Connected medical devices in the internet of things

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The next wave of the Internet will connect machines and devices together into functioning, intelligent systems. This "Internet of Things" (IoT) will change every industry, every job, and every home. How will it impact medicine? When? This webinar will reveal how the Internet of Things is changing medicine today by examining real applications of advanced networking technology. The applications include from 911 dispatch, EMS transport, imaging, surgery, ICU interoperability, patient safety, hospital integration, and treatment. We will discuss critical needs: finding the right data, delivering high-fidelity waveforms, integrating large hospital systems, ensuring EMR accuracy, and guarding sensitive information.

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<ul><li> 1. Connected Medical Devices in the Internet of Things Emergency Response, Patient Safety, Imaging, Surgery, Advanced TreatmentYour systems. Working as one.</li></ul><p> 2. Last Mile problems Example - Infusion technology: 1. Decision support? 2. Prevent contra-indicated infusion? 3. Artificial pancreas Capabilities? (closed loop) 4. Consolidate all data for adverse event analysis? 5. Check device status, software version? Recall? 6. Support Meaningful Use #3? 2014 Real-Time Innovations, Inc. 3. SpO2 must be interpreted appropriately. Erroneous data points could be flagged/rejected 1. BP cuff inflation status is not recorded in EHR 2. Waveforms not recordedNIBP-SpO2 Interaction 2014 Real-Time Innovations, Inc. 4. Problem Pulse-rate counting error due to atypical plethysmogram. Other monitor data could be used to detect and reject this error. Waveforms could be recorded to enable manufacturers to improve device algorithms.ECG dataECG dataPulse Ox dataEMR data 2014 Real-Time Result: False alarms, incorrect data in Innovations, Inc. record. permanent 5. What Can Change That? 2014 Real-Time Innovations, Inc. 6. The Internet of Things 2014 Real-Time Innovations, Inc. 7. 2014 Top Tech Trends 1) Internet of Things The IoT promises to be the most disruptive technological revolution since the advent of the World Wide Web. Projections indicate that up to 100 billion uniquely identifiable objects will be connected to the Internet by 2020, with enormous technical, socioeconomic, political, and even spiritual consequences. 2014 Real-Time Innovations, Inc. 8. What is the Internet of Things? Cisco Internet of Everything the latest wave of the Internet -- connecting physical objectsto provide better safety, comfort, and efficiency IBM Internet of Things a completely new world-wide web, one comprised of the messages that digitally empowered devices would send to one another. It is the same Internet, but not the same Web. GE Industrial Internet convergence of machine and intelligent datato create brilliant machines RTI Your Systems. Working as One. an entirely new utility. As profound as the cell network, GPS, or the Internet itself. The Internet of Things and the Intelligent Systems it enables will fundamentally change our world. 2014 Real-Time Innovations, Inc. 9. IoT Taxonomy Access Web Services and Business Apps Process Link sparse endpoints XMPP Process AccessBiz intelligence Centralized/ESB ~100ms MQ/AMQP CollectCollect ControlDevices and Intelligent Systems 2014 Real-Time Innovations, Inc.Collect data Hub &amp; spoke ~10ms MQTT/CoAP Control, distribute DataBus ~.01ms DDS 10. DDS: Distribute Device DataReal-Time Analytics &amp; ControlOperator HMISensorsActuatorsData Distribution Service (DDS) 2014 Real-Time Innovations, Inc.Cloud Integration 11. Core Nervous System for the IoT 2014 Real-Time Innovations, Inc. 12. Some Things that Things Can DoDDS IoT Applications &amp; Background 2014 Real-Time Innovations, Inc. 13. What Does DDS Middleware Do? Reliable Operation Deterministic Performance Systems of Systems Flexible Transports Crisp Interface Design Easy Tech Upgrades Multi-Channel Connections Open Architecture Wireless Links Legacy Integration Hardware in the Loop Scalability Database Integration High Throughput Reliable Uptime Industry Interoperation Small Device Connection Large Fan In/Out Real-Time and IT Integration 2014 Real-Time Innovations, Inc. 14. Reliable Operation The LPD-17 Ship-Wide Area Network (SWAN) runs machinery, damage control, steering, magnetic signature, mission control, navigation, communication DDS middleware supports redundant networks, data &amp; sensors without servers for non-stop reliability 2014 Real-Time Innovations, Inc. 15. Real-Time Delivery The Ship Self Defense System is the last line of defense SSDS coordinates highspeed radars, targets defensive missiles, and directs 1000+ rounds/sec at incoming cruise missiles SSDS is at sea now DDS delivers messages in real time 2014 Real-Time Innovations, Inc. 16. System-of-Systems Integration Raytheon uses RTI middleware to control the new Zumwalt DDG 1000 destroyer RTI DDS coordinates and manages complex, diverse onboard hardware and software systems RTI connects hundreds of computers, thousands of applications, and more than 10m publish-subscribe pairs RTI middleware extends real-time scalability 2014 Real-Time Innovations, Inc. 17. Industry Interoperability Next-generation of Aegis DDG 1000 SSDS LCS (both variants) LPD-17 Many more, US and allies Highly distributed systems include radar, weapons, displays, contr ols Standards-based, highperformance middleware breaks vendor lock-in, drives interoperability ,and futureproofs the architectural design 2014 Real-Time Innovations, Inc. 18. Legacy System Integration The VW Driver Assistance and Integrated Safety system combines radars, laser range finders, and video to assist safe operation It helps avoid obstacles, detect lane departures, track eye activity, and safely negotiate bends Advanced safety systems must connect to existing hardware. RTI DDS middleware bridges high speed networking to the CAN bus 2014 Real-Time Innovations, Inc. 19. Interoperable Distributed Testing A modern car contains 100+ CPUs Audi uses hardware-inthe-loop simulation to feed realistic data to components in a lab for testing DDS middleware enables a multi-vendor test environment that scales to work with hundreds of devices 2014 Real-Time Innovations, Inc. 20. Real-Time High Fidelity Recording Light and strong advanced composites make advanced aircraft quiet and efficient Lund Engineering uses RTI to integrate the composite inspection system Critically, all data must be saved for validation; RTIs database integration saves all data to permanent storage Replay also supported 2014 Real-Time Innovations, Inc. 21. Interoperability Standards RTI leads in defining a standard architectures for unmanned vehicles and avionics RTI chairs the architecture for UCS (ground stations) and is key at FACE (avionics) DDS-based designs match data models for component reuse. 2014 Real-Time Innovations, Inc. 22. 24x7 OperationRTI Connext DDS was selected for its extensive compliance with the Object Management Group (OMG) DDS standard; its high security rating; its wide support of tools and programming languages, and its reputation for performance, scalability, and 24/7 reliability. Sid Koslow, Chief Technology Officer, NAV CANADA.Air Traffic Control for Canada 2nd largest ANSP in the world 80 sites 2014 Real-Time Innovations, Inc. 23. Safety-Critical Software RTI Connext Micro Cert Stringent SWaP requirements Complete certification evidence Full interoperability with Connext product line DO-178C Level A UAS &amp; ATC integration Flight management systems IEC 60601 class 3 Medical devices 2014 Real-Time Innovations, Inc. 24. Scalable Networking Harmonic transmission and video switching equipment delivers worldwide video-ondemand RTI handles 1,000s of clients, 1,000,000s of messages DDS enables highperformance scalability and future extensibility 2014 Real-Time Innovations, Inc. 25. Harsh Environment Operations Joy Mining is the worlds largest mining equipment manufacturer DDS connects the controller, operator GUI, and historian Reliable, fast connectivity enables control, debugging, and system health monitoring for continuous mining 2014 Real-Time Innovations, Inc. 26. Real-Time &amp; IT Integration Siemens Wind Power fields farms of 500 turbines with 100m blades DDS enables fast control within turbines and distributed gust mitigation across the array RTI will also integrate with predictive maintenance and business diagnostics RTI melds real-time with IT 2014 Real-Time Innovations, Inc. 27. How Networked Things Are Changing MedicineReal applications in connected medical devices 2014 Real-Time Innovations, Inc. 28. What is Your Application? A. B. C. D. E.Patient monitoring; Hospital/EMS integration Imaging Surgical systems Other medical Im just curious or an RTI competitor 2014 Real-Time Innovations, Inc. 29. Fast Emergency Response Exelis (ITT) C4i provides command and control systems for military and civilian agencies (fire/police/emergency response) RTI Connext DDS connects GUIs to servers that route voice and video RTI met the critical needs: scalability, routing, recording 2014 Real-Time Innovations, Inc. 30. EMS Device Integration Platform The largest EMS equipment provider will use RTI for their entire product linefor the next 20 years Provides emergency response equipment to 60% of the worlds emergency vehicles DDS middleware provides easy connectivity, performa nce, reliability, medical certification option 2014 Real-Time Innovations, Inc. 31. EMS Cloud Integration Connecting devices with hospitals to provide better treatment while en-route4G/LTE 2014 Real-Time Innovations, Inc. 32. High Rate Distributed Control The Minimally Invasive Robotic Surgery (MIRS) system at DLR coordinates three robots to perform delicate heart surgery. The system closes a distributed loop between the robots and the remote surgeons control at 3kHz. RTI enables new medical techniques 2014 Real-Time Innovations, Inc. 33. Hospital Patient Safety Hospital error is the 6th leading cause of preventable death DocBox integrates devices to improve patient safety RTI Connext ties together devices, services, and displays in real timeRTI Connext DDS met all our needs whether were handling 12 patients, or 200. -- DocBox Founder, Tracy Rausch 2014 Real-Time Innovations, Inc. 34. Industry Interoperation The Integrated Clinical Environment (ICE) standard specifies interoperability for medical devices All ICU &amp; operating room devices from blood pressure cuffs to intravenous pumps to ventilators could be interconnected according to the ICE standard Complete logging Automatic error detection Better care The DDS standard and RTI middleware enables plug &amp; play interoperability across manufacturers ASTM F2761 2014 Real-Time Innovations, Inc. 35. 2014 Real-Time Innovations, Inc. 36. Data Distribution Service for ICE AppADTExternal InterfaceAppExternal InterfaceEMRAppDDS Global Data Space Data LoggerDeviceDeviceDeviceBenefits offered by DDS Discovery / Presence Data-Centric Information Model / Type Safety (agree to data structure in advance) (Distinct from underlying messaging) QoS Policy Compatibility Checking / Runtime Enforcement 2014 Real-Time Innovations, Inc. 37. DDS Global Data Space Device Identity UDI stringModel Name string DepictionIcon Numeric UDI stringMetric Id string ValuefloatDDS Global Data Space 2014 Real-Time Innovations, Inc.Shared Information Model Topic What data is exchanged? Key How are unique instances identified? Type What is the data structure? QoS Non-functional policies for data propagation (next slide) Data-Centric DDS standard for sharing data Supports any OS, languages, transports Enforces QoS policies 38. Quality of Service AppExample Deadline Policy Defines the maximum interval between samplesNumeric UDI stringMetric IdstringValue Match only when requested and offered policies are compatible Mis-matches reported at runtime Policy violations reported at runtimefloatDevice5 seconds Requested, 10 seconds Offered NO Match [data is too old] 5 seconds Requested, 2 seconds Offered Match [data is current] 2014 Real-Time Innovations, Inc. 39. ICE Platform Prototype uses this general approach OMG DDS + IEEE 11073 + ASTM F2761 IEEE 11073 ComponentsX73 DIM Data Objects X73 DIM Data Object Attribute GroupsOMG DDSDDS TopicDDS IDL SyntaxASTM F2761 Supervisor FunctionalityControllerData Logger X73 Nomenclature + Other(a lot of work remains)DDS IDL Nomenclature External Interface 2014 Real-Time Innovations, Inc. 40. Patient Safety App PackageCDS Algorithm #1Lab DataPatient HxSupervisory Services Patient Mgmt Device Mgmt Systems Health Interaction Checking LoggingData BusSPO2CO2Infusion Pump Measured Values 2014 Real-Time Innovations, Inc.Infusion Pump SettingsIV Pump Control 41. CIMIT ICE InterfaceCenter for Integration of Medicine and Innovative Technology (CIMIT) See MDPnP.org &amp; docboxinc.com 2013 Real-Time Innovations, Inc. 42. Infusion Safety (PCA) App 2013 Real-Time Innovations, Inc. 43. Hospital Integration 2014 Real-Time Innovations, Inc. 44. Clinical Decision Support Systems AdministrationHL7/EMR Gateway, Enterprise, 3rd Party Care AreaWorkstations, Storage, Historical RoomDevices 2014 Real-Time Innovations, Inc. 45. Data Centricity AdministrationHL7/EMR Gateway, Enterprise, 3rd Party Care AreaLocation: Room 247BWorkstations, Stor age, Historical Room 2014 Real-Time Innovations, Inc.Data: HomerSimpson 46. CDS System of Systems 2014 Real-Time Innovations, Inc. 47. Hospital Integration Hospital net challenge RTI DDS technology 1000s of patients, &gt;100k devices Wired/wireless/ISM Moving patients 100% uptime, security Real-time waveforms 2014 Real-Time Innovations, Inc. Data centric addressing Smart data filtering Routed deployment Optimized updates Automated test harness 48. Medical Imaging RTI powers MRI &amp; CT Imaging systems require massive data flows and fast performance Any one of many MRI receivers can saturate a 1Gbit network. CT machines require precise distributed control DDS controls and optimizes network use to handle megabytes of load without losing data RTI delivered great functionality at a low cost. Using RTI middleware saved us a lot of money, time, and effort compared to our previous in-house developed solution. -- Varian (Agilent) MRI 2014 Real-Time Innovations, Inc. 49. CT Data Challenges Coordination Generator Scanner Power Servo Burst image data acquisition Control &amp; monitoring Systems ready for scan Status during scan Operator interface Integration Many languages, OS, data models Data archiving 2014 Real-Time Innovations, Inc. 50. MRI Data Challenges Gradient coil coordination Excitation control Handle burst imaging data Receiver data throttling Coordinating multiple networks Patient positioning Image transfer 2014 Real-Time Innovations, Inc. 51. Advanced Proton Therapy Mevions ProtonBeam Radiation Therapy system zaps tumors with accelerated protons The treatment must be continuous for 3040 days; downtime endangers treatment successFirst patient treated Dec 2013, Siteman Cancer Center, St. Louis 2014 Real-Time Innovations, Inc. With DDS, Mevions PBRT delivers dependable treatment at low cost 52. Proton Beam Therapy Unlike Xrays, PBRT precisely delivers energy with little tissue exposure Controlling exposure requires positioning patient in 3D 2014 Real-Time Innovations, Inc. 53. PBRT Data Challenges Superconducting synchrocyclotron control Coordinate Imaging Patient positioning Treatment Machine control Hazard mitigation 2014 Real-Time Innovations, Inc. 54. How Can Things Do Those Things?Technology 2014...</p>