Medgadget recently had a chance to talk to Symbol’s Senior Director for Healthcare, Ken Kleinberg. The candid, freewheeling talk started with him promoting Symbol’s wares and approach, and evolved into a discussion about the challenges of marketing to hospitals and changing the way medicine works.
Loads of interesting nuggets and big-picture thinking, after the jump!
For their two new devices, the MC70 (profiled here this week) and the PPT8800, he had much to say. The devices’ wifi capabilities, for instance, ofter higher encryption than consumer PDAs — for patient info protection.
The networked devices allow communication between EKG telemetry and other vital-sign monitors, so that everyone caring for a patient can get a message when a patient has an arrythmia, or the blood pressure drops. Also, for the prospect of morning rounds, the presenter (ie, the intern) can simply beam recent lab results to the rest of the team, bypassing the need to recite every last electrolyte.
Kleinberg talked about some of the technical challenges in bringing these devices forward, including some we hadn’t anticipated. The barcode reader, for instance, is needed for scanning meds and patient bracelets, ensuring proper matching, dosing, and timing. But what about the fact that patient bracelets are round, and med packages can be very small? Symbol had to modify the software designed for manufacturing to make it work in hospitals.
But those challenges are minor compared to product roll-outs and training. Even the simplest use of the scanner — say, to match a mom to her refrigerated breastmilk and her baby — requires time to teach, especially if the technology is unfamiliar. More sophisticated IV medication admin systems, which can also be programmed by Symbol’s MC70, require hours of training. The efficiency gains in adopting the new technology are real — but the hurdles in adopting are time consuming, as well.
Kleinberg continued to note problems with adoption — for instance, accountability. The way it stands now, there’s a fudge factor in carrying out doctors orders — nurses can administer meds and check labs when it’s convenient for the patient, and for themselves. But when everything is tracked with handhelds, will nurses get dinged if the q1hr vitals checks aren’t quite every hour?
On the other hand, if the doctor makes a mistake in ordering an unsafe medication, the handhelds will catch it, instead of forcing the nurses to scrutinize each order. In the current system, nurses are penalized when they propagate a doctor’s mistake. So the handhelds, in addition to putting pressure on nurses to carry out orders promptly, takes some pressure off them by performing their error-checking.
That led to the really mind-blowing part of the conversation for us. If these handhelds are monitoring every medication given, every vital sign, and timestamping each piece of data, we head into the realm of “true evidence-based medicine”.
Researchers can go back and analyze what goes on when, for instance, a septic patient codes — the combos of drugs given, and the patient’s response, second-by-second. They can compare similar patients and tease out differences that were previously impossible to detect. When every decision is recorded and timestamped, it changes the way hospital research is conducted — and for the better.
When we pointed out the results of a recent CPOE trial, showing that computerized physician order entry actually led to an increase in patient mortality, Kleinberg was taken aback but quick to put it in context: computerized order entry will ultimately improve efficiency, reduce errors, and aid research — the fact that CPOE has identified some of its own shortcomings shows its strengths, and points the way to a solution. What kind of patients benefited from CPOE? Which ones died as a result? Was it the patients who were most unstable? Did doctors and nurses have a harder time coding patients with CPOE — if so, why? Is more training necessary?
The problem, Kleinberg thinks, cannot be computerization itself, but the period of transition between what’s known, and what works — and what’s unknown, but works better.
And that led to our final topic, the question we posed at the beginning of the week: why are hospitals slow to adopt new technology? Kleinberg thinks it’s because doctors and administrators are so educated, not in spite of it. They know that adopting each new technology that comes along is expensive, and time-consuming, and may cause errors and delays in the short term, and that the long-term gains may be marginal.
So hospitals are cautious, and they wait for something that’s relatively easy to adopt, and quickly reduces errors and improves productivity. Kleinberg thinks Symbol’s new devices, and its line of healthcare offerings, are the solution hospitals should seek.