Patient Care DevicesPatient Care Devices

HIMSS10 Webinar Series; October 22 2009 HIMSS10 Webinar Series; October 22 2009

22

AgendaAgenda

PCD Domain OverviewPCD Domain Overview Published Profiles: DEC, PIV, ACM, IDCO, Published Profiles: DEC, PIV, ACM, IDCO,

RTMRTM New Profiles/White Papers: DPI, WCM, MEMNew Profiles/White Papers: DPI, WCM, MEM Considered for PCD Cycle 5Considered for PCD Cycle 5 Showcase DemonstrationsShowcase Demonstrations ContactsContacts Q & AQ & A

NOTE: Update to 2008, 2009 IHE PCD WebinarNOTE: Update to 2008, 2009 IHE PCD Webinar

33

IHE Patient IHE Patient CareCare Devices (PCD) Devices (PCD)

IHE-PCD CharterIHE-PCD Charter

The Patient Care Device Domain is concerned The Patient Care Device Domain is concerned with with use casesuse cases in which at least one actor is a in which at least one actor is a patient-centric point-of-care medical devicepatient-centric point-of-care medical device . . The PCD The PCD coordinatescoordinates with other IHE clinical with other IHE clinical specialty based domains such as medical specialty based domains such as medical imaging and lab to ensure imaging and lab to ensure consistencyconsistency of of medical device integration solutions across all medical device integration solutions across all IHE technical frameworks.IHE technical frameworks.

NOTE: NOTE: Formed in 2005 & sponsored by HIMSS & ACCEFormed in 2005 & sponsored by HIMSS & ACCE

44

PCD Domain OverviewPCD Domain Overview

• Heterogeneity – … coexistence in a multi-vendor & multi-modality world, leveraging shared infrastructure

• Semantic Interoperability – … from the sensor to the EHR

• Real-time Availability – … facilitating more timely clinical decisions

PCD Profile Primary Objectives:PCD Profile Primary Objectives:

Ultimately providing improved – … safety, quality of care & workflow efficiency

55

PCD - Published ProfilesPCD - Published Profiles

DEC ProfileDEC Profile

Device to Enterprise CommunicationDevice to Enterprise Communication

Trial ImplementationTrial Implementation

66

Device Enterprise Communication (DEC)Device Enterprise Communication (DEC)

77

(DEC-PIB) Patient ID Binding(DEC-PIB) Patient ID Binding

ITI-PAMITI-PAM

ITI-PDQITI-PDQ

Note: Note: This is an option to DEC for coordinating authenticated patient IDs.This is an option to DEC for coordinating authenticated patient IDs.

88

SPD - Subscribe to Patient DataSPD - Subscribe to Patient Data

Note: Note: This is an option to DEC for configuring PCD-01 content & frequency.This is an option to DEC for configuring PCD-01 content & frequency.

99

SPD - Subscribe to Patient DataSPD - Subscribe to Patient Data

1010

RTMRTM

RTM ProfileRTM Profile

Rosetta Terminology MappingRosetta Terminology Mapping

Trial ImplementationTrial Implementation

1111

Rosetta for Semantic InteroperabilityRosetta for Semantic Interoperability

1212

Rosetta for Semantic InteroperabilityRosetta for Semantic Interoperability

Migrating Toward True PCD Semantic Interoperability

Today HIMSS ’10!

ISO/IEEE 11073Semantic Standards

Vendor Semantics

IHE PCD TF Content

Vendor A

Vendor C

Vendor B

RosettaMappingTables(RTM)

11073PnP Comm

HL7 v3CDA/CCD

HL7 v2Messages

1313

RTM GoalsRTM GoalsExpandExpand the number of numeric parameters

supported by PCD-01 from 40 today to over 350 terms, providing a more comprehensive set for development and validation.

HarmonizeHarmonize the use of existing nomenclature terms defined by ISO/IEEE 11073-10101.

SpecifySpecify the units-of-measureunits-of-measure, enumerated valuesenumerated values and measurement sites associated with each parameter.

Identify and add new nomenclature termsIdentify and add new nomenclature terms that are currently missing from ISO/IEEE 11073-10101.

NOTE: Respiratory / Ventilator terms are a major area. See http://wiki.ihe.net/index.php?title=PCD_RTM_Ventilatorhttp://wiki.ihe.net/index.php?title=PCD_RTM_Ventilator

1414

ACMACM

ACM ProfileACM Profile

Alarm Communication ManagementAlarm Communication Management

Trial ImplementationTrial Implementation

1515

Alarm Communication Management (ACM)Alarm Communication Management (ACM)

Alarm Communication Management

enables systems to deliver the right alarms, with the right priority, to the right individuals via devices with the right content, escalating to other individuals via devices (based on system configuration)

Alarm Communication Management

enables systems to deliver the right alarms, with the right priority, to the right individuals via devices with the right content, escalating to other individuals via devices (based on system configuration)

Trial Implementation

1616

ACM Data FlowsACM Data Flows

AlarmSource

AlarmAggregator

AlarmReceiver

AlarmCoordinator

AlarmDisseminator

AlarmCommunication

AlarmEndpoint

AlarmCommunication

AC

AlarmCommunication

AC

AlarmManagement

AM

AlarmManagement

AM

AlarmReporter

AR

AlarmReporter

AR

AlarmReporter

AlarmCache

Communication detailed in ACM profileCommunication detailed in ACM profile

Communication not detailed in ACM profileCommunication not detailed in ACM profile

.

.

.

.

.

.......

PCD Inputs(PM, NC, Resp,

Pump, etc.)

PCD Inputs(PM, NC, Resp,

Pump, etc.)

Output Devices(Marquee Sign, Pager,

Wi-Fi Phone or Badge, etc.)

Output Devices(Marquee Sign, Pager,

Wi-Fi Phone or Badge, etc.)

HIS, EMRHIS, EMRAlarm

ArchiverAA

AlarmArchiver

AA

Report Alarm Report Alarm

Alarm StatusAlarm Status**Alarm StatusAlarm Status**

*Note: Implementation TBD*Note: Implementation TBD

Subscribe to AlarmSubscribe to Alarm **Subscribe to AlarmSubscribe to Alarm **

** Disseminate Alarm ** Disseminate Alarm Dissemination StatusDissemination Status **Dissemination StatusDissemination Status **

Report AlarmReport AlarmReport AlarmReport AlarmSubscribe to Alarm Subscribe to Alarm ** Subscribe to Alarm Subscribe to Alarm **

GapGap!!

1717

ACM UpdatesACM Updates

Fill Gap: Alarm Manager (AM) to Alarm Communicator (AC)

Define alarm identifier codes (RTM for alarms)

Extend implementation of actors & transactions

Expand to additional IHE domains

1818

PIVPIV

PIV ProfilePIV Profile

Point-of-Care Infusion VerificationPoint-of-Care Infusion Verification

Trial ImplementationTrial Implementation

1919

Point-of-Care Infusion Verification supports the electronic transfer of infusion parameters from a Barcode Point of Care (BPOC) system, also known as a Bar Code Medication Administration (BCMA) system, to an infusion pump.

Point-of-Care Infusion Verification supports the electronic transfer of infusion parameters from a Barcode Point of Care (BPOC) system, also known as a Bar Code Medication Administration (BCMA) system, to an infusion pump.

PIV StatementPIV Statement

2020

PIV WorkflowPIV Workflow

Nurse

Review

MAR Entry

Pharmacist reviews

order detail

(Pharmacy

System)

eMAR updated

Medication

DispensedNurse removes

Medication

from Dispensing

Unit or Med Room

Nurse Confirms 5

Rights:

Right Patient,

Medication,

Dose, Time, Route

AT THE BEDSIDE

Medication

Administered

Physician reviews

data and places

Orders

Nurse

Review

eMAR Entry

Pharmacist reviews

order detail

(Pharmacy

System)

eMAR updated

Medication

DispensedNurse removes

Medication

from Dispensing

Unit or Med Room

Nurse Confirms 5

Rights:

Right Patient,

Medication,

Dose, Time, Route

AT THE BEDSIDE

Medication

Administered

Physician reviews

data and places

Orders

This is the focus ofThis is the focus ofPIV … only!PIV … only!

2121

PIV ActorsActors

DEC!DEC!

2222

IDCOIDCO

IDCO ProfileIDCO Profile

Implantable Device – Implantable Device – Cardiac Cardiac – Observation– Observation

Trial ImplementationTrial Implementation

2323

Implantable Device – Cardiac – Observation ProfileImplantable Device – Cardiac – Observation Profile

• IDCO specifies the creation, IDCO specifies the creation, transmission, and processing of transmission, and processing of discrete data elements and report discrete data elements and report attachments associated with attachments associated with implantable cardiac device implantable cardiac device interrogations (observations) or interrogations (observations) or messages.messages.

2424

Implantable Cardiac DeviceImplantable Cardiac Device

ImplantableCardiac Device

Leads for Sensingor Delivering Electrical Therapy

2525

IDCO Profile ContextIDCO Profile Context• Device is interrogated via inductive or wireless telemetry in clinic or home

environment using vendor proprietary equipment

• Information is transferred to clinic system as structured HL7 v2.6 ORU message using IEEE 11073 IDC nomenclature [PCD-09]

2626

IDCO ActorsIDCO Actors

2727

PCD – Emerging ProfilesPCD – Emerging Profiles

Emerging ProfilesEmerging Profiles Implanted Cardiac Devices (IDCO)Implanted Cardiac Devices (IDCO) Waveform Communication Management (WCM)Waveform Communication Management (WCM) Medical Equipment Management (MEM)Medical Equipment Management (MEM) Real Time Location TrackingReal Time Location Tracking Device Point-of-Care Integration (DPI, a multiyear Device Point-of-Care Integration (DPI, a multiyear

effort)effort) Real-time data archiving and communicationReal-time data archiving and communication Mobile, enterprise-wide, reliable vital signs Mobile, enterprise-wide, reliable vital signs

monitoringmonitoring … … many more!many more!

2828

DPIDPI

Device Point-of-Care Integration Device Point-of-Care Integration [DPI][DPI]

2929

DPI: Scope –

Device Point-of-care Integration (DPI) is concerned with use cases that include care contexts that fall within the stated charter of the IHE PCD, namely where "at least one actor is a one actor is a regulated patient centric point-of-care medical regulated patient centric point-of-care medical devicedevice," and that require device-to-device device-to-device communicationcommunication.

IHE PCD Profile: DPIIHE PCD Profile: DPI

3030

IHE PCD Profile: DPIIHE PCD Profile: DPI

Device Point-of-Care IntegrationDevice Point-of-Care Integration• Discovery and Association (PnP)Discovery and Association (PnP)• Real-Time Data ReportingReal-Time Data Reporting• Bi-Directional / SymmetricBi-Directional / Symmetric• External ControlExternal Control

Enterprise IntegrationEnterprise Integration

Semantic InteroperabilitySemantic Interoperability

Monitored ParametersMonitored ParametersAlarms & LimitsAlarms & LimitsWaveforms (Real-Time)Waveforms (Real-Time)Control ParametersControl Parameters

Semantic InteroperabilitySemantic Interoperability

Monitored ParametersMonitored ParametersAlarms & LimitsAlarms & LimitsWaveforms (Real-Time)Waveforms (Real-Time)Control ParametersControl Parameters

Device Reporting, Device Reporting, Management & Management &

ControlControl

Device Reporting, Device Reporting, Management & Management &

ControlControl

Real-TimeClinical Decision Support

Point-of-Care

Applications Real-Time

Closed / OpenLoop Control

DPI Manager / Enterprise

Gateway

DPI Manager / Enterprise

Gateway

3131

PCD - MEMPCD - MEM

Medical Equipment Management Medical Equipment Management [MEM][MEM]

Imagine … Imagine …

What if I.T. & device vendors gave me What if I.T. & device vendors gave me EVERYTHING I ever wanted?!EVERYTHING I ever wanted?!

3232

MEMMEM

DEVICE MANAGEMENT

REPORTER

Patch ManagementPending patchesPatch history

Location ServicesCurrent locationPrevious locations (Trending)Boundary controls (Alarm when

device leaves area)

Device Configuration Management

Recall ManagementUnique device identificationHardware configuration (serial numbers, etc)Software configuration (revision numbers, etc)

Device ReconfigurationUse profiles (NICU vs. CICU)

Operational Status and Monitoring

Is the device currently in useUsage historyAlarms – which are active, what the trigger

levels, how long has the alarm been onDay/time of last self check and its resultEvent log recordingPreventative Maintanence

Last PMNext scheduled PMLast repair time/date

Battery ManagementOn A/C or D/C? Charge level (% of full)/Est.

operating time left. Charging / Discharging historyBattery type and installation date Est. battery life

IHE

PC

D

Sta

nd

ard

s b

ased

T

ran

sac

tio

ns

DEVICE MANAGEMENT

CONSUMER

DPIDECACM

Risk ManagementSupport for IEC 80001-1 ...

v Activities (incl. configuration and network performance monitoring)

v Risk Management Filev ...

3333

MEM StatusMEM Status

2009 – White Paper2009 – White Paper Ongoing workOngoing work

– Cycle 5 Brief Profile Proposal Cycle 5 Brief Profile Proposal • Real Time Location TrackingReal Time Location Tracking

– Location Boundary AlarmsLocation Boundary Alarms– Battery ManagementBattery Management– Semantic Content RequirementsSemantic Content Requirements

3434

PCD - WCMPCD - WCM

WaveformWaveformCommunicationCommunication

Management [WCM]Management [WCM]

3535

WCMWCM

Waveform Communication ManagementWaveform Communication Management

will extend the [DEC] profile to provide a method will extend the [DEC] profile to provide a method for passing for passing near real-time waveform datanear real-time waveform data using using HL7 v2 observation messagesHL7 v2 observation messages between a between a Reporter and a Consumer.Reporter and a Consumer.

• A filter will be an optional element A filter will be an optional element 

3636

WCMWCM

WCM will cover the following prioritized WCM will cover the following prioritized Use Cases:Use Cases:

1.1. Current Multi-Channel Waveform (MCW) Current Multi-Channel Waveform (MCW) snapshotsnapshot as defined by the source is created/pushed by as defined by the source is created/pushed by alarm source based on alarm source based on eventevent occurrence occurrence

2.2. Current MCW Current MCW snapshotsnapshot as defined by source on as defined by source on requestrequest to source to source

3.3. Continuous MCW Continuous MCW streamsstreams4.4. MCW snapshot MCW snapshot archivearchive query query5.5. Periodic Periodic trendtrend data on request data on request

It is not expected that all Use Cases will be It is not expected that all Use Cases will be covered during the first cycle.covered during the first cycle.

3737

WCMWCM

• A number of existing standards will be A number of existing standards will be evaluated as references:evaluated as references:– MFERMFER (ISO 11973-92001) (ISO 11973-92001)– FEFFEF (ISO 14271) (ISO 14271)– FDA HL7 v3 Annotated ECGFDA HL7 v3 Annotated ECG Guideline Guideline– DICOMDICOM Supplement 30 – Waveform Supplement 30 – Waveform

Interchange Interchange – Previous HL7 v2 waveform spec (deprecated)Previous HL7 v2 waveform spec (deprecated)

• Our scope is to create a profile which Our scope is to create a profile which leverages existing IHE PCD Profiles and leverages existing IHE PCD Profiles and “principles” of using HL7 v2.x and IEEE “principles” of using HL7 v2.x and IEEE 11073 nomenclature.11073 nomenclature.

3838

WCMWCM Key requirements:Key requirements:

LeverageLeverage existing IHE PCD Profiles and existing IHE PCD Profiles and “principles” of using HL7 v2.x and IEEE 11073 “principles” of using HL7 v2.x and IEEE 11073 nomenclature.nomenclature.

Provide Provide raw dataraw data and not bit-maps or pdf files and not bit-maps or pdf files• Supports rendering at end clientSupports rendering at end client• Supports further analysis at end clientSupports further analysis at end client

Support “Support “snapshotssnapshots”, data “”, data “streamsstreams” and ” and retrospective “retrospective “trendtrend” data types” data types

Minimize optionalityMinimize optionality• Focus on simplicity and avoid complexityFocus on simplicity and avoid complexity

3939

PCD - Cycle 5PCD - Cycle 5

Under Consideration for Under Consideration for

the Next Cyclethe Next Cycle

4040

Proposed Work for Cycle 5 (out for ballot)

• Asynchronous Data Query

• Location Tracking

• Medical Equipment Management

• Query for Bulk Data

• Device to Patient Association

• Device Integration (specific devices)

• Device Integration - General Content

• Event Communication

4141

PCD - TestingPCD - Testing

Test Tooling SupportTest Tooling Support

VA’s Message WorkbenchVA’s Message Workbench

NIST ToolsNIST Tools

4242

PCD & SDO CoordinationPCD & SDO Coordination

PCD coordination with SDOs…PCD coordination with SDOs…

IHE - HL7 IHE - HL7 (MoU)(MoU)

IHE - IEEE EMB IHE - IEEE EMB (MoU)(MoU)

IHE – ISO TC215 IHE – ISO TC215 (Liaison)(Liaison)

……

4343

PCD & HITSPPCD & HITSP

(from HITSP TC Orientation 2009.02.17)

4444

PCD & Continua Health AlliancePCD & Continua Health Alliance

Continua & IHE established a Memorandum of Continua & IHE established a Memorandum of Understanding (“MoU”) Understanding (“MoU”) to “to “enable and promote enable and promote interoperability of healthcare devicesinteroperability of healthcare devices.”.”

Provides for joint participation in Interoperability Provides for joint participation in Interoperability Showcases (e.g., @ HIMSS ’10)Showcases (e.g., @ HIMSS ’10)

Coordination on HITSP RMON SDE#2 is laying the Coordination on HITSP RMON SDE#2 is laying the foundation for interoperability from bedroom to OR!foundation for interoperability from bedroom to OR!

4545

PCD & ASTM “ICE” / CIMIT MDPnPPCD & ASTM “ICE” / CIMIT MDPnP

(From ICE-PAC Overview Update 2009.06.22 to IHE PCD)

ICE-PCD Analysis Committee (ICE-PAC)ICE-PCD Analysis Committee (ICE-PAC) – JWG underway to perform a map & gap analysis between “ICE” use case analyses, ISO/IEEE 11073 standards & the IHE DPI WG.

4646

PCD & ICE-PAC JWGPCD & ICE-PAC JWG

(From ICE-PAC Overview Update 2009.06.22 to IHE PCD)

4747

PCD - ShowcasePCD - Showcase

HIMSS ShowcaseHIMSS Showcase

Where we get to show off !!Where we get to show off !!

4848

HIMSS Showcase ’09 - ProductsHIMSS Showcase ’09 - Products

4949

HIMSS Showcase ’09 - ORHIMSS Showcase ’09 - OR

5050

HIMSS Showcase ’09 - ICUHIMSS Showcase ’09 - ICU

5151

HIMSS Showcase ’09 – Step Down UnitHIMSS Showcase ’09 – Step Down Unit

5252

PCD @ HIMSS 2009PCD @ HIMSS 2009

5353

HIMSS ’09 IHE Showcase SponsorsHIMSS ’09 IHE Showcase Sponsors

5454

Why use IHE PCD profiles?Why use IHE PCD profiles?

• Simplified standards-based integration of point-of-care device info & services

• Multi-vendor product integration testing @ Connectathons

• Visibility of products with care providers and peer technology organizations in Showcases

• Path to programs such as the U.S. National Health Information Network (NHIN)

PCD profiles will enable…PCD profiles will enable…

5555

IHE PCD DEC: Simplified SpecsIHE PCD DEC: Simplified Specs

5656

For Further InformationFor Further Information

• InternetInternet– Web:Web: www.ihe.net/pcdwww.ihe.net/pcd

www.accenet.org/ihewww.accenet.org/ihe

– Wiki:Wiki: wiki.ihe.net/index.php?title=Patient_Care_Devicewiki.ihe.net/index.php?title=Patient_Care_Device

• PCD Co-ChairsPCD Co-Chairs– Ken FuchsKen Fuchs Planning CommitteePlanning Committee ken.fuchs@draeger.com ken.fuchs@draeger.com – Steve Merritt Steve Merritt Planning CommitteePlanning Committee steve.merritt@bhs.orgsteve.merritt@bhs.org

– Todd Cooper Todd Cooper Technical CommitteeTechnical Committee t.cooper@IEEE.org t.cooper@IEEE.org – John RhoadsJohn Rhoads Technical CommitteeTechnical Committee john.rhoads@Philips.comjohn.rhoads@Philips.com

• PCD Technical Project ManagerPCD Technical Project Manager– Manny FurstManny Furst efurst@IEEE.orgefurst@IEEE.org

• Sponsor RepresentativesSponsor Representatives– Jack HarringtonJack Harrington HIMSSHIMSS jackh82@comcast.netjackh82@comcast.net– Elliot SloaneElliot Sloane IHE InternationalIHE International ebsloane@IEEE.org ebsloane@IEEE.org – Ray ZambutoRay Zambuto ACCEACCE

Ray.Zambuto@techmed.lincfs.comRay.Zambuto@techmed.lincfs.com

5757