Integrating the Healthcare Enterprise (IHE) Patient Care Devices Domain (PCD) Alarm Communication Management (ACM) IHE PCD 2011 Fall Face-to-Face Kansas.

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)IHE PCD 2011 Fall Face-to-FaceIHE PCD 2011 Fall Face-to-Face

Kansas City, MOKansas City, MO

Monroe PattilloMonroe PattilloPhilips PCCI EPIS, Boca Raton, FL, USAPhilips PCCI EPIS, Boca Raton, FL, USA

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

[email protected]@philips.com

© 2011 ACCE, HIMSS, IHE© 2011 ACCE, HIMSS, IHE

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ACM Supplement UpdateACM Supplement Update

• ACM 2011 Supplement Trial ImplementationACM 2011 Supplement Trial Implementation

• Not in Final TextNot in Final Text

• Approved & included for this cycleApproved & included for this cycle– Deleted – AA actor, transactions PCD-08/PCD-11Deleted – AA actor, transactions PCD-08/PCD-11

– Deleted – SMTP as AM-AC protocol (only WCTP)Deleted – SMTP as AM-AC protocol (only WCTP)

– UpdatesUpdates• spelling/grammarspelling/grammar

• diagram titles/placementsdiagram titles/placements

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Updates in Queue for Next CycleUpdates in Queue for Next Cycle

• Add more details for...Add more details for...– AM–AC WCTP protocol specific messages AM–AC WCTP protocol specific messages

(unofficial separate doc for this cycle to assist (unofficial separate doc for this cycle to assist implementers & referees)implementers & referees)

• More clearly specify ITI-CT requirementMore clearly specify ITI-CT requirement

• More clearly specify use of WCMMore clearly specify use of WCM

• Japan may define national extensionsJapan may define national extensions

• Resolution of HL7 2.8 & pump WG conflictsResolution of HL7 2.8 & pump WG conflicts

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Hurdles for TF InclusionHurdles for TF Inclusion

• Considerable 2010 updates (vendor Considerable 2010 updates (vendor burden) plus addition of WCMburden) plus addition of WCM

• No Connectathon verificationNo Connectathon verification– Transaction – PCD-05Transaction – PCD-05

– Options - PCD-04 PRT, WCM & PCD-06 Options - PCD-04 PRT, WCM & PCD-06 WCMWCM

• Insufficient Connectathon verificationInsufficient Connectathon verification– Alarm Communicator (AC) actorAlarm Communicator (AC) actor

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Progress Towards TF InclusionProgress Towards TF Inclusion

• Goal of ACM inclusion in PCD TF at Goal of ACM inclusion in PCD TF at start of Cycle 7 (2012-2013)start of Cycle 7 (2012-2013)

• Dependent upon 2012 Connectathon Dependent upon 2012 Connectathon vendor involvement and resultsvendor involvement and results

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ACM 2011 Transactions and ProtocolsACM 2011 Transactions and Protocols

WCTPHL7 2.6Alarm

CommunicatorAC

AlarmCommunicator

AC

AlarmManager

AM

AlarmManager

AM

AlarmAlarmReporterReporter

ARAR

AlarmAlarmReporterReporter

ARAR

Report AlarmPCD-04 →

← PCD-05Report Alarm

Status

DisseminateAlarm

PCD-06 →

← PCD-07Report

DisseminationAlarm Status

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AC Connectathon VendorsAC Connectathon Vendors

• AC vendors signed up for 2012 AC vendors signed up for 2012 ConnectathonConnectathon– SiS – WCTP experience from last cycleSiS – WCTP experience from last cycle

– Nuvon – WCTP experience?Nuvon – WCTP experience?

– Vocera – WCTP experience?Vocera – WCTP experience?

• ACM WG to spend time supporting WCTP ACM WG to spend time supporting WCTP implementersimplementers

• Virtual Pre-Connectathon to reduce WCTP Virtual Pre-Connectathon to reduce WCTP learning efforts at Connectathonlearning efforts at Connectathon

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Japan - NA Connectathon DifferencesJapan - NA Connectathon Differences

• Event Trigger for PCD-04 and PCD-05Event Trigger for PCD-04 and PCD-05– NANA PCD-04 (R40), PCD-05 (R41, R42)PCD-04 (R40), PCD-05 (R41, R42)– JapanJapan PCD-04 (R01), PCD-05 (R01)PCD-04 (R01), PCD-05 (R01)

• HL7 Version, common to all profiles in PCD (DEC, ACM, etc.)HL7 Version, common to all profiles in PCD (DEC, ACM, etc.)– NA @ 2.6, to support segments/fields not yet in HL7 NA @ 2.6, to support segments/fields not yet in HL7

standardstandard• Put transducer body part location in OBX-20 Put transducer body part location in OBX-20

Observation SiteObservation Site• Use PRT as indicated destination option in PCD-04Use PRT as indicated destination option in PCD-04• Use PRT as indicated recipients and dissemination Use PRT as indicated recipients and dissemination

status in PCD-05status in PCD-05– Japan @ 2.5, it’s a national requirementJapan @ 2.5, it’s a national requirement

• These changes go well beyond typical national extensionThese changes go well beyond typical national extensionBasically using PCD-01 as a PCD-04 (DEC to communicate Basically using PCD-01 as a PCD-04 (DEC to communicate alarms)alarms)

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Resolution of HL7 2.8 & Pump WG ConflictsResolution of HL7 2.8 & Pump WG Conflicts

• Current ACM TI EventsCurrent ACM TI Events– PCD-04 Report Alarm ORU_R40PCD-04 Report Alarm ORU_R40– PCD-05 Report Alarm Status ORA_PCD-05 Report Alarm Status ORA_

• R41 guaranteed delivery (impractical)R41 guaranteed delivery (impractical)• R42 not guaranteed delivery (real world)R42 not guaranteed delivery (real world)

• HL7 2.8 BallotHL7 2.8 Ballot– Alarms - R40 & R41Alarms - R40 & R41– Pump events - R42Pump events - R42

• Proposed Resolution – CP ACM TIProposed Resolution – CP ACM TI– Drop current R41 as impracticalDrop current R41 as impractical– Change R42 text to indicate R41Change R42 text to indicate R41

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ACM WGACM WG

Co-ChairsCo-Chairs

Monroe PattilloMonroe [email protected]@philips.com

John RhoadsJohn Rhoads [email protected]@philips.com

Google Group (IHE-PCD-ACM)Google Group (IHE-PCD-ACM)

http://groups.google.com/group/ihe-pcd-acmhttp://groups.google.com/group/ihe-pcd-acm

Weekly WebExWeekly WebEx

Thursdays 4 PM ETThursdays 4 PM ET (see Manny’s WebEx schedule) (see Manny’s WebEx schedule)

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ACM - How it works in the real worldACM - How it works in the real world

1)1) AR (device direct or gateway concentrator) sends alarm AR (device direct or gateway concentrator) sends alarm to AM (PCD-04)to AM (PCD-04)

2)2) AM decides who to disseminate to (assignments and job AM decides who to disseminate to (assignments and job roles) on what devices (1 to many individual or to roles) on what devices (1 to many individual or to groups)groups)

3)3) AM sends potentially multiple messages (PCD-06) to AM sends potentially multiple messages (PCD-06) to multiple AC instances and recipients (people and multiple AC instances and recipients (people and devices)devices)

4)4) Each receiving AC sends to multiple devicesEach receiving AC sends to multiple devices5)5) Each AC gets status updates and replies from devices Each AC gets status updates and replies from devices

(wide range of response times – seconds to minutes)(wide range of response times – seconds to minutes)6)6) All the ACs send their updates and replies (PCD-07) to All the ACs send their updates and replies (PCD-07) to

the AMthe AM7)7) AM logs the updates and the replies from all ACs and AM logs the updates and the replies from all ACs and

handles escalation & potential cancel from ARhandles escalation & potential cancel from AR8)8) AM sends status updates, replies, and conclusions (PCD-AM sends status updates, replies, and conclusions (PCD-

05) back to AR05) back to AR

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AR to AC timing - How it works in the real worldAR to AC timing - How it works in the real world

An AR needs response to PCD-04 within a short period of An AR needs response to PCD-04 within a short period of time (<10 SEC) to know that PCD-04 was successfully time (<10 SEC) to know that PCD-04 was successfully handed off to AMhanded off to AM

The AM to AC timing varies widely based upon the type of The AM to AC timing varies widely based upon the type of AC end device communication technology – site local AC end device communication technology – site local paging transmitter or Wi-Fi (seconds to minute) paging transmitter or Wi-Fi (seconds to minute) versus public wireless service provider (seconds to versus public wireless service provider (seconds to minutes to days), and human device operator minutes to days), and human device operator responsiveness (seconds to minutes)responsiveness (seconds to minutes)

It is highly likely that the AM will escalate to alternate It is highly likely that the AM will escalate to alternate recipients within well less than a minute (disjoint of recipients within well less than a minute (disjoint of AC to device timing)AC to device timing)

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How ACM uses Participation (PRT) segmentHow ACM uses Participation (PRT) segment

In PCD-04 (AR to AM)In PCD-04 (AR to AM)One or more optional PRT segments are used to One or more optional PRT segments are used to indicate explicitly to AM the destination AC recipients indicate explicitly to AM the destination AC recipients (people or devices)(people or devices)Used when AR has responsibility to manage Used when AR has responsibility to manage notification recipients and not the AMnotification recipients and not the AMUsed primarily by nurse call systems, but also some Used primarily by nurse call systems, but also some patient monitoring systemspatient monitoring systems

In PCD-05 (AM to AR)In PCD-05 (AM to AR)One or more optional PRT segments are used to One or more optional PRT segments are used to identify to the AR the conclusion of the AM to AC identify to the AR the conclusion of the AM to AC interactions (default) or (optionally) the details of the interactions (default) or (optionally) the details of the recipient notifications (notification sent to who and/or recipient notifications (notification sent to who and/or what devices, did they get there, were they read, did what devices, did they get there, were they read, did the user reply)the user reply)

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For AC WCTP implementers – Do ImplementFor AC WCTP implementers – Do Implement

Asynchronous operating Enterprise Host message sent AM to AC Asynchronous operating Enterprise Host message sent AM to AC (PCD-06) using wctp-SubmitRequest(PCD-06) using wctp-SubmitRequest

PCD-06 AM to AC ACK is WCTP confirmation statusPCD-06 AM to AC ACK is WCTP confirmation status

Enterprise Polling and Post (web push) response for status Enterprise Polling and Post (web push) response for status updates AC to AM (PCD-07), including notifyWhenQueued, updates AC to AM (PCD-07), including notifyWhenQueued, notifyWhenDelivered, and notifyWhernReadnotifyWhenDelivered, and notifyWhernRead

Multiple Choice Response used by the AM actor vendor to Multiple Choice Response used by the AM actor vendor to constrain replies to vendor expected values for Accept and constrain replies to vendor expected values for Accept and RejectReject

When using Post (web push) response for status updates and When using Post (web push) response for status updates and replies the response destination URI is indicated in the replies the response destination URI is indicated in the wctp-SubmitRequest. Do not hard code or make this a wctp-SubmitRequest. Do not hard code or make this a configurable value as it should be capable of being dynamic configurable value as it should be capable of being dynamic based upon the submit request content.based upon the submit request content.

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For AC WCTP implementers – Don’t ImplementFor AC WCTP implementers – Don’t Implement

Transient ClientTransient ClientLookup Subscriber and ResponseLookup Subscriber and ResponseDevice Location and ResponseDevice Location and ResponseMulti-Message (wctp-SendMsgMulti)Multi-Message (wctp-SendMsgMulti)Message Response RedirectionMessage Response RedirectionDelivery AfterDelivery AfterDelivery BeforeDelivery Before