Healthcare Wireless and Device Connectivity

SOLiD Taking over the DAS Marketplace by Storm

Over four years ago, when Ken and Seth silently announced what they were doing, it was yeah, this is great and the right strategy, how can you execute. Problem was some were still caught up in the fog of the traditional DAS deployment technical and business model. That model is legacy and not happening 2011 going forward. It is no longer who are these guys (SOLiD), but stay aware; what they are doing is not only a game changer, but will in the months ahead be major disruptive to what we think as DAS. The traditional big guys in this space are finally waking up.(They have been in mode of "selling" in different business models, but the model has changef in healthcare, it is about owner "owned", carrier with financing as they can, then the integrator installing and supporting. The majority if not all technology in this space is very legacy and in my humble opinion not the best investment for the years ahead when the 4G and LTE and digital optical pathway is where things are going. SOLiD is designed to save costs and provide the next generation digital optical pathway. (Heard today that some do like this term "disruptive", as it gets everybody wrapped around the axle.) But think of desk top computing paving you know who for all kinds of software with a lame OS, to the the "cloud computing model". And in in closing forget about the wireless wonderful end all that a certain entity has been marketing; (dude it about physics) this is the real deal in healthcare. Everybody simply needs to do their homework and deep discovery. If I can help or comments here, just ping me back.

As full transparent and disclosure: I am not compensated on any of these comments, but my full agnostic and professional opinion is provided.

Why Most Product Launches Fail Overview - Consumer to Medical

A friend of mine in the medical device space gave me this article while I was in Boston, MA a couple of weeks ago at the Medical Device Connectivity Conference. While the article is directly from Harvard Business Review; I can definitely see the parallel in the medical device space. The majority of medical devices especially get vetted out through user groups, (before a new product development) but this becomes much more complicated when you start to add wireless "connectivity", or such connectivity options. This is paraphrased from the Harvard Business Review.

Flaw 1: The company cannot support fast growth.
The Lesson: Have a plan to ramp up quickly if the product takes off.

Flaw 2: The product falls short of claims and gets bashed.
The Lesson: Delay your launch until the product is "really" ready.

Flaw 3: The new item exists in "product limbo".
The Lesson: Test the product to make sure its differences will sway buyers. In this case from the medical device side, build the business and clinical justification as well as business ROI.

Flaw 4: The product defines a new category and requires substantial education, but does not get it.
The Lesson: If customers cannot quickly grasp how to use your product, it is toast. So when you look at say IV therapy or patient monitoring in becoming a highly commodity base market, what are the technical attributes that can really bring huge business value and reduce risk and save $$

Flaw 5: The product is revolutionary, but there's no market for it.
The Lesson: Don't gloss over the basic question "Who will buy this and at what price."
R&D and Engineering groups take sometimes great pride in the technology, but at the end of the day what is the value proposition?

Ways to Crash A Product Launch
Pre-Launch Phase
1. No market research on the product or the market has been done.
2. Most of the budget was used the create the product, but little is left to launching, marketing, and selling it.
3. The product is interesting but lacks a precise market.
4. The products key differentiators and advantages are not easily articulated.
5. The product defines a new category, so customers will need considerable education before it can be sold. (They do not get it!)
6. The sales force does not believe in the product and is not committed to selling it.
7. Because the target audience is unclear, the marketing campaign is unfocused.
8. Distribution takes longer than expected and lags behind the launch.
9. Sales channels are uneducated about the product, and the distribution channel simply sees this as a long sales cycle. End point they will concentrate on the quick hit.
10. The product lacks formal independent testing to support the claims.
11. The marketing campaign is developed in-house by the manufacture and lacks objectivity. Pride of ownership takes over here, versus outside vetting.
12. The product is untested by customers, only the company can assert its benefits. What have been the customer success stories via clinical improvements and case studies before launch.
13. The web site description of the product launch is unclear, vague and the site is not fully functional. Search engine optimization is not complete on specific word groups.

Launch Phase
14. The product is launched hastily and it does not work in a reliable fashion.
15. The launch is aimed at the wrong target audience. (IT, clinical, or Engineering, or CEO, CIO, or CTO)
16. Supplies are inefficient to fill orders. (We did not anticipate the orders)
17. The product is launched too late at the wrong time. (Not hitting the specific trade shows)
18. The manufacture's claims cannot be backed up.(Where is the testing information and case studies to back this up?)
19. A governing body like the FCC or FDA pulls the product, citing false claims, or yet delayed FDA 510K approval because the reviewer feels in sufficient testing.
20. The product is given a limited "trial", but without public relations, marketing, or promotion to "turn" it.
21. The product is launched without influence to promote it's efficacy.

New Age of Wireless Connected Medical Devices

I have seen the revolution in non-intelligent non-networked medical devices, essentially becoming connected. Three significant events triggered this revolution. 1. This all started out with the approval of 802.11b in 1999, and simply has not stopped. 2. The next event was the roll-out of 3G both GSM and CDMA, and then the new "smart phone" form factors. Essentially like my son said, it is a PC that just happens to make phone calls. So this convergence has brought many possibilities. I have known David Albert, M.D., for almost 20 years, even when I lived in Oklahoma. Dave is one of the most brilliant and visionary guys I know. Well he has taken what used to be the Heart Card (former Instromedix), then turned the I-Phone into full fledged "cardiac event recorder". However, rather than having to hold the Heart Card up to an old telephone, you use the cellular services to send this into your own personal portal. Exact same with Wi-Things, and complete portable Non-Invasive Blood Pressure monitor that follows the same use model. So what really does this all mean? If you were in the past having to self monitor your pulse and blood pressure there was not a real effective way to do this real time and send the results to your physician. Especially, if you are like me who likes to travel across the pond the Europe. This convergence and ability to real time take measurements have them centralized so your physician can see is going to lower healthcare costs. An easy way to take these measurements, also will help with changes in lifestyle and improve long term results. I think any person that had a pacemaker or AICD implanted should have these tools at their disposal.

802.11ac

Just when folks are moving to 802.11n, we now have 802.11ac coming around the corner. (Well a few years out at least) Interesting that it is in the 5GHz range, just as 802.11a. (Both Welch Allyn and Masimo use 802.11a). The specification will enable multi-station WLAN throughput of at least a Gigabit per second and a maximum single link throughput of at least 500 megabits per second (500 Mbits.second). This definitely puts "wireless" in the afterburner mode! Hardwired Ethernet...legacy. How this is done is by enhancing the air interface concepts of 802.11n. For instance providing wider channel bandwidth of 80MHz and 160MHz versus 40MHz of 802.11n, supporting more MIMO spatial streams up to 8 versus 4 in 802.11n, multi-user MIMO, and high density modulation (up to 256 QAM) The initial technical draft 0.1 was confirmed by IEEE 802.11 TGac on January 20, 2011, with standard finalization anticipated in 2012. Just like 802.11n, this will be a boon to say laptops, I-Pads, to say download PAC images, video, etc. Never see any current potential in medical devices. There will continue to be a mixture of medical devices using 802.11b/g/a for the portended future. However, the issue will be the backhaul. I expect that this will change the landscape of the L2/L3 model and digital fiber to the AP, or that digital fiber will be the new highway replacing traditional copper. Maybe intelligence built into optical head ends? At the end of the day you need the pipe ( the utility) and this is perhaps a direct head on to LTE. Just my thoughts.

Cellular Network Connectivity for Real Time Medical Device Connectivity

I am very firm believer in the use of 3G and 4G capabilities for network connectivity, however there are implications for when you consider any use model that demands a quality of service requirement. Some smoke was blown last week at the MDC conference that a specific frequency (lets say LTE), should be allocated for medical device connectivity. After spending years validating the use of WLAN for real time patient monitoring and other medical devices, you simply have to develop the right design to ensure "quality of service", as well as security. This is required if you intend to share the enterprise network with other applications, such as data, voice and video. You simply have to demonstrate that alarms, physiological waveforms, and recordings can get through in a reliable and persistent fashion. This is not only important to gain the appropriate regulatory approval, but also for end user deployments. According to a recent study by the researchers from teh University of Michigan and MicroSoft Research, wireless network management can result in slower phone performance, weaker battery life, and even increased security issues for consumers. The study released a smart phone application called NetPiculet to the Android Market which allowed them to study how 400 consumers using 107 global networks were impacted by network management. The data found that network management at many carriers not only degraded application performance and battery life, but left some vulnerable to IP spoofing. One of the first things that researchers discovered was the apparent handicap on network speed imposed by a major U.S. carrier (For legal reasons the team anonymized the data). Suprisingly, packets of data sent across this network are buffered by the carrrier itself. This means that when a packet of data fails to make it to its destination - a common occurence on wireless networks - it cannot be instantly retransmitted as it would normally be on the Internet. Instead, the sending device must wait a long time - on the order of seconds - for a time out to alert it to the failure.
Download Untold Story of Middleboxes in Cellular Networks

MDC Conference Wrap Up Boston MA at Harvard Medical School

This was a very busy but good conference. Had a good presentation today with Tom Boston of www.gtri.com on best practices for medical device connectivity. Thanks Tom, you did a great presentation,i.e. our joint presentation. In the afternoon I conducted the second (first in 2009) MDC workshop on DAS (Distributed Antenna Systems). Not hundreds of people attending, but a small group of luminary medical device companies that were very much appreciative of the education and subject matter expertise. All in all it seemed that in this third year that the conference was again well attended. I applaud both Tim and Satish for a job well done in orchestrating this event. My feeling is that is a "min" HIMSS of which if were HIMSS, these topics would have never been discussed. Also, it is an opportunity for serious hard line debate and networking on serious topics...of which in my opinion probably could not have or would not have happened at HIMSS. Finally, it allows an opportunity to have a one to one discussion to figure out the reality from the fog in medical device connectivity. Hence why everyone simply needed to hang out for the entire two days.

In this day of proven standard networking schemas, i.e. 802.11x for both enterprise and medical devices; it was interesting to see that an another WMTS like derivative, or 700MHz frequency was proposed. Not quite realy clear why this is proposed, as it just adds huge costs, when it is realized that we need to simply to reduce costs for healthcare! As John Chambers, CEO John Chambers said in 2005, proprietary networks are dead, as well as my opinon that proprietary "spectrum", is dead. The challenges are that carriers simply have limited spectrum, probably would not want to share the risk, and what would be the increased or additive costs to the medical device? WMTS has proven itself to be a costly endevor over the years, hence why the continual march to incorporate medical devices over the WLAN with proven QoS and security. Cisco Systems, Inc. and Aruba Networks are the two market leaders in the WLAN space and they have demonstrated significant and proven expertise and the ability to incorporate WLAN enabled medical devices into their WLAN ecosystem. Seven proven years of integration. These two companies alone control around 90% of the WLAN space across ALL vertical markets. So with this market dominance (from a WLAN perspective) you would think they would know and have the right deployment model "baked"? Philips Medical Systems introduced in August 2011, the Mx40 of which is extremely similiar or somewhat identical to the Draeger M300 in functionality. Some of the publich domain annoucements seems like a M300 advertisgin. My hats off to Draeger for setting the bar here. However, the real difference is that Drager has OneNet, uses 802.11x enterprise, while the Mx40 of Philips continues to use the existing WMTS (higher frequency of WMTS) infrastructure. It is my opinion that Philips will use WMTS to work out kinks of this new patient worn monitor with their existing customer base. May take a year or so. However, like the rest of the medical device community, they will probably abandon WMTS and move this over to the enteprise LAN and WLAN. Since they are the market leader they have the luxury of doing this. Bottom line is that Draeger and Philips seem to be the movers and shakers in the space. Not quite clear where the strategy of General Electric and Spacelabs are? However, watch out for some up and coming players in patient monitoring that have taken a whole new approach to algorithms, physiological parameters, and networking innovations. They will be appearing on the scene in 2012 and simply will challenge convention in what we consider the traditional "patient monitoring space". More later on this. This is exciting time to be in this space as innovation in terms of wireless technology is happening on a daily basis.

MDC Conference Boston, MA First Day

Good opening sessions by Julian Goldman, M.D., and currently now by Tim Gee real time. It is interesting that wireless and wireless networking both on an embedded side is no longer a nice to have but a must have. Both the provider and embedded medical device company are finally it seems coming together. However, there is a real need to come up with best of practice. The next blog that I will come out with a blog surrounding "Why Most Product Launches Fail" - By the Harvard Business Review. I will put this into the context of actually "Launching a IT wired or wireless medical device". I was given this Harvard Business Review, must will translate into where I think it fit's into the Medical Device Connectivity space.

MDC Medical Device Connectivity Conference the 3rd Event - Boston, MA

Just got in into Boston, MA (ahead) on Tuesday, but Boston is a great city. Will be synching up with a lot of collegues and friends over the next week. Thanks to Tim to putting this all together. I will provide blogs over the next few days.

Wireless Integration and Design BSL- 4 for NIAID for the National Institute of Health

Integra Systems, Inc. is working with www.tcg.com to provide the SME for a very unique wirless voice over IP design. We are honored to be able to work with NIH to make this happen.
http://www.hemisphere-eng.com/showcase/high-containment/niaid-national-institute-of-health-integrated-research-facility-fort-detrick/