interoperability showcase ihe domain updates: interoperability showcase ihe domain updates: patient...
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Interoperability Interoperability Showcase Showcase
IHE Domain Updates:IHE Domain Updates:
Patient Care Devices
Co-Chairs:Co-Chairs:Todd CooperTodd Cooper Ken FuchsKen FuchsSteve MerrittSteve Merritt John RhoadsJohn Rhoads
Welcome and Overview
Brief IHE Overview – big picture
Domain overview - Mission/scopeProfile overview
New Profiles for 2010
Future Work – Roadmap Upcoming events & Resources
Q & A & Wrap
IHE Overview
IHE is… a global initiative started in 1997 that creates the framework for passing vital health information seamlessly – from application to application, system to system, and setting to setting – across multiple healthcare enterprises.
IHE Overview
IHE is… led by volunteer members and sponsors representing diverse
communities:– 300 organizational members worldwide on four continents and
over 24 countries representing– Academic Medical professionals– Practicing Clinicians– Healthcare Administrators– Membership Organizations [ACP, HIMSS< RSNA etc]– HIT Vendors, Consultants– And more
IHE Overview
IHE… hosts two major types of activities:– Conformance testing at
Connectathons– Demonstrations at
Interoperability Showcases
IHE Process IHE Process OverviewOverview
12 IHE Development Domains12 IHE Development Domains
IHE Domains
Anatomic PathologyCardiologyEye CareIT InfrastructureLaboratoryMammographyNursing SCPatient Care Coordination
(PCC)Patient Care Devices (PCD)Patient Care Devices (PCD)
PharmacyQuality, Research & Public
HealthRadiology Radiation OncologyFuture Domains may include:DentistrySurgery …And more
PCD Domain Overview
• Established in 2005 when the “charter” was awarded to the ACCE
• Jointly sponsored by ACCE and HIMSS as of July 1, 2006
• Technical Framework 2006-7 developed to communicate patient data (asynchronous)
• Successful demonstration at the Connectathons and HIMSS Interoperability Showcases since 2007
PCD Domain Overview
IHE PCD Charter• The Patient Care Devices Domain is concerned with Use
Cases in which at least one actor is a patient-centric point-of-care medical device that communicates with at least one other actor such as a medical device or information system.
• The PCD domain coordinates with and supports other domains, such as Radiology (medical imaging), Laboratory, and Cardiology to ensure consistency in use cases involving regulated medical devices as they occur throughout the Enterprise.
PCD Domain Overview
• Heterogeneity – Coexistence & interoperability in a multi-manufacturer / multi-modality world, leveraging shared infrastructure
• Semantic Interoperability – … from the sensor to the HER• Reduce healthcare delivery cost by improving efficiency,
reliability, and operational flexibility for healthcare providers • Expand the international marketplace for patient care device
vendors • Enable innovative patient care capabilities• Improve patient safety and clinical efficacy
PCD Profile Value Objectives:
Device Enterprise Communication (DEC) Profile - Year 1
HL7 v2.6 ORU Message
ISO/IEEE 11073 Semantics
Preserves device “context”
Device Data Subscription& Filtering
Rosetta for Semantic Interoperability
IHE PCD Rosetta Terminology Management
VendorTerms
RTM1400 rows
HarmonizedTerms
hRTM440 terms
ISO/IEEE 11073Semantic Standards
Vendor A
Vendor B
Vendor C
HL7 V2 Messages
HL7 V3 CDA/CCD
11073PnP Comm
VendorSemantics
IHE PCD Technical Framework Content
• Open consensus process• Observation identifiers and co-constraints• New terms incorporated into standards• hRTM used for conformance testing
AlarmSource
AlarmAggregator
AlarmReceiver
AlarmCoordinator
AlarmDisseminator
AlarmCommunication
AlarmEndpoint
AlarmCommunication
(AC)
AlarmCommunication
(AC)
AlarmManagement
(AM)
AlarmManagement
(AM)
AlarmReporter
(AR)
AlarmReporter
(AR)
AlarmReporter
AlarmCache
Alarm
Query
(AQAQ)
Alarm
Query
(AQAQ)
Communication detailed in ACM profileCommunication detailed in ACM profile
Communication not detailed in ACM profileCommunication not detailed in ACM profile
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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, EMROptionalOptional
Alarm CommunicationManagement
AlarmReporter
AlarmManager
AlarmCommunicat
or
HL7HL7
HL7 Messagesper ACM andWCM profiles
HL7 Messagesper ACM andWCM profiles
AlarmArchiver
Waveforms and annotations asevidentiary data items
Waveforms and annotations asevidentiary data items
DeviceSpecificgraphics
DeviceSpecificgraphics
Profiledefined
dataitems
Profiledefined
dataitems
Historical StorageHistorical Storage
Alarm InformationSource, Phase, State, Priority
PatientLocationInstance
Alarm textCallback
TimestampEvidentiary data (WCM)
Dissemination StatusInstance
Accepted by ACUndeliverable
DeliveredRead
AcceptedRejected
CancelledCallback start/stop
AlarmSource
CommunicationDevice
HL7HL7
ACM & Waveform Comm. Management (WCM)
Point-of-Care Infusion Verification (PIV)
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
Point-of-Care Infusion Verification - Actors
Implantable Device – Cardiac Observation (IDCO)• 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]
Implantable Device – Cardiac Observation (IDCO)
Device Point-of-Care Integration
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
Medical EquipmentManagement (MEM)
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 on
Day/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
sact
ion
s
DEVICE MANAGEMENT
CONSUMER
DPIDECACM
Risk ManagementRisk analysisRisk evaluationVerification of risk control measuresResidual risks
NIST - Test Tooling Support
• NIST Test Tools– ICSGeneratorICSGenerator
• Medical Device Profiles (specializations)• Implementation Conformance Statements
– ValidatePDUValidatePDU • X73 Application Layer Message Syntax and Semantic Validation
• NIST Medical Device Standards Work– ISO/IEEE 11073 Standard (X73): Medical Device Communication
• XML SchemaXML Schema: NIST P11073-10202 Domain Information Model• Collaborations
– Integrating Health Enterprise - Patient Care Devices (IHE-PCD)– IEEE 11073 Personal Health Devices (PHD) Working Group (WG)– ISO/IEEE 11073 WG
• On-going Work and Future Direction…– IHE-PCD profile and message generation and testing (includes enterprise – e.g., HL7 V2 & V3HL7 V2 & V3)– PHD X73 profile and message testing (ContinuaContinua)– X73 Java Class LibraryX73 Java Class Library
• NIST Team Members– John Garguilo ([email protected] 301-975-5248), Sandra Martinez,
Maria Cherkaoui (guest researcher), and Richard Theimer (contractor)
http://www.nist.gov/medicaldeviceshttp://www.nist.gov/medicaldevices
NIST Test Tooling Support
DIM MOCICS
Reports
DIMXSchema
Compare Devices
HL7/OBXMapping
(XML)
Service Support ICS
ReportService Support
ICS XML
Transport ICS Report
TransportICS XML
General ICS
Report
General ICS XML
Device Specialization
(DIM MOC XML)
Device UML Diagram
ISO/IEEE 11073
DIMPart 10201
NomenclaturePart 10101
ICSGenerator
www.nist.gov/medicaldevices
Now Developing
Terminology Management
Tools
PCD & PCD & SDO CoordinationSDO 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)
……
… … don’t reinvent the wheel or don’t reinvent the wheel or “base” standards!“base” standards!
PCD & ICE-PAC JWGPCD & ICE-PAC JWG
(From ICE-PAC Overview Update 2009.06.22 to IHE PCD)
PCD & Continua PCD & Continua Health AllianceHealth Alliance
Continua & IHE established a Memorandum of Understanding Continua & IHE established a Memorandum of Understanding (“MoU”) (“MoU”) to “to “enable and promote interoperability of healthcare enable and promote interoperability of healthcare devicesdevices.”.”
SeeSee http://www.ihe.net/News/ihe-continua_mou_release_2008-10-28.cfmhttp://www.ihe.net/News/ihe-continua_mou_release_2008-10-28.cfm
Joint participation in 2010 IHE Showcase!Joint participation in 2010 IHE Showcase!
Coordination on HITSP RMON SDE#2 is laying the foundation Coordination on HITSP RMON SDE#2 is laying the foundation for interoperability from bedroom to OR!for interoperability from bedroom to OR!
HIMSS ’09 IHE HIMSS ’09 IHE Showcase SponsorsShowcase Sponsors
PCD & HITSPPCD & HITSP
Support for Support for ARRA / ARRA / HITECH & HITECH & Meaningful Meaningful UseUse
Get involved
• Membership is free! • To learn more, visit
www.ihe.net/governancewww.ihe.net/governance//
• Visit the PCD “cube”!• PCD Contact:
Manny Furst ([email protected])
Thanks for joining us!
Find out more at ihe.netFind out more at ihe.net