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-INÎnsp. O2^143-240||21|%

OBX|10|NM|SET-O2Ôxigen (in) set^143-257||21|%

OBX|11|NM|SET-PEEP^PEEP set^143-267||5|mbar

OBX|12|NM|SET-APN-TÂpnea Time^143-273||32|s

OBX|13|NM|SET-ASBÂssisted 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-RAMPÂssisted 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-O2Ô2% 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-TÂpnea interval^199-21|||s

OBX|14|NM|SET-APN-TVÂpnea tidal volume^199-22|||cmH2O

OBX|15|NM|SET-APN-RRÂpnea respiratory rate^199-23|||/min

OBX|16|NM|SET-APN-FLWÂpnea peak flow^199-24|||L/min

OBX|17|NM|SET-APN-O2Âpnea 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-INÔ2 Supply^199-30|||

OBX|21|NM|VNT-RR^Total respiratory rate^199-34||10|/min

OBX|22|NM|TVÊxhaled tidal volume^199-35||0.23|L

OBX|23|NM|MVÊxhaled 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|PIPÊnd 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-APNÂpnea 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-INÎnsp. Sevoflurane^148-88||2|kPa

OBX|7|NM|SEV-P-EXÊxp. Sevoflurane^148-89||1.8|kPa

OBX|8|NM|AGNT1-P-INÎnsp. Agent 1^148-90||2|kPa

OBX|9|NM|AGNT1-P-EXÊxp. Agent 1^148-91||1.8|kPa

OBX|10|NM|MAC-INÎnsp. MAC^148-172||0.9|kPa

OBX|11|NM|MAC-ECÊxp. MAC^148-173||0.9|kPa

OBX|12|NM|SEV-INÎnsp. Sevoflurane^148-176||2|%

OBX|13|NM|SEV-EXÊxp. Sevoflurane^148-177||1.9|%

OBX|14|NM|AGNT1-INÎnsp. Agent 1^148-233||2|%

OBX|15|NM|AGNT1-EXÊxp. Agent 1^148-234||1.9|%

OBX|16|NM|N20-INÎnsp. N20^148-251||0|%

OBX|17|NM|N20-EXÊxp. N20^148-252||0|%

OBX|18|NM|COMP^Compliance^148-6||23.8|mL/mbar

OBX|19|NM|BARO-MBARÂmbient 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-INÎnsp. Tidal Volume^148-139||584|ml

OBX|26|NM|P-RR^Respiratory Rate - pressure^148-180||1.2|/min


OBX|28|NM|APN-TÂpnea 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-INÎnsp. CO2^148-218||0.1|%

OBX|33|NM|CO2-EXÊxp. CO2^148-219||4.9|%

OBX|34|NM|CO2-P-INÎnsp. CO2^148-255||0.1|kPa

OBX|35|NM|CO2-P-EXÊxp. CO2^148-227||4.8|kPa

OBX|36|NM|CO2-PHG-INÎnsp. CO2^148-229||1|mm(Hg)

OBX|37|NM|CO2-PHG-EXÊxp. 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-INÎnsp. Sevoflurane^148-88||2|kPa

OBX|7|NM|SEV-P-EXÊxp. Sevoflurane^148-89||1.8|kPa

OBX|8|NM|AGNT1-P-INÎnsp. Agent 1^148-90||2|kPa

OBX|9|NM|AGNT1-P-EXÊxp. Agent 1^148-91||1.8|kPa

OBX|10|NM|MAC-INÎnsp. MAC^148-172||0.9|kPa

OBX|11|NM|MAC-ECÊxp. MAC^148-173||0.9|kPa

OBX|12|NM|SEV-INÎnsp. Sevoflurane^148-176||2|%

OBX|13|NM|SEV-EXÊxp. Sevoflurane^148-177||1.9|%

OBX|14|NM|AGNT1-INÎnsp. Agent 1^148-233||2|%

OBX|15|NM|AGNT1-EXÊxp. Agent 1^148-234||1.9|%

OBX|16|NM|N20-INÎnsp. N20^148-251||0|%

OBX|17|NM|N20-EXÊxp. N20^148-252||0|%

OBX|18|NM|COMP^Compliance^148-6||23.8|mL/mbar

OBX|19|NM|BARO-MBARÂmbient pressure^148-107||982|mbar






OBX|25|NM|TV-INÎnsp. Tidal Volume^148-139||584|ml

OBX|26|NM|P-RR^Respiratory Rate - pressure^148-180||1.2|/min


OBX|28|NM|APN-TÂpnea Duration^148-189||0|s


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-INÎnsp. CO2^148-218||0.1|%

OBX|33|NM|CO2-EXÊxp. CO2^148-219||4.9|%

OBX|34|NM|CO2-P-INÎnsp. CO2^148-255||0.1|kPa

OBX|35|NM|CO2-P-EXÊxp. CO2^148-227||4.8|kPa

OBX|36|NM|CO2-PHG-INÎnsp. CO2^148-229||1|mm(Hg)

OBX|37|NM|CO2-PHG-EXÊxp. CO2^148-230||36|mm(Hg)








OBX|8|NM|O2-INÎnsp. O2^147-240||67|%

OBX|9|NM|FGF-O2Ô2 Flow^147-226||1.492|L/min

OBX|10|NM|FGF-N2O^N2O Flow^147-221||0|L/min

OBX|11|NM|FGF-AIRÂir Flow^147-222||1.045|L/min

OBX|12|NM|SET-TVÎnsp. Tidalvolume set^147-260||730|ml

OBX|13|NM|SET-IEIÎ:E I Part^147-263||1|

OBX|14|NM|SET-IEEÎ:E E Part^147-264||2.5|

OBX|15|NM|SET-IPPV^Frequency set^147-266||14|/min

OBX|16|NM|SET-PEEPÎntermit. PEEP set^147-268||5|mbar

OBX|17|NM|SET-HI-AWP^Max. insp. Airway Pressure set^147-

OBX|18|NM|SET-INSP-PRÎnsp. Pause/insp. Time set^147-295||10|%

OBX|19|ST|SET-IEÎ: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

16

Thank you.

Contact:

Email: [email protected]://www.nuvon.com

mailto:[email protected]

Aligning on SH Needs - Zaleski v0103

Documents

Transcript of Aligning on SH Needs - Zaleski v0103