patient care device domain update todd cooper president, breakthrough solutions foundry, inc. ray...
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Patient Care Device Domain Update
Todd Cooper President, Breakthrough Solutions Foundry, Inc.
Ray Zambuto President, Technology in Medicine, Inc.
Jack Harrington Co-Chair, IHE Patient Care Device Domain
Ken Fuchs Director of Systems and Connectivity Engineering, Draeger Medical Systems, Inc.
IHE Patient Care Devices (PCD)
“Providers and vendors working together to deliver interoperable health information systems within and between enterprises and settings”
The PCD, helping to fulfill the general IHE Vision:
IHE Patient Care Devices (PCD)
Why Patient Care Devices?
• There are over 1500 Patient Care Device manufacturers and over 3500 Make-Model combinations
• The typical 200 bed hospital contains 1,000’s of Patient Care Devices
• …that are constantly changing with updated/upgraded technology … and interoperability too?!
• For every connected IT Device in the hospital, there are 4 Patient Care Devices that are not connected
IHE Patient Care Devices (PCD)
Patient Care Devices are unique …• Many devices are used in multiple clinical contexts, with
acquired data having different implications depending upon the clinical setting.
• Many devices provide signals or critical alarms that have direct significance to patient safety and well being in real-time, and should be accorded appropriate priority in the system.
• Many devices are portable, meaning that connectivity must include wireless portions, direct network connections, and Internet links, all with “hacker and virus” risks, too.
• Many devices provide data that should be automatically and accurately incorporated directly into the information stream that feeds the emerging Electronic Health Record (EHR).
The Patient Care Device Domain
The PCD
• Established in 2005 when the “charter” was awarded to the ACCE
• Jointly sponsored by ACCE and HIMSS as of July 1, 2006
• Technical Framework 2006-7 developed to communicate patient data (asynchronous)
• Successful demonstration at the 2007 & 2008 Connectathons and HIMSS Interoperability Showcases
IHE Patient Care Devices (PCD)
HIMSS Survey IHE pre-2005 Annual Conference results:
• Further, 56% said they’d pay more for IHE-compliant products!
• Survey of all IHE Users
• Over 50% of those surveyed said patient care devices should be the next area developed for IHE *
IHE Patient Care Devices (PCD)
Key Benefits of PCD Interoperability
• Heterogeneity – Multiple manufacturers + multiple device modalities coexisting over a shared infrastructure
• Semantic Interoperability ( comparability) – shared terminology and data models permit users to interpret data based on the clinical context, compare information from different healthcare facilities, and interrogate systems across enterprises and regions.
• Real-Time Availability – ability to provide data in a time frame appropriate to the physiologic function being measured, displayed or affected (controlled).
Why Do I Care About the IHE PCD?
Significance
• Clinical implications– Patient safety– Enterprise wide access to the patient’s data– Quality of care– Ability to implement “best of breed” for your
applications– Workflow improvements
Why Do I Care About the IHE PCD?
Significance
• Technical implications– CE and IT must collaborate on selection,
specification, support of these systems– New knowledge and skills are required
• Financial implications– Rapid changes in technology increase risk– Interoperability reduces risk– Interoperability improves efficiency
Examples of Purchaser and User “Value Propositions” (i.e, ROI and other motivations)
• Automatic population of all information systems – reducing medical errors - integrity of data
• Automated systems - saves time for clinicians• Defined and easily accessible - audit trails• Eases integration of multiple modalities into a single system;
provides one consistent view of patient data• Facilitates intelligent systems to support clinical reasoning• International standardization of systems so that international
outcomes research can be accomplished• Common and safe user authentication• Access to patient data across devices and systems so
custom communication interfaces can be eliminated. Allows best of breed selection for your application
• Efficiency of care, testing and training - Reduces redundancy
User/Provider/Purchaser Benefit Examples
Significance
• Improves agility of enterprises to meet varied patient loads
• Improved life-cycle cost of ownership
– Facilitates heterogeneous brand and model deployment
– May allow use of technologies over longer periods of
time, reducing the “obsolescence effect”
• Vendor-provided IHE-PCD conformance statements will
ease selection decisions and reduce business risk
• Automates clinical data capture for EHR
IHE Patient Care Devices (PCD)
IHE-PCD Charter
The Patient Care Devices Domain is concerned with Use Cases in which at least one actor is a regulated patient care device. The PCD coordinates with other IHE clinical specialty based domains such as medical imaging and laboratory.
IHE Patient Care Devices (PCD)
IHE-PCD Mission
The IHE Patient Care Devices Domain will apply the proven, Use Case driven IHE processes to:
• Deliver the technical framework for the IHE-PCD domain profiles;
• Validate IHE-PCD profile implementations via Connectathons; and
• Demonstrate marketable solutions at public trade shows.
IHE PCD in the HIMSS 2007 Interoperability Showcase
IHE Patient Care Devices (PCD)
Examples of emerging IHE-PCD Work flows Enterprise sharing of Patient Care Data* Patient & Device ID Binding* Point of Care Plug and Play* (multiyear effort) Subscribe to Patient Data Rosetta Stone Terminology Project PCD Alarm Communication Management Real-time data archiving and communication Infusion Pump Integration - Drug Administration Hospital Bed–Blood Pressure Coordination Mobile, enterprise-wide, reliable vital signs monitoring … many more!
Initial device classes…vital sign monitors, bedside monitors, infusion pumps and ventilators
* Key Objectives for 2007/2008
Device
PCD-01: Communicate Device Data
Data Observation Customer (DOC)
DeviceObservation
Reporter (DOR)
Monitor, Ventilator,Infusion Pump…
EHR, CDR,CDSS…
Map Device Data to ConsistentSyntax and Semantics
Device Enterprise Communication (DEC) Profile - Year 1
DEC Profile Mapping Model
• ISO/IEEE 11073 Domain Information Model and Nomenclature mapped to HL7 (v2.5) Observation Report
• ISO/IEEE 11073 Data Types mapped to HL7 Data Types
• Mapping preserves measurement context for complex devices.
Measurement Context is Dynamic
IEEE 11073 Domain Information Model Defines Device Context
10..n
Medical Device System (MDS)
Virtual Medical Device (VMD)
Channel (Chan)
Numeric
Enumeration
1
*
1
*
1
*
1
0..*
Metric
Mapping preserves measurement context
<vmd> <parametric instance>
<chan><mds>Medical:
Containment Tree Hierarchical LevelSubject
3121Ordinal
<HR><Ctach><ECG><VS Mon>Virtual (Medical)3
2211Ordinal
<PR><Ptach><PulsOxim><VS Mon>Virtual (Medical)2
Ordinal
Virtual (Medical)
11
<Oxim><PulsOxim>
1
<Spo2>
1
<VS Mon>1
Examples
OBX-4
Recommend that Ordinal value is unique among entire set
Medical Device System (MDS)
Virtual Medical Device (VMD)
Channel (Chan)
Numeric
Enumeration
1
*
1
*
1
*
1
0..*
Metric
Example PCD-01 Message
MSH|^~\&|INFO_SRC_PHILIPS^ACDE48234567ABCD^EUI-64||||20061215153500||ORU^R01^ORU_R01|PMS116621490051| P|2.5|||NE|AL||8859/1 PID|||AB60001^^^Philips Medical^PI||Brooks^Albert^^^^^L||19610101|M PV1||I|UNIT_1^^Bed1 OBR|1|PMS116621490051^INFO_SRC_PHILIPS^ACDE48234567ABCD^EUI-64| PMS116621490051^INFO_SRC_PHILIPS^ACDE48234567ABCD^EUI-64| 69837^MDC_DEV_METER_PHYSIO_MULTI_PARAM_MDS^MDC|||20061215153500 OBX|1|ST|184326^MDC_ECG_STAT_ECT^MDC|1.5130.1.184326|""||||||F OBX|2|ST|184327^MDC_ECG_STAT_RHY^MDC|1.5130.1.184327|Sinus Rhythm||||||F OBX|3|NM|150456^MDC_PULS_OXIM_SAT_O2^MDC|1.5238.1.150456|99|262688^MDC_DIM_PERCENT^MDC|||||F OBX|4|NM|147842^MDC_ECG_HEART_RATE^MDC|1.5130.1.147842|81|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|5|NM|150037^MDC_PRESS_BLD_ART_ABP_SYS^MDC|1.5190.1.150036|126|266016^MDC_DIM_MMHG^MDC|||||F OBX|6|NM|150038^MDC_PRESS_BLD_ART_ABP_DIA^MDC|1.5190.1.150036|76|266016^MDC_DIM_MMHG^MDC|||||F OBX|7|NM|150039^MDC_PRESS_BLD_ART_ABP_MEAN^MDC|1.5190.1.150036|92|266016^MDC_DIM_MMHG^MDC|||||F OBX|8|NM|148065^MDC_ECG_V_P_C_CNT^MDC|1.5130.1.148065|0|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|9|NM|150045^MDC_PRESS_BLD_ART_PULM_SYS^MDC|1.5190.1.150044|26|266016^MDC_DIM_MMHG^MDC|||||F OBX|10|NM|150046^MDC_PRESS_BLD_ART_PULM_DIA^MDC|1.5190.1.150044|9|266016^MDC_DIM_MMHG^MDC|||||F OBX|11|NM|150047^MDC_PRESS_BLD_ART_PULM_MEAN^MDC|1.5190.1.150044|14|266016^MDC_DIM_MMHG^MDC|||||F OBX|12|NM|149538^MDC_PLETH_PULS_RATE^MDC|1.5238.1.149538|55|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|13|NM|150067^MDC_PRESS_BLD_ATR_LEFT_MEAN^MDC|1.5190.1.150064|4|266016^MDC_DIM_MMHG^MDC|||||F OBX|14|NM|150087^MDC_PRESS_BLD_VEN_CENT_MEAN^MDC|1.5190.1.150084|12|266016^MDC_DIM_MMHG^MDC|||||F
Process for Year 2
Year 2
• 2006 Survey• Call for Short Proposals• “Vetting” by Planning and Technical
Committees• Setting of Priorities• Development of the T/F Supplements• Testing of new profiles @ Connectathon• Demonstration at HIMSS 2008 – TODAY!!!
PCD HIMSS Showcase Scenario
Patient ID Binding
Device
PCD-01: Communicate Device Data
Data Observation Customer (DOC)
DeviceObservation
Reporter (DOR)
DeviceObservation Filter
(DOF)
PCD-02: Subscribe to PCD Data
PCD-01: Communicate Device Data
DEC - Subscribe to Patient Data
Note: SPD is a DEC Profile option.
DEC - Subscribe to Patient Data
Rosetta Terminology Profile
IHE-PCD Future Developments - Roadmap
Year 2007 2008 2009 2010 2011 2012
Profiles Device-Enterprise Communications
PCD-01 - Asynchronous DEC Parametric Data
PCD-02 - Query Cross Enterprise Sharing, Real -time storage & retrieval
Decision Support Data Mining
Device Context Management
PCD-03 - Patient ID ADT PAM Based
Bar code RFID Associations
Plug & Play PCD-04 - PnP-MDRT Device Interrogation, Wireless transport
Device-Device Interation Device Control
Device Inter-Enterprise Communications
PCD-HH Transport - Pre Hospital, waveforms
Wellness , Smart home Fitness
Privacy & Security Security, Privacy
Standards HL-7 2.5 ISO/IEEE 11073-
1010111073-10201
TBD
Clinical Charting Vital Signs, alarm information
Interlocks, alarm controls,authentication
Alarm Interoperability, controls, authentication
Alarm Control
Device Control
Medication Management
Alarm Management
Emergency Care Services
Comphrehensive Data
Heterogeneity: Guarantee that different devices can work together. Can easily substitute medical devices
Value Propositions
Clinical Applications
Increased workflow efficiency by decreasing documentation time
Timeliness: Vendor Independent Real Time patient data reporting. Centrally monitor physiological waveforms from multiple vendors
Agility: Interchangeability of devices; can change devices in system without breaking functionality
Semantic Interoperability: Vendor independent communication of patient data. Allows best of breed devices to be used in populating CDR
Increased Semantic Interoperability: Allows control types and frequence of patient data communication. Based on patient acuity can adjust patient data frequency of updates and types of parameters that are communicated
Risk Management: Matching treatment to patient. Rightt patient, right time; right treatment; right drug; right site
Accuracy of Data
IHE-PCD Survey Summer- Winter 2008
2008 Survey – We want your input!
• Survey Managed by HIMSS Analytics• Open Solicitation to HIMSS, ACCE,
AdvaMed, Anesthesia Patient Safety Foundation, ECRI, …
• Survey URL:http://surveys.himss.org/himss/Surveys/TakeSurvey.aspx?surveyid=1456
What Can You Do?
To Define the Future• Become a member of a Domain’s Planning or
Technical Committees– Help establish priorities – what the domain will
work on– Help define profiles – clinical, IT requirements– Provide the “business case” to encourage
developments
• What’s required of you?• Poll the room--- Questions, etc.
PCD Contacts
PCD CoChairs:– Todd Cooper [email protected] – Ken Fuchs [email protected] – Jack Harrington [email protected]– Ray Zambuto
• PCD Technical Project Manager:– Manny Furst [email protected]
• IHE (International) Strategic Development Committee Co-Chair:– Elliot Sloane [email protected]
