The monthly roundtable article continues to be a popular feature in TechNation. This month we look at patient monitors. We found several industry experts eager to share their insights on these important devices. In this month’s installment we explore what to look for when buying patient monitors in regards to basic functions, the latest features, cybersecurity and more.
The members of the panel sharing their insights on patient monitors in 2019 are Bio-Medical Equipment Service Company’s Ethan Baker, Avante Patient Monitoring Technical Solutions Manager Brian Barton, USOC Medical Quality Manager Joseph Bowen, BETA Biomed Services Inc. COO DR Flower, Elite Biomedical Solutions Patient Monitoring Specialist Alero Olomajeye and Integrity Biomedical Services Owner Michele Shahbandeh.
Q: What are the basic capabilities biomeds must insist upon when purchasing patient monitors?
Baker: When selecting your patient monitoring system, you must be careful to set yourself up for the future. As we all know patient monitoring systems are not cheap, so it is imperative to select a system that allows growth in the quantity of connected devices, capability add ons and, most importantly, service options for warranty and non-warranty requirements.
Barton: Biomeds don’t insist on having basic capabilities or measurements. They may require specific software and settings so that the monitor will be compatible with other systems in the hospital. The specific hospital department that has the need for the monitors will have requirements per their patient type. The most basic parameters that you will have on any patient monitor will be NIBP, Sp02, and ECG beyond these the clinical staff may call for things like C02, temperature, invasive blood pressure, cardiac output, bispectral index, etc.
Bowen: Well, the basics to patient monitoring are ECG, SP02 and NiBP. However, before making any purchases the biomed staff needs to ensure that the patient monitors they are purchasing fit the needs of the hospital staff. There are a wide variety of monitors, each with their own capabilities. To determine which monitors are best used for the hospital, good communication between departments and staff is key. The needs of the patient, the capabilities of the staff and the business needs of the organization all play a role.
Flower: This would depend on the area of the facility that the monitors are being used. An ER suite would have different requirements than a general ward or an EMS setting. A thorough understanding of the environment in which the monitor is being used is paramount in deciding what capabilities are a must – whether it is a hand held or a multiparameter monitor. Ease of use, durability and support of OEM are other aspects to be concerned with.
Olomajeye: The basic capabilities biomeds must insist upon when purchasing patient monitors are ECG, NIBP, SPO2, vitals data storage, network capability, backwards compatibility and electronic medical record firmware.
Shahbandeh: The basic capabilities are mostly the same, it is the aesthetics and ease of use for the staff that are more of a concern.
Q: What are some new features they should seek out when purchasing patient monitors?
Baker: Some of the most exciting new features we are seeing on the market are real-time/remote monitoring, expanded mobility and patient privacy security upgrades. Real-time and remote monitoring are allowing shorter hospital stays which is resulting in the need for higher level of security of patient data. Overall, this is helping to drive patient and doctor costs lower.
Barton: Features on patient monitors haven’t changed tremendously in recent years. Networking capability and wireless function continue to get stronger. There are monitors that are small enough to be patient worn and at the same time transmit an RF signal back to a central monitoring station.
Flower: As technology is changing quite frequently there will always be new features or bells and whistles. It is very important to realize which is which. Many of the newer bells and whistles are not necessary, but some features, such as touch screens, are very valuable in certain settings. Again, it would depend on the area that the monitors are being used.
Olomajeye: Some of the new features that should be sought out when purchasing patient monitors are modular scalability, ability to display pertinent data from other equipment such as ventilators, portability, mobile platform and wireless network capability.
Shahbandeh: Wireless capabilities, displays with information directly on the transmitters have been a plus with staff use. Portability of one unit to another- thru modular exchange.
Q: What should be taken into consideration in regards to cybersecurity concerns?
Baker: As with any item that is connected to a network there are security risks at some level, regardless if the device is medical related or not. We must always be on the front line of our security to identify those risks and mitigate to the highest levels. We have to be willing to continue to upgrade our people, products, systems and process as cybersecurity evolves.
Barton: All reputable manufacturers will have continual advances in software and hardware, but concern over cybersecurity rests in the hands of hospital information systems staff.
Bowen: All systems should undergo a risk analysis and, based upon the risks, controls and policies should be implemented to mitigate them. Some of the basics for protecting against cybersecurity threats are encryption of sensitive data, a password policy, data back-up policy, personal device policy, a software update policy, and education and training.
Flower: With the cooperation from IT, understanding how the network works and making sure the firewall is adequate for the environment. Knowing what is involved in any software updates and how this can affect the cybersecurity effectiveness of the system. How easily can, or should, backups be made. As there are more and more telemetry and wearable devices being introduced to the market, the facility’s overall network needs to be assured of security.
Olomajeye: Central monitoring systems, patient vitals storage and EMI servers should have proper password management, redundant data storage (cloud and data center), proper back-up protocol, emergency preparedness measures, such as data storage servers that only connected to load data for the day and are then disconnected in case there is a ransomware attack.
Q: How can biomeds make sure purchased equipment does not violate any HIPAA regulations?
Baker: In order to properly protect patient information you have to understand what equipment in your network is capable of gathering, storing, and reporting patient information. Once this process and understanding is in place, you can identify high risk devices and add a higher level of security to prevent violations of HIPPA regulations.
Barton: When purchasing refurbished or previously used equipment biomeds would want to be sure to “wipe clean” any patient information and demographics. Most patient monitors do not store other pertinent patient information.
Bowen: Given that HIPPA’s primary concern is with the safe keeping of patient data, biomeds should check all used equipment to make sure that they have been properly purged of any previous patient data. The biggest concern here is when a biomed is decommissioning, transferring or recycling older equipment. They must make sure that any data that might be needed is retained, and that all patient related information is removed from any and all equipment before transferring.
Flower: This would come from the vendor. Most OEMs can provide the clinical environment with proof of adherence to HIPAA regs. After purchase, careful consideration of cybersecurity concerns mentioned above should prevent any violations of HIPAA regulations.
Olomajeye: Biomeds can ensure that purchased equipment does not violate any HIPAA regulations by purchasing equipment that has screens that can be put on standby while still monitoring at the nursing station and patient profile data that can encrypted in the patient room and hallway screens, while still visible at the nursing station.
Q: When it comes to end of life, what steps can be taken to help further extend usefulness of patient monitors?
Baker: It is key that you follow OEM recommended maintenance, and procedures on your devices. Our customers have been the most successful in extending the lives of their devices when they engage with us early in the process. Customers willing to invest in preventative maintenance programs, repairs and software upgrades throughout the life of the products, rather than at the end have seen product life extension that pays for itself.
Barton: Staying up to date on preventative maintenance is a great way to make sure end of life equipment will continue to perform. Teaming up with Pacific Medical will allow hospitals to use their monitors and service them well after the OEM announces end of life. We have aftermarket and refurbished parts for almost every major manufacturer and we have the ability to perform sophisticated repairs on monitors.
Bowen: Keep up with your PMs. If it’s a piece of equipment that has air vents and fans to help vent out heat, include it in your PM schedule at least once a year to open it up and dust it out. Heat and dust are the number one killer of electronic equipment. This can be time consuming, but it is without a doubt the simplest and easiest way to extend the life of your equipment and save potentially thousands of dollars. You would be shocked at the amount of dust we have observed in customer equipment.
Flower: Most monitors do not die at the OEMs EOL date. If the monitors are staying in the clinical environment, the HTM professional should have a maintenance history of the monitor and with the understanding of the OEMs suggestive PMs and a little TLC, it should be able to last a bit longer. If the monitors are going to be replaced, there are third-party vendors that will take the monitors and refurbish them and place them in another clinical setting.
Olomajeye: Many hospitals use patient monitors well past end of life. Reaching out to ISOs who always have monitors and monitor parts in stock is a viable solution. They also have certified technicians on site to repair equipment with end of life status.
Shahbandeh: Find an ISO 9001-2015 certified company that supports your end of life units, using parts that are comparable to OEM parts and the facility gives you a substantial warranty.
Q: With systems transitioning, how can biomeds ensure that monitors are compatible?
Baker: OEMs will regularly publish compatibility matrix for the equipment they currently have in the field against new products that will be released. The biomed department should ensure that they are staying up to date with current and future releases. A subscription to TechNation can help keep them up to date on technologies and compatibilities with a little research.
Barton: This is difficult to ensure. The best way to be sure monitors are compatible is use the same manufacturer hospital wide for monitoring.
Bowen: Typically, the OEM that you are purchasing from should be able to tell you what the new equipment is or isn’t compatible with. If you’re transitioning to newer equipment but keeping older equipment in service, make sure to ask the right questions from whomever you are purchasing new equipment from.
Flower: An understanding at the beginning of the purchasing process of what the compatibility is and what the expandability of the monitor will be in the future. Be sure that the vendor is willing to work with you to meet any changes in the technology in the future. Software upgrades are a must when negotiating the purchase of new monitors. As quickly as technology is changing, the monitors must be able to change with the times.
Olomajeye: When transitioning systems, biomeds should ensure backwards compatibility and compatibility in general, by performing full systems tests as well as testing different scenarios in different departments (ICU, surgery, etc.) to ensure a successful transition.
Shahbandeh: Up-to-date software applications through the OEM and continue to purchase through reliable second-source companies with the integrity of the software.
Q: What alarm features (alarm delays, ability to customize alarms, alarm enable/disable, etc.) should biomeds seek out?
Baker: Most patient monitoring equipment comes with features that allow alarm customization. The biomed needs to ask the question: Does the hospital want the nursing staff to have the ability to change alarm features? If not, then the hospital needs to make sure that the equipment they are purchasing is protected from these types of changes.
Barton: This will be the decision of the clinical staff. Most patient monitoring allows for customized settings of alarm function. There are standard settings or configurations that can be loaded on a monitor but those can be adjusted to suit the needs of the department they are going into.
Bowen: These types of things shouldn’t be the concern of the biomed. The clinical staff needs to make this determination. Certain units within a hospital might want only visual alarms, while other more critical units might want the loudest and brightest alarm available.
Flower: All the ones mentioned plus a lockout to prevent the patient from making any changes to the settings.
Olomajeye: The alarm features biomeds should seek out are easily customizable alarms that are unique to each department and patient in order to reduce alarm nuisance. Alarm features that can allow alarms to be escalated to different staff and devices as well as one that can collect data for analysis for process improvement purposes are important.
Q: What else do you think TechNation readers need to know about purchasing and servicing patient monitoring devices?
Flower: The most important thing to keep in mind, is that all parties must come together to make these decisions. Which type of monitor that will be purchased will come from what is the environment that it will be used. Don’t think of the OEM as a combatant in the process. They should be looked at as a partner in the decision. Purchasing, IT, biomed, clinical users and senior level management should all be included in the decision. Also, consumables need to be addressed at the point of purchase. Make sure to check on the availability of replacement cables or can they be repaired. Please make sure that all documentation for the monitor is provided – preferably in PDF format. Any training necessary for the operation of the monitor(s) should be included in the purchase contract.
Olomajeye: Patient monitors are versatile, long-lasting equipment. They are modular and feature driven. Purchasing can be done by feature and module to fit different departments. Most monitor vendors have equipment that is backwards compatible to allow for efficient and optimal use. They can be used well past the end of life. ISOs have parts and equipment to keep monitors running if needed.
Shahbandeh: Do research on who you are using for repairs and purchases. Can they support the equipment? Do they have access to parts? Are they knowledgeable? Buy from a qualified company that focuses on the quality of the equipment and ask for details on their warranty. Check out their customer service and desire to help the customer. Inquire on technical support and the availability of it.
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