Smaller, smarter technology offers new freedom—Philips Respironics EverGo

The exact definition of “smart product” is an elusive thing these days, and it ultimately depends on whom you ask. In the purest sense of the word, a smart piece of equipment uses its electronic brain to detect and adjust to human interaction. The BiPAP AVAPS noninvasive home ventilator from Philips Respironics fits this definition because the AVAPS (average volume assured pressure support) algorithm provides an average tidal volume, and automatically adapts pressure support to meet the patient’s needs. “With a dumb product, you set it and it does not know if there is a patient connected to it or not,” says Bob McCoy, RRT, managing director, Valley Inspired Products, Apple Valley, Minn. “It operates without any understanding of what it is doing in relation to patients. Smart products try to respond to patients.”

Consumer gadgets such as cell phones tend to set the pace when it comes to high technology, and health care often scrambles to catch up. Smart homes received a lot of publicity in recent years with no edifice garnering more notoriety than Bill Gates’ house. Huge corporations are getting into the act, making it possible for home owners to program sprinklers that turn off when it rains, send video of pets to their cell phone, and even warm up the pool on their way home.

If houses can be smart, medical equipment cannot be far behind. The idea of a home “thinking” for the owner is analogous to respiratory devices making adjustments for clinicians. For RTs with many patients and increasingly varied responsibilities, better equipment can relieve some of the burden. “Newer mechanical ventilators have the ability to adjust based on patient breathing,” says Vernon R. Pertelle, MBA, RRT, senior director/assistant vice president for the Tri-City Healthcare District, Oceanside, Calif. “A mode on the ventilator can deliver a set rate for the patient if they are not breathing. But if they are breathing, it also allows them to breathe on their own using their own breathing rate, which helps patients wean off a lot quicker—without involving the respiratory therapist.”

Respiratory veteran Pertelle counts the new machines as a considerable advance over the old days when RTs routinely had to go in—many still do—and put patients on altogether different ventilator devices. “RTs then stayed with patients to make sure they could tolerate it,” Pertelle adds. “So it was time consuming. Nowadays, with reimbursement being so poor, smart technology is even more valuable because you have the ability to do more without taking up more of the RT’s time.”

Technology Threatens Some

RTs typically view new bells and whistles with a healthy amount of skepticism. If studies do not prove better patient outcomes, there is a natural hesitancy to adopt new technology. “Even if we don’t have proof that putting intelligence in machines improves patient care—at the very least, it cuts the cost because it reduces the amount of human labor that is necessary,” says Robert L. Chatburn, RRT-NPS, FAARC. “I think smart technology has a vast potential for increasing the level and quality of patient care for no other reason than machines are more consistent.”

As smart products progress over time, experts say that pushback is inevitable. Chatburn, who serves as clinical research manager for the respiratory therapy section at the Cleveland Clinic, says that part of that resistance is a natural resistance to change. “RTs see smart technology as a threat to their authority,” explains Chatburn, also an associate professor of medicine at Cleveland’s Case Western Reserve University. “They are used to a certain culture, and if you remove pieces of that culture and offload it to machines, it forces change upon them. It forces them to bring their assessment skills to a new level and look at things in a different way—and humans don’t like to do that.”

Much the same can be said of other health care professionals beyond the respiratory world. “Everyone wants improvement, but nobody wants change,” laments Chatburn. “As machines get smarter, we have to likewise become smarter and be able to see the overall picture. We have to think in systems. People probably resisted autopilots on planes, but autopilots made flying safer and did not decrease the [number] of pilots in the sky. Pilots just got trained in a different way and everybody benefited.”

With time and money inextricably linked in today’s tough economic climate, the definition of “smart” can branch out to mean economically smart, or even just more efficient. Jay Vreeland at Philips Respironics Home Healthcare Solutions, Murrysville, Pa, sees customers who are hungry for products that can solve both business and clinical needs. “We have our Freedom series, which is our EverFlow and our EverGo portable concentrator,” says Vreeland, who serves as the company’s director of US marketing for home respiratory care. “Patients can use the EverFlow as a stationary concentrator in the home and the EverGo allows them to travel. To us, that is a nice solution where patients get a robust concentrator to use in the home. It makes sense clinically and from a business standpoint. With the older business model, the patients were getting cylinders.”

Almost anything is possible with smaller, smarter technology.

Better Is Smarter

Over the past few years, RTs have seen a massive push from manufacturers to lighten portable oxygen concentrators (POCs), increase battery life, and necessitate fewer maintenance calls—all of which are advantages over older, bigger, and dumber products. Many of these features fall under the smart umbrella simply because they make more sense. When you factor in the narrower definition, a smart respiratory product should also adapt to the needs of the patient. “A smart product is dynamic, not static. If the patients’ needs change, the equipment should evolve and change with them—improving compliance and outcomes,” says Ron Richard, RRT, CEO of San Diego-based SeQual Technologies. “Smart technology should have components built in that provide feedback. In the case of our product, the Eclipse, we have a feature called AutoSat, which actually looks at a patient’s breath rate.”

Richard explains that as breath rate indicates input or uptake, the machine actively calculates motor speed, valve speed, and interactions of other components—all of which help produce more consistent oxygen levels. “It would be akin to cruise control in your car that adjusts power based on the needs of the terrain,” Richard says. “In the case of AutoSat, patients don’t always breathe at 10 breaths a minute. They breathe at 10 breaths a minute while they’re sitting watching TV, 15 breaths with light exertion, and sometimes 20 to 30 a minute in a pulmonary exercise program. AutoSat adjusts and adapts to the patient’s demand. Smart technology in this case is helping to improve outcomes and efficacy.”

In the never-ending race to build a better mousetrap, the definition of smart has expanded to include products that simply have more logical interfaces and are easier to use. Another growing concern is ensuring that complex machines work properly, a task that can increasingly be performed “smartly” from great distances. SeQual’s Eclipse Diagnostic Acquisition Tool (EDAT) is a new product that combines telemedicine and smart technology via the Internet.

The EDAT gives therapists the ability to look at a portable oxygen device from virtually anywhere, as long as they have the software and the correct elements installed on their computers. “It improves uptime, reduces downtime, and increases the amount of time the device can be out generating revenue and being used on a patient, rather than being in a shop,” Richard explains. “I think that long-term oxygen therapy is going to evolve in a similar direction as what we’ve seen happen in obstructive sleep apnea, where we are looking at compliance data.”

In addition to the natural resistance to change, Richard says RTs and consumers in general are reluctant to quickly adopt new technology because they often fear the new product will quickly become obsolete. “You never know when the next better mouse trap is going to come out,” Richard says. “You have early adopters, and others who wait to work out the bugs and software problems. For portable oxygen, we’ve had the early adopters, and people are now starting to see that it is a reliable quality product, and they have identified a population of patients that it works well for. Pricing has stabilized, and you’re starting to see it become more mainstream.”

Another key to mainstreaming so-called smart technology is making it cost-effective. Ultimately, it’s up to manufacturers to chart a reimbursement course sometimes years in advance. In the case of telemonitoring, opportunities abound to network once-disparate elements and keep a better eye on patients. The Philips Respironics entry into this market is called Encore Anywhere, a product that Gretchen Jezerc, marketing director for the company’s sleep disordered breathing sector, says was created with reimbursement firmly in mind. “We proactively applied for a code for compliance monitoring equipment,” Jezerc says, “and that is the A9279 code that was established about a year ago.”

Encore Anywhere is a Web-based system that manages patient records, develops patient reports, and tracks treatment progress. Company officials say that compliance data can be automatically uploaded on a daily basis via a wired modem, with prescription changes automatically communicated back to the patient’s device. The care team, including RTs, physicians, and clinicians, can all access the same information and communicate via notification messages.

All of these capabilities point squarely at “integration,” a smart concept that experts agree is the next big buzzword. “Integration is essentially the ability to track, treat, and observe a variety of disease states even beyond OSA,” Jezerc says. “There are so many comorbidities associated with sleep apnea, such as cardiovascular disease, diabetes, obesity, and other interrelated conditions. While you have a unit in place that can be transmitting information about the patient’s apnea-hypopnea index or a possible leak, other disease parameters could be tracked and transported through that same data management system.”

Over at the Cleveland Clinic, Chatburn points out that there is still plenty of potential for connectivity via the Internet. “You might have a blood pressure device connected to an IV pump, which is connected to a cardiac monitor—and all these devices are talking to each other,” Chatburn says. “It’s going to be a network of distributed intelligence. The power from that is you have multiple feedback points and the synergy that comes from that. It takes the huge burden of data collection that we have now and turns it over to a network.”

For RTs who fear the prospect of turning over job functions and/or decision-making to smart machines, Chatburn thinks the concern is unfounded. Ultimately, he says, it will be up to RTs to decide what to do with the information that gets collected. “There is a difference between intelligence and wisdom,” he says. “Intelligence is just a set of facts, and wisdom is knowing when and how to act. Knowledge is no substitute for wisdom.”

Greg Thompson is a contributing writer to RT. For further information, contact [email protected].