A HIMSS Analytics White Paper

Medical Devices
Landscape
Current and Future Adoption,
Integration with EMRs,
and Connectivity

Sponsored by

December 1, 2010
2 Medical Devices Landscape

HIMSS Analytics

Medical Devices Landscape

Table of Contents

Executive Summary ………………………………………………………....… 3

Background ………………………………………………………………….… 3
Study Methodology and Demographics ………………………………………. 5
Medical Devices Summary ………………………………………………..….. 7
Device by Device Summary ………………………………………………….. 10
Cardiac Output Monitors ………………………………………….…… 10
Defibrillators ……………………………………………………………... 11
Electrocardiographs ……………………………………………………. 11
Fetal Monitors ……………………………………………………………. 12
Infant Incubators …………………………………………………………. 12
Infusion Pumps …………………………………………………………… 12
Intelligent Medical Device Hubs ........…………………………………. 13
Interactive Infusion Pumps ..…………………………………………….. 13
Physiologic Monitors ..…………………………………………………… 14
Ventilators .……………………………………………………………….. 14
Vital Signs Monitors ……………………………………………………… 14
Interface with Electronic Medical Record Environment ..……………………... 15
New Equipment Purchases ……………………………………………………... 17
Conclusion ..…………………………………………………………………….. 18
About HIMSS Analytics ..……………………………………………………… 20
About Lantronix ...……………………………………………………………… 20

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3 Medical Devices Landscape

Executive Summary

W
hile use of key medical devices such as defibrillators, physiologic
monitors, electrocardiographs and vital signs monitors is widespread
among 825 U.S. hospitals providing data on medical device utilization,
only one-third of hospitals are presently interfacing the medical devices at their
organization with the electronic medical record (EMR). By percentage, intelligent
medical device hubs and physiologic monitors are most likely to be identified as types
of medical devices that are interfaced to an EMR.

At most hospitals, the sole method of connectivity between EMRs and medical
devices was through the use of a Wired local area network (LAN) connection. And,
while a number of organizations are using wireless connectivity in conjunction with
wired LAN connectivity, only 8 percent of respondents reported that their hospital
relies solely on wireless connections.

The potential growth in key devices areas, such as interactive infusion pumps, fetal
monitors and infant incubators, along with the limited number of hospitals that are
presently interfacing devices and EMRs, suggest that there is tremendous potential for
healthcare organizations to connect their existing devices to their EMRs.

Respondents that interface devices to the EMR at their organization report that the
ability to automatically chart data from the device directly to the EMR is a primary
reason for creating the interface. The automatic transfer of this type of data has a
number of potential benefits to healthcare organizations, including a reduction of
medical errors, improved workflow for clinicians, and additional data analytics
opportunities, all of which will lead to improved quality of care.

Background
On July 15, 2010, the Centers for Medicare and Medicaid Services (CMS)
published the final rules on the Electronic Health Record Incentive Program, only
six months after it published a Notice of Proposed Rulemaking. According to the
Federal Register, “The HITECH Act statutorily requires the use of health information
technology in improving the quality of care, reducing medical errors, reducing health
disparities, increasing prevention and improving the continuity of care among health
settings.”1 In order to meet the goals of this statement, CMS identified a core set of 14
meaningful use objectives in which eligible hospitals (EH), including Critical Access

1 http://www.himss.org/content/files/MU_Final_Rule.pdf Accessed September 12, 2010

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4 Medical Devices Landscape

Hospitals (CAH). It also identified 15 core meaningful use objectives in which

eligible professionals (EP) need to focus to qualify for incentive funds provided
through the new CMS Medicare and Medicaid incentive program. Additionally,
EHs and EPs must also focus on five of 10 menu set objectives to quality for
incentive funds. The Federal Register continues, “These core set of measures are also
foundational and aligned with each other. For example, electronic copies of health
information given to a patient will be useless if it does not contain basic information
such as a problem list, medication list or allergy list.”2

Recording and charting changes in vital signs has been identified as one of the core
areas that will be measured to qualify for meaningful use incentives. This area provides a
good example of the way in which the integration of the data from a medical device into
an electronic medical record (EMR) can improve the quality of patient care delivered.

Documentation of accurate vital signs during

hospitalization provides clinicians with key data on Transfer of vital signs
blood pressure, pulse, temperature and other metrics information from the
that are critical for monitoring a patient’s condition. device to the EMR
Requiring clinicians to either document vital signs on should result in a
a patient chart or enter them directly into a computer near zero error rate.
system using a computer or mobile device such as a
tablet PC has the potential to not only result in errors
in entry, but can also delay the entry of the information into the EMR.3 This is
particularly critical in an area like the Intensive Care Unit (ICU) where vital signs
need to be constantly monitored.

While many hospitals aren’t conducting formal return on investment (ROI) studies,
transfer of vital signs information from the device to the EMR should result in a near-
zero error rate, as well as produce other efficiencies. At St. John’s Medical Center in
Wyoming, for instance, the integration information from vital signs monitors into the
EMR has yielded a 60 percent time savings as a result of importing, not entering vital
signs data.4

Integration of EMRs and vital signs monitors or other devices can take place
in numerous ways, including a hard-wiring (such as a USB connection), wireless ​

2 http://www.himss.org/content/files/MU_Final_Rule.pdf Accessed September 12, 2010

3 “Comparison of the Quality and Timeliness of Vital Signs Data Using Three Different Data-Entry Devic-
es”. Wagner, Schaffner, Foulois, Swanson Kazley, Parker, Walo. CIN: Computers, Informatics, Nursing. July/August
2010. Volume 28, Number 4 205-212.
4 Medical Device Integration: CIOs must bridge the digital divide between devices and electronic medical
records. Healthcare Informatics, February 2009. David Raths. http://www.healthcare-informatics.com/ME2/dir-
mod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F8
7F791&tier=4&id=FBACE42BBB304C4F82020BE422FD8EBF Accessed November 11, 2010

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5 Medical Devices Landscape

technology or Bluetooth technology.5 Medical devices

Only one-third of that have this integration capability are referred to as
hospitals reported “intelligent medical devices.” Because the data in the
that an interface HIMSS Analytics study on which this paper is written is
was present at their based on the interface of data from the medical device
organization between to the EMR environment at the healthcare organization
devices and their EMRs. at which the device is located, the term EMR is used
throughout the remainder of the paper, even though
it is understood that the broader implications of the
meaningful use criteria are related to the broader EHR environment.

Only one-third of the hospitals in this sample reported that an interface was present
between devices at their organization and their EMR. A 2009 HIMSS Analytics white paper
suggests that intelligent medical devices are emerging as a critical component of the EMR
environment, as the ability to automatically capture and manage patient data from these
devices becomes a function of improving both patient safety and clinical outcomes.6

In fact, recent research on the capability of hospitals from HIMSS suggests that 56
percent of respondents that answered the question, “Does your EHR capture flow sheet
data and changes in vital signs including: height, weight, blood pressure, calculate and
display Body Mass Index (BMI), and plot and display growth charts for children 2-20
years old including BMI?” reported that their organization had the capability to do so.7

This importance, and thus the number of hospitals developing interfaces between
their EMRs and medical devices, will likely increase in 2015, when hospitals have
the opportunity to meet Stage 3 Meaningful Use requirements as medical device
interoperability is one of the goals outlined to achieve and improve performance and
support care processes and on key health system outcomes. Thus, it would be expected
that not only will more hospitals develop interfaces between their EMRs and medical
devices, but also that those that already have this type of interface in place will increase
both the number and breadth of devices that are integrated.

Study Methodology and Demographics

This report is based on data collected from 825 U.S. hospitals. The data for this
report were collected between June 2009 and June 2010 and primarily captured using a
web-based survey tool supported by telephone follow up.
5 http://www.himss.org/content/files/ConnectMedDeviceEMRFlyer4.pdf “Connecting a Diagnostic Medical
Device with Your EMR”. Accessed October 19, 2010
6 http://www.himssanalytics.org/docs/HA_MedDevices.pdf Accessed September 12, 2010
7 From HIMSS Meaningful Use Data

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6 Medical Devices Landscape

The respondents to this survey are primarily located in either the West South
Central8 or South Atlantic9 regions. Each region comprises about 18 percent of the
survey respondents. The smallest number of respondents comes from New England.10
More than three-quarters of the hospitals in the sample (79 percent) are classified as
urban.11

Approximately half of the hospitals are part of an integrated delivery system (54
percent); the remaining hospitals represent a single-hospital delivery system. By type of
organization, slightly more than two-thirds of the hospitals in this sample are classified
as general medical/surgical or general medical. Another 19 percent are critical access
hospitals and 6 percent are academic facilities. The remaining 7 percent of the hospitals
include a wide variety of organizations that offer more specialized services, including
pediatrics/women’s health or long-term acute care services.

By bed size, one-third of the hospitals in the sample (35 percent) have less than 75
licensed beds. Another third (37 percent) have 75 to 249 beds. The final 29 percent
of the sample has 250 or more beds. The average number of beds per hospital in
the sample is 187.54; the median number of beds is 131.50. For the purposes of this
research, those hospitals with under 75 beds will be identified as “small hospitals”;
those with 75 to 249 beds will be identified as “medium hospitals”; and those with
250 or more beds will be identified as “large hospitals.”

HIMSS AnalyticsTM devised the EMR Adoption Model (EMRAMSM)12 to track

EMR progress at hospitals and health systems. The EMRAM scores hospitals in
the HIMSS Analytics Database on their progress in completing the eight stages to
creating a paperless patient record environment. Half of the hospitals represented in
this study scored within Stage 3 of the EMRAM.13 One-quarter are below Stage 3
and 7 percent are Stage 6 or Stage 7 hospitals.14

One-third of the hospitals in this sample have identified themselves as trauma

facilities. By definition, this means the hospital is equipped to provide comprehensive

8 West South Central Region – Arkansas, Louisiana, Oklahoma, Texas

9 South Atlantic Region – Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia,
West Virginia and Washington, DC
10 New England – Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont
11 In this study, a hospital is designated urban if they have a mailing address located in a designated Core
Based Statistical Area (CBSA), which is the official term for a functional region based around an urban center of
at least 10,000 people. Source -- http://www.census.gov/population/www/metroareas/metroarea.html Accessed
September 27, 2010
12 More information on the EMRAM model can be found at http://www.himssanalytics.org/hc_providers/
emr_adoption.asp
13 http://www.himssanalytics.org/hc_providers/emr_adoption.asp - Accessed October 21, 2010
14 A current list of Stage 6 and Stage 7 hospitals can be found at http://www.himssanalytics.org/hc_provid-
ers/emr_adoption.asp -- accessed October 21, 2010.

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7 Medical Devices Landscape

emergency medical services to patients suffering traumatic injuries. Nine percent of the
hospitals in this sample indicated they are Magnet hospitals.15

Medical Devices Summary

This research explores utilization of 11 medical devices used in healthcare

organizations. We asked questions about medical devices in general; we also asked
questions about if and how these devices are being integrated to the EMR environment.

A full list of the devices included in this research is listed below.

➣➣ Cardiac output monitors

➣➣ Defibrillators

➣➣ Fetal monitors

➣➣ Electrocardiographs

➣➣ Infant incubators

➣➣ Infusion pumps

➣➣ Intelligent medical device hubs

➣➣ Interactive infusion pumps

➣➣ Physiologic monitors

➣➣ Ventilators

➣➣ Vital signs monitors

None of the hospitals in this sample report use all 11 medical devices tracked by
this research. Thirteen percent use 10 of the devices and another third use nine of the
devices. Nearly one-quarter (23 percent) use eight of the 11 devices. Less than 10
percent of the hospitals in this sample have deployed five or fewer of these devices.

15 The ANCC Magnet Recognition Program® recognizes healthcare organizations that provide the very best in
nursing care and professionalism in nursing practice. The program also provides a vehicle for disseminating best prac-
tices and strategies among nursing systems. It is the gold standard for nursing excellence. http://www.nursecredential-
ing.org/FunctionalCategory/AboutANCC.aspx -- Accessed on October 20, 2010

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8 Medical Devices Landscape

Among the devices for which data are captured in this study, defibrillators are most
widely deployed with 99 percent of the hospitals reporting this type of device was
in use. Also used by at least 90 percent of hospitals in the sample were physiologic
monitors (97 percent), electrocardiographs (97 percent) and vital signs monitors
(94 percent). Least frequently deployed are intelligent medical device hubs; only 11
percent of the hospitals in this sample reported using this type of device.

Additional information about the market can be determined when the overall
installation of intelligent medical devices is analyzed by examining a number of
the demographic variables. More specifically in this area, we explored the number
of types of devices in place at an organization, not the overall number of devices
present. For instance, organizations that provide trauma services have, on average,
a greater number of types of devices (8.48) than do those organizations that do not
offer trauma services (7.74) (see Table 1).

Measure Number Minimum Maximum Average Median

Trauma 283 2.00 10.00 8.48 9.00
Not Trauma 542 2.00 10.00 7.74 8.00

Table 1

By region, those respondents working in the Pacific16 region have the highest
average number of devices types (8.29) compared to those who work in the West
South Central region (7.57) (see Table 2).

Measure† Number Minimum Maximum Average Median

East North
118 4.00 10.00 8.51 9.00
Central
East South
73 3.00 10.00 7.74 8.00
Central
Mid Atlantic 78 2.00 10.00 8.32 9.00
Mountain 65 3.00 10.00 8.01 8.00
Pacific 62 5.00 10.00 8.29 9.00
South Atlantic 145 5.00 10.00 8.07 9.00
West North
104 3.00 10.00 7.62 8.00
Central
West South
148 3.00 10.00 7.57 8.00
Central

Table 2

16 Pacific Region – Alaska, California, Hawaii, Oregon, Washington

† Full census breakdowns can be found at http://www.census.gov/geo/www/us_regdiv.pdf

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9 Medical Devices Landscape

By EMRAM scores, hospitals that are in Stage 3 or higher tend to have an average
of eight types of medical devices installed at their organization (see Table 3).

Measure Number Minimum Maximum Average Median

Stage 0 69 2.00 10.00 6.30 6.00
Stage 1 44 5.00 10.00 7.27 7.00
Stage 2 107 5.00 10.00 7.81 8.00
Stage 3 416 3.00 10.00 8.15 9.00
Stage 4 97 4.00 10.00 8.62 9.00
Stage 5 38 3.00 10.00 8.12 8.00
Stage 6 46 4.00 10.00 8.70 9.00
Stage 7 8 8.00 9.00 8.63 9.00

Table 3

Urban and rural hospitals also have differences in the number of types of devices
deployed. On average, rural hospitals have an average of 6.81 types of devices
deployed, compared to 8.31 for urban hospitals (see Table 4).

Measure Number Minimum Maximum Average Median

Rural 176 3.00 10.00 6.81 7.00
Urban 649 2.00 10.00 8.31 9.00

Table 4

Hospitals that are part of an integrated delivery system are more likely to have a
greater variety of devices deployed (8.12) than are hospitals that are part of a single
hospital system (7.86) (see Table 5).

Measure Number Minimum Maximum Average Median

Single 384 2.00 10.00 7.86 8.00
IDS 441 3.00 10.00 8.12 8.00

Table 5

There are also clear differences in the number of device types deployed when the
type of services a hospital offers is taken into consideration. Academic facilities
(8.88) and general medical/surgical hospitals (8.36) have a greater average number of
types of devices than do critical access hospitals (CAH) (6.83) (see Table 6).

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10 Medical Devices Landscape

Measure Number Minimum Maximum Average Median

Academic 52 7.00 10.00 8.88 9.00
CAH 156 3.00 10.00 6.83 7.00
Medical/Surgical 559 2.00 10.00 8.36 9.00
Other 58 3.00 10.00 6.79 7.00

Table 6

By bed size, smaller organizations are more likely to use a smaller complement of
devices (7.04) compared to larger hospitals (8.68) (see Table 7).

Measure Number Minimum Maximum Average Median

Small 289 3.00 10.00 7.04 7.00
Medium 301 2.00 10.00 8.37 9.00
Large 235 4.00 10.00 8.68 9.00

Table 7

There are also differences when the Magnet status of a hospital is taken into
consideration. On average, Magnet hospitals use 8.65 different device types,
compared to 7.93 device types for non-Magnet hospitals (see Table 8).

Measure Number Minimum Maximum Average Median

Not Magnet 748 2.00 10.00 7.93 8.00
Magnet 77 3.00 10.00 8.65 9.00

Table 8

Device by Device Summary

Cardiac Output Monitors

In this HIMSS Analytics Database study, a cardiac output monitor is defined as a

device that shows the electrical and pressure waveforms of the cardiovascular system
for measurement and treatment. Parameters specific to respiratory function can also
be measured. Because electrical connections are made between the cardiac monitor
and the patient, the device is kept at the patient’s bedside.

More than half of the hospitals in this sample (58 percent) reported that they
have deployed cardiac output monitors. There is an average of 22.23 cardiac

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11 Medical Devices Landscape

output monitors in place at these hospitals. The median number is 8.00 cardiac
output monitors.

Approximately 20 percent of hospitals plan to purchase cardiac output monitors

in the future. Only 10 percent of those hospitals that plan to purchase cardiac output
monitors in the future will do so in the next year. The majority (84 percent) will wait
more than 18 months to make this purchase. Nearly all of the hospitals that indicated a
plan to purchase cardiac output monitors (92 percent) will replace monitors that are in
place at this time or buy additional units; only 8 percent will purchase cardiac output
monitors for the first time.

Defibrillators

Respondents to the survey were given the following definition for defibrillators:
“A device used to correct a dangerously abnormal heart rhythm, usually ventricular
fibrillation, or to restart the heart by depolarizing its electrical conduction system and
delivering brief measured electrical shocks to the chest wall or the heart muscle itself
(e.g., pacemakers, AED or Automated External Defibrillators).”

Nearly all of the hospitals in this sample (99 percent) have deployed defibrillators.
The average number of defibrillators in place at these hospitals is 33.66; the median
number of defibrillators is 20.00.

Approximately one-third of the hospitals in this sample (39 percent) reported plans
to purchase defibrillators in the future. Nearly all of the hospitals that plan to purchase
defibrillators (99 percent) will do so to either expand their number of defibrillators or
replace existing units. A vast majority of respondents (87 percent) reported that they
will not make a purchase in this area for more than 18 months.

Electrocardiographs

An electrocardiograph (ECG or EKG) is defined as a device used in the detection

and diagnosis of heart abnormalities that measures electrical potentials on the body
surface and generates a record of the electrical currents associated with the heart
muscle activity. Use of electrocardiographs is nearly universal, as 97 percent of the
hospitals in this sample reported using this type of device. On average, these hospitals
have 11.27 electrocardiographs, with a median of 6.00 devices.

Approximately one-third of hospitals in this study plan to purchase

electrocardiographs in the future and nearly all of these hospitals will either replace

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12 Medical Devices Landscape

existing devices or add to the number of devices in place. Only two hospitals will
purchase electrocardiographs for the first time. Only 8 percent of these devices will
be purchased in the next year. Most hospitals with planned purchases will wait at
least 18 months until they purchase new electrocardiographs (89 percent).

Fetal Monitors

A fetal monitor is an electronic instrument used to record the heartbeat of the

fetus and contractions of the mother’s uterus. Approximately three-quarters of the
hospitals in this sample (72 percent) reported using fetal monitors. On average, these
organizations have 14.42 fetal monitors (median 9.00).

Slightly more than one-quarter of the hospitals in this study (28 percent) reported
plans to purchase fetal monitors in the future. Most respondents reported that the
fetal monitors that will be purchased will either replace existing devices or be in
addition to devices that are already in place. Less than 1 percent will purchase
devices for the first time. Twelve percent will purchase fetal monitors in the next
year; 82 percent will wait more than 18 months before making a purchase.

Infant Incubators

For the purposes of this research, an infant incubator was defined as an enclosed
apparatus used for the protection and care of prematurely born infants that are
kept in controlled conditions. About two-thirds of the hospitals in this sample (69
percent) reported that infant incubators are deployed at their organization. On
average, these hospitals have 13.35 infant incubators in place, with a median of
6.00 incubators.

One-quarter of the hospitals in this sample (26 percent) have plans to purchase
infant incubators in the future. Nearly all of these purchases (98 percent) will be at
hospitals that already use these devices. The majority of the purchases (91 percent)
will take place at least 18 months into the future.

Infusion Pumps

An infusion pump has been defined as an apparatus designed to deliver measured

amounts of a drug or intravenous (IV) solution through IV injection over time.
Some kinds of infusion pumps can be implanted surgically. Infusion pumps are
used at nearly two-thirds of the hospitals (64 percent) represented in this sample.

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13 Medical Devices Landscape

On average, these hospitals use 210.49 infusion pumps, with a median of 108
infusion pumps.

Nearly one-third of respondents (23 percent) reported that they plan to purchase
infusion pumps in the future. Only 6 percent of these purchases will be by
organizations that are planning to purchase infusion pumps for the first time. While
20 percent of infusion pumps purchases are anticipated to take place in the next year,
71 percent of the purchases are not expected to take place for at least 18 months.

Intelligent Medical Device Hubs

For the purposes of this research, an intelligent medical device hub was defined as
a product similar to an interface engine that is designed to capture and manage data
streams from medical devices.

This device also provides a variety of processing functions, including network

management, bridging, routing, and switching. If there is not interfacing going on,
then no data is streaming from the medical devices, and this device is, by default,
not deployed.

Use of this type of device is limited at this time – only 11 percent of the hospitals in
this sample reported having this type of device deployed. On average, these hospitals
use 18.76 hubs (median 1.00).

Future activity in this space will be slow. Only 8 percent of hospitals reported plans
to purchase this technology in the future. In addition, three-quarters of purchases will
not take place for 18 months or more. Half of these purchases (46 percent) will be
made by organizations that already use this technology.

Interactive Infusion Pumps (Smart Pump)

For the purposes of this research, an interactive infusion pump, or smart pump,
is a device that uses clinical decision support technology to avoid dosing errors.
Smart pumps can be programmed and adjusted from a nurse’s portal when they are
interfaced with the EMR, thus making them interactive. However, a smart pump
does not need to have this capability. Information on this device can often be found
in the pharmacy. Half of the hospitals in this sample have interactive infusion pumps
deployed in the organization. On average, these hospitals use 280 interactive infusion
pumps (median 150.00).

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14 Medical Devices Landscape

One-quarter of respondents reported that they have plans to purchase smart

pumps in the future. The majority of these (83 percent) will replace existing
technology. Only 25 percent of the hospitals that reported plans indicated that they
will make this purchase in the next year; 70 percent will wait at least 18 months to
make this type of purchase.

Physiologic Monitors

In this research, a physiologic monitor was defined as a patient monitoring system

that can be configured to continuously measure and display various parameters via
electrodes and sensors that have been connected to the patient. Examples include
electrical activity of the heart via an EKG, respiration rate for breathing, blood
pressure, their body temperature, their cardiac output, and amount of oxygen and
carbon dioxide in the blood. It is essential that these devices support multiple
functions.

Use of physiologic monitors is widespread among the hospitals in this sample, with
97 percent reporting that this type of device is deployed. On average, these hospitals
have 106 physiologic monitors (median 49.50). Forty percent of the hospitals in
this sample have plans to purchase physiologic monitors. Most of these purchases,
however, won’t take place for at least 18 months and nearly all physiologic monitors
will be purchased to replace existing technology.

Ventilators

For the purposes of this research, a ventilator was defined as a machine that
mechanically assists patients in the exchange of oxygen and carbon dioxide
(sometimes referred to as artificial respiration). Approximately 90 percent of the
hospitals in this sample reported that their organization has deployed ventilators.

On average, hospitals have an average of 21 ventilators (median 10.00). Slightly

more than one-third of respondents (35 percent) reported plans to purchase
ventilators in the future. Only 13 percent of these purchases are projected to take
place in the next 18 months; nearly all will be to replace existing ventilators.

Vital Signs Monitors

In this research, a vital signs monitor was defined as a device that has the sole
purposes of monitoring temperature, blood pressure measurements, and pulse (e.g.

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15 Medical Devices Landscape

NIBP or Non-Invasive Blood Pressure (NIBP), SPO2). Use of vital signs monitors is
nearly universal, with 94 percent of the hospitals in this sample reporting use of this
type of device. On average, these hospitals have 63 devices (median 30.00).

Approximately one-third of respondents (36 percent) plan to purchase vital signs

monitors in the future. However, nearly all of these purchases will replace existing
monitors. In addition, most healthcare organizations will wait at least 18 months before
investing in vital signs monitors.

Interface with EMR Environment

As the summary section of each device above alluded to, this research captured
information on whether or not an interface between an organization’s devices and EMR
was in place.

Only one-third of the hospitals in this sample reported that an interface was present
between devices at their organization and their EMR. The table below outlines the
percent of hospitals that have a deployed device and interface at least one of those
devices to the EMR (see Table 9).

Device Number Deployed Percent Interfaced with EMR

Defibrillator 815 1.60%
Physiologic Monitors 798 24.30%
Electrocardiograph 796 15.10%
Vital Signs Monitors 779 6.80%
Ventilators 750 9.30%
Fetal Monitor 590 19.00%
Infant Incubator 566 2.70%
Infusion Pump 527 3.40%
Cardiac Output Monitor 474 7.50%
Interactive Infusion Pump 406 6.90%
Intelligent Medical Devices Hub 92 71.70%

Table 9

On average, the hospitals interface an average of 2.59 device types to their EMRs
(median 2.00). None of the respondents are interfacing devices in all 11 areas
above to the EMR and only five interface 10 of the device types to the EMR at their
organizations.

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16 Medical Devices Landscape

Respondents that are presently interfacing at least one type of device to their
EMR were also asked to identify their reason(s) for integrating the medical devices’
transactions.

Nearly all respondents (96 percent) indicated that their primary reason was to
have the ability to automatically chart the data from the device directly to the EMR.
This is nearly triple the next frequently given response, which is to identify and
communicate alarm conditions to staff for appropriate clinical response; this response
was selected by 33 percent of respondents (see Table 10).

Reason for Integrating Device with EMR Percent Reporting “Yes”

Automatic Charting to the EMR 96.20%
Clinical Decision Support Purposes 33.10%
Enable Remote Support of Medical Devices 17.50%
Closed Loop Medication Needs 12.70%
Capturing Data for Research Purposes 8.60%

Table 10

Respondents were also asked to identify the means by which medical devices
at their organization were interfaced with their EMRs. Approximately half of
respondents indicated that their sole method of connectivity was via a wired LAN
connection. Another quarter of respondents (28 percent) indicated that they used a
combination of wired LAN and wireless connections.
Eight percent relied on only wireless connections. The
remaining respondents did not identify the type of Approximately half of
connectivity that was in place. respondents indicated
that their sole method
When the specific type of device is taken into of connectivity was via
consideration, interactive infusion pumps and a wired LAN.
electrocardiographs are most likely to use only a
wireless connection to integrate with the EMR. Healthcare
organizations are least likely to rely on wireless technology as the sole means for
integrating fetal monitors to the EMR; only 1 percent of respondents report this to be
the case and none of the respondents reported using only a wireless connection for
cardiac output monitors, defibrillators and infant incubators.

Following (see Table 11) is a complete listing of the means by which devices are
integrated with the electronic medical record.

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17 Medical Devices Landscape

Wireless
Number Wired and Wired LAN Not
Device LAN
Deployed Wireless LAN Connection Specified
Connection
Cardiac Output Monitor 29 27.60% 55.20% 0.00% 17.20%
Defibrillator 4 50.00% 50.00% 0.00% 0.00%
Electrocardiograph 120 11.70% 35.00% 28.30% 25.00%
Fetal Monitor 112 8.90% 61.60% 0.90% 28.60%
Infant Incubator 15 33.30% 6.70% 0.00% 60.00%
Infusion Pump 18 22.20% 5.60% 16.70% 55.60%
Intelligent Medical Devices Hub 66 16.70% 62.10% 7.60% 13.60%
Interactive Infusion Pump 28 32.10% 14.30% 28.60% 25.00%
Physiologic Monitors 194 13.90% 66.00% 6.70% 13.40%
Ventilators 70 20.00% 64.30% 2.90% 12.90%
Vital Signs Monitors 53 18.90% 43.40% 15.10% 22.60%

Table 11

New Equipment Purchases

This report has also already suggested that most of the device purchases that
will be made will be by healthcare organizations that either plan to replace existing
devices or purchase devices to supplement those already in place at their organization.
Respondents were asked to identify their reasoning for planning to purchase additional
devices in the future.

Nearly two-thirds of respondents indicated that new productivity or safety features

are a key driver for making a new equipment purchase. Respondents were least likely
to identify the expiration of a contract date as a driver for purchasing new equipment
(see Table 12).

Driver for New Equipment Purchase Percent Reporting “Yes”

New Productivity or Safety Feature 62.70%
Equipment Manufacturer at End of Life 40.02%
Data Integration 38.00%
EMR Installation 32.00%
Adverse Safety Events 26.60%
Expiration of a Contract or Lease 23.50%

Table 12

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18 Medical Devices Landscape

Conclusion

Among the hospitals in this sample, medical device utilization varies by

device type, regardless of whether they are connected to the EMR environment.
Electrocardiographs, defibrillators, physiologic monitors, ventilators and vital signs
monitors have reached market saturation; this represents a scenario in which at least
90 percent of the market uses the technology.

There is still tremendous opportunity for growth in this

market with fetal monitors having the next highest level It stands to reason that
of market penetration at 72 percent. Intelligent medical any data transferred
device hubs have the lowest market penetration at 11 directly from a
percent. device into the EMR
environment would
Research has suggested that manually entering medical reduce medical errors.
information, such as vital signs data, into a computerized
system at the point of care results in a lower rate of errors
than does entering this information into a paper record. It could be expected that
transferring this type of data directly from an intelligent medical device into the EMR
environment would further reduce the error rate to near zero.

While the previous research demonstrated this capability specifically with regard
to vital signs data, it stands to reason that any data transferred directly from a device
into the EMR environment would reduce the opportunity for a medical error.

For instance, integration of an infusion pump to the EMR could trigger information
about patient allergy to a medication, allowing for real-time intervention of a
medication to which a patient is allergic.17

In addition to a reduction of patient error, automatic charting to the EMR can

also have an impact on staffing. In an industry that is confronted with a nurse
staffing shortage18, integration offers the ability to improve workflow and time
savings for nursing and other clinical staff. Technology is identified as a means
by which organizations can achieve greater efficiency and improve care among an
organization’s nursing staff.

17 Medical Device Integration: CIOs must bridge the digital divide between devices and electronic medical
records. Healthcare Informatics, February 2009. David Raths. http://www.healthcare-informatics.com/ME2/dir-
mod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F8
7F791&tier=4&id=FBACE42BBB304C4F82020BE422FD8EBF Accessed November 11, 2010
18 American Association of Colleges of Nursing. Nursing Shortage Fact Sheet, Updated September 2010.
http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm Accessed November 11, 2010

HIMSS Analytics™ Database © 2010 HIMSS Analytics

19 Medical Devices Landscape

The integration of data directly from a medical device into the EMR offers one area
to improve efficiency, freeing nurses to focus on other areas of care.19

This research suggests that most of the hospitals that

The integration of have devices in place are not integrating the data from
data directly from those devices directly into the EMR at their organization.
a medical device into Among those that are integrating data from devices into
the EMR could free their EMR, the primary reason for doing so was to enable
nurses to focus the ability to automatically chart the data from the device
on other areas of care. directly to the EMR, thus reducing the potential for errors
in the data entered into the patients’ medical record,
ultimately improving quality of care.

A tremendous opportunity exists in this market for healthcare organizations to

continue to interface data from their medical devices directly into their EMR. One
critical factor in achieving integration is determining how to connect an intelligent
medical device to the EMR environment, such as using a wired LAN or a wireless
connection. The majority of respondents indicated they are presently interfacing their
devices with their EMR using a wired LAN connection. But when wireless technology
is in place, a wireless connection is often used even though the organization already
has wired LAN connections available.

Although this research project did not address the location of intelligent medical
devices in relation to wired LAN and wireless access points, this factor may explain
why some hospitals are using wireless connections in an environment that also includes
wired LAN connections. For example, an intelligent medical device may be used in an
area that does not have any wired LAN connection ports, therefore the device must be
connected using a wireless connection.

Another example may be the need for an intelligent medical device to remain
connected to a patient during transport within the hospital. And, while the data
presented here is limited to information collected from hospitals, ambulatory facilities
that use devices will likely face many of the same challenges and opportunities.

Intelligent medical devices will continue to emerge as a critical component of the EMR
environment as the ability to automatically capture and manage patient data from these
devices becomes a function of improving both patient safety and clinical outcomes.

19 Medical Device Integration: CIOs must bridge the digital divide between devices and electronic medical
records. Healthcare Informatics, February 2009. David Raths. http://www.healthcare-informatics.com/ME2/dirmod.
asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&t
ier=4&id=FBACE42BBB304C4F82020BE422FD8EBF Accessed November 11, 2010

HIMSS Analytics™ Database © 2010 HIMSS Analytics

20 Medical Devices Landscape

This also has the potential to impact the bottom lines of EHs and EPs as they strive
to achieve meaningful use in order to receive Medicare and Medicaid incentive
funds.

The importance of integrating intelligent medical devices with EHRs is expected to

increase when we learn about the Stage 2 and Stage 3 meaningful use requirements
over the next three to five years.

About HIMSS Analytics

HIMSS Analytics supports improved decision–making for healthcare

organizations, and healthcare information technology (IT) companies and consulting
firms by delivering high quality data and analytical expertise. The company collects
and analyzes healthcare organization data relating to IT processes and environments,
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management metrics, healthcare delivery trends and purchasing related decisions.

HIMSS Analytics is a wholly owned, not-for-profit subsidiary of the Healthcare

Information and Management Systems Society (HIMSS). For more information, visit
www.himssanalytics.org.

About Lantronix

Lantronix, Inc. (NASDAQ: LTRX) is a global leader of secure communication

technologies that simplify remote access, management and control of any electronic
device. With over 650 hospital and medical manufacturer customers worldwide,
along with a dedicated health care team, we are committed to enabling safer, higher
quality care delivery. Easy to integrate and deploy, Lantronix products remotely
connect and control electronic equipment via the Internet, provide secure remote
access to firewall-protected equipment, and enable remote management of IT
equipment over the Internet. Lantronix serves some of the largest medical, security,
industrial and building automation, transportation, retail/POS, financial, government,
consumer electronics/appliances, IT/data center and pro-AV/signage entities in
the world. Since 1989, we have connected over 2 million devices across 10,000+
customers globally – every 10 seconds of the work day, Lantronix enables another
device on the network. The company’s headquarters are located in Irvine, Calif. For
more information, visit www.lantronix.com.

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