Invitation to Send, Interface, and/or Receive DMC and LS

Databy

Manny Furst, Improvement Technologies and Monroe Pattillo, Managing Member, Practical Health Interoperability, LLC

PCD Planning Committee Co-Chair, Chair of the MEMDMC and MEMLS WGs

PCD Meeting June 23, 2015

You Have The Ability To Dramatically Improve Device Management

• More effective and efficient management of medical devices– Maintenance– Availability– Reliability

• Improved safety and better patient care• Accomplished with standards-based messages

developed by the IHE-PCD

Introductory Meetings• Introduction: What and Why Now; Available Support: today’s

meeting• Detailed Description: 3 Profiles: MEMDMC, MEMLS, ACM

– A profile is a tightly constrained message, removing all optionality/variability not needed for the purpose.

– MEMDMC: Medical Equipment Device Management Communication– MEMLS: Medical Equipment Device Location Services– ACM: Alert Communication Management

• NIST Resources: Test Tools and Rosetta Mapping: Available 24x7 at no charge

Introduction To Just A Few Folks• The Patient Care Device domain (PCD) of Integrating the Healthcare

Enterprise (IHE) is populated by an extremely competent, collaborative and cooperative group of developers and others who have developed a number of profiles supporting standards-based messaging for patient data.

• The Medical Equipment Management (MEM) initiative builds upon those HL7 v2 messages to provide interoperability to manage these systems.

• We cannot introduce all who contribute to PCD success, but will introduce those who will organize these webinars and help facilitate your implementation and assist you in participating in the Connectathon and Showcase demonstrations if you choose to do so.

Monroe Pattillo: Three Profiles• Monroe Pattillo leads development of three PCD

profiles: MEMDMC, MEMLS, ACM– Monroe is the managing member of Practical Health

Interoperability, LLC and is an independent consultant in healthcare systems integration. Monroe is a Planning Committee Co-Chair of the IHE Patient Care Device Domain, the Co-Lead of the Alert Communication Management working group, and lead of the Medical Equipment Management working groups for Device Management Communication and for Location Services.

John Garguilo: Test Tools and Rosetta Mapping

• John Garguillo leads test tool development at the National Institute of Standards and Technology (NIST)– Computer Scientist, Software and Systems Division,

Information Technology Laboratory• The Rosetta Terminology Mapping (RTM)Project led

by Paul Schluter (GE) provides a database assuring semantic interoperability. This database is hosted by NIST under John’s leadership.

Paul Sherman: Technical Program Manager of IHE-PCD

• Paul Sherman is Technical Program Manager for Integrating the Healthcare Enterprise, Patient Care Devices Domain (IHE-PCD). – Paul is president of Sherman Engineering, LLC, and He

retired as Senior Biomedical Engineer with the Dept of Veterans Affairs Center for Engineering and Occupational Health, where he served as the VA's senior in-house medical technology consultant. Paul is also a President of the American College of Clinical Engineering.

Manny Furst: Technical Project Manager, HIMSS Interoperability Showcases

• Manny Furst is responsible for the technical aspects of PCD demonstrations in HIMSS Showcases. – Until July, 2014 he was also Technical Project Manager

for the PCD domain responsible for PCD portions of the Connectathon and other domain responsibilities. Manny has managed clinical engineering departments and provided clinical engineering and environment of care consulting services.

– Manny is president, Improvement Technologies, LLC

Your Participation• You can make an important contribution to

– Patient safety and patient care– Clinical productivity, workflow and job satisfaction– Equipment availability and reliability– Technology management and productivity– Customer satisfaction with your devices and

systems

Imagine When• Devices report Condition and call for service

– Self-test passed/failed, battery charge level, battery or other component failure

• Devices report Status – In use/standby/paused and on/off

• Devices report Location – Location by itself or as part of device or patient data

These Profiles Have Been Demonstrated

• Location (RTLS) along with Patient Physiologic Data, Pump Data, Alerts

• Device Condition, Status reported to CMMS• Location along with Device Condition, Status• Alerts (alarms to a person, advisories for later

reference) along with Patient and Pump Data

Fast and Easy• Implement standards-based messaging• Use Gateways/Interface Systems to support

receiving and sending proprietary formatted data currently available from devices to avoid delay in implementation

• Use Gateways/Interface Systems already in place within hospitals as interfaces or aggregators

Standards-Based Messages• IHE Standards-Based messages make it

economically possible to send and receive data– Only one message profile is required to achieve

semantic interoperability for device data and only one for location

– Rosetta table provides unambiguous data– NIST test tools facilitate development– Connectathon provides supportive testing

Medical Equipment Management - Device Management Communication (MEMDMC)

Messages

MEMDMCDMIR

MEMDMCDMIC

Device Management Information

Observation, DMIO PCD-15

CMMS/CEMS

Information collected from sourcesEquipment identificationEquipment power source (mains, battery)Network connection transition (wired, wireless)Base configuration and network changesVersion data

Reporter Consumer

Battery status, charging status, self-test statusSelf-test, last attempted, last statusDuty cycle status, # uses, time in useCalibration status, needed, last completedUsability status, clean/in use/dirty

Benefits of MEMDMC Messages

MEMDMCDMIR

MEMDMCDMIC

DMIO PCD-15

CMMS/CEMS

Reporter Consumer

BenefitsAutomate maintenance management Device self-reports when repairs and other maintenance is required Self-test passed provides frequent assurance of safe and effective operation Device requests low level actions as well (please plug me in)Provide high level of patient safety Maintenance required linked to “in use” or “standby” requires immediate attentionMore information populated in CMMS for more complete recordMore specific report of failure modesEquipment identified prior to disappearance (battery, network)Potential for automatic work ticket generation in CMMS

Gateways as an interim solution• If a vendor engineered embedded solution is

not currently available then potentially a technically feasible solution can be achieved through the use of gateway systems (integration engines)

• The gateway can make use of its access to closed data plus open observations to achieve implementation of an open integration

Gateway Produced DMIO PCD-15 Messages

MEMDMCDMIR

ClosedData

Source

OpenData

Source

MEMDMCDMIC

DMIO PCD-15

CMMS/CEMSGatewayInterface System

Proprietary

Reporter Consumer

Gateway provides the ability to rapidly participate with whatever data is currently available

Device vendors gain rapid participationDevelopers gain feedback from users regarding real needsInterface vendors add to existing products in place and saleableCMMS vendors need implement only one message

Similarly, Direct or Gateway LS Messages

MEMLSLOR

Report Location Observation, PCD-16

RTLS System

BenefitsLocation data available wherever, whenever needed Maintenance is more efficientProvide even higher level of patient safety Maintenance required linked to “in use” or “standby” requires immediate attention

AND location is knownMore information populated in CMMS for more complete recordMore specific data for utilization, accessibility of available devicesEquipment identified when alarms are required

MEMLSLOC

CMMS/CEMS

ConsumerReporter

OpenData

Source

ClosedData

Source

GatewayInterface System

ACM Profile• Alert Communication Management (ACM)

– Alarms – human response required– Advisories – document for later review, action

• Alerts can be sent by – The device as is done with physiologic data– The gateway or the CMMS as defined by

developers and users

Alert Communication Management (ACM) Basic Elements

HL7 Messagesper ACM andWCM profiles

HL7 Messagesper ACM andWCM profiles

Parameters, waveforms, etc.as evidentiary data items

Parameters, waveforms, etc.as evidentiary data items

DeviceSpecificgraphics

DeviceSpecificgraphics

Alert InformationSource, Phase, State, Priority

PatientLocationInstanceAlert textCallback

TimestampEvidentiary data

Dissemination StatusInstance

Accepted by ACUndeliverable

DeliveredRead

AcceptedRejectedCancelled

Callback start/stop

AlertCommunicator

AC

AlertCommunicator

AC

AlertManager

AM

AlertManager

AM

AlertReporter

AR

AlertReporter

AR

Report AlertPCD-04 →

← PCD-05Report Alert

Status

Disseminate AlertPCD-06 →

← PCD-07DisseminateAlert Status

AlertSource

PCD History• The gateway approach was used in the early days of the PCD

domain to demonstrate communication of patient physiologic observations (DEC profile, PCD-01) not yet integrated into observation source systems

• This provided the DEC profile with the ability to demonstrate its usefulness without having to wait for native integration implementations to be developed

• In early commercial deployments this approach also provided vendors with time to engineer native support for the DEC profile into their product

History Repeats Itself• The gateway approach can once again be used to

implement technically feasible solutions to produce…– MEMDMC observation messages from open or

closed equipment observation sources– To improve DEC, ACM, and IPEC observations

through the inclusion of MEMLS observation data

Profiles and Actor Mutability• IHE profile observation message content are not

isolated islands of communication• Observations included in the messages of one

profile can be cached and included in the observation messages of another profile

• I.e., DMC, LS and ACM messages can be sent at the same time, from the same source as our clinical messages (DEC and other profiles)

Combining Approaches: CMMS + RTLS

RTLSEnhancedMessages

MEMDMCDMIR

ClosedData

Source

OpenData

Source

MEMDMCDMIC

DMIO PCD-15

CMMS/CEMSGateway

Proprietary

DEC DORIPEC DOR

PCD-01PCD-10

Reporter Consumer

BenefitsReduced CE work steps trying to find equipment needing serviceCMMS doesn’t have to integrate with RTLS systemGateway need only integrate with one RTLS integration interface MEMLSGateway and CMMS are abstracted from LS implementation technology

MEMLSLOR

PCD-16RTLS System

Why Participate?Join your peers in advancing interoperability

- In a safe, highly collaborative venue.

Focus on your core business - limit your interface design costs.

Simplify logistics for updates and recalls

http://www.iheusa.org/about-iheinternational-benefits.aspx

Available Resources• Monroe led weekly (mostly) MEM and ACM

WGs – Be Sure You Are In The Google Groups• A Sample of IHE Resources

– IHE: www.ihe.net– Test Tools (General):

http://www.ihe.net/Testing_Tools/ – IHE-PCD: www.ihe.net/pcd

For More Detail

PCD ftp Siteftp://ftp.ihe.net/Patient_Care_Devices/ PCD Testsftp://ftp.ihe.net/Patient_Care_Devices/ConnectathonsIncludingProcessAndTesting/YR9-2015Connectathon-NIST-And-Virtual/YR9-2015%20North%20American%20Connectathon%20Testing/

PCD Messages and Test Schedule

June – Sep: Review/add/update tests

Oct – Nov: Pre Connectathon

Late Jan: F2F Connectathon

The Financials

The PCD messages are open source and available on line

To Join IHE:More than 250 employees: $1,5004 to 250 employees: $500Less than 4 employees: $250

Connectathon Participation, Cleveland

Connectathon participation is voluntary; however it may be required to participate in a Showcase

SystemsFirst system - $8400; may include two peopleOther systems - $4300

People$300 each preregistered$550 late and on-site

Showcase Participation

http://www.interoperabilityshowcase.org/

Fees not yet available for 2016

HIMSS16

AAMI 2016

Discussion• Contact Information:

– Manny Furst efurst@imp-tech.com – O: (520) 721-2856, M: (520) 405-2140

– Monroe Pattillo monroe.pattillo@gmail.com – M: (954) 398-5534

– John Garguilo John.Garguilo@nist.gov – O: (301) 975-5248

– Paul Sherman paulrshermancce@gmail.com – O: (314) 752-3487, M: (314) 422-2688