Mark Smith --  Medical Devices Integration: break through the barriersWell thank you very much for inviting us here today. My name is Mark Smith and I’m the Business Development Director for Enovacom. But before I do that I wanted to just carry on the theme really of what’s been said today. And that’s all about transformation for you guys. So my experience has been 22 years in healthcare now and I have a lot of passion around the patient actually, and all of us here in this room have all experiences of being in hospitals or being with relatives, and for me there is a collective effort required from everybody that’s involved focused on the patient. And I think as healthcare recognises the value of wholesale digitalisation so the biomedical engineer plays an important part in emerging role of ensuring that real time data is available to clinicians, and to effect a positive patient outcome. And I think that’s a really strong message to send.

It’s not easy for you, and I recognise that, because your world is changing. You know, you need new skills, you need to understand about new devices, and there’s a wealth of new devices and there’s a wealth of new devices coming onto the market. There’s an explosion of these devices and wearables. You need to know how to connect them. You’ll need to know also how to, for instance, send messages or alarms in some way. So it’s a kind of very complex situation. And of course the environment in care is changing as well. So you might actually become mobile. People are being looked after in their own homes, in community hospitals and mental health as well as the acute trusts.

So, as I said, my name is Mark Smith and I represent Enovacom and in the next 30 minutes I’ll just go through the following slides. I’m going to give you first of all just a brief overview of who Enovacom is and looking at the company profile. I’ll then just share with you what I think are the three main problems within healthcare or priorities in healthcare being delivered. And look at some positive impact of technology. I think it’s quite important to show you some things that are reflective of real improvements in patient care with technology. And then I’m going to just focus on some basic connectivity to look at full, seamless integration in terms of what connectivity we’re talking about. Look at the benefits of an interoperability platform. The need for teamwork, I think there’s a crucial element of the next phase of development, you can’t work in silos anymore. Everyone’s got to come together. So the IT people, you guys and also the clinicians. And I’m seeing that a lot more now in healthcare which is really encouraging. The financial benefits and then I’ll just make a very quick introduction to Enovacom patient connect solution.

So, looking at the company profile then, Enovacom has been around for about 16 years. They are actually a wholly owned subsidiary of the Orange Group. So that’s probably more familiar to you guys. And what they do is they’re a software editor dedicated to healthcare information systems. So it was founded back in 2002 and it was with a view to look at facilitating the secure exchange of health data. That’s what Enovacom do very well. We are also hundred percent healthcare, so we don’t stray away from that. And we have customers all over the place. So we don’t care where the data comes from. We work with public hospitals. As you can see there’s 900 public hospitals. We work in the private sector. And we have over 1,600 clients across the whole of the health economy across the world.

So if I just tell you about the main issues I think and the priorities around healthcare today. And I think we all know this, but the first thing is about improving patient safety. This all sort of started really with the Francis Report with the Mid-Staffs situation, disaster as we kind of already know about. But also the Secretary of State, the previous Secretary of State for Health, Jeremy Hunt, presented the fact that we haven’t got any resources. I think there’s something like 30,000 vacancies in the clinical world alone. And hearing other people today about the transformation of resources and different skills means that there’s going to be a dearth of people needed in, well, medical engineering for instance. And of course the last thing is around wholesale digitisation, that the NHS in particular is completely consumed by making sure that everything is digital.

But we all know what the situation was like before digitisation. Medical records were on paper, you had handwritten notes and readings, and then of course you’ve got to search for information which becomes difficult given the many archives. We all know about those problems. I’m sure there’s lots of people that can give us lots of examples of those situations with damaged papers and not being able to retrieve information on the patient. But when we focus on, actually when you digitise, what are the problems then? Well for you guys I can see as I mentioned that you’re going to need a different set of skills. You don’t really need a spanner and a screwdriver anymore. It’s about software and how you connect to that software. It’s about changing the role of the engineer. So you guys are then starting to work very closely as I mentioned with clinicians and IT people. And working very strategically around how you would actually impact the movement of data around the hospital to really affect some really important patient care decisions for clinicians that need that data.

There’s a massive amount of new devices and IT wearables. The environments of care are changing as I already mentioned. So you might be working in someone’s own home to look at medical devices or look at things remotely. You have a lot of synergies with the operational departments. And of course as data becomes more real time and needed more real time, there needs to be the support of that urgency. So in terms of getting data at the right place at the right time it’s incredibly important for the clinicians. And of course dealing with suppliers, you’re dealing with different people, different models. You’re going to need to get familiarisation in the future of how those companies work and how you’re going to work with them.

So I want to move on then to the clinicians, because this is one of the areas where I have a lot more experience of. So I’m learning about the biomedical engineer guys and what’s important to you in the future. But I wanted to share with you that the clinicians are your customers essentially. And being able to align resources to patients’ needs, as I mentioned there’s 30,000 different vacancies at the moment in nursing in particular. It’s about trying to find those resources. The second thing is the accessibility of patient data is one of the biggest issues, and which you guys have a really good opportunity to support. And then of course the ability to track patients through the hospital to make sure that they have everything that they need before they leave the hospital and then go on to other services.

If you look at some data for clinicians and look half of nurses have actually said that they’ve witnessed a medical error because of a lack of device coordination. That’s because some devices can’t actually send the information at the right time or they don’t actually physically do that. 91% of nurses report that if they could spend more time with the patient than with fiddling around with devices that would make their lives much easier. And then if you look at the number of devices that are actually integrated within hospitals in particular, there’s fewer than three different types, manufacturers that actually are integrated. So there’s a massive opportunity to actually integrate with much more devices which is going to affect patient care. Which I’m very passionate about as you probably can tell.

So there are age old problems with technology or not having technology. You have transcription errors when collecting patients’ vital signs. That actually translates then into claims. Where I think the latest figures are something like a billion pounds in terms of compensation claims, where patients or patients’ relatives have taken trusts to court because of the fact that they haven’t got those vital signs data. Of course it’s time consuming and there’s manual collection of data.

So why is MDI, as I like to call it, medical device integration, so important to them? Well if you can alternate the process for them, if there’s a lack of resources then surely there’s going to be more efficiency by helping them to create the wards where they have automatic collection of vital signs, which means they’ve got more time to care. Reducing the number of errors of course, when you look at technology it helps you to calculate different things much more easily so it’s not on paper, and you increase patient safety. And delivering the right care at the right place at the right time with a complete or more complete record allows that care continuum to be much more valuable to clinicians.

Real time transfer of data to district systems and more data parameters, so what I learnt actually that the manufacturers actually have an enormous amount of data on the medical devices which is really valuable to a clinician. And I’m not sure that everybody knows that. For instance, you have sepsis patients and they don’t know their CRP level that data can come from that medical device. So there’s lots of opportunity I feel within this field to support better information around the patient. And as I mentioned already the explosion of software apps and IOT wearables where people are being monitored more remotely, how do you look after that in medical device integration? And then of course the IT department, they need to know new knowledge. They need to understand the new knowledge of software. They need to be able to resource that. They need the security information governance. How does that fit in with their policies around security and information? And they have budget constraints. So which project are they going to look at first, second or third?

So what I want to do now is just show you some positive impacts of technology and hopefully I’ll explain this clearly for you, but basically this is a piece of data which shows before technology and an after picture. And what this is showing is that, on the left-hand side, on my left-hand side, before technology, this is a paperless system of collecting observations. So nurses are collecting observations on paper. The other side is after tech where the first electronic observations were taken for patients in Portsmouth. This is actually in UCHW, which is Coventry and Warwick hospital. And what you can see is that in the middle of the graph you can see the technology adoption progress. This is the amount of observations taken electronically.

On the left-hand side, you see there’s a big variation of the readings, but also there’s a higher mortality rate based on the fact that people or patients were deteriorating. On the right-hand side, obviously after tech, you can see that the actual distance between the readings is less and the improvement is actually sustained. And that’s actually in the BJM. Of course there are some other clinical aspects which are happening at the same time, but that contributed, technology contributed to the success of that project.

The second slide is actually from, it’s been taken from a Welsh Alum research that they did, which shows the manual and automatic collection of data and the differences. So you can see the error comparison, and to very quickly highlight the fact that if you automate the process you actually reduce the error rate by about 50%. And actually when you look at changing to time in terms of the manual and automatic collection, you can see that if you were documenting on paper, it would take you twice as long as if you had a wireless application that sent the information directly. So there’s a clear indication that technology has a massive impact in terms of looking at improving patient care and efficiency; there’s two aspects to that.

So what I’m going to do now is just look at the basic level of connectivity and move that up into the slides to full seamless integration in terms of interoperability. Which is the nice buzzword the NHS like to use. So if you look at the definition of connectivity. We’re talking about setting up a connection through which data is transferred between a medical device and a system. A medical device ability to communicate, there’s no data integration, so that’s point to point as we like to say in the industry. But what’s the risks of a point-to-point solution? The patient record can only receive a limited amount of data. And different devices have different languages. The protocol messages are different. There’s various entry points as well. And then managing and updating these communicating protocols for the EPR vendors is very difficult for them.

If you look at connectivity then directly from the device, the advantages of course are the source systems: the monitoring and the surveillance systems. And data is integrated directly into the patient EPR file. We know that. But the disadvantages are they’re vendor specific. They can lead to equipment replacement. What happens when you replace the manufacturer? There’s no data flow monitoring. There’s no patient identity management. How do you know that’s for the right patient? And sometimes the connection is just not possible. If you then focus on specialising in a CIS system, a computerised information system, the solution, for the advantages, the solution is coming from a specific need and the ability to receive the structured information which is fine. But the disadvantages are that the information is usually location-based and not patient-based in terms of the patient ID. The maintenance and development of libraries is difficult versus the new. So basically the organisation prefers to do new functionalities, providing functionalities for their customers, rather than looking at maintenance and development of new libraries. There’s potentially then the lock-in and it’s unable to expand to other services.

So if you look now at the advanced level of interoperability versus connectivity. The definition of interoperability is the ability of different information technology systems and software applications to communicate, exchange data and use the information that has been exchanged. And that could be to other systems for other clinicians or other users that need that data in some way to ensure that the patient’s journey is seamless and that data is received at the right place at the right time and the right data. So the key message is saying that you can communicate, exchange and integrate this information.

So when you use a centralised interoperability platform the advantages are huge. You have a controlled investment, a strategic investment. There’s hospital-wide interoperability projects possible. There’s any service to any device. There’s positive patient identification. My name is Mark Smith, if I sat next to somebody else in a bed who’s also a Mr Mark Smith I want to make sure that they’ve got my right details. And it’s a vendor neutral solution. So it can actually work with anybody. What’s the benefits of an interoperability platform? Well specifically manage the different exchange protocols, you can direct the information on a central point, and there is secure data transfer. Somebody mentioned earlier about the fact is that medical devices are now up for scrutiny around security. And that’s really important.

So there are various methods of using in terms of medical device connectivity with continuous care versus punctual care. Continuous care or intensive care services requires the interfacing of a larger volume of data samples, filters, alarm processing, that kind of thing. And then of course you’ve got point of care services. So where nurses are taking observations on the wards for instance, where they transmit information in a periodic manner, but there will be less data exchange simultaneously. And this is really important because, because there’s such a dearth of clinical resource the hospitals that suffer are the ones that are not the big trusts, because they can’t get resources to actually come to work in certain places. And therefore that puts a lot of stress on the clinicians. It puts a lot of stress on those people, they take sick, and all of a sudden you have a real problem, a big circular problem around not having enough clinicians because there just isn’t enough people to look after the patients coming in the front door; in both of those cases though you still need to identify the patient and to transmit the validated information to the target systems.

So continuous care is where patients are monitored permanently. They’re plugged in basically in ICU; we all know this. Data is regularly written on medical records or they can be paperless. The nurse and physician are taking care of the patient and the devices that we talk about are things like monitors, gateways, ventilators, respiratory pumps. It doesn’t really matter in terms of the ECGs. And which departments are we talking about? We’re talking about ICU, of course, and HDU, those kind of specialised environments.

This is just an example that I have of the ICU, intensive care unit. As you can see, there’s a lot of handwritten information. The idea of the utopia and some of the people that I’ve been speaking to in ICU recently is to try to replicate that from an electronic point of view, so it provides a much better auditing process and less error opportunity.

Here’s another example of manual charting. I won’t go into too much detail but you can just see there’s, I think they call this is the seagulls. So you can see the seagulls above the dots in terms of looking at the vital signs of patients. If you look at punctual care then, we’ve already spoken about a periodic collection of vital signs, when do you do that? Nurse rounds, first time somebody comes into an A&E, transfer to another department, you’re talking about spot check monitors, that kind of thing. And it will involve all departments in the hospital or as I said in the community, or in community hospitals. This is what a punctual care record looks like.

And so what I mentioned earlier was this real importance about the benefits of teamwork, and I’ve seen now that some hospitals are now starting to put teams together, so biomedical engineers, IT department and clinicians, and they’re working together to provide a highly responsive service to meet the clinical need, a structured and non-invasive way, and it’s traceable in security aspects. So the biomedical engineers are becoming much more savvy if you like with the IT department. The IT department want to know about what biomedical engineers need to know, and of course the clinicians have more time to care and they have time saving, but these guys are all working together now.

Financial benefits, the evidence I have is from the US. There’s a concrete return on investment. 7% of this nurse’s time is spent capturing vital signs manually. Which if you look at her salary of $33.94 per hour and a 175-bedded hospital employing 140 nurses it’s around $½m per year I should say. This is real. This is real opportunity.

So just to, finally, just plug what we do, we have a solution called Patient Connect. And basically that solution is a strategic solution which allows you to connect all your devices at any one point in time. The important thing is that it collects obviously the information from all the medical devices. It also then has a patient positive ID. So it takes the ADT feed from the EPR, and it also takes the user information from the HR system. So you know you’ve got the right user taking the right information from the patient and you’re associating the patient in a very simple way. If anybody wants to know any more about the solution we’re in the exhibition hall in F09.

The workflow basically is to authenticate the user, as I mentioned, to identify the patient, and that is you have to guarantee that before you can associate the device. And then you integrate that wherever you want. We have a strong interoperability with all the players. So we work with all the major manufacturers. We create all the drivers that they have. They’re getting much more interested in being a partner of ours because they want to provide more functionality rather than doing the technical aspects of interoperability. And just to give you an example really of what we’ve done.

As I mentioned, we’re just beginning to expand into different markets and in the UK we have a customer, the Wirral University which is a GDE hospital, which is a global digital exemplar. Good example is they received a number of devices that they couldn’t connect. They went to their major provider to look at how they might connect these new devices. The lead time was unacceptable and the cost was extremely high. We went into the organisation, did low risk investment in terms of looking at a proof of concept to connect those devices. And I can tell you that they are now up and running in ITU, the clinical risk has been solved, and if you need any more information about that please come and see me. And we also have our latest white paper on medical device connectivity which is a really good overall understanding of how biomedical devices can be used in tomorrow’s hospital. Please download that for free.

Thank you for listening to my presentation.

 

Mark Smith's presentation at the EBME Expo Medical Devices Integration: break through the barriers