Authors : Jack Harrington, Ray Zambuto, Todd Cooper 20070227 Integrating the Healthcare Enterprise- Patient Care Device Domain (IHE-PCD)

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



Electronic Health Record

Cardiology

Laboratory

Radiology

Oncology

Future

Domains

IHE

IT Infrastructure

16 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


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 **


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


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.


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.


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.


Agenda





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


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


Static Message Profile

...

...

...

MSH

EVN

PID

NK1 NK1 NK1 NK1 NK1

PV1

PV2

OBX

AL1

ADTÂ01

...

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)


Profiles Simplify Implementation


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




Device Enterprise Communication (DEC) Profile - Year 1


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.


Measurement Context is Dynamic


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


Mapping preserves measurement context

Medical Device System (MDS)

Virtual Medical Device (VMD)

Channel (Chan)

Numeric

Enumeration

1

*

1

*

1

*

1

0..*

Metric


Example PCD-01 MessageMSH|^~\&|INFO_SRC_PHILIPSÂCDE48234567ABCDÊUI-64||||20061215153500||ORU^R01ÔRU_R01|PMS116621490051| P|2.5|||NE|AL||8859/1 PID|||AB60001^^^Philips Medical^PI||BrooksÂlbert^^^^^L||19610101|M PV1||I|UNIT_1^^Bed1 OBR|1|PMS116621490051ÎNFO_SRC_PHILIPSÂCDE48234567ABCDÊUI-64| PMS116621490051ÎNFO_SRC_PHILIPSÂCDE48234567ABCDÊUI-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


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


InfusionDevices

CT (Time)Feed

PhilipsPhilipsCareVueCareVue

CISCIS


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

Unvalidated Med (Infusion System)

exported every 1 minute


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


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


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


Agenda





Device Enterprise Communication Profile – Year 2


Process for Year 2

• 2006 Survey• Call for Short Proposals• “Vetting” by Planning and Technical Committees• Setting of Priorities


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)


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


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


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


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


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


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


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


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



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



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


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.


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


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


Home Telehealth

Alarm Interoperability

PCA Infusion Safety

PCD-02 Query


Short Proposals Setting PrioritiesPolling Results of Planning Committee Three Proposals for 2007*

Profile Name

Patient ID

PCD-02 Query

PoCRealTimePnPDeviceIntegration

HomeTelehealth


PCA Infusion Safety

1

2

3

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


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.


To Learn More This Week – Visit the IHE PCD in the HIMSS Interoperability Showcase


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]

http://www.ihe.net/Technical_Framework/index.cfm

mailto:[email protected]





Documents

Authors : Jack Harrington, Ray Zambuto, Todd Cooper 20070227 Integrating the Healthcare Enterprise- Patient Care Device Domain (IHE-PCD)