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Healthcare IT advances are pulling together to manage an expanding universe.
IT and BIOMEDICAL DEVICES - by Kevin Featherly

For most of recorded history, medical devices have been the province of a hospital's biomedical engineers and clinical staff. Say a nursing unit needed a new glucometer; staff would simply go out and buy one. Patient monitors? Ditto. Biomedical devices, while critical for patient care, were essentially dumb readout machines and didn't require much critical review from the executive suite.

Not anymore. In these days of proliferating digital data and blossoming electronic health records, it's increasingly hard to sneak medical devices past the CIO's door. When even an average IV pump has a virtual brain, generates digital data and hooks up wirelessly to the hospital's backbone infrastructure to feed information into the patient record, there's little equipment that doesn't require a CIO's imprimatur.

Demands of digitization
The shift to CIO involvement in device integration is "a solid trend," according to Ravi Nemana, senior healthcare IT adviser at research firm HealthTech, San Francisco. "Anything that's being developed in terms of medical devices and sensors now is digital," Nemana says. "That means you can transmit it anywhere and process it distributively, you can decouple diagnosis and treatment, you can do lots of things. ... The minute you are transmitting, sorting or processing this information, you now have an involvement with the CIO," Nemana says.

According to the research firm Freedonia Group Inc., Cleveland, demand for patient monitoring systems is expected to grow 6.7 percent annually by 2008. Roughly half the sales--$3.6 billion--will go toward hospital systems and the rest to home monitoring equipment and the like. Freedonia has no statistical data indicating how much of that patient monitoring equipment will process and produce digital information, but anecdotal evidence, and common sense, points to ever-accelerating digitization. Larry Sharrott, CIO for AtlantiCare and the Atlantic City Medical Center, Egg Harbor, N.J., says he began noticing the shift perhaps four years ago.
But it began in earnest within the past year or two as device manufacturers began converting their wares to digital. "What we're all finding is, where that stuff used to be kind of its own closed product—its own separate monitoring product--it now happens to be a computer with a different front end that's got to ride on the network," says Sharrott. "What it really means is that we end up having to assign analysts to a heck of a lot more stuff than we did just a year ago."

One simple example: Atlantic City's medical staff decided to deploy new point-ofservice glucometers that plug directly into a desktop computer, which displays and records the readings. That required building a lot of new interfaces. "Because we are moving in the direction of an electronic medical record," Sharrott says, "every one of those desktop glucometers had to get connected in a way that we see the results back into the laboratory database."

Making the sale
Hospital staff and CIOs aren't the only ones forced to respond to what amounts to wholesale transformation in biomed equipment purchasing. Vendors' sales staffs also are changing tactics. To sell a monitor in the past, says Isabelle Werkheiser, senior modality manager for patient monitoring at Dräger Medical, Telford, Pa., sales staff would describe things like functionality, features, ease of repair and service availability to prospective customers.

The CIO had little involvement.
"Now what's happening is that, because hospitals are looking at going to the electronic medical record, they are looking for ways to make these devices work with that strategy," she says. "I hear now that about 50 percent of the decision factor is on the CIO." In the simplest terms, Werkheiser says, what was once almost entirely a medical device manufacturer has become an ersatz IT company, heavily invested in software development. Something similar is happening at GE Healthcare, Waukesha, Wis., one of the largest companies involved in both the medical-device and radiological spaces--though, of course, GE's stature as an IT firm is long-standing. Like Werkheiser, GE's acute care business marketing manager Philip Settimi says that CIOs have veto power over about half of the monitoring equipment that his company sells to hospitals. "What has happened, I think, is a bit of a role-reversal," Settimi says. "We now see in our business about one-half of the hospitals have their biomed and IT reporting up to a single
CIO, so that the CIO now has operational responsibility for both of those businesses."
As for the other half, Settimi says, the trend is moving solidly in the same direction, with biomed purchasing decisions gradually becoming the province of the CIO. In fact, Nemana's HealthTech colleague, analyst Kent Soo Hoo, projects that within a few years, it will be almost impossible to distinguish between most hospitals' IT and biomed departments.

At CentraCare HealthSystem, St. Cloud, Minn., the biomed department does not currently report directly to CIO Charles Dooley, but he recognizes the digitized-device trend and is working a lot more closely with his biomedical engineers as more monitoring equipment goes online. So far that list includes neonatal monitors, critical care monitors and endoscopy procedural machines. To some degree, lines of duty demarcation already are blurring, he says.

"We basically have a joint service-level agreement that says when a help desk call comes in, we'll take the call for each other's department," Dooley says. "And whichever department would get the call first would do the assessment and then bring in the other department if it falls into their realm." The line between biomed and IT is drawn at the point where equipment is attached to patients, he says. "Then biomed services the hardware. If not, IT services it."

All this is happening, notes Hardy North, director of healthcare business development for Dell Computer Corp., Round Rock, Texas, at the same time that mobile devices such as tablet PCs, PDAs and Blackberry-type email devices are proliferating to a critical mass in clinical medicine. These also require wireless connections into hospitals' infrastructure and, increasingly, must fit with electronic medical record strategies.

"You have to find the way to share information across not only physical boundaries in a hospital but logical boundaries, like departments and functionalities," North says. "It's a world where you're going to have seven-by-24 connectivity between the patient and the care provider and all of the hospital support functions like financial services and housekeeping. ... The whole idea in healthcare today is that we're building out a realtime environment."

Techie, know thy physician
Atlantic City's Sharrott prides himself on having always staffed his IT department with clinicians, saying he has found it easier to train medical experts in technology than to teach medicine to technology geeks. That approach has been fortuitous, he says, because as his department's responsibilities draw closer to the point of care, an appreciation of clinicians' medical needs has proven essential. Unfortunately, says Sharrott, the reverse is not always true. While clinicians really should consider overall IT strategy as they suggest and make equipment purchases, they don't always take an enterprisewide view of their needs. And it can mean real headaches. "What's problematic is when people go ahead and buy things and they don't realize that these are now computer devices that have to have servers and all kinds of other things installed, and they don't find out until it kind of rolls in the door," Sharrott says. "And all of a sudden we find that we're being called to the table."

The biggest change CentraCare's Dooley has noticed is the need to incorporate device vendors into his department's vendor-access support policies--resulting from the introduction of a computer virus into the health system's network by a biomedical device vendor. "We've blocked out all vendor access," he says. "They have to call first and have their access opened."

Just the beginning
Sharrott is a little surprised that major vendors like GE and Dräger see as little as 50 percent of equipment purchasing authority falling to the CIO. In his institution, he says, it's more like 90 to 95 percent; what doesn't get CIO review has simply slipped through the cracks. However, despite a dramatic spike in new responsibilities, Sharrott warns, the digital-device cascade has barely begun. Consider the forthcoming arrival of radio frequency identification tags, he says. Or the proliferation of so-called mini-PACS units that already are in production. Or what's going to happen shortly with voice over Internet protocol. And who can say where nanotechnology will eventually leave the CIO?

"I really think we're just beginning to see digitization," Sharrott says. "I think if we're talking 10 or 20 years out, the amount of integrated digitization is going to be amazing."

(extraído da publicação Healthcare Informatics, focada no estudo de TICs para Healthcare) Fevereiro 2005