Integrating Medical Devices into EMRs
Currently there is little interoperability amongst medical devices. Vital sign stations can transmit data but not every company implements communication in the same way. In the OR or ICU the issue is multiplied by the sheer volume of data being generated and the constant shuffling of equipment from one patient to the next. At present there is a standard for interfaces but no real compliance.
The issue of interconnection is one of safety and efficiency. Without direct communication advanced alert systems on items such as bypass pumps and ventilators cannot be implemented. Large volumes of data are produced but require manual entry into EMR systems. Current interfaces have to be reworked when new equipment is purchased. Even when a system is set up each device seems to have its own style of cable. Add a new device to the mix and all new interfaces have to be built. The goal is for a Plug-and-Play environment for these devices. Currently it looks like the landscape of the early Windows Plug-and- Pray standard.
Medical Information Bus
The current Medical Bus grew from an idea in the 1980=s by LDS hospital in Utah, MGH hospital in Boston and the Mayo Clinic. The early standard used RS 232 interfaces mainly for connection of infusion pumps. The early efforts did not catch on due to cost ond demand issues. This is an emerging standard that attempts to specify how to connect and communicate between different medical devices. There is an approved standard IEEE 1073 for the Medical Information Bus. http://www.ieee1073.org/overview/overview.html now an ISO standard ISO 11073. The IEEE 1073 / ISO 11073 standards aim to improve the ability to have truely plug-and-play devices with improved ease of use, enhanced patient safety, automated device and patient assignment to match the device attached to a given patient.
At the heart of the bus is a master/slave arrangement. The standard call these the BCC and DCC for Bedside Communication Controller and Device Communication Controller. The BCC could accept input from the ventilator and infusion pumps and then relay that information (now acting as a DCC) to the Clinical information system acting as the BCC for the entire unit.
The first prototypes were "hardwired" but with the tangle of wires at the bedside being an issue newer devices are using IR and radiofrequency communications.
There is a standard way of communication amoung devices. There is still work to do to make the devices HL7 compliant. http://www.itu.int/itudoc/itu-t/workshop/e-health/addinfo/info009.pdf
The Medical Device "Plug and Play" program (MDPnP)
The Medical Device "Plug and Play" Interoperability Program [MDPnP] http://mdpnp.org/Home_Page.html is baset at CMIT and Massachusetts General Hospital. They are working on a broad range of solutions from the physicians office to the futuristic operating room of the future. http://www.cimit.org/heal_orfinit.html The CMIT lab was set up in 2004 to provide a vender neutral site for design and evaluation of MIB devices. It is here that products can be tested to see if they comply with the IEEE 1073 standards.
These solutions depend on a reliable interface between the devices and the EHR. The purpose of the standards are to promote integration by data communication and device control. One common scenerio talked about is the ability of the ventilator to coordinate inspiration with the operation of an x-ray machine. Smart pumps could alert the nurse anywhere and allow the remote management of infusions.
Standards have been adopted and coordinated with industry.
The demand for such devices remain low and industry has not seen the need to push development.
For more information visit the website for the June 2007 conference on MDPnP http://rtg.cis.upenn.edu/hcmdss07/index.php3