to patients wishing to improve their nutrition program.