1. IHE PCD Interoperability Mini-Showcase at AAMI 2013 Long Beach, CA CMMS New Directions Demonstrations Monroe Pattillo Practical Health Interoperability, LLC 4/8/2013

2. Scope This is likely too broad to be demonstrated in its entirety at the AAMI event – pick & choose It is likely too little and too fast for proper IHE PCD WG profile development – profile development should proceed asynchronously to the AAMI New Directions demonstration event While the individual slides should not be thought of as the actual posters for the AAMI demonstration event some of the slide content may be useful in the development of the posters This is meant as an accelerator to meet the AAMI event demonstration deadline and as an information collective for proper IHE PCD WG profile development

3. Use Cases CMMS reports (generated reports, not msgs to wireless/mobile devices) – UC #1 Device utilization by patient association by events when patient associated – UC #2 Device issues management battery not maintaining charge malfunction Staff notification of device alarms & events (not by CMMS) – UC #3 Notify clinicians of issues when device is associated with patient – Leads off, pump flow issues, bag empty – UC #4 Notify Biomeds of issues when device is not associated with patient – Battery not maintaining charge Staff notifications of CMMS alerts & events (by CMMS use of ACM AM) – UC #5 Device management cleaning, calibration, recalls, lease return – UC # 6 Device issue resolution repair, S/W updates

4. Medical Devices to CMMS for Reporting Overview (UC # 1 & 2) Medical equipment sends messages to CMMS – Patient Association/De-association – Utilization by patient – Start, Pause, Stop/End – Equipment management events – Battery management Medical Devices - Infusion Pumps, Patient Monitoring Patient Specific Information is ignored (HIPAA) Equipment identification is significant Equipment location is significant

5. Medical Devices to CMMS for Reporting Message Flow Medical Device CMMS Report HL7 v2 ORU^ R01, R40, R43 HL7 v2 ACK Alarm or Event Receipt Acknowledgement

6. Medical Devices to CMMS for Reporting HL7 v2 Message Content as seen by CMMS MSH-3 Sending Application – identifies sending application, MSH-4 Sending Facility – identifies instance of application, MSH-5 – identifies CMMS as application, MSH-6 – identifies instance of CMMS MSH-7 Timestamp – when message was sent (yyyymmddhhmmss±zzzz), MSH-8 Security = Empty MSH-9 Message Type Identification – ORU^xxx^ORU_xxx (R01 Observation, R40 Alarm, R43 Event) MSH-10 Message Control – message ID #, MSH-11 Processing ID = “P”, MSH-12 HL7 Version ID = “2.6” MSH-13 Sequence Number – for transport error retransmission, MSH-14 Continuation Pointer = Empty MSH-15 Accept Acknowledgement Type = “NE”, MSH-16 Application Acknowledgement Type = “AL” MSH-17 Country Code = Empty, MSH-18 Character Set – either Empty or “ASCII” MSH-19 Principal Language – either Empty or “EN^English^ISO639”, MSH-20 Alternate Character Set = Empty MSH-21 Message Profile Identifier – for alarms = “IHE_PCD_ACM_001^IHE PCD^1.3.6.1.4.1.19376.1.6.1.4.1^ISO” PID Segment Patient Identification (ignored – HIPAA) – may be useful for traceability, i.e. which patients have been associated with defective, out of rev, or out of calibration equipment PV1-3 Patient Location – ADT Assigned Patient Location – Unit^Room^Bed, alternative in case RTLS not supported OBR Event or Alarm Indication – OBR-3 Unique status update ID on event or alarm, OBR-4 Identifies the observation, OBR-29 Parent ID for multiple update notifications OBX Segment, multiple occurrences – pertinent parameters relating to alarm or event – OBX-3 Observation Identifier, OBX-4 Sub-ID FACET, OBX-5 Observation value, OBX-6 Units of Measurement, OBX-7 Range, OBX- 8 Flags (priority & class for alarms) – Source MDS/VMDS/Chan – OBX-14 Observation timestamp (yyyymmddhhmmss±zzzz) – OBX-18 Equipment identification (event or alarm source, not the application/gateway that sent it) How will equipment location (RTLS) be passed – OBX-5 when OBX-4 Sub ID FACET = 6 per ACM TI 2012

7. Medical Devices to CMMS for Reporting HL7 v2 Acknowledgement Content as Sent by CMMS MSH-3 Sending Application – identifies CMMS as sender, MSH-4 Sending Facility – identifies instance of CMMS, MSH-5 Receiving Application, from original message, MSH-6 Receiving Facility, from original message MSH-7 Timestamp – when acknowledgement was sent, MSH-8 Security = Empty MSH-9 Message Type Identification – ACK^xxx^ACK (R01 Observation, R40 Alarm, R43 Event) MSH-10 Message Control – message ID # MSH-14,15,16,17,18,19,20,21 = Empty MSA-1 Acknowledgement Code – “AA”=Ok, “AR”=Retransmit, “AE”=Error MSA-2 Message ID of message being acknowledged MSA-4 Expected Sequence Number, for transport error retransmission ERR Segment – used to indicate specifics of an error - ERR-2 Error Location, ERR-3 Error Code, ERR-4 Severity, ERR-5 Application Error Code

8. Medical Devices as ACM AR to AM to AC for Staff Notifications Overview (UC # 3 & 4) Medical equipment sends messages as ACM AR to ACM AM to ACM AC for delivery to staff (clinician/biomed) – Device in need of assistance (door, syringe, paper out) – Workflow – dose end, bag empty, bag near empty, leads off – Equipment management events – Battery management Medical Devices – Infusion Pumps, Patient Monitoring Patient Specific Information is Ignored (HIPAA) Equipment identification is significant Equipment location is significant

9. Medical Devices as ACM AR to AM to AC for Staff Notifications Message Flow Medical Device as ACM AR ACM AM ACM AC IHE PCD-07 WCTP Implementation Specific Alarm or Event Receipt Acknowledgement IHE PCD-04 HL7 v2 ORU^R40 HL7 v2 ACK IHE PCD-06 WCTP Disseminate Notification Status Updates (delivery, read) & Replies (accept, reject)

10. Medical Devices as ACM AR to AM to AC for Staff Notifications IHE PCD-04 (HL7 v2) Message Content sent by AR MSH-3 Sending Application – identifies sending application, MSH-4 Sending Facility – identifies instance of application, MSH-5 – identifies receiving ACM AM application, MSH-6 – identifies receiving ACM AM instance MSH-7 Timestamp – when message was sent (yyyymmddhhmmss±zzzz), MSH-8 Security = Empty MSH-9 Message Type Identification – ORU^R40^ORU_R40 (alarm or alert) MSH-10 Message Control – message ID #, MSH-11 Processing ID = “P”, MSH-12 HL7 Version ID = “2.6” MSH-13 Sequence Number – for transport error retransmission, MSH-14 Continuation Pointer = Empty MSH-15 Accept Acknowledgement Type = “NE”, MSH-16 Application Acknowledgement Type = “AL” MSH-17 Country Code = Empty, MSH-18 Character Set – either Empty or “ASCII” MSH-19 Principal Language – either Empty or “EN^English^ISO639”, MSH-20 Alternate Character Set = Empty MSH-21 Message Profile Identifier – for alarms = “IHE_PCD_ACM_001^IHE PCD^1.3.6.1.4.1.19376.1.6.1.4.1^ISO” PID Segment Patient Identification (ignored – HIPAA) – may be useful for traceability, i.e. which patients have been associated with defective, out of rev, or out of calibration equipment PV1-3 Patient Location – ADT Assigned Patient Location – Unit^Room^Bed, alternative in case RTLS not supported OBR Event or Alarm Indication – OBR-3 Unique status update ID on event or alarm, OBR-4 = “ALARM^ALARM”, OBR-29 Parent ID for multiple update notifications OBX Segment, multiple occurrences – pertinent parameters relating to alarm or event OBX-3 Observation Identifier, OBX-4 Sub-ID FACET, OBX-5 Observation value, OBX-6 Units of Measurement, OBX-7 Range, OBX-8 Flags (priority & class for alarms) Source MDS/VMDS/Chan OBX-14 Observation timestamp (yyyymmddhhmmss±zzzz) OBX-18 Equipment identification (event or alarm source, not the application/gateway that sent it) How will equipment location (RTLS) be passed – OBX-5 when OBX-4 Sub ID FACET = 6 per ACM TI 2012

11. CMMS as ACM AR to AM to AC for Staff Notifications Overview (UC # 5 & 6) CMMS sends messages as ACM AR to ACM AM to ACM AC for delivery to staff (clinician/biomed) – Device in need of forced maintenance – Outside utilization limit – Periodic workflow – Used and needs cleaning, Time for calibration – Equipment management – Replace battery, Needs S/W Update Medical Devices – Infusion Pumps, Patient Monitoring Equipment identification is significant Equipment location is significant

12. CMMS as ACM AR to AM to AC for Staff Notifications Message Flow CMMS as ACM AR ACM AM ACM AC IHE PCD-07 WCTP Implementation Specific Alarm or Event Receipt Acknowledgement IHE PCD-04 HL7 v2 ORU^R40 HL7 v2 ACK IHE PCD-06 WCTP Disseminate Notification Status Updates (delivery, read) & Replies (accept, reject)

13. CMMS as ACM AR to AM to AC for Staff Notifications IHE PCD-04 (HL7 v2) Message Content sent by CMMS MSH-3 Sending Application – identifies CMMS application, MSH-4 Sending Facility – identifies instance of CMMS, MSH-5 – identifies receiving application, MSH-6 – identifies receiving application instance MSH-7 Timestamp – when message was sent (yyyymmddhhmmss±zzzz), MSH-8 Security = Empty MSH-9 Message Type Identification – ORU^R40^ORU_R40 alarm or alert MSH-10 Message Control – message ID #, MSH-11 Processing ID = “P”, MSH-12 HL7 Version ID = “2.6” MSH-13 Sequence Number – for transport error retransmission, MSH-14 Continuation Pointer = Empty MSH-15 Accept Acknowledgement Type = “NE”, MSH-16 Application Acknowledgement Type = “AL” MSH-17 Country Code = Empty, MSH-18 Character Set – either Empty or “ASCII” MSH-19 Principal Language – either Empty or “EN^English^ISO639”, MSH-20 Alternate Character Set = Empty MSH-21 Message Profile Identifier – for alarms = “IHE_PCD_ACM_001^IHE PCD^1.3.6.1.4.1.19376.1.6.1.4.1^ISO” PID Segment Patient Identification (ignored – HIPAA) – may be useful for traceability, i.e. which patients have been associated with defective, out of rev, or out of calibration equipment PV1-3 Patient Location – ADT Assigned Patient Location – Unit^Room^Bed, alternative in case RTLS not supported OBR Event or Alarm Indication – OBR-3 Unique status update ID on event or alarm, OBR-4 = “ALARM^ALARM”, OBR-29 Parent ID for multiple update notifications OBX Segment, multiple occurrences – pertinent parameters relating to alarm or event OBX-3 Observation Identifier, OBX-4 Sub-ID FACET, OBX-5 Observation value, OBX-6 Units of Measurement, OBX-7 Range, OBX-8 Flags (priority & class for alarms) Source MDS/VMDS/Chan OBX-14 Observation timestamp (yyyymmddhhmmss±zzzz) OBX-18 Equipment identification (event or alarm source, not the application/gateway that sent it) How will equipment location (RTLS) be passed – OBX-5 when OBX-4 Sub ID FACET = 6 per ACM TI 2012

14. CMMS as ACM AR to AM to AC for Staff Notifications HL7 v2 Acknowledgement Content Received by CMMS MSH-3 Sending Application – identifies ACM AM application, MSH-4 Receiving Facility – identifies ACM AM application instance, MSH-5 Receiving Application – identifies CMMS applicaiton, MSH-6 Receiving Facility – identifies CMMS application instance MSH-7 Timestamp – when acknowledgement was sent, MSH-8 Security = Empty MSH-9 Message Type Identification – ACK^xxx^ACK (R01 Observation, R40 Alarm, R43 Event) MSH-10 Message Control – message ID # MSH-14,15,16,17,18,19,20,21 = Empty MSA-1 Acknowledgement Code – “AA”=Ok, “AR”=Retransmit, “AE”=Error MSA-2 Message ID of message being acknowledged MSA-4 Expected Sequence Number, for transport error retransmission ERR Segment – used to indicate specifics of an error - ERR-2 Error Location, ERR-3 Error Code, ERR-4 Severity, ERR-5 Application Error Code