How visualization and clinical decision support can improve patient care

Ashwin Rangan

Ashwin Rangan is the CIO of Edwards Lifesciences

Ashwin Rangan details what's different about hemodynamic monitoring methods these days.

Interview conducted by Bud Mathaisel and Alan Morrison

PwC: What are Edwards Lifesciences' main business intelligence concerns given its role as a medical device company

AR: There’s the traditional application of BI [business intelligence], and then there’s the instrumentation part of our business that serves many different clinicians in the OR and ICU. We make a hemodynamic [blood circulation and cardiac function] monitoring platform that is able to communicate valuable information and hemodynamic parameters to the clinician using a variety of visualization tools and a rich graphical user interface.  The clinician can use this information to make treatment decisions for his or her patients.

PwC: You’ve said that the form in which the device provides information adds value for the clinician or guides the clinician. What does the monitoring equipment do in this case?

AR: The EV1000 Clinical Platform provides information in a more meaningful way, intended to better inform the treating clinician and lead to earlier and better diagnosis and care. In the critical care setting, the earlier the clinician can identify an issue, the more choices the clinician has when treating the patient. The instrument’s intuitive screens and physiologic displays are also ideal for teaching, presenting the various hemodynamic parameters in the context of each other.   Ultimately, the screens are intended to offer a more comprehensive view of the patient’s status in a very intuitive, user-friendly format.

PwC: How does this approach compare with the way the monitoring was done before?

AR: Traditional monitoring historically presented physiologic information, in this case hemodynamic parameters, in the form of a number and in some cases a trend line.  When a parameter would fall out of the defined target zones, the clinician would be alerted with an alarm and would be left to determine the best course of action based upon the displayed number or a line.

Comparatively, the EV1000 clinical platform has the ability to show physiologic animations and physiologic decision trees to better inform and guide the treating clinician, whether it is a physician or nurse.

PwC: How did the physician view the information before?

AR: It has been traditional in movies, for example, to see a patient surrounded by devices that displayed parameters, all of which looked like numbers and jagged lines on a timescale. In our view and where we’re currently at with the development of our technology, this is considered more basic hemodynamic monitoring.

In our experience, the “new-school” hemodynamic monitoring is a device that presents the dynamics of the circulatory system, the dampness of the lungs and the cardiac output real-time in an intuitive display.  The only lag time between what’s happening in the patient and what’s being reflected on the monitor is the time between the analog body and the digital rendering.

PwC: Why is visualization important to this process?

Figure 1
Edwards Lifesciences EV1000 wireless monitor

AR: Before, we tended to want to tell doctors and nurses to think like engineers when we constructed these monitors. Now, we’ve taken inspiration from the glass display in Minority Report [a 2002 science-fiction movie] and influenced the design of the EV1000 clinical platform screens. The EV1000 clinical platform is unlike any other monitoring tool because you have the ability to customize display screens to present parameters, color codes, time frames and more according to specific patient needs and/or clinician preferences, truly offering the clinician what they need, when they need it and how they need it.

We are no longer asking clinicians to translate the next step in their heads.  The goal now is to have the engineer reflect the data and articulate it in a contextual and intuitive language for the clinician.  The clinician is already under pressure, caring for critically ill patients; our goal is to alleviate unnecessary pressure and provide not just information but also guidance, enabling the clinician to more immediately navigate to the best therapy decisions.

PwC: Looking toward the next couple of years and some of the emerging technical capability, what do you think is most promising?

AR: Visualization technologies. The human ability to discern patterns is not changing. That gap can only be bridged by rendering technologies that are visual in nature. And the visualization varies depending on the kind of statistics that people are looking to understand.

I think we need to look at this more broadly and not just print bar graphs or pie graphs. What is the visualization that can really be contextually applicable with different applications? How do you make it easier? And more quickly understood?