I have had the opportunity to most recently review a well written article by Brian McAlpine, Director of Strategic Products for Capsule Technologies.  The following comments are based upon my agreement with Mr. McAlpines article and also reference my experience with the very important issue of how technologies can impede or improve the clinical care process.

All of what was discussed in this article and the followng from the early stages when WIFI (or 802.11b), was ratified in 1999.  This set into motion great technological innovation surrounding the point of care, but also posed new challenges for the clinical care giver. The logical move with the adoption of wireless in the healthcare enterprise was to now enable early laptops with external WIFI client adapters and allow the point of care access to the EMR, not from the nurse's station.  This mobility greatly increased the patient to care-giver interaction.

Around this same time, the advent of BCMA (Bar Code Medication Administration), started to take hold because of the roll-out within the V.A. Healthcare System.  While the intent was there (the five rights), the healthcare industry had not and to this day has not standarized on a standard bar code symbology.  Unlike the consumer products industry with the UPC code that created standarization across the industry, healthcare is behind the times in supply chain management. One major reason is because it involves patient safety.

The author worked for the leading bar-code scanning company (Symbol Technologies)…now Motorola at thsi time and experienced first hand the frustrations of clinicians tryingto scan a 1-D linear wristband with a laser tethered scanner on a curved surface.

In order to de-code the actual laser scanner had to scan the entire bar code.  To relieve the need to use a tethered scanner, the BMCA application (for the V.A. application), was ported to a ruggedized hand-held scanner with a built in 1-D scan engine.  While the intent was there to allow for portability, it was an application specific PDA device, and clinicians did not welcome wearing a tool-belt of PDA(s).   With the aging nursing population, trying to read the EMR application on a PDA was pretty overwhelming.  Clinicians ofter overcame the problem (of scanning a curved bar code), by simply printing out an additional bar-coded wristband, taping it to the chart, and scanning it.  Thus, the entire application and completion of the 5-rights was defeated and/or "worked around"

Moving forward to the EMR, the majority of the EMR vendors now incorporated bar-code scanning to validate the patient's ID.  Then next came the use of bar-code scanning by the IV pump companies to valide the IV order (actual bag), with the patient. So in essence you had two different systems working in place at the point of care, neither of which are standarized on a "symbology" or even talk to one another.

In order to solve the issue of the linear bar-code, now CCD imagers started to emerge (they take a picture and decode), and the use of matrix, 2-D, composite symbologies allowed small bar codes to be imaged.

Again, there was no standarization in hospitals from the supply chain to the point of care.  Multiple systems, different symbologies, multiple scanners/imagers…no integration.

Additional questions came up such as after the patient is discharged, where does the actual IV pump go, when it is picked up for cleaning?  If the patient has a ventilator, how is it charged for and when the patient is discharged, how is the respiratory therapist notified?

If I go back to my original thought process of supply chain automation, this is one area surrounding the point of care where throwing more and more disconnected technology will impede workflow.  In some cases actually adding more and more layers of technology will demand more input from the clinician, and could/may create more safety related issues.

Application based patient association needs to have automation in the background working to help the clinician.  One simple example here on the East Coast is the E-Z pass toll system.  Using passive RFID you can drive anywhere on the highway system at the speed limit of course, it will know your car/license number, charge your credit card without slowing down a bit.  The same thought process surrrounding the point of care could be looked at from the glass of an aircraft cockpit.

The complexity of today's care delivery process and the potential for errors is highly present. It is not that we do not have highly intelligent care givers, but the ability to be able to handle more and more IT and imput demands can be difficult.  That it why on todays' modern aircraft not only do we have auto-pilot, but also automation of control surfaces such as fly by wire.  All this translates into allowing intelligent automation working in the background help with the job of flying a complex aircraft.

The technology is present to provide this kind of automation in today's healthcare environment, however it needs to be agnostic to the medical manufacture and or the EMR vendor.  The rationale for this is pretty simple. Just like what happened with bar code scanning solutions, they are all different and each company wants to have its unique competitive advantage.

A solution to these nagging work flow, association, disassociation problems seems to be the Capsule Neuron.

These are some of the potential future solutions and new power for intelligent automation.  Example One:  When 1 to xx IV pumps are brought into the room, what if the Neuron screen could automatically show those respective pumps.  Also, imagine that the care giver could be automatically identified by vicinity based RFID.  The same with the patient who is wearing an RFID band.

All the care giver would have to do is to "confirm" on the screen and a HL-7 message would be sent to any third party EMR.  Now this is some of the interesting stuff. When the patient is ready to be discharged, the pumps are taken out of the vicinity of the patient.  The Neuron screen could automatically show that they are dissassociated.  All the care-giver would have to do is confirm this again. An algorithm could be built to automatically notify the Sterile Processing Department to come pick up the pumps for cleaning. Since these specific pumps are assigned to this patient in this specific room, everybody would know where these pumps are on a real time basis.

Another interesting application is for ventilators.  Many times these are not charged for or it not known exactly when the ventilator is not needed anymore.  So, idel equipment sits in a room, waiting to be picked up.  Why not have the Capsule Neuron know when the ventilator comes into a patient's room.  It could automatically be associated to the patient and the Neuron screen would identify the ventilator.  The caregiver would simply confirm on the screen for this medical device and a HL-7 message could be sent to the EMR to charge for this ventilator at this time and data.  When the patient is disconnected from the ventilator (now the ventilator is disssociated), the care giver again confirms this on the screen.  This then sends a HL-7 message out to the EMR to "charge capture", and other message to the respiratory therapist that this ventilator is ready to be picked up.

The time has come to provide the right technolgoy and solutions that will "automate" the association and disassociation of medical devices, the patient, and the care-giver. This workflow should not demand more from the care-giver, but lessen the work load of the management of the complexity of interactions surrounding the point of care.  In doing so, new algorithms can be created that allow for automated charge capture, and provide real time knowledge awareness of medical equipment.  This will lessen stress of patient care, potentially lower risks of mistakes and save capital equipment dollars.