Presentation on theme: "Clinical Engineering Association of Illinois"— Presentation transcript:
1Clinical Engineering Association of Illinois Patient Care Devicespresentation for theClinical Engineering Association of IllinoisApril 25, 2009Paul Schluter, Ph.D.GE Healthcare (Milwaukee, WI)IHE Patient Care Devices Domain
2Agenda IHE Overview PCD Domain Overview Published Profiles: DEC, PIB & SPDNew Profiles: RTM, ACM, PIVEmerging Profiles: IDCO, WCM, MEM, PNP, ...Test ToolingConnectathonShowcase DemonstrationsSummary and Contact InformationQ & A
3Integrating the Healthcare Enterprise What is IHE?IHEIntegrating the Healthcare EnterpriseIn a nutshell:IHE identifies real-world interoperability problemsBrings people together to design, test and demonstrate solutions using existing standards.3
4IHE International IHE International is … An international umbrella organization sponsored by RSNA, HIMSS and others…Voluntary, non-profit, operating in public viewLargely manufacturers, users, regulatorsAn initiative by healthcare professionals and industry to improve the way computer systems share information.4
6PCD Domain OverviewIHE PCD DomainPatient Care Devices6
7PCD Domain Overview A Brief History of PCD Established in 2005 when the “charter” was awarded to the ACCEJointly sponsored by ACCE and HIMSS as of July 1, 2006Technical Framework developed to communicate patient data (asynchronous)Successful demonstration at the 2007 & 2008 Connectathons and HIMSS Interoperability Showcases
8PCD Domain Overview 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 cardiology, pharmacy, laboratory and medical imaging.
9PCD Domain Overview 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; andDemonstrate marketable solutions at public trade shows.
10PCD Profile Value Objectives: PCD Domain OverviewPCD Profile Value Objectives:Heterogeneity – … coexistence in a multi-vendor and multi-modality world, leveraging shared infrastructureSemantic Interoperability – … from the sensor to the EHRReal-time Availability – … facilitating more timely clinical decisions
11IHE PCD Profiles and Objectives PCD Technical Frameworks for 2007/2008Device Enterprise Communication (of device data) (DEC, PCD-01)Patient Identity Binding to Device Data (PIB)Subscribe to Patient Data (SPD)PCD Technical Frameworks for 2008/2009Rosetta Terminology Management Project (RTM)Alarm Communication Management (ACM)Infusion Pump Integration - Drug Administration (PIV)Key Objectives 2009 and beyondImplanted Cardiac Devices (IDCO)Waveform Communication Management (WCM)Medical Equipment Management (MEM)Device Point-of-Care Integration (DPI, a multiyear effort)Real-time data archiving and communicationMobile, enterprise-wide, reliable vital signs monitoring… many more!Initial device classes…vital sign monitors, bedside monitors, infusion pumps and ventilators
12PCD - Published Profiles DEC ProfileDevice to Enterprise Communication12
15DEC Profile Mapping Model ISO/IEEE Domain Information Model and Nomenclature mapped to HL7 (v2.5) Observation ReportISO/IEEE Data Types mapped to HL7 Data TypesMapping preserves measurement context for complex devices.
22Patient Identity Binding DEC-PIB profile…Automates identity association / authentication process using standard ITI profiles.Option for the DEC ProfileAsync identity access using ITI-21 Patient Demographics Query (PDQ)Sync identity acquisition using ITI-30 Patient Admin Management / Patient Identity Feed (PAM)22
23PCD - Published Profiles SPD ProfileSubscribe to Patient Data23
24DEC - Subscribe to Patient Data Note: SPD is a DEC Profile option.
30RTM Goals for 2009/10Expand the number of numeric parameters supported by PCD-01 from 40 today to nearly 300, providing a more comprehensive set.Harmonize the use of existing nomenclature terms defined by ISO/IEEESpecify the units-of-measure and enumerated values associated with each numeric parameter.Identify and add new nomenclature terms that are currently missing from ISO/IEEENOTE: Respiratory / Ventilator terms are a major area. See
31RTM Technical Steps Create the Rosetta Terminology Mapping Table Current draft (1k) has over 930 rows submitted by six vendors.Identify implementation differences and resolve.Resolve differences in interpretation.Pre- or post-coordinated measurement site location(s).Identify missing terms and propose new terms to standards organizations.IHE PCD – need to add 40+ terms to ISO/IEEEContinua – need to add 100+ terms to ISO/IEEEGenerate final set of terms, units-of-measure and enumerations for testing.Working with NIST for HL7 test and validation toolingWiki:
32Alarm Communication Management PCD - New ProfilesACM ProfileAlarm Communication Management32
33ACM StatementAlarm Communication Management enables systems to deliver the right alarms, with the right priority, to the right individuals, via devices with the right content, escalating to other individuals via devices (based on system configuration)33
34Wi-Fi Phone or Badge, etc.) ACM ActorsPCD Inputs(PM, NC, Resp,Pump, etc.)Output Devices(Marquee Sign, Pager,Wi-Fi Phone or Badge, etc.)AlarmReporter(AR)AlarmManagement(AM)AlarmCommunication(AC)AlarmSourceAlarmAggregatorAlarmReceiverAlarmCoordinatorAlarmDisseminatorAlarmCommunicationAlarmEndpointAlarmReporter..AlarmCacheOptionalAlarm Query(AQ)Communication detailed in ACM profileHIS, EMRCommunication not detailed in ACM profile34
35What Actor does What?AR – knows originating alarm, ultimately responsible for clearing it, knows how to get the alarm to the AMAM – a giant offloading engine, dumb or intelligent, dispatching, escalation, filtering, assignments, content harmonization, knows how to communicate with multiple, potentially proprietary, AC actors, may know end device distinctions, may gather RTLS samples at alarm timeAC – data communication gateway to the endpoint device, understands how to communicate to end devices across things like Wi-Fi and WANs, knows device specific characteristics, and concepts like presence, read, read receipt, accept, cancel, etc. and how to communicate those back to the AM, might also know how to bridge to telephony and web based systems for things like callbacks and hyperlinksAQ – standalone optional subscriber and query source for gathering ad-hoc or long term information35
36ACM Data Flows Inputs Outputs Historical Capture and Reporting ¬ Alarm Status [ACM-02]*¬ Dissemination Status [ACM-04]AlarmReporter(AR)Report Alarm [ACM-01] ®Disseminate Alarm [ACM-03] ®AlarmManagement(AM)AlarmCommunication(AC)¬ Subscribe to Alarm [ACM-05]*Subscribe to Alarm Cache [ACM-06]* ¯ Report Alarm [ACM-01]Query for Alarm [ACM-07]* OptionalAlarmQuery(AQ)Historical CaptureandReporting* Not planned for implementation in 2008/0936
37Point-of-Care Infusion Verification PCD - New ProfilesPIV ProfilePoint-of-Care Infusion Verification37
38PIV StatementPoint-of-Care Infusion Verification supports the electronic transfer of infusion parameters from a Barcode Point of Care (BPOC) system, also known as a Bar Code Medication Administration (BCMA) system, to an infusion pump.38
39PIV BenefitsPIV will reduce errors by eliminating keystroke errors and by increasing the use of automatic dosage checking facilitated by onboard drug libraries.Supports the ‘Five+ Rights’ of Medication Administration:Right Patient, Drug, Dose, Route, Time and Pump.39
40PIV as part of overall workflow… NurseReviewMAR EntryPharmacist reviewsorder detail(PharmacySystem)eMAR updatedMedicationDispensedNurse removesfrom DispensingUnit or Med RoomNurse Confirms 5Rights:Right Patient,Medication,Dose, Time, RouteAT THE BEDSIDEAdministeredPhysician reviewsdata and placesOrderseMAR EntryNurse Confirms 5 Rights
46Test Tooling Support - NIST NIST Test ToolsICSGeneratorMedical Device Profiles (specializations)Implementation Conformance StatementsValidatePDUX73 Application Layer Message Syntax and Semantic ValidationNIST Medical Device Standards WorkISO/IEEE Standard (X73): Medical Device CommunicationXML Schema: NIST P Domain Information ModelCollaborationsIntegrating Health Enterprise - Patient Care Devices (IHE-PCD)IEEE Personal Health Devices (PHD) Working Group (WG)ISO/IEEE WGOn-going Work and Future Direction…IHE-PCD profile and message generation and testing (includes enterprise – e.g., HL7 V2 & V3)PHD X73 profile and message testing (Continua)X73 Java Class LibraryNIST Team MembersJohn Garguilo ), Sandra Martinez, Maria Cherkaoui (guest researcher), and Richard Theimer (contractor)In today’s presentation I will provide with an update of the NIST Test tools including the DIM Schema and some open issues related to the DIM.
47What is NIST doing? Test Tools! ICSGeneratorValidatePDUWhat is it?Implementation Conformance Statement Generator, Profile builderX73 Message validation: profile and standardWhy?Easy to use interfaceBased on standardPromote InteroperabilityWho’s using it?Most major medial device manufacturersIHE-PCD participants (pre-connectathon, connectathon, HIMSS)PHD participants (smaller devices - Continua effort)A few small manufactures have expressed interestCountries participating: US, Europe, Japan, Korea, CanadaHow is it being used?As a requirement to standard (ICSs)Early stage interoperabilityHelp produce more accurate standards documentationIHE-PCD profile validationMessage validationWho are we working with?IHE-Patient Care DomainIEEE Personal Health Device WGIEEE WGICSGeneratorTo support interoperability of applications and systems, an implementation based on the X73 standard shall providespecific details about the way that the definitions of the standard are applied.These specifications have to be provided in form of a set of implementation conformance statements (ICSs).An ICS is a form of data sheet that discloses details of a specific implementation and specifies which featuresare provided. Specific applications or functional communication profiles that are based on the X73standard shall define more specific conformance requirements in addition to or as a replacement of the ICSdefined.
49Test Tool Support – R-T PnP IHE-PCD Point-of-Care, Plug-n-Play, Real-Time ProfileMedical Device Profiles and Implementation Conformance Statements (ICS) are generated using ICSGenerator according to X73 StandardDevice Profiles are used to configure medical devices (Agent/Manager) which, in turn, exchange X73 dataX73 messages are captured and validated against X73 standard and profile (from ICSGenerator) using ValidatePDU
50Where we prove that it really works !! PCD - ShowcaseConnectathonWhere we prove that it really works !!50
57Hospital Bed, BIS Monitor Hospital Bed, VS Monitor PCD at HIMSS (infusors, alarms)EnterpriseGECentricity®EnterprisePDQ/PAM ServerTime ServerAlarm ClientPolycomWireless PhoneDOCACPatientPatientICUPatientPatientORStep-DownGECentricity®Periop Anes.SIS Periop SolutionPhilips EmerginLiveDataAlert ManagerDOCDOCAMAMCernerCareMobileTMPhilips IntelliVueClinicalInfo PortfolioDOCDraegerInnovian® WebCapsuleCernerCareMobileTMDOCIOPLiveDataOR – DashBoardTMDOCARIOPDOCDOCDOR,ARCan we find a way to spell out VSM, CIS, GW, perhaps as a footnote?Make orange and type larger, perhaps making the blocks a little smaller.Need to show the VSM is in the ER and not ICUTwo of the logos will be HIMSS and IHEDOR,ARInfusion DevicesB. BraunHospiraCardinalDOR,ARInfusion DevicesIOCB. BraunHospiraCardinalHospital Bed, BIS MonitorCapsule DataCaptorDOR,ARPatient Monitor,VentilatorDORGE AwareGatewayDOR,ARInfusion DevicesIOCB. BraunHospiraCardinalDOR, ARHospital Bed, VS MonitorCernerCareAwareTMPatient MonitorDOR, ARPhilips IntelliVueInfo. CenterDOR, ARCapsuleDraeger Infinity GatewayPatient Monitor, Anesthesia SysDOR = Device Observation Reporter IOP = Infusion Order ProgrammerDOC = Device Observation Consumer IOC = Infusion Order ConsumerAR = Alarm Reporter / AM = Alarm Manager57
58PCD – IHE Showcase at HIMSS HIMSS ShowcaseWhere we get to show it off !!58
63IHE PCD Profiles and Objectives (Recap) PCD Technical Frameworks for 2007/2008Device Enterprise Communication (of device data) (DEC, PCD-01)Patient Identity Binding to Device Data (PIB)Subscribe to Patient Data (SPD)PCD Technical Frameworks for 2008/2009Rosetta Terminology Management Project (RTM)Alarm Communication Management (ACM)Infusion Pump Integration - Drug Administration (PIV)Key Objectives 2009 and beyondImplanted Cardiac Devices (IDCO)Waveform Communication Management (WCM)Medical Equipment Management (MEM)Device Point-of-Care Integration (DPI, a multiyear effort)Real-time data archiving and communicationMobile, enterprise-wide, reliable vital signs monitoring… many more!Initial device classes…vital sign monitors, bedside monitors, infusion pumps and ventilators
64PCD Profile Development 2009 White Paper ProposalsDevice Point-of-care Integration (DPI)Medical Equipment Management (MEM)Medical Device Semantic ArchitectureRegulatory Considerations in Deploying Systems Incorporating IHE PCD ProfilesIHE PCD Users HandbookWhat is and is not specified in PCD ProfilesHow to assess PCD profile supportSystem verification & validation testing considerations
65Why use IHE PCD profiles? PCD profiles will enable…Simplified standards-based integration of point-of-care device info & servicesMulti-vendor product integration and testing at ConnectathonsVisibility of products with care providers and peer technology organizations in ShowcasesPath to programs such as the U.S. National Health Information Network (NHIN)
66PCD Contacts http://www.IHE.net/pcd PCD CoChairs: Todd CooperKen FuchsRay ZambutoPCD Technical Project Manager:Manny FurstIHE (International) Strategic Development Committee Co-Chair:Elliot SloaneRosetta Terminology Mapping Working Group Co-Chair:Paul Schluter