PCD Showcase 2009 Scenario

Establishing Page

Patient Care Device Domain HIMSS 2009 Showcase Scenario Development

This page is provided to

facilitate development of the Showcase demonstration and its clinical story

enable the participating companies to post and refine their portion of the Showcase scenario and to develop their "script".

Companies and Systems

B Braun, Capsule, Cardinal Health, Cerner, Draeger, Epic, GE Gateway, GE Centricity Periop, GE Centricity Enterprise, Hospira VeriScan, Hospira MedNet, LiveData, Philips CIS, Philips IIC, Philips Emergin, Polycom

Settings and Tours

The physical structure will have four walls, which will display devices and systems that contribute to improved patient care, safety, workflow and/or productivity because of interoperability.

Three of the walls demonstrate specific devices and systems within a clinical scenario. The scenario is summarized below. Further down, each step in the scenario is described in greater detail by the company providing the device/system.

Three clinical "sites" are provided: OR, ICU, Step Down (SD). Visitors will participate in tours that start in one of these three areas and proceed to the next (OR to ICU, ICU to SD, SD to OR). Tours will rotate. Some devices/sytems participate in every tour that includes a site they participate in, while others rotate.

Docents will bring a group of visitors to the PCD structure and provide an introduction to the portion of the scenario they will see, and will seek a volunteer in the group to act as the patient for the demonstration.

Vendors will describe their contribution to interoperability, the benefits and the nature of their systems (see developing scripts, below)

Overview of the Scenario

Male patient, 65 years, BMI 32, weight 90 kg, coronary artery disease (AMI 6 months ago), moderate COPD (smoker), compensated renal insufficiency (40% GFR). Adenocarcinoma of the lower esophagus (close to the entry into the stomach), scheduled for gastrectomy and distal, transabdominal esophagectomy.

OR

Patient needs full invasive CV monitoring starting at induction.

Patient identified on each of the 3 vendor pumps and started on 3 infusions: Dextrose 5% 1000 mL @ 75 mL/hr, propofol, 1000 mg/ 100 mL @100 mcg/kg/min and morphine 100 mg/ dextrose 5% 100 mL @ 1 mg/hr. Status of all 3 infusions is viewable on monitors via PCD01/02

Intensive Care Unit

After surgery patient remains intubated and is transferred to ICU. After initial stabilization (fluids according to CO and SvO2, low dose Dopamine), rapid weaning of the ventilator on SmartCare/PS.

Using PIV, the nurse uses BCMA to send low dose Dopamine 400 mg in Dextrose 5% 250 mL @ 2.5 mcg/kg/min) to pump to aid kidney perfusion. The infusion status is viewable on monitors via PCD01/02

The patient is extubated 12 hours after admission to ICU. Ventilator Alarms are managed, routed and displayed Discharge to SDU after 36 hours.

Step-Down Unit

On SDU patient require still monitoring of HR, BP, RR and SpO2 (RR and SpO2 due to COPD).

Antibiotic continued for 72 hours. Vancomycin 1 g in Dextrose 5% 250 mL is infused over 60 minutes via IV device. Using PIV, the nurse uses BCMA to send Vancomycin order data to pump. The infusion status is viewable on monitors via PCD01/02

Clinical Sites and Steps

The Scripts supporting the demonstration in each site are provided in the next section, below.

Operating Room (OR)

Step	Company	System	Type	Function	Actor	Role
1	Epic or GE, alternating	Inpatient EMR or Centricity Enterprise	EMR	Patient ID, Admit	PAM	Admit patient, generate bar code and MRN; this step takes place only when tour starts in OR; otherwise previous speaker points out data will be sent, received by systems in advance of patient arriving
2	Draeger	Infinity Gateway	Gateway	Phys Mon	DOR	Patient attached to physiologic monitor
3	B Braun or Cardinal or Hospira, alternating	Pump	Pump	Pump	DOR	Connected to patient for drug delivery
4	GE	Periop Anesthesia	CIS	Display	DOC	Display data the system received consistent with the Scenario
5	LiveData	OR Dashboard	Dashboard	Display	DOC	Display data the system received consistent with the Scenario
6	LiveData	OR Dashboard	Send Alarm	Alarm	AR	Local workflow alarm
7	Philips Emergin	Alarm Manager	Receive Alarm	Alarm	AM	Receive alarm, forward to Polycom, receive response
8	Polycom	SpectraLink	Clinician's Phone	Alarm	AC	Receive alarm, respond to AM
9	Epic or GE, alternating	Inpatient EMR or Centricity Enterprise	EMR	EMR	DOC	All appropriate data, everywhere needed, immediately; if this is the initial site on the tour, pass on to ICU
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Intensive Care Unit (ICU)

Step	Company	System	Type	Function	Actor	Role
1	Epic or GE	Inpatient EMR or Centricity Enterprise	EMR	Patient ID, Admit	PAM	Admit patient, generate bar code and MRN; this step takes place only when tour starts in ICU; otherwise previous speaker points out data will be sent, received by systems in advance of patient arriving
2	GE or Capsule	Gateway or DataCaptor	Monitor & Central St or Middleware/Gateway	Display	DOR or DOR and AR	NOTE: Patient attached to physiologic monitor; if Capsule connects unique devices it will become step 3; it may be moved to SD
3	Capsule	DataCaptor	Middleware	Gateway	DOR, AR	Can be step 3 if unique devices attached
4	Philips	Intellivue Clin Info Portfolio	CIS	Display	DOC, AR	Display of all data the system received consistent with the Scenario
5	B Braun and Cardinal and Hospira		Pumps	Pumps	DOR, IOC and AR for Cardinal, Hospira	Pump(s) added; PIV to be employed
6	Cerner or Epic	CareMobile or Inpatient EMR	BCMA or EMR	BCMA	DOC, IOP	Employ PIV
7	LiveData	OR Dashboard	Alarm	Alarm	AR	Send alarm, later receive clinician acknowledgement
8	Emergin		Alarm	Alarm	AM	Receive alarm, forward to Polycom, receive response, forward to AR
9	Polycom	SpectraLink	Phone	Alarm	AC	Receive alarm, respond to AM
10	Epic or GE, alternating	Inpatient EMR or Centricity Enterprise	EMR	EMR	DOC	All appropriate data, everywhere needed, immediately; if this is the initial site on the tour, pass on to ICU

Step Down Unit (SD)

Step	Company	System	Type	Function	Actor	Role
1	Epic or GE	Inpatient EMR or Centricity Enterprise, alternating	EMR	Patient ID, Admit	PAM	Admit patient, generate bar code and MRN; this step takes place only when tour starts in SD; otherwise previous speaker points out data will be sent, received by systems in advance of patient arriving
2	Philips	Intellivue Info Ctr	Monitor	Phys Mon	DOR, AR	Obtain data, forward to EMR; for Philips, participate in ACM
3	Cerner	CareAware	Middleware	Gateway	DOR	Connected to both beds (ICU, SD); need to determine what is displayed
4	Draeger	Innovian Web	CIS	CIS	DOC	Display of all data the system received consistent with the Scenario
5	GE or Hospira	Centricity Enterprise or VeriScan	BCMA	PIV	IOP	Employ PIV
6	B Braun and Cardinal and Hospira		Pumps	Pumps	DOR, IOC and AR for Cardinal, Hospira	Pump(s) added; PIV to be employed -- but no description if this follows ICU where this was described
7	LiveData	Alert Manager	Alarm	Alarm	AM	Receive alarm, forward to Polycom, receive response
8	Polycom	SpectraLink	Phone	Alarm	AC	Receive alarm, respond to AM
9	Epic or GE, alternating	Inpatient EMR or Centricity Enterprise	EMR	EMR	DOC	All appropriate data, everywhere needed, immediately; if this is the initial site on the tour, pass on to ICU
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Scripts

<Please assure that your script is properly placed by Step Number within the Scenario; please include your company name, system name, and your name at the top of your document>

Operating Room (OR)

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3 B Braun, Scott Zaffrin • Hello, my name is xxxxxxx with B. Braun Medical • In this scenario we will be demonstrating the use of PCD01 and PCD02 transactions as defined by the IHE Patient Care Devices domain. PCD01 allows infusion data to be sent from our DoseTrac application to, in this example, GE, and LiveData. PCD02 allows for filtering of the data to make it more specific to the general need. • The patient is in the OR, about to undergo their surgical procedure. A prophylactic antibiotic has been ordered and will be delivered by the Outlook 300/400 infusion pump. • This model includes a wireless network card allowing infusion data to be sent to and from the pump. It also includes pump-based barcode scanning capabilities enabling Patient Matching, ensuring that the right patient is receiving the medication, and order programming to reduce errors • The Medication is received from pharmacy with barcode segments on the IV label – these can include; (Show the IV Bag with the Barcode Label) o Patient ID o Drug name o Concentration o Dosage o Patient Weight/Height, depending on medication • Demonstrate scanning process to program the pump o Nurse ID o Patient ID on wristband o Patient ID on bag – note that the patient matching cannot be circumvented by scanning the same Patient ID twice o Infusion order info • The Outlook Pump is designed to send out status information every 3 seconds. This data is transferred over the hospitals wireless network and collected in our DoseTrac application. o DoseTrac is a central server application that collects and stores infusion data o DoseTrac is a Browser-based application which;  Displays real-time information from all pumps in facility  Retrospective reports for data analysis • DoseTrac has an interface called DoseLink that forwards information to 3rd party systems using the PCD01 and PCD02 format.  Infusion data is displayed, captured, and automatically updated, as we see here, in applications such as GE, and LiveData • Integrating infusion information with clinical systems provides caregivers with more complete information, enabling them to make better decisions and support workflow. For example, Drug and rate information can be updated in the electronic Anesthesia record without having to manually input data.

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Intensive Care Unit (ICU)

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Step Down Unit (SD)

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Links

http://wiki.ihe.net/index.php?title=PCD_Connectathon%26Showcase_WG_2008-9

http://wiki.ihe.net/index.php?title=IHE_PCD_2009_Showcase