“The Intelligent Hospital”Adaptive Information Management
Paul, H. Frisch, PhD. FHIMSSAttending Department of Medical Physics Chief, Biomedical Physics & Engineering
Memorial Sloan-Kettering Cancer Center. New York, NY
Dec 8-11, 2013 , Washington DC mHealth Summit
PhysiologicData Manager
(Connectivity)
Directed Communications
Nurse CallApplication Server
VentilatorManagementApplication
PhysiologicalMonitoring
Pump Medication
Management
Hospital GatewayRTLS
Hospital Backbone
Alarm & Physiologic Data Manager
Nurse Hands Free Wireless Devices
Intelligent Hospital
CISCOAccess Point
Outside of RoomDome Indicator
Patient Station
Toilet Emergency
Code Blue
Router
Room HUB
Hub
(Emergin)
(Vocera)
RFID
Room Level Devices
Medication Administration
Sample Collection RTLS EMR
Archiving
Objective: Design of an Integrated Intelligent Hospital
Increased Data Accuracy & Availability Electronic Medical Records Shared Medical Device Interconnectivity and Integration Global View of the Patient / Unit
Rapid Information Dissemination & Response Physiological Data Alarm Event Management Advanced Communication Platforms (PDA, iPhone, etc.) Location Content
Enhanced Error Checking & Validation Identification & Association Location Content Correct Information
Optimization of Workflow & Resource Management
Hospital Environment
OR Acute Care (ICU) Emergency
Department General Patient Care
Areas Outpatient Specialty Areas
Radiology Radiation Oncology Cardiology Suite
Pharmacy Central Supply War Room Data Center Biomedical
Engineering Information
Technology
Patient Treatment & Care
Supporting Operations
Real Time Information DeliveryDemographicsStatus , ETA Field AssessmentAllergiesPhysiological Data
GPS Treatment PlanningStaffing / AssessmentRapid Routing OR , Cath LabNecessary Supplies
Time Sync. ClocksMedical Devices & Connectivity (Barcode & RFID)RFID Hand Hygiene ComplianceRFID Coupled Patient / Staff TrackingPatient Identification generate wristband @ bedside (Barcode, Passive & Active RFID)Label Scanners & Printers: Wristband, Sample CollectionRFID Coupled Bed / Patient Management System
RFIR Virtual Wall Emergency Room (ER)
Wall of Knowledge
Integrated Philips C-Arm
RFID Surgical Table
Video Camera
Drager Anesthesia System
2012 HIMSS Expo. RHCC Intelligent Hospital Pavilion
Wall of Knowledge - Routable Images
Minimally Invasive Surgery Boom
Device Control RFID Coupled Surgical
Instruments RFID Coupled Sponges OR RFID Couple Status Board RFID Coupled Supplies Interactive Consultation /
Education Robot Boom Mounted Video
Integrated Hybrid OR
ICU
2012 HIMSS Expo. RHCC Intelligent Hospital Pavilion
Intelligent Pharmacy
Environmental Metrics & Safety
TelemedicineAmbulance Data ER / OR Dashboards Bedside PC
Ventilator Management& Analytics
Alarm Management Physiological Data Bed Management
Education / Consultation
War RoomTactical Strategic (Business Intelligence)
Big Data Clinical Data
Physiological Parameters Physician Orders Laboratory Information Radiological Information
Alarm Management Alarms & Alerts Real Time Location Content
Workflow Resource Availability
Equipment & Supplies Staff
Environment of Care Temperature Humidity Fire Protection
Administrative / Management Information Business Intelligence
Real Time Information
Reports
Alarm Volume ICU (12 Bed Unit)
Physiological Monitoring Only 72 Hour Full Disclosure Results 36,000 Alarms 42 Alarms / Bed / Hour
Telemetry (90 beds) 72,397 Alarms over 20 days 3620 Alarms / Unit / Day
Filtering ThresholdingEscalation
Intelligent Alarm Processing
0
50
100
150
200
250
300
350
400
450
500
1406
*
1407
*
1410
A*14
10B*
1411
B*
1412
B*
1415
A*14
15B*
1417
A*
1417
B*
1417
C*
1417
D*
1420
A*14
20B*
1421
A*
1421
B*14
22A*
1422
B*
1424
A*
1424
B*
1425
A*14
25B*
1426
A*
1426
B*
1428
*14
29*
1430
*
1431
A*
1431
B*14
32A*
1433
A*
1433
B*
1435
A*14
35B*
1436
*
1437
*
1438
*
1439
*
Daily Average per bed
Telemetry SummaryTotal For 20 days
Daily Average for the whole Unit
Daily Average for one bed
All Alarms 72,397 3,620 86
Critical Alarms 5,194 260 6
Selective Filtering
Telemetry Ratio4:1 24 Alarms 2 / hr6:1 36 Alarms 1.5 /hr
0
10
20
30
40
50
60
70
80
ASYSTOLE LEADS FAIL PAUSE V BRADY V TACH VFIB/VTAC VT > 2
Critical Alarms Daily Average
Thresholding
Alarm on
t1 t2
Alarm # 1 Alarm # 2
SpO2 < 85 278 1.15 Alarms / Hr / NurseSpO2 < 80 198 .8 Alarms / Hr / NurseSpO2 <70 24 1.0 Alarm / Hr / Unit
Limit Adjustment Filtering
1406
*
1410
A*
1411
B*
1415
A*
1417
A*
1417
C*
1420
A*
1421
A*
1422
A*
1424
A*
1425
A*
1426
A* 14
28* 14
30*
1431
B*
1433
A*
1435
A* 14
36* 14
38*
0
5
10
15
20
25
30
35
40
45
VT>2VBradyVtachLeads OffAsystole
Patient Staff Ratio 4:1 64 Critical Alarms / HourCritical Event Every 11 minutes
Average Alarms Per Bed Per Shift
Connentivity & Point of Care Information Delivery
Handheld IP Phone Alarms Delivery Staff to Staff Communications
Handheld PCCan access all Hospital Applications Pagers
Dynamic Identification and Association
Equipment to Patient
Pharmaceutical
Frisch, P.H., Miodownik, S., Booth, P., Carragee, P., Dowling, M., Patient Centric Identification and Association. IEEE Engineering in Medicine and Biology Society, Proceedings of the 31th International Conference. 2009: 1722-5
Medical Devices & Systems Physiological Monitoring Bernoulli Ventilator Management Infusion Pump Systems Nurse Call
Alarm Management & Data Distribution Critical Alarms to the Point of Care Staff to Staff Communications
Medication Administration Sample Collection Electronic Medical Record
Active RFID Bar CodesPassive RFID
Processor
Applications
IdentificationAssociationData
RTLS, Network Clients, ADT, etc.
User Interface
Institutional RTLS Solution
• Item Level Identification• Shelf level Tracking• Validation of Supplies Check Expiration Serial #, Lot #• Update Inventory
Supply Chain
RFID Antenna Bar Code
2012 HIMSS Expo. RHCC Intelligent Hospital Pavilion
Surgical Applications - Retained Objects: • 1 in 5,000 open cavity surgeries result in a retained object• 40% of surgical cases are open cavity• 70% of retained objects are sponges
Ascension Health, Scott Lambert, Lead Partner, Engagements & Prototypes Transformational Development, 2008 Midwest Chapter HIMSS
• 764 Medicare incidents in 2006
• Tray Development • Validate Surgical Tray Content Before & After Procedure• Validate Sponge Counts• Confirm Cleaning & Sterilization Processes
Medication AdministrationRFID Coupled Dispenser
Hand Held Bar Code Reader
2012 HIMSS Expo. RHCC Intelligent Hospital Pavilion
Application Workstation: Integrates to Physician Order Entry Validate 5 Rights (Bar Code)
……….Station #1 #2 #3 #4
ID#1
If #1 and #2 and # 3 and #4 Good to Go
Antenna Network
Cleaning ProcessesLaboratory ProcessesDocument Transfer
Scope SterilizationHand Hygiene
Process Validation
Infusion Pump Server
Gateway RFID System
Device Location
Status
Formulary Version
Channels in Use
Operation Parameters
Alarms
RFID Coupled Device Status & Utilization
MSKCC – Carefusion- Aeroscout Collaboration
Programmable Events
Is Location Sufficient ?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%Bo
bst 9
Bobs
t 14
Haup
t 1Ha
upt 2
Haup
t 3Ha
upt 4
Haup
t 5MP
1MP
2MP
6 M 1
M 10
M 11
M 12
M 14
M 15
M 16
M 17
M 19 M 4
M 5
M 6
M 7
M 8
M 9
Rad O
nc 2
Rad O
nc 3
Rad O
nc 4
Schw
artz 1
Schw
artz 2
Percentage Average Utilization by Care Unit
Percentage Utilization
EXCITER EXCITEREXCITER EXCITEREXCITER
EXCITER EXCITER EXCITER EXCITER
Synchronized RF-ID Tracking & Event Streaming “ Dynamic Workflow “
• Patient Wait Times
• Treatment Time
• Staff Presence By Specialty
• Time Sequence of Alarms & Events
• Utilization & Availability of Devices & Supplies
Workflow Metrics & Analytics
10:19 10:33 10:48 11:02 11:16 11:31 11:450
0.1
Tag #12Patient Alice Smith June 18, 2012
Registration
Check outFellow
RN
Room
MD
The Patient ExperienceWorkflow Metrics
Cautions & Considerations Lack of Strategic Vision & Planning ROI Based on Institutional Plan
Not Application Specific Network Impact Interference (EMI) Regulatory Issues Business Intelligence Management Application Development Simulation / Test Environment
Simulation Laboratory
Duplicates Environment of Care Infrastructure Devices Applications
Enables Test & Evaluation Upgrades to Infrastructure Wireless Network / AP’s Device Upgrades Application Changes New Technologies
Dynamic Training &Facilities Modeling
Automatic Patient Centric Identification
Bed Centric Identification
Envelope
Equipment to Patient
Pharmaceutical
Bed Embedded
RF Transmitter
Receiver
Embedded Bed / Nurse CallStaff Workstation
Middleware
Devices
EMR
PhysiologicData Manager
Directed Communications
Outside of RoomDome Indicator
Patient Station
Toilet Emergency
Code Blue
Router
Room HUB
Hub
Nurse CallApplication Server
VentilatorManageme
ntApplication
PhysiologicalMonitoring
Pump Medication
Management
Hospital Gateway
RFID
Hospital Backbone
Alarm & Physiologic Data Manager
Nurse Hands Free Wireless Devices
Biomedical Device Information System
CISCOAccess Point
(Emergin)
(Vocera)
RFID
Patient Centric Identification
Questions ?