Parameters - IHE

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					Parameter                 Rosetta (IEEE 11073-10101) Term(s)          Comments / Issues
                                                                      ISSUE: providing a human-readable label to assist in reliable manual
                                                                      association of pump to EMR element. Rationale: if clinician needs to make a
                                                                      manual association between pump and an element of the EMR, or to confirm
                                                                      an ongoing association, there needs to be some unique (within hospital) yet
                                                                      concise label on the pump and on the EMR's user interface.

                                                                      Is this of interest to any EMR vendor?

                                                                      STATUS: These 2 MDC__ATTR* terms are declared in Appendix D.5 MDS
                                                                      semantics of the Tech. Framework.
Pump vendor / model /                                                 Jan Wittenber thought this area was fodder for the DPI (Device Point-of-care
label                     MDC_ATTR_ID_MODEL and MDC_ATTR_ID_SOFT      Integration) workgroup.

                                                                      ISSUE: How (in general) for caregivers to distinguish Primary from Secondary?
                                                                      I understand that the mds.vmd.chan.metric notation provides a machine-
                                                                      parsable discriminator. This issue has to do with human-readable discrimination
                                                                      for such use cases as manual pump-EMR association and also periodic
                                                                      confirmation of existing associations. AFAIK this is N/A to syringe pumps
                                                                      because they don't do Secondary / Piggyback infusions.

Primary / Secondary                                                   STATUS: As of Oct '09 there is no resolution of this issue. Todd Cooper
Infusion                                                              mentionel "channel name" but no follow-up.
                                                                      Often refered to as TVI Total Volume Infused.
                                                                      (A nit: -10101 (2004 edition) has the term MDC_VOL_FLUID_DELIV but NOT
Infused volume            MDC_FLUID_VOL_DELIV [OK]                    the term MDC_FLUID_VOL_DELIV.)

                                                                      This parameter also contains the KVO rate when Infusion Status == KVO.

                                                                      ISSUE: What is the meaning of this term for pumps such as Plum A+ which in
                                                                      "concurrent delivery" mode can infuse both primary & secondary solutions
                                                                      ISSUE: Rate parameters should indicate the actual rate as of the reporting
                                                                      timestamp. Historically, some infusion systems have reported the programmed
                                                                      rate independent of the current pumping status.
                                                                      STATUS: The answer according to Pumps workgroup: Pumps have multiple
                                                                      Source channels each with a Set Rate, and one Delivery channel with an Actual
                                                                      Rate. Consumers use MDC_PUMP_STAT and this collection of Rate parameters
                                                                      to figure out Primary & Secondary actual rate. This is NOT completely nailed
Current Infusion rate     MDC_FLOW_FLUID_PUMP                         down or documented as far as I can tell.

                                                                      Rationale: The Bolus terms support automatic charting of a bolus dose, or
                                                                      nurse validation of same. The units-of-measure for Bolus Dose do NOT contain
                                                                      time in the denominator and AFAIK are absolute doses and not normalized to pt
                                                                      weight or BSA. MDC_RATE_DOSE is not the appropriate domain for this term.

                                                                      ISSUE: Interplay with Pump Events: many boluses complete in less than a
                                                                      minute, so just about any periodic unsolicited data can fail to report the bolus.
                                                                      Pump Events may solve this problem, provided these related terms are sent
                                                                      along with the event.

                                                                      ISSUE: Is MDC_MASS_DRUG_DELIV at all relevant and if so, how? Or is it to
                          MDC_DOSE_DRUG_BOLUS (-10101) < NOT in       some extent redundant?
Bolus dose                RTM                                         STATUS: Paul Schluter acknowledges that the model is lacking in this area.
                                                                      ISSUE: Is the intent of RTM to express bolus rate with
                                                                      MDC_FLOW_FLUID_PUMP combined with MDC_PUMP_MODE == pump-mode-
                          MDC_FLOW_FLUID_BOLUS (-10101) < NOT in      STATUS: Brad Lunde thinks the emerging Pump Event model may solve this
Bolus rate                RTM                                         issue.

Bolus volume [VTBI]       MDC_VOL_FLUID_BOLUS (-10101) < NOT in RTM   Provided at start of bolus and is bolus VTBI.

                                                                      Must be coordinated with MDC_PUMP_MODE in order to determine actual
Infusion Status           MDC_PUMP_STAT [OK]                          current operating state.

Infusion Mode             MDC_PUMP_MODE [OK]
                                                                      There is an enumeration in Rosetta that seems complete for all units with time
Current [drip] dose       MDC_RATE_DOSE [OK]                          in the denominator.

d4e6df24-30ee-4ce6-a6f0-723ded71e7c2.xls, page1       Fred Ehrhardt                                                   Capsule Technologie, 2010
Parameter                   Rosetta (IEEE 11073-10101) Term(s)                   Comments / Issues
                                                                                 ISSUE: I would appreciate any pointers to the definition of this term. In non-
                                                                                 BCMA implementations a coded drug ID may be helpful to EMR logic for
                                                                                 proposing pump-flowsheet associations that the nurse then validates. The
                                                                                 answer may be as simple as, it is a text string without any accompanying code.
                                                                                 Alternatively, it could follow RXG-4 Give Code but so far I can't find evidence of
                                                                                 Applies to the RUNNING Primary OR Secondary solution. N/A for maintenance
                                                                                 infusions or multiple additives.
                                                                                 STATUS: Paul Schluter agrees this needs work. Someone (Ruth?) stated we
                                                                                 should do this same way as in RXG-4. Paul not familiar with
Drug ID (coded)             MDC_DRUG_NAME_TYPE??                                 MDC_DRUG_NAME_TYPE.
                                                                                 Any consumer may solve for drug Amount given Concentration and Diluent
                                                                                 volume. [Might be useful if EMR or BCMA has business logic to detect an
Concentration of [single]                                                        inconsistency between the ordered concentration and the [pump] programmed
drug in solution.           MDC_CONC_DRUG [OK]                                   concentration.
Diluent volume
(continuous single-drug
infusion only)              MDC_FLUID_VOL_DILUENT [OK]                           Volume in bag / syringe

                                                                                 ISSUE: Examples of such data: "Dopamine," "Dopamine 250mg in 250ml NS,"
                                                                                 "Ringers Lactate," "Fentanyl PCA." I can think of two reasons for this variable:
                                                                                 (a) in the absence (or outage) of BCMA app or hardware, this human-readable
                                                                                 label lets nurses confirm an association between pump channel and an order
                                                                                 (eMAR) or Flowsheet row.
                                                                                 (b) permits reviewing and re-affirming pump associations from the EMR user
                                                                                 interface, for example upon shift change or patient transfer.
                                                                                 STATUS: I was told to look at "substance_label_string" in Rosetta info model,
Fluid composition / label   no term apparently exists or I can't find it         but there are no matches in the Jun 17 RTM.

                                                                                 ISSUE: Machine-readable model number and serial number, for EMR checking
                                                                                 upon temporary disconnects in data flow from pump to EMR.
                                                                                 The indicated MDC is declared in -10101 and -10102 but I have not found any
                                                                                 decomposition of this object. And is it redundant with _ID_MODEL??

                                                                                 STATUS: PCD may argue for using EUI-64 device IDs exclusively. In which
Pump unique ID              MDC_ATTR_ID_PROD_SPECN ??                            case this is not a pump-specific issue at all.
                                                                                 ISSUE: For pumps containing, within one physical package / housing, multiple
                                                                                 pumping devices. Again this is helpful / essential for association to EMR
Infusion Channel            no term apparently exists or I can't find it         element when done manually by clinician.
VTBI (Volume To Be                                                               ISSUE: is this always Volume Remaining to be Infused, and not the originally
Infused)                    MDC_VOL_FLUID_VTBI                                   programmed VTBI? Can IHE PCD be prescriptive on this topic?
                                                                                 ISSUE: What Rosetta term to carry this absolute dose (e.g., 2gm)?

Intermittent / secondary /                                                       ISSUE: (maybe inconsequential distinction) proposed / requested dose vs.
piggyback Dose             MDC_MASS_DRUG_DELIV ??                                dose actually delivered (in case infusion is stopped prematurely).
Patient Weight             MDC_ATTR_PT_WEIGHT [OK]                               As set in the pump (may not agree with weight in EMR)
Patient Height             MDC_ATTR_PT_HEIGHT [OK]

d4e6df24-30ee-4ce6-a6f0-723ded71e7c2.xls, page2                  Fred Ehrhardt                                                   Capsule Technologie, 2010
_ENUM_GROUPS     GroupDescription     TOKEN
_MDC_PUMP_MODE   Operational Mode     pump-mode-nominal
_MDC_PUMP_MODE   Operational Mode     pump-mode-drug-dosing
_MDC_PUMP_MODE   Operational Mode     pump-mode-ramp-taper
_MDC_PUMP_MODE   Operational Mode     pump-mode-multi-step
_MDC_PUMP_MODE   Operational Mode     pump-mode-multi-dosing
_MDC_PUMP_MODE   Operational Mode     pump-mode-bolus
_MDC_PUMP_MODE   Operational Mode     pump-mode-loading-dose
_MDC_PUMP_MODE   Operational Mode     pump-mode-multi-channel
_MDC_PUMP_MODE   Operational Mode     pump-mode-pca
_MDC_PUMP_MODE   Operational Mode     pump-mode-continuous
_MDC_PUMP_MODE   Operational Mode     pump-mode-pca-and-continuous
_MDC_PUMP_MODE   Operational Mode     pump-mode-piggyback
_MDC_PUMP_MODE   Operational Mode     pump-mode-concurrent

_MDC_PUMP_STAT   Operational Status   pump-status-ready
_MDC_PUMP_STAT   Operational Status   pump-status-infusing
_MDC_PUMP_STAT   Operational Status   pump-status-paused
_MDC_PUMP_STAT   Operational Status   pump-status-kvo
_MDC_PUMP_STAT   Operational Status   pump-status-delayed
_MDC_PUMP_STAT   Operational Status   pump-status-standby
_MDC_PUMP_STAT   Operational Status   pump-status-vtbi-complete
_MDC_PUMP_STAT   Operational Status   pump-status-off

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