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Device Observation Semantic Bridge ( DSB/DOSB) Phase 1 IHE Proposal Draft Graphics

Device Observation Semantic Bridge ( DSB/DOSB) Phase 1 IHE Proposal Draft Graphics September 04, 2014 Amended Based on NLM/IHTSDO Meeting – September 09, 2014 (last slide). Team. VHA Ioana Singureanu Greg Staudenmaier Loren Stevenson Dan Morford Catherine Hoang. IHE

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Device Observation Semantic Bridge ( DSB/DOSB) Phase 1 IHE Proposal Draft Graphics

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  1. Device Observation Semantic Bridge (DSB/DOSB) Phase 1 IHE Proposal Draft Graphics September 04, 2014 Amended Based on NLM/IHTSDO Meeting – September 09, 2014 (last slide)

  2. Team • VHA • Ioana Singureanu • Greg Staudenmaier • Loren Stevenson • Dan Morford • Catherine Hoang • IHE • Alex Lippitt (HIMSS, IHE) • Paul Sherman – Technical Project Manager – IHE Patient Care Device Domain(retired VHA) • John Garguilo (NIST) • Paul Schluter (GE)

  3. The Device Observation Semantic Bridge (DSB/DOSB) Challenge • Getting semantically correct data from patient care devices into clinical applications is difficult for a number of reasons: • The applicable nomenclature from medical devices, IEEE 11073 10101, is not one of the Meaningful Use approved nomenclatures, reducing the incentive to use IEEE 11073 data in clinical applications • There are no commonly accepted mappings of IEEE 11073 10101 to Meaningful Use approved nomenclatures (LOINC and SNOMED primarily) for clinical measures although there are vendors who have done so as proprietary interfaces • There are still many circumstances where the specific numeric measures are not codified in a generally accepted standard, for example the current work with ventilators • There are no good filtering standards to drive constraining device streams to be usable by clinical applications

  4. The Patient Data is Here....

  5. But Not Here...............

  6. BENEFITS of Patient Care Device Clinical and Operations Data Acquisition • Improved workflow • Improved data collection • Improved safety • Improved patient care

  7. Proposed Constraints • Principles • Avoid semantic transformation where possible; work with both nomenclatures to align terminology and value sets with each other (include whole chunks of 11073 101101 nomenclature where possible) – needs to merge into clinical realm - a lot of work done • This is the start of an on-going process to ensure device / clinical harmonization over time • Scope Deferred • Use cases beyond inpatient vital signs, events and alerts • Usage with consumer devices • Usage with portable lab devices • Environmental Goals • Obtain approval to include this standard as a gap closer in the ONC Interoperability Roadmap • Obtain approval for IEEE 11073 10101 to be recognized as an MU approved nomenclature/vocabulary Prove acceptance of a certain set of IEEE data; Obtain approval to add an MU 3 requirements requirement for hospitals and ambulatory clinics to use this standard to obtain vital signs from medical devices, with incremental (stretch goal)

  8. Proposed Inpatient Use Case – ICU, Step Down, Observation, General/Surgical Patient is admitted – monitors are attached:

  9. Nomenclature / Terminologies Used • Device (IHE PCD Technical Framework Volume 3 – Semantic Content) • IEEE 11073 10101 Nomenclature • MDC terms • Clinical (HL7 Implementation Guide for CDA R2: IHE Health Story Consolidation, DSTU R1.1) • LOINC (observations) • SNOMED (constraints primarily) • Device Information Model (DIM) – how a device maps to a hierarchical, containment tree model – GMDN. MDNS assumed in use but being phased out

  10. HIT Detail • Messaging • HL7 V2.6 constrained by IHE DEC PCD-01 and RTM – Device Operations • Consolidated CDA, IHE Health Story Consolidation, DSTU R1.1* - Clinical Observations • Message Transport • Minimum Lower Layer Protocol (MLLP) over TCP/IP – Device Operations • Web Services(REST/SOAP) - Clinical Observations • Systems Impacted • EHRs primarily currently • Over time: Clinical Decision Support, Population Management, Clinical Research * FHIR impact likely

  11. Content Type and Direction

  12. Value Sets

  13. Vital Sign Observation Vocabulary Constraints

  14. Actor Definitions, Data Stores and Interactions (Key) NA Event Existing IHE Actor Trigger Data / Image / Document Repository Proposed IHE Actor Document or Transaction

  15. IHE Actors Diagram (Current State) Device Observation Filter (DOF) Note – limited implementation with infusion pumps (ex: 1 per minute observations) PCD-02: Subscribe to PCD Data (inactive) PCD-01: Communicate Device Data Device Observation Consumer (DOC) Device Observation Reporter (DOR) Device Observation Bridge (DOB) PCD-01: Communicate Device Data

  16. Actor Definitions and Interactions (Initial Use Case) 1 Configure/subscribe/query Feed Availability / Publish Notification 1 2 Patient Records Device Observation Consumer (DOC) A (EHR) Device Observation Filter (DOF) Device Observation Reporter (DOR) Device Observation Consumer (DOC) B (CDS) 7 CDS Audit Trail C-CDA payload 4 Device Observation Clinical Repository Device Observation Consumer (DOC) C (Population Mgmt.) 8 3 Population Data Warehouse 6 Device Observation Bridge (DOB): mapping and transform where necessary – (DOB) Device Observation Consumer (DOC) D (Clinical Research) HL7 v2.6 messaging 4 Clinical Research Data Warehouse 5 Device Operations Repository Publish • Added value: • Research • Patient safety • CDS

  17. Inpatient Use Case Steps – ICU, Step Down, Observation, General/Surgical • Configuration for Device DOF/DOB – stream and timing scope, auto push / pull mode requirements • Device sends data to DOR • DOR sends observation stream to DOF; • DOF filters stream to retain what is useful for retrospective work and stores filtered stream in Device Operations Repository; minimally includes alerts in initial phase • DOB maps clinical observations from filtered HL7 v2.6 messages to C-CDA and applies data transformations required for LOINC and SNOMED nomenclatures • DOB sends stream to Device Observation Clinical Repository, for storage • Repositories a) trigger availability notification to applicable DOC or b) DOC auto pushes depending on configuration • DOCs query streams as appropriate

  18. Filtered Clinical and Device Operations Data: Avoiding Flooding • Sample at specified intervals – EHR maintains sample data : all devices • Intermittent example – PCA pump overdose, endangering patient: oxygen saturation: limited devices (may add or replace) • Intermittent example – noninvasive blood pressure – clinician initiated

  19. IHE Technical Solution Device Observation Reporters (DOR) Network Gateways Device Integration Engines Individual Devices Device Observation Consumers (DOC) Enterprise EMR, EHR, … 1 2 ISO/IEEE 11073 mapping to SNOMED and/or LOINC for vital sign numerics IHE PCD DEC IHE PCD DEC WCM, EC, ACM, … 3 4

  20. IHE Technical Solution • Enterprise gateways, device integration engines (e.g. Capsule, Iatric, iSirona, Nuvon) and possibly individual devices send near real-time medical device data using the IHE PCD DEC Profiles (HL7 V2.6 messaging and ISO/IEEE 11073 nomenclatures. Filtering needs to be applied to meet data requirements without flooding. • For numeric vital signs observations, a normative mapping from ISO/IEEE 11073 to SNOMED and/or LOINC are developed (by organizations representing SNOMED and/or LOINC) and are made available on the NIST RTMMS and other nomenclature repositories. Enterprise “Device Observation Consumers” would use the normative mapping table to translate the ISO/IEEE 11073 nomenclature to SNOMED and/or LOINC. • Device-centric data (waveforms, events, alerts, configuration and commands) would use the ISO/IEEE 11073 nomenclature. • The IHE PCD DEC (Device Enterprise Communication) Technical Framework and ISO/IEEE 11073 nomenclature are recognized as “Meaningful Use” or equivalent profiles and standards for medical device data transfer to and from enterprise entities.

  21. HL7 / IEEE / IHE Asks from NLM/IHTSDO • Clarification on the scope of IEEE 11073 10101 Nomenclature: US, Europe, International: where would there be interest/need regarding the work proposed? • Clarification on the level of adoption of IEEE 11073 10101 Nomenclature: US, Europe, International? • Any reference / contacts regarding anesthesia work harmonizing IEEE 11073 and SNOMED in the past • List of the high-priority 100+ concepts from IEEE 11073 to be mapped to LOINC/SNOMED

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