How to architect smarter systems for healthcare

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According to the Leapfrog Group, hospitals in the US pay a surcharge of $5900-$7800 per admission to cover a wide range of medical errors. Smart point-of-care systems address the source of these …

According to the Leapfrog Group, hospitals in the US pay a surcharge of $5900-$7800 per admission to cover a wide range of medical errors. Smart point-of-care systems address the source of these errors to help reduce healthcare expenditures while improving patient care. The systems reliably connect and transmit critical data for medical devices, clinicians and patients – ensuring information is shared exactly when and where it's needed most.

However, it is extremely challenging to address data interoperability, safety, security and integration with other systems in today's healthcare environment. As data volume grows and becomes increasingly valuable, these issues will affect system and data architecture, especially with the rise of smart analytics used to improve the quality of treatment. Join Tracy Rausch, founder and CTO of DocBox Inc., and Sumeet Shendrikar, RTI Solutions Architect, as they discuss the challenges of developing smarter point-of-care systems and how a data-centric architecture can ensure the right data gets to the right place at the right time to improve patient healthcare.

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  • 1. Agenda • Intelligent Healthcare Use Cases & Needs • RTI Connext DataBus • Deep Dive: DocBox • Healthcare & the Internet of Things
  • 2. Intelligent Healthcare Use Cases • Clinical Decision Support Systems • Monitoring/Telemetry • Machine Command/Control • Data Acquisition • Device Interoperation • Hospital Operations Management
  • 3. Intelligent Healthcare IT Needs • Reliable Operation • Real-Time Performance • System Integration • Flexible Transports • 24x7 Operation • Location Abstraction • WIFI, WIMAX, ISM Bands • Secure Communications • Certifiable • Plug N’ Play Design • Open Architecture • Fast Development • Legacy Integration • Hardware in the Loop • Scalability • High Throughput • Industry Interoperation • Small Device Connection • Small Device Mobility • Large Fan In/Out • Real-Time and IT Integration
  • 4. It’s All About the Data “Health care is burdened by a system where doctors and caregivers have to go searching for vital information; it is inefficient at best and life threatening at worst. We need to make the data more intelligent and integrated, more predictive and proactive, so information finds the doctor instead of the other way around. Intelligent data flows speed up care delivery and can prevent chronic conditions by getting the treatment right the very first time. Similarly, in terms of health management costs, “intelligent” hospitals are deploying systems that behave like air traffic control for medical staff and devices, and provide a full detailed view of hospital resources. Better utilization cuts capital expenses. Better asset location leaves nurses more time to focus on patients. Better management improves patient flow, cuts operating costs, and saves hospitals millions.” - Jeff Immelt (Nov 2012) http://gigaom.com/2012/11/28/the-future-of-the-internet-is-intelligent-machines/
  • 5. Connecting the Data Need to construct the “Data Graph”
  • 6. RTI Connext: Distribute the Data Real-Time Analytics & Control Operator HMI Sensors Actuators IT and/or Cloud Integration
  • 7. RTI Connext: The Software DataBus™ • Data centric – Structured, accessible data – Like a database for moving data • Independent modules – Supports SOA • Plug and play flexibility – Like a hardware bus • Peer-to-peer performance – Like streaming protocols • Standards-based interoperability – Like TCP/IP • Abstracts Location RTI Connext DataBus™ Scalable, high- performance, reliable infrastructure that eases integration
  • 8. Why a DataBus Transport? • Connects quickly, easily, powerfully • Reduces risk – Proven, reusable, certified • Saves money – Decouples large problem into solvable pieces • Enables advanced capability – Reliability: redundant, 24x7 operation – Performance: microsecond latency, megabyte throughput – Integration: Any transport, OS, language RTI Connext DataBus™
  • 9. RTI Connext: Building Blocks RTI DataBus Peer-to-peer: • Superior for real-time & near real- time delivery Integration Services to connect system-of- systems RTI DataBus R RTI DataBus R R R R R R R Integration Services can be composed into a hierarchical topology
  • 10. Connext Builds Intelligent Systems
  • 11. Clinical Decision Support Systems Workstations, Stor age, Historical HL7/EMR Gateway, Enterprise, 3rd Party Room Devices Care Area Administration
  • 12. CDS System of Systems
  • 13. Remote Monitoring 4G/LTE Connecting devices with hospitals to provide better treatment while en-route
  • 14. Machine Command/Control • Mevion’s Proton- Beam Radiation Therapy system zaps tumors with accelerated protons • The treatment must be continuous for 30- 40 days; downtime endangers treatment success • Mevion’s PBRT delivers dependable treatment at low cost
  • 15. Data Acquisition • RTI powers Varian’s NMR and MRI product lines • Any one of the sixteen MRI receivers can saturate a 1Gbit network. • RTI 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.”
  • 16. Device 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
  • 17. Agenda • Intelligent Healthcare Use Cases & Needs • RTI Connext DataBus • Deep Dive: DocBox • Healthcare & the Internet of Things
  • 18. The Problem • 25% of all hospital admissions have a medical error • 4 Jumbo Jets full of people a week die from medical errors • Leapfrog Group has stated it could cost up to $7800 per admit for medical errors in the US
  • 19. Devices, processes, non-integrated system  errors
  • 20. Requirements from Providers • Complete and Accurate Data • Safe Systems • Secure Systems • Increased Efficiency – Clinical Workflow – Device and Systems Maintenance • Improved Quality • Flexible (Inpatient to Outpatient) • Able to deal with new and legacy equipment • Scalable • Facilitation of decision support and data visualization
  • 21. “Achieving higher quality care at lower cost will require fundamental commitments to the incentives, culture, and leadership that foster continuous "learning”, as the lessons from research and each care experience are systematically captured, assessed, and translated into reliable care.” -IOM 2013
  • 22. Hospitals are Distributed Systems • Medical Devices • IT Systems – EMR – Lab – Pharmacy – Radiology • Clinicians and Support Staff • Patient
  • 23. Example Scenario 1: Patient Controlled Analgesia (PCA) • 2-3 Patients per day in the US die from opiate overdose. • Very little understanding of the cause • Patient presses button to receive intravenous pain medication • Patients can call to request more analgesia, but, cannot call for help when over-medicated. • Over-medication can cause respiratory and cardiac arrest • Comprehensive monitoring is not typically used due to high false/nuisance alarm rate • How can we improve safety of this system?
  • 24. ICE Supervisor Network Controller ICE Interface Data Logger External Interface Medical Device ICE Interface Other Equipment Integrated Clinical Environment (ICE) Functional Elements of the Integrated Clinical Environment ASTM standard F2761-2009 Published January 2010 Clinician Functional Elements of the Integrated Clinical Environment Patient
  • 25. Smart PCA System Patient Demographics and History Medication HistoryDiagnosis Co- morbidities Orders Monitoring Data Enterprise Point of Care CDS Algorithm(s) Observations Lab Results PCA Pump Other Infusions Other Devices Safety Interlock Clinician Patient
  • 26. Data-centric Approach Device 1 Device 2 Device n Medical App 1 Medical App 2 Medical App n EMR/Other IS Systems DDS RTPS Bus
  • 27. Agenda • Intelligent Healthcare Use Cases & Needs • RTI Connext DataBus • Deep Dive: DocBox • Healthcare & the Internet of Things
  • 28. Tim O’Reilly @ GE’s Minds + Machines event in Nov 2012 http://www.slideshare.net/timoreilly/lessons-for-the-industrial-internet-pdf-with-notes/
  • 29. The Internet of Things • Healthcare IT is not just a part of the Internet of Things – It’s also an instantiation of the Internet of Things • Smart devices sharing data with doctors, nurses, and analytics to deliver better healthcare.
  • 30. Internet of Things - Planes Web Services and Business Apps Server-to-Server (S2S) Devices and Intelligent Systems Control Plane Device-to-Device Device to Server (D2S) TimelinessofResponse 10μs–10ms10ms–1s>1s
  • 31. Another Perspective Control Management Analysis TimelinessofResponse 10μs–10ms10ms–1s>1s •Process control and workflow •Presentation of “live” data •Security policy enforcement •Human input / output •Configuration •Data mining and analysis •Equipment control and monitoring •Performance measurement and calibration •Fault isolation and automated recovery
  • 32. Want to Learn More? Watch Stan Schneider’s webinar replay: “Understanding the Internet of Things protocols: DDS, MQTT, AMQP” https://www.rti.com/mk/webinars.html
  • 33. About RTI • Market Leader – Over 70% DDS mw market share1 – Largest embedded middleware vendor2 • Standards Leader – Active in 15 standards efforts – OMG Board of Directors – DDS authors • Real-Time Pedigree – Founded by Stanford researchers – High-performance control, tools history • Maturity Leader – 600+ designs – TRL 9 1Embedded Market Forecasters 2VDC Analyst Report
  • 34. Global Support and Distribution
  • 35. About Us Tracy Rausch, CCE CTO and Founder, Docbox tracy@docboxinc.com 617.997.8375 Sumeet Shendrikar Solutions Architect, RTI sumeet@rti.com 408.990.7424
  • 36. Your systems. Working as one. Download Connext Free Trial NOW www.rti.com/downloads