connected medical devices in the internet of things

Your systems. Working as one.

Connected Medical Devices in the Internet of Things

Emergency Response, Patient Safety, Imaging, Surgery, Advanced Treatment

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?

“Last Mile problems”

© 2014 Real-Time Innovations, Inc.

NIBP-SpO2 Interaction

SpO2 must be interpreted appropriately. Erroneous data points could be flagged/rejected1. BP cuff inflation status is not recorded in EHR2. Waveforms not recorded


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.

Result: False alarms, incorrect data in permanent record.

ECG data ECG data

Pulse Ox data

EMR data© 2014 Real-Time Innovations, Inc.


What Can Change That?


The Internet of Things

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.


IEEE

Gartner

http://www.computer.org/portal/web/computingnow/cocfp2


What is the Internet of Things?

• Cisco “Internet of Everything”– …the latest wave of the Internet -- connecting physical

objects…to 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 data…to 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.


IoT Taxonomy• Access

– Link sparse endpoints

– XMPP• Process

– Biz intelligence– Centralized/ESB– ~100ms– MQ/AMQP

• Collect– Collect data– Hub & spoke– ~10ms– MQTT/CoAP

• Control, distribute– DataBus– ~.01ms– DDS

Web Services and Business Apps

Process

Devices and Intelligent Systems

Control

Collect

Access

DDS: Distribute Device Data


Real-Time Analytics &

ControlOperator HMI

Sensors Actuators

Cloud Integration

Data Distribution Service (DDS)


Core Nervous System for the IoT

Some Things that Things Can Do

DDS IoT Applications & Background


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


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 & sensors without servers for non-stop reliability


Real-Time Delivery

• The Ship Self Defense System is the “last line of defense”

• SSDS coordinates high-speed radars, targets defensive missiles, and directs 1000+ rounds/sec at incoming cruise missiles

• SSDS is at sea now

• DDS delivers messages in real time



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


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, controls

• Standards-based, high-performance middleware breaks vendor lock-in, drives interoperability ,and future-proofs the architectural design

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


Interoperable Distributed Testing

• A modern car contains 100+ CPUs

• Audi uses hardware-in-the-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


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; RTI’s database integration saves all data to permanent storage

• Replay also supported



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.

24x7 Operation

RTI 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 Canada2nd largest ANSP in the world80 sites

Safety-Critical Software

• RTI Connext Micro Cert– Stringent SWaP

requirements– Complete certification

evidence– Full interoperability

with Connext product line

• DO-178C Level A– UAS & ATC integration– Flight management

systems• IEC 60601 class 3

– Medical devices© 2014 Real-Time Innovations, Inc.

Scalable Networking

• Harmonic transmission and video switching equipment delivers worldwide video-on-demand

• RTI handles 1,000s of clients, 1,000,000s of messages

• DDS enables high-performance scalability and future extensibility



Harsh Environment Operations• Joy Mining is the

world’s 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

Real-Time & 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


How Networked Things Are Changing Medicine

Real applications in connected medical devices



What is Your Application?

A. Patient monitoring; Hospital/EMS integrationB. ImagingC. Surgical systemsD. Other medicalE. I’m just curious or an RTI competitor

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


EMS Device Integration Platform

• The largest EMS equipment provider will use RTI for their entire product line…for the next 20 years

• Provides emergency response equipment to 60% of the world’s emergency vehicles

• DDS middleware provides easy connectivity, performance, reliability, medical certification option


EMS Cloud Integration


Connecting devices with hospitals to provide better treatment while en-route

4G/LTE

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 surgeon’s control at 3kHz.

• RTI enables new medical techniques


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 time


“RTI Connext DDS met all our needs – whether we’re handling 12 patients, or 200.”

-- DocBox Founder, Tracy Rausch

Industry Interoperation

• The Integrated Clinical Environment (ICE) standard specifies interoperability for medical devices

• All ICU & 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 & play interoperability across manufacturers


ASTM F2761


Data Distribution Service for ICE

DDS Global Data Space

App App App

Device Device Device

Data Logger

ExternalInterfaceADT

EMR ExternalInterface

Benefits 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



Shared Information ModelTopic – 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


Device IdentityUDI 🔑 stringModel Name string

Depiction Icon

NumericUDI 🔑 stringMetric Id🔑

string

Value float


Quality of Service

App

Device

Numeric

UDI 🔑 string

Metric Id🔑

string

Value float

Requested QoS

Offered QoS

• “Match” only when requested and offered policies are compatible

• Mis-matches reported at runtime• Policy violations reported at runtime

ExampleDeadline Policy – Defines the maximum interval between samples

5 seconds Requested, 10 seconds OfferedNO Match [data is too old]5 seconds Requested, 2 seconds OfferedMatch [data is current]


OMG DDS + IEEE 11073 + ASTM F2761

X73 DIMData Objects DDS Topic

IEEE 11073 Components OMG DDS

X73 DIMData Object

Attribute Groups

DDS IDL Syntax

X73 Nomenclature

+ Other

DDS IDL Nomenclature

ASTM F2761

Supervisor Functionality

Controller

Data Logger

External Interface

ICE Platform Prototype uses this general approach …

(a lot of work remains)

Patient Safety App Package


Data Bus

Supervisory Services

Patient MgmtDevice Mgmt

Systems HealthInteraction CheckingLogging

CDS Algorithm

#1

Lab Data

SPO2 CO2

PatientHx

Infusion Pump

Settings

IV Pump

Control

Infusion Pump

Measured

Values

CIMIT ICE Interface


Center for Integration of Medicine and Innovative Technology (CIMIT)See MDPnP.org & docboxinc.com

Infusion Safety (PCA) App



Hospital Integration

Clinical Decision Support Systems


Workstations, Storage, Historical

HL7/EMR Gateway, Enterprise, 3rd Party

Room

Devices

Care Area

Administration

Data Centricity


Workstations, Storage, Historical

HL7/EMR Gateway, Enterprise, 3rd Party

Room

Care Area

Administration

Location: Room 247B

Data: HomerSimpson

CDS System of Systems



Hospital Integration

• Hospital net challenge– 1000s of patients, >100k

devices– Wired/wireless/ISM– Moving patients– 100% uptime, security– Real-time waveforms

• RTI DDS technology– Data centric addressing– Smart data filtering– Routed deployment– Optimized updates– Automated test harness

Medical Imaging

• RTI powers MRI & 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


CT Data Challenges

• Coordination– Generator– Scanner– Power– Servo

• Burst image data acquisition

• Control & monitoring– Systems ready for scan– Status during scan

• Operator interface• Integration

– Many languages, OS, data models

– Data archiving


MRI Data Challenges

• Gradient coil coordination

• Excitation control• Handle burst

imaging data– Receiver data

throttling– Coordinating

multiple networks• Patient positioning• Image transfer

Advanced Proton Therapy

• Mevion’s Proton-Beam Radiation Therapy system zaps tumors with accelerated protons

• The treatment must be continuous for 30-40 days; downtime endangers treatment success

• With DDS, Mevion’s PBRT delivers dependable treatment at low cost


First patient treated Dec 2013, Siteman Cancer Center, St. Louis


Proton Beam Therapy

• Unlike Xrays, PBRT precisely delivers energy with little tissue exposure

• Controlling exposure requires positioning patient in 3D


PBRT Data Challenges

• Supercon-ducting synchro-cyclotron control

• Coordinate– Imaging– Patient

positioning– Treatment– Machine

control– Hazard

mitigation

How Can Things Do Those Things?

Technology


Evolution of Middleware


Point-to-Point Client/Server

BrokeredESB

Daemon

Publish/Subscribe

Pub/Sub Messaging

Data-CentricPublish/Subscribe (DCPS)

Data-Centric

DataBus

DDS: The Software DataBus

• Data centric– Like a database for moving

data• Decouples modules

– Like SOA• Plug and play flexibility

– Like a hardware bus• Peer-to-peer performance

– Like streaming protocols• Standards-based

interoperability– Like TCP/IP


Data-Centric Messaging Bus

Scalable, high performance, reliable infrastructure

DataBus™


Message Centric Approach

• Traditional middleware exchanges messages• Infrastructure is unaware of the content• Developers write applications that send messages

between participants

Popular standards: JMS API; AMQP wire spec

Data Centric Approach

• Data-centric middleware maintains state• Infrastructure manages the content• Developers write applications that read and update a virtual

global data space


PersistenceService

RecordingService

Source(Key) Power Phase

WPT1 37.4 122.0 -12.20

WPT2 10.7 74.0 -12.23

WPTN 50.2 150.07 -11.98

Popular standards: DDS API, wire spec

12,000

25,000

50,000

100,000

200,000

300,000

400,000

500,000peak

0

50

100

150

200

250

300

350

400

1 (1 per CPU and NIC)20 (1 per CPU and NIC)40 (1 per CPU, 2 per NIC)

Throughput (Messages per Seconds)

Ave

rage

Laten

cy (M

icroseco

nds)

Performance Under Load

• Reliable multicast• Fully meshed, reliable

Number of Subscribers

Orders of magnitude faster

than IT solutionsFastest DDS solution

Comprehensive results online at www.rti.com© 2014 Real-Time Innovations, Inc.

Reliable Multicast

1 ~1000 subscribers, < 15% throughput decrease

600,000

500,000

400,000

300,000

200,000

100,000

0

Message

s pe

r Secon

dPe

r Sub

scrib

er (2

00 Bytes)

0 200 400 600 800 1,000

Number of Subscribers

• Millions of data elements

• .5m updates/sec (batched)

• 10s µs latency• 1000s of

consumers


The DDS Standard

• Data Distribution Service from OMG• OMG: world’s largest systems

software standards org– 470+ members– UML, DDS, SysML, MoDAF, DoDAF,

more• DDS: open & cross-vendor

– Standard API enables choice of middleware

– Standard wire spec enables subsystem physical interoperability

– 11 implementations


Cross-vendor source portability

Cross-vendor interoperability

DDS-RTPS ProtocolReal-Time Publish-Subscribe

Distribution Fabric

DDS API


The DDS standard: a hotly contested market

OCI ETRI PrismTech IBM RTI TwinOaks

Community (aka Help)

©2014 Real-Time Innovations, Inc. Confidential

Downloads 2877 306% increase

Visitors 68567 452% increase

37636 412% increaseUnique

Forum Posts 950 426% increase

Grew just a bit in 2013…


About RTI

• Market Leader– Over 70% DDS mw market share1

– Largest embedded middleware vendor2

– 2013 Gartner Cool Vendor for technology and Open Community Source model

• Standards Leader– Active in 15 standards efforts– OMG Board of Directors– DDS authors, chair, wire spec, security, more

• Real-Time Pedigree– Founded by Stanford researchers– High-performance control, tools history

• Maturity Leader– ~700 designs; by far the most-used DDS– TRL 9

1Embedded Market Forecasters2VDC Analyst Report


Critical Infrastructure Trusts RTI

• World’s largest Wind Power company• World’s largest Underground Mining Equipment company• World’s largest Navy (all surface ships)• World’s largest Automotive company• World’s largest Emergency Medical System company• World’s largest Medical Imaging provider• World’s 2nd largest Patient Monitoring manufacturer• World’s 2nd largest Air Traffic control system• World’s largest Broadcast Video Equipment manufacturer• World’s largest Launch Control System• World’s largest Telescope (under construction)• World’s 5th-largest Oil & Gas company• World’s 6th-largest power plant (largest in US)• All of world’s top ten defense companies

Over $1 trillion relies on RTI


Before this Webinar, I Thought DDS

A. Is my dentist’s last nameB. Is a military technologyC. Is a research technology, not ready for prime

timeD. Enables the future of medicineE. Is spelled wrong


After this Webinar, I Think DDS

A. Is amazingly flexibleB. Is used on many real-world applicationsC. Is the main real-time protocol for the

Internet of ThingsD. Enables the future of medicineE. Is probably really expensive


Some Resources

• Papers, C+C, community: www.rti.com• Wired article: http://blogs.rti.com/2013/11/18/a-

day-in-your-life-with-the-internet-of-things/• EDN on patient safety:

http://electronicdesign.com/communications/internet-things-can-save-50000-lives-year

• PBRT system: http://www.barnesjewish.org/news/?id=5032&sid=2&nid=3068

• Video: http://goo.gl/WnO5LE

connected medical devices in the internet of things

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