Real-World Applications of OMG Technology in Medicine
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Real-World Applications of OMG Technology in Medicine

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Real-World Applications of OMG Technology in Medicine Real-World Applications of OMG Technology in Medicine Presentation Transcript

  • Your systems. Working as one. Real-World Applications of OMG Technology in Medicine Stan Schneider, PhD
  • 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? “Last Mile problems” © 2014 Real-Time Innovations, Inc.
  • NIBP-SpO2 Interaction 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 © 2014 Real-Time Innovations, Inc.
  • 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. Result: False alarms, incorrect data in permanent record. ECG data ECG data Pulse Ox data EMR data © 2014 Real-Time Innovations, Inc.
  • What Can Change That? © 2014 Real-Time Innovations, Inc.
  • The Internet of Things ©2014 Real-Time Innovations, Inc.
  • DDS: Distribute Device Data © 2014 Real-Time Innovations, Inc. Real-Time Analytics & Control Operator HMI Sensors Actuators Cloud Integration Data Distribution Service (DDS)
  • The DDS Standard • Data Distribution Service from OMG • OMG: world’s largest systems software standards org – 470+ members – UML, DDS, Industrial Internet Consortium • DDS: open & cross-vendor – Standard API enables choice of middleware – Standard wire spec enables subsystem physical interoperability – 12 implementations ©2014 Real-Time Innovations, Inc. Cross-vendor source portability Cross-vendor interoperability DDS-RTPS Protocol Real-Time Publish-Subscribe Distribution Fabric DDS API
  • ©2014 Real-Time Innovations, Inc. Your systems. Working as one. The Core Nervous System for the Industrial Internet of Things
  • DDS: The Software DataBus • Data centric – Like a database for moving data • Decouples modules – Like SOA • Plug and play flexibility – Like a hardware bus • Peer-to-peer performance – Like streaming protocols • Standards-based interoperability – Like TCP/IP ©2014 Real-Time Innovations, Inc. Data-Centric Messaging Bus Scalable, high performance, reliable infrastructure DataBus™
  • Smart Machines in the IIoT • Defense • Transportation • Industrial • Energy • Communications • Healthcare ©2014 Real-Time Innovations, Inc.
  • How Networked Things Are Changing Medicine Real applications in connected medical devices © 2014 Real-Time Innovations, Inc.
  • DDS in Medical • Imaging & Treatment Systems – Compelling problem: fast device integration • Surgical Systems – Compelling problem: feedback, video, patient monitoring • Connected Medical Devices – Compelling problem: Patient safety, multi-device platform, hospital integration ©2014 Real-Time Innovations, Inc. Confidential
  • DDS in Medical • Imaging & Treatment Systems – Compelling problem: fast device integration • Surgical Systems – Compelling problem: feedback, video, patient monitoring • Connected Medical Devices – Compelling problem: Patient safety, multi-device platform, hospital integration ©2014 Real-Time Innovations, Inc. Confidential
  • Medical Imaging & Treatment Systems • Imaging systems require massive data flows and fast performance – CT machines require precise distributed control – Any one of many MRI receivers can saturate a 1Gbit network • Treatment systems require precise distributed control and safe operation ©2014 Real-Time Innovations, Inc.
  • Computed Tomography (CT) ©2014 Real-Time Innovations, Inc. Revolution®
  • CT Basics • Spin an xray source around an object • Time exposure carefully to get the right image or freeze motion • Collect the projection data during spin • Do the math © 2014 Real-Time Innovations, Inc.
  • CT Scanner: Coordinated Control • Coordination – Generator – Scanner – Power – Servo • Burst image data acquisition • Control & monitoring – Systems ready for scan – Status during scan • Operator interface • Integration – Multiple programming languages, OS, data models – Data archiving ©2014 Real-Time Innovations, Inc. Image is for conceptual understanding only. This is a previous generation device.
  • CT Scanner in Operation ©2014 Real-Time Innovations, Inc. Confidential http://www.youtube.com/watch?v=bg0iNhw2ARw
  • CT Scanner Control ©2014 Real-Time Innovations, Inc. Image Store Machine Domain Scanner HMI Machine Net Gantry Servo Machine Control (SRIO) Emitter Control Dosage Monitor ECG Sync Scanner Control Power System Patient Status Image Domain Image Databus Image Generation Scanner Data Acquisition
  • Ultrasound Imaging ”BK Medical is truly redefining Medical Ultrasound Imaging where the traditional single user / single system approach is being replaced with fully scalable and distributed multi-user systems This required a completely new way of gluing the individual components together. For this reason we selected the RTI DDS middleware as this gives us all the flexibility and the abstraction layer needed for the future of Analogic Ultrasound” -- Jesper Lomborg Manigoff, VP of Engineering, Analogic Global Ultrasound ©2014 Real-Time Innovations, Inc.
  • ©2014 Real-Time Innovations, Inc.
  • MRI Basics • Start with a strong (2T) magnetic field • Excite H nuclei in a plane • Control gradient magnets to get different (phase, frequency) resonance from every point in that plane • Collect the data • Do the math © 2014 Real-Time Innovations, Inc.
  • 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.
  • Advanced Proton Therapy • 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 • With DDS, Mevion’s PBRT delivers dependable treatment at low cost ©2014 Real-Time Innovations, Inc. First patient treated Dec 2013, Siteman Cancer Center, St. Louis
  • 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.
  • PBRT Data Challenges • Supercon- ducting synchro- cyclotron control • Coordinate – Imaging – Patient positioning – Treatment – Machine control – Hazard mitigation ©2014 Real-Time Innovations, Inc.
  • DDS in Medical • Imaging & Treatment Systems – Compelling problem: fast device integration • Surgical Systems – Compelling problem: feedback, video, patient monitoring • Connected Medical Devices – Compelling problem: Patient safety, multi-device platform, hospital integration ©2014 Real-Time Innovations, Inc. Confidential
  • Surgical Operating Room Integration • Patient status – Waveforms – Data recording • Multi-channel video • Many recipients – Surgeon – Operating theater – Students & observers – Offsite ©2014 Real-Time Innovations, Inc. Image is for conceptual understanding only. This is not a current RTI application
  • Surgical Robotics • 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.
  • Interventional Surgical Theatre ©2014 Real-Time Innovations, Inc. Operating Room Domain High-Speed DataBus Xray UltrSnd ProbeVid Image Fusion Instrument Integration Room Control Surgeon Display Data Storage EHR ECG PxR SpO2 Down Sample Graphics System GPU Graphics System GPU Tablet Tablet TabletRemote Monitors WirelessDataBus
  • DDS in Medical • Imaging & Treatment Systems – Compelling problem: fast device integration • Surgical Systems – Compelling problem: feedback, video, patient monitoring • Connected Medical Devices – Compelling problem: Patient safety, multi-device platform, hospital integration ©2014 Real-Time Innovations, Inc. Confidential
  • Device Connection for 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 ©2014 Real-Time Innovations, Inc. “RTI Connext DDS met all our needs – whether we’re handling 12 patients, or 200.” -- DocBox Founder, Tracy Rausch
  • 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 © 2014 Real-Time Innovations, Inc. ASTM F2761
  • © 2014 Real-Time Innovations, Inc.
  • Data Distribution Service for ICE DDS Global Data Space App App App Device Device Device Data Logger External Interface ADT EMR External Interface 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.
  • DDS Global Data Space 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 DDS Global Data Space Device Identity UDI 🔑 string Model Name string Depiction Icon Numeric UDI 🔑 string Metric Id🔑 string Value float © 2014 Real-Time Innovations, Inc.
  • Quality of Service App Device Numeric UDI 🔑 string Metric Id🔑 string Value float • “Match” only when requested and offered policies are compatible • Mis-matches reported at runtime • Policy violations reported at runtime Example Deadline Policy – Defines the maximum interval between samples 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.
  • OMG DDS + IEEE 11073 + ASTM F2761 X73 DIM Data Objects DDS Topic IEEE 11073 Components OMG DDS X73 DIM Data Object Attribute Groups DDS IDL Syntax X73 Nomenclature + Other DDS IDL Nomenclature ASTM F2761 Supervisor Functionality Controller Data Logger External Interface ICE Platform Prototype uses this general approach … (a lot of work remains) © 2014 Real-Time Innovations, Inc.
  • Patient Monitoring ©2014 Real-Time Innovations, Inc. Data Bus Supervisory Services Patient Mgmt Device Mgmt Systems Health Interaction Checking Logging CDS Algorithm #1 Lab Data SPO2 CO2 Patient Hx Infusion Pump Settings IV Pump Control Infusion Pump Measured Values
  • CIMIT ICE Interface © 2013 Real-Time Innovations, Inc. Center for Integration of Medicine and Innovative Technology (CIMIT) See MDPnP.org & docboxinc.com
  • Infusion Safety (PCA) App © 2013 Real-Time Innovations, Inc.
  • Patient Monitoring: ICE © 2014 REAL-TIME INNOVATIONS, INC. 3/17/14 COMPANY CONFIDENTIAL
  • ©2014 Real-Time Innovations, Inc.
  • Inter-Vehicle Communications • 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.
  • EMS Device Integration Platform • The largest EMS equipment provider supplies emergency response equipment to 60% of the world’s emergency vehicles • Uses RTI middleware for mobile device bus, in-vehicle platform, cloud connectivity ©2014 Real-Time Innovations, Inc.
  • EMS Cloud Integration © 2014 Real-Time Innovations, Inc. Connecting devices with hospitals to provide better treatment while en-route 4G/LTE
  • Hospital Integration © 2014 Real-Time Innovations, Inc.
  • CDS Data Architecture ©2014 Real-Time Innovations, Inc. Room Domain Central Domain Admin Domain (Cloud) Patient Monitoring Devices Workstations, Storage, Historian Gateway, IX, Enterprise, 3rd Party
  • CDS System of Systems ©2014 Real-Time Innovations, Inc.
  • Hospital Integration Data Challenges • Hospital net challenge – 1000s of patients, >100k devices – Wired/wireless/ISM – Moving patients – 100% uptime, security – Real-time waveforms • RTI DDS technology – Data centric addressing – Smart data filtering – Routed deployment – Optimized updates – Automated test harness © 2014 Real-Time Innovations, Inc.
  • How Can Things Do Those Things? Technology © 2014 Real-Time Innovations, Inc.
  • Types of Middleware ©2014 Real-Time Innovations, Inc. Point-to-Point Client/Server Brokered ESB Daemon Publish/Subscribe Data-Centric Publish/Subscribe (DCPS) Data-Centric DataBus Queuing
  • Message Centric Approach • Traditional middleware exchanges messages • Infrastructure is unaware of the content • Developers write applications that send messages between participants ©2014 Real-Time Innovations, Inc. Popular standards: JMS API; AMQP wire spec
  • Data Centric Approach • Data-centric middleware maintains state • Infrastructure manages the content • Developers write applications that read and update a virtual global data space ©2014 Real-Time Innovations, Inc. Persistence Service Recording Service Source (Key) Wind Power Phase WPT1 37.4 122.0 -12.20 WPT2 10.7 74.0 -12.23 WPTN 50.2 150.1 -11.98 Popular standards: DDS API, wire spec
  • Coupling • Verb-based: applications interact with each other • Noun-based: applications interact with data model © 2014 Real-Time Innovations, Inc. Set B3 to 27 B3
  • Managing State • Data centric – Single version of truth enables interoperation – Content-aware infrastructure eases integration – Clear rules for access, changes, updates tame complexity • Technologies – Database – Data-centric middleware ©2014 Real-Time Innovations, Inc.
  • QoS Policy QoS Policy DURABILITY USER DATA HISTORY TOPIC DATA READER DATA LIFECYCLE GROUP DATA WRITER DATA LIFECYCLE PARTITION LIFESPAN PRESENTATION ENTITY FACTORY DESTINATION ORDER RESOURCE LIMITS OWNERSHIP RELIABILITY OWNERSHIP STRENGTH TIME BASED FILTER LIVELINESS DEADLINE LATENCY BUDGET CONTENT FILTERS TRANSPORT PRIORITY QoS: Quality of Service Volatility UserQoS Delivery PresentationRedundancy Infrastructure Transport © 2014 Real-Time Innovations, Inc.
  • 0 50 100 150 200 250 300 350 400 AverageLatency(Microseconds) Throughput (Messages per Seconds) 1 (1 per CPU and NIC) 20 (1 per CPU and NIC) 40 (1 per CPU, 2 per NIC) Performance Under Load • Reliable multicast • Fully meshed, reliable Number of Subscribers Orders of magnitude faster than IT solutions Fastest DDS solution Comprehensive results online at www.rti.com© 2014 Real-Time Innovations, Inc.
  • Reliable Multicast 1  ~1000 subscribers, < 15% throughput decrease 600,000 500,000 400,000 300,000 200,000 100,000 0 MessagesperSecond PerSubscriber(200Bytes) 0 200 400 600 800 1,000 Number of Subscribers • Millions of data elements • .5m updates/sec (batched) • 10s µs latency • 1000s of consumers © 2014 Real-Time Innovations, Inc.
  • Unit DataBus Unit DataBus End-to-End DataBus • Connect… – Fast – Seamless – QoS controlled – Secure – Data centric • …80 Platforms… – Micro controllers – Certified systems – Embedded – Mobile – Desktop – Cloud • …over 12 Transports – UDP or TCP – D/TLS (secure) – Wireless or wired – Shared memory – Backplane – Cloud virtual connect ©2014 Real-Time Innovations, Inc. Intelligent Machines Intelligent Systems Intelligent Industrial Internet Cloud DataBus Site DataBus Intelligent System of Systems Unit DataBus Sense Act Think HMI Machine DataBus Think HMI Machine DataBus Sense Act Think HMI Machine DataBus
  • Route to Build Complete Hierarchy • Routing Technology – Encapsulate subsystem data – Translate data models/formats – Match comm patterns © 2014 Real-Time Innovations, Inc. MQTT Web Field Busses AMQPJMS TCP Routing Service Pluggable Adapters Transformation Engine Database Historian DDS DataBus DDS DataBus
  • Strive For: One Logical Dataspace… © 2014 Real-Time Innovations, Inc. DDS DataBus Sensors Actuators Analytics & Control HMI/UI IT, Cloud & SoS Connectivity
  • …Hiding Complex Network Topologies © 2014 Real-Time Innovations, Inc. ActuatorsSensors Analytics, control HMI ActuatorsSensors Analytics, control HMI ActuatorsSensors Analytics, control HMI Analytics, control HMI Centralized analytics Decentralized devices, streaming analytics and control
  • Choose DDS If… • Disaster if offline for 5 minutes? • Measure performance in ms or us? Or scale >100+ applications? Or 10k+ data values? • Code active lifetime >3 yrs? • 2 or 3 => DDS ©2014 Real-Time Innovations, Inc. Control: DDS
  • DDS in Medical • Imaging & Treatment Systems – Compelling problem: fast device integration • Surgical Systems – Compelling problem: feedback, video, patient monitoring • Connected Medical Devices – Compelling problem: Patient safety, multi-device platform, hospital integration ©2014 Real-Time Innovations, Inc. Confidential
  • Connext Case + Code ©2014 Real-Time Innovations, Inc. Confidential
  • The Future of Medicine • Connected – Local, hospital, cloud • Capable – Real-time waveforms – Location transparency – Vendor plug-n-play • Systems-level thinking ©2014 Real-Time Innovations, Inc.
  • Systems-Level Communications • Reliable Operation • Real-Time Delivery • System of Systems Integration • Connect any OS, Language, Transport • Crisp Interface Design • Easy Tech Upgrades • Multi-Channel Flow • Plug & Play Discovery • Open Architecture • Wireless Links • Fine-Grain Security • Physics-Speed Response • Scalability • Database Integration • High Throughput • Hyper-Efficient Filtering • Reliable Uptime • System Evolution Support • Small Device Connection • Safety-Critical Certification • Large Fan In/Out • Real-Time and IT Integration • Standards Based © 2014 Real-Time Innovations, Inc. Confidential
  • 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 – Launch member of Industrial Internet Consortium • Real-Time Pedigree – Founded by Stanford researchers – High-performance control, tools history • Maturity Leader – 750+ designs; by far the most-used DDS – Used in TRL 9 systems © 2014 Real-Time Innovations, Inc. 1Embedded Market Forecasters 2VDC Analyst Report
  • 2008 Global Support and Distribution ©2014 Real-Time Innovations, Inc.
  • The Future of Intelligent Machines ©2014 Real-Time Innovations, Inc.
  • Some Resources • Papers, C+C, community: www.rti.com • Wired article: http://blogs.rti.com/2013/11/18/a- day-in-your-life-with-the-internet-of-things/ • EDN on patient safety: http://electronicdesign.com/communications/int ernet-things-can-save-50000-lives-year • PBRT system: http://www.barnesjewish.org/news/?id=5032&si d=2&nid=3068 • Video: http://goo.gl/WnO5LE © 2014 Real-Time Innovations, Inc.