How a Washing Machine Inspired Me to See the Future of a Safer ICU

Berg, the company the brought along fun internet-connected concepts and products such as the Little Printer released this interesting video recently.

[vimeo=87522764 W=900&H=325]

The amazing part of this is that Cloudwash is foundational and will just be built on. It shows where the current state of the Internet of Things is and where it can go in the future. What Berg did was amazing to me.

It took a regular “dumb” appliance with software and electronics that were trapped in and made the interaction richer and its meaning and value richer.

In a way, they radically changed the way I viewed how devices could be connected and created the possibility for a new class of devices in our daily lives.

And in a way, I saw so many parallels to healthcare.

In the video, Berg mentioned how the action of washing clothes can be quite complicated. There are baroque symbols on how clothes should be treated and this in turn is reflected by different sets of complicated icons on machines

Healthcare delivery can be far more complex though.

“In any given hospital, as many as 15 medical devices, including monitors, ventilators and infusion pumps, are connected to an ICU patient, but because they are made by different companies, they don’t “talk” with one another. Patient-controlled analgesic pumps that deliver powerful narcotics, where a known side effect is respiratory depression, aren’t linked to devices that monitor breathing, for example.”Today’s ICU is arguably more dangerous than ever,” says Peter Pronovost.

Just last week, I had the privilege of shadowing the pain service team at work. The team had to go one by one to each patient while rounding throughout the hospital. At each patient, a nurse practitioner checked their PCA. These are supposed to the safest ways to deliver analgesics and are self-containing boxes that are locked except for their interface.

No one except the pain service team is supposed to even touch those boxes due to the level of training needed to even interface with them. But it relies on human systems to ensure that the correct concentration of drug is put in with the right dosage according to each patient.

Yet like Dr. Pronovost mentions, these pumps aren’t linked to devices that monitor breathing so that IF a wrong dosage is placed in the PCA, there is no way of stopping it before its too late.

Now imagine if they were connected through something like the Berg Cloud? We could create something with a clearer UI. The machine would be able to say a lot less but do so much more. With a relatively small intervention of a Berg microcontroller and dev board, we can bring ICU medical devices into the networked world and finally have them “talk” to each other.

When a respiratory rate reaches dangerous levels, the PCA pump can automatically shut down.

Not only will these devices make the ICU safer, they can also make it far more patient centered. The Berg cloudwash was incredibly user-focused. It took a complex interface and simplified it and allowed to to be controlled from anywhere by phone. It even had a quite mode for the evenings. Now imaging something similar applied to an ICU unit.

Noise and distraction is always a constant presence and makes the ICU the opposite of patient and family friendly. With internet connected medical devices, we could create alerts to notify nurses on their pagers, smartphones, or even a LE bluetooth-enabled wearable when there is an alarm.

It would get their attention without creating the shrill alarms associated with medical machines.

In another parallel, cloudwash is enabled for dorms or shared laundry machines so that you can keep track and know when someone else has a wash going. A device connected to the cloud means that everyone will be able to keep track of what’s happening.

Sounds like a great way to keep care teams coordinated on how their patients are doing too! This isn’t even science fiction.

It’s already being done in ICUs at Johns Hopkins Hospital as part of project EMERGE where teams (and families) are able to keep track of their daily goals and patient conditions. Now imagine that in the previous situation, the respiratory rate decreases automatically shutting off the PCA and notifying a nurse during quiet hours by having her wearable device vibrate.

She could then go to a patient dashboard and see exactly what is happening.

Simultaneously, the patient’s physician, resident, and the intensivist also get the alarm and are able to assign tasks to each other on how to respond. Within a few minutes, they are able to convene at the patient’s side and inform the family of what is happening and determine that the analgesic dosage had been too high and are able to remove it and replace it with the right dosage without harm coming to the patient.

This is the future of a safer ICU using the internet of things…and the technology is already here.

Kevin Wang (@kvnwang) is a quality improvement fellow at Columbia University Medical Center.

5 replies »

  1. The Internet of Things is expanding exponentially everywhere … except healthcare. Interop of data systems is still *such* a thorny issue (thank you, Old Skool Vendor Lock-in Thinking Syndrome), but I’ve long shared your vision of an interconnection that enables and accelerates getting from sick/hurt back to well.

    I hope more front line clinical folks are having your same lightbulb moment, because if those lightbulb-illuminated clinicians align with us peeps (commonly called “patients”) who’ve seen this same light … we could make some real magic happen.

  2. Hi Ms. Sprague,

    Apologies if that came out brusque. Of course, the providers should keep the patient at the center of everything they do. The numbers are always just an indication on the state of the patient. But when patients are unresponsive, its just as critical knowing their current state rather than waiting for the worst to happen. But the patient should always be the focus.

  3. Hi John,

    Thanks for taking the time to respond. It’s exactly that kind of issue that I was taking aim at with this article. Initiatives such as Project EMERGE came about because they were taking aim at connecting the ICU’s personnel and make sure all tasks are accomplished with accountability to the family.

    But its not enough just to make sure that healthcare personnel do everything. Technology is supposed to make things easier for us, not to put us in danger.

    The amazing thing is that the technology to make Thing A talk to Thing B is already here but we just need to show initiative and experiment with that in a simulation lab. AHRQ is offering up to $1 million for this! http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-14-005.html

  4. Mr Wang- “She could then go to a patient dashboard and see exactly what is happening.”

    Is this the best this system can offer? How about “she could then go look at the patient to see what is happening.”

    Who are we taking care of? The patient’s digital doppelganger or the real patient?

  5. This is example of the kind of thing that can be done once we build a system where Thing A can talk to Thing B. We’re clearly overloading providers with way too much information and running the risk of building a completely unmanageable system, something that cannot happen when lives are at stake and the “data” is linked to a heartbeat.