University of Central Florida

Interoperability Standards for Healthcare Simulators

Rachel Ellaway1, Brian Goldiez2

1Northern Ontario School of Medicine, 2University of Central Florida

MedBiquitous 2012

University of Central Florida

Conflict of interest

We have no involvement with industry that constitutes a conflict of interest to disclose with respect to this workshop

University of Central FloridaWhere is now?

University of Central Florida

Simulation-based Education (SBE)

Simulation – what you doSimulator – what you use:• Mannequins• Part task trainers• Haptics• Appendages (moulage)• Virtual worlds• Virtual patients• Simulated patients, HPs and others• Simulated environments

University of Central Florida

Healthcare Simulation Industry

• 200+ vendors– Systems– Components

• Mannequins• Part task trainers• Human appended devices (eg moulage)• Haptic devices• Virtual devices• Virtual environments• Supplies

University of Central Florida

Healthcare Simulator Users

• The military• Emergency services• Hospitals• Regional simulation centers• College programs• University programs• Medical schools• First aid training• Major investment and expansion

University of Central Florida

Issues

• Proliferation of simulation and simulators• Where does a device fit into education,

training and assessment?• How is usage maximized?• How are efficiency and utility maximized?• How do we rip, mix burn while allowing

providers to sustain and innovate

University of Central Florida

S&S Targets

• Scenarios and profiles• State data - vital signs, algorithms,

interactions, progress• Algorithms• Report data and inject into reporting stream• HW-HW, HW-SW, SW-SW • Vocabularies• Typologies• Operating systems and abstractions• Sensors, scutters and non-medical data

University of Central Florida

Approaching S&S

• What problems need to be addressed?• What systems are out there?• What systems are in the pipeline?• Who (if anyone) “owns the space”?• Where is there leverage?• Where are the communities?

– SSH– MedBiquitous– SISO

University of Central Florida

What Standards Already Exist?

• IEEE 1278 (Distributed Interactive Simulation - DIS) - Simulator Interoperability Standards Organization (SISO)

• IEEE 1516 (High Level Architecture - HLA) via SISO

• ANSI VP.10.1-2010 (aka MedBiquitous VP)• Health Level 7 (HL7) via ANSI & ISO• Picture ArChiving System (PACS)• Digital Imaging & COmmunication in Medicine

(DICOM)

University of Central Florida

ANSI VP.10.1-2010 MedBiquitous Virtual Patient

• XML-based• 4 components:

– Activity Model– Virtual Patient Data– Media Resources– Data Availability Model

• For system-system transport• Limited rendering into runtime – player

dependent• No state modeling or intra-system comms or

interop

University of Central Florida

IEEE 1278 Distributed Interoperable Simulation (DIS)

• Supports a variety of connection strategies– No middleware– Self-developed middleware– COTS middleware

• Arguably provides a relatively simple implementation for the medical and non-DoD communities– Consistent with portions of MedBiquitous

Virtual Patient• Nevertheless very DoD-focused• No XML – short live binary data exchanges

(1.5k max per message)

University of Central Florida

Medical Coding Systems

• International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM) 16,000 codes in Diagnosis & Procedures

• International Classification of Diseases, Clinical Modifications, 10th Revision (ICD-10-CM/PCS) 140,000 codes

• Systemized Nomenclature of Medicine, Clinical Terms (SNOMED-CT) 350,000+ terminologies

• Current Procedural Terminology (CPT) 7800 codes• Diagnostic Related Groups (DRG) 500

medical/surgical groups, 1,200 subclasses

University of Central FloridaWhere is next?

University of Central Florida

Open for business?

• Limited by simulator complexity and proprietary control– CAE-METI – systems closed– Gaumard – limited computer capabilities– Laerdal SimMan 3G API closest to open

access but limited functionality– Other providers closed systems and no

standards to work to– Options? DIY beyond most of us– … so we hack

University of Central Florida

DIS to SimMan 3G

• Virtual mannequin created with Laerdal simulator Software Development Kit (SDK)

• Send & receive healthcare PDUs (Protocol Data Unit):– Variable Parameter (VP) record (PCR

223)– Medical Attribute PDU (PCR 224)

• Ethernet network for messages (wifi used for laptop-mannequin – interface computer needs multiple NICs)

University of Central Florida

HSVO to SimMan 3G

• Laerdal SimMan SDK = .NET tech• Limitations to what it can do in a live situation• Laerdal: “If you want to transfer mannequin state,

why not simply use the existing functionality – save the session to a file, transfer the file to the Instructor Workstation for the next mannequin, and then start that mannequin from that file.”

• Multi-mannequin remote/distributed simulation activities

University of Central Florida

HSVO to SimMan 3G

• HSVO hub loads a VNC client for each mannequins’ Instructor Workstations and Patient Monitors on VNC

• Remote operators could reliably switch between mannequins, controlling them one at a time

• Remote students at sites can watch each others’ Patient Monitors

• State and management data transferred between remote mannequins

University of Central Florida

Conclusions

• Big money in simulation• Driven by large centres and vendors• Very limited capacity for interoperability• Nevertheless a growing interest and

opportunity• A number of standards for and adjacent to

simulation already in place• Core mainstream simulation interop still to be

resolved, claimed• Many labs, projects, researchers pushing

boundaries …

University of Central Florida

Simulation Interop Space

Vendors military/aerospace

Educational interop

Clinical systems

Administration and reportingEducational

researchers

University of Central Florida

Simulation Interop Space

Vendors

military/aerospaceEducational

interop

Clinical systems

Administration and reporting

Educational researchers

University of Central Florida

Where is next?

• Great potential but immature technology space• Agencies and societies (SSH, MedBiq, SISO)

identify and pursue low hanging fruit• Vendor leverage• Complexity but opportunity in bringing domains

into a common sim interop space• Sim<>other med-ed connectors • Explore what sim interop means• Explore what value sim interop brings

University of Central Florida

Contact and Acknowledgements

• rachel.ellaway@nosm.ca• bgoldiez@ist.ucf.edu

• Dr Ellaway’s work was funded in part by CANARIE Inc, Canada

• Dr Goldiez’ work was funded, in part, by the US Army Research Laboratory under W91CRB-10-C-0046 and PEO STRI SE CORE Contractors

University of Central Florida

Interoperability Standards for Healthcare Simulators

Rachel Ellaway1, Brian Goldiez2

1Northern Ontario School of Medicine, 2University of Central Florida

MedBiquitous 2012