RTI Connext DDS messaging software helps evolve standalone systems to integrated distributed systems, connect devices to improve patient outcomes, and replace dedicated point-to-point wiring with networks. A wide range of additional benefits are possible, including improved diagnosis and safety, delegated care or treatment, and smarter machine assistance for healthcare.

1. Your systems. Working as one.
How Networked Things Are Changing Medicine
Real applications in connected medical devices
© 2014 Real-Time Innovations, Inc.

2. •Bettina Swynnerton
•bettina@rti.com
•RTI Focus: Industrial Internet of Things
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3. RTI Named Most Influential IIoT Company
© 2014 Real-Time Innovations, Inc. Confidential.

4. RTI solves problems like
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Room Domain
Central Domain
Admin Domain (Cloud)
Workstations, Storage, Historian
Gateway, IX, Enterprise, 3rd Party

5. Small scale, large scale
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6. Systems as a sum of their parts
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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

7. How could connected things change medicine?
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8. Just some of the problems…
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9. Result: False alarms, incorrect data in permanent record.
ECG data
ECG data
Pulse Ox data
EMR data
Or this…
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10. How could medicine change?
•Improved diagnosis?
•Delegated care? Delegated treatment?
•Machine assisted diagnosis, care and treatment?
•Improved safety?
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11. Three important drivers
•Evolution from the stand-alone system to a distributed system
•Connection of devices to improve patient outcome
•The replacement of dedicated point-to-point wiring with networks

12. 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.

13. ©2014 Real-Time Innovations, Inc.

14. 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
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15. Driver 2: Connect devices to improve patient outcome
•IT problem: Patient records
•M2M problem: Intensive care diagnostics
•HMI problem: Enable staff to come to a safe diagnosis and safe decisions assisted by data correlation
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16. 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

17. 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
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ASTM F2761

18. © 2014 Real-Time Innovations, Inc.

19. 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
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20. ©2014 Real-Time Innovations, Inc.

21. 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
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22. 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
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23. EMS Cloud Integration
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Connecting devices with hospitals to provide better treatment while en-route
4G/LTE

24. Hospital Integration
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25. Clinical Diagnostic System
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Room Domain
Central Domain
Admin Domain (Cloud)
Patient Monitoring Devices
Workstations, Storage, Historian
Gateway, IX, Enterprise, 3rd Party

26. CDS System of Systems
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27. 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
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28. Driver 3: Integration of intelligent machines
•Point to point
•Tightly coupled
•Data-centric networks
•Loosely coupled
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29. Surgical Operating Room Integration
•Patient status
–Waveforms
–Data recording
•Multi-channel video
•Many recipients
–Surgeon
–Operating theater
–Students & observers
–Offsite
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Image is for conceptual understanding only. This is not a current RTI application

30. Interventional Surgical Theatre
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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
Tablet
Remote Monitors
Wireless DataBus

31. How Can Things Do Those Things?
Technology
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32. What is interoperability?
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32
Level 0
No Interoperability
Level 6 Conceptual Interoperability
Level 5
Dynamic Interoperability
Level 4
Pragmatic Interoperability
Level 3
Semantic Interoperability
Level 2
Syntactic Interoperability
Level 1 Technical Interoperability
Stand alone systems that have no interoperability
Full assumptions and constraints of meaningful abstraction of reality. Fully specified but independent model
Maintains state changes between systems during run time. Includes assumptions and constraints that effect data interchange
Systems are aware of methods & procedures of other systems. Context is understood by all participating systems
Meaning of data is exchanged through use of a common information model. The meaning of information is shared and unambiguously defined.
Common structure or common data format for exchanging information. The format of the information exchange is unambiguously defined
Communication protocol for exchanging data. Bits & Bytes are exchanged in an unambiguous manner
Levels of Conceptual Interoperability Model (LCIM) for Systems Engineering VMASC (Virginia Modeling, analysis and simulation centre)

33. Open standards-based middleware?
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Point-to-Point Client/Server
Brokered
ESB
Daemon
Publish/Subscribe Queuing Data-Centric

34. Data Centric Approach?
•Data-centric middleware maintains state
•Infrastructure manages the content
•Developers write applications that read and update a virtual global data space
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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

35. De-coupled?
•Verb-based: applications interact with each other
•Noun-based: applications interact with data model
© 2014 Real-Time Innovations, Inc.
Set B3 to 27
B3

36. 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.

37. QoS: Quality of Service
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
© 2014 Real-Time Innovations, Inc.
Volatility
User QoS
Delivery
Presentation
Redundancy
Infrastructure
Transport

38. 0
50
100
150
200
250
300
350
400
Average Latency (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.

39. 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

40. 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
AMQP
JMS
TCP
Routing Service
Pluggable Adapters
Transformation Engine
Database
Historian
DDS DataBus
DDS DataBus

41. Strive For: One Logical Dataspace…
© 2014 Real-Time Innovations, Inc.
DDS DataBus
Sensors
Actuators
Analytics & Control
HMI/UI
IT, Cloud & SoS Connectivity

42. …Hiding Complex Network Topologies
© 2014 Real-Time Innovations, Inc.
Actuators
Sensors
Analytics, control
HMI
Actuators
Sensors
Analytics, control
HMI
Actuators
Sensors
Analytics, control
HMI
Analytics, control
HMI
Centralized analytics
Decentralized devices, streaming analytics and control

43. 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

44. Some Resources
•Papers, evaluation downloads, 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/internet-things-can-save-50000-lives-year
•PBRT system: http://www.barnesjewish.org/news/?id=5032&sid=2&nid=3068
•Video: http://goo.gl/WnO5LE
© 2014 Real-Time Innovations, Inc.