1. Invitation to Send, Interface, and/or Receive DMC and LS Data by Manny Furst, Improvement Technologies and Monroe Pattillo, Managing Member, Practical Health Interoperability, LLC PCD Planning Committee Co-Chair, Chair of the MEMDMC and MEMLS WGs PCD Meeting June 23, 2015

2. You Have The Ability To Dramatically Improve Device Management More effective and efficient management of medical devices – Maintenance – Availability – Reliability Improved safety and better patient care Accomplished with standards-based messages developed by the IHE-PCD

3. Introductory Meetings Introduction: What and Why Now; Available Support: today’s meeting Detailed Description: 3 Profiles: MEMDMC, MEMLS, ACM – A profile is a tightly constrained message, removing all optionality/variability not needed for the purpose. – MEMDMC: Medical Equipment Device Management Communication – MEMLS: Medical Equipment Device Location Services – ACM: Alert Communication Management NIST Resources: Test Tools and Rosetta Mapping: Available 24x7 at no charge

4. Introduction To Just A Few Folks The Patient Care Device domain (PCD) of Integrating the Healthcare Enterprise (IHE) is populated by an extremely competent, collaborative and cooperative group of developers and others who have developed a number of profiles supporting standards-based messaging for patient data. The Medical Equipment Management (MEM) initiative builds upon those HL7 v2 messages to provide interoperability to manage these systems. We cannot introduce all who contribute to PCD success, but will introduce those who will organize these webinars and help facilitate your implementation and assist you in participating in the Connectathon and Showcase demonstrations if you choose to do so.

5. Monroe Pattillo: Three Profiles Monroe Pattillo leads development of three PCD profiles: MEMDMC, MEMLS, ACM – Monroe is the managing member of Practical Health Interoperability, LLC and is an independent consultant in healthcare systems integration. Monroe is a Planning Committee Co-Chair of the IHE Patient Care Device Domain, the Co-Lead of the Alert Communication Management working group, and lead of the Medical Equipment Management working groups for Device Management Communication and for Location Services.

6. John Garguilo: Test Tools and Rosetta Mapping John Garguillo leads test tool development at the National Institute of Standards and Technology (NIST) – Computer Scientist, Software and Systems Division, Information Technology Laboratory The Rosetta Terminology Mapping (RTM)Project led by Paul Schluter (GE) provides a database assuring semantic interoperability. This database is hosted by NIST under John’s leadership.

7. Paul Sherman: Technical Program Manager of IHE-PCD Paul Sherman is Technical Program Manager for Integrating the Healthcare Enterprise, Patient Care Devices Domain (IHE-PCD). – Paul is president of Sherman Engineering, LLC, and He retired as Senior Biomedical Engineer with the Dept of Veterans Affairs Center for Engineering and Occupational Health, where he served as the VA's senior in-house medical technology consultant. Paul is also a President of the American College of Clinical Engineering.

8. Manny Furst: Technical Project Manager, HIMSS Interoperability Showcases Manny Furst is responsible for the technical aspects of PCD demonstrations in HIMSS Showcases. – Until July, 2014 he was also Technical Project Manager for the PCD domain responsible for PCD portions of the Connectathon and other domain responsibilities. Manny has managed clinical engineering departments and provided clinical engineering and environment of care consulting services. – Manny is president, Improvement Technologies, LLC

9. Your Participation You can make an important contribution to – Patient safety and patient care – Clinical productivity, workflow and job satisfaction – Equipment availability and reliability – Technology management and productivity – Customer satisfaction with your devices and systems

10. Imagine When Devices report Condition and call for service – Self-test passed/failed, battery charge level, battery or other component failure Devices report Status – In use/standby/paused and on/off Devices report Location – Location by itself or as part of device or patient data

11. These Profiles Have Been Demonstrated Location (RTLS) along with Patient Physiologic Data, Pump Data, Alerts Device Condition, Status reported to CMMS Location along with Device Condition, Status Alerts (alarms to a person, advisories for later reference) along with Patient and Pump Data

12. Fast and Easy Implement standards-based messaging Use Gateways/Interface Systems to support receiving and sending proprietary formatted data currently available from devices to avoid delay in implementation Use Gateways/Interface Systems already in place within hospitals as interfaces or aggregators

13. Standards-Based Messages IHE Standards-Based messages make it economically possible to send and receive data – Only one message profile is required to achieve semantic interoperability for device data and only one for location – Rosetta table provides unambiguous data – NIST test tools facilitate development – Connectathon provides supportive testing

14. Medical Equipment Management - Device Management Communication (MEMDMC) Messages MEMDMC DMIR MEMDMC DMIC Device Management Information Observation, DMIO PCD-15 CMMS/CEMS Information collected from sources Equipment identification Equipment power source (mains, battery) Network connection transition (wired, wireless) Base configuration and network changes Version data Reporter Consumer Battery status, charging status, self-test status Self-test, last attempted, last status Duty cycle status, # uses, time in use Calibration status, needed, last completed Usability status, clean/in use/dirty

15. Benefits of MEMDMC Messages MEMDMC DMIR MEMDMC DMIC DMIO PCD-15 CMMS/CEMS Reporter Consumer Benefits Automate maintenance management Device self-reports when repairs and other maintenance is required Self-test passed provides frequent assurance of safe and effective operation Device requests low level actions as well (please plug me in) Provide high level of patient safety Maintenance required linked to “in use” or “standby” requires immediate attention More information populated in CMMS for more complete record More specific report of failure modes Equipment identified prior to disappearance (battery, network) Potential for automatic work ticket generation in CMMS

16. Gateways as an interim solution If a vendor engineered embedded solution is not currently available then potentially a technically feasible solution can be achieved through the use of gateway systems (integration engines) The gateway can make use of its access to closed data plus open observations to achieve implementation of an open integration

17. Gateway Produced DMIO PCD-15 Messages MEMDMC DMIR Closed Data Source Open Data Source MEMDMC DMIC DMIO PCD-15 CMMS/CEMS Gateway Interface System Proprietary Reporter Consumer Gateway provides the ability to rapidly participate with whatever data is currently available Device vendors gain rapid participation Developers gain feedback from users regarding real needs Interface vendors add to existing products in place and saleable CMMS vendors need implement only one message

18. Similarly, Direct or Gateway LS Messages MEMLS LOR Report Location Observation, PCD-16 RTLS System Benefits Location data available wherever, whenever needed Maintenance is more efficient Provide even higher level of patient safety Maintenance required linked to “in use” or “standby” requires immediate attention AND location is known More information populated in CMMS for more complete record More specific data for utilization, accessibility of available devices Equipment identified when alarms are required MEMLS LOC CMMS/CEMS Consumer Reporter Open Data Source Closed Data Source Gateway Interface System

19. ACM Profile Alert Communication Management (ACM) – Alarms – human response required – Advisories – document for later review, action Alerts can be sent by – The device as is done with physiologic data – The gateway or the CMMS as defined by developers and users

20. Alert Communication Management (ACM) Basic Elements HL7 Messages per ACM and WCM profiles HL7 Messages per ACM and WCM profiles Parameters, waveforms, etc. as evidentiary data items Parameters, waveforms, etc. as evidentiary data items Device Specific graphics Device Specific graphics Alert Information Source, Phase, State, Priority PatientLocationInstance Alert text CallbackTimestamp Evidentiary data Dissemination Status Instance Accepted by AC UndeliverableDeliveredReadAcceptedRejectedCancelled Callback start/stop AlertCommunicatorACAlertCommunicatorACAlertManagerAMAlertManagerAMAlertReporterARAlertReporterAR Report Alert PCD-04 → ← PCD-05 Report Alert Status Disseminate Alert PCD-06 → ← PCD-07 Disseminate Alert Status Alert Source

21. PCD History The gateway approach was used in the early days of the PCD domain to demonstrate communication of patient physiologic observations (DEC profile, PCD-01) not yet integrated into observation source systems This provided the DEC profile with the ability to demonstrate its usefulness without having to wait for native integration implementations to be developed In early commercial deployments this approach also provided vendors with time to engineer native support for the DEC profile into their product

22. History Repeats Itself The gateway approach can once again be used to implement technically feasible solutions to produce… – MEMDMC observation messages from open or closed equipment observation sources – To improve DEC, ACM, and IPEC observations through the inclusion of MEMLS observation data

23. Profiles and Actor Mutability IHE profile observation message content are not isolated islands of communication Observations included in the messages of one profile can be cached and included in the observation messages of another profile I.e., DMC, LS and ACM messages can be sent at the same time, from the same source as our clinical messages (DEC and other profiles)

24. Combining Approaches: CMMS + RTLS RTLS Enhanced Messages MEMDMC DMIR Closed Data Source Open Data Source MEMDMC DMIC DMIO PCD-15 CMMS/CEMS Gateway Proprietary DEC DOR IPEC DOR PCD-01 PCD-10 Reporter Consumer Benefits Reduced CE work steps trying to find equipment needing service CMMS doesn’t have to integrate with RTLS system Gateway need only integrate with one RTLS integration interface MEMLS Gateway and CMMS are abstracted from LS implementation technology MEMLS LOR PCD-16 RTLS System

25. Why Participate? Join your peers in advancing interoperability - In a safe, highly collaborative venue. Focus on your core business - limit your interface design costs. Simplify logistics for updates and recalls http://www.iheusa.org/about-iheinternational- benefits.aspx

26. Available Resources Monroe led weekly (mostly) MEM and ACM WGs – Be Sure You Are In The Google Groups A Sample of IHE Resources – IHE: www.ihe.netwww.ihe.net – Test Tools (General): http://www.ihe.net/Testing_Tools/ http://www.ihe.net/Testing_Tools/ – IHE-PCD: www.ihe.net/pcdwww.ihe.net/pcd

27. For More Detail PCD ftp Site ftp://ftp.ihe.net/Patient_Care_Devices/ PCD Tests ftp://ftp.ihe.net/Patient_Care_Devices/ConnectathonsI ncludingProcessAndTesting/YR9-2015Connectathon- NIST-And-Virtual/YR9- 2015%20North%20American%20Connectathon%20Test ing/

28. PCD Messages and Test Schedule June – Sep: Review/add/update tests Oct – Nov: Pre Connectathon Late Jan: F2F Connectathon

29. The Financials The PCD messages are open source and available on line To Join IHE: More than 250 employees: $1,500 4 to 250 employees: $500 Less than 4 employees: $250

30. Connectathon Participation, Cleveland Connectathon participation is voluntary; however it may be required to participate in a Showcase Systems First system - $8400; may include two people Other systems - $4300 People $300 each preregistered $550 late and on-site

31. Showcase Participation http://www.interoperabilityshowcase.org/ Fees not yet available for 2016 HIMSS16 AAMI 2016

32. Discussion Contact Information: – Manny Furst efurst@imp-tech.comefurst@imp-tech.com – O: (520) 721-2856, M: (520) 405-2140 – Monroe Pattillo monroe.pattillo@gmail.commonroe.pattillo@gmail.com – M: (954) 398-5534 – John Garguilo John.Garguilo@nist.govJohn.Garguilo@nist.gov – O: (301) 975-5248 – Paul Sherman paulrshermancce@gmail.compaulrshermancce@gmail.com – O: (314) 752-3487, M: (314) 422-2688