ice + dds + 11073 tracy rausch, cce cto and founder [email protected] 617.997.8375
TRANSCRIPT
Requirements from Providers• Complete and Accurate Data• Safe Systems• Secure Systems• Increased Efficiency
– Clinical Workflow– Device and Systems Maintenance
• Improved Quality• Flexible (Inpatient to Outpatient)• Able to deal with new and legacy equipment• Scalable• Facilitation of decision support and data visualization
“Achieving higher quality care at lower cost will require fundamental commitments to the
incentives, culture, and leadership that foster continuous "learning”, as the lessons from
research and each care experience are systematically captured, assessed, and
translated into reliable care.” -IOM 2013
Example Scenario 1:Patient Controlled Analgesia (PCA)• 2-3 Patients per day in the US die from opiate
overdose.• Very little understanding of the cause
• Patient presses button to receive intravenous pain medication• Patients can call to request more analgesia, but, cannot call
for help when over-medicated.• Over-medication can cause respiratory and cardiac arrest• Comprehensive monitoring is not typically used due to high
false/nuisance alarm rate• How can we improve safety of this system?
Smart PCA SystemPatient
Demographics and History
Medication HistoryDiagnosis
Co-morbidities Orders
Sensor Data
Enterprise
Point of Care
CDS Algorithm(s)
Observations
Lab Results
PCA Pump(Actuator)
Other Infusions
Other Devices
Safety Interlock
Clinician
Patient
Data-centric Approach
Device 1 Device 2 Device n
Medical App 1
Medical App 2
Medical App n
EMR/Other IS Systems
DDS RTPS Bus
What is DDS?• Mature International Standard from OMG
– Platform neutral: OS and programming languages– Deployed worldwide– ~18 Implementations
• Originally developed for the US Navy• Currently mandated
– UK Generic Vehicle Architecture– DoD Information Technology Standards and Profile Registry (DESI)
• Mandates DDS for Pub-Sub API• Mandates DDS-RTPS for Interop
– Army, OSD• Unmanned Vehicle Control• Future Airborne Capability
– US Navy Open Architecture• Mandates DDS for Pub-Sub
– Net-Centric Enterprise Solutions for Interoperability (SPAWAR NESI)• Mandates DDS for Pub-Sub SOA
DDS Deployed Applications
Machine Machine
App
App 3rd Party
App
CLOUD
Enterprise
Cloud• Security Services• Asset Services
Real-Time
Near Real-Time
• Heterogeneous• Device to device• SCADA• Multiple Protocols
Today: Batch/DB AnalyticsFuture: real-time analytics
Historian; store-and-forward
Alarms recognized here
Sing
le d
ata
bus
DocBox Proprietary 2012
DDS & Quality of Service (QoS)
• Aside from the actual data (WHAT) to be delivered users often need to specify (HOW) to send it…..– Reliably– How much data– How long before data is regarded as ‘stale’– How may publishers of the same data is allowed– How to ‘failover’ if an existing publisher stops sending data– How to detect “dead” applications
• Options are controlled by formally-defined QoS policies
DocBox Proprietary 2012
QoS
• QoS is determined per-entity• QoS Contract: Request-Offered• Publishing and subscribing applications can be
notified when QoS contract is violated• High availability via automatic failover
Features
• Ability Isolate subsystems• Built in discovery service• Mechanism to detect entities• Data Durability• Monitoring of Application Health• Monitors Health of data-objects– Deadlines and lifespans
• Ensures reliable data delivery• Built in QoS • Built in Security (2013)
DDS Entities
Domain: World you’re talking aboutTopic: Group of Similar Objects
Similar structures (“type”)Similar way they change over time (“Qos”)
Instance: Individual object
Datawriter: source of observations about a set of data-objectsDataReader: observer of a set of data-objects (Topic)
OMG DDS & IEEE 11073
X73 DIMData Objects DDS Topic
IEEE 11073 Components OMG DDS
X73 DIMData Object
Attribute Groups
DDS IDL Syntax
X73 Nomenclature
+ Other
DDS IDL Nomenclature
NumericSample Array RTPatient
Metric Observed Value - NumericContext Attribute Group (Static + Dynamic)
Physiological Parameters in 11073 + SNOMED CT
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
ASTM F2761 FunctionalitySupervisory Functions:• Patient Identity Management• Provider Identity Management• Systems Health Monitoring• Interaction Checking• Device Management• Hosting of CDS Apps• Hosting of CLC Apps• QoS MonitoringData Logging Forensic playback
PCA Example
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
ICU Bedside System of System
Data Bus
ICE Supervisory
ServicesPatient MgmtDevice Mgmt
Systems HealthInteraction CheckingLoggingCDS
Algorithm #1
Lab Data
SPO2 CO2Infusion Pump
Settings
IV Pump
Control
Infusion Pump
Measured
Values
CDS Algorithm
#2
CDS Algorithm
#n
Components for Interoperable System
• Define IDL Syntax– Starting with Medical Package– Starting with 11073 – IDL’s are extensible therefore backward compatible
• Define Standard Topics– Starting 11073 Data Objects
• Define Standard Semantics– Starting with 11073– Also utilize LOINc and SnoMedCT
Distributed System
• CDS Apps can be located physically anywhere as long as they publish and subscribe to the BUS and follow the rules.
• Supervisor Services can be located physically anywhere as long as they publish and subscribe to the BUS
• CDS Apps act as if they are “virtual medical systems”
What is needed to be defined
• Supervisory Services (ICE)• IDL • Quality of Service Profiles– These could be completely customized but initially
guidance profiles should be determined.• Security Profiles• Safety Nomenclature and Objects to be Developed• Data Fusion Alert Nomenclature• Quality of Service Nomenclature
Questions???
Funding Provided by USAMMRC Integrating Clinical Technology for Military Health (JPC-1 W81XWH-13-C-0107)NIH NIBIB U01 The Healthcare Intranet of the Future
ICE Supervisor
NetworkController
ICE Interface
DataLogger
ExternalInterface
Medical Device
ICE Interface
Other Equipment
Integrated Clinical Environment (ICE)
Functional Elements of the Integrated Clinical EnvironmentASTM standard F2761-2009Published January 2010 Clinician
Functional Elements of the Integrated Clinical Environment
Patient