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Transcript of International Telecommunication Union Workshop on Standardization in E-health Geneva, 23-25 May 2003...
International Telecommunication Union
Workshop on Standardization in E-healthGeneva, 23-25 May 2003
Interoperability & Interoperability & QoS Implications of QoS Implications of
ISO TC215 WG2.1ISO TC215 WG2.1Todd Cooper([email protected])
Chairman, IEEE 1073Technical Director, MDCIG / IEEE-ISTO
President, Breakthrough Solutions
223-25 May 2003 Workshop on Standardization in E-health
ITU-T
Overview
ISO TC215 Interoperability & QoS
TC215 WG 2.1 X73 Standards
QoS for Point-of-Care Medical Device Communication
323-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO TC 215 Interoperability
o Interoperability : ability of two or more systems
or components to exchange information and to use the information that has been
exchanged.
source : IEEE Standard Computer Dictionary : A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990
o Functional interoperabilityShared Architectures, Methods & Frameworks
o Semantic interoperabilityShared data types, terminologies, codings
423-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO TC 215 Interoperability
o WG 1: EHR architecture and modeling
o WG 2: Messaging architecture & methods
o WG 3: Terminology Methods
o WG 4: Shared security architecture
o WG 5: Shared health card framework
523-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO TC 215 Interoperability
o For Quality of Service :
WG 1 - Health indicators conceptual framework
WG 2 - Quality indicators for health information made available on
the Internet
623-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO TC215 Health Informatics
o Focus is primarily on Level 7 Interoperability
ISO/OSI Level 7: Application
ISO/OSI Level 6: Presentation
ISO/OSI Level 5: Session
ISO/OSI Level 4: Transport
ISO/OSI Level 3: Network
ISO/OSI Level 2: Datalink
ISO/OSI Level 1: Physical
o Medical Device Communications covers all 7 layers.
723-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO TC215 Health Informatics
ISO TC215
International
National
Standards
Bodies
CEN TC251
WG1:Models
e.g USA (ANSI)HL7
ASTM
WG1:Models andMessages
WG2:Terminology
WG3:Security
WG4:Technology
forInteroperability
WG2:Messages and
Communications
WG3:Terminology
WG4:Security
WG5:Cards
EuropeanNational
StandardsBodies
Type A Liaison
DICOM
"Pilot Process
MOU
IEEE NCCLS
"Pilot Process
823-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE/CEN X73 Process
Establish Work Plan for Standard(incl. resolution of all issues between IEEE, ISO, and CEN)
Develop and Ballot Draft Using IEEE ProcessStandard fails ISO DIS/FDIS
ballot
Completed Published Standard
Ballot Approved IEEE DocumentUsing ISO Process (DIS/FDIS)
Draft passes IEEE ballot
Publish ISO/IEEE/CEN Standard
Draft passes ISO DIS/FDIS ballots
923-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Provide real-time plug-n-play interoperability for patient-connected medical devices
X73 Charter:
…leveraging off-the-shelf technologies, scaling across a wide range of system complexities, and supporting commercially viable implementations.
Facilitate the efficient exchange of vital signs and medical device data, acquired at the point-of-care, in all health care environments
1023-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Primary focus is on…
Point-of-Care (POC)…
Medical Device…
Communications
ISO/IEEE 11073 Health informatics –Point-of-care medical device communications - …
1123-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
X73’s architecture ensures…
True interoperability across all 7-layers: From the connector to the end
application! QoS mechanisms designed to support the
strong requirements placed on regulated medical devices
Maintainability as communications technology and applications change
1223-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Device Data & Services1073.1.x
General Application Services1073.2.x
Transport & Physical Layers1073.3.x
Internetw orking Support1073.5.x
Application Gatew ays1073.6.x
1323-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Medical Device Data Language (MDDL):Semantics needed to communicate a
device’s application status and control information.
Device Data & Services1073.1.x
Consists of three main components: Nomenclature (1073.1.1.1) Domain Information Model (DIM)
(1073.1.2.1) Device Specializations (1073.1.3.x)
1423-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 StandardsNomenclature:
A set of numeric codes that identify every item that is communicated between systems.
31 . . . . . . 23 . . . . . . . 15 . . . . . . . 7 . . . . . .0
msblsb
Codeblock Number (Hi-order 16 bits)1 Object-Oriented (OO)2 Supervisory Control and Data
Acq’n (SCADA)3 Events4 Dimensions (Units of Msmt)5 Virtual Attributes6 Parameter Groups7 [Body] Sites8 Infrastructure…256 External Nomenclature Ref's…1024 Private
Term Code (Lo-order 16 bits)Context-sensitive parts
Context-free code
1523-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Domain Information Model:An object oriented data model that specifies objects, attributes, attribute groups, event reports, and services that may be used to communicate device data and to control / configure the reporting of information.
Does not imply a specific implementation technology
Objects include Medical Device System, Virtual Medical Device, Numeric, Enumeration, Real-Time Sample Array, Battery, Scanners, Alert Monitor, …
1623-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
System
Medical
Communication
Archival
Patient
MDS
VMD
CommunicationController
PatientDemographics
Metric
Channel
Control
Service+Control
Scanner
Extended Services
Alert
Alert
Patient-Archive
Session-Archive
.9 .10
.5
.7
.4
.3
.8
.6
Top
Domain Information Model Subject Areas
1723-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 StandardsVMO
Sample ArrayNumeric
RealTime-SATime-SA Distribution-SA
Enumeration
MDS(from System)
Session-Test(from Archival)
VMD1
0..n
1
0..n
PM-Store
0..n
0..1
0..n
0..1
0..n
0..1
0..n
0..1
Channel
0..n
1
0..n
1
0..n
0..1
0..n
0..1
PM-Segment
0..n
1
0..n
1
Metric
0..n
1
0..n
1
0..n
0..n
0..n
0..n
Complex Metric
1..n
0..n
1..n
0..n
1823-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Generalized application profile standards …
General Application Services1073.2.x
A generic (non-device specific) set of data and services needed to initiate, configure, and maintain communication.
Connect ~ Disconnect, Create ~ Delete, Get ~ Set, Event Report, Invoke, etc.
Standard Services: ACSE, ROSE, CMISE, ASN.1, MDER (based on BER+), Etc.
Beginning work on XML & Web Services profile
1923-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Domain Information
Model
Abstract Syntax(ASN.1)
Transfer Syntax
(MDER)
‘On-the-Wire’ Format
2023-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Generalized application profile standards … Profiles:
• Specific set of capabilities tailored for a class of communication needs / architectures
• Limits the options that are available
• Remaining options must be discovered and in some cases negotiated when a connection is made (enabling plug-n-play interoperability!)
2123-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
2223-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Transport & Physical Layers1073.3.x
IrDA-Based Cable Connected (1073.3.2) IrDA-Based Infrared Wireless (1073.3.3)
RF Wireless – high emphasis on QoS! IP-Based (Ethernet)
Available (point-to-point) transport standards…
Transport standards (LANs) under consideration…
Key: Shared IT infrastructure with guaranteed QoS
2323-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Internetw orking Support1073.5.x
1073AgentDevice
1073M anagerSystem
1073.3.x
Transport
Patient MonitorDevice Manager
Infusion PumpVentilator
Pulse-Oximeter
Examples: LAN Access Points, Wired-to-Wireless Transport Gateways,
1073AgentDevice
1073ManagerSystem
1073.5Internetw orking
1073.3.x
Transport
1073.3.x
Transport
2423-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Application Gatew ays1073.6.x
Objective: Interoperability between different application-layer protocols
+Bi-Directional Transparency
Example: HL7 / IEEE Gateway: IEEE 1073.6.1.1 … HL7 - Observation Reporting Interface!
1073System(A gent/
M anager)
non-VITALApplication
1073.6 Gatew ay(poss. 1073.5 Internetw orking)
1073.3.x
Transport
1073.3/.5
Transport
2523-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
1073Network
HL7Network
1073System HL7/1073
Gateway
HL7System
1073System
HL7System
HL7-IEEE JWG Project Scope: Identification and definition of interfaces to support interoperability between HL7 and 11073 based systems for Point-Of-Care testing / monitoring use cases.
2623-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
o X73 – Real-time plug-n-play interoperability across all 7-layers
ISO/OSI Level 7: Application
ISO/OSI Level 6: Presentation
ISO/OSI Level 5: Session
ISO/OSI Level 4: Transport
ISO/OSI Level 3: Network
ISO/OSI Level 2: Datalink
ISO/OSI Level 1: Physical
o FromDevice-to-device up to Device-to-EMR
2723-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
X73 includes QoS management support:
Negotiated Bandwidth at association
Start-up configuration minimizes network usage to that which is needed for client applications.
Management Information Bases (MIBs) provide dynamic visibility to communications performance
State models and confirmed delivery provide a high level of reliability for medical data transfer
2823-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Drivers of X73 QoS:
Regulated industry: “Safe & Effective”
Clinical Use Cases for devices – esp. real-time requirements: User needs & expectations!
Transport and service profile technologies (LAN based vs. point-to-point)
System wide topologies (local vs. wide area)
Non-clinical stakeholders (…finance)
2923-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Key X73 QoS considerations:
Reliability – FMEA, error detection & mitigation
Latency – from device detection to end annunciation for the data client
Priority – Not all medical device data has the same communications priority
Bandwidth – Allocation and dynamic management
3023-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
X73 Data Categorization: Alerts (both physiological & technical)
Real-time Waveforms
Real-time Parameters (Breath-to-breath)
Non-RT Parameters (battery level, metric label)
Non-RT Event (low battery)
Controls
History / Archival
Web Browsing
3123-25 May 2003 Workshop on Standardization in E-health
ITU-T
Data Type Bandwidth
Priority
Reliability
Latency
Alerts Lo (64B/Al.), Intermittent
Highest Hi 3 sec
RT-WavesHi (120 to
4KB/s/chan) Predictable
High Hi<RT> or
CS=3 sec
RT-Param’s
Lo-Med, Predictable
High Hi 3 sec
Non-RT Param’s
Lo (20B/p), Unpredict.
High Hi ---
Non-RT Events
Lo-Med, Unpredict.
Medium HiPoC: 3
secCS: 5 sec
ControlsLo,
Unpredict.Medium Hi
PoC: 3 sec
CS: 5 sec
History / Archive
Hi, Bursty, Unpredict.
Low Med->HiPush: >5 sec; Pull: < 5 sec
Web Browsing
Hi, Bursty, Unpredict.
Low Med->Hi 3-5 sec
3223-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
X73 QoS Issues: Latency:
Prioritization support Shared Bandwidth management
architecture(across multiple manufactures /
devices) Reliability:
Prioritization policies – guaranteed B/WNetwork fault detection &
Annunciation Graceful system performance degradation
Co-existence Management (esp. RF wireless)
3323-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
And what about…
Remote Control: a virtual plug-n-play remote control network!
Global access: Real-time vital signs viewing across the world (w/security, authentication, …)
3423-25 May 2003 Workshop on Standardization in E-health
ITU-T
ISO/IEEE 11073 Standards
Conclusions… X73 are the only comprehensive point-of-
care medical device communication standards on the horizon!
Need additional pilot projects to show capabilities of X73 protocols
Health care providers and management organizations must demand medical device interoperability using X73
We welcome support in adding security, web services, and rigorous LAN-based QoS support to our standards