ClinicalGradeMobileHealth mHIseminar.Beaulieu


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“Clinical Grade" Requirements to Enable a Mobile Health and Advanced Workflow Environment by Laurence Beaulieu; Chief Architect, Healthcare Solutions
Nortel Business Solutions

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ClinicalGradeMobileHealth mHIseminar.Beaulieu

  1. 1. quot;Clinical Gradequot; Requirements To Enable A Mobile Health And Advanced Workflow Environment Laurence Beaulieu Chief Architect - Healthcare Solutions Mar. 31, 2009 BUSINESS MADE SIMPLE 1
  2. 2. The Challenges Facing Healthcare Globally… Improve Patient Care Reduce Medical Errors Reduce Wait Times Contain/Reduce Costs Enhance Clinician Productivity Healthcare providers are focused on improving patient care & safety through increased efficiency of their limited staff and resources, reducing errors, and improving capacity to match increase in demand 2
  3. 3. How can we achieve improvement in healthcare? 3
  4. 4. Healthcare Workflow Improvements with Smart Context Aware Apps Out of HIS Clinician EHR, Bounds (Patient Data, Skills EMR, EPR Policy Lab Data) Automation of workflows Event Dynamic event driven workflows Smart Context Incident Aware Engine Immediate access to information Request Real-time collaboration “Presence” “Location” “Schedule” Patient Nurse Physician Bio-Med Transportation Housekeeping Pharmacy Smart Context Aware systems: reduce human latency & error, free up staff, reduce workload, eliminate delays, ensure consistency and accuracy, increases capacity & throughput, engage the right people, log all events, enable faster care delivery, enable audits, reduce wastage, reduce costs, improve collaboration 4
  5. 5. Adoption Challenges for Advanced Workflow Solutions & Implications Infusion John is here” Pump X “Dr J. Smith” X Challenges Implications • Limited/no wireless voice and data • Demand on infrastructure and systems • Limited/no RTLS, sensors, etc. needed • Network & application performance • Flexible building block solutions needed • Clinician trust and confidence • Drives mobility • Elimination of parallel backup processes • Pervasive RF --- multiple RF sources and and associated costs potential EMC concerns • Security of private data • Workflow analysis/research • Scalability Investments needed to ready Healthcare organizations to support advanced workflows 5
  6. 6. Need for better infrastructure 6
  7. 7. Carrier Grade Systems – Current Gold Standard for Communications Networks • Carrier Grade – Critical for public network telecommunications products • Carrier Grade attributes continuously being adopted, adapted and evolved • Hospitals typically not built to carrier grade standards • Hospital “mission critical, life critical” workflows need new set of requirements “Clinical Grade” New requirements need to be met to support advanced workflows – “Clinical Grade” 7
  8. 8. Clinical Grade Solutions Clinical Grade allows Clinicians to depend upon and trust the infrastructure – it does not impede their work, neither does it require their attention – they must come to assume that it is always there and always delivers Key Attributes of Clinical Grade Solutions • Availability/Resiliency • Non-repudiation • Pervasive Coverage of the • Quality of Service (QoS) & • Provides ability to evolve – Facility and beyond Performance • Seamless mobility with “future-proof” • Service Level Agreements session permanence & • Human-system interactions - (SLA) adaptation ease and consistency • Security • Transaction integrity • Workflow engaged – Dynamic • EMI Safety adaptation to demand Source: IEEE 2005 Paper: Clinical grade - a foundation for healthcare communications networks Graves, A.F. Wallace, B. Periyalwar, S. Riccardi, C., Nortel, Ottawa, Ont., Canada; 8
  9. 9. Clinical Grade Attributes Applied to Elements of Healthcare IT LAN, WAN HIT HIT Clinical Hospital Clinical Grade Attributes Device WLAN /Carrier Infrastructure Applications Systems Environment Availability/Resiliency Quality of Service (QoS) & Performance Service Level Agreements (SLA) EMI Safety Security Pervasive Coverage of the Facility and beyond Seamless mobility with session permanence & adaptation Transaction integrity Non-repudiation Provides ability to evolve – “future-proof” Human-system interactions - ease and consistency Workflow engaged – Dynamic adaptation to demand 9
  10. 10. Availability/Resiliency Essential Application Critical Application Service Service Example of Alert Management, Nurse Call, Patient & Application Services/ Nurse in Distress, Staff Tracking Application Patient Monitoring End-End Application < 3 min./yr < 15 min./yr Service Path Downtime (>99.99943%) (>99.99715%) Major Application < 1 min./yr < 3 min./yr Service (multi- application service (>99.99981%) (>99.99943%) impact) Downtime End-user Application < 1 occurrence /yr < 2 occurrences /yr service Failure Rate Need for industry standards and guidelines 10
  11. 11. QoS & Performance ITU-T G.1010 Recommandations on Maximum Acceptable Delay • Performance attributes: Task Category Maximum Acceptable Delay responsiveness, quality of communication and dependability Interactive tasks << 1s (Real time) • Alarming/alerting services have ≈ 2s Responsive tasks stricter performance requirements (High priority transactions) ≈ 10s Timely tasks • Emergency situations raise (Messaging, Downloads) performance requirements but Non-critical tasks > 10s hard to quantify • WLAN planning and engineering is Essential Critical most challenging Application Application Service Service Example of Alert Nurse Call, Application Management, Patient & Staff Services/ Nurse in Tracking Application Distress, Patient Monitoring ≈ 2s Need for industry standards Acceptable << 1s Delays and guidelines QoS DSCP CS7 CS7 11
  12. 12. EMI Safe • 2.4GHz & 5GHZ WLAN devices do not interfere with clinical Cellular systems provider services • Cellular devices may impact old Carrier Network clinical equipment Cellular Cellular • Deploy dual mode handheld devices (cellular to WLAN) to PSTN Gateway Enterprise Network reduce use of cellular devices Call Servers, inside hospitals Multimedia Servers WLAN AP Wi-Fi • Avoid deployment of wireless VPN Gateway systems that use the 125kHz and Internet 868MHz spectrum Wi-Fi Access Point [JAMA. 2008;299(24):2884-2890] • Implement centrally managed and coordinated RF planning 12
  13. 13. Security • Use biometric or other key secure identifiers • Secure encryption required on all accessible paths • Consider using network-centric computing that allows for no / minimal information on portable devices • Consider location tracking portable devices and invoking memory wipe if device is removed by unauthorized persons • Use secure memory stick access appliance 13
  14. 14. Transaction Integrity & Non-Repudiation • Source and destination of all Nurse Call “Alarm” alarms, alerts and System Text Msg notifications must be logged Policy Voice Patient Clinical “Alarm” • Use centralized alarm “Alarm” Monitoring Alarm Clinician System Management E-Mail Security management for consistent Logging Bio-Med SMS Porters Personnel treatment, routing and logging Housekeeping /Asset “Alarm” Tracking & • Data sources must be notified Management of transaction failures 14
  15. 15. Current State of Healthcare Systems Characteristic Clinical Grade Situation Today Essential Service <1-3 min./yr Many single points of failure, Limited App Available/Resilient Critical Service < 3-5 min./yr level resiliency, < 99.99% Essential Service << 1 sec latency No differentiated services, no service level Reliable (QoS Defined) Critical Service ~ 2 sec latency engineering Restricted access, biometrics, secure Good use of authorized access, limited Secure remote access biometrics, limited secure remote access Pervasive (Anywhere, Anytime, Pervasive WLAN Limited WLAN, Dept. level WLAN Seamless) Integrity (Traceable, Non-reputable) Centralized logging Limited logging, not centralized Expandable, Vendor Independent App abstraction from infrastructure Tight integration of apps to infrastructure Easy to Use, Flexible, Quick, Limited single sign-on, very little click to Single sign-on, Click to communicate Improves Workflow communicate Centrally managed & coordinated RF No managed & coordinated RF plan; EMI Safe plan 125kHz deployed Industry Challenge: Provide products & systems meeting Clinical Grade Healthcare Challenge: Upgrade & build to meet Clinical Grade 15
  16. 16. Healthcare IT Standards/Guidance Needs • Define classes of Healthcare services • Essential e.g., patient or staff life safety • Critical e.g., patient location tracking messages • For each class of Healthcare service define: • Availability requirements (up time %, e.g., 99.9999%) • End-user application service Failure Rate (e.g., < 1 occurrence per year) • Acceptable end to end delay (e.g., < 1 sec for life critical alarm messages) • Quality of Service – Differentiated Services Code Point (DSCP) marking • Mobility network • Unlicensed (2.4GHz, 5GHz) or licensed spectrum • Interface protocols • Web Services interfaces between clinical systems (vs HL7) • Clinical systems to mobile device interfaces (e.g., SIP) Mix of: leverage existing IT standards, adapting existing standards, or developing new standards 16
  17. 17. Hospital Healthcare IT Policy & Strategy Deploy advanced composite solutions to enhance care delivery, streamline workflow, Automated & Dynamic Workflows increase operational efficiency, reduce medical errors, while saving cost Deploy “Clinical Grade” IT system Unified Communications enablers & integrate with clinical devices, systems, and applications Asset, Patient & Mobile Alarm (e.g., fault tolerant, pervasive, future Staff Comms Mgmt proof, transaction integrity, etc.) Tracking Build a “Clinical Grade” Network VoIP MM IVR CC RFID RFID Infrastructure (e.g., fault tolerant, high WAN LAN WLAN performance, EMI safety, etc.) 17
  18. 18. Mobility a key enabler 18
  19. 19. Mobility Use Cases – Text or Voice Query Location of Equipment, Alerts, Alarms Nurse Call Staff, Patients Delivery “Location – System Location Closest Porter” Patient Monitoring Service System Nurse Nurse Physician Bio-Med Peer to Peer Information Medication Collaboration Access eMR Info “Location – Lab Closest Porter” Results Push or Pull Guidelines Nurse Nurse Nurse Physician Physician Physician Submit Work Team Orders Formation Code Call Medical Response Team Call Emergency Response Nurse Porters Call Nurse Physician Bio-Med Physician Housekeeping Security Patient Reminder, Follow-up Hospital Patient 19
  20. 20. Seamless Mobility Call Server Carrier Network Cellular Hospital WLAN Network Call Server Physician Physician Session Continuity Dual Mode PDA / Dual Mode PDA / Smart Phone Smart Phone Supported on WLAN inside Hosted off carrier hospital and converts to an network outside of extension on hospital Call Server hospital 20
  21. 21. Mobile Device Requirements Characteristics Nurses Physicians Robust drop spec No MIL STD 810F Proc IV 516.5 Resistance to spraying water & dust protection ? IP 53 standard Resistant to Hospital Liquid Disinfectants ? Extended capacity battery options ? Up to 8hrs Talk Time / 160hrs Stand-By Backlit keypad ? Web Browser Trend Screen Size - 3.5-inch (diagonal) widescreen Trend 480-by-320-pixel resolution at 163 ppi Push to Talk ? WiFi - 802.11 a/b/g 802.11 & Cellular Integrated Barcode Reader ? 21
  22. 22. WLAN Challenges - Performance • Predicting AP traffic load Security Switch • Radio coverage & channel interference IP Network • Design and engineering trade offs for Core Switch data, voice and RFID Security Switch • Trade offs between 802.11 technology (a, b, g, n) PoE Switch • Sensitivity to physical changes • Responsiveness in transferring large files AP • Equivalent to wire: security, resiliency, signal quality, capacity • Simplified configuration: AutoConfig, AutoRF Wi-Fi Clients 22
  23. 23. Meeting hospital needs: Where we should be going? 23
  24. 24. Direction Recommendations Industry Hospitals • Provide “Clinical Grade” solutions • Build “Clinical Grade” systems • Develop guidelines & standards for • Build-out pervasive WLAN “Clinical Grade” systems • Integrated business case & design • Based on classes of services - data, voice and RTLS • Dependability, performance, etc • Deploy real-time location systems • Develop next gen mobile devices for • Deploy mobile devices & systems hospital user groups • Nurses, physicians, porters..... • Enhance today’s WLAN systems to • Embrace mobility use cases improve robustness, performance, engineering, deployability • Enable seamless mobility with dual mode clients • Automate & optimize workflows using smart context aware systems and mobility • Central management of RF environment 24
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