PCD Pump 2012-03-27 to 29 F2F

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(Infusion Pump Main Page)


Meeting Purpose

IHE PCD Infusion Pump Working Group Face-to-Face Summit to finalize details of pump device specialization profiles.


NOTE: WIKI PAGE REORGANIZED POST-SUMMIT TO PLACE THE LOGISTICS INFORMATION AFTER THE DISCUSSION NOTES.


Attachments / Materials

  • Tuesday Files
- Tuesday Discussion Slides
  • Wednesday Files
- Wednesday Discussion Slides
- IPEC - Commented
- Syringe Semantics Spreadsheet (r2)
- PCA Semantics Spreadsheet (r2)
- Smiths Medical Syringe / PCA Spreadsheet
- Smiths Medical Events vs. DEC Charting Data Spreadsheet
  • Thursday Files
- Syringe Semantics Spreadsheet (r3)
- PCA Semantics Spreadsheet (r3)
  • Final Files
- ZIP of the Final Files (R2) - updated 2012.04.03


- Final Discussion Slides (R4 / PDF)
- General Semantics Spreadsheet (r1)
- Syringe Semantics Spreadsheet (r4)
- PCA Semantics Spreadsheet (r5 - updated 2012.04.03)
- PCIM Review Graphics (Flanders/ZIP)


Discussion Notes

Chair/Host: Jeff Rinda (Hospira)
Participants:
(In Person)
Janet Anna (CareFusion), Greg Borges (CF), Todd Cooper (BSF), Jeff Dern (CF), Paul Elletson (Smiths Medical), Al Engelbert (Protolink/B.Braun), Jeff Gaetano (CF), Vivek Kamath (West Wireless), Chris Kohlbrecher (Hospira), Duke Ngyuen (CF), Gary Mills (Hospira), Amnon Ptashek (West Wireless), Bill Van Dyke (Smiths Medical), Patrick Ward (CF), Michael Workman (CF), Khalid Zubaidi (CF)
(On the Phone)
Chris Courville (Epic), Robert Flanders (GE), Bill Hawley (Intermountain HC/ SLC), John Rhoads (Philips), Brian Witkowski (Epic)


NOTE: Action Item Review updates have been posted directly to the Infusion Pump Action Items wiki page


Item Topic Discussion
1 Introductions & Agenda Review
- Chair
Status/Discussion:
  • Attendees are listed above and were introduced as they came into the meeting; note that some attendees were there the entire time and others came in for only part of the discussions; there was no accounting for who attended which parts of the meetings.

Decisions/Issues:


Action(s):

2 IHE PCD & Device Specialization Review
- Todd
Status/Discussion:

The group spent most of Tuesday morning reviewing IHE and IHE PCD technical framework components. This was followed by a discussion of the general approach for device specialization profiles and content modules.

See final set of discussion slides.

Decisions/Issues:

Action(s):


3 General and IP / LVP Device Specializations
- Todd
Status/Discussion:

Tuesday afternoon focused on:

  • Review of the published PCD TF-3 Semantic Content volume
  • Review of the ISO/IEEE 11073-10201 domain information model elements that might apply for the General device specialization (DS-General) content module
  • Review of the published Infusion Pump Event Communication (IPEC) profile to determine what elements should be captured in the (a) DS-General, (b) DS-Infusion Pump, and (c) DS-IP-LVP content modules & profile.\

Decisions/Issues:

The results of these discussions were captured in the following files:

- General Semantics Spreadsheet (r1)
- IPEC - Commented


4 Syringe & PCA Device Specialization Discussion
- Todd
Status/Discussion:

Wednesday's discussions focused on the Syringe pump and PCA pump device specializations. A key component of these discussions was determining what was part of the DS-General and DS-LVP device, as opposed to what was unique to syringe and PCA devices. It was determine that through there are some very unique aspects to each (e.g., syringe size or "granted requests"), there was a high level of common semantics between all three devices.

Another topic that was deferred due to time constraints for subsequent discussion was the use and definition of the infusion pump mode (MDC_PUMP_MODE) and status (MDC_PUMP_STAT) nomenclature. Once the syringe and PCA models are completed and harmonized with the existing LVP model, including the set of operational events that are communicated, the definition and use of the Mode and Status terms shall be revisited.

The need for and use of "shift counters" was also discussed at length, with those who have implemented DEC and IPEC noting that they obviated the need for a device to provide internal counters (e.g., for VI since last cleared) that are maintained by the clinicians managing the device. In the end, terms for the counters were added; however, their use optional and a discussion is to be added to the related content module explaining that the need for their use is greatly reduced with the deployment of PCD "auto-documentation" profiles.

Decisions/Issues:

Initial (very very preliminary!) term sets were captured in the following spreadsheets:

- Syringe Semantics Spreadsheet (r4)
- PCA Semantics Spreadsheet (r4)


Action(s):


5 PCIM Review & Discussion
- Todd
Status/Discussion:

Thursday morning Robert Flanders (GE) provided a review of the PCIM (Point-of-Care Identity Management) that their profile working group has completed.

This was followed by a lengthy discussion about the workflow around patient & device identification and association / disassociation, which included definition of some possible new actors and transactions. The discussion diagrams are captured on slides #51 and #52 in the final discussion slides.

Decisions/Issues:

Action(s):

  • PCIM WG will review the discussion outputs and determine next steps including potentially how to revise the PCIM work-in-progress. This will be reviewed in subsequent WG discussions and will be presented at the PCD face-to-face late April in San Diego ... America's Finest City!
6 Closing Discussions
- Todd
Status/Discussion:

There were a number of discussions Thursday afternoon including the identification of new terms to be processed using the NIST RTMMS tool, a review of pump-related CPs, possible future profiling efforts by the pump WG, and a review of the action items from the Summit.

A number of IHE PCD TF Change Proposals (CP) were identified, including:

  • IPEC: Add a Note Box to the beginning of the currently published document indicating its current and future status, namely that some of its content will be migrated to the device specialization supplements and that a standalone EC profile will be created
  • TF-1 add a general discussion about the "typical" use of DEC for periodic reporting, EC for episodic reporting and ACM for episodic-alarm reporting
  • Fused DOR/DOF actor (DORF)
  • Add discussion to TF-2 regarding options for expressing containment in reporting messages;
Note: discussion about whether to recommend for IP profile that reporting messages are sent per VMD or per Channel / drug; though the channel-specific messaging may provide for simplified processing on the receiving (DOC) end, it will not be appropriate in other messaging applications and thus is not a general approach that should be encouraged within the PCD TF
  • OID allocation discussions in the TF volumes (1 - 3) as well as on the OID wiki page. John Garguilo will lead this effort
  • In TF, discuss what to do with buffered data while device offline and then reconnects; especially the difference between buffered episodic vs. periodic data
  • Enhanced mode accept ACK question (Al E.)


Decisions/Issues:

Action(s):

Collected during the Summit:

(1) Public comment - When PCD publishes TF supplements for public comment prior to releasing a Trial Implementation version, we can provide the IHE secretariat with a list of groups to include in press release (e.g. AAMI alarm commmittee, AAMI HITI Health IT and Interoperability ad hoc committee or its replacement, AAMI Infusion pump committee) ACTION - put on agenda for the April F2F meeting for discussion (John Rhoads)
(2) "IHE Profiles" slide (#9 from slide deck) to include IPEC from pump to EMR (Ken Fuchs) - COMPLETED
(3) ADQ profile - see diagram on slide #65 from deck ; new version to be released within the next 2 weeks; John R to include links to new version (where?); ACTION - pump group members to read and think about its relevance; be prepared to discuss at upcoming PCD F2F (Pump group) - COMPLETED
(4) Determine testing process for content profiles; include the likelihood that the Pump Vendors (Actors) register for IP actor (agent) using PCD01, 03, 04, 10 but BCMA/EMR systems are unlikely to support all profiles (esp ACM); How to register on receiving side? Can they just register for DEC, ACM, PIV, IPEC individually but the pump vendor can still "pass"? e.g. pump vendor claims conformance with pump profile and EMR vendor conforms to individual profiles; no need for EMR to register as infusion pump consumer (manager); ACTION - John Garguilo to coordinate with co chairs; THIS WILL BE DISCUSSED AT THE PCD F2F LATE APRIL & MAY HL7 MEETINGS IN VANCOUVER
(5) Versioning of PCD transactions needed; content modeling versioning; OID's for new actors and transactions; ACTION - John Garguilo
(6) Submit MDCX terms from IPEC to MDC (Event identifiers); Todd will do global search of document for "MDCX"
(7) Sandra M - clean up MDCX terms from raw Rosetta table
(8) Schedule separate discussion of operational status vs mode; Issue - some PCA infusers work by giving Patient dose on top of continuous rate (additive); Todd, John R, Jan W
(9) Online/offline - expected behavior is to buffer events that occurred while offline so that they can be relayed when back online; should DEC allow for same?; (Todd or John R - CP for IPEC, DEC)
(10) IPEC - add new event clear cumulative volume counters to IP-General (Todd)
(11) Document best practice in DS-IP-PCA: use DEC (periodic status reporting) to supply number of patient dose delivered and denied and use IPEC (infus start/stop) for patient dose delivery (Todd)
(12) CP - Add note box at beginning to current published version of IPEC to indicate its future path (Todd)
(13) PCIM - Define a single basic tx as first approximation (PCIM-01/02) with the understanding that there is more to come (Todd and John R)
(14) Add new terms defined to vendor Rosetta; enter proposals for changed terms as needed (Todd)
(15) Tutorial for pump group on how RTMMS will be used for content module & new term definition (Todd) - COMPLETED
(16) New Term codes for source/delivery channels. Term codes provisionally assigned to these are from the private space, Channel types currently being used are in the infusion pump containment tree. (Todd)
(17) Do search on hRTM to see whether there are other problematic term codes (either (1) not formal or (2) using a private code) and add (Sandra) - THIS WILL BE REVIEWED AT VANCOUVER MAY MEETINGS
(18) DEC messages sent without identified patient; Previous discussion was that DEC did not support since it was a risk management issue - mandatory field in HL7; However we possibly could use fake defined name/id and namespace (John R) - THIS WILL BE DISCUSSED AT THE PCD SPRING F2F
(19) Is there a need for an event from when pump is first programmed vs. when it is started? (Bill Hawley / Paul Elletson)
7 Next Meeting
- Chair
Status/Discussion:

Decisions/Issues:

  • The group decided that the next meeting will be 2012.04.04.
  • Topics
- Review of Summit Discussion Notes
- Review of term definition using the NIST RTMMS tool
- Discussion of semantics (terms & models) that would support devices that combined LVP, syringe and PCA capabilities
- Review of the term sets from the discussions - hopefully in an initial set of tables

Action(s):

Proposed Summit Agenda

FINAL AGENDA is posted in the discussion slides below...

Note: Q's (e.g., "Q1") roughly represent 90 minute segments. The time allotment is rough though depending on how the topic discussion develops.

Tuesday:
Q1
  • Review Summit Agenda
  • Review Draft Document Status & Work Plan
  • TF Planning ...
- IPEC Supplement Partitioning
- TF Volumes & Target Content
- CP's of Pump Interest
  • Communication Status Events
- How to indicate the online/offline status of a given device (in PCD-01)
Q2
  • Device Specialization - General Supplement Review
  • Device Specialization - Infusion Pump (general) Supplement Review
Q3-4
  • LVP Device Specialization
- Incl. IPEC Content Review


Wednesday:
Q1
  • Syringe Pump Device Specialization
Q2-4
  • PCA Device Specialization
Thursday:
Q1-2
  • PCIM Technical Direction
- Review PCIM profile requirements / Scope
- Resolve technical direction
- Establish profile elements
Q3
  • Mixed Modality Modeling (e.g., LVP w/ PCA Module Attached)
  • Review new term process, tooling & proposals
  • Medication Administration Strategy White Paper
  • Pump-related CP's Review
  • Future Development Cycle Proposals (e.g., drug library support, or intra-operative anesthesia pumps, etc.)
  • Review Summit Action Items & Work Plan


For each of the Device Specialization documents, the following general pattern will be followed:

  1. Device Characterization & Use Cases
  2. Detailed semantics - models & terminology (incl. gaps)
  3. Alarm semantics w/ evidentiary data
  4. Operational modes & event semantics w/ state/context data
  5. Auto-programming support (e.g., a la PIV extension)
  6. Review of TF Updates + Completion Strategy


Confirmed Attendees

Todd Cooper (BSF)
Paul Elletson (Smiths Medical)
Al Engelbert (B.Braun)
Vivek Kamath (West Wireless) + 2
Michael Kremliovsky (Hospira)
Chris Kohlbrecher (Hospira)
Gary Mills (Hospira)
Jeff Rinda (Hospira)
Bill Van Dyke (Smiths Medical)
Khalid Zubaidi (CareFusion) + ???


Meeting Logistics

Dates:
March 27-29, 2012
Tuesday & Wednesday: 09:00 - 17:00
Thursday: 08:00 - 15:00
Location:
CareFusion Technology Center – Bld C
6055 Lusk Blvd
San Diego, CA 92121
Hotels:
HYATT house San Diego/Sorrento Mesa
10044 Pacific Mesa Blvd.,
San Diego, California, USA 92121
Tel: +1 858 597 0500 Fax: +1 858 597 0550
Maps & Directions
Ask for CareFusion rate of $118.00 per night for a single room suite
Holiday Inn Express & Suites Sorrento Valley
5925 Lusk Boulevard
San Diego, CA 92121
Get directions
(858) 731-0100
www.hiexpress.com
CareFusion rate is $150
Country Inn & Suites By Carlson San Diego North
5975 Lusk Boulevard
San Diego, CA 92121
Get directions

(858) 558-1818
www.countryinns.com


WebEx & Internet Information

Guest Internet access should be provided at the venue.

WEBEX ACCESS If you plan to attend a Webex session please let Todd know in advance. Individual Webex sessions will be available if there is interest.

Password and Phone numbers are the same as for all other PCD Working Group Webex meetings.

Tuesday Morning: Go to https://himss.webex.com/himss/j.php?ED=15493583&UID=0&PW=NYjVjMjEzODYy&RT=MiMxMQ%3D%3D Meeting Number: 490 288 360

Tuesday Afternoon: Go to https://himss.webex.com/himss/j.php?ED=15493913&UID=0&PW=NMTZjMTMxYWI1&RT=MiMxMQ%3D%3D Meeting Number: 495 508 153

Wednesday Morning: Go to https://himss.webex.com/himss/j.php?ED=15494483&UID=44635338&PW=NMDM5ZWU4ZjBj&RT=MiMxMQ%3D%3D Meeting Number: 490 789 053

Wednesday Afternoon: Go to https://himss.webex.com/himss/j.php?ED=15494778&UID=0&PW=NYTM2YjdhMDA3&RT=MiMxMQ%3D%3D Meeting Number: 495 765 492

Thursday Morning: Go to https://himss.webex.com/himss/j.php?ED=15495163&UID=0&PW=NYTZhOTRhNGU5&RT=MiMxMQ%3D%3D Meeting Number: 493 647 491

Thursday Afternoon: Go to https://himss.webex.com/himss/j.php?ED=15495228&UID=0&PW=NNDcxNWUyNTY5&RT=MiMxMQ%3D%3D Meeting Number: 495 941 469


Next Meeting

NOTE: Next Meeting will be held during the regularly scheduled time: 14:00 (Eastern) on <TBD> (60 minutes)


(Reviewed & approved by PCD Infusion Pump WG on 2012.04.04 WebEx


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