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Integrating the Healthcare Enterprise Patient Care Device Domain

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					Integrating the Healthcare EnterprisePatient Care Device Domain (IHE-PCD)

Authors : Jack Harrington, Ray Zambuto, Todd Cooper

September, 2005

What IHE Delivers

Agenda
Evolution of the IHE PCD
Year 1 - Device Enterprise Communication Profile

Year 2 – Survey and Proposed Profile Development

1

IHE Patient Care Device (PCD) – A New Domain

Electronic Health Record
Radiology
16 Integration Profiles

Cardiology
4 Integration Profiles

Laboratory
5 Integration Profiles

IHE IT Infrastructure
13 Integration Profiles

Patient Care Coordination
1 Integration Profile

Future Domains Pathology Eye Care

Patient Care Device

Oncology

2

IHE Patient Care Device (PCD)
HIMSS Survey IHE pre-2005 Annual Conference results:

• Survey of all IHE Users

• Over 50% of those surveyed said patient care devices should be the next area developed for IHE *

3

IHE 2005 Summer Survey Results
Highest priority devices for integration are Vital Signs Monitors, Blood Gas Analyzers (POC), and Infusion Pumps

Highest priority departments are ICU, Emergency, OR/Anesthesia, and Lab (POC)
Highest technology priority is Enterprise Wide Sharing

Highest priority for clinical application is EHR or CIS integration followed by Improved Management and Decision Support

4

IHE PCD Formed in September 2005
In September, 2005, the PCD gathered 60 vendors, purchasers, providers, and regulators in Washington D.C. for 2 days to explore the value propositions, explore the scope and mission of the domain, and begin the process of use case development.
IHE Charter - The Patient Care Device 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 medical imaging. Current membership is 100+ and growing.2

5

IHE-PCD Domain Vision Statement
The IHE Patient Care Device Domain (IHE PCD) is the nexus for vendors and providers to jointly define and demonstrate unambiguous interoperability specifications, called profiles, which are based on industry standards, and which can be brought to market.

6

IHE-PCD Mission
The IHE Patient Care Device 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; and Demonstrate marketable solutions at public trade shows.

7

Agenda
Evolution of the IHE PCD
Year 1 - Device Enterprise Communication Profile

Year 2 – Survey and Proposed Profile Development

8

IHE Patient Care Devices (PCD)
One Patient – Many Devices

9

IHE Process

Product IHE Integration Statement
IHE Connect-a-thon Results

IHE Technical Framework Standards

Product With IHE

Easy to Integrate Products

IHE IHE Integration Integration Profiles B Profile A

IHE Connect-a-thon

IHE Demonstration

User Site

RFP
10

IHE PCD Technical Framework Volume1 Integration Profiles

11

IHE PCD Technical Framework Volume 2 Transactions

12

Device Enterprise Communication (DEC) Profile - Year 1
Data Obse rvation Custome r (DOC)
EHR, CDR, CDSS…

PCD-01: Communicate Device Data

Device Obse rvation Reporte r (DOR)

Map Device Data to Consistent Syntax and Semantics

Device

Monitor, Ventilator, Infusion Pump…

13

DEC Profile Mapping Model
ISO/IEEE 11073 Domain Information Model and Nomenclature mapped to HL7 Observation Report ISO/IEEE 11073 Data Types mapped to HL7 Data Types Mapping preserves measurement context for complex devices.

14

Measurement Context is Dynamic

15

IEEE 11073 Domain Information Model Defines Device Context
1

Medical Device System (MDS)

0..*

0 . . n

1

1 Virtual Medical Device (VMD) * 1 Channel (Chan) * 1 Metric *

Numeric

Enumeration

16

Mapping preserves measurement context

Medical Device System (MDS)

0..*

1

1 Virtual Medical Device (VMD) * 1 Channel (Chan) * 1 Metric *

Subject
Numeric

Containment Tree Hierarchical Level <mds> <vmd> <chan> <parametric instance>

Medical:

Enumeration

OBX-4
Examples

1 2 3

Virtual (Medical) Ordinal Virtual (Medical) Ordinal Virtual (Medical) Ordinal

<VS Mon> 1 <VS Mon> 1 <VS Mon> 1

<PulsOxim> 1 <PulsOxim> 1 <ECG> 2

<Oxim> 1 <Ptach> 2 <Ctach> 1

<Spo2> 1 <PR> 2 <HR> 3

Recommend that Ordinal value is unique among entire set

17

Example PCD-01 Message
MSH|^~\&|INFO_SRC_PHILIPS^ACDE48234567ABCD^EUI-64||||20061215153500||ORU^R01^ORU_R01|PMS116621490051| P|2.5|||NE|AL||8859/1 PID|||AB60001^^^Philips Medical^PI||Brooks^Albert^^^^^L||19610101|M PV1||I|UNIT_1^^Bed1 OBR|1|PMS116621490051^INFO_SRC_PHILIPS^ACDE48234567ABCD^EUI-64| PMS116621490051^INFO_SRC_PHILIPS^ACDE48234567ABCD^EUI-64| 69837^MDC_DEV_METER_PHYSIO_MULTI_PARAM_MDS^MDC|||20061215153500 OBX|1|ST|184326^MDC_ECG_STAT_ECT^MDC|1.5130.1.184326|""||||||F OBX|2|ST|184327^MDC_ECG_STAT_RHY^MDC|1.5130.1.184327|Sinus Rhythm||||||F OBX|3|NM|150456^MDC_PULS_OXIM_SAT_O2^MDC|1.5238.1.150456|99|262688^MDC_DIM_PERCENT^MDC|||||F OBX|4|NM|147842^MDC_ECG_HEART_RATE^MDC|1.5130.1.147842|81|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|5|NM|150037^MDC_PRESS_BLD_ART_ABP_SYS^MDC|1.5190.1.150036|126|266016^MDC_DIM_MMHG^MDC|||||F OBX|6|NM|150038^MDC_PRESS_BLD_ART_ABP_DIA^MDC|1.5190.1.150036|76|266016^MDC_DIM_MMHG^MDC|||||F OBX|7|NM|150039^MDC_PRESS_BLD_ART_ABP_MEAN^MDC|1.5190.1.150036|92|266016^MDC_DIM_MMHG^MDC|||||F OBX|8|NM|148065^MDC_ECG_V_P_C_CNT^MDC|1.5130.1.148065|0|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|9|NM|150045^MDC_PRESS_BLD_ART_PULM_SYS^MDC|1.5190.1.150044|26|266016^MDC_DIM_MMHG^MDC|||||F OBX|10|NM|150046^MDC_PRESS_BLD_ART_PULM_DIA^MDC|1.5190.1.150044|9|266016^MDC_DIM_MMHG^MDC|||||F OBX|11|NM|150047^MDC_PRESS_BLD_ART_PULM_MEAN^MDC|1.5190.1.150044|14|266016^MDC_DIM_MMHG^MDC|||||F OBX|12|NM|149538^MDC_PLETH_PULS_RATE^MDC|1.5238.1.149538|55|264864^MDC_DIM_BEAT_PER_MIN^MDC|||||F OBX|13|NM|150067^MDC_PRESS_BLD_ATR_LEFT_MEAN^MDC|1.5190.1.150064|4|266016^MDC_DIM_MMHG^MDC|||||F OBX|14|NM|150087^MDC_PRESS_BLD_VEN_CENT_MEAN^MDC|1.5190.1.150084|12|266016^MDC_DIM_MMHG^MDC|||||F

18

IHE PCD Connectathon Systems
ADT A04 Feed CT (Time) Feed
MWB

DOC

LiveData OR Mgr

GE Centricity Periop CIS

Philips CareVue CIS

Validated Vitals export, Batch

Validated VS, Vent, Anesth & Med Export, max every 3 minutes

Unvalidated VS, Vent, Anesth. Data export every 1 minute

Unvalidated VS, Vent, Anesth. Data export every 1 minute

Validated VS, Vent, Anesth & Med Export, max every 5 minutes

Unvalidated Med (Infusion System) exported every 1 minute

DOR

Welch Allyn Connex CIS
VS Mon

Draeger Innovian CIS
Pt Mon, Vent, Anesthesia

GE Aware GW
Pt Mon, Vent, Anesthesia

Philips IIC GW
Pt Mon, Vent, Anesthesia

Philips CareVue CIS
Pt Mon, Vent, Anesthesia

B. Braun DoseTrac GW
Infusion Devices

19

Connectathon 2007: 430 engineers, 80+ organizations, 160+ systems and applications

20

THE HI MS S / I H E IN TEROPERABI LI TY SHO WCASE Pro udl y pre se nts

A H EARTFELT P ATIENT
Starr i ng : IBM, Mysis, Epic, Medinotes, GE, Acuo, McKesson, Alert, Siemens, Eclipsys, CPSI, Draeger, Philips, LiveData, Allscripts, e-ClinicalWorks, NextGen, Capmed, GHNIHE, Dynamic, Agfa, Kodak, Quovadx, Axolotl, Initiate Systems, Quadramed, HXTI, WebChart, NDMA , Welch Allyn, B. Braun

…
Cardiologist Office Primary Care Physician Office XDS, XDR Medical Summary

And YOU
XDS Medical Summary  HIS SWF, XDS-I Radiology XDS EDR







EKG


Cardiology

Home

Ambulatory Care XDM, XPHR
 

XDS Medical Summary

Acute Care
Act 3 Act 4

DEC

 
ICU



OR

Act 1 Act 2

DEC

21

HIMSS Showcase Scenario
Emergency Care Intensive Care Perioperative Care

Philips
Intellivue Clinical Information Portfolio

LiveData
OR-DashBoard

GE
Centricity® Periop Anesthesia

Welch Allyn
ConnexTM Data Management System

GE
Aware Gateway

Philips
Intellivue Information Center

B. Braun
DoseTracTM Infusion Management Software

Draeger
Innovian® Solution Suite

Vital Signs Monitor

Patient Monitor, Ventilator

Patient Monitor, Ventilator

Infusion Devices

Patient Monitor, Anesthesia Sys

22

Agenda
Evolution of the IHE PCD
Year 1 - Device Enterprise Communication Profile

Year 2 – Survey and Proposed Profile Development

23

Device Enterprise Communication Profile – Year 2
Data Observation Customer (DOC)
PCD-02: Subscribe to PCD Data PCD-01: Communicate Device Data

Device Observation Filter (DOF)
PCD-01: Communicate Device Data

Device Observation Reporter (DOR)

Device

24

Process for Year 2
2006 Survey

Call for Short Proposals “Vetting” by Planning and Technical Committees Setting of Priorities

25

IHE-PCD Survey Summer-Fall 2006
Survey Managed by HIMSS Analytics
Open Solicitation to HIMAA, ACCE, AdvaMed, Anesthesiologist Patient Safety Foundation, ECRI

171 Responses, (103 Users, 68 Vendors)

26

Respondent Demographics 171 Individual Responses
Purchaser / Materials Mgr. Regulator - Government or Other Hospital CIO Hospital Department Head User of Medical Devices / Caregiver Other Hospital Based I.T. Professional Other Hospital based Clinical Engineer Vendor 0 10 20 30 40 50 60 70 80

= Hospital Based

27

Vendor Position on IHE and Interoperability 68 Vendor Responses (Checking all that apply)

We are designing IHE co mpliance into o ur pro ducts as they emerge

We wo uld use IHE based so lutio ns if they were available

We have pro prietary co nnectivity so lutio ns

We do no t currently pro vide co nnectivity o ptio ns o utside o f o ur o wn pro ducts/systems

0

10

20

30

40

50

28

Vendor Demographics: Vendor Products 68 Vendor Responses
Women's Health Pharmacy Bone Density Scanner Ultrasound Laboratory

Dialysis
Defibrillators

Ventillators POC Lab Devices Infusion Devices Anesthesia Home Care Other Monitors - Vital Signs 0 5 10

Imaging - PACS ECG 0 1 2 3 4 5 6

15

20

25

30

29

Demographics: User Organization Types 77 Hospital Based Respondents*
Ot her For P r of i t Chai n 100-299 B ed Non P r of i t M uni ci pal or St at e I nst i ut i on Smal l er Non P r of i t 300+B ed Non P r of i t Uni ver si t y / T er t i ar y Car e

0

5

10

15

20

25

30

35

40

*26 of the 103 Non-Vendor Respondents do not work in hospitals

30

Relationship of Clinical Engineering and IT at Respondents’ Hospitals 77 Hospital Based Respondents*

CE i s Par t of IT CE and IT ar e separ ate - wor k cl osel y

Do not cr oss paths

CE i s Outsour ced

Do not know

0

5

10

15

20

25

30

35

40

45

*26 of the 103 Non-Vendor Respondents do not work in hospitals

31

Importance of Interoperability to Hospital Based Respondents
IHE compl i ance i s a r equi r ement f or pur chase i f i t i s avai l abl e Movi ng to compl i ance wi l l i ng to pay a pr emi um f or i nter oper abi l i ty

Pr ef er i nter oper abl e devi ces but not r equi r ed

Not a Pr i or i ty

0

5

10

15

20

25

30

35

40

32

Survey Question: With respect to Medical Devices, how important is it for the following devices to become integrated under the IHE?

Vital Signs Reporting Devices Physiological Waveform Monitors Ventilators Anesthesia Systems Infusion Pumps Intra-Aortic Balloon Pumps Dialysis (acute / chronic) 0 10 20 30 40 50 60 70 80

Percent of respondents that consider it important

= Vendors

= Users

33

Survey Question: Rate the importance to each department below in terms of the benefit from implementing IHE

ICU Surgery ED Pharmacy Anesthesia General Med/Surg Infusion Therapy OB/GYN Oncology Home Health 0 20 40 60 80 100

Percent of respondents that consider it important

= Vendors

= Users

34

Survey Question: Which clinical applications should IHE target?
Communicating physiologic measures to the EHR Real-time medical error detection / mitigation Medication Management Drug Administration Remote Viewing of patient information on PDA or Tablet devices Alarm Notification Management Clinical Decision Support Integration of live waveform information into Clinical Systems Remote viewing of waveforms Asset Utilization Management (Such as asset tracking, self-diagnosis / reporting systems) Image Guided Surgery Remote Consultation Home Health monitoring (Such as remote monitoring of key indicators, smart healthcare appliances, etc.) Wellness Monitoring (Such as non-clinical fitness activities)

0
= Vendors

10

20

30

40

50

60

70

80

Percent of respondents that consider it important

= Users

35

Survey Question: Which technological areas are the most important for Patient Care Device integration?

Common Terminology / Data Structures / Protocols Cross-enterprise information sharing Security RF Wireless Quality of Service Management 0 10 20 30 40 50 60 70 80 90

= Vendors

= Users

36

IHE Profile Proposal (Short) Proposed Profile: Patient Identification Proposal Editor: Ray Zambuto Date: February 16, 2006 Version: 3 Domain: Patient Care Devices
The Problem Manual entry of patient identification to Patient Care Devices is inefficient and subject to error. Patient Identification is perhaps the most essential component of any interoperability and communication process, particularly when PCD data is exported to the enterprise. It is the basis for communication and control of any medical device, data analysis, reporting and record keeping. Automation of the entry of patient identification to Patient Care Devices has the potential for reducing errors, and is an essential component of any effort to increase safety, device and drug effectiveness, and efficiency. Key Use Case 1) Setup of PCD. The caregiver connects the patient to a Patient Care Device. The patient is physically identified by some institutionally unique means of identification such as a wrist band barcode, RFID or other means which may or may not be solely considered as authoritative. The caregiver uses the information from the physical patient identification to obtain an authoritative electronic identifier which is associated with all data communicated from the PCD. The interaction may involve direct entry of the data to the device based on the physical identifier, a dialog between a PCD Manager and an authoritative source, and the use of more than one identifier. The end result is that data communicated from the PCD or PCD Manager contains an authoritative institutionally unique identifier. 2) Disconnect PCD. The caregiver removes the PCD causing the data from that device to no longer be communicated to the enterprise. Standards & Systems This profile is intended for identification of patients by patient monitors, infusion pumps, ventilators, point of care glucometers etc..> ISO/IEEE 11073, HL7, IHE-ITI Patient Administration, IHE-ITI PDQ Discussion Patient identification is a fundamental requirement for any electronic communication from or to a medical device. As such, t he IHE with its broad scope, full range of stakeholders, and present or future involvement in the development of interoperability specifications for the vast number of types of medical devices and information technology is the ideal (and only) logical place for this universally needed specification.

37

Short Proposals Submitted for 2007
Version Profile File Name Patient ID RealTimeClinicalDataManagementStorageAndRetrieval CrossEnterpriseSharingofPatientCareDeviceData-Synchronous IHE-ECG-Workflow InfusionPumpIntegrationToBPOC PoCRealTimePnPDeviceIntegration SmallDataElementExchange No. 4.11 1.0 1.0 1.0 1.0 1.0 1.1 Author/ Champion Name Ray Zambuto Jack Harrington Jack Harrington Jack Harrington Scott Zaffrin Todd Cooper Karen Witten, Beth Hurter

HomeTelehealth
AlarmInteroperability

1.1
1.0

Vern Williams, Jim McCain
Elliot Sloane, Tobey Clark

PCAInfusionSafety
PCD-02Query

1.0
1.0

Julian M. Goldman, MD
Paul Schluter

38

Short Proposals Vetting 2007 vs reconsideration in 2008
Version Profile File Name Patient ID RealTimeClinicalDataManagementStorageAndRetrieval No. 4.11 1.0 Author/ Champion Name Ray Zambuto Jack Harrington

CrossEnterpriseSharingofPatientCareDeviceData-Synchronous
IHE-ECG-Workflow

1.0
1.0

Jack Harrington
Jack Harrington

InfusionPumpIntegrationToBPOC
PoCRealTimePnPDeviceIntegration SmallDataElementExchange HomeTelehealth AlarmInteroperability

1.0
1.0 1.1 1.1 1.0

Scott Zaffrin
Todd Cooper Karen Witten, Beth Hurter Vern Williams, Jim McCain Elliot Sloane, Tobey Clark

PCAInfusionSafety
PCD-02Query

1.0
1.0

Julian M. Goldman, MD
Paul Schluter

39

Short Proposals Setting Priorities Polling Results of Planning Committee Three Proposals for 2007*

Author/ Champion

Profile File Name

Name
Ray Zambuto

1

Patient ID

2 3

PCD-02Query
PoCRealTimePnPDeviceIntegration

Paul Schluter
Todd Cooper

HomeTelehealth

Vern Williams, Jim McCain

SmallDataElementExchange PCAInfusionSafety

Karen Witten, Beth Hurter Julian M. Goldman, MD

* Based on resource limitations. Additional work can be added if author/champion demonstrates sufficient additional resources

40

Summary
From its inception in September 2005 the IHE PCD has grown to 100+ members representing vendors, purchasers, providers, and regulatory agencies. The Device Enterprise Communication (DEC) Framework for Trial Implementation published in August 2006. 6 Vendors and 8 systems/applications tested at Connectathon 2007
Process for developing Year 2 profiles is in progress.

41

Your Participation in IHE PCD is Encouraged
http://www.ihe.net/Technical_Framework/index.cfm

PCD CoChairs:
 Todd Cooper

- t.cooper@ieee.org  Jack Harrington - jack.harrington@philips.com  Ray Zambuto - rzambuto@techmed.com
Other Contacts:
 Manny Furst

 Elliott Sloane

- efurst@imp-tech.com - elliot.sloane@villanova.edu

42

September, 2005

What IHE Delivers


				
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