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1 Todd Cooper, Breakthrough Solutions Foundry Ken Fuchs, Mindray North America Steve Merritt, Baystate Health John Rhoads, Philips Healthcare Patient Care.

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Presentation on theme: "1 Todd Cooper, Breakthrough Solutions Foundry Ken Fuchs, Mindray North America Steve Merritt, Baystate Health John Rhoads, Philips Healthcare Patient Care."— Presentation transcript:

1 1 Todd Cooper, Breakthrough Solutions Foundry Ken Fuchs, Mindray North America Steve Merritt, Baystate Health John Rhoads, Philips Healthcare Patient Care Devices Patient Care Devices Overview & Update HIMSS Webinar – 3 August

2 2 Devices and Interoperability Medical Devices - Not a Simple Problem!! IHE PCD – Overview IHE PCD – Profiles IHE PCD – Testing and Demonstrations Getting to Yes!! Questions & Answers IHE Patient Care Devices - Overview and Update

3 3 President Barack Obama announces an audacious plan: Computerize all health records within five years. - January 12, – Obama vows to continue the HIT Plan begun by President Bush February 17, 2009 – the American Reinvestment and Recovery Act (ARRA) is signed into law HITECH Act component of ARRA provides a $19 billion program to stimulate the adoption and use of HIT, with a focus on meaningful use of certified EHR-S

4 4 Download What about Device Connectivity?

5 5 HITSP/TN905 Roadmap

6 6 The Dream! Heterogeneity Multiple manufacturers + multiple device & application modalities coexisting & interoperating over a shared infrastructure Best of Breed Selection Comprehensive, Real-time Availability Semantic Comparability Enables… Ability to base product acquisition on most appropriate technology without requiring HIT re-engineering. Harmonized semantics (terminology & models) enable next generation applications, incl. real-time CDSS. Timely health care decisions based on richer, more complete information. Medical Device HIT: No longer a nice to have

7 7 The Benefits! Integrity of data – automatic population of all information systems – reducing medical errors Automated systems saves time for clinicians Improved agility of enterprises to meet varied patient loads Improved life-cycle cost of ownership Automated clinical data capture for EHR Access to patient data across devices and systems so custom communication interfaces can be eliminated. Allows for best of breed selection Integration – Provider value propositions…

8 8 Devices and Interoperability Medical Devices - Not a Simple Problem!! IHE PCD – Overview IHE PCD – Profiles IHE PCD – Testing and Demonstrations Getting to Yes!! Questions & Answers IHE Patient Care Devices - Overview and Update

9 9 Multiple Care Contexts (Jan Wittenber, Philips Medical, HITSP/TN905)

10 10 Device Integration for Multiple Applications (Jan Wittenber, Philips Medical, HITSP/TN905)

11 11 Medication Administration (Erin Sparnon, ECRI Institute, IHE-PCD Infusion Pump Summit, , wiki.ihe.net) Its not just interfacing the infusion pumps! Many clinical systems must be integrated – from many vendors – using many technologies!

12 12 Example: CDSS & Multi Data Sources (John Zaleski, Nuvon, HITSP/TN905)

13 13 Devices and Interoperability Medical Devices - Not a Simple Problem!! IHE PCD – Overview IHE PCD – Profiles IHE PCD – Testing and Demonstrations Getting to Yes!! Questions & Answers IHE Patient Care Devices - Overview and Update

14 14 IHE Patient Care Devices IHE-PCD Charter The Patient Care Device Domain is concerned with use cases in which at least one actor is a patient- centric point-of-care medical device. The PCD coordinates with other IHE clinical specialty based domains such as medical imaging and lab to ensure consistency of medical device integration solutions across all IHE technical frameworks. NOTE: NOTE: Formed in 2005 & sponsored by HIMSS & ACCE

15 15 ADT, Orders Physiological and Operational Data (PCD) Information Reporters: Medical Devices with Server/Gateway Information Reporters: Standalone Medical Devices Information Consumers: (HIS, PhIS, eMAR, EMR) Physiological and Operational Data (PCD) ADT, Orders Server/Gateway ADT, Orders Physiological and Operational Data (PCD) Technical Framework IHE PCD Overview

16 16 Heterogeneity – … coexistence in a multi-vendor & multi-modality world, leveraging shared infrastructure Semantic Interoperability – … from the sensor to the EHR Real-time Availability – … facilitating more timely clinical decisions PCD Profile Primary Objectives: Ultimately providing improved – … safety, quality of care & workflow efficiency PCD Domain Overview

17 17 Profiles Simplify Development All implementation detail!

18 18 IHE PCD Profiles Current Profiles: Current Profiles: Enterprise sharing of Patient Care Data (DEC) Subscribe to Patient Data (SPD) Rosetta Stone Terminology Project (RTM) PCD Alarm Communication Management (ACM) Point-of-care Infusion Verification (PIV) Work in Process: Work in Process: Device Point-of-care Integration (DPI) Waveform Communication Management (WCM) Event Communication (EVT) Medical Equipment Management (MEM) Patient – Device Association (PDA) Initial device classes… Initial device classes… vital signs / physiological monitors, infusion pumps and ventilators

19 19 CPOE/ Pharmacy System Future PCD Current PCD Infusion Pump Barcode Medication Administration System Other Devices Equipment Management System Future Non- PCD Clinical Decision Support System Implantable Device IDCO ACM, DEC, WCM ACM, MEM ACM, DEC, WCM ACM: Alarm Communication Management DEC: Device Enterprise Communication IDCO: Implantable Device – Cardiac – Observation MEM: Medical Equipment Management PIV: Point-of-Care Infusion Verification WCM: Waveform Communication Management Home Based System Ventilation/ Anesthesia System EMR/EHR CIS Physiologic Monitoring System DEC ACM, DEC ACM, DEC, WCM PIV IHE PCD – Profile Overview

20 20 IHE Patient Care Devices 2009 White Paper Proposals 2009 White Paper Proposals Device Point-of-care Integration (DPI) Medical Equipment Management (MEM) – Complete! Medical Device Semantic Architecture Regulatory Considerations in Deploying Systems Incorporating IHE PCD Profiles IHE PCD Users Handbook IHE PCD Users Handbook What is & is not specified in PCD Profiles How to assess PCD profile support System verification & validation testing considerations

21 21 Devices and Interoperability Medical Devices - Not a Simple Problem!! IHE PCD – Overview IHE PCD – Profiles IHE PCD – Testing and Demonstrations Getting to Yes!! Questions & Answers IHE Patient Care Devices - Overview and Update

22 22 DEC Profile Device to Enterprise Communication Trial Implementation PCD Published Profiles

23 23 DEC Profiles PCD DEC profile supports the communication of patient clinical data from devices. This data can include: Vital Signs (profile available) Alarm information (2008/2009 profile) Waveform information (emerging profile) Device configuration information (MEM) Etc.

24 24 Device to Enterprise Comm. (DEC) The Device to Enterprise Communication (DEC) profile allows a consuming device to receive patient clinical information including vitals, settings, demographics and location from a reporting device.

25 25 MSH|^~\&|INFO_SRC_PHILIPS^ACDE ABCD^EUI-64|||| ||ORU^R01^ORU_R01|PMS | P|2.5|||NE|AL||8859/1 PID|||AB60001^^^Philips Medical^PI||Brooks^Albert^^^^^L|| |M PV1||I|UNIT_1^^Bed1 OBR|1|PMS ^INFO_SRC_PHILIPS^ACDE ABCD^EUI-64| PMS ^INFO_SRC_PHILIPS^ACDE ABCD^EUI-64| 69837^MDC_DEV_METER_PHYSIO_MULTI_PARAM_MDS^MDC||| OBX|1|ST|184326^MDC_ECG_STAT_ECT^MDC| |""||||||F OBX|2|ST|184327^MDC_ECG_STAT_RHY^MDC| |Sinus Rhythm||||||F OBX|3|NM|150456^MDC_PULS_OXIM_SAT_O2^MDC| |99|262688^MDC_DIM_PERCENT^MDC|||||F OBX|4|NM|147842^MDC_ECG_HEART_RATE^MDC| |81|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|5|NM|150037^MDC_PRESS_BLD_ART_ABP_SYS^MDC| |126|266016^MDC_DIM_MMHG^MDC|||||F OBX|6|NM|150038^MDC_PRESS_BLD_ART_ABP_DIA^MDC| |76|266016^MDC_DIM_MMHG^MDC|||||F OBX|7|NM|150039^MDC_PRESS_BLD_ART_ABP_MEAN^MDC| |92|266016^MDC_DIM_MMHG^MDC|||||F OBX|8|NM|148065^MDC_ECG_V_P_C_CNT^MDC| |0|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|9|NM|150045^MDC_PRESS_BLD_ART_PULM_SYS^MDC| |26|266016^MDC_DIM_MMHG^MDC|||||F OBX|10|NM|150046^MDC_PRESS_BLD_ART_PULM_DIA^MDC| |9|266016^MDC_DIM_MMHG^MDC|||||F OBX|11|NM|150047^MDC_PRESS_BLD_ART_PULM_MEAN^MDC| |14|266016^MDC_DIM_MMHG^MDC|||||F OBX|12|NM|149538^MDC_PLETH_PULS_RATE^MDC| |55|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|13|NM|150067^MDC_PRESS_BLD_ATR_LEFT_MEAN^MDC| |4|266016^MDC_DIM_MMHG^MDC|||||F OBX|14|NM|150087^MDC_PRESS_BLD_VEN_CENT_MEAN^MDC| |12|266016^MDC_DIM_MMHG^MDC|||||F PCD-01 Message Example Note: Extensive message examples on the PCD FTP Site: ftp://ftp.ihe.net/Patient_Care_Devices/ConnectathonsIncludingProcessAndTesting

26 26 Subscribe to Patient Data (SPD)

27 27 ACM Profile Alarm Communication Management Trial Implementation PCD Published Profiles

28 28 Alarm 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) Alarm Communication Management (ACM)

29 29 Alarm Source Alarm Aggregator Alarm Receiver Alarm Coordinator Alarm Disseminator Alarm Communication Alarm Endpoint Alarm Communication AC Alarm Management AM Alarm Reporter AR Alarm Reporter Alarm Cache Communication detailed in ACM profile Communication not detailed in ACM profile PCD Inputs (PM, NC, Resp, Pump, etc.) Output Devices (Marquee Sign, Pager, Wi-Fi Phone or Badge, etc.) HIS, EMR Alarm Archiver AA Report Alarm Alarm Status* Alarm Status* *Note: Implementation TBD Subscribe to Alarm * Subscribe to Alarm * * * Disseminate Alarm Dissemination Status * Dissemination Status * Report Alarm Report Alarm Subscribe to Alarm * Subscribe to Alarm * Gap! ACM Data Flows

30 30 Fill Gap: Alarm Manager (AM) to Alarm Communicator (AC) Define alarm identifier codes (RTM for alarms) Extend implementation of actors & transactions Expand to additional IHE domains ACM Status Update

31 31 PIV Profile Point-of-Care Infusion Verification Trial Implementation PCD Published Profiles

32 32 Point-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. PIV Objective

33 33 This is the focus of PIV … only! PIV Workflow Context Nurse removes Medication from Dispensing Unit or Med Room Nurse removes Medication from Dispensing Unit or Med Room Medication Dispensed Medication Dispensed Pharmacist reviews order detail (Pharmacy System) eMAR updated Pharmacist reviews order detail (Pharmacy System) eMAR updated Physician reviews data and places Orders Physician reviews data and places Orders Nurse Review eMAR Entry Nurse Review Medication Administered Medication Administered Nurse Confirms 5 Rights: Right Patient, Medication, Dose, Time, Route AT THE BEDSIDE Nurse Confirms 5 Rights: Right Patient, Medication, Dose, Time, Route AT THE BEDSIDE

34 34 DEC! PIV Actors & Data Flows

35 35 IDCO Profile Implantable Device – Cardiac – Observation Trial Implementation PCD Published Profiles

36 36 IDCO specifies the creation, transmission, and processing of discrete data elements and report attachments associated with implantable cardiac device interrogations (observations) or messages. IDCO Objective

37 37 Implantable Cardiac Device Leads for Sensing or Delivering Electrical Therapy Implantable Cardiac Devices

38 38 Device is interrogated via inductive or wireless telemetry in clinic or home environment using vendor proprietary equipment Information is transferred to clinic system as structured HL7 v2.6 ORU message using IEEE IDC nomenclature [PCD-09] IDCO Profile Context

39 39 RTM Profile Rosetta Terminology Mapping Trial Implementation PCD Published Profiles

40 40 Rosetta for Semantic Interoperability

41 41 Rosetta for Semantic Interoperability Vendor Terms RTM 1400 rows Harmonized Terms hRTM 440 terms ISO/IEEE Semantic Standards Vendor A Vendor B Vendor C HL7 V2 Messages HL7 V3 CDA/CCD PnP Comm Vendor Semantics IHE PCD Technical Framework Content Open consensus process Observation identifiers and co-constraints New terms incorporated into standards hRTM used for conformance testing

42 42 GroupREFIDDIMUOM_MDCUOM_UCUM CVS_ECG_HRMDC_ECG_HEART_RATET-1MDC_DIM_BEAT_PER_MIN {beat}/min {beats}/min 1/min /min CVS_ECG_STMDC_ECG_AMPL_ST_IML2I-1T-3 MDC_DIM_MILLI_VOLT MDC_DIM_MICRO_VOLT MDC_DIM_MILLI_M# mV uV(added by scripting rule) mm# (voted off-the-island ) GASMON_AA_ENFLMDC_CONC_ENFL_ETL3L-3 LMT-2L-2 LMT-2L-2 MDC_DIM_VOL_PERCENT MDC_DIM_KILO_PASCAL MDC_DIM_MMHG %{vol} kPa mm[Hg] Specifies for each IEEE REFID observation identifier: the MDC and UCUM units-of-measure includes dimensional analysis to ensure correct units-math enumerated values and measurement sites numeric codes, where appropriate An extract from the hRTM is shown below: Harmonized Rosetta (hRTM)

43 43 Unified semantics and semantic model are essential prerequisites for safe and effective interoperability between devices and systems. The hRTM rigorously defines what may be sent and informs recipients of what they may expect to receive. For each observation identifier, the hRTM specifies the units-of-measure, enumerated values, measurement sites and other co-constraints. The hRTM is based on the ISO/IEEE standards and leverages and extends that work by using an open consensus process. The hRTM is publicly available for IHE PCD clinical devices and will be available shortly for IEEE personal health devices. The hRTM supports message conformance testing frameworks that can be used for both clinical and personal health devices. RTM & hRTM Highlights

44 44 Emerging Profiles Waveform Communication Management (WCM) Medical Equipment Management (MEM) Event Communication Device Point-of-Care Integration (DPI) Real Time Location Tracking Real-time data archiving and communication Mobile, enterprise-wide, reliable vital signs monitoring … many more! PCD Emerging Profiles

45 45 Device Point-of-Care Integration [DPI] PCD Emerging Profiles

46 46 DPI: Scope – Device Point-of-care Integration (DPI) is concerned with use cases that include care contexts that fall within the stated charter of the IHE PCD, namely where "at least one actor is a regulated patient centric point-of-care medical device," and that require device-to-device communication. Device Point-of-Care Integration

47 47 Device Point-of-Care Integration Discovery and Association (PnP) Discovery and Association (PnP) Real-Time Data Reporting Real-Time Data Reporting Bi-Directional / Symmetric Bi-Directional / Symmetric External Control External Control Enterprise Integration Semantic Interoperability Monitored Parameters Alarms & Limits Waveforms (Real-Time) Control Parameters Device Reporting, Management & Control Real-Time Clinical Decision Support Point-of-Care Applications Real-Time Closed / Open Loop Control DPI Manager / Enterprise Gateway Device Point-of-Care Integration

48 48 Medical Equipment Management [MEM] Imagine … What if I.T. & device vendors gave me EVERYTHING I ever wanted?! What if I.T. & device vendors gave me EVERYTHING I ever wanted?! PCD Emerging Profiles

49 MEM (Medical Equipment Management)

50 – White Paper 2009 – White Paper Ongoing work Ongoing work Cycle 5 Brief Profile Proposal Real Time Location Tracking Location Boundary Alarms Battery Management Semantic Content Requirements MEM Status

51 51 Waveform Communication Management [WCM] PCD Emerging Profiles

52 52 Waveform Communication Management will extend the [DEC] profile to provide a method for passing near real-time waveform data using HL7 v2 observation messages between a Reporter and a Consumer. A filter will be an optional element STATUS: Supplement currently undergoing TC review Supplement currently undergoing TC review WCM Objective

53 53 Devices Aggregation Manager Telehealth Service Center Health Records PAN LAN WANHRN Personal Area Network Local Area Network Wide Area Network Health Reporting Network Continua / IHE PCD WAN Interface

54 54 Message Transport Web Services WS-I BP IHE IT Infrastructure TF Vol 2 Appendix V Rev 6.0 WS-I BP over SOAP 1.2 Plus WSI-BSP, TLS and IHE ATNA HL7 MLLP IHE HL7 V2 Msg Transport HL7 Minimum Lower Layer Protocol (MLLP) over TCP/IP Messaging HL7 V2.6 constrained by IHE DEC PCD-01 and RTM. Semantics IEEE and 104xx terms IEEE terms and –10201 info model (beyond the firewall)(behind the firewall) Continua/IHE PCD DEC WAN Note: This is new to the IHE PCD … not IHE ITI … test tooling, test scripts, etc.

55 55 (From ICE-PAC Overview Update to IHE PCD) ICE-PCD Analysis Committee (ICE-PAC) ICE-PCD Analysis Committee (ICE-PAC) – JWG underway to perform a map & gap analysis between ICE use case analyses, ISO/IEEE standards & the IHE DPI WG. PCD & ASTM ICE/CIMIT MDPnP

56 56 RDC Project ~ Building on Clinical Requirements Risk Analysis System Modeling Technical Solution and Clinical Implementation Design Engineers Clinical Engineers Clinical Scenario Clinical Workflow Analysis Clinical Scenario Clinicians Gathering Requirements from Clinical System Providing Traceability of System Requirements Provide Systems Level Risk Analysis Provides Traceability to Mitigating Risk Designing for the System, not modifying the system causing unintended consequences General Building Blocks and Interactions between the blocks are key to Safety If General Building Blocks make up Specific Systems then Systems are safe

57 57 RDC Project ~ Logical Actors / Intermediary Architecture Logically, the actors are relatively simple. DTBR must supply configuration & status info to the RDC. The RDC also retrieves configuration (static & operational) from the DR + interacts with the clinician, especially to resolve non-compatibility DTBR-to-DR issues; RDC may also automatically program the DR if supported; otherwise, it may monitor DR configuration status as the clinician interacts both with it and the DR (manually configuring / confirming). DTBR DOR/agent Rapid Device Configurator DOC/manager DR DOR/agent Monitor Device Configuration / Status Auto-Configure Device (external control) Clinician Reviews / Manually Configures Device via User Interface

58 58 Devices and Interoperability Medical Devices - Not a Simple Problem!! IHE PCD – Overview IHE PCD – Profiles IHE PCD – Testing and Demonstrations Getting to Yes!! Questions & Answers IHE Patient Care Devices - Overview and Update

59 59 IHE Standards Adoption Process 59 Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IEEE, IETF) Develop technical specifications Testing at Connectathons IHE Demonstrations Products with IHE Easy to integrate products 59 Improved safety, quality & efficiency!

60 60 Locked in the … dungeon?!

61 61 IHE Testing Process In-House Testing Demonstration Deploy Systems Testing Results Approves Test Logs IHE Technical Framework (IHE Profile Specifications) Product + Integration Statement Users Sponsors: Project Management Team Vendors Sponsors: Exhibits Implement Profile Actors Develop Testing Tools Connectathon Interview

62 62 Conformance Testing of an HL7 V2 Message Report Test Artifacts Conformance Profile HL7 Tables Device Test Agents ISO/IEEE 11073/Rosetta Terminology Test Artifacts Conformance Profile HL7 Tables Device Test Agents ISO/IEEE 11073/Rosetta Terminology HL7 V2 Message Validation HL7 V2 Message Validation ServicesTest Management HL7 V2 Message Validation Test Case HL7 V2 Message Validation Test Case Results HL7 V2 Message Validation Report Results HL7 V2 Message Validation Report Test Harness (Java Code) Test Harness (Java Code) Test Execution User Web Application Client HL7 V2 Message HL7 V2 Message Registry/ Repository NIST Tools: Instance System Test Environment See NIST HL7-PCD Validation

63 63 IHE-PCD Testing using a Web Application Client Report IHE-PCD DOR/DOF Test Agent IHE-PCD DOR/DOF Test Agent HL7 V2 Message Generation HL7 V2 Message Generation IHE-PCD DOC Test Agent IHE-PCD DOC Test Agent HL7 V2 Message Validation HL7 V2 Message Validation Services Test Management Router/Logger/Proxy Vendor System Under Test IHE-PCD Client Test Scenario IHE-PCD Client Test Scenario Results HL7 V2 Message Validation Reports Results HL7 V2 Message Validation Reports Test Harness (Java Code) Test Harness (Java Code) Test Execution Web Application Client IHE-PCD IOR Test Agent IHE-PCD IOR Test Agent IHE-PCD AM Test Agent IHE-PCD AM Test Agent IHE-PCD IOC Test Agent IHE-PCD IOC Test Agent IHE-PCD AR Test Agent IHE-PCD AR Test Agent IHE-PCD IDCC Test Agent IHE-PCD IDCC Test Agent IHE-PCD IDCR Test Agent IHE-PCD IDCR Test Agent NIST Tools: Isolated System Test Environment

64 64 A Framework for Building Test Systemsan SOA Approach Test Data ServicesTest Management Test Description Test Description Results Test Harness Test Harness Test Execution Router/Logger/Proxy User Facilitator Monitor System Under Test Validation Generation Test Agent Evaluation Agent Aggregated Services Test Artifacts Time Report Security Logging Proxy Log Analyzer Specialized Validation Specialized Validation External Services Other Services Test Analyzer Test Analyzer NIST Tools: Peer-2-Peer Test Environment

65 65 IHE Standards Adoption Process 65 Document Use Case Requirements Identify available standards ( e.g. HL7, DICOM, IEEE, IETF) Develop technical specifications Testing at Connectathons IHE Demonstrations Products with IHE Easy to integrate products 65 Improved safety, quality & efficiency!

66 66 HIMSS 2010

67 67 CPOE/ Pharmacy System Future PCD Current PCD Infusion Pump Barcode Medication Administration System Other Devices Equipment Management System Future Non- PCD Clinical Decision Support System Implantable Device IDCO ACM, DEC, WCM ACM, MEM ACM, DEC, WCM ACM: Alarm Communication Management DEC: Device Enterprise Communication IDCO: Implantable Device – Cardiac – Observation MEM: Medical Equipment Management PIV: Point-of-Care Infusion Verification WCM: Waveform Communication Management Home Based System Ventilation/ Anesthesia System EMR/EHR CIS Physiologic Monitoring System DEC ACM, DEC ACM, DEC, WCM AAMI Demo PIV IHE PCD – AAMI Demonstration

68 68 HIMSS 07 IHE PCD Showcase

69 69 HIMSS 08 IHE PCD Showcase

70 70 HIMSS 09 IHE PCD Showcase

71 71 HIMSS 10 Atlanta Showcase Floorplan HIMSS 10? Too big for a single diagram!

72 72 IHE PCD – HIMSS 10 Wall 1

73 73 IHE PCD – HIMSS 10 Wall 2

74 74 IHE PCD – HIMSS 10 Wall 3

75 75 IHE PCD – HIMSS 10 Wall 4

76 76 Devices and Interoperability Medical Devices - Not a Simple Problem!! IHE PCD – Overview IHE PCD – Profiles IHE PCD – Testing and Demonstrations Getting to Yes!! Questions & Answers IHE Patient Care Devices - Overview and Update

77 77 Great Expectations? IHE PCD – Vendor value propositions… Simplify product development process Spend time innovating rather than supporting infrastucture work – again & again &... Facilitate clinical decision support - innovation - increased functionality Reduce regulatory impact/work Improve patient safety - reduce liability - make operations easier - device aware

78 78 The Dream … Deferred! Why has it not yet happened? Incomplete standards … but no longer the case! Uncoordinated & inconsistent demand from providers and other user stakeholders Undefined stakeholder value propositions Resources – esp. for standards–related projects Dr. Brailer: Infrastructure is a hard sell: Concentrated cost – Diffuse benefit A business issue – not a lack of technology!

79 79 Devices and Interoperability Medical Devices - Not a Simple Problem!! IHE PCD – Overview IHE PCD – Profiles IHE PCD – Testing and Demonstrations Getting to Yes!! Questions & Answers IHE Patient Care Devices - Overview and Update

80 Q & A Find out more at


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