Integrating the Healthcare Enterprise (IHE) Patient Care Devices Domain (PCD) Alarm Communication Management (ACM) Requirements for AM – AC Interoperability Monroe Pattillo Philips Patient Monitoring Informatics (PMI) Boca Raton, FL, USA IHE Patient Care Devices Domain ACM Working Group monroe.pattillo@philips.com © 2009 ACCE, HIMSS, IHE

2009-10-22 ACM AM-AC Requirements 01.ppt This presentation can be found at... ftp.ihe.net/ Patient_Care_Devices/ Presentations/ ACM/ 2009-10-22 ACM AM-AC Requirements 01.ppt

AM-AC Protocol Requirements What are some possibilities? Outline ACM AM – AC Messages AM-AC Protocol Requirements What are some possibilities? What do we do next? 3

ACM AM – AC Messages ← PCD-07 ← PCD-05 Disseminate Alarm PCD-06 → Report Dissemination Alarm Status Report Alarm PCD-04 → ← PCD-05 Status Alarm Reporter AR Alarm Manager AM Alarm Communicator AC PCD-08 ↑ Subscribe To Alarm PCD-04 ↓ Report Alarm PCD-06, PCD-07 Data items defined Currently using SMTP as open standards based transport, but needs better PCD-04, PCD-05, PCD-08 all HL7 v2.6→v2.7 Alarm Archiver AA 4

PCD-04 Message An HL7 ORU^R01 message containing segments for... MSH Header PID Patient Identification PV1 Location Information OBR Unique Observation Identification ORC Optional Order Information OBX Observations, containing Type, Units, Range, Text description, Priority (indication - low, med, high), Type (physiological, technical, etc.), State (onset, continue, escalate, end) NTE Notes and Comments 5

PCD-06 AM to AC Message AM to AC PCD-06 – Disseminate Alarm Sends the message to the AC’s device by way of AC Identification of message recipients Message, containing Location associated with alarm Patient associated with alarm Message text (incl. physiological info.) Identifier unique identifier Callback (telephony dial back) Contextual Data Reference (URL) Comment Evidentiary Data 6

PCD-07 AC to AM Message AC to AM PCD-07 – Report Dissemination Alarm Status Sends message deliver status updates to the AM Accepted by AC (delivered to carrier) Undeliverable to endpoint Delivered to endpoint Accepted by endpoint Accepted by endpoint as true positive (info) Accepted by endpoint as true positive however not clinically relevant (operator note) Accepted by endpoint as false positive (info) Rejected by endpoint Canceled by endpoint (escalation, not alarm) 7

AM-AC Protocol Requirements Must be an existing protocol IHE uses standards, it does not develop them Must be an open protocol Not proprietary Must have unrestricted use 8

AM-AC Protocol Requirements Preferences/Focus Contemporary, Healthcare, People Communications XML based – extensible HTTP transport – works with firewalls and NATs Multiple Choice Response (MCR) – “soft keys” Pushed, not polled status updates – quicker Presence/Status – for escalation responsiveness Dynamic – online/offline, busy, BRB, away, DND TLS capable – SSL securable, messages contain ePHI WCM Supportive – hyperlink or large evidentiary data 9

AM-AC Protocol Requirements ACM Specific Messaging Items Device is on network identified by ID/Number/Name Delivery target is ultimately people, not systems Dissemination/Status unsolicited, not subscribed PCD-04 round trip event message identification Many status potentials in status enumeration delivery/not at multiple levels (carrier, device) human interactions read receipt multiple response possibilities more than accept/reject or timeout 10

2009-10-22 ACM AM-AC Requirements 01.ppt Resources This presentation can be found at... ftp.ihe.net/ Patient_Care_Devices/ Presentations/ ACM/ 2009-10-22 ACM AM-AC Requirements 01.ppt 11

IHE PCD Contacts PCD Co-Chairs Todd Cooper t.cooper@ieee.org Ken Fuchs ken.fuchs@draeger.com PCD Secretariat Manny Furst efurst@imp-tech.com ACM WG Co-Chairs Monroe Pattillo monroe.pattillo@philips.com John Rhoads john.rhoads@philips.com

Thank You