CMBES 2006: June 1-3, Vancouver, BC CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba Point of Care Engineering and Technology

Dept. of Electrical and Computer Dept. of Electrical and Computer Engineering, University of Engineering, University of ManitobaManitoba

CMBES 2006: June 1-3, CMBES 2006: June 1-3, Vancouver, BCVancouver, BCCMBEC-29CMBEC-29

Point of Care Engineering Point of Care Engineering and Technology and Technology — an overview— an overview

Blake W. PodaimaBlake W. Podaima1,2,31,2,3, Robert D. McLeod, Robert D. McLeod2,32,3

© B. W. Podaima, 2006© B. W. Podaima, 2006

Email: [email protected]; [email protected]

1.1. Virtuistix Inc., Winnipeg, ManitobaVirtuistix Inc., Winnipeg, Manitoba

2.2. TRTRLabsLabs: Telecommunications Research Laboratory, Winnipeg, Manitoba: Telecommunications Research Laboratory, Winnipeg, Manitoba

3.3. Department of Electrical and Computer Engineering, University of Department of Electrical and Computer Engineering, University of ManitobaManitoba

CMBEC-29CMBEC-29 Dept. of Electrical and Computer Dept. of Electrical and Computer Engineering, University of Engineering, University of ManitobaManitoba

CMBES 2006: June 1-3, CMBES 2006: June 1-3, Vancouver, BCVancouver, BC

MissionMission

• Heightened demand for improvements in Heightened demand for improvements in Patient Patient Safety and Quality of CareSafety and Quality of Care at patient at patient Point of Care Point of Care (POC).(POC).

• Errors and other adverse incidents are inevitable in Errors and other adverse incidents are inevitable in complex systems.complex systems.

• The goal of Virtuistix is in mitigating medical errors The goal of Virtuistix is in mitigating medical errors through the use of technology and protocols via through the use of technology and protocols via systems engineering. systems engineering.

• Specifically, Specifically, SmartSmart RFID Enabled Medical DevicesRFID Enabled Medical Devices..



To Err is HumanTo Err is Human

• Approximately 36% of adverse drug events occur at Approximately 36% of adverse drug events occur at the patient POC while only 2% are intercepted.the patient POC while only 2% are intercepted.

• Technology can be used in conjunction with Technology can be used in conjunction with human human factors engineeringfactors engineering to improve the accuracy and to improve the accuracy and efficiency of protocols and practice with the objective efficiency of protocols and practice with the objective

of reducing errors.of reducing errors.

• Systems engineeringSystems engineering implies the use of tools such as implies the use of tools such as Failure Mode and Effects Analysis and Root Cause Failure Mode and Effects Analysis and Root Cause Analysis (FMEA and RCA).Analysis (FMEA and RCA).



CoCossttss

• Estimated costs associated with adverse medical Estimated costs associated with adverse medical events have been estimated to be in the billions.events have been estimated to be in the billions.– Mortality + human suffering

– Litigation

– Extended stay

– Complications

– Adverse drug interactions

• Dissemination of Innovation: Costs of technology Dissemination of Innovation: Costs of technology adoption.adoption.– Can we afford not to?



InterventionIntervention

• Technologies play a major role in modernizing and Technologies play a major role in modernizing and improving medical and health systems. improving medical and health systems.

• Those being considered utilize information and Those being considered utilize information and communication technology in mobile deployment: communication technology in mobile deployment: – Hand held mobile devices (PDAs) with integrated RFID

readers; local wireless communication technologies, such as 802.11x; Wi-Fi Protected Access; ZigBee; Wireless USB; Infrared; integrated sensor based devices; Barcodes, and RFID tags.

• Back-end information systems are replacing much of Back-end information systems are replacing much of the paper storage and retrieval systems that still prevail the paper storage and retrieval systems that still prevail in health care today. in health care today.



ImplementationImplementation

• The greatest benefit of an The greatest benefit of an Electronic Records SystemElectronic Records System, , is that relevant patient information can be readily is that relevant patient information can be readily available to practitioners — whenever and wherever available to practitioners — whenever and wherever needed. (PDAs, wireless, ERS) needed. (PDAs, wireless, ERS)

• Sufficient security and standards will ensure reliable Sufficient security and standards will ensure reliable and secure management of sensitive medical records. and secure management of sensitive medical records. (encryption, authentication, privacy) (encryption, authentication, privacy)

• Security is a problem of perception — one that needs Security is a problem of perception — one that needs to be addressed thoroughly and implemented properly to be addressed thoroughly and implemented properly to be effective as to be effective as Clinical Grade NetworksClinical Grade Networks are are developed and deployed. (properly implemented developed and deployed. (properly implemented protocols)protocols)



RFID in HealthcareRFID in Healthcare

• Conventional RFID technology in healthcareConventional RFID technology in healthcare

– Primarily based upon identification. – Built around inventory tracking and control. – Extensions include pharmaceutical supply chain inventory and

tracking for medical reconciliation. – Tied into a hospital management system, they have considerable

potential to reduce adverse drug events at the patient POC. – This is accomplished through corroboration of the patient ID with

the drug prescribed by the physician

• ““Smart” RFID Enabled Devices are new technologies Smart” RFID Enabled Devices are new technologies that have the potential to improve patient safety and that have the potential to improve patient safety and quality of care.quality of care.



PlatformPlatform

Medical Compliance Platform — POC Interaction Components:Medical Compliance Platform — POC Interaction Components:

Pharmacy

HospitalInformation

System

Central MedicalProcessing

Unit

Disposal +Sterilization

RFIDReader

Patient

(RFID)

OverseeingPhysician

(RFID)

Smart Medical Device

MedicalContent/

Apparatus RFID +Interface

(RFID)

Care Provider

Mobile PDARFID

Reader

Central MedicalSupply Unit

RFID Reader

RFID Reader

Monitoring

Preparation



Smart RFID DevicesSmart RFID Devices

• What is Smart RFIDWhat is Smart RFID Deployment?Deployment?• A Smart RFID enabled device and its system of A Smart RFID enabled device and its system of

deployment include methods of deployment include methods of identificationidentification and and controlcontrol for medical compliance. for medical compliance. – Identification is accomplished with the aid of RFID. – Control is enabled through a mechanism that can be

activated to prevent improper, erroneous, or unauthorized access.

• Smart RFID enabled devices attempt to facilitate error-free Smart RFID enabled devices attempt to facilitate error-free dispensing and administration (of medication and/or dispensing and administration (of medication and/or medical supplies), and other clinical practices, to reduce or medical supplies), and other clinical practices, to reduce or prevent prevent adverse medical events, near misses, adverse medical events, near misses, oror sentinel sentinel eventsevents. .



RFID BasicsRFID Basics

Basic RFID Near-Field Coupling and Telemetry:Basic RFID Near-Field Coupling and Telemetry:

O s c i l l a t i n gM agn e tic f ie ld

C o ilN - tu rn s

Capacitor

O s c i l la ti n gM a g n e t i c F ie ld

C oilM -turns

Capacitor

ac

+

-IC

Data (e.g. ID)

T he im pedance seen b y th e read er is m odu la ted by the load .

This is not part icula rlyeasy to decod e.

25Kbps

F r e q . E x t r a c t i o n /3 2 (4 2 3 . 7 5 K H z )

1 3 . 5 6 M H z

Modulates(sub carrier)

M anches ter D ata, OO K/F SKM odu lation

BP F ilter

De-mod

13 .98 M H z

Data (e.g. ID) 25Kbps




• Incorporate an RFID enabled interface capable of Incorporate an RFID enabled interface capable of controlling access, (providing actuation, and sensor controlling access, (providing actuation, and sensor information collection): information collection): smart medical containers, smart medical containers, smart pumps, smart clamps, smart valves, smart smart pumps, smart clamps, smart valves, smart syringes and pipettes, syringes and pipettes, andand smart bandages. smart bandages.

• The RFID tags on these devices can be either passive The RFID tags on these devices can be either passive or active, and the control and communication can be or active, and the control and communication can be derived from the interaction of an RFID reader and tag derived from the interaction of an RFID reader and tag in conjunction with the associated electronics and in conjunction with the associated electronics and overseeing medical information management system. overseeing medical information management system.




Assorted Smart RFID Enabled Medical Devices:Assorted Smart RFID Enabled Medical Devices:

– Smart Clamps (mechanical and electromechanical)Smart Clamps (mechanical and electromechanical)

– Smart Valves (mechanical and electromechanical)Smart Valves (mechanical and electromechanical)

– Smart Syringes (mechanical and electromechanical)Smart Syringes (mechanical and electromechanical)



Smart ClampSmart Clamp

Smart Rotational Clamp (in-line or clam shell type — electromechanical instance):Smart Rotational Clamp (in-line or clam shell type — electromechanical instance):

Tubing

RFID EnabledLock/Unlock Mechanism and/or

[Pinched Off]

RFID

Gear

Drive Gear Motor

Motor Control

Position Sensor

OverrideKey

Visual/AudioIndicator

Power Supply

Internal Clock-wise(Restriction)



Smart ClampSmart Clamp

Smart Roller-Actuator Clamp (electromechanical instance):

Lock/Unlock Mechanismand/or Position Sensor

Cap

Visual/AudioIndicator

RFID

Top View

Tubing

TubingUn restric ted F lo w

TubingRestricted Flow

Override Key

Override Keyhole (slot)

LinearActuator

Power Supply Roller Pincer

LinearActuator-Motor/Servo



Smart ValveSmart Valve

Smart Stop-cock [3-port] Valve (electromechanical instance):Smart Stop-cock [3-port] Valve (electromechanical instance):

Conduit

RFIDElectronics

ElectromechanicalCylinder Valve

PowerSupply

Valve shown witht h ro u g h w ay o p en

OverrideKey

Port 1

Port 2Port 3

Port 1

Port 3Port 2 (into the page) not shown

TopView

Lock/UnlockMechanism

[Rotary]




Smart Stop-cock [3-port, 4-way] Valve Flow Channels:Smart Stop-cock [3-port, 4-way] Valve Flow Channels:

C on d u it

F l ow

C on d u it

F lo w

C o n du it

F lo w

C on d u it

F lo w

Note: Can stop flow entirely by offsetting the Stop-cock to 45 degrees.




Smart Butterfly Valve (mechanical and electromechanical instance):Smart Butterfly Valve (mechanical and electromechanical instance):

Flow

RFID Status Indicator

Butterfly

Flow

RFID Status

Butterfly

Override Key

Electric Motor

Power SupplyElectronics and

Mechanical (Split View) Electromechanical (Split View)

Butterfly ValveClosed

Butterfly ValveOpen

Butterfly ValvePartially Closed

Lock/UnlockMechanism

OptionalLock/UnlockMechanism

Butterfly Valve Cut away View



Smart SyringeSmart Syringe

Smart Syringe (Smart Syringe (Fail-safe Fail-safe Control Mechanism at Finger-Flange): Control Mechanism at Finger-Flange):

Typical Syringe

RFID

Lock/Latch Mechanism (Grip/Release)

RFID

Latch/Lock

e.g. Friction Grip

Finger Flange

RFID

Latch/Lock

e.g. Keyed Stop

KeyedPlungerShaft




Smart Syringe (Smart Syringe (Fail-safe or Operator Responsible Fail-safe or Operator Responsible Rotation and Push-pull Latch Rotation and Push-pull Latch Mechanism):Mechanism):

Typical Syringe

RFID

Go/No-Go Indicator (Color Code)Push/Pull or Rotate to unlock

Cross SectionPlunger Shaft

(Lock/Latch)

RFID

e.g. Push to unlock

PlungerShaft

e.g. Rotate to Unlock




Smart Syringe Smart Syringe (Possible Position [Resolver] Sensors):(Possible Position [Resolver] Sensors):

Resistance Measurement

Shaft Encoded Wheel (Friction)

Magnetic Strip

Reader

Encoded Grating

Optical Read/Write




Smart Syringe Smart Syringe (Fail-safe (Fail-safe Intersticed control device):Intersticed control device):

Typical Syringe

Typical Syringe

RFID

RFID controlled valve

Standard Coupler




Smart Syringe (Smart Syringe (Fail-safe Fail-safe Motorized Control and Actuator Device):Motorized Control and Actuator Device):

Typical Syringe

Typical Syringe

Section Plunger Shaft

RFID

MotorizedPlunger

RFID controlled Actuator

Motor

Motor

Linear Actuation

e.g.



SummarySummary

• POC engineering and technology are brought to bear on the POC engineering and technology are brought to bear on the medical community with the overall goal of improving patient medical community with the overall goal of improving patient safety and quality of care. safety and quality of care.

• We ascertain the emerging field of RFID technology has the We ascertain the emerging field of RFID technology has the potential to improve medical compliance via human factors potential to improve medical compliance via human factors protocols and practice at the patient POC. protocols and practice at the patient POC.

• Within a ubiquitous or pervasive health computing Within a ubiquitous or pervasive health computing environment, novel Smart RFID medical devices, in environment, novel Smart RFID medical devices, in conjunction with wireless PDAs, are proposed to integrate conjunction with wireless PDAs, are proposed to integrate identification, security, control, and actuation. identification, security, control, and actuation.

• Various POC embodiments along these lines are currently Various POC embodiments along these lines are currently under IP development and technology capture.under IP development and technology capture.

Documents

CMBES 2006: June 1-3, Vancouver, BC CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba Point of Care Engineering and Technology