PCD Detailed Profile Proposal Cycle6 LTS

Proposed Work Item: Location Tracking Services [LTS]

• Proposal Editor: Steve Merritt / Ken Fuchs / Ben Mannisto
• Editor: TBA
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: Patient Care Device

The Problem

LTS are being introduced into the healthcare environment at increasing rates. They are used to track clinicians, patients, devices and other critical resources. LTS consist of tracking devices and tracking management systems. The interface from the tracking management system to the tracking device is typically proprietary and probably will remain so for the foreseeable future due to the various types of tracking technologies and transmission approaches. The interface of the LTS tracking management system to other hospital systems that may want to use the data is currently also proprietary. Lack of standards in this area results in integration issues and substantial development costs.+

NOTE: The technology used to provide the location is out of scope and how that information gets stored is out of scope

• LTS Key Properties
  • Object Identification
    • IP Address of tag, or,
    • S/N of tag, or,
    • MAC/OUI address of tag, or,
    • EPC address (RFID electronic product code), or,
    • ???
  • Object Location (will define schema)
    • Longitude and Latitude, or,
    • Address, or,
    • Ward / Room / Bed, or,
    • ???
  • The information can be provided as:
    • Unsolicited
    • Query by Object Identification for location information
    • Solicited (Publish/Subscribe) information at a query rate of x/minute
  • The information can be event driven (otherwise unsolicited)
    • Time-Based
    • Movement-Based
    • Area Containment
    • Other events…

Key Use Case(s)

Category 1 – Patient Tracking

  1a – Telemetry Step-Down

In hospital step-down units patients are provided portable patient monitors which can be worn by the patient and communicate via RF to the nursing central station. The patients are allowed to roam within a certain area as part of their rehabilitation and RTLSs are used to track their movement. The user is interested in: - Where the patient is located, especially if he/she runs into any trouble. - Whether the patient has exited the monitored area

  1b – Emergency Department

During a typical visit to an Emergency Department a patient can move from one area to another. Tracking a patient’s location allows providers to more easily find the patient and automatically document when certain procedures have been completed such as X-Ray, examination, etc.

  1c – Surgery Department

Tracking of patients as they move through the surgical workflow. Admission, assessment, holding area, OR, recovery room, etc.

  1d – Infant Nursery

RTLS is used to track newborns to make sure they are only “associated” with authorized personnel and cannot be moved outside of a certain perimeter.

  1e – “Nurse Call”

Some tags support additional features such as a patient activated button which can be used as a Nurse Call or for other functions.

  1f – General Ward

Patient on ‘fall alert’, or Alzheimer’s or other reasons for restricted movement has left their room or other specified area.

  1g - Community home

Patient on 'fall alert', or Alzheimer's or other reasons for restricted movement has left their room or other specified area.

  1h - Home

Patient on 'fall alert', or Alzheimer's or other reasons for restricted movement has left their room or home.

  1j - Mobile

Patient on 'cardiac alert', or Alzheimer's or other reasons for needs to be located has a) left their home or street or b) can be traced on request to location X. (Note from Melvyn Reynolds: I believe that such a system as (b) is operational some Japanese cities using mobile phones... and we tag and trace (not investigated technology) some offenders here in the UK!)

  1k – Association for billing

Patients are automatically associated with equipment based on distance and/or time spent within range of that equipment. This enables the hospital to automatically (and more accurately) bill based on usage.

  1l – Association for safety/liability

Patients are automatically associated with staff members based on distance and/or time spent within range of that staff member. This gives the hospital a safety check to ensure that doctors and other staff are spending the appropriate amount of time with their patients, and historical data for liability issues – eg if the patient complains that the doctor did not give them appropriate attention.

  1m – Patient throughput 

Patients are tracked so that they can be easily found by nurses prior to a medical procedure or any ADT-related process. This speeds the patient’s progression through the hospital system, opening up the availability of beds/rooms/fixed equipment sooner. The end result is faster patient throughput, and therefore higher capacity (and the ability to attain more value) from fixed assets such as rooms and fixed equipment.

Category 2 – Provider Tracking

  2a – General Provider Tracking

Tracking of providers in order to more quickly locate them in case of emergency.

  2b – Provider Tracking during Surgery

During a surgical procedure the presence and times of attendance of surgeons, nurses, anesthesiologists and other care givers must be documented. An RTLS can assist in automating this process, it can also have additional intelligence which infers that something has occurred such as “start of surgery” or “surgeon presence”.

  2c – Provider Location based Alarm Notification

Alarms from medical devices and alerts from clinical applications need to be distributed to assigned caregivers. The decision about who to distribute an alarm to can be based on the caregiver’s real-time location. If a nurse is in the cafeteria the alarm can be sent to the closest qualified caregiver that is on the floor.

  2d – Provider Activated Button

Some tags support additional features such as a wearer activated button which can be used by housekeeping staff to indicate a room is clean or for other functions..

Category 3 – Asset Tracking

  3a – Tracking of Critical Equipment

The RTLS can be used to find critical equipment needed for patient care reducing the time staff is needed to track equipment down.

The RTLS can be used to decide whether all necessary equipment are in the same location. Specified activity cannot start unless all equipment is available.

  3b – Documentation of Surgical Equipment.

During a surgical procedure the equipment used needs to be documented. An RTLS can assist in automating this process.

  3c – Tracking of Equipment Utilization

Notification that greater than N of a device type(s) are in one location for greater than x hours/days. Purpose of this is: Many hospitals use a collection area on a floor to put equipment that has to go through decontamination/cleaning. Biomed or Environmental Services is suppose to ‘swing-by’ every so often and empty out these areas.

  3d – Asset Theft Control

Asset location is tracked and monitored. If it is moved beyond a specified perimeter then appropriate personnel are notified.

  3e – Last Reported Location

Last known good location. This is different than current location as we all know there are limitations to the technologies and sometimes tags ‘disappear’ for awhile.

  3f – Rental equipment tracking

Short-term rental equipment is tracked, to ensure that it can be found when it needs to be returned so the hospital is not charged for an additional rental period.

  3g – Maintenance tracking for JCAHO

Biomedical engineering staff has access to the location of all tracked equipment, alongside the PM date for this equipment. This enables them to find all equipment that is due for PM, and reach the mandatory PM rate for JCAHO compliance.

  3h – Historical movement data

Historical data on asset movement, frequency of assets being in certain zones, average number of equipment X within a zone Y over a time period, patterns of movement between point A and point B, etc. can all be used by materials management staff to analyze problems and redesign/streamline their internal processes.

Category 4 – Safety / Security

  4a – Improper Tag Removal

  4b – Tag has been Tampered With

  4c – Wearer is in an unauthorized area

  4d - Equipment status information

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.
• PCD-01 DOC/DOR
• The ‘Unified Code for Units of Measure (UCUM).
• Health Level 7, version X.X
  • There was some work done in HL7 v3.
  • Adaptation of the HL7 v2 OBX messaging structure could be used.
    • Other HL7 v2 messaging methods?

Technical Approach

Existing actors

• DOR/DOC, if PCD-01 could be used as it is documented in the current version of the TF

New actors

Some new actors may include:

• Location Content Provider (LCP)
• Location Content Receiver (LCR)

Existing transactions

• Could PCD-01 be used?

Impact on existing integration profiles

• Location information could be included in other profiles or used to extend other profiles. For example knowing the location of an alarm could be beneficial.
• If existing PCD messaging (HL7 v2) could be used this may ease compatibility with other existing profiles such as ACM, PIV

Support & Resources

The LTS has received support from:

• AIMS
• Baystate Health
• Mindray
• IBM
• Capsule
• Emergin
• SIS
• Ekahau
• Renovo
• VA
• Cisco
• Aeroscout
• Philips

Risks

Technical risks include:

• Complexity of adding a new transaction, especially if a v3 message is deemed the best option.
• Lack of participation from stakeholders

Political risks include:

• This requires participation from new vendors that may not be already participating in IHE PCD activities including the location tracking companies, CMMS companies

Open Issues

• What is the coordinate system? GPS? 3 Dimensional?
• Would zone-based be sufficient?
• How do you express a "location" in a standardized way?
• Is it necessary to include the measurement uncertainty for the location? How would this be expressed?
• Is a location VMD an option, what would it look like?
• Do we include equipment status information in this profile? (i.e. equipment is in use, operational, needs maintenance, etc)? Or at least include the mechanism into the profile today.
• Consideration should be made "to take into account that location tracking information can be an event unto itself (boundary crossing events, periodic position events, dwell too long events, environmental events, etc.) or it can be additional data that comes along with an unrelated event (a non-location event occurred and this identified item, which may not be the same as the item for which the event occurred, was in this last known location when the event occurred – vampire RTLS/RFID tags on the exterior of devices for which the device has no awareness)." -Emerigin comment 2011-01-06

Tech Cmte Evaluation

<The technical committee will use this area to record details of the effort estimation, etc.>

Effort Evaluation (as a % of Tech Cmte Bandwidth):

• Typical for new profile development

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

TBA