Intelligent Healthcare Technology Integration

Transcription

1 Itelliget Healthcare Techology Itegratio April 2, 205 Paul, H. Frisch, PhD. FHIMSS Attedig Departmet of Medical Physics Chief, Biomedical Physics & Egieerig Memorial Sloa-Ketterig Cacer Ceter New York, NY Presidet & CTO RFID i Healthcare Cosortium Chief Techical Officer, Itelliget Health Associatio

2 Icreasig Medical Errors: Medicatio Errors,2 :5 Doses Icorrectly Delivered 7,000 98,000 Deaths Aually 5 % 6 % Errors Occur i IV Medicatio Admiistratio Device Operatig Errors 5-20 % of Idetified Device Failures 2 Idetificatio Errors Drivers: (Errors / Failure + Errors) Icreased Patiet Acuity Icreased Device / Techology Complexity Icreasig Volume of Iformatio Icreasig Workloads o Cliical Staff Morga, S. Medicatio Error Statistics, The Prescriptio, Vol., No., July 2005 Cardial Health: Statistics Medicatio Safety & Educatio Stahel PF, Sabel AL, Victoroff MS Wrog-site ad wrog-patiet procedures i the Uiversal Protocol era: aalysis of a prospective database of physicia self-reported occurreces. Arch Surg. 200;5: Wilcox AB, Che YH, Hripcsak G. Miimizig electroic health record patiet ote mismatches J Am Med Iform Assoc. 20;8:5-5 3

3 Itelliget Hospital Room Level Devices Toilet Emergecy Outside of Room Dome Idicator CISCO Access Poit Nurse Hads Free Wireless Devices Room HUB Code Blue Patiet Statio Directed Commuicatios Hub Router Alarm & Physiologic Data Maager (Coectivity) Hospital Backboe Nurse Call Applicatio Server Vetilator Maagemet Applicatio Medicatio Admiistratio Physiologic Data Maager Pump Medicatio Maagemet Physiological Moitorig Sample Collectio RTLS RTLS RFID EMR Archivig Hospital Gateway

4 Objective: Desig of a Itegrated Itelliget Hospital Icreased Data Accuracy & Availability Electroic Medical Records Shared Medical Device Itercoectivity ad Itegratio Global View of the Patiet / Uit Rapid Iformatio Dissemiatio & Respose Physiological Data Alarm Evet Maagemet Advaced Commuicatio Platforms (PDA, iphoe, etc.) Locatio Cotet Ehaced Error Checkig & Validatio Idetificatio & Associatio

5 Compoets of Itelliget Hospital Trasducers, Sesors Advaced Medical Devices Cetralized or Shared Data Acquisitio -- Coectivity of Devices Physiological & Alarm Data Maagemet Itelliget Data Processig Time Sychroizatio RTLS Patiet Cetric Idetificatio & Associatio Device Trackig Medicatio Admiistratio Sample Collectio Video & Imagig Global / Istitutioal Overview & Visualizatio of Rooms / Uits Ehaced Commuicatios

6 Eviromet of Care Dedicated Pagers Physiological Moitorig Cetral Server Vetilator Maagemet System Nurse Call Cetral Statio Server /Work Statio Wireless Access Poits Video Nurse Call Physiological Moitorig Dedicated Vetilator Pager Ifusio Pumps Vetilatio

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8 Not Just Devices & Iformatio Systems Nurse server & secure ID card access reader E-glass slide & break away doors Iside opeig of urse server Wireless Time Sychroized clock Storage cabiets Bedside Computer with double moitor Barcode reader ad lab label priter Twi mobile articulatig arms (BOOMS) Wireless IR trasmitter Web cam Closet ad DVD player Flat scree TV o articulatig arm Toilet Nursig work area Atimicrobial Surfaces

9 Use Atimicrobial Copper for Cotact Surfaces Patiet Rooms Atimicrobial Copper Idistiguishable: Stailess Steel (cotrol) Silver coatig A Silver coatig B MRSA o Atimicrobial Copper vs. silver cotaiig coatigs 22C ad 50% relative humidity

10 Hospital Eviromet The Cotiuum of Care Supportig Patiet Treatmet & Care OR Acute Care (ICU) Emergecy Departmet Geeral Patiet Care Areas Outpatiet Specialty Areas Radiology Radiatio Ocology Cardiology Suite Pharmacy Cetral Supply War Room Data Ceter Biomedical Eg. / IT

11 GPS Real Time Iformatio Delivery Demographics Status, ETA Field Assessmet Allergies Physiological Data Treatmet Plaig Staffig / Assessmet Rapid Routig OR, Cath Lab Necessary Supplies

12 Itegrated Hybrid OR Wall of Kowledge Video Camera Drager Aesthesia System RFID Surgical Table Wall of Kowledge - Routable Images Miimally Ivasive Surgery Boom Device Cotrol RFID Coupled Surgical Istrumets RFID Coupled Spoges OR RFID Couple Status Board RFID Coupled Supplies Iteractive Cosultatio / Educatio Robot Boom Mouted Video Itegrated Philips C-Arm 202 HIMSS Expo. RHCC Itelliget Hospital Pavilio

13 RFIR Virtual Wall Time Syc. Clocks Medical Devices & Coectivity (Barcode & RFID) RFID Had Hygiee Compliace RFID Coupled Patiet / Staff Trackig Patiet Idetificatio geerate bedside (Barcode, Passive & Active RFID) Label Scaers & Priters: Wristbad, Sample Collectio RFID Coupled Bed / Patiet Maagemet System Emergecy Room (ER)

14 Acute Care (ICU & Step Dow) Medical Devices: Vetilators (ICU) Advaced Ifusio Pump Moitorig RFID Coupled Nurse Call Alarm Moitorig ad Distributio Secodary Notificatio & Escalatio Coectivity Patiet, Staff, Device Associatio Medicatio Admiistratio / Verificatio Bedside PC (Mouted & Portable) RTLS Solutios Workflow Eterprise & Uit Visualizatio Networked Staff to Staff Commuicatio Cosultatio Robot Itelliget Healthcare Pavilio HIMSS 20

15 Itelliget Pharmacy

16 War Room vs. Distributed Iformatio Maagemet Telemedicie Ambulace Data ER / OR Dashboards Bedside PC Educatio / Cosultatio Alarm Mgmt War Room Alarm Mgmt Vetilator Maagemet & Aalytics Alarm Maagemet Physiological Data Bed Maagemet

17 Coectivity - Itegratio Medical Devices Nurse Call Physiological Moitorig Vetilator Maagemet Ifusio Pumps Coectivit y Data & Alarm Maagemet Processig Data Acquisitio & Processig Associatio Locatio Services RFID Device Level Server Based Commuicatio Devices Archive EMR Moitorig Vetilatio Ifusio Pump Nurse Call Smart Bed

18 Cliical Data Delivery to the Poit of Care Arrythmias Alarms ECG Waveforms Echocardiograms CT Scas Lab Results

19 VoIP Bidirectioal Commuicatios Vocera Commuicatios, Cupertio, CA

20 Itelliget Hospital Desig is Depedet o Itegrated Uique Idetificatio & Locatio Cotet Devices & Systems Coectivity II Iformatio Delivery Ifrastructure Idetificatio & Associatio

21 Dyamic Idetificatio ad Associatio Medical Devices & Systems Physiological Moitorig Vetilator Maagemet Ifusio Pump Systems Nurse Call Patiet Cetric Pharmaceutical Alarm Maagemet & Data Distributio Critical Alarms to the Poit of Care Staff to Staff Commuicatios Medicatio Admiistratio Sample Collectio Electroic Medical Record Equipmet to Patiet Frisch, P.H., Miodowik, S., Booth, P., Carragee, P., Dowlig, M., Patiet Cetric Idetificatio ad Associatio. IEEE Egieerig i Medicie ad Biology Society, Proceedigs of the 3th Iteratioal Coferece. 2009: 722-5

22 Ifrastructure Hospital Backboe / Network Wireless 802. (WiFi) Telemetry (WMTS) RTLS / RFID WiFi ZigBee Dedicated Frequecies Time Sychroizatio Evirometal Moitorig Temperature & Humidity Differetial Pressures

23 RTLS Solutios RFID Techology Active vs. Passive RFID Localized Solutio: Global Istitutioal

24 Passive RFID Applicatios I Healthcare Coectivity Medical Supply Trackig Surgical Tray Assembly & Trackig Surgical Spoge & Istrumet Trackig & Verificatio Pharmaceutical Medicatio Admiistratio Laboratory Sample Collectio & Archivig Small Devices / Ivetory Patiet Cetric Idetificatio & Associatio Verificatio of Process Cleaig or Decotamiatio Processes

25 202 HIMSS Expo. RHCC Itelliget Hospital Pavilio Supply Chai RFID Atea Bar Code Item Level Idetificatio Shelf level Trackig Validatio of Supplies Check Expiratio Serial #, Lot # Update Ivetory

26 Surgical Applicatios - Retaied Objects: i 5,000 ope cavity surgeries result i a retaied object 0% of surgical cases are ope cavity 70% of retaied objects are spoges 76 Medicare icidets i 2006 Tray Developmet Validate Surgical Tray Cotet Before & After Procedure Validate Spoge Couts Cofirm Cleaig & Sterilizatio Processes Ascesio Health, Scott Lambert, Lead Parter, Egagemets & Prototypes Trasformatioal Developmet, 2008 Midwest Chapter HIMSS

27 Medicatio Admiistratio RFID Coupled Dispeser Applicatio Workstatio: Itegrates to Physicia Order Etry Validate 5 Rights (Bar Code) Had Held Bar Code Reader 202 HIMSS Expo. RHCC Itelliget Hospital Pavilio

28 Process Validatio Statio # #2 #3 #. If # ad #2 ad # 3 ad # Good to Go Atea Network ID# Cleaig Processes Laboratory Processes Documet Trasfer Scope Sterilizatio Had Hygiee

29 Passive RFID Pro s & Co s Advatages: Tag fuctios without a battery Log Useful Life (20 years) Low Cost Small Coforms to almost ay form factor wristbads, embedded tags Disadvatages: Short Read Distaces (typically 3 ft - up to 00 feet ) Requires Dedicated Ifrastructure Choke Poit Applicatios

30 Active RFID (Beacoig) Battery Powered Beaco at Pre- Programmed Itervals Cotais Idetificatio & Data Fuctioal Eables Positioal Computatios Ca use Existig Commuicatio Protocols Multi- Mode Tags Multiple techologies

31 Triagulatio Existig 802. Wireless Ifrastructure RFID Egie & User Iterface Access Poit Access Poit S2 Sigal Stregth S R2 S3 R3 R Choke Poit Idetificatio Triagulatio Choke Poit Tag ID

32 Active RFID Applicatios Ivetory Maagemet Locatig & Trackig Critical Devices PM Compliace Distributio of Costs Asset Utilizatio Auditig Tax Write Off Workflow ad Maagemet Staff Trackig Idetificatio & Associatio Metrics o Dyamic Time Sequece of Evets Dashboards

33 Scalability Presece Icreasig Cost Locatio Choke-poit Approx feet Room Level Or Better

34 Istitutioal RTLS Solutio RTLS, Network Cliets, ADT, etc. Active RFID Passive RFID Bar Codes User Iterface Processor Idetificatio Associatio Data Applicatios

35 Asset Visualizatio?

36 RFID Coupled Device Status & Utilizatio Programmable Evets Ifusio Pump Server Device Locatio Status Gateway RFID System Formulary Versio Chaels i Use Operatio Parameters MSKCC Carefusio- Aeroscout Collaboratio Alarms

37 R c2 O ad c3 O ad R c O ad R artz w ch S artz2 w ch S B st9 b o st b o B t p au H t2 p au H t3 p au H t p au H t5 p au H M P 2 P M 6 P M M 0 M M 2 M M 5 M 6 M 7 M 9 M M 5 M 6 M 7 M 8 M 9 M Percetage Average Utilizatio by Care Uit 00% 90% 80% 70% 60% 50% Percetage Utilizatio 0% 30% 20% 0% 0%

38 Toilet Emergecy Developig Itelliget Hospital Outside of Room Dome Idicator CISCO Access Poit Nurse Hads Free Wireless Devices Room HUB Code Blue Patiet Statio (Vocera) Directed Commuicatios Hub Router Patiet Cetric Idetificatio Alarm & Physiologic Data Maager Cliical Data Maager (Emergi) Hospital Backboe Nurse Call Applicatio Server Vetilator Maagemet Applicatio Physiological Moitorig Pump Medicatio Maagemet RFID Hospital Gateway

39 Sychroized RF-ID Trackig & Evet Streamig Dyamic Workflow EXCITER EXCITER EXCITER EXCITER EXCITER EXCITER EXCITER EXCITER EXCITER

40 Workflow Visualizatio & Reportig (Chage of State Critical Respose) Patiet Room #2 Patiet Room # GE Moitorig Weiss Ifusio Pump MD RN Nursig Statio Douglas Thomas JSmith VTach Moitorig Alarm Code Blue IV Pump Vet Staff Patiet Ramos SJoes Clea Utility Room Time: 2:05AM 0

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42 The Patiet Experiece Workflow Metrics & Aalytics Room #2 Patiet Alice Smith Jue 8, 202 RN MD Registratio Check out Fellow Patiet Wait Times Treatmet Time Staff Presece By Specialty Time Sequece of Alarms & Evets Utilizatio & Availability of Devices & Supplies 2

43 Cautios & Pitfalls Network Impact Iterferece (EMI) Regulatory Issues Busiess Itelligece Maagemet Applicatio Developmet

44 Medical Data Itegratio Commuicatio Device Medical Devices FDA Regulated Cliical Data Middleware Applicatio Secodary Data Source EMR Archive Primary Source of Medical Iformatio

45 A 0 B 0 B B 2 A 5 B 5 A 7 B 7 C 7 D 7 A 0 2 B 0 2 A 2 B 2 A 2 B 2 A 2 B 2 A 5 2 B 5 2 A 6 2 B A 3 B 3 A 2 3 A 3 B 3 A 5 3 B Big Data Iformatio Overload Telemetry Uit - 2 Beds Daily Average per bed Potetial Tool for Staff to Patiet Assigmet

46 Average Alarms Per Bed Per Shift Patiet Staff Ratio : 6 Critical Alarms / Hour Critical Evet Every miutes

47 Requiremets for Visualizatio ad User Iterfaces Devices Applicatios Had Helds Phoes, ipads Pagers, PC

48 RTLS Solutio Use Case Developmet RTLS, Network Cliets, ADT, etc. Active RFID Passive RFID Bar Codes User Iterface Processor Idetificatio Associatio Data Applicatios

49 Out Toilet Emergecysid e of Roo m Do me Idi cat or Code Blue Biomedical Device Iformatio System CISCO Access Poit Nurse Hads Free Wireless Devices Room HUB Patiet Statio (Vocera) Directed Commuicatios Hub Router Patiet Cetric Idetificatio Alarm & Physiologic Data Maager Physiologic Data Maager (Emergi) Hospital Backboe Nurse Call Applicatio Server RFID Vetilator Maageme t Applicatio Physiological Moitorig Pump Medicatio Maagemet RFID Hospital Gateway Automatic Patiet Cetric Idetificatio Bed Embedded RF Trasmitter Receiver Embedded Bed / Nurse Call Staff Workstatio Pharmaceutical Equipmet to Patiet Middleware Bed Cetric Idetificatio Evelope Devices EMR Questios?