Look Ma, No Middleware: SIP, Nurse Call and the fight to control staff device assignment

Posted by: Kenny Schiff on March 13, 2008

Despite having successfully worked together for a number of years, a while back Rauland-Borg and Emergin came to an apparent major falling out over how Emergin’s Staff Assignment client app would interact (or replace) Rauland’s Responder NET. As I heard it they actually went down to the wire regarding an announcement regarding tight interoperability, and then the whole thing fell apart–clearly a clash of wills (and strategy) between the leadership of Emergin and Rauland.

As a Rauland insider told me a year ago (full disclosure, I worked for Rauland from 1993 through the end of 1999), the new Rauland nursecall platform (shown for the first time at HIMSS 2008 in Orlando) would try very hard to not require Emergin (or anything else) for connectivity on the wireless voice side. In the war of who controls staff assignment, their preference was/is to remain master of their universe.

It appears that Rauland has indeed managed to get their ‘no middleware’ solution working with Ascom. Not sure how the messaging protocol is being handled, but the most significant part of the equation is the SIP to SIP connectivity for voice callbacks to the room. A patient triggering a bed side alert/alarm would be presented to an assigned caregiver on an Ascom device. Should the staff member choose to respond to the patient, they would be connected from their wireless voice device directly to the nursecall patient station in the room. This type of solution has been available in some shape or form for more than 10 years; the problem is that because of limitations on the telephony connectivity of legacy nursecall platforms, it doesn’t work very well.

I did manage to spend a little bit of time at the Rauland booth at HIMSS, and an old friend (and former colleague of mine), was quite proud to demonstrate the lightening fast connection back to the room time on an Ascom i75 handset (it worked great). I had previously spent considerable time with him dealing with several different Vocera and Spectralink integration projects where callback timing and trunking issues were causing serious customer dissatisfaction.

So why am I sharing this?

With the big time nursecall players all finally moving into the native IP realm, I think that it’s very important that those on the wireless voice/messaging side, proactively deal with the interconnect aspects effectively. Clearly Ascom and Rauland have made a big leap here.

The sheer amount of legacy non-enterprise nursecall gear out there that is nowhere close to end of life, is likely to limit the impact of this change in short-term. But life is changing in the hospital enterprise, and with the walls breaking down regarding who owns these respective technologies, savvy buyers will demand interoperability and integration not just work, but work well. This is going to require shifts by the nursecall providers and the wireless voice players.

I’m not sure that the players in the wireless voice space strategically pay much attention to the fact that nursecall sales drive wireless voice sales. Probably no marketing research figures behind this (because it’s still relatively cottage), but if you look at Spectralink, Cisco and Ascom in HC (and previously Nortel and Avaya), tens of thousands of voice handsets were/are purchased as part of these types of solutions. I suspect we’ll see continued demand for better integrated nursecall-handset solutions. As the nursecall vendors begin to provide the integration, it may mean that the hospitals that are looking to integrate other patient monitoring devices will need additional middleware software. So buyer beware in the ever changing world of middleware.


Kenny Schiff (www.tpchealthcare.com) is founder and President of TPC Healthcare, a specialty provider of wireless communications, alarm messaging/workflow products, and services to healthcare customers.

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