1. 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.

2. 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:

3. IHE Patient Care Devices (PCD) Why Patient Care Devices? There are over 1500 Patient Care Device manufacturers and over 3500 Make-Model combinationsThere are over 1500 Patient Care Device manufacturers and over 3500 Make-Model combinations The typical 200 bed hospital contains 1,000s of Patient Care DevicesThe typical 200 bed hospital contains 1,000s of Patient Care Devices …that are constantly changing with updated/upgraded technology … and interoperability too?!…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 connectedFor every connected IT Device in the hospital, there are 4 Patient Care Devices that are not connected

4. 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).

5. 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

6. IHE Patient Care Devices (PCD) HIMSS Survey IHE pre-2005 Annual Conference results: Further, 56% said theyd pay more for IHE-compliant products!Further, 56% said theyd 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 *

7. 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).

8. Why Do I Care About the IHE PCD? Significance Clinical implications –Patient safety –Enterprise wide access to the patients data –Quality of care –Ability to implement best of breed for your applications –Workflow improvements

9. 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

10. 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

11. User/Provider/Purchaser Benefit ExamplesSignificance 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

12. 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. 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.

13. 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.

14. IHE PCD in the HIMSS 2007 Interoperability Showcase

15. 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

16. Device Enterprise Communication (DEC) Profile - Year 1

17. 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.

18. Measurement Context is Dynamic

19. IEEE 11073 Domain Information Model Defines Device Context 1 0..n0..n

20. Mapping preserves measurement context

21. 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

22. 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 TODAY!!!Demonstration at HIMSS 2008 – TODAY!!!

23. PCD HIMSS Showcase Scenario

24. Patient ID Binding

25. DEC - Subscribe to Patient Data Note: SPD is a DEC Profile option.

26. DEC - Subscribe to Patient Data

27. Rosetta Terminology Profile

28. IHE-PCD Future Developments - Roadmap

29. 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

30. What Can You Do? To Define the Future Become a member of a Domains 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 Whats required of you? Poll the room--- Questions, etc.

31. PCD Contacts PCD CoChairs: – Todd Cooper t.cooper@ieee.orgt.cooper@ieee.org – Ken Fuchsken.fuchs@draeger.comken.fuchs@draeger.com – Jack Harrington jack.harrington@philips.comjack.harrington@philips.com – Ray Zambuto ray.zambuto@techmed.lincfs.comray.zambuto@techmed.lincfs.com PCD Technical Project Manager: – Manny Furstefurst@imp-tech.comefurst@imp-tech.com IHE (International) Strategic Development Committee Co- Chair: – Elliot Sloaneebsloane@villanova.eduebsloane@villanova.edu