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Philips 創新智慧生理監控
Anic Liu 劉文超 Healthcare PCMS clinical specialist
Sep. 12 ,2014
Agenda
• eICU---ICU 顧問式服務 • Digital Accelerator Lab – Google Glass 應用
Confidential
Hot Topics in ICU Patient Monitoring
病患警告
設備 /系統互通性
感染控制 無線 /移動性
工作流程 /協作 病患安全
+
成效
3
Confidential
Home Out-patient Emergency & OR ICU General Ward Out-patient Home
Current costs
Future costs
Preventative care
&
chronicle diseases
Acute care
Healthcare 資源 擴展照護範圍以突破ICU瓶頸
4
Preventative care
&
chronicle diseases
Confidential
Home Out-patient Emergency & OR ICU General Ward Out-patient Home
Current
Future
Acute care
Healthcare 資源 Philips 解決方案今昔
5
Preventative care
&
chronicle diseases
Preventative care
&
chronicle diseases
eICU---ICU 顧問式服務 Intellispace Consultative Critical Care
Confidential
The concept – IntelliSpace Consultative Critical Care
• 創新概念,透過整合最新技術和臨床
專業,開啟重症照護的新頁。
• 軸-幅式系統概念,遠端管理多個照護
單位 (Hub and spoke model)。
• 管轄單位的病患生理狀況,可以持續
地全面監控。
Command Centre
(HUB)
Remote ICU
(Spoke 1)
Remote ICU
(Spoke 2)
Remote ICU
(Spoke 3)
Remote ICU
(Spoke N)
7
Confidential
The Innovation – IntelliSpace Consultative Critical Care
8
Confidential
eICU in USA
• eICU/Revolutionizing Critical Care
https://www.youtube.com/watch?v=4aW4WbBkZFc
Confidential
ICU Hospital Infrastructure
LAN
Command Center
5 mbps Firewall
Firewall Intensivist on the move
2 mbps
HIS, LIS, LAB IS, Pharma IS
Inte
rne
t V
PN
A
cce
ss
Monitors, Devices, ICCA, PIIC
General Topography – ICCC Solution
11
Confidential
Example – Implementation in India
12
Confidential
The Command Center - Hub
• 同時連線多個 ICU
• 多組工作站同時運作
• 每個工作站使用4~6組螢幕呈現資訊
• 可利用語音和影像和連線之ICU雙向溝通
• 配置人力為加護病房醫師、受訓完成的資深護理師和資訊專員
Command Centre
(HUB)
Remote ICU
(Spoke 1)
Remote ICU
(Spoke 2)
Remote ICU
(Spoke 3)
Remote ICU
(Spoke N)
13
Confidential
The Command Center – Monitor Configuration
• 資訊儀表板
• Philips 重症暨麻醉臨床資訊系統 ICCA
• 生理監視器遠端監控
• 床邊影音雙向溝通設備
• 其他系統連線需求 ex: PACS and or HIS client
PACS Client
PACS Work list / HIS Client
Remote Monitor View
Dash Board ICCA
AV – View of Bedside
14
Confidential
Innovation Development
15
Confidential
攝影鏡頭 – on a height adjustable mount
顯示螢幕與中心溝通資訊 – swiveling possible to face patient
臨床資訊系統工作站 – enables bed-side charting
收納空間 – opens the AV/UPS cabinet
推車把手 – for easy handling
推車基座 – Large base wheels agility and stability
Mobile Cart – In Remote ICU (Spoke)
Command Centre
(HUB)
Remote ICU
(Spoke 1)
Remote ICU
(Spoke 2)
Remote ICU
(Spoke 3)
Remote ICU
(Spoke N)
16
Confidential
Straw man proposal - Command Center 層級規劃
Extends to other
telehealth
applications
Conducts
proactive
surveillance
Stands by and
responds to
on-demand
requests from
peripheral
ICUs
Reactive
Proactive
ICU
Other
Specialties
• Episodic = Event Driven
• Remote = Involving a clinician physically in another location
• Consultation = Seeking expertise advice
17
Confidential
Straw man proposal - Level 1 :依據需求提供 ICU 諮詢
• Complete patient data
and monitoring data
continuously captured
and made available to
CCC
Peripheral ICU (bedside team)
Central Command Centre
(CCC)
• Stands by for multiple
peripheral ICUs
• Responds to requests
on demand
• Centre of expertise
• Centre of excellence
• Bedside team
consciously filters and
extends to CCC for
help for complicated
cases
network capable
of supporting 2-
way audio-video
communication
Instructions & Guidelines
Near-real-time patient data
Real-time
Collaboration
Request for remote
consultation
18
Confidential
Straw man proposal - Level 2:主動進行 ICU 監控
Peripheral ICU (bedside team)
Central Command Centre
(CCC)
• Also continuously and
proactively monitors
patient data from
peripheral ICUs
• Patient acuity scoring
• Triggers dialogue with
bedside team and care
actions
Instructions & Guidelines
Near-real-time patient data
Real-time
Collaboration
network capable
of supporting 2-
way audio-video
communication
CCC proactively
• Rea-time patient data
and monitoring data
continuously captured
and made available to
CCC
• Bedside team follow
the instructions &
Guidelines from CCC
for complicated cases
19
Confidential
Straw man proposal - Level 3 :不同單位的遠距醫療應用
ICU
Hemodynamic
Management
Transfer to
Tertiary facility
“drip & ship”
Very Rapid
Assessment
Tertiary Hospital
CT images
eCareMobile ED
1
2
Stroke Specialist
3
Transfer
to ICU
Tele-stroke Example
20
Confidential
• 醫院的 50% 死亡案例發生在 ICU。
• 透過 持續監控 和觀察病患變化,對
於照護結果有明顯的改善。
• ICU的死亡率降低 68% 和 46%
(compared to two baselines)
• 醫院的死亡率降低 33% 和 30%
(compared to two baselines)
• ICU 併發症發生率 降低 44% 和 36%
(compared to two baselines)
Literature References:
• Team care: beyond open and closed intensive care
units: Pronovost, Peter J. et al.; Current Opinion in
Critical Care; December 2006 - Volume 12 - Issue 6 - p
604-608;
• Intensive care unit telemedicine: alternate paradigm
for providing continuous intensivist care: Rosenfeld BA,
Dorman T, Breslow MJ, Pronovost P, Jenckes M, Zhang
J, Anderson G, Rubin H; Crit Care Med; 2000 Dec;
28(12): 3925-31.
• Tele-ICU: Experience To Date: Craig M.Lilly, MD and
Eric J. Thomas, MD, MPH; J Intensive Care Med;
September 2009
臨床實例
This data is based on the VISICU eCareManager based eICU implementations within the United States
21
Confidential
穿戴式科技應用 Google Glass IntelliVue Solutions
Confidential
穿戴式裝置變革
Confidential
First proof of concept for delivering vital patient data via Google Glass
• Philips’ newly created “Digital Accelerator Lab” a cross-sector innovation platform with labs based in the Netherlands and India.
• Collaborated with researchers from Accenture Technology Labs to explore the potential use of Google Glass in clinical settings
Dr. David Feinstein with Philips and Accenture developers test out Google Glass before entering OR simulator lab.
Google Glass proof of concept
https://www.youtube.com/watch?v=ssldTFWBv3E
Topics for research may include: • Accessing a near real-time feed of vital signs in Google Glass • Calling up images and other patient data by clinicians from anywhere in the
hospital; • Accessing a pre-surgery safety checklist • Giving clinicians the ability to view the patient in the recovery room after
surgery; • Conducting live, first-person point-of-view videoconferences with other
surgeons or medical personnel • Recording surgeries from a first-person point-of-view for training purposes
創新智慧的生理監視方式
• Philips 提供廣泛多樣的病患生理監測方式;從床邊到穿戴式病患生理監視
器,結合臨床決策支援工具和移動式應用,達到即時取得病患資訊並集中
管理應用的目的。
• 每年超過 1.9 億人使用 Philips 病患生理監視器。透過創新讓世界更健康、
更永續發展。目標在2025年前每年改善30億人的生活。