Integrating the Healthcare Enterprise (IHE) Integrating the Healthcare Enterprise (IHE) Patient Care Devices Domain (PCD)Patient Care Devices Domain (PCD)

Alarm Communication Management (ACM)Alarm Communication Management (ACM)Requirements for AM – AC InteroperabilityRequirements for AM – AC Interoperability

Monroe PattilloMonroe PattilloPhilips Patient Monitoring Informatics (PMI)Philips Patient Monitoring Informatics (PMI)

Boca Raton, FL, USABoca Raton, FL, USA

IHE Patient Care Devices DomainIHE Patient Care Devices DomainACM Working GroupACM Working Group

monroe.pattillo@philips.commonroe.pattillo@philips.com

© 2009 ACCE, HIMSS, IHE© 2009 ACCE, HIMSS, IHE

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This presentation can be found at...This presentation can be found at...

ftp.ihe.net/ftp.ihe.net/Patient_Care_Devices/Patient_Care_Devices/

Presentations/Presentations/ACM/ACM/

2009-10-22 ACM AM-AC Requirements 01.ppt2009-10-22 ACM AM-AC Requirements 01.ppt

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OutlineOutline

• ACM AM – AC MessagesACM AM – AC Messages

• AM-AC Protocol RequirementsAM-AC Protocol Requirements

• What are some possibilities?What are some possibilities?

• What do we do next?What do we do next?

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AlarmCommunicator

AC

AlarmCommunicator

AC

AlarmManager

AM

AlarmManager

AM

AlarmReporter

AR

ACM AM – AC MessagesACM AM – AC Messages

AlarmArchiver

AA

Report AlarmPCD-04 →

← PCD-05Report Alarm

Status

DisseminateAlarm

PCD-06 →

← PCD-07Report

DisseminationAlarm Status

PCD-08 ↑SubscribeTo Alarm

PCD-04 ↓ReportAlarm

PCD-04, PCD-05, PCD-08all HL7 v2.6→v2.7

PCD-06, PCD-07Data items defined

Currently using SMTPas open standardsbased transport,but needs better

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PCD-04 MessagePCD-04 Message

An HL7 ORU^R01 message containing segments for...An HL7 ORU^R01 message containing segments for...

MSHMSH HeaderHeaderPIDPID Patient IdentificationPatient IdentificationPV1PV1 Location InformationLocation InformationOBROBR Unique Observation IdentificationUnique Observation IdentificationORCORC Optional Order InformationOptional Order InformationOBXOBX Observations, containingObservations, containing

Type, Units, Range, Text Type, Units, Range, Text description, description,

Priority (indication - low, med, high),Priority (indication - low, med, high), Type (physiological, technical, etc.),Type (physiological, technical, etc.), State (onset, continue, escalate, State (onset, continue, escalate,

end)end)NTENTE Notes and CommentsNotes and Comments

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PCD-06 AM to AC MessagePCD-06 AM to AC Message

AM to ACAM to ACPCD-06 – Disseminate AlarmPCD-06 – Disseminate AlarmSends the message to the AC’s device by way of ACSends the message to the AC’s device by way of AC

Identification of message recipientsIdentification of message recipientsMessage, containingMessage, containing

Location associated with alarmLocation associated with alarmPatient associated with alarmPatient associated with alarmMessage text (incl. physiological info.)Message text (incl. physiological info.)Identifier unique identifierIdentifier unique identifierCallback (telephony dial back)Callback (telephony dial back)Contextual Data Reference (URL)Contextual Data Reference (URL)CommentCommentEvidentiary DataEvidentiary Data

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PCD-07 AC to AM MessagePCD-07 AC to AM Message

AC to AMAC to AMPCD-07 – Report Dissemination Alarm StatusPCD-07 – Report Dissemination Alarm StatusSends message deliver status updates to the AMSends message deliver status updates to the AM

Accepted by AC (delivered to carrier)Accepted by AC (delivered to carrier)Undeliverable to endpointUndeliverable to endpointDelivered to endpointDelivered to endpointAccepted by endpointAccepted by endpointAccepted by endpoint as true positive (info)Accepted by endpoint as true positive (info)Accepted by endpoint as true positive however not Accepted by endpoint as true positive however not clinically relevant (operator note)clinically relevant (operator note)Accepted by endpoint as false positive (info)Accepted by endpoint as false positive (info)Rejected by endpointRejected by endpointCanceled by endpoint (escalation, not alarm)Canceled by endpoint (escalation, not alarm)

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AM-AC Protocol RequirementsAM-AC Protocol Requirements

Must be an existing protocolMust be an existing protocolIHE uses standards, it does not develop themIHE uses standards, it does not develop them

Must be an open protocolMust be an open protocolNot proprietaryNot proprietaryMust have unrestricted useMust have unrestricted use

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AM-AC Protocol RequirementsAM-AC Protocol Requirements

Preferences/FocusPreferences/FocusContemporary, Healthcare, Contemporary, Healthcare, People CommunicationsPeople Communications

XML based – extensibleXML based – extensibleHTTP transport – works with firewalls and NATsHTTP transport – works with firewalls and NATsMultiple Choice Response (MCR) – “soft keys”Multiple Choice Response (MCR) – “soft keys”Pushed, not polled status updates – quickerPushed, not polled status updates – quickerPresence/Status – for escalation responsivenessPresence/Status – for escalation responsiveness

Dynamic – online/offline, busy, BRB, away, DNDDynamic – online/offline, busy, BRB, away, DNDTLS capable – SSL securable, messages contain ePHITLS capable – SSL securable, messages contain ePHI

WCM Supportive – hyperlink or large evidentiary dataWCM Supportive – hyperlink or large evidentiary data

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AM-AC Protocol RequirementsAM-AC Protocol Requirements

ACM Specific Messaging ItemsACM Specific Messaging ItemsDevice is on network identified by ID/Number/NameDevice is on network identified by ID/Number/NameDelivery target is ultimately people, not systemsDelivery target is ultimately people, not systemsDissemination/Status unsolicited, not subscribedDissemination/Status unsolicited, not subscribedPCD-04 round trip event message identificationPCD-04 round trip event message identificationMany status potentials in status enumerationMany status potentials in status enumeration

delivery/not at multiple levels (carrier, delivery/not at multiple levels (carrier, device)device)

human interactionshuman interactionsread receiptread receiptmultiple response possibilitiesmultiple response possibilities

more than accept/reject or more than accept/reject or timeouttimeout

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ResourcesResources

This presentation can be found at...This presentation can be found at...

ftp.ihe.net/ftp.ihe.net/Patient_Care_Devices/Patient_Care_Devices/

Presentations/Presentations/ACM/ACM/

2009-10-22 ACM AM-AC Requirements 01.ppt2009-10-22 ACM AM-AC Requirements 01.ppt

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IHE PCD ContactsIHE PCD Contacts

PCD Co-ChairsPCD Co-Chairs Todd CooperTodd Cooper t.cooper@ieee.orgt.cooper@ieee.org Ken FuchsKen Fuchs ken.fuchs@draeger.com ken.fuchs@draeger.com

PCD SecretariatPCD Secretariat Manny FurstManny Furst efurst@imp-tech.com efurst@imp-tech.com

ACM WG Co-ChairsACM WG Co-Chairs Monroe PattilloMonroe Pattillo

monroe.pattillo@philips.commonroe.pattillo@philips.com John RhoadsJohn Rhoads john.rhoads@philips.comjohn.rhoads@philips.com

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Thank YouThank You