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Pulmonary Symposium Presentation on Critical Care Presentation Transcript

  • 1. Critical Care in the 21st century A survey of the information technology landscape required to support intensivists and other clinicians in the ICU Dr. John Zaleski Product Manager, Soarian Critical Care Siemens Medical Solutions USA
  • 2. Overview The Specialty Landscape The State of Critical Care Key Requirements The Scope of the Integration Challenge Communication & Connectivity Device-level Interfaces Device Gateways Standards Futures © 2008 Siemens Medical Solutions USA, Inc.
  • 3. Increasing Demand, Limited or Decreasing Supply The Specialty Landscape:§ Billions of $ (US)‡ Allergists & Immunologists: shortage within next 20 years $5,000 Anesthesia: shortage projected through 2015 $4,000 Cardiology: 20% decrease by 2020 $3,000 Child Psych: HHS concluded US should have >30,000 $2,000 but currently <7,000 practicing $1,000 Critical Care: demand exceeds supply through 2020 $0 Dermatology: Nearly half of current community state 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 field can use more % GDP‡ Emergency Medicine: overburdened, under-funded, highly fragmented Endocrinology: current demand exceeds supply by 15% 20% Geriatrics: currently only meet 35% of estimated need 19% Medical Genetics: 58% of current slots unfilled. 17 18% states report shortages and 5-15 year projection indicates continued trend. 17% Neurosurgery: severe decline in number of active 16% neurosurgeons and a static field of residents 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Oncology: demand expected to increase by 48% through 2020 Pediatric Subspecialties: lack of adequately trained •Psychiatry: average age of practitioners is ~56 years and pediatric providers force children to seek care from adult percentage < 40 declined from 24% in 1989 to 8% in 2002 specialists •Rheumatology: average wait for a new appointment of 38 Primary Care: on verge of collapse days ‡Cinda Becker, “Slow: Budget Danger Ahead,” Modern Healthcare. March 3rd, 2008. §”Recent Studies and Reports on Physician Shortages in the US,” Center for Workforce Studies, Association of American Medical Colleges, August 2007. © 2008 Siemens Medical Solutions USA, Inc. J. Zaleski 21 October 2009
  • 4. State of Acute Care Space American College of Physicians estimate 500,000 deaths annually in ICUs (U.S.) Key Drivers (Millenium Research Group) Patient safety Longitudinal EMR deployment Increase efficiency Staffing shortages Increasing numbers of CC beds Larger amounts of hemodynamic, respiratory, I&O information will be automated Motivates enterprise integration Reduces charting workload Improves completeness, accuracy © 2008 Siemens Medical Solutions USA, Inc.
  • 5. Key Requirements © 2008 Siemens Medical Solutions USA, Inc.
  • 6. Key Requirements A complete record © 2008 Siemens Medical Solutions USA, Inc.
  • 7. Key Requirements A complete record All inbound hemodynamic, vitals data from monitors © 2008 Siemens Medical Solutions USA, Inc.
  • 8. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) © 2008 Siemens Medical Solutions USA, Inc.
  • 9. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics & mechanical ventilation charting © 2008 Siemens Medical Solutions USA, Inc.
  • 10. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics & mechanical ventilation charting Scoring © 2008 Siemens Medical Solutions USA, Inc.
  • 11. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics & mechanical ventilation charting Scoring Waveforms © 2008 Siemens Medical Solutions USA, Inc.
  • 12. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics Scoring Waveforms Clinical decision support tools © 2008 Siemens Medical Solutions USA, Inc.
  • 13. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics Scoring Waveforms Clinical decision support tools Effective, intuitive, displays © 2008 Siemens Medical Solutions USA, Inc.
  • 14. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics Scoring Waveforms Clinical decision support tools Effective, intuitive, displays Data in the eyespan © 2008 Siemens Medical Solutions USA, Inc.
  • 15. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics Scoring Waveforms Clinical decision support tools Effective, intuitive, displays Data in the eyespan Trending, flowsheet all in one view © 2008 Siemens Medical Solutions USA, Inc.
  • 16. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics Scoring Waveforms Clinical decision support tools Effective, intuitive, displays Data in the eyespan Trending, flowsheet all in one view Tailored views © 2008 Siemens Medical Solutions USA, Inc.
  • 17. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics Scoring Waveforms Clinical decision support tools Effective, intuitive, displays Data in the eyespan Trending, flowsheet all in one view Tailored views Accessibility © 2008 Siemens Medical Solutions USA, Inc.
  • 18. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics Scoring Waveforms Clinical decision support tools Effective, intuitive, displays Data in the eyespan Trending, flowsheet all in one view Tailored views Accessibility From anywhere (including home) © 2008 Siemens Medical Solutions USA, Inc.
  • 19. Key Requirements A complete record All inbound hemodynamic data, vitals data from monitors Support for fluids I&O (with automated intakes for IV drips, where possible) Integrated respiratory mechanics Scoring Waveforms Clinical decision support tools Effective, intuitive, displays Data in the eyespan Trending, flowsheet all in one view Tailored views Accessibility From anywhere (including home) Ability to detect user, role and authenticate automatically © 2008 Siemens Medical Solutions USA, Inc.
  • 20. Key Requirements Reliability & Availability, Performance © 2008 Siemens Medical Solutions USA, Inc.
  • 21. Key Requirements Reliability & Availability, Performance The best system is the one which remains unnoticed © 2008 Siemens Medical Solutions USA, Inc.
  • 22. Key Requirements Reliability & Availability, Performance The best system is the one which remains unnoticed Display updates < 3 seconds © 2008 Siemens Medical Solutions USA, Inc.
  • 23. Key Requirements Reliability & Availability, Performance The best system is the one which remains unnoticed Display updates < 3 seconds “Drop-down boxes are the work of the devil” (Don Rucker, MD) © 2008 Siemens Medical Solutions USA, Inc.
  • 24. Key Requirements Reliability & Availability, Performance The best system is the one which remains unnoticed Display updates < 3 seconds “Drop-down boxes are the work of the devil” (Don Rucker, MD) Fewer mouse clicks © 2008 Siemens Medical Solutions USA, Inc.
  • 25. Key Requirements Reliability & Availability, Performance The best system is the one which remains unnoticed Display updates < 3 seconds “Drop-down boxes are the work of the devil” (Don Rucker, MD) Fewer mouse clicks Plug and play connectivity © 2008 Siemens Medical Solutions USA, Inc.
  • 26. Key Requirements Reliability & Availability, Performance The best system is the one which remains unnoticed Display updates < 3 seconds “Drop-down boxes are the work of the devil” (Don Rucker, MD) Fewer mouse clicks Plug and play connectivity Medical devices associate with critical care information system software automatically © 2008 Siemens Medical Solutions USA, Inc.
  • 27. Key Requirements Reliability & Availability, Performance The best system is the one which remains unnoticed Display updates < 3 seconds “Drop-down boxes are the work of the devil” (Don Rucker, MD) Fewer mouse clicks Plug and play connectivity Medical devices associate with critical care information system software automatically Patient association is automatic and does not require user intervention © 2008 Siemens Medical Solutions USA, Inc.
  • 28. Key Requirements Reliability & Availability, Performance The best system is the one which remains unnoticed Display updates < 3 seconds “Drop-down boxes are the work of the devil” (Don Rucker, MD) Fewer mouse clicks Plug and play connectivity Medical devices associate with critical care information system software automatically Patient association is automatic and does not require user intervention Logging of device settings changes © 2008 Siemens Medical Solutions USA, Inc.
  • 29. Key Requirements Reliability & Availability, Performance The best system is the one which remains unnoticed Display updates < 3 seconds “Scrolling list boxes are the tool of the devil” (Don Rucker, MD) Fewer mouse clicks Plug and play connectivity Medical devices associate with critical care information system software automatically Patient association is automatic and does not require user intervention Logging of device settings changes Automatic detection of new devices © 2008 Siemens Medical Solutions USA, Inc.
  • 30. Key Technology Enablers © 2008 Siemens Medical Solutions USA, Inc.
  • 31. Key Technology Enablers Real-time location services © 2008 Siemens Medical Solutions USA, Inc.
  • 32. Key Technology Enablers Real-time location services Radio frequency identification using passive and active technologies Patient identification (passive) Patient location (active) Device identification (passive) Device location (active) © 2008 Siemens Medical Solutions USA, Inc.
  • 33. Key Technology Enablers Real-time location services Radio frequency identification using passive and active technologies Patient identification (passive) Patient location (active) Device identification (passive) Device location (active) Portable computing device technology © 2008 Siemens Medical Solutions USA, Inc.
  • 34. Key Technology Enablers Real-time location services Radio frequency identification using passive and active technologies Patient identification (passive) Patient location (active) Device identification (passive) Device location (active) Portable computing device technology iPhone, BlackBerry © 2008 Siemens Medical Solutions USA, Inc.
  • 35. Key Technology Enablers Real-time location services Radio frequency identification using passive and active technologies Patient identification (passive) Patient location (active) Device identification (passive) Device location (active) Portable computing device technology iPhone, BlackBerry Portable PCs © 2008 Siemens Medical Solutions USA, Inc.
  • 36. Medical Device Connectivity: Essential to Future Vision © 2008 Siemens Medical Solutions USA, Inc.
  • 37. Medical Device Connectivity: Essential to Future Vision The Base © 2008 Siemens Medical Solutions USA, Inc.
  • 38. Medical Device Connectivity: Essential to Future Vision The Base Patient survival is dependent upon the devices in the environment Data are the manner of communication in technologically-dependent patients © 2008 Siemens Medical Solutions USA, Inc.
  • 39. Medical Device Connectivity: Essential to Future Vision The Base Patient survival is dependent upon the devices in the environment Data are the manner of communication in technologically-dependent patients The Catalyst © 2008 Siemens Medical Solutions USA, Inc.
  • 40. Medical Device Connectivity: Essential to Future Vision The Base Patient survival is dependent upon the devices in the environment Data are the manner of communication in technologically-dependent patients The Catalyst Displays, flowsheets are the windows to the data Complete and accurate records can only be achieved through data collection © 2008 Siemens Medical Solutions USA, Inc.
  • 41. Medical Device Connectivity: Essential to Future Vision The Base Patient survival is dependent upon the devices in the environment Data are the manner of communication in technologically-dependent patients The Catalyst Displays, flowsheets are the windows to the data Complete and accurate records can only be achieved through data collection The Enabler © 2008 Siemens Medical Solutions USA, Inc.
  • 42. Medical Device Connectivity: Essential to Future Vision The Base Patient survival is dependent upon the devices in the environment Data are the manner of communication in technologically-dependent patients The Catalyst Displays, flowsheets are the windows to the data Complete and accurate records can only be achieved through data collection The Enabler Workflow, clinical decision support require data Decision making and patient care management hinge upon the state of the patient as determined through observations and findings © 2008 Siemens Medical Solutions USA, Inc.
  • 43. Understanding the Scope of Medical Device Connectivity Challenges © 2008 Siemens Medical Solutions USA, Inc.
  • 44. Medical Device Connectivity For the most part, seamless integration between devices and IT systems is possible…as long as standard interfaces are employed Tailoring of interfaces, even with standards, is almost always required (e.g.: HL7 R01 components & segments) Even standards have their limits and, in some circumstances, unique and custom interfaces are required Best practices can vary by customer enterprise, clinical workflow, user preferences © 2008 Siemens Medical Solutions USA, Inc.
  • 45. Devices Self-contained Workstations (e.g.: Nursing station monitors, MRI & CT Scan monitors) Multiple measurement (e.g.: Med/Surg & ICU Monitors, Ventilators) s) tor tila ) O) 8% en ) H2 ,v =9 ce ers tra O2 cm =5 ak Sp G ) C P , era m .E EE ce 7C E) e.g Pa am =3 ,P OL s ( .g. C g. 12 .T . ST g V rm l (e (e. Single measurement e SI M efo dio ( SY tro ts .g. av .A on en (e.g.: glucometers, thermometers, stethoscopes, u e.g e W A C rem ngs ( s( P & eo & ote su probes) i arm TC ett em ea id Al R R V S M Data Point-to-point serial Point-to-point wireless (e.g.: blue tooth, IR) Fixed IP Network enabled (e.g.: TCP/IP & Multicast over Ethernet) DHCP IP Network enabled (e.g.: TCP/IP & Multicast over Ethernet) Wireless Network enabled (e.g.: TCP/IP & Multicast over Ethernet) Secure Wireless Network compliant (e.g.: WPA, WPA2) lo ity no tiv gy ch ec Te onn C © 2008 Siemens Medical Solutions USA, Inc.
  • 46. Devices Self-contained Workstations (e.g.: Nursing station monitors, MRI & CT Scan monitors) Multiple measurement (e.g.: Med/Surg & ICU Monitors, Ventilators) s) tor tila ) O) 8% en ) H2 ,v =9 ce ers tra O2 cm =5 ak Sp G ) C P , era m .E EE ce 7C E) e.g Pa am =3 ,P OL s ( .g. C g. 12 .T . ST g V rm l (e (e. Single measurement e SI M efo dio ( SY tro ts .g. av .A on en (e.g.: glucometers, thermometers, stethoscopes, u e.g e W A C rem ngs ( s( P & eo & ote su probes) i arm TC ett em ea id Al R R V S M rs Data ito on Point-to-point serial M U IC Point-to-point wireless (e.g.: blue tooth, IR) Fixed IP Network enabled (e.g.: TCP/IP & Multicast over Ethernet) DHCP IP Network enabled (e.g.: TCP/IP & Multicast over Ethernet) Wireless Network enabled (e.g.: TCP/IP & Multicast over Ethernet) Secure Wireless Network compliant (e.g.: WPA, WPA2) lo ity no tiv gy ch ec Te onn C JR Zaleski © 2008 © 2008 Siemens Medical Solutions USA, Inc.
  • 47. Communication & Connectivity © 2008 Siemens Medical Solutions USA, Inc.
  • 48. Devices → EMR Respiratory Critical Care Vital Signs Infusion Ad Hoc Vital Signs Scales Results, Findings, EMR Notifications (e.g.: to event queues) Glucose © 2008 Siemens Medical Solutions USA, Inc.
  • 49. EMR → Devices Respiratory Critical Care Vital Signs Infusion Ad Hoc Vital Signs Scales Admission, Discharge, EMR Transfer (where applicable/possible) Glucose © 2008 Siemens Medical Solutions USA, Inc.
  • 50. The essence of the challenge: Communication Many organizations, IEEE, IHE, AHIMA, Individual Device communication, for AAMI, HL7, ACCE, are actively the most part, is non-standard. engaged in promoting standards and Many manufacturers provide proprietary their development. interfaces that follow the EIA232 (i.e., However, even with standards there is RS232) interface requirements, but no no consensus on the best methods for informational formatting requirements device integration. Especially true of smaller, handheld devices (glucometers, flow meters, home blood For example: IEEE 11073 pressure equipment, pulse oximeters, etc.) Thus, claims seamless interfacing are Larger manufacturers—especially those simply not the case: device-level producing vital signs monitors, and interface standards are still not some in the infusion pump market— universally adhered to by device provide gateways. manufacturers. Systems within systems that provide both Yet, the HL7 standard (v2.x and an internal proprietary mechanism for beyond) does provide a framework for communication and a gateway for data communication among disparate establishing a more ubiquitous interface via systems (focused more on interfacing an HL7 messaging approach. of IT systems than medical devices) © 2008 Siemens Medical Solutions USA, Inc.
  • 51. © 2008 Siemens Medical Solutions USA, Inc.
  • 52. © 2008 Siemens Medical Solutions USA, Inc.
  • 53. © 2008 Siemens Medical Solutions USA, Inc.
  • 54. Device-Level Interfaces © 2008 Siemens Medical Solutions USA, Inc.
  • 55. Device Level Interfaces Can be developed using standard Example: Servo-i ventilator Query Sending: RB♦ programming languages Received: 196224862094248920703066229021502317222521462048♦ E.g.: Java supports mature serial Sending: RT♦ communication libraries Received: 031204144241♦ nResults: 12 Response Typically operate in Query- sf = 5000.0 Response mode data = 1962 Asynchronous ::::: -0.0839876 OBX|1|NM|mib Flow^local^8462-4^^LAB||-0.0839876|l/s|||||C|||20031204144241 Proprietary command language sf = 5000.0 Examples data = 2486 ::::: 0.4277508 Mechanical ventilators OBX|1|NM|mib Tvi^local^8462-4^^LAB||0.4277508|l|||||C|||20031204144241 Medical / Surgical Monitors sf = 50.0 Glucometers data = 2094 ::::: 4.49236 Scales OBX|1|NM|mib IAP^local^8462-4^^LAB||4.49236|cm H2O|||||C|||20031204144241 … © 2008 Siemens Medical Solutions USA, Inc.
  • 56. Device Level Interfaces (continued) Not all devices of the same class even produce the same data feeds Different nomenclature Uncertain parameter mappings Example: Servo versus Puritan Bennett Ventilators Expiratory & Inspiratory Minute, Tidal Volumes (Servo) versus Minute, Tidal Volume (7200ae) Example: Vital Sign definitions require some mapping between ad hoc monitors—a posteriori calculation required to equate parameter streams Spot Vitals Signs Monitor temperature data Kelvin, Celsius, Fahrenheit Dinamap temperature data Celsius, Fahrenheit © 2008 Siemens Medical Solutions USA, Inc.
  • 57. Device Level Interfaces (continued) Example: Servo-i ventilator Sending: RB♦ Received: 196224862094248920703066229021502317222521462048♦ Sending: RT♦ Received: 031204144241♦ nResults: 12 sf = 5000.0 data = 1962 ::::: -0.0839876 OBX|1|NM|mib Flow^local^8462-4^^LAB||-0.0839876|l/s|||||C|||20031204144241 sf = 5000.0 data = 2486 ::::: 0.4277508 OBX|1|NM|mib Tvi^local^8462-4^^LAB||0.4277508|l|||||C|||20031204144241 sf = 50.0 data = 2094 ::::: 4.49236 OBX|1|NM|mib IAP^local^8462-4^^LAB||4.49236|cm H2O|||||C|||20031204144241 Inspiratory Tidal Volume vs Tidal Volume © 2008 Siemens Medical Solutions USA, Inc.
  • 58. Device Level Interfaces (continued) Not all devices communicate in same base Some Glucometers, scales, ad-hoc device monitors But, manufacturer-published interfaces facilitate custom development (e.g.: Dinamap, Spot Vitals, Critikon, etc.) Transmit (ASCII) Receive (HEXADECIMAL) © 2008 Siemens Medical Solutions USA, Inc.
  • 59. Device Level Interfaces (continued) Some devices support synchronous communication Transmit all the time Either write to file or transmit over network B.Braun infusion pump Volume Delivered (ml) © 2008 Siemens Medical Solutions USA, Inc.
  • 60. Device Gateways © 2008 Siemens Medical Solutions USA, Inc.
  • 61. Networked Medical Devices Many critical care monitors & other devices communicate via Ethernet to Gateways— Serial Critical Care Infusion Pump Ventilator central points of Monitor communication within a Proprietary communication proprietary network. VL 2 AN A N3 VL Nursing Gateway Server Workstation Access Point Device Subnet Hardwired Ethernet Standards-based communication Critical Care Router Monitor HL7 Communication Cisco 3524 swtich Enterprise Network © 2008 Siemens Medical Solutions USA, Inc.
  • 62. Networked Medical Devices Inbound ADT can be communicated similarly Serial Scope of data content driven Critical Care Infusion Pump Ventilator Monitor by device manufacturers Wireless Ethernet specifications Proprietary communication VL 2 AN A VL N3 Nursing Gateway Server Workstation Access Point Serial-to- Ethernet Adapters (hard- Device Subnet wired) Standards-based communication Critical Care Router Serial-to- Monitor Bluetooth Adapters Cisco 3524 swtich Serial-to-Wi-fi Adapters Enterprise Network © 2008 Siemens Medical Solutions USA, Inc.
  • 63. Standards © 2008 Siemens Medical Solutions USA, Inc.
  • 64. © 2008 Siemens Medical Solutions USA, Inc.
  • 65. Example: HL7 Unsolicited Observation Result: the R01 Transaction Message Header Segment 4D 53 48 7C 5E 7E 5C 26 7C 49 6E 66 69 6E 69 74 MSH|^~&|Infinit 00000 79 7C 7C 4E 55 52 7C 7C 32 30 30 33 30 33 32 38 y||NUR||20030328 00010 30 38 31 31 7C 7C 4F 52 55 5E 52 30 31 7C 7C 50 0811||ORU^R01||P 00020 7C 32 2E 33 0D 00 00 00 00 00 00 00 00 00 00 00 |2.3............ 00030 Patient Identifier Segment 50 49 44 7C 7C 7C 30 30 30 30 30 30 30 30 32 38 PID|||0000000028 00000 30 31 5E 5E 5E 5E 45 78 74 65 72 6E 61 6C 50 61 01^^^^ExternalPa 00010 74 69 65 6E 74 49 44 7C 7C 6E 75 6C 6C 5E 6E 75 tientID||null^nu 00020 6C 6C 7C 7C 7C 55 0D 00 00 00 00 00 00 00 00 00 ll|||U.......... 00030 4F 42 52 7C 7C 7C 7C 30 30 30 30 30 30 30 30 32 OBR||||000000002 00000 38 30 31 7C 7C 7C 32 30 30 33 30 33 32 38 30 38 801|||2003032808 00010 31 31 7C 7C 7C 7C 7C 7C 7C 7C 7C 7C 7C 7C 7C 7C 11|||||||||||||| 00020 7C 7C 7C 7C 7C 7C 32 30 26 30 33 5E 30 33 5E 32 ||||||20&03^03^2 00030 38 5E 30 38 31 31 0D 00 00 00 00 00 00 00 00 00 8^0811.......... 00040 Observation: OBX Segment (Patient Pulse) 4F 42 58 7C 7C 53 4E 7C 48 52 5E 5E 6C 6F 63 61 OBX||SN|HR^^loca 00000 6C 5E 38 38 36 37 2D 34 5E 5E 4C 4F 49 4E 43 7C l^8867-4^^LOINC| 00010 7C 36 37 7C 2F 6D 69 6E 5E 5E 49 53 4F 2B 7C 7C |67|/min^^ISO+|| 00020 7C 7C 7C 52 7C 7C 7C 32 30 30 33 30 33 32 38 30 |||R|||200303280 00030 38 31 31 0D 00 00 00 00 00 00 00 00 00 00 00 00 811............. 00040 Observation: OBX Segment (Patient Respiratory Rate) 4F 42 58 7C 7C 53 4E 7C 52 45 53 50 5E 5E 6C 6F OBX||SN|RESP^^lo 00000 63 61 6C 5E 39 32 37 39 2D 31 5E 5E 4C 4F 49 4E cal^9279-1^^LOIN 00010 43 7C 7C 7C 2F 6D 69 6E 5E 5E 49 53 4F 2B 7C 7C C|||/min^^ISO+|| 00020 7C 7C 7C 52 7C 7C 7C 32 30 30 33 30 33 32 38 30 |||R|||200303280 00030 Observation: OBX Segment (Patient O2 38 31 31 0D 00 00 00 00 00 00 00 00 00 00 00 00 811............. 00040 Saturation) 4F 42 58 7C 7C 53 4E 7C 53 70 4F 32 5E 5E 6C 6F OBX||SN|SpO2^^lo 00000 63 61 6C 5E 32 37 31 30 2D 32 5E 5E 4C 4F 49 4E cal^2710-2^^LOIN 00010 43 7C 7C 39 37 7C 25 5E 5E 49 53 4F 2B 7C 7C 7C C||97|%^^ISO+||| 00020 7C 7C 52 7C 7C 7C 32 30 30 33 30 33 32 38 30 38 ||R|||2003032808 00030 31 31 0D 00 00 00 00 00 00 00 00 00 00 00 00 00 11.............. 00040 © 2008 Siemens Medical Solutions USA, Inc.
  • 66. Future © 2008 Siemens Medical Solutions USA, Inc.
  • 67. Remember the objective… It’s about the data required to support patient care © 2008 Siemens Medical Solutions USA, Inc.
  • 68. Examples of Evolving Capabilities Wireless connectivity to devices Enterprise-wide communication (through existing hospital LANs) Plug-and-play device connectivity Medical device control (ventilation, infusion) Device-patient association (e.g.: radio frequency identification) Integrated infusion for automated intake calculations (I&O) Early warning based on patient state (combination of clinical decision support and expert systems / neural networks) Extension of ICU telemetry across continuum of care (e.g.: ICU- Med/Surg->Outpatient) Telemetry-over-Internet © 2008 Siemens Medical Solutions USA, Inc.
  • 69. Available late Fall 2008… John Zaleski, Integrating Device Data into the Electronic Medical Record A Developer’s Guide to Design and a Practitioner’s Guide to Application ISBN 978‐3‐89578‐323‐4 A19100‐L531‐ B977‐X‐7600 Approx. 300 pages Approx. 100 illustrations Contents: The Medical Device Integration Landscape Device networking and communication Mechanisms for interfacing and integrating device data Real‐time and non‐real‐time data management Computer‐based patient record Correctly associating device data with patients Balancing data quantity with quality: techniques for data analysis and  reduction How to display data in a flowsheet Interface software as a medical device The future of medical device integration, Including Device Command & Control Example methods and software © 2008 Siemens Medical Solutions USA, Inc.