Intelligent Healthcare Technology Integration

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“ Intelligent Healthcare”

Technology Integration

Paul, H. Frisch, PhD. FHIMSS Attending Department of Medical Physics

Chief, Biomedical Physics & Engineering Memorial Sloan-Kettering Cancer Center

New York, NY

President & CTO RFID in Healthcare Consortium Chief Technical Officer, Intelligent Health Association

(2)

n

Increasing Medical Errors:

n

Medication Errors 1,2

n 1:5 Doses Incorrectly Delivered n 7,000 – 98,000 Deaths Annually

n 54 % – 61 % Errors Occur in IV Medication Administration

n

Device Operating Errors

n 15-20 % of Identified Device Failures

n (Errors / Failure + Errors)

n

Identification Errors

n

Drivers:

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Increased Patient Acuity

n

Increased Device / Technology Complexity

n

Increasing Volume of Information

n

Increasing Workloads on Clinical Staff

1 Morgan, S. Medication Error Statistics , The Prescription , Vol.1, No. 1, July 2005 2 Cardinal Health: Statistics – Medication Safety & Education

3 Stahel PF, Sabel AL, Victoroff MS Wrong-site and wrong-patient procedures in the Universal Protocol era:

analysis of a prospective database of physician self-reported occurrences. Arch Surg. 2010;145:978-984 4 Wilcox AB, Chen YH, Hripcsak G. Minimizing electronic health record patient–note mismatches

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Physiologic Data Manager (Connectivity) Directed Communications Nurse Call Application Server Ventilator Management Application Physiological Monitoring Pump Medication Management Hospital Gateway RTLS Hospital Backbone

Alarm & Physiologic Data Manager

Nurse Hands Free Wireless Devices

Intelligent Hospital

CISCO Access Point Outside of Room Dome Indicator Patient Station Toilet Emergency Code Blue Router Room HUB Hub RFID

Room Level Devices

Medication

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Objective: Design of an Integrated

Intelligent Hospital



Increased Data Accuracy & Availability

 _{Electronic Medical Records}

 _{Shared Medical Device Interconnectivity and Integration}  _{Global View of the Patient / Unit}



Rapid Information Dissemination & Response

 _{Physiological Data}

 _{Alarm Event Management}

 _{Advanced Communication Platforms (PDA, iPhone, etc.)}  _{Location Content}



Enhanced Error Checking & Validation

 _{Identification & Association}  _{Location Content}

 _{Correct Information}

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Components of Intelligent Hospital

 _{Transducers, Sensors}

 _{Advanced Medical Devices}

 _{Centralized or Shared Data Acquisition -- Connectivity of Devices}

 _{Physiological}_{& Alarm Data Management}

 _{Intelligent Data Processing}

 _{Time Synchronization}  _RTLS

 _{Patient Centric Identification & Association}  _{Device Tracking}

 _{Medication Administration}  _{Sample Collection}

 _{Video & Imaging}

 _{Global / Institutional Overview & Visualization of Rooms / Units}  _{Enhanced Communications}

 _{Point of Care Information Delivery}  _{Inventory Management}

 _{Supply Chain (High Value Supplies & Pharmaceuticals)}  _{Networked & Wireless Infrastructure}

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Environment of Care

Ventilation Physiological Monitoring Physiological Monitoring Central Server Ventilator Management System Dedicated Pagers Dedicated Ventilator Pager

Wireless Access Points

Nurse Call Nurse Call Central Station Infusion Pumps Server /Work Station Video

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2 3 5 6 7 8 10 11 12 13 ₁₄ 1 9 8

1. Nurse server & secure ID card access reader

2. E-glass slide & break away doors 3. Inside opening of nurse server 4. Wireless Time Synchronized clock 5. Storage cabinets

6. Bedside Computer with double monitor

7. Barcode reader and lab label printer 8. Twin mobile articulating arms (BOOMS)

9. Wireless IR transmitter 10. Web cam

11. Closet and DVD player

12. Flat screen TV on articulating arm

13. Toilet

14. Nursing work area 15. Antimicrobial Surfaces

4

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Use Antimicrobial Copper for

Contact Surfaces

Patient Rooms

MRSA on Antimicrobial Copper vs. silver containing coatings

22C and 50% relative humidity

Antimicrobial Copper

Indistinguishable:

•Stainless Steel (control) •Silver coating A

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Hospital Environment

The Continuum of Care



OR



Acute Care (ICU)



Emergency Department



General Patient Care Areas



Outpatient



Specialty Areas



Radiology



Radiation Oncology



Cardiology Suite



Pharmacy



Central Supply



War Room



Data Center



Biomedical Eng. / IT

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Real Time Information Delivery Demographics Status , ETA Field Assessment Allergies Physiological Data GPS Treatment Planning Staffing / Assessment

Rapid Routing OR , Cath Lab Necessary Supplies

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Wall of Knowledge

Integrated Philips C-Arm

RFID Surgical Table Video

Camera

Drager Anesthesia System

2012 HIMSS Expo. RHCC Intelligent Hospital Pavilion

Integrated Hybrid OR

 Wall of Knowledge - Routable Images

 Minimally Invasive Surgery Boom

 Device Control

 RFID Coupled Surgical Instruments

 RFID Coupled Sponges

 OR RFID Couple Status Board

 RFID Coupled Supplies

 Interactive Consultation / Education Robot

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Time Sync. Clocks

Medical Devices & Connectivity (Barcode & RFID) RFID Hand Hygiene Compliance

RFID Coupled Patient / Staff Tracking

Patient Identification generate wristband @ bedside (Barcode, Passive & Active RFID)

Label Scanners & Printers: Wristband, Sample Collection RFID Coupled Bed / Patient Management System

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Acute Care (ICU & Step Down)

Intelligent Healthcare Pavilion HIMSS 2014

 _{Medical Devices:}

 _{Ventilators (ICU)}

 _{Advanced Infusion Pump}  _Monitoring

 _{RFID Coupled Nurse Call}

 _{Alarm Monitoring and Distribution}

 _{Secondary Notification & Escalation}  _Connectivity

 _{Patient, Staff , Device Association}  _{Medication Administration / Verification}  _{Bedside PC (Mounted & Portable)}

 _{RTLS Solutions}

 _Workflow

 _{Enterprise & Unit Visualization}

 _{Networked Staff to Staff Communication}  _{Consultation Robot}

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Alarm Mgmt

Telemedicine

Ambulance Data ER / OR Dashboards Bedside PC

Ventilator Management & Analytics

Alarm Management _{Physiological Data}

Bed Management

Education / Consultation

War Room

Alarm Mgmt

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Nurse

Call Physiological Monitoring Ventilator Management Infusion Pumps Data Acquisition & Processing Archive Communication Devices EMR Association Location Services RFID

Data & Alarm Management - Processing Connectivity - Integration • Device Level • Server Based

Medical

Devices

Connectivit

y

Monitoring

Ventilation Infusion Pump

Smart Bed

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Clinical Data – Delivery to the Point of Care

• Arrythmias Alarms • ECG Waveforms • Echocardiograms • CT Scans • Lab Results

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Vocera Communications, Cupertino, CA

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II

Devices & Systems

Connectivity Identification_&

Association

Information Delivery

Intelligent Hospital Design is Dependent on

Integrated Unique Identification & Location Content

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Dynamic Identification and Association

Equipment to Patient

Pharmaceutical

Frisch, P.H., Miodownik, S., Booth, P., Carragee, P., Dowling, M., Patient Centric Identification and Association. IEEE Engineering in Medicine and Biology Society, Proceedings of the 31th International Conference. 2009: 1722-5

 Medical Devices & Systems

 _{Physiological Monitoring}  _{Ventilator Management}  _{Infusion Pump Systems}  _Nurse_Call

 _{Alarm Management & Data Distribution}  _{Critical Alarms to the Point of Care}  _{Staff to Staff Communications}  Medication Administration

 Sample Collection

 Electronic Medical Record

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Infrastructure



Hospital Backbone / Network



Wireless 802.11 (WiFi)



Telemetry (WMTS)



RTLS / RFID

 _WiFi  _ZigBee  _{Dedicated Frequencies} 

Time Synchronization



Environmental Monitoring

 _{Temperature & Humidity}  _{Differential Pressures}  _Particulates

 _Light  _Sound

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RTLS Solutions

RFID Technology

Active vs. Passive RFID

Localized Solution:

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Passive RFID Applications In

Healthcare

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Connectivity

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Medical Supply Tracking

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Surgical Tray Assembly & Tracking

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Surgical Sponge & Instrument Tracking & Verification

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Pharmaceutical – Medication Administration

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Laboratory Sample Collection & Archiving

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Small Devices / Inventory

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Patient Centric Identification & Association

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Verification of Process

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• Item Level Identification • Shelf level Tracking

• Validation of Supplies

Check Expiration Serial #, Lot #

• Update Inventory

Supply Chain

RFID Antenna Bar Code

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Surgical Applications - Retained Objects

:

•

1 in 5,000 open cavity surgeries result in a retained object

•

40% of surgical cases are open cavity

•

70% of retained objects are sponges

Ascension Health, Scott Lambert, Lead Partner,

Engagements & Prototypes Transformational Development, 2008 Midwest Chapter HIMSS

• 764 Medicare incidents in 2006

• Tray Development

• Validate Surgical Tray Content

Before & After Procedure

• Validate Sponge Counts

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Medication Administration

RFID Coupled Dispenser

Hand Held Bar Code Reader

2012 HIMSS Expo. RHCC Intelligent Hospital Pavilion

Application Workstation:

Integrates to Physician Order Entry Validate 5 Rights (Bar Code)

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……….

Station #1 #2 #3 #4

ID#1

If #1 and #2 and # 3 and #4 Good to Go

Antenna Network Cleaning Processes Laboratory Processes Document Transfer Scope Sterilization Hand Hygiene

Process Validation

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Advantages:

•

Tag functions without a battery

•

Long Useful Life (20 years)

•

Low Cost

•

Small

•

Conforms to almost any form factor

•

wristbands, embedded tags

Disadvantages:

•

Short Read Distances (typically 3 ft - up to 100 feet )

•

Requires Dedicated Infrastructure

•

Choke Point Applications

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Active RFID

(Beaconing)

•

Battery Powered

•

Beacon at Pre- Programmed Intervals

•

Contains Identification & Data

•

Functional Enables Positional Computations

•

Can use Existing Communication Protocols

Multi- Mode Tags Multiple technologies

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Triangulation

Access Point Access Point

Tag ID Existing 802.11 Wireless Infrastructure

R1

R2 R3

RFID Engine & User Interface

Signal Strength S1

S2

S3

Choke Point Identification

•

Triangulation

•

Choke Point

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

Inventory Management

 _{Locating & Tracking Critical Devices}  _{PM Compliance}

 _{Distribution of Costs}  _{Asset Utilization}

 _{Auditing – Tax Write Off}



Workflow and Management

 _{Staff Tracking}

 _{Identification & Association}

 _{Metrics on Dynamic Time Sequence of Events}

 Dashboards

 _{Event Generation – Staff Duress}

 _{Integration With Biomedical Data Base}  _{Optimization of Processes}

 _{Temperature & Humidity Measurement}

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Presence

Location

Choke-point

Scalability

Approx. 15-20 feet Room Level Or Better Increasing Cost

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Active RFID Passive RFID Bar Codes Processor Applications Identification Association Data

RTLS, Network Clients, ADT, etc.

User Interface

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Infusion Pump Server

Gateway RFID System

Device Location Status Formulary Version Channels in Use Operation Parameters Alarms

RFID Coupled Device Status & Utilization

MSKCC – Carefusion- Aeroscout Collaboration

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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Bobst 9 _{Bobst 14} Haupt 1 Haupt 2 Haupt 3 Haupt 4 Haupt 5 MP 1 MP 2 MP 6

M 1 _{M 10} _{M 11} _{M 12} _{M 14} _{M 15} _{M 16} _{M 17} _{M 19} M 4 M 5 M 6 M 7 M 8 M 9

Rad Onc 2 Rad Onc 3 Rad Onc 4 _{Schwartz 1} _{Schwartz 2}

Percentage Average Utilization by Care Unit

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Clinical Data Manager Directed Communications Outside of Room Dome Indicator Patient Station Toilet Emergency Code Blue Router Room HUB Hub Nurse Call Application Server Ventilator Management Application Physiological Monitoring Pump Medication Management Hospital Gateway Hospital Backbone

Alarm & Physiologic

Data Manager

Nurse Hands Free Wireless Devices

Developing

Intelligent Hospital

CISCO Access Point (Emergin) (Vocera) RFID Patient Centric Identification

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EXCITER EXCITER

EXCITER

EXCITER EXCITER EXCITER EXCITER

Synchronized RF-ID Tracking & Event Streaming

“ Dynamic Workflow “

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Workflow Visualization & Reporting

(Change of State – Critical Response)

IV Pump Vent

Staff Patient

Clean Utility Room

Patient Room #2 Patient Room #1 GE Monitoring Infusion Pump MD RN Nursing Station Weiss Time: 12:05AM JSmith SJones Douglas Thomas Ramos

VTach Monitoring Alarm Code Blue

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0 2 4 6 8 10 12 0

0.1

#12

Patient Alice Smith June 18, 2012

Registration Fellow Check out

RN Room

MD

The Patient Experience

Workflow Metrics & Analytics

•

Patient Wait Times

•

Treatment Time

•

Staff Presence

•

By Specialty

•

Time Sequence of Alarms & Events

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Cautions & Pitfalls



Network Impact



Interference (EMI)



Regulatory Issues



Business Intelligence



Management



Application Development

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Medical

Devices

Middleware

Application

Communication Device

EMR

Questions ?

Minimizing electronic health record patient–note mismatches