AHIC / NeHC Use Case
CmDC Scope
Common device connectivity is the means by which high-acuity and inpatient clinical device information such as settings, measurements, and monitoring values are communicated to and from EHR and other specialized clinical information systems. Examples of devices include hemodynamic monitors, ventilators, anesthesia monitors, and infusion pumps. Radiological devices are not considered in scope for this extension/gap.
Therefore, the requirements for 2009 Common Device Connectivity Extension/Gap can be summarized as:
The ability to communicate high-acuity and inpatient multi and single parameter device information to and from an EHR and other specialized clinical information systems via direct network connections and wireless networking within an
EHR
EHR
EHR Use Case
EHR Use Case
Device Reporting, Control and Management Device Reporting, Control and Management
What is an EHR?
From HIMSS –
The Electronic Health Record (EHR) is a longitudinal electronic record of patient health
information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR
automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related
activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting.
From Wikipedia –
An Electronic Health Record (EHR) refers to an individual patient's medical record in digital format. Electronic health record systems co-ordinate the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed on a computer, often over a network. It may be made up of electronic medical records (EMRs) from many locations and/or sources. Among the many forms of data often included in EMRs are patient demographics, medical history, medicine and allergy lists (including immunization status), laboratory test results, radiology images, billing records and advanced directives
EHR Use Case
The focus of the CmDC Use Case is the EHR process for collection of “validated” patient vital signs, infused drips and other data coming from devices.
This information is collected either: – “Real-Time”
– Via bulk data transfer, especially after the device has been disconnected and then reconnected to the HER
The Use Case also contemplates control from the EHR to devices – Potentially for control of reporting intervals
– For communication of settings from the EHR to the devices – For communication of safe limits from the EHR to the devices
EHR Use Case
The EHR is responsible for a set of patients
The EHR discovers which automatically sourced data is available for these patients.
The EHR starts to collect this data for a specific patient.
– It requests the list of data available for that patient from each device (or device proxy) and the possible reporting intervals.
– It specifies which data it would like to collect. – It selects the data reporting interval.
– The device starts to send the data to the EHR.
The Use Case provides a long (not extensive) list of information to be exchanged with the EHR.
Data Types - Patient Demographics
The EHR requires that all data collected be associated with a specific patient, with the association being done before the data is acquired by the EHR.
Patient Demographics include at a minimum: – Patient Name
– Patient Location – Patient ID
MRN
Encounter
Data Types – Patient Measurements - Periodic
Measurements include: – Hemodynamic Data:
Heart Rate 1 every 30 seconds
Invasive Blood Pressure 1 every 30 seconds – Ventilation Data:
Respiration Rate 1 every 30 seconds
CO2 level 1 every 30 seconds
– Infusion Data:
Infusion Rate 1 every 30 seconds Volume Infused 1 every 30 seconds – Bed
Data Types – Patient Measurements - Aperiodic
Measurements include: – Hemodynamic Data:
Arrhythmia
Non-Invasive Blood Pressure Cardiac Output
12-Lead ECG report… – Ventilation Data:
???
– Infusion Data: ???
Data Types – Patient Measurements – Continuous (Waveform)
Measurements include: – Hemodynamic Data:
ECG Waveform
Invasive Blood Pressure SpO2 Waveform – Ventilation Data: Flow Waveform Pressure Waveform CO2 Waveform – Infusion Data: ??? – Bed ???
Data Types – Patient Events
Patient Events include: – Hemodynamic Data:
Heart rate alarm
Invasive Blood Pressure alarm SpO2 alarm
– Ventilation Data:
Respiration rate alarm Pressure alarm
CO2 level alarm – Infusion Data:
Data Types – Device Settings
Device Settings include … – Hemodynamic Data:
HR Alarm setting
Non-Invasive Blood Pressure reading interval – Ventilation Data: Respiration Rate Mode – Infusion Data: Infusion Rate Volume to be Infused – Bed: Head angle
Data Types – Device Events
Device Events include … – Hemodynamic Data:
Non-Invasive Blood Pressure reading interval – Ventilation Data: Respiration Rate Mode – Infusion Data: Infusion Rate Volume to be Infused – Bed: Head angle
Summary – Section 7.0 Information Exchange
The information exchange requirements for the effective selection and communication of common device information may comprise:
The ability to communicate and associate device and patient information to an electronic health record (EHR);
The ability to communicate device setting and measurement information to the EHR for effective patient monitoring and management;
The ability to communicate and manage measurement intervals and device setting information within the EHR;
The ability to query for additional device information captured by the device that may not have been communicated to the EHR;
The ability to communicate measurement information to the EHR when there is a lapse in EHR connectivity;
The ability to communicate standardized alarm types and alarm violation types to the EHR;
The ability to set and communicate limits and safeguards for device settings from the EHR to a device; and
The ability to wirelessly communicate point of care device information from the device to a device intermediary or EHR.
