PCD Brief Profile Proposal 2008 RAM

1. Proposed Workitem: Real-Time Archival (& Retrieval) Management [RAM]

• Proposal Editor: Jack Harrington
• Editor: TBD
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: Patient Care Device

2. The Problem

In a recent HIMSS survey the respondents identified Cross Enterprise Sharing of Patient Care Device Data as their highest priority. Goals include increased shortening decision time, increasing productivity, minimizing transcription errors, and obtaining increased contextual information regarding the data. Discussions of Cross Enterprise Sharing of Patient Care Device Data can be grouped into three categories – Asynchronous (non-real time), Isochronous (near time), and Synchronous (hard real time). For purposes of this proposal, real-time can be defined as “something can be said to be working in real-time when the time constants of the measurement and control loop are insignificant compared to the time constant of the process. ” Since we are discussing patient care device systems associated with measurement and control of physiologic processes “real-time” will be associated with the underlying chemical, electrical, and mechanical properties of the physiologic processes being measured or controlled. The scope of this proposal is limited to asynchronous patient care device data storage and retrieval. Examples include storage and retrieval of physiologic data by and from a CDSS Application, CDR, EMR, or EHR and may include static snapshots of waveform data. A key requirement is that the semantics of the data which is stored and retrieved is not a function of the storage and retrieval mechanism. Examples of patient care device data included in this profile include, but are not limited to, discrete vital signs parameters, infusion rates and constituents, ventilation rates and settings, and snapshots of waveforms.

3. Key Use Case(s)

1. Storage and retrieval from a Patient Care Device Manager. - Periodic data from all of the patient care devices associated with a particular patient are communicated to a Patient Care Device Manager. Examples include data from a bedside monitor, point of care lab devices, ventilators, and infusion pumps. Both discrete and continuous (waveform snapshot) data are communicated to the Patient Care Device Manager. The primary intent is communication of structured data however provisions are made for inclusion of unstructured data. The patient associated with the data may be identified by the device from which it is gathered and the data is time stamped with a consistent time across the respective patient care devices. Devices local to the Patient Care Device Manager are able to retrieve data using a query mechanism which supports a query and retrieval mechanism which is independent of the local implementation of the storage and retrieval implementation.
2. Storage and retrieval of patient identified periodic data by and from an EMR/EHR – Periodic data which includes an enterprise unique identifier is stored by the EMR/EHR for inclusion in the patient record. Applications are able to retrieve data using a query mechanism which supports a query and retrieval mechanism which is independent of the local implementation of the storage and retrieval implementation. This may include user validation and device identification data associated with the PCD data and queries may be for specific patients, populations of patients, or more general as defined by the appropriate use cases.

4. Standards & Systems

ISO/IEEE 11073-10101 Health informatics — Point-of-care medical device communication — Part 10101: Nomenclature, First edition, 2004-12-15. ISO and IEEE, 2004.

DICOM

CLSI-POCT

The ‘Unified Code for Units of Measure’ (UCUM), [1].

Health Level 7, version 2.5 (which supports large observation messages)

5. Discussion

Cross enterprise sharing of patient care device data has been identified as the top priority in a HIMSS survey. This proposal complements the Cross Enterprise Sharing of Patient Care Device Data-Asynchronous proposal by considering the storage and subsequent retrieval of the PCD data. There are a number of standards which can be used for this purpose and there is a need to select the appropriate profiles among those standards to meet use cases of sufficient breadth to be of interests to both the clinical user and patient care device vendor communities. The proposed profile addresses a broad range of uses of patient care data which do not require “real-time” storage and retrieval.