Published On December 9, 2014
Imagine that doctors or health authorities at the Centers for Disease Control could remotely track the temperature of a patient under quarantine for Ebola, so they would know instantly if that patient developed a fever. Or that, instead of spending precious minutes donning protective gear, a nurse could adjust an IV drip or ventilator from outside the room for an Ebola-infected patient.
On the face of it, such feats shouldn’t be difficult. Automated devices are increasingly familiar in industrial settings, in retail stores and in homes. But in hospitals, automation and device integration has been slow to catch on. “It’s been transformational in every other industry, but we don’t have it in health care yet,” says Julian Goldman, an anesthesiologist who leads the Medical Device Plug and Play Interoperability Program (MD PnP) at Massachusetts General Hospital and Partners HealthCare.
Medical devices such as heart monitors, temperature sensors and ventilators tend to come from different companies and aren’t built to work together or share information, which makes it difficult to involve them in complex automated processes. But the Ebola epidemic has given new impetus to overcoming that hurdle. Goldman is spearheading a renewed effort to integrate clinical environments to automate more medical activities, in part to help limit contact between patients and health care workers in quarantine situations, while still permitting rapid response to clinical needs.
In October, a White House official asked Goldman to work on integrating medical device and other technologies using open platforms to help in treating Ebola patients. Goldman reached out to device manufacturers, clinicians and officials at the Food and Drug Administration to join him on November 4 at the Cambridge headquarters of MD PnP. Twenty-two of them showed up for an intense, three-day session at which they developed a range of new prototypes.
One discussion, for instance, centered on new ways to transmit vital signs from different medical monitors into a single readout. This could be accessed outside the room—or even in another part of the world—to let health officials track progress of sick patients and let specialist physicians remotely lend their expertise. Representatives from Qualcomm, Philips, Covidien, Dräger, GE, and other device manufacturers linked their thermometers, heart rate monitors and ventilators to an open-source software platform called OpenICE (Open-Source Integrated Clinical Environment), developed by Goldman’s team under NIH, DOD, and NSF funding. It was a rare example of cooperation among the companies, the first time they had allowed their devices to work with an open software platform. Companies also used a commercial version of the OpenICE platform built by DocBox to control devices such as ventilators and infusion pumps from a laptop or tablet outside a patient’s room.
Jenny Freeman, a cardiac surgeon and CEO of Respiratory Motion, says that her company has long thought about connecting its respiratory monitor to a syringe pump that delivers pain medications, allowing the monitor to shut off the pump if breathing gets dangerously low. But the prospect of partnering with another company had previously been daunting. “In two days we had a solution to something that we thought was going to take us a year,” she says.
Such new functions will of course need extensive testing and regulatory approval. A representative from the FDA was on hand to provide input on bringing such products to market. For all medical devices, data must be shared in a way that’s safe, reliable, and secure. Suzanne Schwartz, director of emergency preparedness/operations and medical countermeasures at the FDA, says that the MD PnP lab provides an important testing ground to work out the viability and technical details of products before they’re tested clinically. While Goldman has hosted numerous meetings and events over the years, Ebola has raised the stakes.
Time is the issue. Automating hospitals on a wide scale will take a while, although Goldman says that creating “demonstration environments” may be possible in the short term. With government help, for example, intensive care units at several hospitals might be outfitted with new systems to test their effectiveness.
“This is something that matters for patients and healthcare workers.” Says Goldman. “At this point, people are looking at what could be rolled out in 30 to 60 days.”
Stay on the frontiers of medicine