TechNation contacted several industry professionals for this roundtable article on patient monitors. The goal was to find out the latest about these devices with feedback from service professionals and manufacturers.
Participating in the roundtable article are GE Healthcare Monitoring Solutions Chief Technology Officer Oliver Astley, Ph.D.; USOC Biomedical Vice President Duane Gilmore; Avante Director of Biomedical Engineering James Manley; Agiliti’s Dip Niraula; Elite Biomedical Solutions’ Alero Olomajeye; and BMES Director of Sales Nate Thomasson.
Astley: We will see more focus on early detection of patient deterioration; it is not that patients suddenly deteriorate, it’s that caregivers suddenly notice. This means that we will see continuous monitoring proliferate in the low acuity wards, where patients are checked intermittently every four to eight hours. However, in the ward environment, patients are more active and generally encouraged to get out of bed and be mobile. This will demand that the technology applied is wireless, miniature and fits seamlessly into the caregivers’ workflow.
Gilmore: I see remote patient monitoring (RPM) as a major future of patient monitoring. We have already seen that the prudent hospitals were able to implement RPM which helped them care for their non-critical patients during this pandemic when hospital resources were overextended. This, as well as other forms of remote care, is the future.
Manley: I see the future of patient monitoring as bright as ever. Manufacturers are making their equipment smaller and more intuitive, easier to set up and to operate. Self-diagnosing devices are not that far away. Some software does that now. I definitely feel we will see AI devices in our area soon. Telemedicine is becoming more and more popular. We may see monitoring devices designed for home use in the near future with wearable sensors and smaller-sized devices that can interface with a hospital or med center departments.
Niraula: Wireless patient monitoring will impact how and where monitoring occurs. We anticipate that wireless medical body-sensor networks (BSNs) will replace the traditional lead set and bulky transmitter with the wireless body sensor with nano transmitter built within it. This will greatly help in patient transportation, flexible acuity monitoring, patient mobility and data integration, among other things. Additionally, with the availability of web interconnectivity, patient monitoring most likely will expand to remote monitoring from patient homes and 24/7 in daily activities.
Olomajeye: I see patient monitoring being more portable and accessible; on cellphones, watches and hand-held units that can connect to laptops and television displays; even video game consoles.
Thomasson: Patient monitoring will look much different as technology continues to evolve. If you consider that 15 years ago, we were monitoring a few vitals such as BP and ECG; now we have major pushes for end tidal C02 and, at a minimum, devices are accommodating Sp02, ECG, NIBP, temperature, arterial pressure, etc. Eventually, we will see an internal monitoring device that provides real time data of all bodily functions.
Astley: Remote monitoring and disposable devices. In the height of a pandemic, medical staff from a range of specialties are called into action to help manage the patient load. Not all staff will have deep training on handling the COVID symptoms. This gap can be bridged by providing real-time monitoring data and control to specialists that could be thousands of miles away; this is powerful when one region is in the middle of a “wave;” they can get help from a region remotely not in the same level of crisis. This can also help reduce exposure, and hence commutable disease risk, too, and can help to preserve PPE. COVID has also increased the need for disposable sensing devices, also known as disposable parameters. Disposable devices eliminate the workload required for cleaning, eliminate the risk of inadequate cleaning and eliminate the risk created when a virus is resistant to cleaning.
Gilmore: COVID-19 was a wakeup call and hospitals will never again want to be caught unprepared. No hospital wants to be known as the one where lives were lost due to lack of equipment. So prudent hospitals will be prepared by having a reserve of supplies and equipment as a buffer against the emergencies of the future.
Manley: We will be flooded with requests for more monitors, pumps, etc. to be sold and repaired. As a result, our turn times will be impacted negatively. As parts become harder to get and priced higher when in short supply, we may lose the ability to repair devices within the typical turn times. We will work to keep the turn times as low as possible, potentially developing new work flows and procedures to manage the workloads today and beyond.
Niraula: COVID-19 has greatly changed the health care system. Reducing physical contact with patients who have contagious diseases will most likely lead to an increase in wireless connectivity. Touchless technology and remote monitoring could become more streamlined and common practice.
Olomajeye: This pandemic has led to the widespread use of telemedicine, compelling many to be familiar with their vital signs and what they mean. Patients will be able to place sensors and electrodes on themselves at home. I see people being able to measure their own basic vital signs and sending it to their physicians and nurses. This will lead to early diagnosis and treatment, thereby saving lives.
Thomasson: I think, in the past, monitoring equipment and monitoring in general has taken a back seat to imaging and higher dollar equipment. What COVID has proven is how important monitoring is across all departments of a health care facility. Monitoring equipment has proven itself to be absolutely essential in many cases and, as such, spare equipment and parts need to be ready at all times.
Astley: In the early 2000s, GE Healthcare began offering the ability to remotely view the operation of patient monitors; servers that support wireless patient telemetry; mission-critical networking; clinical data gateways; and clinical workstations by our Remote Online Center (ROC). This technology has evolved from sending critical notifications of component failures to providing real-time screen-sharing for technical support, pushing software images for staging updates and collecting device and system performance information. It continues to mature, looking to incorporate modern IoT fleet management technologies, including digital twin concepts. Devices could securely “call home,” reporting their status and any issues detected. Some conditions may turn into notifications directly to the customer via email or trigger a field service request. With redundancy in the system, it’s possible a failure of a component occurs and is corrected without any notice to the clinical users.
Gilmore: It’s a must have for HTM professionals to have an asset management policy. Also consider asset management software that incorporates notifications and reminders.
Manley: With Zoom, Teams and FaceTime we all have the ability to be virtually in the same space and looking at the same thing as the tech needing assistance. We have performed more of these calls in the last few months than pre-COVID. Self-diagnostic software makes our jobs easier. I expect to see more of that in smaller more portable devices. The next of generation of medical devices may recommend which parts to replace, maintenance and calibration needs. Software updates may become more frequent in the future. As software being developed is more robust and harder to hack, I think we will see fewer patching needs for the next few years.
Niraula: Remote performance inspections will enable technicians to inspect and diagnose the patient monitoring software and patches – as long as proper training and support is provided to them. Because of the fast-paced evolution of various medical technology, proper manufacturer training will greatly help technicians navigate any issues in medical care facilities. One key challenge technicians will face, however, is that in many cases, monitors are not networked and are used as bedside monitoring only.
Olomajeye: Most patient monitoring manufacturers have software updates and patches on remote servers that a technician can access and download securely. Patient monitors have a self-diagnostic software that is executed at power-up and stays on during operation. It sends alarms, PM times, error codes to display and emails (for certain servers), alerting the nursing staff and technician of not only a problem but the type of problem. The OEM technician can access the monitoring system and perform PMs remotely. For the inspections, troubleshooting, and updates that require physical access to the monitor, a tech on site can Zoom with the remote tech and/or take a picture to do so.
Thomasson: While I am not a technician at all, based on experience and what I have seen, these are not only convenience features, but they could also be considered safety enhancements. The reason being is that the machines are smart enough to update themselves and diagnose themselves. In times like COVID where people need to be quarantined, this would be a huge benefit. It would allow the patient to be connected to the most updated monitor without risking another person being infected.
Astley: Manufacturers are utilizing the same security tools that are used in other fields. The challenge in patient monitoring is ensuring that security is met while not disrupting workflow nor patient safety. Hospitals have hundreds to thousands of patient monitoring devices and parameters; tracking them and updating them becomes a massive task. Remote update is complex because it must not disrupt the patient workflow. Our devices are on patients 24/7, we cannot simply do a force “reboot.”
Gilmore: Cyberattacks garner attention after the damage is done. Health care providers cannot afford to be apathetic and we must be proactive. There are security tools and security professionals that can protect our high-risk institutions. My advice to health care institutions would be if you don’t have a cyber-attack policy, create one and begin to think about implementing financial-institutions level cybersecurity.
Manley: We are seeing the development of a more “hack resistant” software. HTM professionals should close some of the entry points available and used by hackers if possible. It is important to stay abreast of the latest cyberattacks and the devices affected at other medical centers. Working with internal IT and manufacturers can also help reduce or eliminate their particular vulnerabilities.
Niraula: The integration of clinical engineering with IT has proven to enhance service at the clinical level, but there is also increased risk with more interconnected devices. At minimum, HTM professionals and hospital staff should focus on removing, securing and isolating equipment as soon as an attack is identified. Many IT department are already equipped with the appropriate personnel to tackle these demands of cybersecurity. Yet, as technology evolves, so do cybersecurity threats – and the design of new devices should continue to emphasize better cybersecurity software and firewalls to protect the patient information. Also, in looking at the current technology, artificial intelligence could be integrated to make more statistically accurate security decisions.
Olomajeye: Manufacturers have security software already installed on the monitoring systems. They also have installation procedures that safeguard their systems from cyberattacks. Such as patient monitoring networks being isolated from the hospital network, strong passwords and network traffic monitoring. Manufacturers also work with IT departments during installation to ensure that the security and network traffic monitoring software meets the standard of the hospital. During patches and updates this ensures that the security software is current and able to fight new cyberattacks methods. HTM professionals should involve their IT department in the process of purchasing patient monitors, installation and after, communicating any aberrant behavior in monitor operation, so they can plan and institute strong anti-cyberattack measures.
Thomasson: I think this closely relates to the previous question. Devices that self-diagnose and auto update could also be allowed security updates. Manufacturers should really treat devices as cellphones and push security updates to all connected devices. However, the security really starts at the facility level and the measures that are being taken locally to protect the entire facility network.
Astley: GE Healthcare technical training is available on both our external facing website and on GE Healthcare’s Service Shop.
Gilmore: OEMs provide product specific training, certification bodies offer training, managers especially might benefit from quality process training such as Six Sigma. There are some great online options in this COVID-19 environment.
Manley: HTM professionals can look to their organization for guidance and support. Reach out to equipment manufacturers and dealers and inquire what type of training is available. There may be an independent that can fill the training needs.
Niraula: The best advice is to not be afraid to ask for training if you’re interested. Many vendors will gladly send training manuals, videos and online training resources. Some training HTM professionals should seek includes Comp TIA A+, Security + and Network +.
Olomajeye: Training access options for HTM professionals include OEM technical training, AAMI website and the AAMI conference (annually). The HTM professional has access to service manuals for self-training, as well as HTM-to-HTM training and HTM association meetings.
Thomasson: For the equipment we service, we send our technicians to the OEM training courses. While industry trade shows such as MD Expo and AAMI are great continuing education opportunities, they do not provide the detailed training I interpret you to be asking about. However, the other benefit of going direct to the OEM training is that sometimes, the manufacturer will require this prior to allowing a BMET to order parts. In other words, attending the OEM classes and courses will sometimes unlock other levels of support and I can say this even from a third-party perspective.
Astley: GE Healthcare makes nearly all its parts available to HTM staff to better maintain our patient monitors. Parts can be ordered by calling our parts team at 800-437-1171 or online through our e-commerce portal Service Shop. We have increased our investment during the past 24 months, helping to ensure an ample supply of high-volume parts to meet our customers’ needs.
Gilmore: Third-party service companies, like USOC Biomedical, have been instrumental in assisting HTM professionals with parts availably and overall costs savings. My recommendation is that HTM professionals give third-party service companies a try when a need for parts or service arise.
Manley: 1. As part of the purchase of said equipment, med centers should include in the RFP or quote training and parts availability. 2. Check with the manufacturer to ensure they support in-house repairs. 3. Find a source of parts needed for repairs. 4. Use Avante patient monitoring for your parts, service and repair needs.
Niraula: Failure rate for patient monitors has significantly decreased due to integration of technology. The most frequent failures are related to user interactions such as On/Off buttons and crashed displays. It is advisable to plan ahead, including building a stock of replacement parts of those items in order to improve turnaround time on repairs and anticipating equipment refreshes in advance.
Olomajeye: The HTM can stockpile commonly used parts (This pandemic has shown the necessity for this). Always reach out to ISO or Elite directly. Elite carries not only OEM parts, but manufactures’ new, OEM-quality, replacement parts.
Thomasson: There are tons of resources out there for patient monitoring parts. BMES can provide parts for all of the products that we service; so, the obvious answer would be to always think of service companies as potential parts suppliers as well. However, the best advice I would give is that if a facility has equipment that is no longer supported and they have a unit go bad, purchase a used unit and keep the bad one for parts. Eventually those parts will be tough to come by and if there are no plans to upgrade, you may need those parts for a while. This is especially true for things like cases. The parts that take the physical abuse will be the ones that you need most often.
Astley: Patient monitoring is in the midst of a transformation. Patient monitors traditionally give information about the current patient state. GE Healthcare engineers are now designing systems that could help reduce length of stay, reduce transfers to high acuity units and improve patient outcomes. To do this, we are finding ways to make our devices wireless and as “invisible” as possible. We are liberating more data from “the monitoring box.” We see great potential to use heterogeneous and longitudinal data to predict and give deeper insights to the patient state.
Gilmore: 2020 was a year like none other. Due to the pandemic doctors and nurses get a lot of attention, deservedly so, they do great work. However, USOC wants to personally acknowledge the hard work of HTM professionals that might be behind the scenes but just as courageous and just as essential as the front-line medical workers.
Manley: You will never find a better patient monitoring company to support your needs as well as Avante. We always go the extra mile, it’s just a habit. Thank you for your continued support.
Niraula: The future of clinical engineering is now and will be increasingly more related to IT functions.
Olomajeye: Please stay safe, take precautionary measures, there is no harm in doing that. God bless you. And as always, we are here to help!
Thomasson: There are a lot of options in the patient monitoring service arena and that’s no secret. However, there aren’t many that have been in business, servicing monitoring equipment, for over 30 years. BMES is a great service provider and our longevity is a testament to how we take care of our customers.
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