I this three part series, John R. Zaleski, PhD, CPHIMS, Vice President of Clinical Applications & CTO of Nuvon, Inc. discusses 3 areas of Medical Device Connectivity beginning with the Fundamentals, to Clinical Decision Support, and next generation Mobile Device Connectivity.

1. Fundamentals of Biomedical Device Interconnectivity & Support for Bedside Clinical Decision Making John R. Zaleski, PhD, CPHIMS Vice President of Clinical Applications & CTO jzaleski@nuvon.com C: +1 484 319 7345 O: +1 215 966 6142

2. I will show… Biomedical Device Connectivity Architectures & Supporting Technologies Why biomedical device data are essential to the success of several clinical decision support (CDS) applications How clinical workflow can be improved by employing biomedical device connectivity to support real-time decision making Why point of care IT systems must learn to adapt and support real-time data 2 Sunday, May 29, 2011

3. …If you take only one thing from this presentation… Device connectivity should not be an afterthought Plan as part of your overall IT strategy, not as a “bolt-on” after the fact Device connectivity is part of an expanding framework that grows with clinical and organizational needs over time You should consider those solutions that will meet demands of your enterprise as it expands and evolves. Sunday, May 29, 2011 3

4. Meaningful Use 4 Sunday, May 29, 2011

5. BIOMEDICAL DEVICE CONNECTIVITY ARCHITECTURES 5 Sunday, May 29, 2011

6. Examples of biomedical devices that communicate Devices that produce biomedical measurements from patients—patient care data (PCD)—are essential tools in the care and treatment of patients Sunday, May 29, 2011 6

7. Examples of biomedical devices that communicate 7 Anesthesia Machines Mechanical Ventilators Physiological Monitors Infusion Pumps Devices that produce biomedical measurements from patients—patient care data (PCD)—are essential tools in the care and treatment of patients Sunday, May 29, 2011

8. Examples of biomedical devices that communicate 8 Anesthesia Machines Mechanical Ventilators Physiological Monitors Infusion Pumps All of these devices produce data—measurements and settings—that are essential to clinical use and clinical decision making Sunday, May 29, 2011

9. Translating Data into the Clinical Record A key objective is to ensure that data are translated accurately and in a timely manner to Electronic Medical Record (EMR) or Patient Health Record (PHR) Sunday, May 29, 2011 9

10. Translating Data into the Clinical Record Sunday, May 29, 2011 10

11. Translating Data into the Clinical Record 11 Data Queries Sunday, May 29, 2011

12. Translating Data into the Clinical Record 12 Integrating the Healthcare Environment: Patient Care Device Domain http://www.ihe.net/pcd/ Intermediary PCDEMR : EMRPCD Standardized (i.e., Health Level Seven) Proprietary (i.e., vendor/device specific) Sunday, May 29, 2011

13. Nuvon’s Connectivity Architecture 13 Sunday, May 29, 2011

14. Nuvon’s Mission To deliver critical patient care data from point of care to any location, in any format We develop a medical device connectivity, integration & interoperability platform To enable management of PCD across complex healthcare ecosystem To assist and facilitate with clinical decision making Our 510(k) cleared platform is called VEGA Sunday, May 29, 2011 14

16. Streamlined Implementation and EMR/EHR PCD integration

17. Streamlined Support for clinicians, biomed, and IT

18. No Additional Infrastructure

19. No Additional ServersHome IDN/ACO Enterprise Department 15 Sunday, May 29, 2011

20. VEGA: Secure, Network Overlay Biomedical Device Connectivity Architecture EMBEDDED CONNECTIVITY SERIAL CONNECTIVITY Standalone, possibly remote computing platforms: IDM-MG 1000 IDM 500 Desktop Computer 16 IDM 500 IDM 500 IDM 500 IDM-MG 4000 GATEWAY CONNECTIVITY Workstations on Wheels HL7 I/F: 1200 simultaneous medical devices; warm failover Sunday, May 29, 2011

21. Nuvon’s VEGA Platform Delivers Unique Value 17 Real-time data communication Device-level notifications Securely transmitted (2048 bit) Scalable (single server, 3000 IDMs) Web-based dashboard High Availability (no s.p.f.) Resilient (warm failover of HL7 gateway) VEGA captures, translates, displays biomedical device data, including physiological, alarm, device status in wired, wireless, mobile, and embedded form factors VEGA Synchronizes data from disparate devices in real time to address key decision support analytics needs at point of care (e.g.: charting, guidelines, protocols) Sunday, May 29, 2011

22. Basic Building Blocks of VEGA Hardware & Software appliances at the point of care IDM-MG 1000 IDM-MG 3000 IDM-MG 4000 IDM-MG 500 18  Mobility, portability  In-room, multi-device  HL7 Gateway, device broker sw  Virtualized VIP on workstations; also supports generalized monitoring (e.g.: PACs workstations) Sunday, May 29, 2011

24. Built-in bar code for 2-point verification

25. Multi-patient, multi-medical device

26. WiFi Enabled, secure data communication facilitates mobility

27. Support communication on cellular networks19 Sunday, May 29, 2011

28. Patient Care Data Monitoring on a Handheld 20 Sunday, May 29, 2011

29. Example Uses: Mobile Biomedical Device Data Collection Mobile mount on Dinamap stand Mobile attachment to mechanical ventilator Mobile attachment to IV pole 21 Sunday, May 29, 2011

30. Web access to bedside devices 22 Sunday, May 29, 2011

31. Web access to bedside devices 23 All device data available for visual reference Sunday, May 29, 2011

32. Web access to bedside devices All device data available for visual reference Serial devices shown connected by port 24 Sunday, May 29, 2011

33. HL7, Raw Data visible for comparison, assessment, troubleshooting 25 Sunday, May 29, 2011

34. HL7, Raw Data visible for comparison, assessment, troubleshooting 26 HL7 Gateway can then tailor for a particular EMR or departmental system Sunday, May 29, 2011

35. HL7, Raw Data visible for comparison, assessment, troubleshooting 27 HL7 Gateway can then tailor for a particular EMR or departmental system Sunday, May 29, 2011

36. HL7 Gateway supports 16 simultaneous tailored feeds 28 Sunday, May 29, 2011

37. Example: End-user real-time Charting/Viewing Source: Nuvon, Inc. 29 Sunday, May 29, 2011

38. Example: End-user real-time flowsheet Source: Nuvon, Inc. 30 Sunday, May 29, 2011