TechNation is starting off the New Year with a look at patient monitors. We reached out to experts throughout the HTM community and asked them for the latest information on patient monitors, including new features, cybersecurity issues and more.
The roundtable panel is made up of Mindray North America Marketing Manager for Patient Monitoring Beth Aquaviva, Tenacore Biomedical Engineer Brendan Barry, Pacific Medical Senior Account Manager Bob Brosan, BMES Co. Electronics Technician Iain Johnson, Elite Biomedical Solutions Manager of Patient Monitor Repairs Alero Olomajeye and Integrity Biomedical Services’ Brad Sailsbury.
Brendan Barry, Tenacore
Q: What are the latest advances in patient monitoring in the past year?
Aquaviva: Design innovation has provided compact, lightweight, multi-purpose patient monitors that serve as a transport monitor, multi-parameter module and/or a traditional bedside monitor – all in one device. These monitors move with the patient throughout their care path and provide uninterrupted data acquisition from patient to monitor to central station/EMR through seamless Wi-Fi and hardwired communications, easing clinical workflow and enabling a seamless medical record.
Barry: Remote patient monitoring has become a very useful advancement in the medical field. Not only is it cost effective keeping the chronically ill out of the hospital and more involved with their own health, but also by detecting early warning signs of any future complication which can arise. Wireless capabilities have also been a very functional advancement taking that usual image we have of someone on a hospital bed completely entangled in cables and giving that patient the ability to move around freely and to be more comfortable.
Brosan: Most equipment available now has similar functionality, including networking and integration compatibility, patient parameter availability, and ease-of-use for the staff (touchscreen, straight forward menus, etc.) to name a few. The next big wave of innovation looks to be coming from the telemedicine sector but that integration into mobile apps and wearable technology is still in its infancy.
Johnson: The most recent advance I’ve seen is the addition of remote monitoring to CPAP machines. Sleep therapists and doctors can remotely view sleep habits and analyze sleep patterns in almost real time. It’s like being part of a sleep study in your home, which is especially useful when trying to diagnose complex apnea or complicated sleep behaviors.
Olomajeye: Some of the latest features are a swipe feature on a touchscreen and auto rotation of the display.
Sailsbury: We have noticed in the last year that hospitals have trended on adding to existing systems or maintaining current systems. We have also noted that facilities may want to add more advanced monitoring options like full disclosure to older existing systems.
Bob Brosan, Pacific Medical
Q: What factors should HTM consider to determine cost of ownership?
Aquaviva: Cost of ownership starts with the initial acquisition price of the system including monitors, telemetry solution and central monitoring system. But the costs of ownership go far further. For example there are installation expenses (for site surveys, cable installation, system rack installation), project management charges, and any charges associated with clinical training. For interoperability, there are not only the costs of the interface solutions, but also the implementation costs including HL7 mapping and ADT integration and long-term license and support fees sometimes collected annually. For long-term costs, the customer should also consider warranty and service contract expenses and the costs to access a technical team for phone or remote support. These factors are very much a part of the cost of ownership – and can far exceed the initial acquisition expenses.
Barry: One of the most important decisions a hospital will ever make is choosing the right HCIT system given the enormous amount of money on the line. Total cost of ownership models focus primarily on upfront purchases and labor costs, and need to focus on the ongoing costs as well such as software upgrades, maintenance, staff training, future product purchases, server fees and even back up recovery.
Johnson: Training should be inevitable regardless of the new product being brought in. In a good environment there should be some sort of annual training plan to ensure the workers stay at the top of their industry so that shouldn’t really be a factor other than the cost of the company providing the training. In my experience most are pretty comparable. I think one of the more important factors is whether you can use Lithium Ion battery packs or if the equipment is required to use disposable batteries as far as telemetry is concerned. Not only is that a financial cost but also a potential environmental concern. Costs associated with periodic maintenance is another factor to consider when evaluating cost of ownership. Is it something that can be performed in-house, will it need to be shipped off, can it be covered under a contract?
Olomajeye: Factors include original cost (including technician and nursing staff training), maintenance cost (including preventive maintenance and software upgrades), costs of parts/repair/replacement (under contract and not), cost to scale up (purchase more modules and software.)
Sailsbury: When purchasing equipment, you have to look at the costs of repairs and, depending on the equipment you purchase, the length of time you have a warranty, what that warranty covers and if there is an opportunity for an extended warranty. In addition to the cost of actual repairs, you need to keep these factors in mind: the time you will be down while waiting for repairs, what replacement equipment you will need to rent or purchase to use in the downtime, and the availability of service techs in your area. You will also need to look at how the company handles software updates and if you will be charged for those.
Brad Sailsbury, Integrity Biomedical Services
Q: What are the pros and cons of buying brand new versus buying refurbished units?
Aquaviva: New monitors or systems provide the most up-to-date and advanced software, broadest parameter options, and the full standard warranty. Used monitors can come from a variety of sources, some offering the product “as is” without software updates and with only very limited warranties, if any. Mindray offers a certified refurbished program. The products offered for sale have been upgraded to the latest applicable software release with field updates, refurbished cosmetically, checked out through final quality procedures, and provided with a full six-month warranty. The program allows acquisition within tight budgetary constraints.
Barry: Everyone in the medical field knows how expensive equipment can be. By buying refurbished you can cut that cost dramatically if that is an issue. Refurbished units usually come with a warranty as well and the original problem has been repaired, followed by testing that unit furthermore to make sure it meets all product specifications. The only downside would be any physical defects like scratches or blemishes.
Brosan: The pros for purchasing refurbished/recertified equipment are numerous: drastically reduced upfront costs for the equipment itself, reduced costs for parts/repairs due to availability on the open market, and less troubleshooting/less difficult solutions due to maturity of the equipment. The con is how to decide what to do with all of the money saved! Decisions, decisions!
Johnson: When you buy new you generally purchase a support contract which will include software upgrades and tech support for the duration. Refurbished equipment is obviously cheaper. I think the biggest advantage of going with refurbished over new is that generally smaller companies are providing the equipment and they are usually more willing to bend over backwards to ensure a satisfied customer. GE and Philips are as big as they come as far as a company, so even a large hospital purchasing a equipment to outfit a whole wing is merely a drop in their bucket. That amount of money to a small company is a much larger piece of their budget so they’ll make sure it’s taken care of properly.
Olomajeye: The pros of new are longer warranty, latest models/features/parts/software. The cons are the high costs. The pros of refurbished are cheaper, works as good as new, keeps the monitoring system working past the end of life thereby saving money. The cons of refurbished are shorter warranty periods and you may not get the latest software/upgrade.
Sailsbury: When you purchase new you are paying for the newest technology and a warranty that covers repair costs. What people do not consider is that in the used market you can find that same technology and oftentimes the warranties will meet or exceed what the OEM is offering. You do not necessarily have to spend more to get more.
Beth Aquaviva, Mindray North America
Q: What cybersecurity measures should be taken when it comes to patient monitors?
Aquaviva: It is essential that patient monitors, when adopting cybersecurity measures, use the hospital active directory to support user authentication which provides assignment of privileges to particular users to limit access based on need. This transmission of data from these monitors must be done via secure, encrypted protocols.
Barry: Medical devices are just as exposed to a cyber attack as any IT system. Measures for cybersecurity should include eliminating exposure to external networks, using secure and remote access methods and implementing firewalls.
Johnson: Obviously the most secure setup is a standalone system but that isn’t feasible with the new technology out there. Allowing doctors remote access is a great thing in providing the best care, but it’s important to remember to secure patient data. Using strong passwords and ensuring everybody is using their own log-in when accessing the hospital or clinic network are both good habits to encourage. These are more important to keep in mind when accessing the network the patient monitor is attached to. On the patient monitor itself everything is self-contained so cybersecurity shouldn’t enter the equation.
Olomajeye: Patient monitors are connected to the central stations which in turn is connected to long-term data storage, EHR, middleware, telemetry, etc. It is important to work very closely with IT and manufacturer of these devices to plan and execute recommended cybersecurity measures, such as patch installation and software upgrades and contingency plans. There should also be a proper password management process in place, as well as frequent cybersecurity risk assessment to reveal any loopholes in current processes.
Sailsbury: There is no blanket answer because each facility is set up differently. With systems that have wired, wireless and virtual users it creates many different scenarios. I suggest techs work with the hospital IT provider to make sure the entire network is following the best processes to ensure the safety of the data.
Alero Olomajeye, Elite Biomedical Solutions
Q: Can you explain the importance of holding an in-service or clinician training on how to properly use the devices?
Aquaviva: Monitoring in-service training should be performed by a RN whose expertise with the operation of the solution is equal to their clinical knowledge in the care environment they are training in. Clinical in-service by such individuals for a monitoring solution enhances the operational efficiency of the end users and supports their efforts to provide high-quality patient care.
Barry: Clinician training should be done on any and every device the person will be using. It’s very important to have that hands-on experience with a trained professional and to also read the operating and service manual. Each patient monitor has different settings, configurations, passwords and cables so knowing and getting trained on just one type will not suffice
Johnson: Limiting downtime is always front and center. Everybody is trying to do more with less so wasting someone’s time is never good. Whether it’s a simple thing like knowing which type of sensor to use with a measurement module or knowing that software versions have to match can eliminate potentially damaging equipment by forcing the sensor onto a connector it’s not meant for or just tagging out a piece as bad when it isn’t. That takes man-hours from the BMET who is already probably overtasked to troubleshoot and bring back into service, or if they don’t have time, it will get sent off to a repair facility who will either charge a flat rate or bench fee for their time spent evaluating. Needless shipping costs are a part of that as well.
Olomajeye: Clinician training on how to use patient monitors properly helps the staff to know what features are available. It gives them the ability and confidence to use the patient monitor efficiently and optimally. Knowing how to use the right type of cable and profile for the patient, for instance, helps to get the most accurate data on the patient and leads to fewer nuisance alarms.
Sailsbury: Training is a must for both accurate use and patient safety. Not having proper training can lead to reduced patient care, alarm fatigue and higher equipment downtime due to improper set up and use by hospital staff. Additionally, without training you will be paying for technology the staff will either underutilize or not utilize at all due to not fully understanding how to operate the equipment.
Iain Johnson, BMES Co.
Q: What else do you think readers need to know about purchasing and servicing patient monitoring devices?
Aquaviva: Selecting a patient monitoring system that fits the clinical requirements of a facility is just a start. The monitoring system must be flexible, scalable, fit multiple acuity levels, and provide intuitive operation. Ensuring that the system meets IT requirements is also critical. In this area, monitoring systems that offer standard and open interoperability options leveraging the hospital infrastructure and strengths, can offer overall reductions in system costs and speed the seamless integration of information within hospital systems.
Barry: When it comes to purchasing and servicing patient monitor devices, I recommend using a reputable company that’s certified and has trained professionals.
Johnson: Honestly, when properly trained personnel are using the equipment patient monitors are made very well and will hold up to normal usage for years. It’s not the same as technology in your house that needs to be constantly upgraded. We see things come in for service that have been out in the field for years if not over a decade and are still running strong except when they finally fail. I’ve seen CO2 modules that haven’t been calibrated in 12 years still taking accurate measurements. This equipment is really quite reliable. When purchasing equipment and deciding between new and refurbished remember that there’s only so long a manufacturer will burn in their product before selling it. When you buy refurbished it’s pretty much like it’s had a longer burn-in process which could be years. Equipment will usually fail in the first six months, after that it may run for years without issue. For that reason alone, I would almost always recommend purchasing refurbished equipment except under certain circumstances.
Sailsbury: Make sure you chose a product from a manufacturer or provider that you can use and support. Make sure that manuals and schematics are available and you receive copies of them. Make sure that parts are readily available and that there are service techs in your area to support your product. Finally, make sure you are buying the technology and functions that you need and will use.
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