Design Paper - Vanderbilt University

fortunabrontideInternet and Web Development

Nov 13, 2013 (3 years and 7 months ago)

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BabyView
:

Real Time Monitoring of

Neonatal Intensive Care Patients



Erin L Scott

Advisor: Dr. Bill Walsh



Abstract:

Vanderbilt Children’s Hospital serves as a regional referral center for the middle
Tennessee Region. Families often commute hundre
ds of miles to be with their children
during their stay at Vanderbilt. The Neonatal Intensive Care Unit (NICU) at Vanderbilt
Children’s Hospital receives over 500 transports a year from over a 100
-
mile radius. The
average stay of a patient in the NICU is

17 days, with a daily patient cost of $2,000. The
new NICU has 44 beds, most of which are located in private rooms. One of the goals of
this project is to provide a way the family of NICU patients can stay connected after the
family must return home. O
ne possible solution is to provide a website for each child
with a live image of the patient and current patient information. An Internet Camera with
a built in web server would allow live images to be fed to a server. An additional goal of
the project i
s to provide another way for the hospital staff to monitor patients. Currently
the NICU has cameras monitoring the NICU, however, these cameras mainly serve a
security capacity. A program that provided a monitoring tool and a page where patients’
familie
s could stay connected with their children would be of great use. JAVA and
HTML were used to develop the program prototype. Tomcat 4.1 from Apache Group
was used a container server. The BabyView Program requires a substantial initial
economic investmen
t, especially compared to the incumbent technologies. However, the
yearly costs to run BabyView are substantially less than the incumbent technologies. The
life cycle of this product is expected to be less than five years.
The BabyView Program
proves to

be both technologically and economically feasible for the Vanderbilt NICU to
continue to pursue.



Introduction:


On February 8 of this year, Vanderbilt Children’s Hospital opened its new
building, the Monroe Carell Jr. Children’s Hospital. The new ho
spital is designed around
caring for both the patient and the family. Family involvement is considered a critical
part of patient care at the Vanderbilt Children’s Hospital. Vanderbilt Children’s Hospital
serves as a regional referral center for the midd
le Tennessee Region. Families often
commute hundreds of miles to be with their children during their stay at Vanderbilt. In
2004, it is expected that there will be 9,000 inpatients and 35,000 ER visits to the
Children’s Hospital.

The Neonatal Intensive C
are Unit is no exception to these characteristics. The
Neonatal Intensive Care Unit (NICU) at Vanderbilt Children’s Hospital receives over 500
transports a year from over a 100
-
mile radius. The average stay of a patient in the NICU
is 17 days, with a dai
ly patient cost of $2,000. The new NICU has 44 beds, most of
which are located in private rooms. A few larger rooms, “twin rooms” contain two beds.
The new NICU has been built around meeting family needs. Next to each bed there is a
phone line and Ethe
rnet port that is for the family’s use only. In addition, a family
waiting area and family business center is located on the same floor. The new NICU has
utilized new technology to improve the safety and efficiency of the NICU. At the
entrance to the NI
CU a camera allows staff to identify new visitors before letting them in
to the facility. Similarly, cameras throughout the NICU are monitored on televisions in
the nurses’ stations.



One of the goals of this project is to provide a way the family of N
ICU patients
can stay connected after the family must return home. One possible solution is to provide
a website for each child with a picture and current patient information. Hospitals have
taken many different approaches to this technique. Some hospit
als independently create
a website that is unique to their hospital. These independent websites have varying
degree of complexity from hospital to hospital. Most of the independent hospital
websites are provided to the family free of charge. Other hospi
tals hire outside
companies that provide online nursery programs. The largest company of this type is
Growing Family WebNursery. GrowingFamily requires that hospitals using its service
take professional quality images of each child. The hospital upload
s the images to
GrowingFamily’s website with the patient’s name and brief information. Growing
Family puts these pictures together into a website for each child. For the family to use
this service, the family must purchase the pictures the hospital took.

This service requires
the hospital to purchase digital cameras and a computer.


Another technology that utilizes new technology to support the families of NICU
patients is Baby CareLink. This program at Beth Israel Deaconess Medical Center allows
for
exchange of information between the family, staff, and other medical providers
through videoconferencing and the Internet after the patient is discharged.
i



An additional goal of the project is to provide another way for the hospital staff to
monitor pat
ients. Currently the NICU has cameras monitoring the NICU, however, these
cameras mainly serve a security capacity. Integrating patient live footage from the
hospital rooms into the nurse’s station would build upon the already present
infrastructure.


Methodology:


One of the goals of this project is to provide families of NICU patients with a way
to stay connected and informed about their child’s progress. Since patients in the NICU
are undergoing critical care there are important design constraints f
or any solution.
These constraints include that any devices used for this program cannot interfere with the
medical equipment. In addition, the cost and staff requirements of using the program for
the NICU must be minimized. Specifically, development,

deployment and maintenance
costs must be controlled, as Vanderbilt Children’s Hospital would like to provide this
service free of charge to patients. Similarly, any requirements on the NICU staff must be
controlled, as their jobs are not to as profession
al photographers or web
-
technicians.
Finally, the project must meet HIPAA regulations.


It was decided that a web based program that allows family members of NICU
patients to login to see live images of their children and
patient information would prov
ide a unique way for the
family to stay connected to their children, even when
hundreds of miles away. A stand alone Internet camera
with an Ethernet connection and built in CPU and web
server was purposed as way to provide images of the
patient throughou
t their stay in the NICU without taking NICU staff away from their
normal duties. A stand
-
alone device would allow an Internet camera to be used without a
computer connected to the camera. This reduces both the complexity and cost of the
setup of the pro
ject for each bed. Internet cameras are available for prices between $75

Figure 1:D
-
Link DCS
-
2100+


and $300 depending on image quality, camera size, and
other features. There are very few Ethernet connections
in the old Vanderbilt Children’s NICU. In addition, most
of these conn
ections were a substantial distance from the
beds. As a result of these design constraints wireless
Internet cameras were decided upon to provide images.
The D
-
Link DCS 2100+ wireless Internet camera was chosen based on its quality,
affordability, and ab
ility to operate on Vanderbilt’s network. The camera’s dimensions
are 5.3in x 3.5in x 2.2 in and weighs 0.7lbs. The camera connects directly to both
802.11b and 802.11g networks. Vanderbilt University and Medical Center are
configured with 802.11b wire
less coverage, although Vanderbilt Children’s Hospital will
be converted to 802.11g within two months
ii
.

Some problems were experienced with connecting the D
-
Link camera to the
Cisco wireless network despite assurances from D
-
Link that the two were compati
ble.
While working on this problem, the new Vanderbilt Children’s Hospital opened. During
a visit to the new NICU it was discovered the family designated phone lines in each room
also had an Ethernet port. This resulted in switching the design from a wi
reless Internet
camera to a hard
-
wired camera. The D
-
Link DCS
-
2100+ was still used for the prototype
in its hard
-
wired form.


JAVA and HTML were used to develop the program. JAVA programming
language was chosen because of the ability of a JAVA program to

run cross platform
iii
,
iv
.
JAVA servlets are compiled once into an intermediate language of JAVA bytecodes
v
. A
JAVA interpreter, JVM, parses and runs the bytecode each time the program is run.


Figure 2: Typical NICU Room


Tomcat 4.1 from Apache Group was used a container server. Tom
cat triggers and
runs the JVM, JAVA interpreter, and then outputs the results to the web page
vi
. Tomcat
is open source.


A database was needed for storage of patient information for the camera URLs
and for baby information. Initially Caspio Bridge was r
ecommended for the database
because of it ease of use for new users
vii
. However, inexperience with database
knowledge limited my understanding of Caspio Bridge. Members of the databases class
at Vanderbilt were approached for advice about the database and

getting the database to
communicate with the JAVA program through the administration pages. MySQL was
recommended because of its reliability and open source availability. NASA, Lucent, and
Siemens are among the organizations that depend upon MySQL
viii
. My
SQL Database
Server 4.0.18 was used for this program. Despite switching to a database that more
efficiently communicates with the JAVA program, it still proved quite difficult and above
my skill level and while the program follows my design the administra
tive pages and
database were created by more experienced programmers and edited for the BabyView
needs
ix
.


The program itself was created in stages. Initially, page storyboards were created
to plan the layout of the program. Then the initial JAVA progr
am was developed. This
program distinguished different logins for family members and hospital staff. The family
member page logins pull up an image on the correct child and the hospital staff login
pulls up a monitor page that includes images of all the
patients. After this was developed
the html pages surrounding it were developed. Once this was tested, the patient
information portion of the JAVA program was created. This required creating the
MySQL database in conjunction with adding the patient info
rmation section. Finally, the
administration pages were developed.



Results:

The patient information that the program displays with the image is an important.
This information provides a resource for the parents. However, the amount of
information an
d the frequency with which the information is updated adds additional time
constraints to the hospital staff. Understanding these constraints, the information
displayed for each patient is the same information that is displayed on a card in each
infant ro
om. This information includes the names of the individuals caring for the
patient. These individuals include the child’s attending, fellow(s), resident(s), intern(s),
NNP(s), social worker, and caseworker. In addition, the team assignment is displayed.


While this project does not have as many safety concerns as a device might, there
an issues, which should be addressed especially considering both the physical and social
environment the program will be used under. Physically the program and camera syste
m
is running in a mission critical environment, the NICU. For these reasons it is important
to minimize conflicts with the medical equipment and interfering with the medical staffs
duties. Possible conflicts with other equipment could include electrical
malfunctions
with the Internet camera that causes surges or broken fuses in the NICU room. Should
other equipment be connected to the same fuse, serious problems could arise.
Mechanically, the camera itself, and the electrical and Ethernet cord, provides

an
additional hazard in the NICU. The camera itself could fall off its connections and fall
onto, possibly damaging, other equipment. The cords could prove a tripping hazard for
staff. The program itself could fail because of a down server or network c
onnection or
because of an error in the program. Failure of the program could cause additional stress
on the family. Program failure could cause the family to believe their child’s condition
has worsened. To reduce stress associated with possible progra
m failure, proper
warnings on the program explain that connectivity could be disrupted. Additional
warnings explain that cameras may display images of empty beds during routine
procedures, such as when the infant is being rocked. In addition, laminated s
igns could
be placed in the bed to say the bed saying that the patient is away being “rocked”,
“weighed” or “receiving routine procedure” to calm possible fears parents might have at
seeing an empty bed.


Similarly, images of critical patients receiving
invasive care do not provide a
service to family. To control the medical level of patients using the BabyView program a
protocol was developed with Dr. Walsh. All patients must be in the NICU for at least
three days before they are eligible for the BabyV
iew program. This is in part because
family members are generally with their children for the first part of the stay. In addition,
patients on ventilators are not eligible for the BabyView program. Finally, the patient’s
medical team and guardian must s
ign off for the patient’s participation.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
regulates identifiable health data. The images and patient information provided by this
website are for patient’s guardians and approved medic
al personnel only. Secure logins
and connections for the website will be used to insure the Protected Health Information
(PHI) is controlled.


Economics and Market Concerns:


The BabyView Program requires a substantial initial investment. Especially
compared to the incumbent technologies. However, BabyView requires substantially
daily attention by the medical team as
Figure 3

demonstrates.



This cost model makes the following assumptions:



44 Internet Cameras are required for BabyView at a cost of $1
50/each



Two profession grade digital cameras are required for GrowingFamily at a cost of
$1500/each
x



Two medium quality digital cameras are required for an independent hospital at a
cost of $150/each



All hospitals require a computer at the cost of $500/eac
h



All programs only work on weekdays



BabyView* (VU)

GrowingFamily

Independent Hospital

Equi
pment







Camera(s)

6600

3000

600

Computer

500

500

500

Server

3000

0

3000

Development







Website/JAVA

0

0

1500

Database

0

0

500

Staffing/Year







Daily Picture Taking/Loading on Website

0

14625

14625

Cataloging Information

2925

0

2925

Main
tenance/Year







Equipment Maintenance

100

100

10

Website Maintenance

0

0

100

Setup Costs

10100

3500

6100

Total Costs over 3 years

19175

47675

59350

Figure 3: Cost Break Down of BabyView and Incumbent Technologies.



BabyView development and deployment will utilize the skills and student
resources of the Biomedical Engineering Department



Less than 5 new patients are cataloged a day



Cataloging requires less than 20 minutes of medica
l staff attention a day at a
average medical staff hourly rate of $45/hour



Static Images take 15 minutes / patient to take and load onto the server and are
performed by medical staff at an hourly rate of $45/hour



Maintenance is performed by in
-
house techni
cians with limited additional costs
for parts


The BabyView Program hopes to be a free service provided to all Vanderbilt
NICU patients. However, not all patients will meet the minimum stay or other protocol
requirements to be eligible for the program in a
ddition to having parental consent. Over
500 patients visit the Vanderbilt Children’s Hospital NICU each year. Assuming that
even fifty percent of this modest estimate of patients meet protocol requirements and the
legal guardians agree to the program, t
hat is at least 250 patients a year. At 250 patients
a year, the yearly cost per patient is $12, compared to the other approaches whose
costs/patient average $65. The differences between the three approaches are further
addressed in
Figure 4
.


The cos
t benefits of the BabyView program over the incumbent technologies for
providing a service to parents are clear, however BabyView offers more than these
technologies provide. In addition to providing images of their child, BabyView provides
parents with i
nformation their child and the Vanderbilt NICU. Furthermore, BabyView
provides a monitoring tool for medical staff.

The life cycle of this product is expected to be less than five years. While the
technology could most likely last longer than five year
s, technical innovations with
regard to the internet, digital cameras, and computers will likely provide solutions within
five years that are able to more seamlessly fit into the NICU environment than the larger,
hardwired internet cameras the system expec
ts now.


The Food and Drug Administration (FDA) approval process for software is
relatively new as far as what types of software classify as a medical device.
xi

However,
0
10000
20000
30000
40000
50000
60000
Costs (Dollars)
BabyView* (VU)
GrowingFamily
Independent
Hospital
Estimated NICU Costs
for BabyView vs. Incumbent Technologies
Setup Costs
Cost/Year
Total Costs over 3 years
0
10
20
30
40
50
60
70
80
Cost (Dollars)
BabyView* (VU)
GrowingFamily
Independent
Hospital
Estimated Yearly NICU Costs Per Patient
for BabyView vs. Incumbent Technologies

Figure 4: Summary of Expected
NICU Costs for BabyView and Incumbent Technologies

this software does not control a life sustaining process or aid clinical decision
-
mak
ing
and therefore does not require FDA approval. In addition, there are no animal or human
welfare concerns.


Conclusions:

The BabyView Program proves to be both technologically and economically
feasible for the Vanderbilt NICU to continue to pursue. Ba
byView’s design would
provide the family with more information and updates than conventional online programs
that use a one time static image and limited patient information. In addition, the design
can be integrated with the new NICU monitoring tools to
allow doctors and nurses to
have additional resources. BabyView also proves a much more economical choice over
incumbent technologies, in part because it does not require a great deal of time for the
hospital staff to run it.


Recommendations:


There
is reasonable evidence to conclude that the BabyView project should
continue in the Vanderbilt NICU, however, possibly at a later date when camera
technology is more advanced and less cost prohibitive. The D
-
Link wireless camera was used in this design de
velopment.
Without the constraints of a wireless system that the old NICU
required, a new, less expensive camera can be used. The VEO
Observer Network Camera,
Figure 5
, is an excellent choice
that is widely available for approximately $150
xii
. The camera

Figure 5: VEO
Observer Network
Camera


is small, less than a pound in weight and has an adjustable mount that allows easy
mounting and remounting
xiii
. This mounting ability would allow medical staff to
reposition the camera when it is interfering with medical care. In addition, the camera
has an

on
-
off button and status indicator that allows to the medical staff to have more
control over the program when in the patient’s NICU room. Similarly, I would
recommend the NICU apply for a static IP address for each of their NICU rooms from the
Informati
on Technology Services. This would allow cameras to be unplugged for
lengthy times without affecting the program. Currently the Vanderbilt has dynamic IP
addresses which are assigned when equipment is connected to the network. While the
equipment develo
ps an affinity for a specific IP address, the IP address can change if the
equipment is taken off the network for a lengthy period of time. In addition, future work
on this system should include developing an interface between the program and clinical
wor
kstations to allow more cohesive patient monitoring.


BabyView raises some ethical issues surrounding the protection and use of live
images for patient care. As with any other identifying medical information it is important
that care is taken to protect p
atient privacy. Secure connections and Internet should be
used to protect the information. In addition, the BabyView monitoring tool should not
replace traditional physical monitoring of the patient, but rather enhance the overall
patient monitoring.




Appendix A: Innovation Workbench Design Process

Ideation Process

Innovation Situation Questionnaire


1. Brief description of the problem


Observing Patient in NICU

Families Far Away from Patient would like another resource to monitor child

2. Informatio
n about the system


2.1 System name


NICU Patient Monitoring

2.2 System structure

2.3 Functioning of the system


Provide "live" images of child without interfering with the other systems


Cheap, Easy to initiate and Maintenance Free

2.4 System envir
onment

Patient Room in the NICU


Other monitoring equipment(alarms, flashing lights, other distractions)


Medical Equipment


3. Information about the problem situation


3.1 Problem that should be resolved


Need a way to keep p
atient family connected

Need another way for medical staff to monitor patient, visually

3.2 Mechanism causing the problem

Monitoring is limited by the blankets used to cover children

Parents are 100+ Miles away

3.3 Undesired consequences of unresolved pro
blem



Limited patient monitoring


Additional Stress on Families of Patient

3.4 History of the problem


Additional technology has allowed this opportunity to provide a better solution to patient care. Problem
has not been focused on in the

past because of more immediate concerns with patient health care


3.5 Other systems in which a similar problem exists


Other ICUs, Nurseries for medical monitoring

Day cares for parent monitoring

3.6 Other problems to be solved


Constraints associated wit
h costs, time, hardware

4. Ideal vision of solution

Small wireless camera imbedded in hanging toy or unit covering bed

Images fed to a computer program that allows users to see images of child

Medical Staff sees all babies

Family sees their child

Addition
al information such as patient information is displayed


5. Available resources


Internet Cameras (ethernet) wireless and wired

Network, wireless conenections already installed within hospital unit


***New NICU has network connections in each child's room


6. Allowable changes to the system


Very little can be changed in the system because the system has been defined for patient
health care. This is an additional resource for the medical staff and families

7. Criteria for selecting solution concepts


Size

Cost

Level of maintenance required

Compatibility with existing system

8. Company business environment


Pediatric Intensive Care Unit, part of the Vanderbilt Children's Hospital

Goal of business is to provide superior patient health care

NICU already very
receptive to new technology

VUCH and NICU committed to caring for the family in addition to the child

9. Project data


Name:Centralized User Interface for the Monitoring of Neonatal Intensive Care Patients

Objectives:

Build System of involving wireless cam
era for patient monitoring

Build Secure Website to send information

For Support Staff

For Family


Problem Formulation


1. Build the Diagram












2. Directions for Innovation


4/26/2004 3:05:53 PM Diagram1


»

1. Find an alternative way to obtain [the
] (Monitoring Tool) that offers the following: provides
or enhances [the] (Computer Monitor Tool) and (Additional Tool For NICU Staff), does not
require [the] (Internet Camera) and (Secure Internet).



2. Find an alternative way to obtain [the] (Internet C
amera) that offers the following: provides or
enhances [the] (Monitoring Tool) and (Live Feed of Patient), does not cause [the] (Additional
Costs) and (Additional Hardware).


»

3. Try to resolve the following contradiction: The useful factor [the] (Interne
t Camera) should
be in place in order to provide or enhance [the] (Monitoring Tool) and (Live Feed of Patient),
and should not exist in order to avoid [the] (Additional Costs) and (Additional Hardware).



4. Find an alternative way to obtain [the] (Live Fe
ed of Patient) that offers the following:
provides or enhances [the] (Ability for Family to View Child), eliminates, reduces, or prevents
[the] (HIPAA Concerns), does not require [the] (Internet Camera).


»

5. Find a way to eliminate, reduce, or prevent [t
he] (Additional Costs) under the conditions of
[the] (Internet Camera) and (Secure Internet).



6. Find a way to eliminate, reduce, or prevent [the] (Additional Hardware) in order to avoid [the]
(Additional Maintenance Needs), under the conditions of [the]

(Internet Camera).



7. Find an alternative way to obtain [the] (Secure Internet) that offers the following: provides or
enhances [the] (Monitoring Tool) and (Existing Network), does not cause [the] (HIPAA
Concerns) and (Additional Costs).



8. Try to res
olve the following contradiction: The useful factor [the] (Secure Internet) should be
in place in order to provide or enhance [the] (Monitoring Tool) and (Existing Network), and
should not exist in order to avoid [the] (HIPAA Concerns) and (Additional Cost
s).



9. Find an alternative way to obtain [the] (Computer Monitor Tool) that offers the following:
eliminates, reduces, or prevents [the] (HIPAA Concerns), does not require [the] (Monitoring
Tool).



10. Find a way to eliminate, reduce, or prevent [the] (
HIPAA Concerns) under the conditions of
[the] (Secure Internet).


»

11. Find an alternative way to obtain [the] (Ability for Family to View Child) that does not
require [the] (Live Feed of Patient).



12. Consider transitioning to the next generation of th
e system that will provide [the] (Ability for
Family to View Child) in a more effective way and/or will be free of existing problems.



13. Find an alternative way to obtain [the] (Additional Tool For NICU Staff) that does not
require [the] (Monitoring Too
l).



14. Consider transitioning to the next generation of the system that will provide [the] (Additional
Tool For NICU Staff) in a more effective way and/or will be free of existing problems.



15. Find an alternative way to obtain [the] (Existing Network
) that does not require [the]
(Secure Internet).



16. Consider transitioning to the next generation of the system that will provide [the] (Existing
Network) in a more effective way and/or will be free of existing problems.



17. Find a way to eliminate, r
educe, or prevent [the] (Additional Maintenance Needs) under the
conditions of [the] (Additional Hardware).


Prioritize Directions


1. Directions selected for further consideration




First priority


11. Find an alternative way to obtain [the] (Ability for

Family to View Child) that does not
require [the] (Live Feed of Patient).



11.4. Synthesize the new system to provide [the] (Ability for Family to View Child).



11.6. Consider resources to provide the useful factor (Ability for Family to View Child).



5. Find a way to eliminate, reduce, or prevent [the] (Additional Costs) under the conditions of
[the] (Internet Camera) and (Secure Internet).



5.1. Isolate the system or its part from the harmful effect of [the] (Additional Costs).



5.2. Counteract

the harmful effect of [the] (Additional Costs).

Long
-
term

...

3. Try to resolve the following contradiction: The useful factor [the] (Internet Camera)
should be in place in order to provide or enhance [the] (Monitoring Tool) and (Live Feed of
Patient), a
nd should not exist in order to avoid [the] (Additional Costs) and (Additional
Hardware).



3.1. Apply separation principles to satisfy contradictory requirements related to [the]
(Internet Camera).



3.2. Apply 40 Innovation Principles to resolve contra
diction between useful purpose of
(Internet Camera) and its harmful result.


5.4. Reduce sensitivity of the system or its part to the harmful effect of [the] (Additional
Costs).


5.8. Consider resources to reduce the undesired factor (Additional Costs).

Out
-
of
-
scope

...

1. Find an alternative way to obtain [the] (Monitoring Tool) that offers the following:
provides or enhances [the] (Computer Monitor Tool) and (Additional Tool For NICU Staff),
does not require [the] (Internet Camera) and (Secure Internet)
.

...

1.1. Improve the useful factor (Monitoring Tool).


1.2. Obtain the useful result without the use of [the] (Monitoring Tool).



1.3. Increase effectiveness of the useful action of [the] (Monitoring Tool).



1.4. Synthesize the new system to provide [t
he] (Monitoring Tool).



1.5. Apply universal Operators to provide the useful factor (Monitoring Tool).



1.6. Consider resources to provide the useful factor (Monitoring Tool).



11.1. Improve the useful factor (Ability for Family to View Child).



11.2
. Obtain the useful result without the use of [the] (Ability for Family to View Child).



11.3. Increase effectiveness of the useful action of [the] (Ability for Family to View
Child).



11.5. Apply universal Operators to provide the useful factor (Abili
ty for Family to View
Child).


5.3. Impact on the harmful action of [the] (Additional Costs).


5.9. Try to benefit from the undesired factor (Additional Costs).

Other

...

5.5. Eliminatthe cause of the undesired action of [the] (Additional Costs).e


5.6. Reduce the harmful results produced by [the] (Additional Costs).



5.7. Apply universal Operators to reduce the undesired factor (Additional Costs).


2. List and categorize all preliminary ideas

Reducing Cost
-

reduce NICU sensitivity to cost
-

grant
? reducing amount spent

Hardware Interference (size, mechanical/electrical interference)

Quality of Monitoring Tool

Is there an alternative way to provide family members with a better way to stay connected

Maintenance

Develop Concepts


1. Combine ideas int
o Concepts

Hardware Concepts (Costs, Interference)

Reduce Size, Costs,

Maintenance

Program Concepts


Overall Goal

reduce price sensitivity

alternative way?


2. Apply Lines of Evolution to further improve Concepts


Improved Ideality

-

enhance useful featu
res, reduce undesired features

enhance program features such as BabyInfo and vuneo.org

reduce hardware interference and maintenance issues with higher quality hardware

reduce either cost or cost sensitivity
-

grants, gifts from Hospital (not NICU), NICU pa
rent
support group, from the state, benefactor


Reduce Hardware interference by

making camera dismountable (remove during periods of high stress)

combining the power and ethernet cord into one physical cord

wireless

decrease the rigidity of the camera mou
nt
-

mobile object, flexible, adjustable


Evaluate Results


1. Meet criteria for evaluating Concepts


Concepts met criteria except for cost


Ideally a gift/grant would be received...but what if not

Cost is another problem that should be addressed separetly


2. Reveal and prevent potential failures

Hardware Problems

Hardware does not work as expected

Hardware is not compatible which existing system

Camera interferes with medical equipment

Medical equipment interferes with camera (magnetic, electrical)

Size i
s too large

Requires critical power outlet


Psychological and emotional impact

Parents feel program is not a benefit

Does not provide NICU staff with a useful resource


3. Plan the implementation

Research other solutions available

Research similar solution
s

How do they approach NICU staff time constraints, HIPAA, costs

Research Patents

Research current system (Physical Layout, Hardware and Software availability)

What wireless availability standard is in the hospital?


Research NICU environment

Is less than
15 minutes too much time to spend on the program each day?
-

Dr. Walsh

How secure is secure enough for HIPAA?

Research best software options? (Matlab, LabView, Java, etc)
-

Ray Erlandson, Dr. King,

Prepare hardware/software layout

Research Camera Options

C
hoose best option considering constraints
-

talk to company about compatibility

Order camera

Setup camera for prototype and testing with system


Prepare program layout/storyboards

Begin initial program...work in stages from front pages to back

Determine b
est database to use
-
Ray Erlandson, Database Class

Build Database...add to program

Design Admin Pages in more depth

Add Administration pages

add camera URLs

Test program


Install Cameras in NICU

Test


References:




i

Baby CareLink:Using the Internet and Tel
emedicine to Improve Care for High
-
Risk Infants. Safran et al.
Pediatrics. 2000 Dec; 106(6):1318
-
24.


ii

VUMC Network Computing Services: Vanderbilt Establishes Wireless Network Standard
(
https
://ncs.mc.vanderbilt.edu/SS001/SS206.asp
)


iii

The Source for Developers: A Sun Developer Network Site (
http://java.sun.com/
)


iv

Tutorials & Code Camps: The Java Tutorial (
http://java.sun.com/docs/books/tutorial/
)


v

Java Servlets:An Introduction (
http://www.webdevelopersjournal.com/articles/intro_to_servlets.html
)


vi

The Apache J
akarta Project:Tomcat (
http://jakarta.apache.org/tomcat/
)


vii

Ray Erlandson, Biomedical Engineering Department


viii

MySQL:The World’s Most Popular Open Source Database (
h
ttp://www.mysql.com/
)


ix

Andy Dumitrescu, David Scott, Richard Doyle


x

Canon EOS 10D Camera: Digital Camera Hq (
http://www.digitalcamera
-
hq.com/canon
-
eos
-
10d
-
reviews.html
)


xi

Des
ign of Biomedical Devices and Systems. King, Paul. Fries, Richard. 2003. Marcel Dekker, Inc. New
York, New York.


xii

Froogle Search: VEO Observer Network (
http://www.google.com/froogle
?q=VEO+Observer+Network
)


xiii

VEO Observer Network Camera: VEO Website (
http://www.veo.com/Observer/default.asp
)


Neonatology on the Web (
http://www.neonato
logy.org/
)