AXREM Patient Monitoring SFG Statement: Medical Device in an IT World Statement

01 September 2023

AXREM is the UK trade association representing the interests of suppliers of diagnostic medical imaging, radiotherapy, healthcare IT and care equipment including patient monitoring in the UK. Our group is comprised of most of the industry supply companies, AXREM members supply the majority of diagnostic medical imaging and radiotherapy equipment installed in UK hospitals.

PROBLEM STATEMENT:

Digital maturity, data integration, interoperability and artificial intelligence are commonly used buzz words within the Hospital environment today. Digital Innovations offer an abundance of opportunities to solve some of the most critical issues facing the NHS. Being able to provide fast, meaningful data to healthcare professionals at the point of care, can drastically speed up diagnosis, improve patient pathways, clinician’s workflow, and in turn clinical outcomes. Yet digital healthcare in the NHS is severely hindered by inadequacies in basic IT infrastructure and requirements, meaning our NHS lags behind other developed nations in its ability to deliver the potential benefits of a truly digital ecosystem.

IT Infrastructure Requirements

Medical Equipment providers from the UK face challenges when implementing basic IT solutions into NHS Hospitals. At the latest AXREM focus group meeting for patient monitoring, representatives from some of the leading manufacturers discussed the vast differences observed between different NHS Trusts. Approximately 90% of UK operating theatres do not have the ability to connect a Patient Monitor (or other critical equipment) to a local network, preventing the output of clinical data being relayed to the Electronic Medical Record systems or Clinical Information Systems.

An example of this would be HIMSS EMRAM model. HIMSS EMRAM has been implemented to measure clinical outcomes, patient engagement and the clinician use of Electronic Medical Record technology to strengthen performance and health outcomes across patient populations. The 7 stages that make up the model gauge the level of digital maturity within a given Hospital, however it is open to interpretation when meeting those stages. Two key elements documented within the NHS Long Term Plan strategy (January 2019) are ‘to use intuitive tools to capture data as a by-product of care in ways that empower clinicians and reduce the administrative burden’ and ‘Mandate and rigorously enforce technology standards (as described in The Future of Healthcare) to ensure data is interoperable and accessible’. To achieve these aspirations, basic elements of networking and infrastructure are needed in many care areas to support automated data capture, which is severely lacking. So, how would NHS Hospitals rate against the EMRAM model?

Patient Monitoring is used throughout a hospital in varying levels, giving the Healthcare professional an overview of the patient condition. With continuous patient monitoring specifically in the high acuity level departments (ITU, CCU, Neuro, etc..) networking requirements are generally already in place, and on few occasions need to be installed. Installing such solutions within these departments although disruptive is manageable as it is easier to relocate patients on a temporary basis.

The situation is drastically different in the Operating Theatre. Theatre complexes are typically aged buildings, often impacted by structural hazards such as asbestos. Due to the sterile environment any work required needs full containment and is best completed when the Theatre is closed. As well documented within the media there is a huge backlog of elective care procedures and closing the theatres will only exacerbate the problem.

Another element of huge complexity is Wireless Networking. In many cases Medical Equipment may need to reside on the Hospital’s wireless LAN. With the ever-increasing amount of wireless products and changes to protocols, it is difficult to keep abreast of authentication and encryption requirements. Many existing wireless networks are aged, and are not robust enough to support the amount of data needed to pass through them. In addition to this, with the importance of real-time life critical data being shared on these networks, IT teams are reluctant to take the responsibility of getting data to the point of need over such aging architecture.

There is a balance as to where the priority lies, but our call is for all Hospitals to understand the basic requirements needed to allow equipment providers to offer solutions to aide Healthcare professionals to perform to the best of their ability.

Bio-Medical Engineering collaboration with IT departments.

Medical equipment undergoes a significant amount of validation and testing, and is also hardened with the highest level of security and encryption to protect both the equipment itself as well as electronic patient health information. Operating systems and software can be vulnerable to cybersecurity threats and at all times every effort is taken to protect from such eventualities. It is not possible with Medical devices/Equipment to install anti-virus software or upload patches when released by the OS vendor, as there is no understanding of how such patches could impact the operating structure of the equipment. All vulnerabilities and relevant solutions must be validated by the OEM prior to any installation. Instead, protection can be administered through the use of networking hardware and firewalls. It is therefore critical for the IT department to understand that Medical Equipment is not ‘just like a PC’ and must be handled in a different manner.

The Bio-Medical Engineering teams fully understand the requirements to deploy Medical devices/Equipment and through closer collaboration with the IT department and with better education from the outset, solutions could be implemented in term of infrastructure to support Medical Device Integration.

Conclusion

Digital maturity within the NHS covers a vast area from Acute Trusts through to GP surgeries. Standardisation is needed throughout with focus on the basic infrastructure requirements to improve patient care. Allowing the ability to review data at point of need, or optimising workflows will allow for quicker, higher quality patient care and a reduction in length of stay.

Although the ICB’s have brought Trusts together to prevent working in silos, we call on all Hospitals biomedical and IT teams to work closely together in a common goal of implementing new technology and to locate funding in these key areas.