1. The Integrated Clinical Environment-- Creating Big Data
Steven Dain MD FRCPC
Anesthesiologist, Woodstock Hospital
Associate Adjunct Professor, Department of Electrical and Computer Engineering, University of Waterloo
Collaborator, MDPNP.org, Open ICE Alliance

2. Disclaimers Collaborator, MD Plug and Play Program
Funding of program from US DOD, NIST, NSF, NIH, Partners Healthcare and private sources
Moral support from US FDA, Health Canada
Consultant for DocBox Medical Inc.

4. Current State of Affairs Medical Device Networks
Very little that’s practical or extensible
Proprietary servers and electronic interfaces
Difficult or illegal to connect medical devices
No usable standards for the electrical interface, syntax nor semantics
No easy regulatory pathway for network plug & play for devices from different vendors

5. Roadblocks to Innovation
Absence of smart alarms, automated clinical decision support, and physiologic closed-loop control, etc.
No multi-device black box recorders for clinical and forensic use
Difficult and expensive to write Apps for Health
Inability to collect big data for the ICU and OR

6. Medical Device “Plug-and-Play” Interoperability Program (MD PnP)
Program established 2004 at Mass General Hospital/CIMIT by Dr. Julian Goldman
Vender-neutral Lab for experimenting with safe interoperability (standards technologies, products)
Contains > $1M devices/network technology – production and research
Clinical, biomed, and computer science subject matter experts
Develops OpenICE open-source software
$18M funding primarily from DOD, NIH, NSF, NIST, private funding

8. Integrated Clinical Environment
Courtesy of DocBox Inc

9. Easy to Use Device Adapters
(4 devices per)
Manager Solution
(UI, distributed processing)
Courtesy of DocBox Inc

10. and Display a Cognitive Aid using OpenICE
Demonstration from the American Society of Anesthesiologists meeting Oct 2015:
Safety System to Automatically Detect Cardiac Arrest (Pulseless Electrical Activity)
and Display a Cognitive Aid using OpenICE
App running on OpenICE
Physiologic
Monitor
Simulator
OpenICE App automatically displays correct
Page from Stanford Emergency Manual to treat PEA
PEA page from the Emergency Manual
Stanford Emergency Manual
Note – this demonstrates CDS
Without using the EHR
Non-EMR Clinical Decision Support

11. Apps for Health
App to detect pulseless electrical activity from 2 different monitors from 2 different vendors, then displays protocol for treatment
Normal ECG
No pulsatile flow on SpO2 pleth and Art line
No End-tidal CO2

13. Creation of Big Data

14. Courtesy of DocBox Inc www.docboxmed.com

15. Courtesy of DocBox Inc www.docboxmed.com

16. Courtesy of DocBox Inc www.docboxmed.com

17. Analysis of Raw Alarm Data
Manager
event_message
alarm type
device
Total Count of Alarm Episodes
TOTAL COUNT
Total Time Alarming (sec)
Total Time Alarming (min)
Total Time Alarming (hr)
total time min
TOTAL TIME (hr)
Avg Duration per Alarm Episode (sec)
Avg Duration per Alarm Episode (mins)
Avg Duration per Alarm Episode (hrs)
dbmanager000032
FMS Unsupported
tech
Patient Monitor
101
713.8
424.1
7.1
backup audio failure
Ventilator 23 26
890297
247.3
265.8
645.1
10.8
dbmanager000031 3
66535
1108.9
18.5
369.6
6.2
ABP REDUCE SIZE
2821
5346
398114
6635.2
110.6
230.9
141.1
2.4
0.0
ABP Reduce Size
2525
433121
7218.7
120.3
171.5
2.9
Cannot Analyze QT
657
897
313806
5230.1
87.2
9948.2
165.8
477.6
8.0
0.1
CANNOT ANALYZE QT
240
283085
4718.1
78.6
1179.5
19.7
0.3
Cannot Analyze ST
919
1326
328303
5471.7
91.2
6065.9
101.1
357.2
6.0
CANNOT ANALYZE ST
407
35648
594.1
9.9
87.6
1.5
Resp LEADS OFF
440
738
153058
2551.0
42.5
5514.3
91.9
347.9
5.8
Resp Leads Off
298
177801
2963.4
49.4
596.6
0.2
SpO2 Low Perf
517
984
88909
1481.8
24.7
3600.5
60.0
172.0
SpO2 LOW PERF
467
127120
2118.7
35.3
272.2
4.5
prealarm: end of infusion
Syringe Pump
192
127302
2121.7
35.4
2495.8
41.6
1260.4
21.0
0.4 91
22446
374.1
246.7
4.1
ECG LEADS OFF
168
324
76158
1269.3
21.2
2475.5
41.3
453.3
7.6
ECG Leads Off
156
72373
1206.2
20.1
463.9
7.7
alarms silenced 47 73
72304
1205.1
2356.8
39.3
1538.4
25.6
69104
1151.7
19.2
2657.8
44.3
0.7
RL LEAD OFF 66
131
55726
928.8
15.5
2297.0
38.3
844.3
14.1
RL Lead Off 65
82091
1368.2
22.8
1262.9
exp flow sensor error
285
403
93713
1561.9
26.0
2207.7
36.8
328.8
5.5
118
38749
645.8
328.4
Cannot Analyze ECG
540
720
70006
1166.8
19.4
1930.1
32.2
129.6
2.2
CANNOT ANALYZE ECG
180
45802
763.4
12.7
254.5
4.2
Courtesy of DocBox Inc

18. Courtesy of DocBox Inc www.docboxmed.com

19. Courtesy of DocBox Inc www.docboxmed.com

20. Courtesy of DocBox Inc www.docboxmed.com

21. Benefits of the openICE through Data and Automation
Improvement in Operational Efficiencies
Equipment Utilization, Supply Purchases, Facility and Staff Utilization, Bed Turnover Times, Specialty Response Times, Equipment servicing and PM cycles
Improvement in Care Delivery
Reduction of adverse events, adoption of best practices, automation of care pathways, consistency of care
Determine needs for further staff education

22. Benefits of the openICE through Data and Automation
Improvement in Care Coordination
Shift Handoff, coordination between clinicians, transfer of patient from care environment to care environment, automation of communication.
Drives Innovation
Ability to create clinical applications as medical devices as modular components for real time decision support, data visualization
Open standards based platform

23. The ICE Alliance is a non-profit organization committed to establishing healthcare environments that are safe, secure, and interoperable
Note: The ICE Alliance is hosted by the IEEE-ISTO

24. ICE Alliance Founding Members*
NOTE – Not all pending members are shown
ICE Alliance Founding Members*
Founding Members
Liaison Members
*As of 10/13/15
Additional founding memberships in process

25. More Information www.mdpnp.org www.openince.info www.docboxmed.com

26. Medical Device Interoperability
Networking of medical devices to share data between:
devices
devices and external systems
between apps for health and one or more device(s) or external system(s)
For
Closed loop controllers
Intelligent systems
Smart alarms
Data logging