IHE DEC and Continua WAN Interface Proposals for Remote Monitoring Paul Schluter IHE PCD Meeting at NIST May 6, 2009

EHR or Care Coordination Applications IHE DEC: Same protocol used in two settings … Device Intermediary Device Subset of IHE DEC Home Setting EHR or Care Coordination Applications Device IHE DEC Hospital Setting Device Intermediary

Top-level considerations: HITSP and IHE leadership viewpoints: Use single protocol for both acute-care and home-care. IHE PCD DEC can support both. Continua WAN team viewpoints: Home-hub/gateway/cell-phone participates act as a simple message relay with minimal message translation. Consider sending high-rate data as binary and events and commands as XML.

Continua WAN payload and xport options Payload format and encoding options 20601 encoded as XER; 11073 nomenclature 20601 binary with XML wrapper; 11073 nomenclature xHR (CCD, constrained HL7 V3 CDA, SNOMED nomenclature) IHE PCD DEC (HL7 V2.6, 11073 nomenclature) Transports SOAP ebXML WS-* DPWS HL7 MLLP (with IHE PCD DEC)

IHE DEC (and associated) profiles Provides a Unified Interface that -- Supports the complete range of device data (except for high-bandwidth continuous waveforms) found in health related devices today and in the future. Provides a consistent interface in Health Record, Care Management Systems and Personal Health Records that is: Secure, private High performance even on low bandwidth links Scalable, from a simple device intermediary (a few devices for the same patient) to multiple devices for many patients. Trivial to implement. Straightforward mapping from proprietary and IEEE 11073 formats. (agreement: same nomenclature as X73 Personal Health Devices) Based on proven HL7 standards that are supported by all Care Management and EHRs products today

Extra Slides

Device Observation Consumer (DOC) Device Observation Reporter (DOR) IHE Device Enterprise Communication (DEC) and related Profiles (PCD, SPD, ACM). Device Observation Consumer (DOC) PCD-01 Transaction: Communicate Device Data ISO/IEEE 11073-10101 nomenclature (does not rule out LOINC or SNOMED) ISO/IEEE 11073 or UCUM units-of-measure OBX-4 used for «mds.vmd.chan.metric», OBX-20 for measurement sites Profile and simplify other aspects of HL7 V2.5 messaging Periodic Physiologic Data: Heart Rate, Respiration rate Episodic Physiologic Data: NIBP, Weight, Cardiac tests Primarily structured data but facilities non structured data as well Must include Patient ID > 1 minute sampling rate (but could be faster) Waveform support is simple extension Flexible extensions with: Alarms and alerts supported through related profile (ACM) Subscribe to Patient Data (SPD) Profile Security, privacy, confidentiality through related profile (ATNA) Device Observation Reporter (DOR) Device

Mapping Preserves Measurement Context Overall Device or System Virtual Medical Device Channel (only as needed) A single observation

PCD-01 Message Example (simple heart rate) IEEE EUI-64 MSH|^~\&|HL7^080019FFFF4F6AC0^EUI-64|MMS|||20070118133700||ORU^R01 |a4e2e3:11036b5cdbb:-|P|2.5|20070118133700||NE|AL||8859/1 PID|||6O008D^^^A^PI||DAVIDSON^DAVID^^^^^L PV1||E|3WICU^305^305 OBR|1|080019FFFF4F6AFE200701|080019FFFF4F6AC0200701|126.3.3.1^2000^MDC|||20070118133700 OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC|1.6.1.1|80|/min^/min^UCUM|||||R ‘Heart Rate’ OBX-4 Value ‘/min’ UOM

PCD-01 Message Example (more complex) MSH|^~\&|HL7^080019FFFF4F6AC0^EUI-64|MMS|||20070118133700||ORU^R01|a4e2e3:11036b5cdbb:-|P|2.5|20070118133700||NE|AL||8859/1 PID|||6O008D^^^A^PI||DAVIDSON^DAVID^^^^^L PV1||E|3WICU^305^305 OBR|1|080019FFFF4F6AFE200701|080019FFFF4F6AC0200701|126.3.3.1^2000^MDC|||20070118133700 OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC|1.6.1.1|80|/min^/min^UCUM|||||R OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC|1.6.1.1|60|/min^/min^UCUM|||||R OBX|2|NM|131841^MDC_ECG_AMPL_ST_I^MDC|1.7.1.1|0.0|mm^mm^UCUM|||||R OBX|3|NM|131842^MDC_ECG_AMPL_ST_II^MDC|1.7.1.2|0.0|mm^mm^UCUM|||||R OBX|4|NM|131901^MDC_ECG_AMPL_ST_III^MDC|1.7.1.3|0.0|mm^mm^UCUM|||||R OBX|5|NM|131847^MDC_ECG_AMPL_ST_V5^MDC|1.7.1.4|0.0|mm^mm^UCUM|||||R OBX|6|NM|131902^MDC_ECG_AMPL_ST_AVR^MDC|1.7.1.5|0.0|mm^mm^UCUM|||||R OBX|9|NM|150035^MDC_PRESS_BLD_ART_MEAN^MDC|1.3.1.1|96|mm[Hg]^mm[Hg]^UCUM|||||R OBX|10|NM|150033^MDC_PRESS_BLD_ART_SYS^MDC|1.3.1.2|122|mm[Hg]^mm[Hg]^UCUM|||||R OBX|11|NM|150034^MDC_PRESS_BLD_ART_DIA^MDC|1.3.1.3|82|mm[Hg]^mm[Hg]^UCUM|||||R OBX|12|NM|149522^MDC_BLD_PULS_RATE_INV^MDC|1.2.1.1|60|/min^/min^UCUM|||||R OBX|13|NM|150047^MDC_PRESS_BLD_ART_PULM_MEAN^MDC|1.4.2.1|14|mm[Hg]^mm[Hg]^UCUM|||||R OBX|14|NM|150045^MDC_PRESS_BLD_ART_PULM_SYS^MDC|1.4.2.2|24|mm[Hg]^mm[Hg]^UCUM|||||R OBX|15|NM|150046^MDC_PRESS_BLD_ART_PULM_DIA^MDC|1.4.2.3|10|mm[Hg]^mm[Hg]^UCUM|||||R OBX|16|NM|151610^MDC_VENT_CO2_RESP_RATE^MDC|1.5.1.1|12|{breath}/min^{breath}/min^UCUM|||||R OBX|17|NM|151976^MDC_VENT_PRESS_AWAY_END_EXP_POS^MDC|1.5.1.2|4|cm[H20]^cm[H20]^UCUM|||||R OBX|18|NM|152008^MDC_VENT_VOL_MINUTE_AWAY^MDC|1.5.1.3|0.0|l/min^l/min^UCUM|||||R OBX|19|NM|151920^MDC_VENT_CONC_AWAY_O2_INSP^MDC|1.5.1.4|21|%^%^UCUM|||||R OBX|20|NM|151980^MDC_VENT_VOL_TIDAL^MDC|1.5.1.5|1096|ml^ml^UCUM|||||R OBX|21|NM|151957^MDC_VENT_PRESS_MAX^MDC|1.5.1.6|17|cm[H20]^cm[H20]^UCUM|||||R OBX|22|NM|151784^MDC_PRESS_RESP_PLAT^MDC|1.5.1.7|30|cm[H20]^cm[H20]^UCUM|||||R OBX|23|NM|151792^MDC_PRESS_AWAY^MDC|1.5.1.8|35|cm[H20]^cm[H20]^UCUM|||||R OBX|24|NM|151808^MDC_PRESS_AWAY_END_EXP_POS_INTRINSIC^MDC|1.5.1.9|1|cm[H20]^cm[H20]^UCUM|||||R