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

2. 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

3. 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.

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

5. 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 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

6. Extra Slides

7. 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 nomenclature (does not rule out LOINC or SNOMED)
ISO/IEEE 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

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

9. PCD-01 Message Example (simple heart rate)
IEEE EUI-64
MSH|^~\&|HL7^080019FFFF4F6AC0^EUI-64|MMS||| ||ORU^R01 |a4e2e3:11036b5cdbb:-|P|2.5| ||NE|AL||8859/1
PID|||6O008D^^^A^PI||DAVIDSON^DAVID^^^^^L
PV1||E|3WICU^305^305
OBR|1|080019FFFF4F6AFE200701|080019FFFF4F6AC | ^2000^MDC|||
OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC| |80|/min^/min^UCUM|||||R
‘Heart Rate’
OBX-4
Value
‘/min’ UOM

10. PCD-01 Message Example (more complex)
MSH|^~\&|HL7^080019FFFF4F6AC0^EUI-64|MMS||| ||ORU^R01|a4e2e3:11036b5cdbb:-|P|2.5| ||NE|AL||8859/1
PID|||6O008D^^^A^PI||DAVIDSON^DAVID^^^^^L
PV1||E|3WICU^305^305
OBR|1|080019FFFF4F6AFE200701|080019FFFF4F6AC | ^2000^MDC|||
OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC| |80|/min^/min^UCUM|||||R
OBX|1|NM|147842^MDC_ECG_HEART_RATE^MDC| |60|/min^/min^UCUM|||||R
OBX|2|NM|131841^MDC_ECG_AMPL_ST_I^MDC| |0.0|mm^mm^UCUM|||||R
OBX|3|NM|131842^MDC_ECG_AMPL_ST_II^MDC| |0.0|mm^mm^UCUM|||||R
OBX|4|NM|131901^MDC_ECG_AMPL_ST_III^MDC| |0.0|mm^mm^UCUM|||||R
OBX|5|NM|131847^MDC_ECG_AMPL_ST_V5^MDC| |0.0|mm^mm^UCUM|||||R
OBX|6|NM|131902^MDC_ECG_AMPL_ST_AVR^MDC| |0.0|mm^mm^UCUM|||||R
OBX|9|NM|150035^MDC_PRESS_BLD_ART_MEAN^MDC| |96|mm[Hg]^mm[Hg]^UCUM|||||R
OBX|10|NM|150033^MDC_PRESS_BLD_ART_SYS^MDC| |122|mm[Hg]^mm[Hg]^UCUM|||||R
OBX|11|NM|150034^MDC_PRESS_BLD_ART_DIA^MDC| |82|mm[Hg]^mm[Hg]^UCUM|||||R
OBX|12|NM|149522^MDC_BLD_PULS_RATE_INV^MDC| |60|/min^/min^UCUM|||||R
OBX|13|NM|150047^MDC_PRESS_BLD_ART_PULM_MEAN^MDC| |14|mm[Hg]^mm[Hg]^UCUM|||||R
OBX|14|NM|150045^MDC_PRESS_BLD_ART_PULM_SYS^MDC| |24|mm[Hg]^mm[Hg]^UCUM|||||R
OBX|15|NM|150046^MDC_PRESS_BLD_ART_PULM_DIA^MDC| |10|mm[Hg]^mm[Hg]^UCUM|||||R
OBX|16|NM|151610^MDC_VENT_CO2_RESP_RATE^MDC| |12|{breath}/min^{breath}/min^UCUM|||||R
OBX|17|NM|151976^MDC_VENT_PRESS_AWAY_END_EXP_POS^MDC| |4|cm[H20]^cm[H20]^UCUM|||||R
OBX|18|NM|152008^MDC_VENT_VOL_MINUTE_AWAY^MDC| |0.0|l/min^l/min^UCUM|||||R
OBX|19|NM|151920^MDC_VENT_CONC_AWAY_O2_INSP^MDC| |21|%^%^UCUM|||||R
OBX|20|NM|151980^MDC_VENT_VOL_TIDAL^MDC| |1096|ml^ml^UCUM|||||R
OBX|21|NM|151957^MDC_VENT_PRESS_MAX^MDC| |17|cm[H20]^cm[H20]^UCUM|||||R
OBX|22|NM|151784^MDC_PRESS_RESP_PLAT^MDC| |30|cm[H20]^cm[H20]^UCUM|||||R
OBX|23|NM|151792^MDC_PRESS_AWAY^MDC| |35|cm[H20]^cm[H20]^UCUM|||||R
OBX|24|NM|151808^MDC_PRESS_AWAY_END_EXP_POS_INTRINSIC^MDC| |1|cm[H20]^cm[H20]^UCUM|||||R