Major medtech manufacturers took significant strides toward enabling device interoperability at this year's Healthcare Information and Management Systems Society (HIMSS) conference, held in New Orleans last month. During the conference, the interoperability initiative known as Integrating the Healthcare Enterprise (IHE) demonstrated its first profile designed to enable communication among patient care devices (PCD). As part of IHE's interoperability showcase, such device manufacturers as GE Healthcare, Philips Medical Systems, B. Braun Medical, Welch Allyn, and Draeger Medical demonstrated the seamless communication of information among their devices in a simulated hospital setting.
"It is rewarding to see these truly fierce competitors working on a common platform," says Raymond Peter Zambuto, president of Technology in Medicine Inc. (Holliston, MA) and cochair of the IHE PCD domain. "I believe that the vendors are driven by a number of factors, but at the end of the day, their prime motivation is economic. Each year, when we survey the field, more users and buyers are going on record in favor of interoperability."
IHE was launched in 1998 by HIMSS and the Radiological Society of North America (RSNA; Oak Brook, IL) as a joint effort by healthcare professionals and industry to improve the way computer systems in the healthcare field share information. The effort, which has since been joined by the American College of Cardiology (ACC; Bethesda, MD), promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of patient care. According to the initiative's Web site, systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively.
Zambuto says the initial PCD profile, called Device Enterprise Communication (DEC), addresses the communication of asynchronous data from a device to other devices and to electronic health records. "Asynchronous data is information such as vital signs--heart rate, blood pressure, and other metrics--that is typically reported on intervals of minutes and is not required to be reported in real- or near-real-time for purposes of immediate diagnostics or therapies, or control of one device by another," Zambuto says. "As such, DEC information is sent as HL7 messages.
"DEC can encompass a wide variety of devices," Zambuto adds. "At the showcase, we had vital signs monitors, ventilators, infusion devices, dashboard displays, and cardiac information systems all communicating on a vendor-neutral basis. This is a small segment of the potential usage of DEC, which can include some laboratory reporting from point-of-care devices, anesthesia, dialysis, home-care devices, physical therapy, and others. As such, DEC is really infrastructural because it spans so many clinical disciplines."
The PCD domain has attracted considerable attention from medical device manufacturers. When B. Braun Medical was invited to join the IHE interoperability showcase, the company immediately devoted resources to the project, says Eric G. Melanson, director of marketing. "Our role was to use the example of our Outlook 300 infusion pump to illustrate the ability to match the patient medication to the patient's wristband, and then program the infusion device using barcoding, eliminating the potential errors of manual programming," he says.
"Once infusing, we illustrated the ability to send data wirelessly to our DoseTrac infusion management system, a database application allowing archiving and reporting of critical patient data," he adds. "We could then send an outbound data stream using the IHE-developed standard HL7 PCD-01 transaction from DoseTrac to the Phillips EHR application and the LiveData OR Dashboard, thus demonstrating the interoperability between the infusion device and other patient care devices in the healthcare domain."
IHE expects to roll out additional PCD profiles in coming years.
"Next year, the group will focus on defining the transactions to support consistent workflow for associating patient identification with a device during the period it is associated with a particular patient, and removing that association when the device is no longer associated with a specific patient," says Jack Harrington, senior director of integrated solutions for cardiac and monitoring systems at Philips Medical Systems and cochair of the IHE PCD domain. "The group will also be developing a plug-and-play profile for connecting a PCD to the device observation reporter, and providing a publish-subscribe mechanism that can be used by a device observation consumer to selectively filter the types of data received from a device observation reporter."
Zambuto says additional profiles developed beyond next year may include ones focused on clinical alarms management; real-time waveform transmission, storage, and retrieval; mobile monitoring; real-time decision support; and device-to-device interaction.
IHE's process for standards adoption begins with clinicians and IT personnel working together to identify common interoperability problems with information access, clinical workflow, administration, and the underlying infrastructure. Healthcare IT professionals identify relevant standards and define how to apply them to address the problems. These are documented in the form of IHE integration profiles. Once a profile is established, manufacturers implement the profiles in their products and test their systems for interoperability at the annual IHE Connectathon. Finally, manufacturers can publish IHE integration statements to document the IHE integration profiles their products support. Users can reference the IHE integration profiles in requests for proposals to simplify the systems acquisition process.
"The rate at which the purchasers of PCD devices include the IHE PCD profiles in their purchase specifications is the most significant factor in driving adoption," Harrington says.
Sloane: Benefits for manufacturers.
The American College of Clinical Engineering (ACCE) was appointed as a sponsor of the PCD domain in 2005. That year, HIMSS and ACCE conducted an online survey that indicated that patient care devices--including physiologic monitoring, infusion devices, and anesthesia systems--were among the highest priorities for healthcare professionals in terms of the need for connectivity. IHE's primary sponsors--HIMSS, ACC, and RSNA--then authorized ACCE to begin the formal creation of the IHE PCD domain.
"For the first time, instead of paying for private focus groups that have inherent statistical limitations, manufacturers are able to get comprehensive guidance and feedback directly from clinical professionals," says Elliot B. Sloane, PhD, assistant professor in the department of decision and information technologies at the Villanova School of Business and cochair of the IHE PCD domain. "Knowing exactly what the clinicians need to accomplish--and what they prefer to buy--manufacturers can reduce their product development costs and time to market by actively participating in the selection of technical standards and the development of achievable IHE profiles. These profiles create a level playing field for all vendors to use as an efficient market baseline, allowing them to focus on product usability, reliability, service, and other important market differentiators."
"IHE represents the best chance that we have in the United States and around the globe to put into place a true framework for interoperability," Zambuto says. "The fact that users and vendors are working together, driven by the work of professional societies, tells me that this activity will succeed."
GE's Schluter: A growing trend.
Paul Schluter, PhD, principal engineer with GE Healthcare Monitoring Solutions, agrees. "IHE provides an excellent venue to get like-minded vendors together to solve enterprise connectivity problems by profiling existing standards and then prototyping and proving that they have achieved connectivity at the IHE Connectathon and subsequent demonstrations such as at HIMSS," Schluter says. "GE Healthcare, as well as many of the other companies that participate in the IHE initiative, believes that better connectivity and communication is necessary and desirable--for our industry as well as for the hospitals, clinicians, and patients we serve."I expect to see this trend continue, and I believe IHE provides one of the best venues for doing so, since it provides a venue for healthcare professionals to work closely with vendors to define, prototype, and demonstrate solutions that are clinically useful and implementable," Schluter adds. "Rather that inventing new standards, IHE seeks to profile existing standards that already appear to have traction within the industry, avoiding the blind alleys that can often occur during early or premature standards development."
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