1. Use of IHE DEC Profiles for Remote Monitoring Authors: Paul Schluter and Todd Cooper HITSP RMON discussion October 2, 2008

2. Device Device Intermediary Device EHR or Care Coordination Applications Home Setting Hospital Setting Device Intermediary IHE-DEC Subset of IHE-DEC IHE-DEC: Same protocol used in two settings …

3. IHE Device Enterprise Communication (DEC) and related Profiles (PCD, SPD, ACM). Device Observation Consumer (DOC) Device Observation Reporter (DOR) Device PCD-01 Transaction: Communicate Device Data Periodic Physiologic Data: Heart Rate, Respiration rate Episodic Physiologic Data: NIBP, Weight, Cardiac tests Primarily structured data but facilities non structured data as well Must include Patient ID > 1 minute sampling rate (but could be faster) Waveform support is simple extension Flexible extensions with: Alarms and alerts supported through related profile (ACM) Subscribe to Patient Data (SPD) Profile Security, privacy, confidentiality through related profile (ATNA) ISO/IEEE 11073-10101 nomenclature (does not rule out LOINC or SNOMED) ISO/IEEE 11073 or UCUM units-of-measure OBX-4 used for « mds.vmd.chan.metric», OBX-20 for measurement sites Profile and simplify other aspects of HL7 V2.5 messaging

4. Mapping Preserves Measurement Context Overall Device or System Virtual Medical Device Channel (only as needed) A single observation

5. PCD-01 Message Example (simple heart rate) MSH|^~\&|HL7^080019FFFF4F6AC0^EUI-64|MMS|||20070118133700||ORU^R01 |a4e2e3:11036b5cdbb:-|P|2.5|20070118133700||NE|AL||8859/1 PID|||6O008D^^^A^PI||DAVIDSON^DAVID^^^^^L PV1||E|3WICU^305^305 OBR|1|080019FFFF4F6AFE200701|080019FFFF4F6AC0200701|126.3.3.1^2000^MDC|||20070118 133700 OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC|1.6.1.1|80|/min^/min^UCUM|||||R Heart Rate /min UOM IEEE EUI-64 OBX-4 Value

6. PCD-01 Message Example (more complex) MSH|^~\&|HL7^080019FFFF4F6AC0^EUI-64|MMS|||20070118133700||ORU^R01|a4e2e3:11036b5cdbb:- |P|2.5|20070118133700||NE|AL||8859/1 PID|||6O008D^^^A^PI||DAVIDSON^DAVID^^^^^L PV1||E|3WICU^305^305 OBR|1|080019FFFF4F6AFE200701|080019FFFF4F6AC0200701|126.3.3.1^2000^MDC|||20070118133700 OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC|1.6.1.1|80|/min^/min^UCUM|||||R OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC|1.6.1.1|60|/min^/min^UCUM|||||R OBX|2|NM|131841^MDC_ECG_AMPL_ST_I^MDC|1.7.1.1|0.0|mm^mm^UCUM|||||R OBX|3|NM|131842^MDC_ECG_AMPL_ST_II^MDC|1.7.1.2|0.0|mm^mm^UCUM|||||R OBX|4|NM|131901^MDC_ECG_AMPL_ST_III^MDC|1.7.1.3|0.0|mm^mm^UCUM|||||R OBX|5|NM|131847^MDC_ECG_AMPL_ST_V5^MDC|1.7.1.4|0.0|mm^mm^UCUM|||||R OBX|6|NM|131902^MDC_ECG_AMPL_ST_AVR^MDC|1.7.1.5|0.0|mm^mm^UCUM|||||R OBX|9|NM|150035^MDC_PRESS_BLD_ART_MEAN^MDC|1.3.1.1|96|mm[Hg]^mm[Hg]^UCUM|||||R OBX|10|NM|150033^MDC_PRESS_BLD_ART_SYS^MDC|1.3.1.2|122|mm[Hg]^mm[Hg]^UCUM|||||R OBX|11|NM|150034^MDC_PRESS_BLD_ART_DIA^MDC|1.3.1.3|82|mm[Hg]^mm[Hg]^UCUM|||||R OBX|12|NM|149522^MDC_BLD_PULS_RATE_INV^MDC|1.2.1.1|60|/min^/min^UCUM|||||R OBX|13|NM|150047^MDC_PRESS_BLD_ART_PULM_MEAN^MDC|1.4.2.1|14|mm[Hg]^mm[Hg]^UCUM|||||R OBX|14|NM|150045^MDC_PRESS_BLD_ART_PULM_SYS^MDC|1.4.2.2|24|mm[Hg]^mm[Hg]^UCUM|||||R OBX|15|NM|150046^MDC_PRESS_BLD_ART_PULM_DIA^MDC|1.4.2.3|10|mm[Hg]^mm[Hg]^UCUM|||||R OBX|16|NM|151610^MDC_VENT_CO2_RESP_RATE^MDC|1.5.1.1|12|{breath}/min^{breath}/min^UCUM|||||R OBX|17|NM|151976^MDC_VENT_PRESS_AWAY_END_EXP_POS^MDC|1.5.1.2|4|cm[H20]^cm[H20]^UCUM|||||R OBX|18|NM|152008^MDC_VENT_VOL_MINUTE_AWAY^MDC|1.5.1.3|0.0|l/min^l/min^UCUM|||||R OBX|19|NM|151920^MDC_VENT_CONC_AWAY_O2_INSP^MDC|1.5.1.4|21|%^%^UCUM|||||R OBX|20|NM|151980^MDC_VENT_VOL_TIDAL^MDC|1.5.1.5|1096|ml^ml^UCUM|||||R OBX|21|NM|151957^MDC_VENT_PRESS_MAX^MDC|1.5.1.6|17|cm[H20]^cm[H20]^UCUM|||||R OBX|22|NM|151784^MDC_PRESS_RESP_PLAT^MDC|1.5.1.7|30|cm[H20]^cm[H20]^UCUM|||||R OBX|23|NM|151792^MDC_PRESS_AWAY^MDC|1.5.1.8|35|cm[H20]^cm[H20]^UCUM|||||R OBX|24|NM|151808^MDC_PRESS_AWAY_END_EXP_POS_INTRINSIC^MDC|1.5.1.9|1|cm[H20]^cm[H20]^UCUM| ||||R

7. IHE DEC (and associated) profiles Provides a Unified Interface that -- Supports the complete range of device data (except for high- bandwidth continuous waveforms) found in health related devices today and in the future. Provides a consistent interface in Health Record, Care Management Systems and Personal Health Records that is: -Secure, private -High performance even on low bandwidth links -Scalable, from a simple device intermediary (a few devices for the same patient) to multiple devices for many patients. Trivial to implement. -Straightforward mapping from proprietary and IEEE 11073 formats (uses same nomenclature as X73 Personal Health devices). -Based on proven HL7 standards that are supported by all Care Management and EHRs products today