Use of IHE DEC Profiles forRemote Monitoring

Authors: Paul Schluter and Todd CooperHITSP RMON discussion October 2, 2008

DeviceDevice

Intermediary

Device

EHR or Care Coordination Applications

Home Settin

g

Hospital Setting

Device Intermediary

IHE-DEC

Subset of IHE-DEC

IHE-DEC: Same protocol used in two settings …

IHE Device Enterprise Communication (DEC) and related Profiles (PCD, SPD, ACM).

Device Observation Consumer

(DOC)

Device Observation

Reporter (DOR)

Device

PCD-01 Transaction: Communicate Device Data

• Periodic Physiologic Data: Heart Rate, Respiration rate• Episodic Physiologic Data: NIBP, Weight, Cardiac tests• Primarily structured data but facilities non structured data as well• Must include Patient ID• > 1 minute sampling rate (but could be faster)• Waveform support is simple extension• Flexible extensions with:

• Alarms and alerts supported through related profile (ACM)• Subscribe to Patient Data (SPD) Profile• Security, privacy, confidentiality through related profile (ATNA)

• ISO/IEEE 11073-10101 nomenclature (does not rule out LOINC or SNOMED)• ISO/IEEE 11073 or UCUM units-of-measure• OBX-4 used for «mds.vmd.chan.metric», OBX-20 for measurement sites• Profile and simplify other aspects of HL7 V2.5 messaging

Mapping Preserves Measurement Context Medical Device System (MDS)

Virtual Medical Device (VMD)

Channel (Chan)

Numeric

Enumeration

1

*

1

*

1

*

1

0..*

Metric

Overall Device or System

Virtual Medical Device

Channel (only as needed)

A single observation

PCD-01 Message Example (simple heart rate)

MSH|^~\&|HL7^080019FFFF4F6AC0^EUI-64|MMS|||20070118133700||ORU^R01|a4e2e3:11036b5cdbb:-|P|2.5|20070118133700||NE|AL||

8859/1PID|||6O008D^^^A^PI||DAVIDSON^DAVID^^^^^LPV1||E|3WICU^305^305OBR|1|080019FFFF4F6AFE200701|080019FFFF4F6AC0200701|126.3.3.1^2000^MDC|||20070118133700OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC|1.6.1.1|80|/min^/min^UCUM|||||R‘Heart Rate’ ‘/min’ UOM

IEEE EUI-64

OBX-4 Value

PCD-01 Message Example (more complex)MSH|^~\&|HL7^080019FFFF4F6AC0^EUI-64|MMS|||20070118133700||ORU^R01|

a4e2e3:11036b5cdbb:-|P|2.5|20070118133700||NE|AL||8859/1PID|||6O008D^^^A^PI||DAVIDSON^DAVID^^^^^LPV1||E|3WICU^305^305OBR|1|080019FFFF4F6AFE200701|080019FFFF4F6AC0200701|126.3.3.1^2000^MDC|||20070118133700OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC|1.6.1.1|80|/min^/min^UCUM|||||ROBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC|1.6.1.1|60|/min^/min^UCUM|||||ROBX|2|NM|131841^MDC_ECG_AMPL_ST_I^MDC|1.7.1.1|0.0|mm^mm^UCUM|||||ROBX|3|NM|131842^MDC_ECG_AMPL_ST_II^MDC|1.7.1.2|0.0|mm^mm^UCUM|||||ROBX|4|NM|131901^MDC_ECG_AMPL_ST_III^MDC|1.7.1.3|0.0|mm^mm^UCUM|||||ROBX|5|NM|131847^MDC_ECG_AMPL_ST_V5^MDC|1.7.1.4|0.0|mm^mm^UCUM|||||ROBX|6|NM|131902^MDC_ECG_AMPL_ST_AVR^MDC|1.7.1.5|0.0|mm^mm^UCUM|||||ROBX|9|NM|150035^MDC_PRESS_BLD_ART_MEAN^MDC|1.3.1.1|96|mm[Hg]^mm[Hg]^UCUM|||||ROBX|10|NM|150033^MDC_PRESS_BLD_ART_SYS^MDC|1.3.1.2|122|mm[Hg]^mm[Hg]^UCUM|||||ROBX|11|NM|150034^MDC_PRESS_BLD_ART_DIA^MDC|1.3.1.3|82|mm[Hg]^mm[Hg]^UCUM|||||ROBX|12|NM|149522^MDC_BLD_PULS_RATE_INV^MDC|1.2.1.1|60|/min^/min^UCUM|||||ROBX|13|NM|150047^MDC_PRESS_BLD_ART_PULM_MEAN^MDC|1.4.2.1|14|mm[Hg]^mm[Hg]^UCUM|||||ROBX|14|NM|150045^MDC_PRESS_BLD_ART_PULM_SYS^MDC|1.4.2.2|24|mm[Hg]^mm[Hg]^UCUM|||||ROBX|15|NM|150046^MDC_PRESS_BLD_ART_PULM_DIA^MDC|1.4.2.3|10|mm[Hg]^mm[Hg]^UCUM|||||ROBX|16|NM|151610^MDC_VENT_CO2_RESP_RATE^MDC|1.5.1.1|12|{breath}/min^{breath}/min^UCUM|||||ROBX|17|NM|151976^MDC_VENT_PRESS_AWAY_END_EXP_POS^MDC|1.5.1.2|4|cm[H20]^cm[H20]^UCUM|||||ROBX|18|NM|152008^MDC_VENT_VOL_MINUTE_AWAY^MDC|1.5.1.3|0.0|l/min^l/min^UCUM|||||ROBX|19|NM|151920^MDC_VENT_CONC_AWAY_O2_INSP^MDC|1.5.1.4|21|%^%^UCUM|||||ROBX|20|NM|151980^MDC_VENT_VOL_TIDAL^MDC|1.5.1.5|1096|ml^ml^UCUM|||||ROBX|21|NM|151957^MDC_VENT_PRESS_MAX^MDC|1.5.1.6|17|cm[H20]^cm[H20]^UCUM|||||ROBX|22|NM|151784^MDC_PRESS_RESP_PLAT^MDC|1.5.1.7|30|cm[H20]^cm[H20]^UCUM|||||ROBX|23|NM|151792^MDC_PRESS_AWAY^MDC|1.5.1.8|35|cm[H20]^cm[H20]^UCUM|||||ROBX|24|NM|151808^MDC_PRESS_AWAY_END_EXP_POS_INTRINSIC^MDC|1.5.1.9|1|cm[H20]^cm[H20]^UCUM|||||R

IHE DEC (and associated) profiles

Provides a Unified Interface that --• Supports the complete range of device data (except for

high-bandwidth continuous waveforms) found in health related devices today and in the future.

• Provides a consistent interface in Health Record, CareManagement Systems and Personal Health Records that is:- Secure, private- High performance even on low bandwidth links- Scalable, from a simple device intermediary (a few devices for the

same patient) to multiple devices for many patients. Trivial to implement.

- Straightforward mapping from proprietary and IEEE 11073 formats (uses same nomenclature as X73 Personal Health devices).

- Based on proven HL7 standards that are supported by all Care Management and EHRs products today