Integrating the Healthcare Enterprise (IHE) Integrating the Healthcare Enterprise (IHE) Patient Care Devices Domain (PCD)Patient Care Devices Domain (PCD)

Alarm Communication Management (ACM)Alarm Communication Management (ACM)2010 Change Request Efforts2010 Change Request Efforts

IHE PCD 2010 Spring F2F, Berkeley, CAIHE PCD 2010 Spring F2F, Berkeley, CA

Monroe PattilloMonroe PattilloPhilips Patient Monitoring Informatics (PMI)Philips Patient Monitoring Informatics (PMI)

Boca Raton, FL, USABoca Raton, FL, USA

IHE Patient Care Devices DomainIHE Patient Care Devices DomainACM Working GroupACM Working Group

monroe.pattillo@philips.commonroe.pattillo@philips.com

© 2010 ACCE, HIMSS, IHE© 2010 ACCE, HIMSS, IHE

2

ACM Supplement – TI CR AreasACM Supplement – TI CR Areas

• Trial Implementation HousekeepingTrial Implementation Housekeeping

• Bringing in HL7 2.7/2.8 proposed bits Bringing in HL7 2.7/2.8 proposed bits

• AM-AC ProtocolAM-AC Protocol

• Integration with WCM profileIntegration with WCM profile

3

Trial Implementation HousekeepingTrial Implementation Housekeeping

• Typos, etc.Typos, etc.

• Remove re-use of PCD-04 to go to AA Remove re-use of PCD-04 to go to AA actor (PCD-10?)actor (PCD-10?)

• Change diagram wording AM actor Change diagram wording AM actor function from Alarm Reporter to Alarm function from Alarm Reporter to Alarm Reporting to avoid confusion with AR Reporting to avoid confusion with AR actor nameactor name

4

Bringing in HL7 2.7/2.8 proposed bitsBringing in HL7 2.7/2.8 proposed bits

• Triggers and TypesTriggers and Types– ORU R01 is the current PCD-04ORU R01 is the current PCD-04

• backward compatibilitybackward compatibility

– ORU R40 is the new PCD-04ORU R40 is the new PCD-04

– ORU R01 is the current PCD-05ORU R01 is the current PCD-05• Backward compatibilityBackward compatibility

– ORA R41 and R42 are the new PCD-05ORA R41 and R42 are the new PCD-05• R41 – impractical assurance of delivery and receiptR41 – impractical assurance of delivery and receipt

• Use HL7 ACK of PCD-04 to confirm receipt by AMUse HL7 ACK of PCD-04 to confirm receipt by AM

• Use R42 instead of R41 as it relays actual PCD-07 infoUse R42 instead of R41 as it relays actual PCD-07 info

– Delayed ORA timing makes use of MSA impracticalDelayed ORA timing makes use of MSA impractical

5

Bringing in HL7 2.7/2.8 proposed bitsBringing in HL7 2.7/2.8 proposed bits

• PRT (Participation) Segment usagePRT (Participation) Segment usage– PCD-04 filtering for PCD-05PCD-04 filtering for PCD-05

• avoid PCD-05 fire hoseavoid PCD-05 fire hose

• What is the default, how is filtering indicatedWhat is the default, how is filtering indicated

– PCD-04 indicated destination messagingPCD-04 indicated destination messaging• PIN/Carrier support permits retention of existing usesPIN/Carrier support permits retention of existing uses

– PCD-05 contentPCD-05 content• Indicating to whom or to what the PCD-06 was sent toIndicating to whom or to what the PCD-06 was sent to

• what is the status of the delivery event (OBX content)?what is the status of the delivery event (OBX content)?– delivered to AC, delivered to device, operator read delivered to AC, delivered to device, operator read

receipt, operator accept/reject responsesreceipt, operator accept/reject responses

6

AM-AC Protocol (WCTP)AM-AC Protocol (WCTP)

• Wctp.org need documented approval for use of Wctp.org need documented approval for use of copyrighted work (else we’re back to XMPP-IM plus copyrighted work (else we’re back to XMPP-IM plus numerous extensions)numerous extensions)

• PCD-07 is an unsolicited web push responsePCD-07 is an unsolicited web push response

• Only a subset of WCTP is requiredOnly a subset of WCTP is required– Single messageSingle message

– Multiple Choice Response (MCR) for accept/reject Multiple Choice Response (MCR) for accept/reject response abstraction from devicesresponse abstraction from devices

– Map PCD-04 indicated priority to PCD-06 indicated priority Map PCD-04 indicated priority to PCD-06 indicated priority for implementing ring tonesfor implementing ring tones

– No phone directory functionsNo phone directory functions

– Version query not needed (version in message)Version query not needed (version in message)

7

Current PCD-04, PCD-05, PCD-08 all HL7 v2.6

New PCD-04 and PCD-05Bring forward HL7 2.7 and 2.8

AlarmCommunicator

AC

AlarmCommunicator

AC

AlarmManager

AM

AlarmManager

AM

AlarmAlarmReporterReporter

ARAR

AlarmAlarmReporterReporter

ARAR

ACM AM – AC MessagesACM AM – AC Messages

AlarmAlarmArchiverArchiver

AAAA

AlarmAlarmArchiverArchiver

AAAA

Report AlarmPCD-04 →

← PCD-05Report Alarm

Status

DisseminateAlarm

PCD-06 →

← PCD-07Report

DisseminationAlarm Status

PCD-08 ↑SubscribeTo Alarm

PCD-10? ↓ReportAlarm

PCD-06, PCD-07Data items defined

Currently using SMTPas open standardsbased transport,but needs better

8

PCD-06 AM to AC MessagePCD-06 AM to AC Message

AM to ACAM to ACPCD-06 – Disseminate AlarmPCD-06 – Disseminate AlarmSends the message to the AC’s device by way of ACSends the message to the AC’s device by way of AC

Identification of message recipientsIdentification of message recipientsMessage, containingMessage, containing

Location associated with alarmLocation associated with alarmPatient associated with alarmPatient associated with alarmMessage text (incl. physiological info.)Message text (incl. physiological info.)Identifier unique identifierIdentifier unique identifierCallback (telephony dial back)Callback (telephony dial back)Contextual Data Reference (URL)Contextual Data Reference (URL)CommentCommentEvidentiary DataEvidentiary Data

9

PCD-07 AC to AM MessagePCD-07 AC to AM Message

AC to AMAC to AMPCD-07 – Report Dissemination Alarm StatusPCD-07 – Report Dissemination Alarm StatusSends message deliver status updates to the AMSends message deliver status updates to the AM

Accepted by AC (delivered to carrier)Accepted by AC (delivered to carrier)Undeliverable to endpointUndeliverable to endpointDelivered to endpointDelivered to endpointAccepted by endpointAccepted by endpointAccepted by endpoint as true positive (info)Accepted by endpoint as true positive (info)Accepted by endpoint as true positive however not Accepted by endpoint as true positive however not clinically relevant (operator note)clinically relevant (operator note)Accepted by endpoint as false positive (info)Accepted by endpoint as false positive (info)Rejected by endpointRejected by endpointCanceled by endpoint (escalation, not alarm)Canceled by endpoint (escalation, not alarm)

How do we identify delivery status in OBX?How do we identify delivery status in OBX?

10

AM-AC Protocol RequirementsAM-AC Protocol Requirements

Must be an existing protocolMust be an existing protocolIHE uses standards, it does not develop themIHE uses standards, it does not develop them

Must be an open protocolMust be an open protocolNot proprietaryNot proprietaryMust have unrestricted useMust have unrestricted use

11

AM-AC Protocol RequirementsAM-AC Protocol Requirements

Preferences/FocusPreferences/FocusContemporary, Healthcare, Contemporary, Healthcare, People CommunicationsPeople Communications

XML based – extensibleXML based – extensibleHTTP transport – works with firewalls and NATsHTTP transport – works with firewalls and NATsMultiple Choice Response (MCR) – “soft keys”Multiple Choice Response (MCR) – “soft keys”Pushed, not polled status updates – quickerPushed, not polled status updates – quickerPresence/Status – for escalation responsivenessPresence/Status – for escalation responsiveness

Dynamic – online/offline, busy, BRB, away, DNDDynamic – online/offline, busy, BRB, away, DNDTLS capable – SSL securable, messages contain ePHITLS capable – SSL securable, messages contain ePHI

WCM Supportive – hyperlink or large evidentiary dataWCM Supportive – hyperlink or large evidentiary data

12

AM-AC Protocol RequirementsAM-AC Protocol Requirements

ACM Specific Messaging ItemsACM Specific Messaging ItemsDevice is on network identified by ID/Number/NameDevice is on network identified by ID/Number/NameDelivery target is ultimately people, not systemsDelivery target is ultimately people, not systemsDissemination/Status unsolicited, not subscribedDissemination/Status unsolicited, not subscribedPCD-04 round trip event message identificationPCD-04 round trip event message identificationMany status potentials in status enumerationMany status potentials in status enumeration

delivery/not at multiple levels (carrier, delivery/not at multiple levels (carrier, device)device)

human interactionshuman interactionsread receiptread receiptmultiple response possibilitiesmultiple response possibilities

more than accept/reject or more than accept/reject or timeouttimeout

13

Integration with WCM profileIntegration with WCM profile

• PCD-04 with embedded WCM contentPCD-04 with embedded WCM content

• PCD-04 with no waveform content PCD-04 with no waveform content (embedded hyperlink to waveform (embedded hyperlink to waveform server)server)

14

IHE PCD ContactsIHE PCD Contacts

PCD Co-ChairsPCD Co-Chairs Todd CooperTodd Cooper t.cooper@ieee.orgt.cooper@ieee.org Ken FuchsKen Fuchs ken.fuchs@draeger.com ken.fuchs@draeger.com Steve MerrittSteve Merritt steve.merritt@bhs.orgsteve.merritt@bhs.org John RhoadsJohn Rhoads john.rhoads@philips.comjohn.rhoads@philips.com

PCD Technical Project ManagerPCD Technical Project Manager Manny FurstManny Furst efurst@ieee.orgefurst@ieee.org

ACM WG Co-ChairsACM WG Co-Chairs Monroe PattilloMonroe Pattillo

monroe.pattillo@philips.commonroe.pattillo@philips.com John RhoadsJohn Rhoads john.rhoads@philips.comjohn.rhoads@philips.com

15

Thank YouThank You