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“Last Mile” F2F – Discussion F&O

“Last Mile” F2F – Discussion F&O. ISO/IEEE 11073 F&O d4 jw. Note: slides after p. 5 are from working documents and were added to the initial set (2-5), based on discussion during the F2F. Last Mile – Topo /Ontological Relation. IHE. ICE. NIST. MDC. Continua. ITI. PCD [/HL7v2]. -PHD.

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“Last Mile” F2F – Discussion F&O

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  1. “Last Mile” F2F – Discussion F&O ISO/IEEE 11073 F&O d4 jw Note: slides after p. 5 are from working documents and were added to the initial set (2-5), based on discussion during the F2F. ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

  2. Last Mile – Topo/Ontological Relation IHE ICE NIST MDC Continua ITI PCD [/HL7v2] -PHD See drafts for detail. ICE modality Vent modality PHD modalities ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

  3. Last Mile – MDC modality - Vent MDC Vent modality -10303 Vent Med Dev Info Base (MDIB) (may include [N]RT & Persistent info) “Mode”, e.g. vtPC Functional (behavioral) model See “Vent F&O” for detail. ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

  4. Last Mile + PHD modality IHE Continua MDC -PHD ITI PCD [/HL7v2] PHD modalities See “Bringing IEEE-SA 11073/PHD to Life” diagram ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

  5. Last Mile ++ ICE modality ICE IHE MDC -PHD PCD ICE modality See “Rosetta for Events and Alarms” for detail. ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

  6. Medical Device Info – Use scope [Note: This and subsequent slides are a collection from various working documents that were presented at the F2F [by Jan W.].] The following diagram is “In-Pt. PoC system”-centric but also includes key system scopes in which medical device info is used, although some transformations are typical, such as between IEEE 11073 and IHE PCD/HL7 in order to encompass the composite system scope. HDO System In-Pt. Care System EHR /vMR GUI e.g. PDA HL7 CCD/CDA PCD-ACM* CDS/CIS PCD-Pt.Mon* In-Pt. PoC System [Scaled @ Pt. Acuity and CU typology] PCD-Vent* PCD-PIV* PCA alg DIR Compos MultiBed MDS DIR PCIM Gway/MDS Gway/MDS PCD-01 Gway/MDS Gway X73-P10302 PtMon w/P10303 Vent VMD HL7 CCD /CDA @ftp Pt. Mon [Compos Single Bed MDS] V&V System MDS MDS X73-10302/20202 [/MBAN?] Vitals [MDS] x73-10303 Vent/20202p Vent [MDS] x73-10302 Inf/-20202s PCA Pump [MDS] PCD-01 [WAN] Aggr/GWay PHD Dev [MDS] PHMR CDA [WAN] e.g. x73-10419 Ins Pump In-Home PHD System e.g. x73-10404 PulsOxim PHD Dev [MDS] ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

  7. Medical Device Info – Use scope – In-Patient Care System topology The following diagram focuses up the main PoC-centric subsystem, i.e. In-Patient [Acute] Care Unit with a typical “embedded” PoC. From a scalability perspective, a typical acute care unit has on the order of 10**1 PoC, and a typical CDS/CIS serves on the same order of magnitude PoCU; assuming several medical device systems (MDS) per PoC, this amounts to several hundred MDS per centralized CDS/CIS. While data concentrators may be used to manage data loading in a networked system, from an “end-to-end” (E2E) perspective, multiple E2E associations need to be considered to represent the overall networked system profile for any given device; for example, a Pt. Monitor, Vent or Pump in a PoC may become mobile (or portable), in which case multiple concurrent data flow paths might be needed to maintain overall systemic data flow, resulting in a {many(one-to-many)} or many-to-many topology vs. a hierarchical {many(one-to-one)} topology. In-Pt. Care System CDS/CIS PCD-Pt.Mon* PCD-Vent* Compos MultiBed MDS DIR PCA alg PCD-PIV* Gway/MDS Gway/MDS Gway/MDS DIR X73-P10302 PtMon w/P10303 Vent VMD PCIM In-Pt. PoC System [High Acuity] Pt. Mon [Compos Single Bed MDS] PCD-01 Gway MDS MDS X73-10302/20202 [/MBAN?] Vitals [MDS] V&V System x73-10303 Vent/20202p Vent [MDS] x73-10302 Inf/-20202s PCA Pump [MDS] ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

  8. Medical Device Info – Use scope – Profiling (1 of 3) The following diagram shows key components and related features of a basic system. [w][B/P/L]AN Profile variations may be needed, e.g. RemCtl, Common Net Svcs, etc. 20202 may be configured for any given interface, as appropriate. Other PCD profiles , e.g. PIV for PCA algorithmic decision support, , ACM for alerting adverse events, may be defined, as appropriate. Single Bed context (some components may be mobile) Multi-Bed context Pt. Mon/Gway [Compos MultiBed] CDS/CIS Compos SingleBed GWAY LVP Pump [MDS] Patient context Pt. Mon [Compos Single Bed] Compos MultiBed GWAY PCA Pump [MDS] Vent [MDS] V&V Sim Vitals [MDS] V&V System Various “objects” might be distributed about the patient context, including leads, transducers, RF transceivers, and medical devices B/PAN config may include “‘embedded’ and/or [trans-]portable 11073-based devices. In general, Composite device interfaces are Mgr but might be Agt, such as for “Data Export” . This might be distributed, such as a Network Mgmt System (NMS), specialized CDS, and/or a Simulator.. ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

  9. Medical Device Info – Use scope – Profiling (2 of 3) The following table is overlays the composite system on the HITSP TN905 relational matrix. vMR/EHR GUI e.g. PDA HL7 CCD/CDA PCD-ACM* CDS/CIS PCD-Pt.Mon* PCD-Vent* PCD-PIV* PCA alg DIR Compos MultiBed MDS DIR PCIM Gway/MDS Gway/MDS PCD-01 Gway/MDS HL7 CCD /CDA @ftp X73-P10302 PtMon w/P10303 Vent VMD Gway Pt. Mon [Compos Single Bed MDS] Verif’n & Validn (V&V) Tool MDS MDS X73-10302/20202 [/MBAN?] Vitals [MDS] x73-10303 Vent/20202p Vent [MDS] x73-10302 Inf/-20202s PCA Pump [MDS] PCD-01 [WAN] Aggr/GWay PHD Dev [MDS] PHMR CDA [WAN] e.g. x73-10419 Ins Pump e.g. x73-10404 PulsOxim PHD Dev [MDS] ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

  10. Medical Device Info – Use scope – Profiling (3 of 3) The following table is a relational model defining an MDAP (IEEE 11073-2xxxx) “profile” mapping ontology. See profile table (Paul S.) for list of practical cases . Table C-1. x73 Profile ontology ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

  11. Medical Device Info – Profile ontology – application – topological representation • Characterization of a many to-many topology; in general, MDS agents are to the left and managers to the right. • See profile table (Paul S.) for list of practical cases @ layered [@ OSI ref model], relational framework. • VLANs and Layer 2 & 3 “switch” components are shown to simplify physical pathways, although at the MDAP [stack] level, with suitable internetworking transports, many one-to-many conversations can be conducted, depending on deployed device and network component capabilities. Note that • the “Vitals” component link implies a nested or embedded sub-network, • there might be multiple Home/community contexts, such as Nursing Home, Emergency evacuation/ER, to provide a HC “continuum”, and • switching\routing and VLAN abstractions are used to simplify representation. To the extent that these ‘virtualizing’ capabilities are deployed, multiple concurrent {many(one-to-many)} communication dialogs can be supported. On the other hand, if failures occur, medical devices still need to meet “safety and essential performance” warrants (as in ISO/IEC 14971 and 80001 compliance), so redundant transport and data link-level methods are typically implemented. VLAN (Layer 2) VLAN (Layer 2) In-Patient use context Patient context Pump Central Mgr /Gway LVP Pump [MDS] CDS/CIS PCD/HL7 PoC PoC/20201 Pt. Mon/Gway [Compos MultiBed] PCD/HL7 Pt. Mon [Compos Single Bed MDS] PoC Vent [MDS] Compos MultiBed GWAY PoC/20202 PCD/HL7 PoC/20202* Vitals [MDS] PoC/20202s LAN Bridge / Proxy ) Router (Layer 3 Switch) Home/community use context Layer 3 Layer 3 VLAN (Layer 2) Aggreg. Healthcare Dev. (AHD) Pulse Oximeter [MDS] Patient context Gway PHD Gway PCD/HL7 PCD/HL7 Continua/WAN Basic ECG [MDS] PHD ISO/IEEE 11073 / ISO TC215 WG2 JWG F2F

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