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Enterprise Device Integration Strategy:- Enabling Adoption and Improving Outcomes
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Dharmendra Ghai (CPHIMS)Program Manager,
Hamad Medical Corporation(JCI), Doha, Qatar
dghai@hmc.org.qa
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Medical Devices Integrations ……………………Risks
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Medical Devices Integrations ……………………Risks
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Medical Devices Integrations ……………………Risks
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Medical Devices Integrations …………Landscape
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Medical Devices Integrations …………Landscape
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Medical Devices Landscape: Current and Future Adoption
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Medical Devices Integrations ……………………
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Medical Devices Integrations ……………………
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Medical Device Integration………Benefits• Medical device integration eliminates the redundancy and inefficiency of
entering the same data multiple times.
• Medical device integration increases patient care, safety, and workflow.
• Manual charting has long been a process that slows the efficiency of nurses and other clinicians– Allows the clinician to spend more time on direct patient care– Ensures that vital signs are charted accurately– Increases the adoption of the EMR and CPOE– Improves the timeliness of vital sign documentation and delivers near
real time data to the patient's record for improved decision making
• All of that adds up to healthier patients, staff, and better Outcomes
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Medical Device Integration………IHE• IHE Patient Care Device integration profiles include:
• [ACM] Alarm Communication Management.• [DEC] Device Enterprise.• [DEC-PIB] Patient Identity• [DEC-SPD] Subscribe to Patient Data.• [PIV] Point-of-care Infusion Verification • [RTM] Rosetta Terminology Mapping
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AlarmSource
AlarmAggregator
AlarmReceiver
AlarmCoordinator
AlarmDisseminator
AlarmCommunication
AlarmEndpoint
AlarmCommunicator
(AC)
AlarmManager
(AM)
AlarmReporter
(AR)
AlarmReporter
AlarmCache
Alarm Archiver(AA)
Communication detailed in this profile
Communication not detailed in this profile
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The intended use is to serve in communication of alarm information from patient care devices to an alarm manager system communicating with secondary means of notification to caregivers. Typical secondary notification means would be annunciators, pagers, and smart phones. *Note that in 2009 this profile is being extended to other alarms including from systems such as patient/asset tracking, bed management, etc
Case A1: Location SourcedCase A1: Location Sourced
Patient wants a pillowPatient pulls nurse callNurse call system lights the room’s dome light and light at central station. Nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm
[PCD-04] to Alarm Manager (AM) indicating nurse call alarm. The Alarm Manager (AM) logs receipt of the alarm. The Alarm Manager (AM) identifies
the appropriate nurse based upon configured nurse to patient assignments, identifies the appropriate Alarm Communicator (AC) actor and destination communication device based upon nurse to device configuration in Alarm Manager (AM), sends Disseminate Alarm [PCD-06] to nurse’s communication device. The Alarm Manager (AM) logs the dissemination to the Alarm Communicator (AC).
The nurse receives the alarm on their assigned device. The information minimally includes the patient location (room number). The nurse goes to the room, determines the needs of the patient, and provides the patient with a pillow. The nurse then resets the nurse call pull. The nurse call system turns off the room’s dome light and the light at the central station.
The nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm [PCD-04] to Alarm Manager (AM) indicating reset of the nurse call alarm. The Alarm Manager (AM) receives the alarm turns off any configured alarm escalation and logs the alarm.
Patient wants a pillowPatient pulls nurse callNurse call system lights the room’s dome light and light at central station. Nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm
[PCD-04] to Alarm Manager (AM) indicating nurse call alarm. The Alarm Manager (AM) logs receipt of the alarm. The Alarm Manager (AM) identifies
the appropriate nurse based upon configured nurse to patient assignments, identifies the appropriate Alarm Communicator (AC) actor and destination communication device based upon nurse to device configuration in Alarm Manager (AM), sends Disseminate Alarm [PCD-06] to nurse’s communication device. The Alarm Manager (AM) logs the dissemination to the Alarm Communicator (AC).
The nurse receives the alarm on their assigned device. The information minimally includes the patient location (room number). The nurse goes to the room, determines the needs of the patient, and provides the patient with a pillow. The nurse then resets the nurse call pull. The nurse call system turns off the room’s dome light and the light at the central station.
The nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm [PCD-04] to Alarm Manager (AM) indicating reset of the nurse call alarm. The Alarm Manager (AM) receives the alarm turns off any configured alarm escalation and logs the alarm.
AR -> AM
AM -> AC
AC -> Nurse
AR -> AM
AR
PCD-04 Report Alarm
AM
PCD-06 Disseminate Alarm
AC
PCD-05 Report Alarm Status
PCD-07 Report Dissemination Alarm Status
PCD-05 Report Alarm Status
Opt
Opt
Opt
Alarm Reporter-Nurse Call-Medical Devices -Physio Monitors -Pumps -Apnea-Bedboard System
Alarm Manager-”Smart” alarm systems-Alarm aggregators
Alarm Communicator-Vocera-Cisco Wireless IP Phone-Cell Phone-Pager
Patient Care DevicesHIMSS Interoperability Showcase 2009
GE GE CentricityCentricity®®
PeriopPeriop AnesAnes..
Enterprise
DOC DOC
Patient Patient
LiveDataLiveDataOR OR ––
DashBoardDashBoardTMTM
DOR = Device Observation Reporter / DOC = Device Observation Consumer
AR = Alarm Reporter / AM = Alarm Manager; IOC = Infusion Order Consumer / IOP = Infusion Order Programmer
PDQ/PAMServer
PhilipsPhilipsIntelliVueIntelliVue
ClinicalClinicalInfo PortfolioInfo Portfolio
DOC
Patient MonitorPatient Monitor
DOR, AR
DOC
DraegerDraegerInnovianInnovian®® WebWeb
CapsuleCapsule
GE GE CentricityCentricity®®
EnterpriseEnterprise
DOC
LiveDataLiveDataAlert ManagerAlert Manager
HospiraHospiraVeriScanVeriScan
DOCIOP
EpicEpicInPatientInPatient
EMREMR
DOC
EpicEpicInPatientInPatient
EMREMR
DOC
PhilipsPhilipsEmerginEmergin
AM
OR
TimeServerTime
Server
Step-DownICU
AM
Devices
CapsuleCapsuleDataCaptorDataCaptor
DOR,AR
Devices
CapsuleCapsuleDataCaptorDataCaptor
DOR,AR
PhilipsPhilipsIntelliVueIntelliVue
Info. CenterInfo. Center
AR DOR, AR
CernerCerner
CareMobileCareMobileTMTM
DOCIOP
EpicEpic
IOP
GEGECetricityCetricity®®EnterpriseEnterprise
IOP
AC
DOR
Hospital Bed
CernerCerner
CareAwareCareAwareTMTM
DOR
Hospital Bed
CernerCerner
CareAwareCareAwareTMTM
DOR,AR
InfusionDevices
IOC
B.
Bra
un
B.
Bra
un
Ho
spir
aH
osp
ira
Car
din
alC
ard
inal
DOR,AR
InfusionDevices
IOC
B.
Bra
un
B.
Bra
un
Ho
spir
aH
osp
ira
Car
din
alC
ard
inal
Patient Monitor,Ventilator
DOR
GEGEAwareAware
GatewayGateway
Patient Monitor,Ventilator
DOR
GEGEAwareAware
GatewayGateway
DOR,AR
InfusionDevices
IOC
B.
Bra
un
B.
Bra
un
Ho
spir
aH
osp
ira
Car
din
alC
ard
inal
DOR,AR
InfusionDevices
IOC
B.
Bra
un
B.
Bra
un
Ho
spir
aH
osp
ira
Car
din
alC
ard
inal
Patient Monitor,Anesthesia Sys
DOR, AR
DraegerDraegerInfinityInfinity
GatewayGateway
DOR,AR
InfusionDevices
B.
Bra
un
B.
Bra
un
Ho
spir
aH
osp
ira
Car
din
alC
ard
inal
DOR,AR
InfusionDevices
B.
Bra
un
B.
Bra
un
Ho
spir
aH
osp
ira
Car
din
alC
ard
inal
Patient Patient
PolycomPolycomWirelessWirelessPhonePhone
AlarmClient
CapsuleCapsule
What is a Client Device ?
• “An device, instrument, apparatus, implement, machine, contrivance, or other similar article that is intended for use in accessing, communicating and computing clinical information. Client devices are NOT directly capturing or processing patient physiological, medical, clinical information”• Computerize Carts• Patient Infotainment Systems • POC/ICU Monitors for PACS and EMRs• Clinical Assistants e.g ipad, iphones, tablets, blackberry• IP based nurse call system• Kiosks• Real Time Locating Systems
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Client Devices
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Medical Device Integration………Benefits• What is the correct number of end-user devices required to meet our
needs?• Where should we locate end-user devices?• What types of end-user devices are most appropriate?• What is the space and network infrastructure implications and what
upgrades are required to accommodate these new devices?• How much will it cost?• How do we promote end-user inclusion and buy-in to ensure a smooth
rollout?• What devices can be reused and which should be replaced?• What devices can be standardized?• What non-standard devices will be allowed and how?• How will we connect with the HIE?• How will the system connect with the clinical devices for data capture?
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Conclusion • Device Integration provides Patient safety and Improve Outcomes.
• Form Device Strategy Workgroup involving right stakeholders. • Prepare capital equipment plan with details involving equipment
condemnation. • Consider standardization promote IHE • Ensure devices (both medical devices and end user computing
devices) deployed are useable, safe, workflow enabling and sustainable to use integrated with the Clinical Information system for achieving greater adoption of CIS.
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Thank You
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