An HIT Moment with ... is a quick interview with someone we find interesting. Arnaud Houette is CEO of Capsule.
The future seems to involve having large numbers of pieces of medical equipment sending a nearly constant stream of telemetry data to whatever systems can receive it. What patient care improvement opportunities does that create?
You are correct that the numbers of devices, including telemetry, and the quantity of data from those devices has been increasing in recent years. We see this trend continuing for the foreseeable future. However, we believe there are other changes in the care environment that will actually impact patient care and the need for device connectivity more than the quantity of devices and the data they send. These include:
- More applications and systems that can take advantage of data that is collected and integrated, such as alarm notification systems and the integration of both data and alarms to ventilator management systems;
- Requirements for direct device to device interoperability; and
- Mobility. Perhaps the biggest technology trend we see that will impact patient care is with wireless devices and mobility. Mobility is actually forcing vendors to assess how patient context needs to be handled. When patients and their devices move, the data from the medical device can no longer be reliably tagged to a bed or room location. In our opinion, this leads to the need for positive patient ID and association of the medical device to a confirmed patient.
All of these changes will directly impact the clinician and the patient care process if not implemented properly. At Capsule, we are working on a solution that addresses such issues and will improve clinical workflow. We believe that patient care improvements will come from point of care solutions that properly associate patients to devices rather than devices to location. And we believe that access to all real-time data and alarms across the enterprise will result in improved real-time and retrospective clinical analysis, improved treatments and length of stay, and overall improved patient safety.
Are EMRs vendors ready to automatically accept electronic output from machines to save nurse time in documenting it?
Good question. Here I see a difference between the European market and the US markets. In Europe, a number of EMR applications automatically accept electronic device data without human intervention. The primary driver is efficiency of staff. In the US, however, most EMR implementations require a nurse to validate all data that has been automatically collected from the devices connected to a patient as part of the documentation process. Here the driver seems to be medical-legal requirements. I can see both sides.
There is, however, a class of data parameters from medical devices that could arguably not be subject to clinical interpretation. This class includes measurements of the device’s operation, such as respiratory rate, tidal volume, or infused volume; as opposed to physiologic measurements from the patient. These data are information from the device of what it has done, for which there is no clinical requirement for analysis or validation in order to ensure accuracy of the documented value. So one of the key questions here is not only can or will EMR vendors support this automated documentation (many of them can already), but will clinical users?
How important will home monitoring of patients become and what technology advances will be required to support it?
This is a very important market for device connectivity. Monitoring chronically ill patients in their home has both significant economic impact on the health system (keeping patients out of the hospital) but also wonderful health benefits for the patient themselves. The need and the health benefits are clear. What is not so clear is the business drivers. Telehealth has struggled with a well defined reimbursement model that will foster broad adoption. There have been some interesting “carve out” strategies by some healthcare organizations for specific illnesses, but nothing universal.
On the technology front, we are watching with great interest the Continua Health Alliance and the IEEE 11073 standard efforts. As in the hospital, we believe that adoption of these technologies will depend greatly on the fit with the clinical workflow and the usability of software. This is an area Capsule is investing heavily in right now.
Which hospital areas do you expect to have the highest demand for new data capture solutions?
The highest demand for data collection from medical devices is currently in the areas of the hospital with the highest acuity patients, such as the ICU, PACU, and OR. We expect these areas to continue to have high demand. However, we see increasing interest from lower acuity environments, such as med-surg or even ambulatory clinics.
One interesting way to analyze the need for automated data collection is to go beyond the current model, which tends to focus on the number of devices or complexity associated with each patient. Rather, we see the need to look at the number of devices or complexity associated with each individual nurse. Though the nurses in the med-surg environment are dealing with lower acuity patients with fewer devices, they are dealing with more patients, so they actually have a similar number of devices to manage and interact with.
It is easy to see how these areas would benefit from the adoption of technology that supports automated capture of medical device data. This is an area which we are actively pursuing — not only how to manage the data capture in these lower acuity environments with different work flows, but how to assist the nurse in managing all the devices and their associations with the right patients in all environments.
Surely a company like yours has had acquisition interest from some of the mega-companies whose products you integrate. What is the long-term plan for the company?
Tim, you know if we were having any discussions (which we are not), I couldn’t talk about them anyway. I admire you for trying; you are very good at your job …
As for Capsule’s long-term plans, we are focused on creating value by innovating on behalf of our customers and partners. We are in a unique position in the market from which to innovate. We have perhaps five times more installed, happy customers than all our competitors combined. Our driver library is unmatched in numbers of devices we support (350+) as well as the quality processes we use to build them. (We better have good processes as we have been doing this for more than ten years!) And, our product is a medical device. We are classified by the FDA in the same status as a cardiac monitor (510k Class two). Oh, and let me not forget our vendor-neutral position in the market. It is from this unique business foundation that we will spring board to the next generation of products.
We have a number of products in development that are aligned with our EMR and device partners’ road maps to continue our market leadership in connectivity while also enhancing our partners’ product offering to the health care provider. We are also working closely with a number of thought leaders in the industry to develop new innovative solutions for positive patient ID and wireless device connectivity. I look forward to discussing these in greater detail as we get closer to launch.
Another opportunity in front of Capsule is geographic expansion. We are a truly international company. We literally have employees from nearly every region of the world — from Senegal to Australia, China to Ireland, to the US and France. It has been our mission to build an international company from the start and we see an exciting market opening beyond Europe and the US. The Middle East and Asia are two markets that hold great potential in the near future.
Marriage may come someday, but for the time being, Capsule is all focused on creating value for our customers by working with our partners to deliver the right products to improve workflow and make their lives easier.