Enterprise Device Integration Strategy:- Enabling Adoption and Improving Outcomes

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Dharmendra Ghai (CPHIMS)Program Manager,

Hamad Medical Corporation(JCI), Doha, Qatar

dghai@hmc.org.qa

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Medical Devices Integrations ……………………Risks

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Medical Devices Integrations ……………………Risks

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Medical Devices Integrations ……………………Risks

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Medical Devices Integrations …………Landscape

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Medical Devices Integrations …………Landscape

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Medical Devices Landscape: Current and Future Adoption

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Medical Devices Integrations ……………………

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Medical Devices Integrations ……………………

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Medical Device Integration………Benefits• Medical device integration eliminates the redundancy and inefficiency of

entering the same data multiple times.

• Medical device integration increases patient care, safety, and workflow.

• Manual charting has long been a process that slows the efficiency of nurses and other clinicians– Allows the clinician to spend more time on direct patient care– Ensures that vital signs are charted accurately– Increases the adoption of the EMR and CPOE– Improves the timeliness of vital sign documentation and delivers near

real time data to the patient's record for improved decision making

• All of that adds up to healthier patients, staff, and better Outcomes

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Medical Device Integration………IHE• IHE Patient Care Device integration profiles include:

• [ACM] Alarm Communication Management.• [DEC] Device Enterprise.• [DEC-PIB] Patient Identity• [DEC-SPD] Subscribe to Patient Data.• [PIV] Point-of-care Infusion Verification • [RTM] Rosetta Terminology Mapping

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AlarmSource

AlarmAggregator

AlarmReceiver

AlarmCoordinator

AlarmDisseminator

AlarmCommunication

AlarmEndpoint

AlarmCommunicator

(AC)

AlarmManager

(AM)

AlarmReporter

(AR)

AlarmReporter

AlarmCache

Alarm Archiver(AA)

Communication detailed in this profile

Communication not detailed in this profile

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The intended use is to serve in communication of alarm information from patient care devices to an alarm manager system communicating with secondary means of notification to caregivers. Typical secondary notification means would be annunciators, pagers, and smart phones. *Note that in 2009 this profile is being extended to other alarms including from systems such as patient/asset tracking, bed management, etc

Case A1: Location SourcedCase A1: Location Sourced

Patient wants a pillowPatient pulls nurse callNurse call system lights the room’s dome light and light at central station. Nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm

[PCD-04] to Alarm Manager (AM) indicating nurse call alarm. The Alarm Manager (AM) logs receipt of the alarm. The Alarm Manager (AM) identifies

the appropriate nurse based upon configured nurse to patient assignments, identifies the appropriate Alarm Communicator (AC) actor and destination communication device based upon nurse to device configuration in Alarm Manager (AM), sends Disseminate Alarm [PCD-06] to nurse’s communication device. The Alarm Manager (AM) logs the dissemination to the Alarm Communicator (AC).

The nurse receives the alarm on their assigned device. The information minimally includes the patient location (room number). The nurse goes to the room, determines the needs of the patient, and provides the patient with a pillow. The nurse then resets the nurse call pull. The nurse call system turns off the room’s dome light and the light at the central station.

The nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm [PCD-04] to Alarm Manager (AM) indicating reset of the nurse call alarm. The Alarm Manager (AM) receives the alarm turns off any configured alarm escalation and logs the alarm.

Patient wants a pillowPatient pulls nurse callNurse call system lights the room’s dome light and light at central station. Nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm

[PCD-04] to Alarm Manager (AM) indicating nurse call alarm. The Alarm Manager (AM) logs receipt of the alarm. The Alarm Manager (AM) identifies

the appropriate nurse based upon configured nurse to patient assignments, identifies the appropriate Alarm Communicator (AC) actor and destination communication device based upon nurse to device configuration in Alarm Manager (AM), sends Disseminate Alarm [PCD-06] to nurse’s communication device. The Alarm Manager (AM) logs the dissemination to the Alarm Communicator (AC).

The nurse receives the alarm on their assigned device. The information minimally includes the patient location (room number). The nurse goes to the room, determines the needs of the patient, and provides the patient with a pillow. The nurse then resets the nurse call pull. The nurse call system turns off the room’s dome light and the light at the central station.

The nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm [PCD-04] to Alarm Manager (AM) indicating reset of the nurse call alarm. The Alarm Manager (AM) receives the alarm turns off any configured alarm escalation and logs the alarm.

AR -> AM

AM -> AC

AC -> Nurse

AR -> AM

AR

PCD-04 Report Alarm

AM

PCD-06 Disseminate Alarm

AC

PCD-05 Report Alarm Status

PCD-07 Report Dissemination Alarm Status

PCD-05 Report Alarm Status

Opt

Opt

Opt

Alarm Reporter-Nurse Call-Medical Devices -Physio Monitors -Pumps -Apnea-Bedboard System

Alarm Manager-”Smart” alarm systems-Alarm aggregators

Alarm Communicator-Vocera-Cisco Wireless IP Phone-Cell Phone-Pager

Patient Care DevicesHIMSS Interoperability Showcase 2009

GE GE CentricityCentricity®®

PeriopPeriop AnesAnes..

Enterprise

DOC DOC

Patient Patient

LiveDataLiveDataOR OR ––

DashBoardDashBoardTMTM

DOR = Device Observation Reporter / DOC = Device Observation Consumer

AR = Alarm Reporter / AM = Alarm Manager; IOC = Infusion Order Consumer / IOP = Infusion Order Programmer

PDQ/PAMServer

PhilipsPhilipsIntelliVueIntelliVue

ClinicalClinicalInfo PortfolioInfo Portfolio

DOC

Patient MonitorPatient Monitor

DOR, AR

DOC

DraegerDraegerInnovianInnovian®® WebWeb

CapsuleCapsule

GE GE CentricityCentricity®®

EnterpriseEnterprise

DOC

LiveDataLiveDataAlert ManagerAlert Manager

HospiraHospiraVeriScanVeriScan

DOCIOP

EpicEpicInPatientInPatient

EMREMR

DOC

EpicEpicInPatientInPatient

EMREMR

DOC

PhilipsPhilipsEmerginEmergin

AM

OR

TimeServerTime

Server

Step-DownICU

AM

Devices

CapsuleCapsuleDataCaptorDataCaptor

DOR,AR

Devices

CapsuleCapsuleDataCaptorDataCaptor

DOR,AR

PhilipsPhilipsIntelliVueIntelliVue

Info. CenterInfo. Center

AR DOR, AR

CernerCerner

CareMobileCareMobileTMTM

DOCIOP

EpicEpic

IOP

GEGECetricityCetricity®®EnterpriseEnterprise

IOP

AC

DOR

Hospital Bed

CernerCerner

CareAwareCareAwareTMTM

DOR

Hospital Bed

CernerCerner

CareAwareCareAwareTMTM

DOR,AR

InfusionDevices

IOC

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

DOR,AR

InfusionDevices

IOC

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

Patient Monitor,Ventilator

DOR

GEGEAwareAware

GatewayGateway

Patient Monitor,Ventilator

DOR

GEGEAwareAware

GatewayGateway

DOR,AR

InfusionDevices

IOC

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

DOR,AR

InfusionDevices

IOC

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

Patient Monitor,Anesthesia Sys

DOR, AR

DraegerDraegerInfinityInfinity

GatewayGateway

DOR,AR

InfusionDevices

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

DOR,AR

InfusionDevices

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

Patient Patient

PolycomPolycomWirelessWirelessPhonePhone

AlarmClient

CapsuleCapsule

What is a Client Device ?

• “An device, instrument, apparatus, implement, machine, contrivance, or other similar article that is intended for use in accessing, communicating and computing clinical information. Client devices are NOT directly capturing or processing patient physiological, medical, clinical information”• Computerize Carts• Patient Infotainment Systems • POC/ICU Monitors for PACS and EMRs• Clinical Assistants e.g ipad, iphones, tablets, blackberry• IP based nurse call system• Kiosks• Real Time Locating Systems

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Client Devices

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Medical Device Integration………Benefits• What is the correct number of end-user devices required to meet our

needs?• Where should we locate end-user devices?• What types of end-user devices are most appropriate?• What is the space and network infrastructure implications and what

upgrades are required to accommodate these new devices?• How much will it cost?• How do we promote end-user inclusion and buy-in to ensure a smooth

rollout?• What devices can be reused and which should be replaced?• What devices can be standardized?• What non-standard devices will be allowed and how?• How will we connect with the HIE?• How will the system connect with the clinical devices for data capture?

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Conclusion • Device Integration provides Patient safety and Improve Outcomes.

• Form Device Strategy Workgroup involving right stakeholders. • Prepare capital equipment plan with details involving equipment

condemnation. • Consider standardization promote IHE • Ensure devices (both medical devices and end user computing

devices) deployed are useable, safe, workflow enabling and sustainable to use integrated with the Clinical Information system for achieving greater adoption of CIS.

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Thank You

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