Integrating the Healthcare Enterprise (IHE) Patient Care Devices Domain (PCD) Alarm Communication Management (ACM) 2010 Change Request Efforts IHE PCD 2010 Spring F2F, Berkeley, CA Monroe Pattillo Philips Patient Monitoring Informatics (PMI) Boca Raton, FL, USA IHE Patient Care Devices Domain ACM Working Group © 2010 ACCE, HIMSS, IHE

2 ACM Supplement – TI CR Areas Trial Implementation HousekeepingTrial Implementation Housekeeping Bringing in HL7 2.7/2.8 proposed bitsBringing in HL7 2.7/2.8 proposed bits AM-AC ProtocolAM-AC Protocol Integration with WCM profileIntegration with WCM profile

3 Trial Implementation Housekeeping Typos, etc.Typos, etc. Remove re-use of PCD-04 to go to AA actor (PCD-10?)Remove re-use of PCD-04 to go to AA actor (PCD-10?) Change diagram wording AM actor function from Alarm Reporter to Alarm Reporting to avoid confusion with AR actor nameChange diagram wording AM actor function from Alarm Reporter to Alarm Reporting to avoid confusion with AR actor name

4 Bringing in HL7 2.7/2.8 proposed bits Triggers and TypesTriggers and Types –ORU R01 is the current PCD-04 backward compatibilitybackward compatibility –ORU R40 is the new PCD-04 –ORU R01 is the current PCD-05 Backward compatibilityBackward compatibility –ORA R41 and R42 are the new PCD-05 R41 – impractical assurance of delivery and receiptR41 – impractical assurance of delivery and receipt Use HL7 ACK of PCD-04 to confirm receipt by AMUse HL7 ACK of PCD-04 to confirm receipt by AM Use R42 instead of R41 as it relays actual PCD-07 infoUse R42 instead of R41 as it relays actual PCD-07 info –Delayed ORA timing makes use of MSA impractical

5 Bringing in HL7 2.7/2.8 proposed bits PRT (Participation) Segment usagePRT (Participation) Segment usage –PCD-04 filtering for PCD-05 avoid PCD-05 fire hoseavoid PCD-05 fire hose What is the default, how is filtering indicatedWhat is the default, how is filtering indicated –PCD-04 indicated destination messaging PIN/Carrier support permits retention of existing usesPIN/Carrier support permits retention of existing uses –PCD-05 content Indicating to whom or to what the PCD-06 was sent toIndicating to whom or to what the PCD-06 was sent to what is the status of the delivery event (OBX content)?what is the status of the delivery event (OBX content)? –delivered to AC, delivered to device, operator read receipt, operator accept/reject responses

6 AM-AC Protocol (WCTP) Wctp.org need documented approval for use of copyrighted work (else were back to XMPP-IM plus numerous extensions)Wctp.org need documented approval for use of copyrighted work (else were back to XMPP-IM plus numerous extensions) PCD-07 is an unsolicited web push responsePCD-07 is an unsolicited web push response Only a subset of WCTP is requiredOnly a subset of WCTP is required –Single message –Multiple Choice Response (MCR) for accept/reject response abstraction from devices –Map PCD-04 indicated priority to PCD-06 indicated priority for implementing ring tones –No phone directory functions –Version query not needed (version in message)

7 Current PCD-04, PCD-05, PCD-08 all HL7 v2.6 New PCD-04 and PCD-05 Bring forward HL7 2.7 and 2.8 Alarm Communicator AC Alarm Communicator AC Alarm Manager AM Alarm Manager AMAlarmReporterARAlarmReporterAR ACM AM – AC Messages AlarmArchiverAAAlarmArchiverAA Report Alarm PCD-04 PCD-05 Report Alarm Status Disseminate Alarm PCD-06 PCD-07 Report Dissemination Alarm Status PCD-08 Subscribe To Alarm PCD-10? Report Alarm PCD-06, PCD-07 Data items defined Currently using SMTP as open standards based transport, but needs better

8 PCD-06 AM to AC Message AM to AC PCD-06 – Disseminate Alarm Sends the message to the ACs 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

9 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) How do we identify delivery status in OBX?

10 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

11 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

12 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

13 Integration with WCM profile PCD-04 with embedded WCM contentPCD-04 with embedded WCM content PCD-04 with no waveform content (embedded hyperlink to waveform server)PCD-04 with no waveform content (embedded hyperlink to waveform server)

14 IHE PCD Contacts PCD Co-Chairs Todd Todd Ken Ken Steve Steve John John PCD Technical Project Manager Manny Manny ACM WG Co-Chairs Monroe Monroe John John

15 Thank You