Post on 15-Dec-2015
Future Trends in MonitoringFuture Trends in Monitoring
Keith J Ruskin, MD
Associate Professor of Anesthesiology
Yale University School of Medicine
Future Trends in MonitoringFuture Trends in Monitoring
Smaller Cheaper (hopefully) Well-connected New interpretation of existing information
The Problem:The Problem:
Lots of data Very little recorded or
interpreted Operating rooms isolated Patients on the go
Smaller, Cheaper, ConnectedSmaller, Cheaper, Connected
Wireless Ethernet Telemetry Data collection
G3 wireless data service Remote evaluation,
treatment
BluetoothBluetooth
Wireless connection between personal devices
Short-range Mobile telephone gets
numbers from PIM Wireless data collection
and display, telemetry
Wireless EthernetWireless Ethernet
2 to 11 megabits per second ECRI: No interference with equipment Faster connections on the way Uses: Data collection, telemetry, clinical data
Embedded InternetEmbedded Internet
Equipment can connect to the Internet Communicates with other devices, user,
manufacturer Quality assurance Technical support
The Connected MonitorThe Connected Monitor
Siemens UPTIME service Diagnostic information sent to repair center Technician can diagnose, fix problem
The Connected Record KeeperThe Connected Record Keeper
Vincenzo Lanza, MDOspedale Fatebenefratelli, Palermo, Sicily
Anesthesia record keeping software Designed to use Internet Multiple hospitals throughout Italy
Wireless Technology: The FutureWireless Technology: The Future
IBM Almaden “Digital Jewelry” Eyeglass-mounted camera Wireless connection Name, place recognition
Doctors Without WiresDoctors Without Wires
Medical devices share information Accurate drug administration
Improved communication between practitioners Medical Internet resources at point of care
The Future: Computing PowerThe Future: Computing Power
Data collection Data management Data interpretation
Subtle relationships Decision support systems
Data AcquisitionData Acquisition
Medical Information Bus (IEEE 1073) Standard for connecting up to 255 medical
devices Not all devices compatible Decreases errors in data capture
Automated Record Keeping: Automated Record Keeping: AdvantagesAdvantages
Automatically record information Improved accuracy and legibility More attention to important tasks?
Advantages (Continued)Advantages (Continued)
Information used for research, billing Provide evidence during legal disputes Quality Assurance
Scan records for critical incidents Anesthesia “black box?”
Record Keeping: Quality Record Keeping: Quality AssuranceAssurance
434 incidents found in 5,454 automated records 18 incidents (4.1%) reported voluntarily
Sanborn KV et al Anesthesiology 1996 Nov;85(5):977-987
Data Sharing: NowData Sharing: Now
Anesthesia Record Narcotic use Quality assurance
Operating room management Scheduling
Data Sharing: The FutureData Sharing: The Future
Medical record History, physical, laboratory data Physiologic data
Clinical information Policies and procedures, treatment protocols Communication
Clinical DatabasesClinical Databases
Data entered manually, acquired through ARK Benchmarking
Compare costs, sentinel events Knowledge discovery
Information buried in thousands of records
Decision Support SystemsDecision Support Systems
May improve patient care Recommended by IOM report Successful when integrated into workflow
Flowsheets Links to pertinent literature Corollary orders, treatment guidelines
Decision Support: Expert SystemsDecision Support: Expert Systems
Best when system broken down to simple variables
“If… then… else” rules Good for laboratory values, simple guidelines
Decision Support:Decision Support:Neural NetworksNeural Networks
Complex situations, multiple variables Emulate human neuronal connections Trained with sets of preexisting data Good for alarm analysis, physiologic monitoring
Intelligent AlarmsIntelligent Alarms
Proliferation of monitors and alarms Increasing levels of confusion Analysis of alarms to diagnosis breathing circuit More rapid diagnosis by anesthesia personnel
(Westenskow et al Anesthesiology 77:1074-1079)
Signal FusionSignal Fusion
Simultaneous acquisition from multiple sources Redundancy used to regenerate signals e.g., Heart rate from pulse oximeter, arterial line,
ECG Feldman JM et al. J Clin Monit 12:459