Premarket vs. Postmarket Connectivity

By Lawrence Lloyd
Published: January 18, 2011

This morning I came across a press release for Capsule, which calls itself the leading provider of medical device connectivity for hospitals. (If you're curious, the press release itself wasn't really breaking news—it was just let people know that Capsule "continues to lead" this movement.) What was interesting was that it highlighted the different approaches for medical device connectivity. One school of thought says that manufacturers should be designing features into their medical devices that facilitate interoperability. Capsule, however, is capitalizing on the fact that most OEMs have kept their systems and technology proprietary.
 
"We are continually working to ensure we can deliver connectivity to virtually any device and system a hospital needs. This includes the mainstream and legacy devices a hospital has, as well as highly innovative devices that improve the standard of care. We can deliver this level of support because of our posture of vendor neutrality and our established relationships with nearly every medical device manufacturer," says Neil Henry, Capsule's product manager of device interfaces.
 
Many forward-looking industry observers say that interoperability saves lots of time and money in the long run. Is there room for both approaches here? Capsule already claims to be able to "connect virtually any medical device to any information system," which apparently includes 98% of all patient monitoring equipment, 99% of all infusion systems, 97% of all ventilators, and "an impressive list" of pulse oximeters and critical care beds. Or should a company like Capsule be involved in the design stages? —Lawrence Lloyd

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Yes, yes and maybe

Submitted by Connectologist on January 20, 2011 - 8:27pm.

Connectivity is such a moving target: the technology, OEM solutions (i.e., postmarket connectivity), and market requirements are constantly changing. Another key factor in deciding pre- or postmarket connectivity are the medical device manufacturer's product roadmap and strategies.

When you look at mature connectivity markets, like diagnostic imaging, all the modalities have premarket connectivity with 1) network connectivity, 2) appropriate DICOM services, and 3) have modified their embedded system's user interface to handle the necessary workflow automation. In the early Naughties, many modalities had DICOM acquisition boxes that used the vendor's proprietary serial protocol or video frame grabbers and provided a user interface for worklist management (patient demographics and the order), image acquisition, editing and storing to the PACS.

Modality vendors dropped third party acquisition devices for a number of good reasons like regaining control over a new and important group of features and avoiding the incremental cost burden of postmarket connectivity on their modalities.

Postmarket connectivity solutions are a transitional step for those medical device manufacturers who do not go the built in route right away. And of course the post market approach makes sense for hospitals who don't fancy replacing all of their perfectly adequate bedside medical devices so they can buy new models with connectivity built in (if they're even available from manufacturers.

One difference between the evolution of connectivity in radiology and bedside devices is that some of the postmarket connectivity solutions aim to do more than just acquire data for clinical documentation in EMRs. There are many patient-centric tasks that aren't practical for a medical device vendor's proprietary approach (e.g., messaging/alarm notification, patient-centric decision support systems, device interoperability).

Another contrast with imaging modalities is that bedside medical devices are greater in number than imaging modalities, and are often used for many more years before they're replaced. This factor will play to postmarket connectivity vendor's advantage.