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

  1. Charles Bell
    Apr 17, 2008


    Good article. I just wanted to inform you that we (Intego)deployed our SIP integration over a year ago with Cisco and are currently deploying our SIP integration with Avaya. Our first installation had over 1000 handsets and yes no middleware.

    Charles Bell
    Founder Intego

  2. Nathan Buzza
    May 05, 2008

    Hi Kenny,

    Very good article indeed, with some excellent points. I would also put up for consideration that a staff assignment client needs to encompass a broader cross section of clincial systems outside of nursecall.

    Whilst nursecall is an essential system it forms one of many disparate systems within a healthcare environemnt. One needs to consider staff allocation in the broader context.

    Additionally, the nursecall vendor needs to embrace the bi-directional functionality of the wireless device.

    Whilst SIP / H323 will provide voice connectivity, it will not assist in the task assignment and monitor the workflow associated with the request.

  3. Alan Dash
    Jul 08, 2008

    Yes, good read – but what about all the other points of integration in healthcare? Does it make sense to have additional software running just because we can (or in this case, cannot) run without middleware? While not a fan of putting all the eggs in one basket, I worry since some hospitals already have as many as 600 apps running!! I also worry about all the additional operational costs associated with the additional software.

  4. Kenny
    Jul 08, 2008

    I think conceptually Ascom, Globestar and Emergin (and others, including Commtech) have had this right all along. Having a universal, standards-based application to negotiate messaging communications workflow is a worthy goal. Michael McNeal has worked hard to evangelize about an Enterprise Service Bus.

    Reaching that goal has turned out to be another story.

    I think the hospital customers have been literally caught in the middle (and are the biggest losers here). Middleware turf wars have not helped anyone.

    The middleware providers have had a very hard time coming up with a sustainable business model, as no matter what they do, the “connectology” of it all (nod to Tim Gee) is hard to implement, and even harder to support. Thus, they have not been able to figure out a way to give customers what they need and make money at it.

    As a result of business issues, folks like Emergin (and to some extent Ascom) have clung to an architecture that is not exactly open (to somehow give them the leg up and improve their respective bottom lines).

    Philips’ acquisition of Emergin doesn’t help this cause out very much, as it takes what had been an inherently agnostic utility application (by design) and puts it under the control of an entity that has its own product interests at heart.

    Over time standards are likely to prevail and fix a lot of this (and perhaps eliminate the need for middleware), but the sheer amount of legacy technology in healthcare only means that this will take a very long time to work itself out.

  5. Alan Dash
    Jul 28, 2008


    In taking it a step further from Nurse Call and VoIP phones, in the future we will have IT departments that provide nothing but connectivity and support to interfaced-services for facility systems, bio-medical systems, and clinical systems – a given. Is it possible that we are at the verge of an entire new operational department within the preview of a CIO that connects VoIP, bedside medical devices, chiller plants, security, virtually any element that creates an event and/or alert and we will not have a means to interconnect it all? Talk about IT being in the middle, if I may. Or, will there be some ‘eureka’ moment that some standards-based ideology actually takes place and works without the advent of additional and highly-skilled IT staff to manage additional and highly technical platforms? I wonder the time-frame what with industry infighting, posturing, infringement, and that whole concept of manufactures actually making some money along the way and I wonder the palatability of today’s IT leaders in taking the risks of attempting connectivity at an enterprise level now that so many expectations have been set on – well, almost nothing.

  6. […] generation middleware such as Emergin. As Kenny Schiff noted in his landmark 2008 blog titled “Look Ma, No Middleware: SIP, Nurse Call and the Fight to Control Staff Device Assignment”, this marked the end of a pioneering relationship between Rauland-Borg and […]

  7. Tony Clayton
    Nov 09, 2016

    Agree with others that open standards, i.e. SIP is the way to go. As an example our ICW-1000G Dual Band SIP WiFi phone was designed just for this type of Healthcare environment, just focusing on delivering a couple of very specific functions, HD Voice and Messaging. The benefit for customers is that 3rd party vendors can break through the strangle hold that the middleware providers like Cisco, Avaya/Nortel and Spectralink seem to have and deliver (as in our case) 70% lower cost for similar or better functionality.

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