TOSHIBA

WIRELESS COMMUNICATION AND VIRTUAL HEALTHCARE

A Vision for Remote Diagnostic Access and Service

R

10/18/2011

TM583 Strategic Management of Technology
Professor E
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TABLE OF CONTENTS

I EXECUTIVE SUMMARY……………………………………………………………………………………….3
II ABSTRACT………………………………………………………………………………………………………….3
III OVERVIEW AND COMPETENCIES…………………………….………………………………………….4
IV DISCUSSION OF CURRENT INDUSTRY DYNAMICS………………………………………………..5
V POTENTIAL SOLUTIONS AND SOURCING…………………………………………………………….8
VI RECOMMENDATIONS FOR EXECUTIVE COMMITTEE……………………………………………9
VII ATTATCHMENT………………………………………………………………………………………….………12
VIII REFERENCES………………………………………………………………………………………………………13

I EXECUTIVE SUMMARY
This research paper examines the capabilities of remote diagnostic access (RDA), and a proactive monitoring system as a foundation of medical equipment telemaintenance framework. In addition, this research will show how the cost effectiveness of such a system, can provide consistent monitoring of elaborate time sensitive data and systems without constraints. Due to recent growth and expansion into the medical equipment industry, the centralization of resources can expedite repair services, and this paper will give solutions to many reoccurring problems of the past. Lastly, this paper will propose the best solution for the best outcome to address the current problems as a whole.

II ABSTRACT
As it stands today, the current medical equipment maintenance model is on site and hands on, versus remote and virtual. There is no standardized remote diagnostic access capability for biomedical technicians to troubleshoot, or resolve equipment problems remotely and securely. Currently, our work is more reactive than proactive. This in term does not allow technicians to detect and prevent problems that can be potentially costly, and affect future business decisions. This lack of visibility to the medical equipment, and the need to be on site for problem solving and repairs, causes considerable downtime for critical equipment, and affects long term stability of existing contracts.
Complex equipment such x-ray equipment, magnetic resonance imaging (MRI), computed radiology scanners, and ultrasounds, can severely hamper a physicians’ ability to diagnose and treat patient injuries and their medical conditions. With the ability to prediagnose troublesome areas, as
Engineers, we can determine when equipment is within tolerance; schedule required services, and replace worn parts proactively. Going forth, the technology strategy would be to reinvent the current medical equipment maintenance model from on site to virtual, and streamline service repair to its highest efficiency.

III OVERVIEW AND COMPETENCIES
Aramark Corporation, through acquisition, has branched into the biomedical equipment services industry, and has another division called Aramark CTS (clinical technology service). Traditionally known for its food service and uniform services around the USA, it is now a force in two sectors of hospital services, food and medical equipment service. Despite its new base, medical technology is forever increasing, and to be a global leader in wireless medical service, investing in more networking applications would lead this race. This technology is new and is still in development stages in this industry. This research paper is written to bring to light the concept of hands-off technical service, and its future to the healthcare industry. The focus of this division of Aramark’s comprehensive clinical technology management program ensures that it can quickly resolve medical equipment issues, and maximize an organization’s capital investments. With CTS and its team of biomedical and imaging engineers, hear are its goals:
1) Cap maintenance expenses
2) Reduce equipment lifecycle cost
3) Ensure proper clinical equipment performance
4) Increase clinician satisfaction
5) Depend on timely service response and repair
6) Expect continuity in planned maintenance
7) Rely on comprehensive documentation
8) Expect technical assistance for clinical applications
9) Know that new equipment acquisitions meet current and future demands
Through remote diagnostic monitoring, the goals of CTS can be achieved with less cost and better efficiency. Through this research, and my years working in the biomedical equipment servicing industry, I have learned that medical equipment has become more sophisticated and complex in its use and networking capabilities. In that, most equipment is now linked to some central data collection system, and all information is stored and accessed at will. Traditionally, the collected data has been handled by most hospital IT departments. Now that service companies and IT departments are intertwined, the need to manipulate and even correct certain data has become routine for biomedical, clinical, and technical engineers. This brings a need for centralizing databases to effectively complete needed task.

IV DISCUSSION OF CURRENT INDUSTRY DYNAMICS Issue #1
Currently, there are multiple hospital accounts across the US, and multiple databases of which equipment records are kept. Outside of the local hospital biomeds, the information is not accessible to other engineers. This has especially become an issue when outside help is needed, or the local engineer is taking a vacation. Without a centralized database, it becomes virtually impossible to research the history of down equipment.

Issue #2
This of course brings the second problem. Response time is slow, causing loss of revenue for our customers. In recent history, this has become a hot button issue, and can easily escalate to the top of any corporate chain. Issue #3
The lack of resources has also play a role in equipment downtime. The best and brightest engineers, or those who specialize in certain modalities, may not have to travel long distances if the equipment is connected to a central database for recognizable problems. If the equipment can be remotely monitored and diagnosed from anywhere, routine problems can be resolved, thus saving time and money. This increases efficiency. Issue #4
Proprietary software and communications protocols: the standards are not the same for medical equipment. Each piece of equipment may have a different communication interface, as well as a different software requirement to perform the maintenance. The original equipment manufacturer (OEM) uses proprietary software for the console access, placing dependencies on the manufacturer to provide diagnosis capabilities. This is only good for them as they provide managed services. Issue #5
Adding to the previous problem, as a third party service provider, we are often suppressed by OEM interoperability clause. This causes outside customers to deal exclusively with the vendor, whereas they are reluctant to share or release proprietary hardware and software specifications, share access protocols, or share use application programming interface specs. Issue #6
Traditionally, there has always been operational gaps between the IT and biomedical engineering departments. Some of the more complex medical equipment is partially available via remote access, due to the fact that they have two management points. The first is a computer part that runs a specialized operating system, such as Microsoft, and XP Embedded used by the technician to operate the equipment. The second is a mechanical part that is controlled by circuit board and is accessible by the technician via the serial port running proprietary diagnostic software. To implement full remote access for medical equipment, the IT organization assisting doesn’t always fully understand the dual management points. As a result, IT organizations recommend solutions based on products designed for IT operations, and these solutions do not meet the requirements of biomed telemaintenance.
The issues described have brought challenges that have prohibited organizations from performing efficiently with their respective healthcare facilities. Although the on-site approach can’t be completely eliminated for obvious reasons, there are shortcomings to using it exclusively:
1) It’s slow. Because the engineer has to go on-site for maintenance, the travel time has to be accounted for. This can cause conflict with personal schedules, ultimately effecting repair time.
2) It’s costly. Travel costs are quickly becoming a large expense in most organizations. Because all work is on-site, those travel expenses can quickly grow to be a financial burden. There is also the cost of insuring the vehicles, and possible down time for employee if they have the misfortune of an accident. People rely on this equipment on a daily basis for emergency medical services, and down time can cost people their health, and even their lives.
3) It is reactionary. Due to the nature of on-site repairs, it typically ends up being done in a break-fix manner. This contributes to cost and time needed to properly diagnose and repair. Often, the correct part has to be ordered, or brought at a later time because there was no prior information about the failure. No one can possible carry every part that can cause a failure, and it would not be cost efficient to stock such an inventory for every type of unit in a hospital.

V POTENTIAL SOLUTIONS AND SOUCING
There are several methods, or solutions to build an information infrastructure for RDA. The goal for this type of information system is to implement all access methods for all modalities of medical equipment throughout the hospitals and customers we serve. While doing this, it will be important to remain cost effective during this process, without sacrificing quality of service. To begin, there are commercial off-the-shelf IT products that can centralize current databases, and they have enough data storage capacity. As it now stands, our company is in the process of centralizing our work order software databases into a single source where all equipment serial numbers are easily accessed through your current intranet web browser. Shelf software can account for most equipment modalities, but not older equipment without WIFI, RS-232 protocol, or USB ports.
There are other methods which include in-band, and out-of-band access. A common in-band include virtual private network (VPN). This type of secure gateway enables a remote user to connect to a computer at the office, or allows the IT support to access the computer to troubleshoot a software issue. It has limitations. This system only works well when its operation system is health. It also doesn’t account for the many hospitals and multiple units outside of our region. Our-of-band is a “non-network” access method, which allows a technician to access the medical equipment using a physical connection between the user and the console found on the equipment. With this method, commercial off the shelf products for out-of-band access cannot account for all over-LAN devices designed for Supervisory Control and Data Acquisition applications and KVM-over-LAN for headless server applications. It would be impossible to integrate all these COTS products into a single management point. This sort of bundling would not be ideal for the RDA capability for medical equipment.
Of course, for cost saving measures, the entire project could be simply outsourced (SaaS). With outside parties who specialize in database management, the work load and learning curve for the current staff would be eliminated. Other considerations are:
1) (JAD) joint application design, and (RAD) rapid application design: -time consuming and costly, must be built from ground-up, considerable learning curve
2) Virtualization software: -great concept, good data storage, can run several operating systems at a single time on a single machine, can be accessed anywhere, but clashes with OEM proprietary software
3) Cloud computing: -addresses hardware and software, doesn’t address HIPPA standards for sensitive data such as patient files that can be manipulated, lost, or stolen.

VI RECOMMENDATIONS FOR EXECUTIVE COMMITTEE
There is a new RDA device on the market that is custom build to provide all RDA functions without high cost, complexity, and multiple hardware and software interfaces. This device is known as the Teleconsole. This unique hardware appliance has qualified for all possible RDA methods, and integrates them into a single device with a comprehensive set of port, embedded software, security, and has wireless capabilities. This device can universally transform medical devices with no built-in remote capability into one that is fully ready for telemaintenance.
Teleconsole provides technicians with the ability to remotely perform diagnostic tasks and resolve problems without any time or physical constraints. With new RDA capability, a local maintainer can collaborate with subject matter experts via the “over the shoulder” view of medical device, or the technician can choose secure access through unit components to retrieve error logs, or upgrade configuration files. Because the console has RS-232 protocol, USB ports, DB9 serial ports, it can accommodate almost all equipment types. OEM supplied diagnostic software has been developed to communicate directly with the console port on the medical equipment. This console also has the ability to handle in-band, and out-of-band management operations.
Recommendations (Three -year Timeline)
First year projections are to incorporate the device for basic smart pumps, and the telemetry system that collects the data for these devices. Once the pumps are fully functional, training will follow with these devices, and the daily log file upgrades. Once successful, the console will be integrated into our work order software database.
Second year projections are to incorporate the device for general biomedical equipment that has remote capabilities. This would include all departments outside of sensitive equipment such as x-ray, MRI, ultrasound, and other sensitive data modalities.
Third year projections are to incorporate sensitive high dollar equipment, and complete database upgrades and training. Fortunately, there will be no downsizing, due to the fact that our staff is short handed, and the best resources can be allocated to where it is most needed while saving time, money, and better serving our customers.

The Teleconsole solution resolves the problems of the current medical equipment maintenance model. It provides a standardized secure remote diagnostic access (SRDA) method in a single platform to almost any device, regardless of brand or model. With this platform, CTS can expect improvement in response time, availability of needed equipment; reduce cost, efficiency in unscheduled repairs, and overall improvement in compliance with regulation organizations.

VII ATTATCHMENT

Teleconsole Model of Evolution

VIII REFERENCES

http://www.ejeg.com/issue/download.html?idArticle=171

http://www.wwpi.com/index.php?option=com_content&view=article&id=12676:citrix-unveils-netscaler-sdx-virtual

NETWORK CLOUD COMPUTING-VIRTUAL ENTERPRISE NETWORK ARCHITECTURE http://www.informationweek.com/news/cloud-computing/infrastructure/229301053 Management Information System
Chap 5 IT Infrastructure and Emerging Technologies, power point presentation

Management Information System
Chap 6 Foundation of Business Intelligence: Database Approach to Data Management, power point presentation

11th Edition by Kenneth C. Laudon, and Jane P. Laudon
Management Information Systems: Managing the Digital Firm

Overcoming Cloud Computing’s Biggest Challenge: Virtual Networking http://www.stonesoft.com/en/press_and_media/releases/en/2010/14042010.htm Concepteers Teleconsole Family Version 2.0 http://www.concepteers.com http://knowledge.wpcarey.asu.edu/article.cfm?articleid=1614 http://www.wisegeek.com/what-are-remote-diagnostics.htm http://www.ncbi.nlm.nih.gov/pubmed/10537671 http://www.abb.com/service/seitp335/4bc6960aea228350c12571950054c99f.aspx http://en.wikipedia.org/wiki/Software_as_a_service