1. Philips PCCI EPIS, Boca Raton, FL, USA IHE Patient Care Devices Domain
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 Implementation
Not in Final Text
Approved & included for this cycle
Deleted – AA actor, transactions PCD-08/PCD-11
Deleted – SMTP as AM-AC protocol (only WCTP)
Updates
spelling/grammar
diagram titles/placements 2

3. Updates in Queue for Next Cycle
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 requirement
More clearly specify use of WCM
Japan may define national extensions
Resolution of HL7 2.8 & pump WG conflicts 3

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

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

6. ACM 2011 Transactions and Protocols
WCTP
HL7 2.6
Alarm
Communicator AC
Manager AM
Reporter AR
Report Alarm
PCD-04 →
← PCD-05
Status
Disseminate
PCD-06 →
← PCD-07
Report
Dissemination
Alarm Status 6

7. AC Connectathon Vendors
AC 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 implementers
Virtual Pre-Connectathon to reduce WCTP learning efforts at Connectathon 7

8. Japan - NA Connectathon Differences
Event Trigger for PCD-04 and PCD-05
NA PCD-04 (R40), PCD-05 (R41, R42)
Japan PCD-04 (R01), PCD-05 (R01)
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 Site
Use PRT as indicated destination option in PCD-04
Use PRT as indicated recipients and dissemination status in PCD-05
2.5, it’s a national requirement
These changes go well beyond typical national extension Basically using PCD-01 as a PCD-04 (DEC to communicate alarms) 8

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

10. ACM WG Co-Chairs Google Group (IHE-PCD-ACM) Weekly WebEx
Monroe Pattillo
John Rhoads
Google Group (IHE-PCD-ACM)
Weekly WebEx
Thursdays 4 PM ET (see Manny’s WebEx schedule)

11. ACM - How it works in the real world
AR (device direct or gateway concentrator) sends alarm to AM (PCD-04)
AM decides who to disseminate to (assignments and job roles) on what devices (1 to many individual or to groups)
AM sends potentially multiple messages (PCD-06) to multiple AC instances and recipients (people and devices)
Each receiving AC sends to multiple devices
Each AC gets status updates and replies from devices (wide range of response times – seconds to minutes)
All the ACs send their updates and replies (PCD-07) to the AM
AM logs the updates and the replies from all ACs and handles escalation & potential cancel from AR
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 – Don’t Implement
Transient Client
Lookup Subscriber and Response
Device Location and Response
Multi-Message (wctp-SendMsgMulti)
Message Response Redirection
Delivery After
Delivery Before