Integrating the Healthcare Enterprise Patient Care Device Domain IHEPCD

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Integrating the Healthcare Enterprise-Patient
Care Device Domain (IHE-PCD)
Authors Jack Harrington, Ray Zambuto, Todd
Cooper
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Agenda

• Evolution of the IHE PCD
• Year 1 - Device Enterprise Communication Profile
• Year 2 Survey and Proposed Profile Development

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IHE Patient Care Device (PCD) A New Domain
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IHE Patient Care Device (PCD)
HIMSS Survey IHE pre-2005 Annual Conference
results

• Survey of all IHE Users
• Over 50 of those surveyed said patient care
  devices should be the next area developed for IHE
  

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IHE 2005 Summer Survey Results

• Highest priority devices for integration are
  Vital Signs Monitors, Blood Gas Analyzers (POC),
  and Infusion Pumps
• Highest priority departments are ICU, Emergency,
  OR/Anesthesia, and Lab (POC)
• Highest technology priority is Enterprise Wide
  Sharing
• Highest priority for clinical application is EHR
  or CIS integration followed by Improved
  Management and Decision Support

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IHE PCD Formed in September 2005

• In September, 2005, the PCD gathered 60 vendors,
  purchasers, providers, and regulators in
  Washington D.C. for 2 days to explore the value
  propositions, explore the scope and mission of
  the domain, and begin the process of use case
  development.
• IHE Charter - The Patient Care Device Domain is
  concerned with Use Cases in which at least one
  actor is a regulated patient care device. The
  PCD coordinates with other IHE clinical specialty
  based domains such as medical imaging.
• Current membership is 100 and growing.2

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IHE-PCD Domain Vision Statement

• The IHE Patient Care Device Domain (IHE PCD)
  is the nexus for vendors and providers to jointly
  define and demonstrate unambiguous
  interoperability specifications, called profiles,
  which are based on industry standards, and which
  can be brought to market.

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IHE-PCD Mission

• The IHE Patient Care Device Domain will apply the
  proven, Use Case driven IHE processes to
• Deliver the technical framework for the IHE-PCD
  domain profiles
• Validate IHE-PCD profile implementations via
  Connectathons and
• Demonstrate marketable solutions at public trade
  shows.

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Agenda

• Evolution of the IHE PCD
• Year 1 - Device Enterprise Communication Profile
• Year 2 Survey and Proposed Profile Development

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IHE Patient Care Devices (PCD)
One Patient Many Devices
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IHE Process
IHE Connect-a-thonResults
IHETechnicalFramework
User Site
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IHE PCD Technical Framework Volume1 Integration
Profiles
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IHE PCD Technical Framework Volume 2 Transactions
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Device Enterprise Communication (DEC) Profile -
Year 1
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DEC Profile Mapping Model

• ISO/IEEE 11073 Domain Information Model and
  Nomenclature mapped to HL7 Observation Report
• ISO/IEEE 11073 Data Types mapped to HL7 Data
  Types
• Mapping preserves measurement context for complex
  devices.

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Measurement Context is Dynamic
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IEEE 11073 Domain Information Model Defines
Device Context
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Mapping preserves measurement context
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Example PCD-01 Message
MSH\INFO_SRC_PHILIPSACDE48234567ABCDEUI-64
20061215153500ORUR01ORU_R01PMS116621490051
P2.5NEAL8859/1
PIDAB60001Philips MedicalPIBrooksAlbert
L19610101M PV1IUNIT_1Bed1
OBR1PMS116621490051INFO_SRC_PHILIPSACDE482345
67ABCDEUI-64 PMS116621490051INFO_SRC_PH
ILIPSACDE48234567ABCDEUI-64
69837MDC_DEV_METER_PHYSIO_MULTI_PARAM_MDSMDC2
0061215153500 OBX1ST184326MDC_ECG_STAT_ECTMD
C1.5130.1.184326""F OBX2ST184327MDC_E
CG_STAT_RHYMDC1.5130.1.184327Sinus
RhythmF OBX3NM150456MDC_PULS_OXIM_SAT_O
2MDC1.5238.1.15045699262688MDC_DIM_PERCENTMD
CF OBX4NM147842MDC_ECG_HEART_RATEMDC1.
5130.1.14784281264864MDC_DIM_BEAT_PER_MINMDC
F OBX5NM150037MDC_PRESS_BLD_ART_ABP_SYSMD
C1.5190.1.150036126266016MDC_DIM_MMHGMDC
F OBX6NM150038MDC_PRESS_BLD_ART_ABP_DIAMDC1
.5190.1.15003676266016MDC_DIM_MMHGMDCF
OBX7NM150039MDC_PRESS_BLD_ART_ABP_MEANMDC1.
5190.1.15003692266016MDC_DIM_MMHGMDCF
OBX8NM148065MDC_ECG_V_P_C_CNTMDC1.5130.1.14
80650264864MDC_DIM_BEAT_PER_MINMDCF
OBX9NM150045MDC_PRESS_BLD_ART_PULM_SYSMDC1.
5190.1.15004426266016MDC_DIM_MMHGMDCF
OBX10NM150046MDC_PRESS_BLD_ART_PULM_DIAMDC1
.5190.1.1500449266016MDC_DIM_MMHGMDCF
OBX11NM150047MDC_PRESS_BLD_ART_PULM_MEANMDC
1.5190.1.15004414266016MDC_DIM_MMHGMDCF
OBX12NM149538MDC_PLETH_PULS_RATEMDC1.5238.1
.14953855264864MDC_DIM_BEAT_PER_MINMDCF
OBX13NM150067MDC_PRESS_BLD_ATR_LEFT_MEANMDC
1.5190.1.1500644266016MDC_DIM_MMHGMDCF
OBX14NM150087MDC_PRESS_BLD_VEN_CENT_MEANMDC
1.5190.1.15008412266016MDC_DIM_MMHGMDCF
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IHE PCD Connectathon Systems
ADTA04 Feed
CT (Time)Feed
MWB
LiveDataOR Mgr
GECentricity Periop CIS
PhilipsCareVueCIS
DOC
Validated VS, Vent, Anesth Med Export, max
every 3 minutes
Validated Vitals export, Batch
Unvalidated VS, Vent, Anesth. Data export every 1
minute
Unvalidated VS, Vent, Anesth. Data export every 1
minute
Validated VS, Vent, Anesth Med Export, max
every 5 minutes
Unvalidated Med (Infusion System) exported every
1 minute
DraegerInnovian CIS
GEAware GW
PhilipsIIC GW
B. BraunDoseTrac GW
Welch AllynConnex CIS
PhilipsCareVue CIS
DOR
VS Mon
Pt Mon, Vent, Anesthesia
Pt Mon, Vent, Anesthesia
Pt Mon, Vent, Anesthesia
InfusionDevices
Pt Mon, Vent, Anesthesia
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Connectathon 2007 430 engineers, 80
organizations, 160 systems and applications
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HIMSS Showcase Scenario
Emergency Care
Perioperative Care
Intensive Care
Philips Intellivue Clinical Information Portfolio
LiveData OR-DashBoard
GE Centricity PeriopAnesthesia
Welch AllynConnexTM Data Management System
GE Aware Gateway
Philips Intellivue Information Center
Draeger Innovian Solution Suite
B. BraunDoseTracTM Infusion Management Software
Vital Signs Monitor
Patient Monitor, Ventilator
Patient Monitor, Ventilator
Patient Monitor, Anesthesia Sys
InfusionDevices
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Agenda

• Evolution of the IHE PCD
• Year 1 - Device Enterprise Communication Profile
• Year 2 Survey and Proposed Profile Development

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Device Enterprise Communication Profile Year 2
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Process for Year 2

• 2006 Survey
• Call for Short Proposals
• Vetting by Planning and Technical Committees
• Setting of Priorities

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IHE-PCD Survey Summer-Fall 2006

• Survey Managed by HIMSS Analytics
• Open Solicitation to HIMAA, ACCE, AdvaMed,
  Anesthesiologist Patient Safety Foundation, ECRI
• 171 Responses, (103 Users, 68 Vendors)

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Respondent Demographics171 Individual Responses
Hospital Based
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Vendor Position on IHE and Interoperability 68
Vendor Responses (Checking all that apply)
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Vendor Demographics Vendor Products68 Vendor
Responses
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Demographics User Organization Types77
Hospital Based Respondents
26 of the 103 Non-Vendor Respondents do not work
in hospitals
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Relationship of Clinical Engineering and IT at
Respondents Hospitals 77 Hospital Based
Respondents
26 of the 103 Non-Vendor Respondents do not work
in hospitals
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Importance of Interoperability to Hospital Based
Respondents
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Survey Question With respect to Medical
Devices, how important is it for the following
devices to become integrated under the IHE?
Percent of respondents that consider it important
Users
Vendors
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Survey Question Rate the importance to each
department below in terms of the benefit from
implementing IHE
Percent of respondents that consider it important
Users
Vendors
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Survey Question Which clinical applications
should IHE target?
Percent of respondents that consider it important
Users
Vendors
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Survey Question Which technological areas are
the most important for Patient Care Device
integration?
Users
Vendors
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• IHE Profile Proposal (Short)
• Proposed Profile Patient Identification
• Proposal Editor Ray Zambuto
• Date February 16, 2006
• Version 3
• Domain Patient Care Devices
• The Problem
• Manual entry of patient identification to
  Patient Care Devices is inefficient and subject
  to error. Patient Identification is perhaps the
  most essential component of any interoperability
  and communication process, particularly when PCD
  data is exported to the enterprise. It is the
  basis for communication and control of any
  medical device, data analysis, reporting and
  record keeping. Automation of the entry of
  patient identification to Patient Care Devices
  has the potential for reducing errors, and is an
  essential component of any effort to increase
  safety, device and drug effectiveness, and
  efficiency.
• Key Use Case
• 1) Setup of PCD. The caregiver connects the
  patient to a Patient Care Device. The patient is
  physically identified by some institutionally
  unique means of identification such as a wrist
  band barcode, RFID or other means which may or
  may not be solely considered as authoritative.
  The caregiver uses the information from the
  physical patient identification to obtain an
  authoritative electronic identifier which is
  associated with all data communicated from the
  PCD. The interaction may involve direct entry of
  the data to the device based on the physical
  identifier, a dialog between a PCD Manager and an
  authoritative source, and the use of more than
  one identifier. The end result is that data
  communicated from the PCD or PCD Manager contains
  an authoritative institutionally unique
  identifier.
• 2) Disconnect PCD. The caregiver removes the PCD
  causing the data from that device to no longer be
  communicated to the enterprise.
• Standards Systems
• This profile is intended for identification
  of patients by patient monitors, infusion pumps,
  ventilators, point of care glucometers etc..gt
• ISO/IEEE 11073, HL7, IHE-ITI Patient
  Administration, IHE-ITI PDQ
• Discussion
• Patient identification is a fundamental
  requirement for any electronic communication from
  or to a medical device. As such, the IHE with its
  broad scope, full range of stakeholders, and
  present or future involvement in the development
  of interoperability specifications for the vast
  number of types of medical devices and
  information technology is the ideal (and only)
  logical place for this universally needed
  specification.

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Short Proposals Submitted for 2007
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Short Proposals Vetting 2007 vs reconsideration
in 2008
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Short Proposals Setting Priorities Polling
Results of Planning Committee Three Proposals
for 2007
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2
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Based on resource limitations. Additional work
can be added if author/champion demonstrates
sufficient additional resources
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Summary

• From its inception in September 2005 the IHE PCD
  has grown to 100 members representing vendors,
  purchasers, providers, and regulatory agencies.
• The Device Enterprise Communication (DEC)
  Framework for Trial Implementation published in
  August 2006.
• 6 Vendors and 8 systems/applications tested at
  Connectathon 2007
• Process for developing Year 2 profiles is in
  progress.

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Your Participation in IHE PCD is Encouraged

• http//www.ihe.net/Technical_Framework/index.cfm
• PCD CoChairs
• Todd Cooper - t.cooper_at_ieee.org
• Jack Harrington - jack.harrington_at_philips.com
• Ray Zambuto - rzambuto_at_techmed.com
• Other Contacts
• Manny Furst - efurst_at_imp-tech.com
• Elliott Sloane - elliot.sloane_at_villanova.edu
  

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