Today’s vital signs monitors are like smartphones. Just as smartphones are more like small networked computers than phones, monitors are no longer only monitors, but multifunctional, connected software platforms.
Like many pieces of modern technology, today’s medical vital signs monitors have outrun the functionality that gave them their name. Electronic vital signs monitors were originally introduced to replace the subjective and poorly measured recording of vital signs that prevailed in the past. Instead of capturing a patient’s heart rate by putting a finger on the patient’s wrist, monitors capture data from electronic sensors, thereby providing a much more accurate reading.
These monitors have since moved past the area of vital signs to automate and facilitate a range of other important procedures—such as ultrasound examinations and defibrillation—that help caregivers at all levels better perform their jobs. Monitors may be thought of as software platforms that perform a range of functions, communicate with remote personnel and systems, inform upstream care levels on the condition of incoming patients and share data with other systems to complete the electronic health record. And they perform all of these tasks in smaller and smaller packages.
“Monitors are now more compact and include color displays,” said David Jones, en route care and airworthiness division test manager at the United States Army Aeromedical Research Laboratory (USAARL). “Functions include communication features such as WiFi, Bluetooth and Ethernet, oxygen saturation testing improvements, a more detailed user interface, an internal data recording of patient vitals and built-in cameras. These new features enable the medic to provide the patient more efficient care and to document the patient’s results while en route to a medical facility or triage.” USAARL tests and evaluates medical systems for use in medical evacuation helicopters.
The Tempus Pro, the vital signs monitor from RDT, was designed as a communications platform from the beginning, noted Barnie Howell, the company’s U.S. military director of business development. “We provide communications software free of charge to receiving facilities that enables them to set up a link from a Tempus Pro to a computer anywhere in the world,” she said. “This has been a core competency of ours for the last 15 years. Commercial airliners have used our product to communicate data on sick passengers to facilities on the ground to determine whether the flight needs to be diverted or can keep flying.”
The same system can be used to transmit data on casualties from an evacuation scene to a hospital where they are going to be treated. “Health professionals can see the condition of patients before they get there,” Howell added. “That is the best hope for improved outcomes and the best thing for the patient.”
“Monitoring devices are increasingly getting software-rich,” said Olivia Hecht, field marketing director for patient care and monitoring solutions at Philips Healthcare. “Vital signs monitors have evolved from a box on a wall into software platforms capable of interacting with other software platforms. In acute settings, they are becoming networked systems that interface with lab systems and electronic medical records. They run applications for nurse and physician notification for remote viewing. We are seeing more intelligence and flexibility being built into these devices so that they can be used to customize protocols for critical decision-making and use data for operational challenges like alarms. In military and commercial environments, we are also seeing more wireless applications, such as for blood pressure cuffs and respiration sensors.”
“Everybody wants a lighter, more durable and compact vital signs monitor and long-lasting battery power, and we achieve that on our Propaq line,” said Andrew Fleischacker, senior director of marketing for military products at Zoll Medical. “Communications is a key component of all vital signs monitors these days. One of the key development efforts when we developed the Propaq line was to include a very advanced communications module in the device.”
Zoll’s communications module can facilitate connections from the Propaq over a variety of communications modalities. “We work over the Internet and on Bluetooth and cellular networks,” said Fleischacker. “We are now working with some partners to integrate with tactical radios. That is still a work in progress.”
The ability to view patients’ conditions from a central monitor is important for military field hospitals and in cases of mass casualty evacuations and humanitarian missions, noted Fleischacker. “We have a central viewing capability built into the device that can remotely view the screens of up to 10 monitors on one display,” he added. “Depending on the networking available, as many as 125 monitors can be networked together. That is an illustration of the power of Propaq’s communications module.”
The capabilities of the software embedded in monitors allow health care personnel to set customized alarms for individual patients, but that is just the beginning. “The monitor can interact with electronic health records, not only to record data, but also to pull information relevant to patient care for the benefit of health care providers,” said Hecht. “This has a positive impact on the workflow of physicians and nurses.”
Monitors have also been embedded with software that helps health care workers develop early warning scores, predictors of the short-term possibility of adverse patient events. “Early warning scores help to predict the possibility of adverse events four to six hours before an event,” said Eric Schaeffer, a senior marketing manager at Philips Healthcare. “This is typically a manual process, but as devices become more sophisticated, are connected to hospital systems and have access to all that information, the scoring can be automated at the bedside device."
USAARL conducts airworthiness testing on medical systems, such as monitors for the Army. “We ensure the safe interaction among medical equipment, patients, aircrew and aircraft,” said Jones. “The main difference in requirements for monitors for the military health system and elsewhere is that monitors used in the military health system have to withstand extreme conditions such as vibration, temperature, altitude, sand, dust and rain. Night vision device compatibility and electromagnetic compatibility is also a consideration.”
“Equipment used in garrison and in the veterans health system doesn’t differ much than what is used in the civilian system,” said Hecht. “Combat care workflow models are different. We see more equipment and more sophisticated equipment going closer to the point of initial care to treat casualties during the golden hour. More intelligent equipment is getting closer to warfighters to get them the care they need as soon as possible.”
In the last two to three years, RDT has added EKG, ultrasound and video laryngoscopy capabilities to its Tempus Pro. “The idea is that any ultrasound probe or laryngoscopy blade that we provide can work on any monitor,” said Howell. “A facility may have a pool of 100 Tempus Pro monitors but only 15 to 20 ultrasound probes. The probes can be plugged into any monitor and the monitor becomes an ultrasound machine. That is the philosophy we follow whenever we introduce a new capability. The same box and the same display can be used for all of these new capabilities. We typically upgrade our software every quarter. All users need is a USB cable to plug into the monitor to easily upload new capabilities.”
Zoll also views its Propaq monitor as a platform, not merely a monitor. “Users want to protect their investment,” said Fleischacker. “They don’t want to have to invest in a new monitor when new features come. The Propaq is a platform that you spring off of. As we develop new technologies, we make them compatible with our existing devices, protecting our customers’ investments in the monitors they purchase. The military has made it very clear that we should come up with more technology but not give them anything more to carry.”
In the case of the military, and especially when it comes to equipment that is hauled into the field, there is a great interest in size and weight. “The military wanted the option to have a defibrillator built into the monitor because they wanted to limit the gear that warfighters had to carry in the field,” said Fleischacker. “We responded to that requirement when we incorporated a defibrillator in some of our models. The idea is to make monitors more plug and play and intuitive to use in order to limit the necessary training.”
Much of the equipment Zoll sells to the military is used at different levels of care, noted Fleischacker. “Another advantage of integrating the defibrillator into the monitor is that someone who knows how to use one device can use the other device. It can be used far forward as well as at levels of care located further back. We wanted to develop rugged devices which could be used in hospitals as well as in deployed settings.”
Zoll has a remote viewing capability in place which has been deployed by the U.S. Navy. “The Navy currently has it set up on two hospital ships, the USNS Comfort and the USNS Mercy,” said Fleischacker. “They have the ability to remotely view a number of monitors from remote locations.”
RDT plans on integrating a defibrillator onto its Tempus Pro by early 2017. “We are calling it the shock box,” said Howell. “It will be plugged into the Tempus Pro by way of a USB connection. It will be a fully loaded defibrillator.”
Some of RDT’s other innovations concern providing greater automation to patient records. A new form replacing the tactical combat casualty care called the DD1380 will be incorporated into the monitor. “Tempus Pro software enables the creation of an electronic version of the record that is automatically populated with vital signs,” said Howell. “The touch display facilitates entering of drugs, fluids, interventions and notes. The electronic generation of this data helps to eliminate errors.”
Also of importance to RDT is the ability to transmit patient records of care to the next level of care before the patient arrives. “Studies have shown that patient outcomes can be improved if the full patient data is transmitted to the receiving facility prior to patient arrival,” said Howell. “We will soon introduce the capability of password protecting and encrypting all patient data and enabling its transmission by email to a list of recipients.”
In addition, RDT will be introducing a capability that will enable care providers to easily supplement monitor data with their notes about interventions. “Care is often provided in fast-paced, frenetic situations,” said Howell. “Providers don’t have time to stop and write down or enter the details of the intervention.”
RDT’s new software will enable care providers to click in real time on the type of intervention performed and provide the details. For example, in the case of administering medication, the provider will touch one button to indicate that. Later, when the provider is making notes, the data from the monitor will prompt the provider to enter the details. The provider then clicks on a screen to indicate what medication was provided, which becomes part of the patient record.
“This eliminates the need for providers to remember all the details of the encounter after the fact when they are making their notes,” said Howell. “All of this data from the monitor is entered into the patient’s electronic medical record and into the Joint Theater Trauma Registry.”
Among recent advancements to the Propaq platform, two parameters, total hemoglobin and PVI, an indication of how well a patient’s fluid levels are being managed, are now available in all devices. “The capabilities are built in and customers can purchase them and turn them on if they like,” said Fleischacker. Total hemoglobin measurements tell care providers whether and when they need to deliver blood.
Zoll recently acquired Reflectance Medical, a company that has a technology called Care Guide. “Care Guide noninvasively measures muscle oxygenation levels and pH,” said Fleischacker. “Both of these parameters were initially developed in cooperation with the military. We are integrating a version of that into the Propaq platform, and those two unique parameters will be available in the Propaq monitor and the Propaq monitor-defibrillator lines.”
Zoll has also acquired Impact Instrumentation, which is focused on innovations to improve survivability for combat casualty care. There is a lot of interest in the military in how to take all of the individual parameters and help make decisions easier. “It’s one thing to throw parameters up on a screen and tell physicians what to do,” said Fleischacker. “We are interested in how we can make our products smarter. One way is to incorporate closed-loop processes that can automate some of the care and free up clinicians.”
In closed-loop automation processes, a computer decides on an intervention and executes it in the absence of qualified medical personnel. In that vein, Zoll recently acquired Rescue Guard, a company that produces an intrathoracic pressure regulatory mechanism that provides profusion on demand. “That is the kind of work we are doing to make the lives of care providers and their patients easier,” said Fleischacker. “Those are the efforts we are working on right now.”
USAARL’s Jones foresees telemedicine and wireless capabilities playing increasingly important roles in future vital signs monitors.
“As data communications and electronic patient care records becomes more important,” said Fleischacker, “Zoll’s open data architecture allows the patient data to flow from our device into a number of different EHR systems or telemedicine solutions.” Last year, Zoll demonstrated a capability to transmit and view vital signs data, as well as information from Impact Instrumentation ventilators and aspirators to remote command and control locations during a medical evacuation exercise.
RDT’s equipment also supports telemedicine capabilities, according to Howell. “The optional ReachBak telemedicine capability enables users to transmit all medical data, waveforms, still images, records and EKG recordings,” she said. “This can be accomplished over various communications links, including standard military radios and military and civilian satellite communications. Over the last several years, the Tempus has successfully operated over various military radios with no need for a laptop or other portable computing device.”
“We are working on wireless and cableless monitoring,” said Hecht. “That way, patients don’t have to be tied to traditional monitors. From a macro perspective, we are looking at the continuum of health care. We are not just looking at symptoms and disease, but at health and wellness. That new kind of health model means monitoring and tracking individual patients across care settings and even across their lifetimes. That aligns well with what DoD and VA have to do with their missions and how to get, maintain and share that data about patients across a continuum of care over a long period of time.” ♦
- Issue: 1
- Volume: 19