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Connected Medical Devices in the Internet of Things
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Connected Medical Devices in the Internet of Things


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The next wave of the Internet will connect machines and devices together into functioning, intelligent systems. This "Internet of Things" (IoT) will change every industry, every job, and every home. …

The next wave of the Internet will connect machines and devices together into functioning, intelligent systems. This "Internet of Things" (IoT) will change every industry, every job, and every home. How will it impact medicine? When?

This webinar will reveal how the Internet of Things is changing medicine today by examining real applications of advanced networking technology. The applications include from 911 dispatch, EMS transport, imaging, surgery, ICU interoperability, patient safety, hospital integration, and treatment. We will discuss critical needs: finding the right data, delivering high-fidelity waveforms, integrating large hospital systems, ensuring EMR accuracy, and guarding sensitive information.

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  • 1. Connected Medical Devices in the Internet of Things Emergency Response, Patient Safety, Imaging, Surgery, Advanced Treatment Your systems. Working as one.
  • 2. “Last Mile problems” Example - Infusion technology: 1. Decision support? 2. Prevent contra-indicated infusion? 3. “Artificial pancreas” Capabilities? (closed loop) 4. Consolidate all data for adverse event analysis? 5. Check device status, software version? Recall? 6. Support Meaningful Use #3? © 2014 Real-Time Innovations, Inc.
  • 3. SpO2 must be interpreted appropriately. Erroneous data points could be flagged/rejected 1. BP cuff inflation status is not recorded in EHR 2. Waveforms not recorded NIBP-SpO2 Interaction © 2014 Real-Time Innovations, Inc.
  • 4. Problem – Pulse-rate counting error due to atypical plethysmogram. Other monitor data could be used to detect and reject this error. Waveforms could be recorded to enable manufacturers to improve device algorithms. ECG data ECG data Pulse Ox data EMR data © 2014 Real-Time Result: False alarms, incorrect data in Innovations, Inc. record. permanent
  • 5. What Can Change That? © 2014 Real-Time Innovations, Inc.
  • 6. The Internet of Things © 2014 Real-Time Innovations, Inc.
  • 7. 2014 Top Tech Trends • 1) Internet of Things • The IoT promises to be the most disruptive technological revolution since the advent of the World Wide Web. Projections indicate that up to 100 billion uniquely identifiable objects will be connected to the Internet by 2020, with enormous technical, socioeconomic, political, and even spiritual consequences. © 2014 Real-Time Innovations, Inc.
  • 8. What is the Internet of Things? • Cisco “Internet of Everything” – …the latest wave of the Internet -- connecting physical objects…to provide better safety, comfort, and efficiency • IBM “Internet of Things” – …a completely new world-wide web, one comprised of the messages that digitally empowered devices would send to one another. It is the same Internet, but not the same Web. • GE “Industrial Internet” – …convergence of machine and intelligent data…to create brilliant machines • RTI “Your Systems. Working as One.” – …an entirely new utility. As profound as the cell network, GPS, or the Internet itself. The Internet of Things and the Intelligent Systems it enables will fundamentally change our world. © 2014 Real-Time Innovations, Inc.
  • 9. IoT Taxonomy • Access Web Services and Business Apps Process – Link sparse endpoints – XMPP • Process – – – – Access Biz intelligence Centralized/ESB ~100ms MQ/AMQP • Collect Collect – – – – Control Devices and Intelligent Systems © 2014 Real-Time Innovations, Inc. Collect data Hub & spoke ~10ms MQTT/CoAP • Control, distribute – DataBus – ~.01ms – DDS
  • 10. DDS: Distribute Device Data Real-Time Analytics & Control Operator HMI Sensors Actuators Data Distribution Service (DDS) © 2014 Real-Time Innovations, Inc. Cloud Integration
  • 11. Core Nervous System for the IoT © 2014 Real-Time Innovations, Inc.
  • 12. Some Things that Things Can Do DDS IoT Applications & Background © 2014 Real-Time Innovations, Inc.
  • 13. What Does DDS Middleware Do? • Reliable Operation • Deterministic Performance • Systems of Systems • Flexible Transports • Crisp Interface Design • Easy Tech Upgrades • Multi-Channel Connections • Open Architecture • Wireless Links • • • • • • • • • • Legacy Integration Hardware in the Loop Scalability Database Integration High Throughput Reliable Uptime Industry Interoperation Small Device Connection Large Fan In/Out Real-Time and IT Integration © 2014 Real-Time Innovations, Inc.
  • 14. Reliable Operation • The LPD-17 Ship-Wide Area Network (SWAN) runs machinery, damage control, steering, magnetic signature, mission control, navigation, communication • DDS middleware supports redundant networks, data & sensors without servers for non-stop reliability © 2014 Real-Time Innovations, Inc.
  • 15. Real-Time Delivery • The Ship Self Defense System is the “last line of defense” • SSDS coordinates highspeed radars, targets defensive missiles, and directs 1000+ rounds/sec at incoming cruise missiles • SSDS is at sea now • DDS delivers messages in real time © 2014 Real-Time Innovations, Inc.
  • 16. System-of-Systems Integration • Raytheon uses RTI middleware to control the new Zumwalt DDG 1000 destroyer • RTI DDS coordinates and manages complex, diverse onboard hardware and software systems • RTI connects hundreds of computers, thousands of applications, and more than 10m publish-subscribe pairs • RTI middleware extends real-time scalability © 2014 Real-Time Innovations, Inc.
  • 17. Industry Interoperability • Next-generation of – – – – – – Aegis DDG 1000 SSDS LCS (both variants) LPD-17 Many more, US and allies • Highly distributed systems include radar, weapons, displays, contr ols • Standards-based, highperformance middleware breaks vendor lock-in, drives interoperability ,and futureproofs the architectural design © 2014 Real-Time Innovations, Inc.
  • 18. Legacy System Integration • The VW Driver Assistance and Integrated Safety system combines radars, laser range finders, and video to assist safe operation • It helps avoid obstacles, detect lane departures, track eye activity, and safely negotiate bends • Advanced safety systems must connect to existing hardware. RTI DDS middleware bridges high speed networking to the CAN bus © 2014 Real-Time Innovations, Inc.
  • 19. Interoperable Distributed Testing • A modern car contains 100+ CPUs • Audi uses hardware-inthe-loop simulation to feed realistic data to components in a lab for testing • DDS middleware enables a multi-vendor test environment that scales to work with hundreds of devices © 2014 Real-Time Innovations, Inc.
  • 20. Real-Time High Fidelity Recording • Light and strong advanced composites make advanced aircraft quiet and efficient • Lund Engineering uses RTI to integrate the composite inspection system • Critically, all data must be saved for validation; RTI’s database integration saves all data to permanent storage • Replay also supported © 2014 Real-Time Innovations, Inc.
  • 21. Interoperability Standards • RTI leads in defining a standard architectures for unmanned vehicles and avionics • RTI chairs the architecture for UCS (ground stations) and is key at FACE (avionics) • DDS-based designs match data models for component reuse. © 2014 Real-Time Innovations, Inc.
  • 22. 24x7 Operation RTI Connext DDS was selected for its extensive compliance with the Object Management Group (OMG) DDS standard; its high security rating; its wide support of tools and programming languages, and its reputation for performance, scalability, and 24/7 reliability. – Sid Koslow, Chief Technology Officer, NAV CANADA. Air Traffic Control for Canada 2nd largest ANSP in the world 80 sites © 2014 Real-Time Innovations, Inc.
  • 23. Safety-Critical Software • RTI Connext Micro Cert – Stringent SWaP requirements – Complete certification evidence – Full interoperability with Connext product line • DO-178C Level A – UAS & ATC integration – Flight management systems • IEC 60601 class 3 – Medical devices © 2014 Real-Time Innovations, Inc.
  • 24. Scalable Networking • Harmonic transmission and video switching equipment delivers worldwide video-ondemand • RTI handles 1,000s of clients, 1,000,000s of messages • DDS enables highperformance scalability and future extensibility © 2014 Real-Time Innovations, Inc.
  • 25. Harsh Environment Operations • Joy Mining is the world’s largest mining equipment manufacturer • DDS connects the controller, operator GUI, and historian • Reliable, fast connectivity enables control, debugging, and system health monitoring for continuous mining © 2014 Real-Time Innovations, Inc.
  • 26. Real-Time & IT Integration • Siemens Wind Power fields farms of 500 turbines with 100m blades • DDS enables fast control within turbines and distributed gust mitigation across the array • RTI will also integrate with predictive maintenance and business diagnostics • RTI melds real-time with IT © 2014 Real-Time Innovations, Inc.
  • 27. How Networked Things Are Changing Medicine Real applications in connected medical devices © 2014 Real-Time Innovations, Inc.
  • 28. What is Your Application? A. B. C. D. E. Patient monitoring; Hospital/EMS integration Imaging Surgical systems Other medical I’m just curious or an RTI competitor © 2014 Real-Time Innovations, Inc.
  • 29. Fast Emergency Response • Exelis (ITT) C4i provides command and control systems for military and civilian agencies (fire/police/emergency response) • RTI Connext DDS connects GUIs to servers that route voice and video • RTI met the critical needs: scalability, routing, recording © 2014 Real-Time Innovations, Inc.
  • 30. EMS Device Integration Platform • The largest EMS equipment provider will use RTI for their entire product line…for the next 20 years • Provides emergency response equipment to 60% of the world’s emergency vehicles • DDS middleware provides easy connectivity, performa nce, reliability, medical certification option © 2014 Real-Time Innovations, Inc.
  • 31. EMS Cloud Integration Connecting devices with hospitals to provide better treatment while en-route 4G/LTE © 2014 Real-Time Innovations, Inc.
  • 32. High Rate Distributed Control • The Minimally Invasive Robotic Surgery (MIRS) system at DLR coordinates three robots to perform delicate heart surgery. • The system closes a distributed loop between the robots and the remote surgeon’s control at 3kHz. • RTI enables new medical techniques © 2014 Real-Time Innovations, Inc.
  • 33. Hospital Patient Safety • Hospital error is the 6th leading cause of preventable death • DocBox integrates devices to improve patient safety • RTI Connext ties together devices, services, and displays in real time “RTI Connext DDS met all our needs – whether we’re handling 12 patients, or 200.” -- DocBox Founder, Tracy Rausch © 2014 Real-Time Innovations, Inc.
  • 34. Industry Interoperation • The Integrated Clinical Environment (ICE) standard specifies interoperability for medical devices • All ICU & operating room devices — from blood pressure cuffs to intravenous pumps to ventilators — could be interconnected according to the ICE standard – Complete logging – Automatic error detection – Better care • The DDS standard and RTI middleware enables plug & play interoperability across manufacturers ASTM F2761 © 2014 Real-Time Innovations, Inc.
  • 35. © 2014 Real-Time Innovations, Inc.
  • 36. Data Distribution Service for ICE App ADT External Interface App External Interface EMR App DDS Global Data Space Data Logger Device Device Device Benefits offered by DDS • Discovery / Presence • Data-Centric Information Model / Type Safety (agree to data structure in advance) (Distinct from underlying messaging) • QoS Policy Compatibility Checking / Runtime Enforcement © 2014 Real-Time Innovations, Inc.
  • 37. DDS Global Data Space Device Identity UDI 🔑 string Model Name string Depiction Icon Numeric UDI 🔑 string Metric Id🔑 string Value float DDS Global Data Space © 2014 Real-Time Innovations, Inc. Shared Information Model Topic – What data is exchanged? Key – How are unique instances identified? Type – What is the data structure? QoS – Non-functional policies for data propagation (next slide) Data-Centric • DDS standard for sharing data • Supports any OS, languages, transports • Enforces QoS policies
  • 38. Quality of Service App Example Deadline Policy – Defines the maximum interval between samples Numeric UDI 🔑 string Metric Id🔑 string Value • “Match” only when requested and offered policies are compatible • Mis-matches reported at runtime • Policy violations reported at runtime float Device 5 seconds Requested, 10 seconds Offered  NO Match [data is too old] 5 seconds Requested, 2 seconds Offered  Match [data is current] © 2014 Real-Time Innovations, Inc.
  • 39. ICE Platform Prototype uses this general approach … OMG DDS + IEEE 11073 + ASTM F2761 IEEE 11073 Components X73 DIM Data Objects X73 DIM Data Object Attribute Groups OMG DDS DDS Topic DDS IDL Syntax ASTM F2761 Supervisor Functionality Controller Data Logger X73 Nomenclature + Other (a lot of work remains) DDS IDL Nomenclature External Interface © 2014 Real-Time Innovations, Inc.
  • 40. Patient Safety App Package CDS Algorithm #1 Lab Data Patient Hx Supervisory Services Patient Mgmt Device Mgmt Systems Health Interaction Checking Logging Data Bus SPO2 CO2 Infusion Pump Measured Values © 2014 Real-Time Innovations, Inc. Infusion Pump Settings IV Pump Control
  • 41. CIMIT ICE Interface Center for Integration of Medicine and Innovative Technology (CIMIT) See & © 2013 Real-Time Innovations, Inc.
  • 42. Infusion Safety (PCA) App © 2013 Real-Time Innovations, Inc.
  • 43. Hospital Integration © 2014 Real-Time Innovations, Inc.
  • 44. Clinical Decision Support Systems Administration HL7/EMR Gateway, Enterprise, 3rd Party Care Area Workstations, Storage, Historical Room Devices © 2014 Real-Time Innovations, Inc.
  • 45. Data Centricity Administration HL7/EMR Gateway, Enterprise, 3rd Party Care Area Location: Room 247B Workstations, Stor age, Historical Room © 2014 Real-Time Innovations, Inc. Data: HomerSimpson
  • 46. CDS System of Systems © 2014 Real-Time Innovations, Inc.
  • 47. Hospital Integration • Hospital net challenge • RTI DDS technology – 1000s of patients, >100k devices – Wired/wireless/ISM – Moving patients – 100% uptime, security – Real-time waveforms © 2014 Real-Time Innovations, Inc. – – – – – Data centric addressing Smart data filtering Routed deployment Optimized updates Automated test harness
  • 48. Medical Imaging • RTI powers MRI & CT • Imaging systems require massive data flows and fast performance – Any one of many MRI receivers can saturate a 1Gbit network. – CT machines require precise distributed control • DDS controls and optimizes network use to handle megabytes of load without losing data “RTI delivered great functionality at a low cost. Using RTI middleware saved us a lot of money, time, and effort compared to our previous in-house developed solution.” -- Varian (Agilent) MRI © 2014 Real-Time Innovations, Inc.
  • 49. CT Data Challenges • Coordination – – – – Generator Scanner Power Servo • Burst image data acquisition • Control & monitoring – Systems ready for scan – Status during scan • Operator interface • Integration – Many languages, OS, data models – Data archiving © 2014 Real-Time Innovations, Inc.
  • 50. MRI Data Challenges • Gradient coil coordination • Excitation control • Handle burst imaging data – Receiver data throttling – Coordinating multiple networks • Patient positioning • Image transfer © 2014 Real-Time Innovations, Inc.
  • 51. Advanced Proton Therapy • Mevion’s ProtonBeam Radiation Therapy system zaps tumors with accelerated protons • The treatment must be continuous for 3040 days; downtime endangers treatment success First patient treated Dec 2013, Siteman Cancer Center, St. Louis © 2014 Real-Time Innovations, Inc. • With DDS, Mevion’s PBRT delivers dependable treatment at low cost
  • 52. Proton Beam Therapy • Unlike Xrays, PBRT precisely delivers energy with little tissue exposure • Controlling exposure requires positioning patient in 3D © 2014 Real-Time Innovations, Inc.
  • 53. PBRT Data Challenges • Superconducting synchrocyclotron control • Coordinate – Imaging – Patient positioning – Treatment – Machine control – Hazard mitigation © 2014 Real-Time Innovations, Inc.
  • 54. How Can Things Do Those Things? Technology © 2014 Real-Time Innovations, Inc.
  • 55. Evolution of Middleware Point-to-Point Client/Server Publish/Subscribe Data-Centric Pub/Sub Messaging Brokered ESB Daemon Data-Centric Publish/Subscribe (DCPS) DataBus © 2014 Real-Time Innovations, Inc.
  • 56. DDS: The Software DataBus • Data centric – Like a database for moving data • Decouples modules – Like SOA • Plug and play flexibility – Like a hardware bus Data-Centric Messaging Bus DataBus™ • Peer-to-peer performance – Like streaming protocols • Standards-based interoperability – Like TCP/IP Scalable, high performance, reliable infrastructure © 2014 Real-Time Innovations, Inc.
  • 57. Message Centric Approach • Traditional middleware exchanges messages • Infrastructure is unaware of the content • Developers write applications that send messages between participants Popular standards: JMS API; AMQP wire spec © 2014 Real-Time Innovations, Inc.
  • 58. Data Centric Approach • Data-centric middleware maintains state • Infrastructure manages the content • Developers write applications that read and update a virtual global data space Source (Key) Power Phase WPT1 37.4 122.0 -12.20 WPT2 10.7 74.0 -12.23 WPTN 50.2 150.07 -11.98 Persistence Service Recording Service Popular standards: DDS API, wire spec © 2014 Real-Time Innovations, Inc.
  • 59. Average Latency (Microseconds) Performance Under Load 400 Number of Subscribers 350 1 (1 per CPU and NIC) 20 (1 per CPU and NIC) 40 (1 per CPU, 2 per NIC) 300 250 200 150 • Reliable multicast • Fully meshed, reliable 100 50 0 Orders of magnitude faster Throughput (Messages per Seconds) Comprehensive results online 2014 Real-Time Innovations, Inc. at © than IT solutions Fastest DDS solution
  • 60. Reliable Multicast Messages per Second Per Subscriber (200 Bytes) 600,000 500,000 • Millions of data elements • .5m updates/sec (batched) • 10s µs latency • 1000s of consumers 400,000 300,000 200,000 100,000 0 0 200 400 1,000 600 800 Number of Subscribers 1  ~1000 subscribers, < 15% throughput decrease © 2014 Real-Time Innovations, Inc.
  • 61. The DDS Standard • Data Distribution Service from OMG • OMG: world’s largest systems software standards org – 470+ members – UML, DDS, SysML, MoDAF, DoDAF, more • DDS: open & cross-vendor – Standard API enables choice of middleware – Standard wire spec enables subsystem physical interoperability – 11 implementations Cross-vendor source portability DDS API Distribution Fabric DDS-RTPS Protocol Real-Time Publish-Subscribe Cross-vendor interoperability © 2014 Real-Time Innovations, Inc.
  • 62. The DDS standard: a hotly contested market OCI ETRI PrismTech © 2014 Real-Time Innovations, Inc. IBM RTI TwinOaks
  • 63. © 2014 Real-Time Innovations, Inc.
  • 64. Connext Case + Code ©2014 Real-Time Innovations, Inc. Confidential
  • 65. Community (aka Help) Forum Posts 950 426% increase Downloads 2877 306% increase Visitors 68567 452% increase Unique 37636 412% increase Grew just a bit in 2013… ©2014 Real-Time Innovations, Inc. Confidential
  • 66. About RTI • Market Leader – Over 70% DDS mw market share1 – Largest embedded middleware vendor2 – 2013 Gartner Cool Vendor for technology and Open Community Source model • Standards Leader – Active in 15 standards efforts – OMG Board of Directors – DDS authors, chair, wire spec, security, more • Real-Time Pedigree – Founded by Stanford researchers – High-performance control, tools history • Maturity Leader – ~700 designs; by far the most-used DDS – TRL 9 1Embedded Market Forecasters Report 2VDC Analyst © 2014 Real-Time Innovations, Inc.
  • 67. Critical Infrastructure Trusts RTI • • • • • • • • • • • • • • World’s largest Wind Power company World’s largest Underground Mining Equipment company World’s largest Navy (all surface ships) World’s largest Automotive company World’s largest Emergency Medical System company World’s largest Medical Imaging provider World’s 2nd largest Patient Monitoring manufacturer World’s 2nd largest Air Traffic control system World’s largest Broadcast Video Equipment manufacturer World’s largest Launch Control System World’s largest Telescope (under construction) World’s 5th-largest Oil & Gas company World’s 6th-largest power plant (largest in US) All of world’s top ten defense companies © 2014 Real-Time Innovations, Inc. Over $1 trillion relies on RTI
  • 68. Global Support and Distribution 2008 © 2014 Real-Time Innovations, Inc.
  • 69. Before this Webinar, I Thought DDS A. Is my dentist’s last name B. Is a military technology C. Is a research technology, not ready for prime time D. Enables the future of medicine E. Is spelled wrong © 2014 Real-Time Innovations, Inc.
  • 70. After this Webinar, I Think DDS A. Is amazingly flexible B. Is used on many real-world applications C. Is the main real-time protocol for the Internet of Things D. Enables the future of medicine E. Is probably really expensive © 2014 Real-Time Innovations, Inc.
  • 71. © 2014 Real-Time Innovations, Inc.
  • 72. Some Resources • Papers, C+C, community: • Wired article: • EDN on patient safety: ernet-things-can-save-50000-lives-year • PBRT system: d=2&nid=3068 • Video: © 2014 Real-Time Innovations, Inc.