Today your cell phone is an entertainment center, computer, game system and communication device; a pair of glasses can serve as your keyboard. Your watch is your personal trainer.

Multi-function, minimization and personalization are major trends across all technology—and medical devices are no exception. Functionality and features are expanding. While hardware platforms are converging and often incorporating IT solutions. In the coming years, we can expect to see a dramatic growth of medical devices with multiple personalities that cater to a variety of needs in the hospital, outpatient and home environments.

Many of the benefits of these converging multi-purpose devices are obvious, including convenience, space-saving footprints and cost economies. But not always so obvious are the design and decision-making that underlie the success of a converged medical device. From a vendor’s standpoint, this calls for a strong understanding of medical workflow across multiple hospital departments, expertise in particular types of medical devices, hardware design, software engineering and IT connectivity.

Technology is tricky—especially in healthcare. Convergence must enhance patient care delivery, streamline clinical workflows and contribute to cutting costs. Convergence for its own sake is not helpful, and so not every vendor will get it right.

The Need

Breakthroughs that seemed unimaginable only a few years ago are now standard on the typical hospital floor. Technology is playing a greater role in patient care than ever before and is helping to guide therapies and improve outcomes. While all this is good news, it does come with significant challenges. Hospital rooms are often extremely crowded with bedside devices including physiological patient monitors, smart pumps, ventilators and PCs. Often this technology may not be used to its full benefit simply because caregivers struggle to navigate a crowded patient room. Today the average 200-bed hospital is equipped with hundreds of medical devices from a host of manufacturers. A typical operating room (OR) patient is connected to more than 10 of these simultaneously.

The Enablers

Advances in engineering and the constantly evolving healthcare landscape both play significant roles in driving the trend toward device convergence. More powerful and compact technology enables multiple devices to be integrated into a single hard hardware and software platform with a compact and maneuverable form factor. Also powering this is the proliferation of “plug and play” technology. For example, while pulse oximetry measurements have traditionally been obtained from internal computer boards integrated into monolithic patient monitors, today freestanding SpO2 modules are available that connect to an industry-standard USB port. Such components make it possible to develop converged devices that are highly usable and modular while benefiting from PC economies of scale.

Additionally, healthcare reform has challenged hospitals to deliver care and cost efficiencies. This can be supported through technology consolidation, since a single multi-function device should cost less to purchase and maintain than multiple pieces of equipment. And if designed for upgradeability, it may have a longer useful life than the multiple devices it replaces. Reform also demands greater documentation and quality reporting, which renders many of today’s standalone devices technologically obsolete. Fortunately, this need for enhanced IT functionality and network connectivity is being met in the new generation of converged medical devices, as once again necessity proves to be the mother of invention.

The Benefits

When technology consolidation is well planned and designed, the benefits can cut across many hospital functions and departments. Most important for clinicians is that converged devices potentially diminish hours spent dealing with technology and expand the time available for patient care. In particular, consolidating multiple devices onto a single platform can mean less time spent on: 1) logging on to multiple systems 2) powering up or recharging individual devices 3) ensuring patient association with each device and 4) managing multiple data transfer streams. Additionally, consolidation minimizes operational learning curves and reduces time spent walking around a unit or patient room to access multiple devices.

Consolidation also reduces device management complexity for clinical engineering. Clearly, the training, setup, maintenance, tracking and procurement for a converged device is simpler than for the multiple units it replaces. The same is true for IT departments managing network-connected devices. Instead of repeating many similar operational steps across multiple different device types—sometimes one per device—they can use one step to change the configuration of a group of converged devices in a common care area.

Not surprisingly, significant cost savings can be realized by consolidating multiple devices onto a single platform. For example, converged devices reduce the upfront purchase and ongoing costs of roll stands, input devices, software licenses, displays, back-end server infrastructure, rechargeable batteries, vendor support contracts and more. Multiply these costs by a hospital’s large inventory of bedside devices, and the savings are sizeable. And, of course a single multi-function device makes the most out of ever more limited hospital space—offering direct benefits in terms of new or reconfigured care areas.

The most important impact of device convergence is on patient care. Everyone benefits. With fewer devices to manage and many operational complexities eliminated, clinicians have more time to spend with their patients. To patients and their families, clinician interaction with them now may seem more of a priority than their interaction with machines. Cost savings realized through technology consolidation can be channeled into funding for clinical or patient service initiatives. With less cumbersome equipment, hospital rooms can become more open, inviting spaces that enhance the comfort and satisfaction of patients and their families.

Evaluating Converged Medical Devices

Not every vendor will deliver equally on the promises of multi-functional devices. Success is complex because it means addressing the specific challenges for each individual device type and optimizing the technologies to work together to meet varied user needs. It also means building into the device operational efficiency, simple and cost effective design, as well as simple maintenance and upgrade procedures.

The best multi-functional devices will be developed by vendors with deep experience in all of the functions incorporated into the new product platform.

Here’s what to look for:

Simple, Intuitive Operation Based on Clinical Workflow

Multi-function devices should streamline workflow and consolidate operations across equipment. Therefore, they must be based on a clear understanding of all the clinical workflows involved. For example, device components should be optimally placed for access at the bedside and for easy clinician manipulation both independently and together as a system. Mobile devices must be easily maneuverable in small spaces. LED interfaces and IT displays must be accessible from multiple angles and easy to read. If the device is attached to a network, it should have a single login for all functionalities and a minimal number of well-organized screens for patient-centric information display.

Overall consistency is key. The user interface should be similar across all devices and operational steps should be consolidated for efficiency. Naturally, the user interface should be simple and intuitive to understand for rapid adoption across all clinicians. Experts agree that difficult-to-use devices with complex settings and features often are not leveraged to full advantage in a busy hospital environment. When a device is shared between different user types—say nurse techs, RNs and rapid response teams—the design must consider the workflows of each and their coordination points.

Compact Footprint

As noted, size matters in today’s overcrowded hospital environment. Thoughtful space-saving design is paramount. For example, an OR with equipment stacked on carts, mounted on walls and suspended from ceiling booms requires lengthy set up time and restricts the movement and communication of the OR team during surgery. This creates well-acknowledged visual stress at a time when seconds count and concentration is key. The same complexities and crowding affect clinician workflow in the intensive care unit (ICU) and other high a acuity environments. Simplifying the equipment and landscape has major benefits.

Similarly, in a patient room, unobtrusive, streamlined technology creates a more relaxing environment, which is far more conducive to healing and positive interaction with family and friends.

Modular Design

A good multi-functional device should be based on modular components that can be individually replaced in the event of failure or for upgrades. Malfunction of a blood pressure module on a failing physiological monitor, for example, would require removing the entire unit for service and replacing it with a backup. Modular devices, however, allow a quick and convenient swap out of the failing component—even right on the floor of the care area.

Equally important, devices should allow for expansion with new vital signs technologies as they become available. A device with a well-planned upgrade path can take hospitals well into the future with the addition of new modules and without the need to replace monitors which have useful life remaining. The ability to control future costs helps justify expenditures today.

Flexibility

To make the most of an investment devices must also deliver flexibility to support the needs of various care environments.

For example, a physiological patient monitor should be deployable across the emergency department (ED), outpatient ambulatory and perioperative care areas. Whether mobile or wall-mounted, with a clinician-friendly user interface and a range of vital signs modules, this device should be able to easily meet the monitoring needs of a particular patient from spot check to continuous monitoring. Likewise, through a web-based console, IT should be able to easily configure default profiles for each department just as clinical engineering should able to customize hardware configurations and applied parts.

Some devices will provide even greater flexibility by providing special device integration for ventilators, dialysis machines infusion pumps and more. This level of multi­-function will enable clinicians to rely upon the monitor for authentication, patient association, charting and data transfer—including data both from the directly measured vital signs and all the attached devices.

IT Integration

To be truly useful in today’s hospital environment, converged medical devices must be integrated into the back-end IT infrastructure. From a technology perspective they need to support the latest networking standards with secure, encrypted communications. And from a user perspective, clinicians will require this from the device if they are to easily authenticate it themselves—one time instead of repeatedly with all their roles and privileges. This will go hand-in-hand with the ability to securely associate the patient to the device. So seamless integration from the device to authentication, ADT, and perhaps lab, imaging, medication and staffing systems will be essential for a streamlined clinician workflow.

In today’s digital healthcare age we appreciate that medical device data is rich, varied and valuable. It’s no longer just about getting the data to the electronic medical record (EMR) system, but instead this data—often continuous streams of it—can play a role in a wide range of downstream systems, including alarms and alerts, patient surveillance, clinical decision support, and asset tracking. Therefore, devices should be able to supply data to all these systems simultaneously particular to the needs of each via a dedicated medical device information system.