Integrating the Healthcare Integrating the Healthcare Enterprise and the Enterprise and the Patient Care Devices Domain Patient Care Devices Domain Ken Fuchs Draeger Medical Systems, Inc. (Andover, MA) IHE Patient Care Devices Domain Co- Chair [email protected]NESCE October 9, 2008
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Integrating the Healthcare Enterprise and the Patient Care Devices Domain Ken Fuchs Draeger Medical Systems, Inc. (Andover, MA) IHE Patient Care Devices.
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Integrating the Healthcare Enterprise Integrating the Healthcare Enterprise and the and the
Patient Care Devices DomainPatient Care Devices Domain
Ken FuchsDraeger Medical Systems, Inc. (Andover, MA)
The Goal - Interoperability:The Goal - Interoperability:
The ability of two or more systems or components to exchange and use the information exchanged– Accurately, securely, verifiably– When and where needed
Adapted from HL7, www.hl7.org
– With minimal or no effort, “Plug and Play”With minimal or no effort, “Plug and Play”
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What is IHE?
8
Integrating the Healthcare Enterprise International
The IHEThe IHE• An international umbrella organization sponsored
by RSNA, HIMSS and others…• Voluntary, non-profit, operating in public view
– Largely manufacturers, users, regulators
• An initiative by healthcare professionals and industry to improve the way computer systems share information. Systems developed in accordance with IHE Profiles communicate with one another better, are easier to implement, and enable care providers to use information more effectively.
9
What is IHE?
What does IHE Do?What does IHE Do?
• In a nutshell:– IHE identifies Real-World Interoperability problems– Brings people together to design, test and demonstrate
solutions using existing standards.
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IHE International
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What is the IHE?
Value PropositionsValue Propositions
• The IHE supports– Patient safety and reduced medical errors– Effective patient care with information when,
where needed– Efficient organizations, less tedious and
redundant work– Reduced cost
• Development is facilitated now, more in the future• Complexity of interface deployment, management• Regulatory compliance
– Best of breed for the organization– National mandate for electronic medical
records
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Standards: Necessary…Not Sufficient
• Generally Standards are:– Foundational - to interoperability and
communications– Broad - varying interpretations and
implementations– Narrow - may not consider relationships between
standards domains– Plentiful - often redundant or disjointed– Focused - standards implementation guides
typically focus on a single standard
IHE provides a defined process for IHE provides a defined process for implementingimplementing standards standards
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IHE: Connecting Standards to Care
• Coordinate implementation of standards to meet clinical and administrative needs– Clinicians and HIT professionals identify the key
interoperability problems they face– Providers and industry work together to develop
and make available standards-based solutions– Implementers are able to follow common
guidelines in purchasing and integrating effective systems
• IHE is not an SDOSDO, but does provide feedback
IHE: A forum for defining needs, implementing IHE: A forum for defining needs, implementing standards and processes for making it happenstandards and processes for making it happen
•Testing at “Connectathons” world-wideTesting at “Connectathons” world-wide• Demonstrations at major conferences world-wideDemonstrations at major conferences world-wide
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Two Foundational Domains
• IT Infrastructure Domain– Common foundational profiles
• Patient Care Coordination Domain– Coordination between specific domains
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What are Profiles?
• A profile describes the application of a standard(s) to provide specific requirements to accomplish the communication requirements.– Provides an opportunity for users & vendors to
define requirements• Requirements for development • With Conformance Statements, for purchase
• Examples– HL7/DICOM – IHE Radiology– HL7/IEEE 11073 – Patient Care Devices
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What is the Process?
• Define needs• Set priorities• Develop “profiles” with use cases• Recruit volunteers for each profile to be
developed• Develop the technical solutions• Demonstrate successful implementation
– Connectathons– Showcases
• Publish for public access, comment at various stages
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IHE – One Year Cycle
Q2 Q3 Q4 Q1Survey & Propose Use Cases (Profiles)
Develop Use Cases
Prioritize Use Cases
Document Technical Profiles
Develop Product SW
Bench Test Software
Connectathon(s)
Public Demonstration(s)
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What is PCD?
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PCD Domain Overview
IHE PCD CharterIHE PCD Charter
The Patient Care Devices Domain is concerned with Use Cases in which at least one actor is a regulated regulated patient care devicepatient care device. The PCD coordinates with other IHE clinical specialty based domains such as medical imaging and laboratory.
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PCD Domain Overview
• Established in 2005 when the “charter” was awarded to the ACCE
• Jointly sponsored by ACCE and HIMSS as of July 1, 2006
• Technical Framework 2006-7 developed to communicate patient data (asynchronous)
• Successful demonstration at the 2007 & 2008 Connectathons and HIMSS Interoperability Showcases
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PCD Participation in IHE
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PCD Domain Overview
IHE PCD MissionIHE PCD Mission
The IHE Patient Care Devices Domain will apply the proven, Use Case drivenUse Case driven IHE processes to:
– DeliverDeliver the technical frameworktechnical framework for the IHE-PCD domain profiles;
– ValidateValidate IHE-PCD profile implementations via ConnectathonsConnectathons; and
– Demonstrate Demonstrate marketable solutions at public trade public trade showsshows.
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PCD Domain Overview
• Heterogeneity – Coexistence in a multi-manufacturer / multi-modality world, leveraging shared infrastructure
• Semantic Interoperability – … from the sensor to the EHR
• Real-time Availability – Facilitating more timely clinical decisions
PCD Profile Value Objectives:PCD Profile Value Objectives:
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Emerging IHE-PCD Workflows
Key Objectives 2007/2008Key Objectives 2007/2008• Enterprise sharing of Patient Care Data• Patient Identity Binding to Device Data• Subscribe to Patient Data
Key Objectives 2008/2009Key Objectives 2008/2009• Rosetta Stone Terminology Project• PCD Alarm Communication Management• Infusion Pump Integration - Drug Administration
Key Objectives 2009 and beyondKey Objectives 2009 and beyond• Point of Care Plug and Play (multiyear effort)• Real-time data archiving and communication• Medical Device Management• Mobile, enterprise-wide, reliable vital signs monitoring• … many more!
Initial device classes…vital sign and patient monitors, infusion pumps, ventilators and anesthesia systems
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Process
ProcessProcess
• Survey• Brief Profile Proposals• “Vetting” by Planning and Technical Committees• Setting priorities• Development of Technical Framework Supplements• Design of new profiles• Virtual testing• Face-to-Face testing at Connectathon• Demonstration at HIMSS
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IHE-PCD Surveys 2005 and 2006
SurveysSurveys
• To set priorities, direction• Survey Managed by HIMSS Analytics• Open Solicitation to HIMSS, ACCE,
CVS_ECG_ST MDC_ECG_AMPL_ST ST generic label 768 ST ST
CVS_ECG_ST MDC_ECG_AMPL_ST_AVF ST lead aVF 832 STaVF ST-AVF ST-aVF
CVS_ECG_ST MDC_ECG_AMPL_ST_AVL ST lead aVL 831 STaVL ST-AVL ST-aVL
CVS_ECG_ST MDC_ECG_AMPL_ST_AVR ST lead aVR 830 STaVR ST-AVR ST-aVR
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PCD - New Profiles 08/09
ACM ProfileACM Profile
Alarm Communication ManagementAlarm Communication Management
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ACM Statement
Alarm Communication Management enables systems to deliver the right alarms, with the right priority, to the right individuals via devices with the right content, escalating to other individuals via devices (based on system configuration)
Alarm Communication Management enables systems to deliver the right alarms, with the right priority, to the right individuals via devices with the right content, escalating to other individuals via devices (based on system configuration)
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AlarmSource
AlarmAggregator
AlarmReceiver
AlarmCoordinator
AlarmDisseminator
AlarmCommunication
AlarmEndpoint
AlarmCommunication
(AC)
AlarmCommunication
(AC)
AlarmManagement
(AM)
AlarmManagement
(AM)
AlarmReporter
(AR)
AlarmReporter
(AR)
AlarmReporter
AlarmCache
Alarm
Query
(AQAQ)
Alarm
Query
(AQAQ)
Communication detailed in ACM profileCommunication detailed in ACM profile
Communication not detailed in ACM profileCommunication not detailed in ACM profile
Point-of-Care Infusion Verification supports the electronic transfer of infusion parameters from a Barcode Point of Care (BPOC) system, also known as a Bar Code Medication Administration (BCMA) system, to an infusion pump.
Point-of-Care Infusion Verification supports the electronic transfer of infusion parameters from a Barcode Point of Care (BPOC) system, also known as a Bar Code Medication Administration (BCMA) system, to an infusion pump.
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PIV Benefits
PIV will reduce errorsreduce errors by eliminating keystroke errors and by increasing the use of automatic dosage checking facilitated by onboard drug libraries. In addition to the reduction of medication administration errors, this integration may also increase caregiver productivityincrease caregiver productivity and provide more contextual information regarding infusion data.
PIV will reduce errorsreduce errors by eliminating keystroke errors and by increasing the use of automatic dosage checking facilitated by onboard drug libraries. In addition to the reduction of medication administration errors, this integration may also increase caregiver productivityincrease caregiver productivity and provide more contextual information regarding infusion data.
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PIV as part of overall workflow…
Nurse
Review
MAR Entry
Pharmacist reviews
order detail
(Pharmacy
System)
eMAR updated
Medication
DispensedNurse removes
Medication
from Dispensing
Unit or Med Room
Nurse Confirms 5
Rights:
Right Patient,
Medication,
Dose, Time, Route
AT THE BEDSIDE
Medication
Administered
Physician reviews
data and places
Orders
Nurse
Review
eMAR Entry
Pharmacist reviews
order detail
(Pharmacy
System)
eMAR updated
Medication
DispensedNurse removes
Medication
from Dispensing
Unit or Med Room
Nurse Confirms 5
Rights:
Right Patient,
Medication,
Dose, Time, Route
AT THE BEDSIDE
Medication
Administered
Physician reviews
data and places
Orders
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PIV Actors
Infusion OrderFiller(IOF)
Device
PCD-03: Communicate Infusion Order
BPOC or BCMA
Infusion OrderPlacer (IOP)
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PCD – “In the Works”
• For the coming year, PCD is currently in the process of evaluating a number of Brief Profile Proposals:– WCM – Waveform Comm. Management– DPI – Device Point-of-Care Integration– MEM – Medical Equipment Mgmnt– Extensions to
• DEC• ACM• PIV• etc.
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PCD - Showcase
HIMSS ShowcaseHIMSS Showcase
Where we get to show off !!Where we get to show off !!
• Visibility of products with care providers and peer technology organizations in Showcases
• Path to programs such as the U.S. National Health Information Network (NHIN)
PCD profiles will enable…PCD profiles will enable…
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Year 3 Implementation
Companies registered for the 2009 Companies registered for the 2009 Connectathon and HIMSS ShowcaseConnectathon and HIMSS Showcase
– B Braun, Cardinal, Hospira IV pumps with DEC, PIV
– Draeger, GE, Philips, Capsule - monitors, ventilators, anesthesia systems, with DEC
– Capsule, Cardinal, LiveData, Philips, Draeger - with ACM, DEC
• Above as of Oct. 1
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Why Should You Care?
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Why Should You Care?
Significance for Users/PurchasersSignificance for Users/Purchasers
• You Job (CE and IT)– CE and IT must collaborate on
selection, specification, installation, maintenance and support of these systems
– New knowledge and skills are required
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Why Should You Care?
Significance for Users/PurchasersSignificance for Users/Purchasers
• Clinical implications– Patient safety– Enterprise wide access to the patient’s data– Quality of care– Ability to implement “best of breed”– Workflow improvements
• In continuing discussions with vendors – at all levels– Push IHE, Interoperability
• Refer to lower deployment, maintenance costs– Encourage vendors’ active IHE participation
• Lower development, installation, support costs– Refer to profiles
• Leverage public and objective commitments
• In RFPs– Refer to profiles, Conformance Statements– Use Conformance Statements to “nail down” vendor’s
representations– Adopt very specific language
Raise the Bar!!Raise the Bar!!
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What Can You Do?
ParticipateParticipate
The Planning Committee (PC):• Set member based priorities• Conduct Surveys• Develop Use Cases• Manage Connectathon, Showcase
The Technical Committee (TC):• Determine technical feasibility• Research standards• Develop Technical Framework• Establish conformance tests
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What Can You Do?
To Help Define the FutureTo Help Define the Future• Become a member of a Domain’s Planning or
Technical Committees– Help establish priorities – what the domain will work on– Help define profiles – clinical, IT requirements– Provide the “business case” to encourage developments
• Provide Public Comments on Technical Framework Supplements
• Attend Demonstrations, Educational Events and Workshops
• Parisot, Charles. What IHE Delivers for Vendors, Purchasers, Users and Patients. IHE Interoperability Workshop Sept. 2004. http://www.ihe.net/Participation/upload/2_What%20IHE%20Delivers_final.ppt#319,1,Integrating the Healthcare Enterprise
• Gauvin, Alain. How to Purchase IHE Functionality. IHE Canada Workshop 2006. http://www.ihe-canada.com/Events/2006/06SepGauvin2.pdf
• Haramati, Nogah and Goodhew, Beth. Purchasing IHE Functionality. IHE Canada Workshop 2006. http://www.ihe-canada.com/Events/2006/06SepHaramati-Goodhew.pdf
• Bak, Peter. Achieving Interoperability Across Canada. IHE Workshop, June 2006. http://www.ihe.net/Events/upload/IHE%20Workshop%20June%202006%20Bak%20Infoway%20v2.ppt#724,1,Slide 1
• Braithwaite, William. IT at the Core of Healthcare Transformation. Proceedings, HIMSS 2007.