Your systems. Working as one.

How Networked Things Are Changing Medicine

Real applications in connected medical devices © 2014 Real-Time Innovations, Inc.

• Bettina Swynnerton

• bettina@rti.com

• RTI Focus: Industrial Internet of Things

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RTI Named Most Influential IIoT Company

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RTI solves problems like

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Room Domain

Central Domain

Admin Domain (Cloud)

Workstations, Storage, Historian

Gateway, IX, Enterprise, 3rd Party

Small scale, large scale

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Systems as a sum of their parts

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Data Bus

Supervisory Services

Patient Mgmt Device Mgmt

Systems Health Interaction Checking Logging

CDS Algorithm

#1

Lab Data

SPO2 CO2

Patient Hx

Infusion Pump Settings

IV Pump Control

Infusion Pump Measured

Values

How could connected things change medicine?

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Just some of the problems…

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Result: False alarms, incorrect data in permanent record.

ECG data ECG data

Pulse Ox data

EMR data

Or this…

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How could medicine change?

• Improved diagnosis?

• Delegated care? Delegated treatment?

• Machine assisted diagnosis, care and treatment?

• Improved safety?

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Three important drivers

• Evolution from the stand-alone system to a distributed system

• Connection of devices to improve patient outcome

• The replacement of dedicated point-to-point wiring with networks

Ultrasound Imaging

”BK Medical is truly redefining Medical Ultrasound Imaging where the traditional single user / single system approach is being replaced with fully scalable and distributed multi-user systems

This required a completely new way of gluing the individual components together. For this reason we selected the RTI DDS middleware as this gives us all the flexibility and the abstraction layer needed for the future of Analogic Ultrasound”

-- Jesper Lomborg Manigoff, VP of Engineering, Analogic Global

Ultrasound

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Surgical Robotics

• The Minimally Invasive Robotic Surgery (MIRS) system at DLR coordinates three robots to perform delicate heart surgery.

• The system closes a distributed loop between the robots and the remote surgeon’s control at 3kHz.

• RTI enables new medical techniques

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Driver 2: Connect devices to improve patient outcome

• IT problem: Patient records

• M2M problem: Intensive care diagnostics

• HMI problem: Enable staff to come to a safe diagnosis and safe decisions assisted by data correlation

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Device Connection for Patient Safety

• Hospital error is the 6th leading cause of preventable death

• DocBox integrates devices to improve patient safety

• RTI Connext ties together devices, services, and displays in real time

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“RTI Connext DDS met all our needs – whether

we’re handling 12 patients, or 200.”

-- DocBox Founder, Tracy Rausch

Industry Interoperation

• The Integrated Clinical Environment (ICE) standard specifies interoperability for medical devices

• All ICU & operating room devices — from blood pressure cuffs to intravenous pumps to ventilators — could be interconnected according to the ICE standard

– Complete logging – Automatic error detection – Better care

• The DDS standard and RTI

middleware enables plug & play interoperability across manufacturers

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ASTM F2761

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Data Distribution Service for ICE

DDS Global Data Space

App App App

Device Device Device

Data Logger

External Interface

ADT

EMR External Interface

Benefits offered by DDS • Discovery / Presence • Data-Centric Information Model / Type Safety (agree to data structure in advance)

(Distinct from underlying messaging) • QoS Policy Compatibility Checking / Runtime Enforcement

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Inter-Vehicle Communications

• Exelis (ITT) C4i provides command and control systems for military and civilian agencies (fire/police/emergency response)

• RTI Connext DDS connects GUIs to servers that route voice and video

• RTI met the critical needs: scalability, routing, recording

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EMS Device Integration Platform

• The largest EMS equipment provider supplies emergency response equipment to 60% of the world’s emergency vehicles

• Uses RTI middleware for mobile device bus, in-vehicle platform, cloud connectivity

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EMS Cloud Integration

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Connecting devices with hospitals to provide better treatment while en-route

4G/LTE

Hospital Integration

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Clinical Diagnostic System

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Room Domain

Central Domain

Admin Domain (Cloud)

Patient Monitoring Devices

Workstations, Storage, Historian

Gateway, IX, Enterprise, 3rd Party

CDS System of Systems

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Hospital Integration Data Challenges

• Hospital net challenge – 1000s of patients, >100k

devices

– Wired/wireless/ISM

– Moving patients

– 100% uptime, security

– Real-time waveforms

• RTI DDS technology – Data centric addressing

– Smart data filtering

– Routed deployment

– Optimized updates

– Automated test harness

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Driver 3: Integration of intelligent machines

• Point to point

• Tightly coupled

• Data-centric networks

• Loosely coupled

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Surgical Operating Room Integration

• Patient status – Waveforms

– Data recording

• Multi-channel video

• Many recipients – Surgeon

– Operating theater

– Students & observers

– Offsite ©2

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Image is for conceptual understanding only. This is not a current RTI application

Interventional Surgical Theatre

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Operating Room Domain

High-Speed DataBus

Xray

UltrSnd

ProbeVid

Image Fusion

Instrument Integration

Room Control

Surgeon Display

Data Storage

EHR

ECG

PxR SpO2

Down Sample

Graphics System G

PU

Graphics System G

PU

Tablet

Tablet Tablet Remote Monitors

Wir

eles

s D

ataB

us

How Can Things Do Those Things?

Technology

© 2014 Real-Time Innovations, Inc.

What is interoperability?

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Level 0 No Interoperability

Level 6 Conceptual Interoperability

Level 5 Dynamic Interoperability

Level 4 Pragmatic Interoperability

Level 3 Semantic Interoperability

Level 2 Syntactic Interoperability

Level 1 Technical Interoperability

Stand alone systems that have no interoperability

Full assumptions and constraints of meaningful abstraction of reality. Fully specified but independent model

Maintains state changes between systems during run time. Includes assumptions and constraints that effect data interchange

Systems are aware of methods & procedures of other systems. Context is understood by all participating systems

Meaning of data is exchanged through use of a common information model. The meaning of information is shared and unambiguously defined.

Common structure or common data format for exchanging information. The format of the information exchange is unambiguously defined

Communication protocol for exchanging data. Bits & Bytes are exchanged in an unambiguous manner

Levels of Conceptual Interoperability Model (LCIM) for Systems Engineering VMASC (Virginia Modeling, analysis and simulation centre)

Open standards-based middleware?

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Point-to-Point Client/Server

Brokered

ESB

Daemon

Publish/Subscribe Data-Centric Queuing

Data Centric Approach?

• Data-centric middleware maintains state • Infrastructure manages the content • Developers write applications that read and update a

virtual global data space

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Persistence Service

Recording Service

Source (Key)

Wind Power Phase

WPT1 37.4 122.0 -12.20

WPT2 10.7 74.0 -12.23

WPTN 50.2 150.1 -11.98

Popular standards: DDS API, wire spec

De-coupled?

• Verb-based: applications interact with each other

• Noun-based: applications interact with data model

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Set B3 to 27 B3

Managing State

• Data centric

– Single version of truth enables interoperation

– Content-aware infrastructure eases integration

– Clear rules for access, changes, updates tame complexity

• Technologies

– Database

– Data-centric middleware

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QoS: Quality of Service

QoS Policy QoS Policy

DURABILITY USER DATA

HISTORY TOPIC DATA

READER DATA LIFECYCLE GROUP DATA

WRITER DATA LIFECYCLE PARTITION

LIFESPAN PRESENTATION

ENTITY FACTORY DESTINATION ORDER

RESOURCE LIMITS OWNERSHIP

RELIABILITY OWNERSHIP STRENGTH

TIME BASED FILTER LIVELINESS

DEADLINE LATENCY BUDGET

CONTENT FILTERS TRANSPORT PRIORITY

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Vo

lati

lity

User Q

oS

Del

iver

y

Presen

tation

R

edu

nd

ancy

Infr

astr

uct

ure

Transp

ort

0

50

100

150

200

250

300

350

400

Ave

rage

Lat

en

cy (

Mic

rose

con

ds)

Throughput (Messages per Seconds)

1 (1 per CPU and NIC)

20 (1 per CPU and NIC)

40 (1 per CPU, 2 per NIC)

Performance Under Load

• Reliable multicast • Fully meshed, reliable

Number of Subscribers

Orders of magnitude faster

than IT solutions Fastest DDS solution

Comprehensive results online at www.rti.com

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Unit DataBus Unit DataBus

End-to-End DataBus

• Connect… – Fast – Seamless – QoS controlled – Secure – Data centric

• …80 Platforms… – Micro controllers – Certified systems – Embedded – Mobile – Desktop – Cloud

• …over 12 Transports – UDP or TCP – D/TLS (secure) – Wireless or wired – Shared memory – Backplane – Cloud virtual connect

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Intelligent Machines

Intelligent Systems

Intelligent Industrial Internet

Cloud DataBus

Site DataBus

Intelligent System of Systems

Unit DataBus

Sense Act

Think HMI

Machine DataBus

Think HMI

Machine DataBus

Sense Act

Think HMI

Machine DataBus

Route to Build Complete Hierarchy

• Routing Technology

– Encapsulate subsystem data

– Translate data models/formats

– Match comm patterns

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MQTT

Web

Field Busses

AMQP JMS

TCP

Routing Service Pluggable Adapters

Transformation Engine

Database Historian

DDS DataBus

DDS DataBus

Strive For: One Logical Dataspace…

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DDS DataBus

Sensors Actuators

Analytics & Control

HMI/UI IT, Cloud & SoS

Connectivity

…Hiding Complex Network Topologies

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Actuators Sensors

Analytics, control

HMI

Actuators Sensors

Analytics, control

HMI

Actuators Sensors

Analytics, control

HMI

Analytics, control

HMI

Centralized analytics

Decentralized devices, streaming analytics and control

Choose DDS If…

• Disaster if offline for 5 minutes?

• Measure performance in ms or us? Or scale >100+ applications? Or 10k+ data values?

• Code active lifetime >3 yrs?

• 2 or 3 => DDS

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Control: DDS

Some Resources

• Papers, evaluation downloads, community: www.rti.com

• Wired article: http://blogs.rti.com/2013/11/18/a-day-in-your-life-with-the-internet-of-things/

• EDN on patient safety: http://electronicdesign.com/communications/internet-things-can-save-50000-lives-year

• PBRT system: http://www.barnesjewish.org/news/?id=5032&sid=2&nid=3068

• Video: http://goo.gl/WnO5LE

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