Aligning on SH Needs - Zaleski v0103
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Transcript of Aligning on SH Needs - Zaleski v0103
Aligning Stakeholder Patient Care Data Needs
JOHN ZALESKI , PH.D. , CPHIMS
CTO & VP OF CLINICAL APPLICATIONS
NUVON, INC.
1
Who are stakeholders & what are their needs?Clinicians: Need data for decision making, charting
◦ Anesthesiologists, surgeons, intensivists, pulmonologists, CRNAs, nurses, respiratory therapists, phlebotomists, etc.
IT Staff: support of Clinician, application needs◦ Software support, interoperability support, internal and external (vendor)
EMR implementation staff
Clinical Engineering: in support of biomedical devices implemented at point of care
◦ Management & Maintenance of h/w, devices that support patient care and the clinicians that employ them for patient care management
2
Summary of key stakeholder needsRich, timely data for patient care management
Temporally and semantically synchronized data to ensure accuracy for patient care management
Secure, ubiquitous access to ensure availability to data for patient care management
Clinically sensitive IT solutions that support data needs as well as support clinical workflow
3
Management of the Technologically-Dependent patient
4
Source: http://www.wltx.com/story/news/health/2014/02/11/1669870/
Management of the Technologically-Dependent patient
5
• Each Medical Device has its own autonomous and independent timing• Each Medical Device employs its own syntax and method of communication (many
proprietary)• Each medical device must be validated with end point receptor systems (e.g.: AIMS, CIS,
EMRs)
End-point receiving system
(EMR, Data Warehouse,
etc.)
The State of Medical Device Data
6
The Tower of Babel, as painted by Pieter Bruegel the Elder (c. 1563), according to the biblical account, as a metaphor for the challenges existing in medical device semantic interoperability today
Source: Wikipedia: The Tower of Babel. http://en.wikipedia.org/wiki/The_Tower_of_Babel_(Bruegel)
Wikipedia: Pieter Brugel – The Tower of Babel. http://en.wikipedia.org/wiki/File:Pieter_Bruegel_the_Elder_-_The_Tower_of_Babel_(detail)_-_WGA3410.jpg#filelinks
Medical Device Data Tower of BabelMedical device data are trapped in silos
◦ Unique protocols
◦ Unique physical connectivity
◦ Unique clock settings
◦ Unique output frequencies
◦ Unique terminology
Differences must be harmonized before data can be used
7
8
“Confusion about nomenclature leads to confusion about clinical application, which adversely affects patient care…on any given day you could walk into an intensive care unit anywhere in the world and observe a patient…panic stricken and struggling to breathe even though connected to a state-of-the-art intensive-care ventilator, because some clinician has failed to understand the capability of the machine and has an incomplete or inaccurate paradigm of ventilator mode functionality.”
Chatburn, RL. “Classification of Ventilator Modes: Update and Proposal for Implementation. Respiratory Care. March 2007. VOL 52 No 3.
Comparable function / Unique semantic reporting
9
OBX|1|NM|MINAWP^Minimum Airway Pressure^143-113||0|mbar
OBX|2|NM|AWP^Mean Airway Pressure^143-115||0|mbar
OBX|3|NM|PIP^Peak Airway Pressure^143-125||0|mbar
OBX|4|NM|SPO-RR^Spont Breathing Frequency^143-181||0|/min
OBX|5|NM|SPO-MV^Spont Minute Volume^143-122||0|ml
OBX|6|NM|MV^Minute Volume^143-184||0.01|L/min
OBX|7|NM|TRG-FR^Mandatory Trigger Frequency^143-208||0|/min
OBX|8|NM|RR^Respiratory Rate^143-214||0|/min
OBX|9|NM|O2-IN^Insp. O2^143-240||21|%
OBX|10|NM|SET-O2^Oxigen (in) set^143-257||21|%
OBX|11|NM|SET-PEEP^PEEP set^143-267||5|mbar
OBX|12|NM|SET-APN-T^Apnea Time^143-273||32|s
OBX|13|NM|SET-ASB^Assisted spon. Breath set^143-274||12|mbar
OBX|14|NM|SET-TACFR^Tachyapnea Frequency^143-278||100|/min
OBX|15|NM|SET-FLW-TRG^Flow Trigger set^143-297||2|L/min
OBX|16|NM|SET-RAMP^Assisted spon. Breath Slope time set^143-302||0.2|s
OBX|17|NM|SET-BCK-RR^Backup Frequency^143-322||12|/min
OBX|18|NM|SET-BCK-TV^Backup Tidal Volume^143-324||0.5|L
OBX|19|NM|SET-TUBE-COMP^Tube-Compensation^143-326||100|%
OBX|20|NM|SET-TUBE-DIAM^Tube-Diameter^143-327||8|mm
OBX|21|NM|SET-CPAP-ASB-T^Maximal Inspiratory Time for CPAP ASB^143-355||40|s
OBX|22|NM|SET-EOF-TRS^Threshold of end of flow cycled stroke^143-370||2.5|%
OBX|23|ST|DEV-MODEL^Device Model Text^143-513||EvitaXL
OBX|24|ST|DEV-CODE^Device Model Code^143-514||8260
OBX|25|ST|DEV-PROT^Device Protocol^143-515||MEDIBUS
OBX|26|ST|DEV-PROT-VER^Device Protocol Version^143-516||04.00
OBX|27|ST|DEV-VER^Device Software Version^143-518||07.00
OBX|28|ST|DEV-TXT-TS^Device Native Timestamp^143-519||10:2721-SEP-12
OBX|29|TS|DEV-TS^Device Timestamp^143-520||20120921102700
OBX|30|NM|IDM-SRC^Device connection port^143-521||6
OBX|31|ST|DEV-MODE^Device Mode^143-640||mode Adults\IV - Invasive Ventilation\Ventilator
STANDBY\Mode CPAP/ASB
OBX|1|ST|DEV-TIME^Ventilator time^199-5||10:32|
OBX|2|ST|DEV-ID^Ventilator ID^199-6|||
OBX|3|ST|DEV-DATE^Ventilator Date^199-8||SEP 21 2012|
OBX|4|TS|DEV-TS^Device Timestamp^199-107||20122109103200|
OBX|5|ST|VNT-MODE^Ventilator Mode^199-9||S/T|
OBX|6|NM|SET-RR^Respiratory rate^199-10||10|/min
OBX|7|NM|SET-TV^Tidal volume^199-11|||L
OBX|8|NM|SET-MFLW^Peak flow setting^199-12|||L/min
OBX|9|NM|SET-O2^O2% setting^199-13||21|%
OBX|10|NM|SET-PSENS^Pressure sensitivity^199-14|||cmH2O
OBX|11|NM|SET-PEEP^PEEP^199-15||6.0|cmH2O
OBX|12|NM|IN-HLD^Plateau^199-16|||cmH2O
OBX|13|NM|SET-APN-T^Apnea interval^199-21|||s
OBX|14|NM|SET-APN-TV^Apnea tidal volume^199-22|||cmH2O
OBX|15|NM|SET-APN-RR^Apnea respiratory rate^199-23|||/min
OBX|16|NM|SET-APN-FLW^Apnea peak flow^199-24|||L/min
OBX|17|NM|SET-APN-O2^Apnea O2%^199-25|||%
OBX|18|NM|SET-PPS^Pressure support^199-26||12|cmH2O
OBX|19|ST|SET-FLW-PTRN^Flow pattern^199-27|||
OBX|20|ST|O2-IN^O2 Supply^199-30|||
OBX|21|NM|VNT-RR^Total respiratory rate^199-34||10|/min
OBX|22|NM|TV^Exhaled tidal volume^199-35||0.23|L
OBX|23|NM|MV^Exhaled minute volume^199-36||2.30|L/min
OBX|24|NM|SPO-MV^Spontaneous minute volume^199-37|||L
OBX|25|NM|SET-MCP^Maximum circuit pressure^199-38||17.9|cmH2O
OBX|26|NM|AWP^Mean airway pressure^199-39|||cmH2O
OBX|27|NM|PIP^End inspiratory pressure^199-40|||cmH2O
OBX|28|NM|IE-E^1/E component of I:E ^199-41|||
OBX|29|NM|SET-HI-PIP^High circuit pressure limit^199-42||50|cmH2O
OBX|30|NM|SET-LO-TV^Low exhaled tidal volume limit^199-45||0.00|L
OBX|31|NM|SET-LO-MV^Low exhaled minute volume limit^199-46||0.0|L
OBX|32|NM|SET-HI-RR^High respiratory rate limit^199-47||44|/min
OBX|33|ST|ALR-HI-PIP^High circuit pressure alarm status^199-48||NORMAL|
OBX|34|ST|ALR-LO-TV^Low exhaled tidal volume alarm status^199-51||NORMAL| OBX|35|ST|ALR
LO-MV^Low exhaled minute volume alarm status^199-52||NORMAL| OBX|36|ST|ALR
respiratory rate alarm status^199-53||NORMAL|
OBX|37|ST|ALR-NO-O2^No O2 supply alarm status^199-54||NORMAL|
OBX|38|ST|ALR-NO-AIR^No air supply alarm status^199-55|||
OBX|39|ST|ALR-APN^Apnea alarm status^199-57|||
OBX|40|NM|SET-FLW-BASE^Ventilator-set base flow^199-70|||L/min
Require translation from proprietary to standardized format
10
01 55 35 36 0D 1B 52 36 44 0D 01 52 38 30 35 37 .U56..R6D..R8057
27 41 70 6F 6C 6C 6F 27 30 34 2E 33 30 3A 30 34 'Apollo'04.30:04
2E 30 33 30 30 0D 01 53 30 30 20 20 20 31 36 30 .0300..S00 160
30 30 2D 20 20 32 30 20 20 31 30 30 34 42 30 30 00- 20 1004B00
31 20 20 20 31 36 30 30 30 2D 20 32 30 30 20 20 1 16000- 200
32 30 30 46 41 30 30 35 20 20 20 31 36 30 30 30 200FA005 16000
20 20 20 20 30 20 20 31 31 30 34 34 43 30 36 20 0 11044C06
20 20 31 36 30 30 30 20 20 20 20 30 20 20 31 30 16000 0 10
30 33 45 38 30 37 20 20 20 31 36 30 30 30 20 20 03E807 16000
20 20 30 20 20 20 31 35 35 44 43 30 38 20 20 20 0 155DC08
31 36 30 30 30 20 20 20 20 30 20 20 20 31 34 35 16000 0 145
37 38 30 41 20 20 20 31 36 30 30 30 20 20 20 20 780A 16000
30 20 20 20 32 34 39 36 30 32 41 20 20 20 31 36 0 249602A 16
30 30 30 20 20 20 20 30 20 20 20 32 34 39 36 30 000 0 24960
30 46 20 20 20 31 36 30 30 30 20 20 20 20 30 20 0F 16000 0
20 20 31 31 34 34 43 32 46 20 20 20 31 36 30 30 1144C2F 1600
30 20 20 20 20 30 20 20 20 31 31 34 34 43 41 32 0 0 1144CA2
0D 01 24 30 36 32 33 2E 38 31 42 20 20 20 30 31 ..$0623.81B 01
43 20 20 20 30 31 44 20 20 20 30 31 45 20 20 20 C 01D 01E
30 31 46 20 20 32 35 35 38 20 32 2E 31 35 39 20 01F 2558 2.159
31 2E 39 35 41 20 32 2E 31 35 42 20 31 2E 39 36 1.95A 2.15B 1.96
34 20 20 33 38 36 42 20 39 38 32 37 33 20 20 38 4 386B 98273 8
20 37 34 20 32 35 20 37 38 20 20 30 20 37 44 20 74 25 78 0 7D
32 35 20 38 38 20 35 35 30 38 42 20 35 39 30 41 25 88 5508B 590A
43 20 31 2E 30 41 44 20 30 2E 39 42 30 20 32 2E C 1.0AD 0.9B0 2.
31 42 31 20 31 2E 39 42 32 20 20 31 37 42 34 31 1B1 1.9B2 17B41
32 20 20 42 39 20 36 2E 36 42 44 20 20 30 20 43 2 B9 6.6BD 0 C
34 20 20 20 36 44 35 31 32 20 20 44 37 31 32 20 4 6D512 D712
20 44 39 31 32 20 20 44 41 20 30 2E 31 44 42 20 D912 DA 0.1DB
34 2E 39 44 44 20 20 20 30 44 45 31 31 30 30 45 4.9DD 0DE1100E
32 31 38 30 30 45 33 20 34 2E 38 45 35 20 30 20 21800E3 4.8E5 0
20 45 36 33 36 20 20 45 39 20 32 2E 31 45 41 20 E636 E9 2.1EA
31 2E 39 45 46 20 36 30 20 46 30 20 36 36 20 46 1.9EF 60 F0 66 F
42 20 20 30 20 46 43 20 20 30 20 46 46 20 30 2E B 0 FC 0 FF 0.
31 34 46 0D 01 28 30 38 3A 34 30 3A 32 34 32 31 14F..(08:40:2421
2D 53 45 50 2D 31 32 44 37 0D 01 27 32 38 0D 01 -SEP-12D7..'28..
29 30 34 30 2E 36 30 30 30 35 20 20 31 2E 39 30 )040.60005 1.90
OBX|1|NM|HAL-CONS^Consumption Halothane^148-27||0|ml
OBX|2|NM|ENF-CONS^Consumption Enflurane^148-28||0|ml
OBX|3|NM|ISO-CONS^Consumption Isoflurane^148-29||0|ml
OBX|4|NM|DES-CONS^Consumption Desflurane^148-30||0|ml
OBX|5|NM|SEV-CONS^Consumption Sevoflurane^148-31||26|ml
OBX|6|NM|SEV-P-IN^Insp. Sevoflurane^148-88||2|kPa
OBX|7|NM|SEV-P-EX^Exp. Sevoflurane^148-89||1.8|kPa
OBX|8|NM|AGNT1-P-IN^Insp. Agent 1^148-90||2|kPa
OBX|9|NM|AGNT1-P-EX^Exp. Agent 1^148-91||1.8|kPa
OBX|10|NM|MAC-IN^Insp. MAC^148-172||0.9|kPa
OBX|11|NM|MAC-EC^Exp. MAC^148-173||0.9|kPa
OBX|12|NM|SEV-IN^Insp. Sevoflurane^148-176||2|%
OBX|13|NM|SEV-EX^Exp. Sevoflurane^148-177||1.9|%
OBX|14|NM|AGNT1-IN^Insp. Agent 1^148-233||2|%
OBX|15|NM|AGNT1-EX^Exp. Agent 1^148-234||1.9|%
OBX|16|NM|N20-IN^Insp. N20^148-251||0|%
OBX|17|NM|N20-EX^Exp. N20^148-252||0|%
OBX|18|NM|COMP^Compliance^148-6||23.8|mL/mbar
OBX|19|NM|BARO-MBAR^Ambient pressure^148-107||982|mbar
OBX|20|NM|AWP^Mean Breathing Pressure^148-115||8|mbar
OBX|21|NM|PPLAT^Plateau Pressure^148-116||24|mbar
OBX|22|NM|PEEP^PEEP Breathing Pressure^148-120||0|mbar
OBX|23|NM|PIP^Peak Breathing Pressure^148-125||25|mbar
OBX|24|NM|TV^Tidal Volume^148-136||549|ml
OBX|25|NM|TV-IN^Insp. Tidal Volume^148-139||584|ml
OBX|26|NM|P-RR^Respiratory Rate - pressure^148-180||1.2|/min
OBX|27|NM|MV^Minute Volume^148-185||6.6|L/min
OBX|28|NM|APN-T^Apnea Duration^148-189||0|s
OBX|29|NM|RR^Respiratory Rate (Volume/Flow)^148-215||12|/min
OBX|30|NM|D-RR^Respiratory Rate Derived^148-217||12|/min
OBX|31|NM|CO2-RR^Respiratory Rate CO2^148-213||12|/min
OBX|32|NM|CO2-IN^Insp. CO2^148-218||0.1|%
OBX|33|NM|CO2-EX^Exp. CO2^148-219||4.9|%
OBX|34|NM|CO2-P-IN^Insp. CO2^148-255||0.1|kPa
OBX|35|NM|CO2-P-EX^Exp. CO2^148-227||4.8|kPa
OBX|36|NM|CO2-PHG-IN^Insp. CO2^148-229||1|mm(Hg)
OBX|37|NM|CO2-PHG-EX^Exp. CO2^148-230||36|mm(Hg)
Not only data…but settings
11
OBX|1|NM|HAL-CONS^Consumption Halothane^148-27||0|ml
OBX|2|NM|ENF-CONS^Consumption Enflurane^148-28||0|ml
OBX|3|NM|ISO-CONS^Consumption Isoflurane^148-29||0|ml
OBX|4|NM|DES-CONS^Consumption Desflurane^148-30||0|ml
OBX|5|NM|SEV-CONS^Consumption Sevoflurane^148-31||26|ml
OBX|6|NM|SEV-P-IN^Insp. Sevoflurane^148-88||2|kPa
OBX|7|NM|SEV-P-EX^Exp. Sevoflurane^148-89||1.8|kPa
OBX|8|NM|AGNT1-P-IN^Insp. Agent 1^148-90||2|kPa
OBX|9|NM|AGNT1-P-EX^Exp. Agent 1^148-91||1.8|kPa
OBX|10|NM|MAC-IN^Insp. MAC^148-172||0.9|kPa
OBX|11|NM|MAC-EC^Exp. MAC^148-173||0.9|kPa
OBX|12|NM|SEV-IN^Insp. Sevoflurane^148-176||2|%
OBX|13|NM|SEV-EX^Exp. Sevoflurane^148-177||1.9|%
OBX|14|NM|AGNT1-IN^Insp. Agent 1^148-233||2|%
OBX|15|NM|AGNT1-EX^Exp. Agent 1^148-234||1.9|%
OBX|16|NM|N20-IN^Insp. N20^148-251||0|%
OBX|17|NM|N20-EX^Exp. N20^148-252||0|%
OBX|18|NM|COMP^Compliance^148-6||23.8|mL/mbar
OBX|19|NM|BARO-MBAR^Ambient pressure^148-107||982|mbar
OBX|20|NM|AWP^Mean Breathing Pressure^148-115||8|mbar
OBX|21|NM|PPLAT^Plateau Pressure^148-116||24|mbar
OBX|22|NM|PEEP^PEEP Breathing Pressure^148-120||0|mbar
OBX|23|NM|PIP^Peak Breathing Pressure^148-125||25|mbar
OBX|24|NM|TV^Tidal Volume^148-136||549|ml
OBX|25|NM|TV-IN^Insp. Tidal Volume^148-139||584|ml
OBX|26|NM|P-RR^Respiratory Rate - pressure^148-180||1.2|/min
OBX|27|NM|MV^Minute Volume^148-185||6.6|L/min
OBX|28|NM|APN-T^Apnea Duration^148-189||0|s
OBX|29|NM|RR^Respiratory Rate (Volume/Flow)^148-215||12|/min
OBX|30|NM|D-RR^Respiratory Rate Derived^148-217||12|/min
OBX|31|NM|CO2-RR^Respiratory Rate CO2^148-213||12|/min
OBX|32|NM|CO2-IN^Insp. CO2^148-218||0.1|%
OBX|33|NM|CO2-EX^Exp. CO2^148-219||4.9|%
OBX|34|NM|CO2-P-IN^Insp. CO2^148-255||0.1|kPa
OBX|35|NM|CO2-P-EX^Exp. CO2^148-227||4.8|kPa
OBX|36|NM|CO2-PHG-IN^Insp. CO2^148-229||1|mm(Hg)
OBX|37|NM|CO2-PHG-EX^Exp. CO2^148-230||36|mm(Hg)
OBX|1|NM|AWP^Mean Breathing Pressure^147-115||14|mbar
OBX|2|NM|PPLAT^Plateau Pressure^147-116||37|mbar
OBX|3|NM|PEEP^PEEP Breathing Pressure^147-120||5|mbar
OBX|4|NM|PIP^Peak Breathing Pressure^147-125||45|mbar
OBX|5|NM|TV^Tidal Volume^147-130||360|ml
OBX|6|NM|MV^Minute Volume^147-185||5.3|L/min
OBX|7|NM|RR^Respiratory Rate (Volume/Flow)^147-215||14|/min
OBX|8|NM|O2-IN^Insp. O2^147-240||67|%
OBX|9|NM|FGF-O2^O2 Flow^147-226||1.492|L/min
OBX|10|NM|FGF-N2O^N2O Flow^147-221||0|L/min
OBX|11|NM|FGF-AIR^Air Flow^147-222||1.045|L/min
OBX|12|NM|SET-TV^Insp. Tidalvolume set^147-260||730|ml
OBX|13|NM|SET-IEI^I:E I Part^147-263||1|
OBX|14|NM|SET-IEE^I:E E Part^147-264||2.5|
OBX|15|NM|SET-IPPV^Frequency set^147-266||14|/min
OBX|16|NM|SET-PEEP^Intermit. PEEP set^147-268||5|mbar
OBX|17|NM|SET-HI-AWP^Max. insp. Airway Pressure set^147-
OBX|18|NM|SET-INSP-PR^Insp. Pause/insp. Time set^147-295||10|%
OBX|19|ST|SET-IE^I:E Ratio set^147-688||1:2.5
OBX|20|ST|DEV-MODEL^Device Model Text^147-513||Fabius GS premium
OBX|21|ST|DEV-CODE^Device Model Code^147-514||8088
OBX|22|ST|DEV-PROT^Device Protocol^147-515||MEDIBUS
OBX|23|ST|DEV-PROT-VER^Device Protocol Version^147-16||04.00
OBX|24|ST|DEV-VER^Device Software Version^147-518||03.32
OBX|25|ST|DEV-TXT-TS^Device Native Timestamp^147-519|| 8:41:2121:SEP:12
OBX|26|TS|DEV-TS^Device Timestamp^147-520||20120921084121
OBX|27|NM|IDM-SRC^Device connection port^147-521||4
OBX|28|ST|DEV-MODE^Device Mode^147-640||Volume Mode
Volume Mode – Vent 1 Volume Mode – Vent 2
Translating the “Babel” can be arduous
12
HRSpO2NBPsNBPdNBPmARTsARTdARTmCOPVCetCO2…
HRSpO2fRMveTvefRePIPetCO2…
HR-ECG
NBPs
NBPd
NBPm
RR
MVe
TVe
Medical Device 1
Desired Unified Output
SpO2-1
SpO2-2
HR-SPO2
Medical Device 2
Task involves:• Mapping• Clinical Validation• Parameter de-
confliction• Iteration• Mode alignment• Re-training of
clinical staff to new workflows
…as well as synchronizing clocks
13
Device 1 Reporting Time
Device 2 Reporting Time
Device M Reporting Time
.
.
.
Common Reporting Timeline
tR
tR1
tR2
tMk
To properly support patient care management…Medical devices must…
◦ Support delivery of rich, timely data
◦ Provide temporally and semantically synchronized data
◦ Provide secure, ubiquitous access to data
◦ Feed IT systems & data warehouses using common clinical definitions that remove ambiguity from clinical interpretation
14
A key challenge in medical device interoperability remains achieving these features / functions SIMULTANEOUSLY for all
devices at point of care, anywhere in environment
In Support of Patient Care Management, Medical Devices Need to…
Support delivery of rich, timely data for patient care management…
Provide temporally and semantically synchronized data…
Provide secure, ubiquitous access to data…
Feed IT systems & data warehouses using common clinical definitions that remove ambiguity from clinical interpretation
15
A key challenge in medical device interoperability remains achieving these features / functions for all devices at the
point of care, anywhere in the environment