Authors : Jack Harrington, Ray Zambuto, Todd Cooper 20070227 Integrating the Healthcare Enterprise-...
Transcript of Authors : Jack Harrington, Ray Zambuto, Todd Cooper 20070227 Integrating the Healthcare Enterprise-...
Authors : Jack Harrington, Ray Zambuto, Todd Cooper
20070227
Integrating the Healthcare Enterprise-Patient Care Device Domain (IHE-PCD)
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 2
Agenda
• Evolution of the IHE PCD
• Year 1 - Device Enterprise Communication Profile
• Year 2 – Survey and Proposed Profile Development
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 3
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 4
Electronic Health Record
Cardiology
Laboratory
Radiology
Oncology
Future
Domains
IHE
IT Infrastructure
16 Integration Profiles
5 Integration Profiles
4 Integration Profiles
1133 IInntteeggrraattiioonn PPrrooffiilleess
Patient Care Coordination
1 Integration Profile
Patient Care
Devices
Pathology
Eye Care
Over 100 vendors involved world-wide,Over 100 vendors involved world-wide, 5 Technical Frameworks5 Technical Frameworks39 Integration Profiles, Testing at Connectathons39 Integration Profiles, Testing at ConnectathonsDemonstrations at major conferences world-wideDemonstrations at major conferences world-wide
16 Active national chapters on 4 continents16 Active national chapters on 4 continents
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 5
IHE Patient Care Devices (PCD)HIMSS Survey IHE pre-2005 Annual Conference results:
• Survey of all IHE Users Survey of all IHE Users
• Over 50% of those Over 50% of those surveyed said patient surveyed said patient care devices should be care devices should be the next area developed the next area developed for IHE for IHE **
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 6
IHE 2005 Summer Survey Results
• Highest priority devices for integration are Vital Signs Monitors, Highest priority devices for integration are Vital Signs Monitors, Blood Gas Analyzers (POC), and Infusion PumpsBlood Gas Analyzers (POC), and Infusion Pumps
• Highest priority departments are ICU, Emergency, OR/Anesthesia, Highest priority departments are ICU, Emergency, OR/Anesthesia, and Lab (POC)and Lab (POC)
• Highest technology priority is Enterprise Wide SharingHighest technology priority is Enterprise Wide Sharing
• Highest priority for clinical application is EHR or CIS integration Highest priority for clinical application is EHR or CIS integration followed by Improved Management and Decision Supportfollowed by Improved Management and Decision Support
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 7
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 Devices 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.
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 8
IHE-PCD Domain Vision Statement
The IHE Patient Care Device Domain (IHE PCD) is The IHE Patient Care Device Domain (IHE PCD) is the nexus for vendors and providers to jointly define the nexus for vendors and providers to jointly define and demonstrate unambiguous interoperability and demonstrate unambiguous interoperability specifications, called profiles, which are based on specifications, called profiles, which are based on industry standards, and which can be brought to industry standards, and which can be brought to market. market.
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 9
IHE-PCD Mission
• The IHE Patient Care Devices Domain will apply The IHE Patient Care Devices Domain will apply the proven, Use Case driven IHE processes to:the proven, Use Case driven IHE processes to:
–DeliverDeliver the technical framework for the IHE-PCD the technical framework for the IHE-PCD domain profiles;domain profiles;
–ValidateValidate IHE-PCD profile implementations via IHE-PCD profile implementations via Connectathons; andConnectathons; and
–DemonstrateDemonstrate marketable solutions at public trade marketable solutions at public trade shows.shows.
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 10
Agenda
• Evolution of the IHE PCD
• Year 1 - Device Enterprise Communication Profile
• Year 2 – Survey and Proposed Profile Development
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 11
IHE Patient Care Devices (PCD)One Patient – Many Devices
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 12
Profiles Simplify Implementation
• Single Standard – Constrain optionality, choose terminology, define dynamic interactions– HL7 Conformance
• Multiple Standards – Coordinate workflow, define mappings between standards- HL7/DICOM – IHE Radiology- HL7/IEEE 11073 – Patient Care Devices
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 13
Static Message Profile
...
...
...
MSH
EVN
PID
NK1 NK1 NK1 NK1 NK1
PV1
PV2
OBX
AL1
ADT^A01
...
Fields/Components: - Field Usage (Optionality) - Cardinality (min, max) - Value Sets/Coding system - Descriptions
...
...
MSH
EVN
PID
NK1 NK1 NK1 NK1 NK1
PV1
PV2
OBX
AL1
Segments/Segment Groups: - Segment Usage (Optionality)
HL7 Message Profile HL7 Message Structure
- Cardinality (min, max)
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 14
Profiles Simplify Implementation
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 15
IHE Process
IHEIntegrationProfiles B
IHEIntegrationProfile A
Easy toIntegrateProducts
IHEIHEDemonstrationDemonstration
User Site
RFPRFP
StandardsStandards
IHETechnical
Framework
Product IHE IntegrationStatement
IHEIHEConnect-a-thonConnect-a-thon
ProductWith IHE
IHE Connect-a-thonResults
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 16
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 17
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 18
Device Enterprise Communication (DEC) Profile - Year 1
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 19
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.
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 20
Measurement Context is Dynamic
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 21
IEEE 11073 Domain Information Model Defines Device Context
10..n
Medical Device System (MDS)
Virtual Medical Device (VMD)
Channel (Chan)
Numeric
Enumeration
1
*
1
*
1
*
1
0..*
Metric
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 22
Mapping preserves measurement context
Medical Device System (MDS)
Virtual Medical Device (VMD)
Channel (Chan)
Numeric
Enumeration
1
*
1
*
1
*
1
0..*
Metric
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 23
Example PCD-01 MessageMSH|^~\&|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
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 24
IHE PCD Connectathon Systems
LiveDataLiveDataOR MgrOR Mgr
GEGECentricity Centricity Periop CISPeriop CIS
PhilipsPhilipsCareVueCareVue
CISCIS
DOR
DOC
ADTA04 Feed MWB
DraegerDraegerInnovianInnovian
CISCIS
GEGEAwareAware
GWGW
PhilipsPhilipsIICIICGWGW
B. BraunB. BraunDoseTracDoseTrac
GWGW
Welch AllynWelch AllynConnexConnex
CISCIS
Validated VS, Vent, Anesth & Med Export, max
every 3 minutes
Validated Vitals export, Batch
Unvalidated VS, Vent, Anesth. Data export
every 1 minute
Unvalidated VS, Vent, Anesth. Data export
every 1 minute
VS MonPt Mon, Vent,Anesthesia
Pt Mon, Vent,Anesthesia
Pt Mon, Vent,Anesthesia
InfusionDevices
CT (Time)Feed
PhilipsPhilipsCareVueCareVue
CISCIS
Pt Mon, Vent,Anesthesia
Validated VS, Vent, Anesth & Med Export, max every 5 minutes
Unvalidated Med (Infusion System)
exported every 1 minute
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 25
Connectathon 2007: 430 engineers, 80+ organizations, 160+ systems and applications
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 26
T H E H I M SS / I H E I N TE R OP E R A BI L I TY SH OW CA SE P r ou d l y p r esen t s
A H EA R TFELT PA TIEN T
St a r r i n g: I BM , M ysis, Epic, M edinotes, GE, A cuo, M cK esson, A ler t, Siemens, Eclipsys, CPSI , D r aeger , Phi lips,
LiveD ata, A llscr ipts, e-ClinicalW or ks, N extGen, Capmed, GH N I H E, D ynamic, A gfa, K odak, Quovadx, A xolotl, I nitiate Systems, Quadr amed, H XTI , W ebChar t, N D M A , W elch A llyn, B . Br aun
… A nd Y OU
XDS Medical Summary
Acute Care
Home
Primary Care Physician Office
Cardiologist Office
HIS
Radiology
ICU
Ambulatory Care
Act 2
Act 3 Act 1
XDM, XPHR
XDS, XDR Medical Summary
DEC
SWF, XDS-I
XDS EDR
XDS Medical Summary
Act 4
EKG
Cardiology
DEC
OR
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 27
HIMSS Showcase Scenario
Welch AllynWelch AllynConnexConnexTMTM
DataDataManagementManagement
SystemSystem
Vital Signs Monitor
GEGE
AwareAwareGatewayGateway
Patient Monitor, Ventilator
PhilipsPhilips
IntellivueIntellivueInformationInformation
CenterCenter
Patient Monitor, Ventilator
Emergency Care Intensive Care
LiveDataLiveData
OR-DashBoardOR-DashBoard
GE GE
CentricityCentricity®®
PeriopPeriopAnesthesiaAnesthesia
DraegerDraeger
InnovianInnovian®®
Solution SuiteSolution Suite
Patient Monitor, Anesthesia Sys
B. BraunB. BraunDoseTracDoseTracTMTM
InfusionInfusionManagementManagement
SoftwareSoftware
InfusionDevices
Perioperative Care
PhilipsPhilips
Intellivue ClinicalIntellivue ClinicalInformationInformation
PortfolioPortfolio
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 28
Agenda
• Evolution of the IHE PCD
• Year 1 - Device Enterprise Communication Profile
• Year 2 – Survey and Proposed Profile Development
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 29
Device Enterprise Communication Profile – Year 2
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 30
Process for Year 2
• 2006 Survey• Call for Short Proposals• “Vetting” by Planning and Technical Committees• Setting of Priorities
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 31
IHE-PCD SurveySummer-Fall 2006
• Survey Managed by HIMSS Analytics
• Open Solicitation to HIMSS, ACCE, AdvaMed, Anesthesia Patient Safety Foundation, ECRI
• 171 Responses, (103 Users, 68 Vendors)
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 32
Respondent Demographics171 Individual Responses
0 10 20 30 40 50 60 70 80
Vendor
Hospital based Clinical Engineer
Other
Other Hospital Based I.T. Professional
User of Medical Devices / Caregiver
Hospital Department Head
Hospital CIO
Regulator - Government or Other
Purchaser / Materials Mgr.
= Hospital Based
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 33
Vendor Position on IHE and Interoperability
68 Vendor Responses (Checking all that apply)
0 10 20 30 40 50
We do not currently provide connectivityoptions outside of our own
products/systems
We have proprietary connectivitysolutions
We would use IHE based solutions if theywere available
We are designing IHE compliance intoour products as they emerge
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 34
Vendor Demographics: Vendor Products68 Vendor Responses
0 5 10 15 20 25 30
Monitors - Vital Signs
Other
Home Care
Anesthesia
Infusion Devices
POC Lab Devices
Ventillators
Dialysis
0 1 2 3 4 5 6
ECG
Imaging - PACS
Defibrillators
Laboratory
Ultrasound
Bone Density Scanner
Pharmacy
Women's Health
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 35
Demographics: User Organization Types
77 Hospital Based Respondents*
*26 of the 103 Non-Vendor Respondents do not work in hospitals
0 5 10 15 20 25 30 35 40
University / Tertiary Care
300+ Bed Non Profit
Smaller Non Profit
Municipal or State Instiution
100-299 Bed Non Profit
For Profit Chain
Other
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 36
Relationship of Clinical Engineering and IT at Respondents’ Hospitals
77 Hospital Based Respondents*
*26 of the 103 Non-Vendor Respondents do not work in hospitals
0 10 20 30 40 50
Do not know
CE is Outsourced
Do not cross paths
CE and IT are separate - work closely
CE is Part of IT
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 37
Importance of Interoperability to Hospital Based
Respondents
0 10 20 30 40
Not a Priority
Prefer interoperable devicesbut not required
Moving to compliance - willingto pay a premium for
interoperability
IHE compliance is a requirementfor purchase if it is available
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 38
Survey Question: With respect to Medical Devices, how important is it for the following devices to become integrated
under the IHE?
= Users= Vendors
0 10 20 30 40 50 60 70 80
Dialysis (acute / chronic)
Intra-Aortic Balloon Pumps
Infusion Pumps
Anesthesia Systems
Ventilators
Physiological Waveform Monitors
Vital Signs Reporting Devices
Percent of respondents that consider it important
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 39
Survey Question: Rate the importance to each department below in terms of the benefit from implementing IHE
= Users= Vendors
0 20 40 60 80 100
Home Health
Oncology
OB/GYN
Infusion Therapy
General Med/Surg
Anesthesia
Pharmacy
ED
Surgery
ICU
Percent of respondents that consider it important
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 40
Survey Question: Which clinical applications should IHE target?
= Users= Vendors
0 10 20 30 40 50 60 70 80
Wellness Monitoring (Such as non-clinical fitness activities)
Home Health monitoring (Such as remote monitoring of key indicators, smarthealthcare appliances, etc.)
Remote Consultation
Image Guided Surgery
Asset Utilization Management (Such as asset tracking, self-diagnosis / reportingsystems)
Remote viewing of waveforms
Integration of live waveform information into Clinical Systems
Clinical Decision Support
Alarm Notification Management
Remote Viewing of patient information on PDA or Tablet devices
Drug Administration
Medication Management
Real-time medical error detection / mitigation
Communicating physiologic measures to the EHR
Percent of respondents that consider it important
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 41
Survey Question: Which technological areas are the most important for Patient Care Device integration?
= Users= Vendors
0 10 20 30 40 50 60 70 80 90
Quality of Service Management
RF Wireless
Security
Cross-enterprise information sharing
Common Terminology / Data Structures / Protocols
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 42
IHE Profile Proposal (Short)Proposed Profile: Patient Identification
Proposal Editor: Ray ZambutoDate: February 16, 2006
Version: 3Domain: 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 Case1) 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 PDQDiscussion Patient identification is a fundamental requirement for any electronic communication
from or to a medical device. As such, the 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.
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 43
Short Proposals Submitted for 2007
Profile Name
Patient ID
Cross-Enterprise Sharing of Patient Care Device Data Synchronous
Real-Time Clinical Data Management Storage and Retrieval
IHE-ECG-Workflow
Infusion Pump Integration to Medication Administration Process
PoC Real-Time PnP Device Integration
Small Data Element Exchange
HomeTelehealth
Alarm Interoperability
PCA Infusion Safety
PCD-02 Query
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 44
Short Proposals Vetting 2007 vs reconsideration in 2008
Profile Name
Patient ID
Cross-Enterprise Sharing of Patient Care Device Data-Synchronous
Real-Time Clinical Data Management Storage and Retrieval
IHE-ECG-Workflow
Infusion Pump Integration to Medication Administration Process
PoC Real-Time PnP Device Integration
Small Data Element Exchange
Home Telehealth
Alarm Interoperability
PCA Infusion Safety
PCD-02 Query
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 45
Short Proposals Setting PrioritiesPolling Results of Planning Committee Three Proposals for 2007*
Profile Name
Patient ID
PCD-02 Query
PoCRealTimePnPDeviceIntegration
HomeTelehealth
Small Data Element Exchange
PCA Infusion Safety
1
2
3
* Based on resource limitations. Additional work can be added if author/champion demonstrates sufficient additional resources
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 46
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.
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 47
To Learn More This Week – Visit the IHE PCD in the HIMSS Interoperability Showcase
Jack Harrington, Ray Zambuto, Todd Cooper 20070227 48
Your Participation in IHE PCD is Encouraged
• http://www.ihe.net/Technical_Framework/index.cfm
• PCD CoChairs:– Todd Cooper - [email protected] – Jack Harrington - [email protected]– Ray Zambuto - [email protected]
• Other Contacts:– Manny Furst - [email protected] – Elliot Sloane - [email protected]