Integrating the Healthcare Enterprise (IHE) Patient Care Devices Domain (PCD) Alarm Communication Management (ACM) IHE PCD 2011 Fall Face-to-Face Kansas City, MO Monroe Pattillo Philips PCCI EPIS, Boca Raton, FL, USA IHE Patient Care Devices Domain ACM Working Group © 2011 ACCE, HIMSS, IHE

2 ACM Supplement Update ACM 2011 Supplement Trial ImplementationACM 2011 Supplement Trial Implementation Not in Final TextNot in Final Text Approved & included for this cycleApproved & included for this cycle –Deleted – AA actor, transactions PCD-08/PCD-11 –Deleted – SMTP as AM-AC protocol (only WCTP) –Updates spelling/grammarspelling/grammar diagram titles/placementsdiagram titles/placements

3 Updates in Queue for Next Cycle Add more details for...Add more details for... –AM–AC WCTP protocol specific messages (unofficial separate doc for this cycle to assist implementers & referees) More clearly specify ITI-CT requirementMore clearly specify ITI-CT requirement More clearly specify use of WCMMore clearly specify use of WCM Japan may define national extensionsJapan may define national extensions Resolution of HL7 2.8 & pump WG conflictsResolution of HL7 2.8 & pump WG conflicts

4 Hurdles for TF Inclusion Considerable 2010 updates (vendor burden) plus addition of WCMConsiderable 2010 updates (vendor burden) plus addition of WCM No Connectathon verificationNo Connectathon verification –Transaction – PCD-05 –Options - PCD-04 PRT, WCM & PCD-06 WCM Insufficient Connectathon verificationInsufficient Connectathon verification –Alarm Communicator (AC) actor

5 Progress Towards TF Inclusion Goal of ACM inclusion in PCD TF at start of Cycle 7 ( )Goal of ACM inclusion in PCD TF at start of Cycle 7 ( ) Dependent upon 2012 Connectathon vendor involvement and resultsDependent upon 2012 Connectathon vendor involvement and results

6 ACM 2011 Transactions and Protocols WCTPHL7 2.6 Alarm Communicator AC Alarm Communicator AC Alarm Manager AM Alarm Manager AMAlarmReporterARAlarmReporterAR Report Alarm PCD-04 PCD-05 Report Alarm Status Disseminate Alarm PCD-06 PCD-07 Report Dissemination Alarm Status

7 AC Connectathon Vendors AC vendors signed up for 2012 ConnectathonAC vendors signed up for 2012 Connectathon –SiS – WCTP experience from last cycle –Nuvon – WCTP experience? –Vocera – WCTP experience? ACM WG to spend time supporting WCTP implementersACM WG to spend time supporting WCTP implementers Virtual Pre-Connectathon to reduce WCTP learning efforts at ConnectathonVirtual Pre-Connectathon to reduce WCTP learning efforts at Connectathon

8 Japan - NA Connectathon Differences Event Trigger for PCD-04 and PCD-05Event Trigger for PCD-04 and PCD-05 –NAPCD-04 (R40), PCD-05 (R41, R42) –JapanPCD-04 (R01), PCD-05 (R01) HL7 Version, common to all profiles in PCD (DEC, ACM, etc.)HL7 Version, common to all profiles in PCD (DEC, ACM, etc.) 2.6, to support segments/fields not yet in HL7 standard Put transducer body part location in OBX-20 Observation SitePut transducer body part location in OBX-20 Observation Site Use PRT as indicated destination option in PCD-04Use PRT as indicated destination option in PCD-04 Use PRT as indicated recipients and dissemination status in PCD-05Use PRT as indicated recipients and dissemination status in PCD , its a national requirement These changes go well beyond typical national extension Basically using PCD-01 as a PCD-04 (DEC to communicate alarms)These changes go well beyond typical national extension Basically using PCD-01 as a PCD-04 (DEC to communicate alarms)

9 Resolution of HL7 2.8 & Pump WG Conflicts Current ACM TI EventsCurrent ACM TI Events –PCD-04 Report Alarm ORU_R40 –PCD-05 Report Alarm Status ORA_ R41 guaranteed delivery (impractical)R41 guaranteed delivery (impractical) R42 not guaranteed delivery (real world)R42 not guaranteed delivery (real world) HL7 2.8 BallotHL7 2.8 Ballot –Alarms - R40 & R41 –Pump events - R42 Proposed Resolution – CP ACM TIProposed Resolution – CP ACM TI –Drop current R41 as impractical –Change R42 text to indicate R41

10 ACM WG Co-Chairs Monroe John Google Group (IHE-PCD-ACM) Weekly WebEx Thursdays 4 PM ET (see Mannys WebEx schedule)

11 ACM - How it works in the real world 1)AR (device direct or gateway concentrator) sends alarm to AM (PCD-04) 2)AM decides who to disseminate to (assignments and job roles) on what devices (1 to many individual or to groups) 3)AM sends potentially multiple messages (PCD-06) to multiple AC instances and recipients (people and devices) 4)Each receiving AC sends to multiple devices 5)Each AC gets status updates and replies from devices (wide range of response times – seconds to minutes) 6)All the ACs send their updates and replies (PCD-07) to the AM 7)AM logs the updates and the replies from all ACs and handles escalation & potential cancel from AR 8)AM sends status updates, replies, and conclusions (PCD-05) back to AR

12 AR to AC timing - How it works in the real world An AR needs response to PCD-04 within a short period of time (<10 SEC) to know that PCD-04 was successfully handed off to AM The AM to AC timing varies widely based upon the type of AC end device communication technology – site local paging transmitter or Wi-Fi (seconds to minute) versus public wireless service provider (seconds to minutes to days), and human device operator responsiveness (seconds to minutes) It is highly likely that the AM will escalate to alternate recipients within well less than a minute (disjoint of AC to device timing)

13 How ACM uses Participation (PRT) segment In PCD-04 (AR to AM) One or more optional PRT segments are used to indicate explicitly to AM the destination AC recipients (people or devices) Used when AR has responsibility to manage notification recipients and not the AM Used primarily by nurse call systems, but also some patient monitoring systems In PCD-05 (AM to AR) One or more optional PRT segments are used to identify to the AR the conclusion of the AM to AC interactions (default) or (optionally) the details of the recipient notifications (notification sent to who and/or what devices, did they get there, were they read, did the user reply)

14 For AC WCTP implementers – Do Implement Asynchronous operating Enterprise Host message sent AM to AC (PCD-06) using wctp-SubmitRequest PCD-06 AM to AC ACK is WCTP confirmation status Enterprise Polling and Post (web push) response for status updates AC to AM (PCD-07), including notifyWhenQueued, notifyWhenDelivered, and notifyWhernRead Multiple Choice Response used by the AM actor vendor to constrain replies to vendor expected values for Accept and Reject When using Post (web push) response for status updates and replies the response destination URI is indicated in the wctp- SubmitRequest. Do not hard code or make this a configurable value as it should be capable of being dynamic based upon the submit request content.

15 For AC WCTP implementers – Dont Implement Transient Client Lookup Subscriber and Response Device Location and Response Multi-Message (wctp-SendMsgMulti) Message Response Redirection Delivery After Delivery Before