Several trends are shaping the need for remote diagnostics in medical equipment. For one, medical devices are growing more sophisticated all the time. It would be difficult to find a machine without some sort of computer control.

Another is that hospital IT staffs are fairly lean compared to corporate America. So downstream technology support in health-care is minimal. That means lab and nursing staffs have little time to monitor equipment. And lastly, medical-equipment builders are under pressure to differentiate themselves by bringing value to their equipment. Remote diagnostics, or intelligent device management (IDM), is one strategy that serves the trends.

The benefit of adding IDM to medical equipment is more than a convenience feature. Take a particular blood analyzer, for instance. It sent a notice to a maintenance center that its readings were drifting out of an accepted accuracy band. The remote maintenance staff confirmed that a substrate was running low and notified the lab to discard the machine's reports. After refilling the fluids, the staff reran the tests and got different figures. So remote monitoring and prompt action from the maintenance staff prevented a misdiagnoses.

Intelligent device monitoring extends beyond the lab as well. For example, hospital nursing staffs carry high work loads which leads to transcription errors. Remote downloads from smart equipment solves the two problems at once. Downloading data takes no human intervention and transcription errors are eliminated. In addition, technology allows sending data to more than one place. For instance, information from blood tests can be sent to patient records and labs.

Adding remote monitoring also lets manufacturers “watch” their products in the field and collect data on how it is being used. The data lets medical-device manufacturers better plan features for future models.

Remote monitoring

A few years ago when a machine malfunctioned, a lab technician would have to notice the problem and call a repair technician to the site. “The first thing that person would do is plug in their laptop computer to the machine through its serial port and run through several tests,” says Emil Wang, CEO of Questra Corp., Redwood City, Calif. “If that is possible locally with a piece of equipment, why not plug in remotely over the Internet?”

Wang's company develops software that provides remote diagnostics. In general, expensive equipment is outfitted with IDM. Good candidates are CAT scanners, MRI and X-ray equipment, and other capital-intensive equipment with support contracts.

“Two pieces of software are needed,” says Questra VP Walt Rossi. “A Control Center installed in the service center of the medical-device manufacturer. It runs on Windows and different flavors of Unix. A smaller program called a Service Agent gets installed either on the device or a computer running the device. The Agent can also be embedded in the equipment. The Service Agent communicates in real time with the control center over the Internet.”

Remotely monitoring equipment changes the relationship between customer and client. Without IDM, hospitals and labs must decide whether or not equipment is working. “But with sophisticated products, it can be broken or just not working right,” says Wang. Take an MRI machine, for example. The magnets might be out of calibration so it's not working right. But the operator might not be able to tell.

Rossi says installing Questra software is similar to typical enterprise applications: It comes prepared for a job so there is no real programming by the equipment manufacturer. He says the company assists with installation, and the service team gets the software working. It's like using Excel - most people know how to use it, but they don't program it.

Most IDM software developers offer a range of capability. “The first thing a manufacturer wants to know about its equipment is: ‘How's it doing? Is it working or not?’” says Wang. “This is a task for monitoring software. If something happens, alarm software should notify the service department. And if something is wrong, you'd like to go in and do some diagnoses.”

Online diagnoses are near instantaneous because most labs keep equipment online 24/7, adds Wang. Occasionally, fixes can be made remotely. “Of course, if a physical component needs replacing, a repair person must be sent. But maintenance staff can start solving problems instead of waiting for someone to show up and run a few tests.”

Users might discover that a machine is running an older version of software and needs an updated version. “Updating software is now a remote operation. In fact, built-in business rules let the machine's computer run tests the technician would have run. A rule might be that when a particular error code pops up, check the customer service database to see if this is a known bug. If so, look for an existing fix. If there is one, see if the machine has it. If not, download the fix. And when the machine cannot cure itself, get a person involved,” says Wang.

In the same way alarms are sent to browsers on computers, they can also be sent to wireless devices such as a handheld computer or PDA. “It's just another mechanism.”

Network me

Even equipment designed without the initial intention of a network connection can be retrofitted with IDM. For example, Lantronix, Irvine, Calif., develops several device servers that attach to a device's serial port. Data from mobile equipment can be sent from wireless connections to hospital networks. Access to what a medical machine is doing opens several doors. “For example, meter readings suggesting an error to remote technicians could lead them to instruct equipment to limit a particular operation until corrective action is taken,” says Lantronix manager Mark Prowten.

“The easiest and quickest way to add connectivity is with external device servers,” says Prowten. “Almost any equipment can be put online as long as it has a serial interface. From there we provide connections and access to wired or wireless networks.”

The WiBox, another Lantronix product, retrofits onto existing equipment so it can be accessed remotely by 802.11 wireless. Wired or wireless connections are typical for equipment without Ethernet designed into it. “An external device server is good way to go for companies that want to offer an option of network connectivity, or for a connection to legacy device,” adds Prowten.

Devices from Lantronix provide connectivity to machines or equipment, but not diagnostic software. However, the company provides software that simultaneously monitors several devices. “Engineers could have events show up for diagnostics, or data could come into a storage facility,” says Lantronix's Jerry Kornblau. “For example, the XPort, an embedded device server, provides connectivity by Ethernet. It's a miniature computer with a processor, OS, protocol stack, and I/O, Ethernet and serial connections.”

Putting remote diagnostics to work

The Immulite series of random-access analyzers for hospital and reference labs now includes real-time monitoring. “We moved to intelligent-device-management software to monitor instrument functions for predictive failures,” says Linda Tucci, director of service at DPC Inc., Los Angeles, (dpcweb.com), a manufacturer of medical diagnostic equipment. “We monitor system logs for frequency of events, such as self-correcting jams. Increased frequency of such events within a certain period indicates a more serious problem.”

Remote diagnostics in analyzers work like this: Software gathers performance data and sends it by Internet to a service center. It is sifted and analyzed by Questra software based on business rules and parameters established by DPC. Software also analyzes instrument performance data and location, day of week, time of day, and sends email alerts to its service team. They evaluate the alert, review event-log files, and consult with field service to confirm the plan of action is sound. The team then calls the client and resolves the issue over the phone or arranges a service visit for a time that won't disrupt lab operations.

Tucci says troubleshooting tools should not require user intervention. “A lot of what we do needs a real-time connection so we can minimize operator intervention from the other end.”

This type of remote service relies on high-speed connections to hospital networks. A PC holds service-agent software which collects performance data. DPC also dumps event logs daily when the lab signs off. “Wireless connections are under investigation, but for the amount of data moved, we prefer not to use modems,” adds Tucci.

She says timing is right for remote diagnostics because hospitals are losing analytical skills as lab staffing levels continue to fall, and labs must do more with less while the systems they manage are more complex. So equipment developers should make service transparent to customers without interrupting work.

Until recently, trouble-shooting equipment was customer driven. “They would call because of an event and we would help determine the problem at hand,” says Tucci.

But the paradigm has shifted. “Our first remote trouble-shooting in 1998 required operator intervention but gave access to system features and let service staff remotely drive the instrument,” says Tucci. “In 2002, we launched remote services using intelligent-device management. It can monitor characteristics users are not even aware of, and in doing so increases equipment uptime. When necessary, we ensure the right field service person with the right part is on site. The first-time fix rates are now higher, and call-back rates are lower.”

A problem with networks

For every problem technology solves, it uncovers another, suggests Lantronix's Mark Prowten. “For example, legacy software on medical equipment can become an obstacle because early devices were not designed to be networked,” he says. Putting something on a network usually exposes a flaw, so to speak. For instance, software written with tight timing constraints between device and software might not allow communication over the network because network latency adds time which may cause the software to ‘error out’. As time goes on, most software engineers figure that out.

Also, putting devices on the network calls for some way to manage them. “That's a dilemma for the engineering company because they don't know what they want or need. So they are not sure what is relevant for them.”

Security is another opportunity and problem, adds Prowten. Put a device on a wired network and only people in the organization can access it. It's thought to be secure. But statistics from security organizations say threats are usually internal, not external. “So you also have to protect devices against those with access,” says Prowten. “In these case, encryption can be useful.”

Wireless connections introduce different security issues. A false sense of security comes with encryption for the wireless part of the transmission. But once the signals hits the wire, it's clear text and available to intercept.