1. 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
© 2009 ACCE, HIMSS, IHE

2. 2009-10-22 ACM AM-AC Requirements 01.ppt
This presentation can be found at...
ftp.ihe.net/
Patient_Care_Devices/
Presentations/
ACM/
ACM AM-AC Requirements 01.ppt

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. IHE PCD Contacts PCD Co-Chairs Todd Cooper t.cooper@ieee.org
Ken Fuchs
PCD Secretariat
Manny Furst
ACM WG Co-Chairs
Monroe Pattillo
John Rhoads

13. Thank You