Medtech IoT: We need to talk about what is happening in middleware

Middleware could be the key when it comes to discussing how the Internet of Things is going to succeed in medtech. In the most simplistic definition, middleware is software that acts as a bridge between an operating system or database and applications, especially on a network. For example, if a bedside monitor is designed to deliver waveforms to a smartphone, middleware is what helps the devices speak the same language.

The challenge is that there is no single messaging middleware vendor with an overarching solution…yet. Instead, vendors are joining in partnerships to deliver a single solution. The results are good, but there are lingering questions on cost over value when it comes to implementing such a system.

Case in point: Bernoulli, Voalte, and Connexall have partnered to offer a middleware messaging service.

The integration offers some intriguing opportunities. Let’s say a patient in a hospital has a heartbeat monitor. This monitor is tied to a healthcare provider’s medical smartphone. The alarm goes off, and a waveform is delivered to the smartphone. From there, the healthcare provider can look at the waveform and determine whether it is an arrhythmia, or a motion artifact (or false positive). From there, the healthcare provider can make the decision whether to go directly to the patient or continue to make rounds.

Each vendor brings a different expertise to the system. Connexall provides alarm management and event notification platform. Bernoulli brings real-time collection, aggregation, and distribution of physiological data from a range of medical devices (the waveforms).Both Connexall and Bernoulli have 510(k) for their respective products. Voalte provides the basic messaging framework and mobile client, as well as sales and marketing. It relies on third parties to fully meet customer requirements.

The technology is valuable, but because it requires the cooperation of three separate vendors, the cost is higher than it might be if the entire solution was provided by one vendor, says Tim Gee, principle of Medical Connectivity Consulting. He notes that one of the main challenges is due to lack of consolidation in vendors.

Connexall, for example, is a closely held private company; Gee suspects the company’s owners will never sell. “Voalte and Connexall have been in partnership for almost 5 years,” Gee says, “I think Voalte would have bought Connexall already if it could have.”

As the market saturates and matures, it is likely these vendors will consolidate. That might be 10 to 15 years down the road, however.

As the messaging middleware, or clinical communications and collaboration market matures, the product/market fit of vendor’s solutions will improve, some through internal development broadening the features available in the solution and some through strategic acquisitions. In the end, hospitals’ long-held preference for single vendor solutions will win out.

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