PCD Showcase 2009 Scenario

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, Surgical Information Systems

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 Unit (SDU). 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

This section is an overview of the Clinical Sites and the Steps in the demonstration. The Scripts for the demonstration are provided later on this page.

Operating Room (OR)

Note: SIS has been added

Step	Company	System	Type	Function	Actor	Role
1	Epic or GE, alternating	Inpatient EMR or Centricity Enterprise	EMR	Patient ID, Admit	PDQ or 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 Role of Registration/EMR • Patient presents If MRN is on HIMSS badge, scan the barcode If not seek a different volunteer Admit the patient to PCD via John Donnelley's Showcase Registration system Identify the patient (Epic via PDQ, GE via PAM) Admit the patient to a bed Print the label for use by the other PCD participants who will scan or manually enter the demographics Attach showcase devices to the patient Receive PCD-01 transactions from monitors, vents, beds and pumps Participate as appropriate at end of OR: If the OR is the first site visited, handoff to the ICU If the OR is the second site visited, wrap up with description of the benefits that the ICU has <hand the wrist band and microphone off>
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	SIS	Surgical Info System - Periop	CIS	Display	DOC	Display data the system received consistent with the Scenario
5	GE or SIS if separate step; otherwise they will alternate	Periop Anesthesia or Surgical Info System	Aggregated display	Display	DOC	Display data the system received consistent with the Scenario
6	LiveData	OR Dashboard	Dashboard	Display	DOC	Display data the system received consistent with the Scenario
7	LiveData	OR Dashboard	Send Alarm	Alarm	AR	Local workflow alarm
8	Philips Emergin	Alarm Manager	Receive Alarm	Alarm	AM	Receive alarm, forward to Polycom, receive response
9	Polycom	SpectraLink	Clinician's 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
11

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 Role of Registration/EMR • Patient presents If MRN is on HIMSS badge, scan the barcode If not seek a different volunteer Admit the patient to PCD via John Donnelley's Showcase Registration system Identify the patient (Epic via PDQ, GE via PAM) Admit the patient to a bed Print the label for use by the other PCD participants who will scan or manually enter the demographics Attach showcase devices to the patient Receive PCD-01 transactions from monitors, vents, beds and pumps Participate as appropriate at end of OR: If the ICU is the first site visited, handoff to the SD If the ICU is the second site visited, wrap up with description of the benefits that the patient receives when moved to the SD <hand the wrist band and microphone off>
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	Programmer	IOP	Employ PIV; Role of IOP • Order placed and verified in background • Scan the wrist band • Scan the medication • Scan the device • Order placed for specific drug • IOP message triggered outbound <hand the microphone to Infusion Vendor>
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 Role of Registration/EMR • Patient presents If MRN is on HIMSS badge, scan the barcode If not seek a different volunteer Admit the patient to PCD via John Donnelley's Showcase Registration system Identify the patient (Epic via PDQ, GE via PAM) Admit the patient to a bed Print the label for use by the other PCD participants who will scan or manually enter the demographics Attach showcase devices to the patient Receive PCD-01 transactions from monitors, vents, beds and pumps Participate as appropriate at end of OR: If the SDU is the first site visited, handoff to the OR If the SDU is the second site visited, wrap up with description of the benefits that the patient and OR receive from interoperability - as they prepare to receive the patient <hand the wrist band and microphone off>
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 a bed (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
10

Tour Scripts

When developing your tour scripts, please keep in mind:

• The intention is to promote interoperability and its benefits.
• Indicate what your system is, and how its function is enhanced by interoperability and how interoperability improves patient care, safey, efficiency, workflow, etc.

• For PCD, one of the primary messages that ties us together is patient safety.

• With approximately 15 steps/vendors speaking to each tour group, you should plan on 90 - 110 seconds to deliver your message.

<Please assure that your script is properly placed by Step Number within the Scenario (see above); please include your company name, system name, and your name at the top of your document> Suggestions for changing the sequence of presentations within a specific clinical area should be discussed with the group. Feel free to use the Google Group for this purpose.

Operating Room (OR)

1

Summary script

Hi and welcome to the PCD tour. I'm Colin FX from Epic and I will be playing the role of the registration and EMR system.

I will start the tour by registering one of you as a patient in the showcase. Who will volunteer as our test patient? <wait for response> Thank you. I am going to admit the patient to <use scenario department> so I can print out a wristband with a bar code that will be used through out the showcase. This wristband will be used by all of the vendors in the scenario to identify the patient in a variety of ways - such as scanning or using the MRN on the label to locate the patient in the system.

Now that the patient is admitted the EMR and associated with the showcase devices, Epic is ready to receive data from all of the different vendors participating in the showcase via the PCD01 transaction.

2

3 • 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 • For the purpose of this demonstration we will simply use the Barcode Scanner to scan the Patient ID into the pump. The outbound data will now have the Patient ID included. o Demonstrate scanning process to program the pump • We’ve programmed the Medication using our onboard Drug Library. This could also have been accomplished by using an additional barcode label. • 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.

Hi, I’m ______________. With Alaris Systems

Today I’d like to show you how the Alaris System contributes to patient safety.

The Alaris System uses IHE Patient Care Device messages to seamlessly communicate IV infusion and other medical device information to clinicians. The PCD-01 communicates infusion data from the pump to hospital systems, in this case GE Centricity Enterprise and Epic EMR systems. Just about everyone is aware of the importance of medication errors today. A few key facts to keep in mind include:

• Despite our heightened awareness of medication errors and efforts to prevent them, they continue to occur and they are costly. Preventing Medication Errors: Quality Chasm Series, Institute of Medicine, July 2006

• 61% of the most serious and costly medication errors are IV-related Communication with D.W. Bates, M.D., M.Sc. of Brigham & Women's Hospital in Boston, October 2001

So we’ll be showing you how you can improve IV medication delivery safety.

Our patient a 65 year old male is being prepped for a gastrectomy and distal transabdominal esophagectomy.

The surgery protocol calls for:

Dextrose 5%W 1000ml at 75mL/hr

Propofol 100mcg/kg/min

Morphine 100mg/D5w 100ml

The pump based barcode reader provides patient, medication and pump connection confirmation. The pump based reading of solution barcodes populates the pump with initial infusion parameters:

• Scan patient id – confirming correct patient

• Scan solution

• Select medication.

• Enter program parameters.

• Confirm pump entry.

• Start infusion.

• Infusion info can be confirmed on monitor. (PCD-01 message)

4 GE Centricity Perioperative Anesthesia, Brian Fors

Hello, my name is XXXXXX with GE Healthcare.

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 data to be sent from various devices into the Centricity Perioperative Anesthesia (CPA) system. PCD02 allows for filtering of the data based on the needs specific to the consuming system.

The patient is in the OR, about to undergo their surgical procedure. The patient is connected to a physiological patient monitor, anesthesia machine and an infusion pump. CPA is acting as a device observation consumer (DOC), receiving data from all 3 devices into the anesthesia documentation system. Data from the monitor and anesthesia system is received from the Draeger Infinite gateway. Data from the infusion pump is received from the B. Braun DoseTrac application, Hospira and Cardinal systems.

The device observation reporters translate data from the proprietary data protocol for each device to a standard message structure and format. The message structure is an HL7 v2.5 message with constraints to ensure conformity across device observation reporters. Furthermore, the device data within the message is created using a standard nomenclature, the ISO/IEEE 11073 standard. This means the PCD01 transaction ensures that the data is transported in a standard message format, but also ensures the data within the message can be interpreted correctly, ensuring semantic interoperability.

Device data received from the various reports is coalesced for display within the anesthesia documentation system flowsheet in both grid and graph format. Configuration and layout of device parameters within the flowsheet can be configured based on the type of surgical procedure.

The automated charting of device data and the ease of manual charting with mechanisms such as the pre-built anesthesia scripts and touch screen dramatically reduce time spent on documentation and allow the provider to focus on caring for the patient.

When we close a case, we have a legible record with all the required elements for complete documentation. Other clinicians, like the post-op nurses, can view the anesthesia record. And the record is shared with the anesthesia department, for billing, quality initiative monitoring and outcomes research.

Hi, I am Cathleen Olguin with Surgical Information Systems. Today I would like to show you how the SIS Solution is uniquely designed to add value at every point of your perioperative process.

Information from the facility Registration system seamlessly flows to SIS Scheduling where the perioperative process is initiated. The procedure is scheduled with a tool known to our users as a “Wizard” that will guide the user through a defined series of screens in a logical and efficient flow, reducing the time to schedule cases and assuring a complete record. Utilizing SIS Scheduling to improve accuracy on the day of surgery, our clients have seen a 10% increase in case volumes and 25-40% reductions of nursing staff overtime.

On the day of surgery, the Anesthesiologist sees the benefit of Nursing and Anesthesia residing on a single database when they can review all of the clinical data captured by the clinicians in preadmissions testing and other preoperative areas. This unique feature allows them to spend more time with the patient by eliminating the need for redundant documentation.

As the patient enters the room, the Anesthesiologist selects a “Wizard” that will capture the time and initiate the automated medical device connectivity, allowing the clinician to provide care to the patient. This functionality leverages your software investment by: • Increasing staff productivity • Eliminating medical transcription errors • Improving patient care and safety

Once the immediate needs of the patient have been met, the care provider then selects a “Wizard” that has been designed to guide staff through the documentation of a recommended workflow supporting an organizational standard and best practice.

Further interoperability is recognized in the system’s ability to capture all charges related to time, materials and professional fees; completing the electronic billing process. Our current clients have reported a significant return on investment related to increased drug reimbursement and decreased turnaround time for payment related to a complete, accurate and legible medical record.

As the patient moves through perioperative services, SISComm provides real-time displays to communicate real-time information to clinicians and loved ones at-a-glance, throughout the course of their stay. Simple documentation provides comprehensive visibility to the entire patient flow process, enabling staff to anticipate demand and manage bottlenecks. Automated time stamps and milestone documentation drive the synchronization of tasks from preop through PACU, alerting staff when patients are ready to proceed to their next phase of care. This up-to-the-minute snapshot of each patient’s status provides you with the ability to optimize operating room performance and patient care quality, and improve customer satisfaction with the elimination of obstacles.

5

Holding until determination of whether GE and SIS alternate or are sequential

6

7

8

9

10

Intensive Care Unit (ICU)

1

2 IHE PCD ICU Scripts for GE Patient Monitor, Clinical Information Center,Aware Gateway, Unity-ID and Engstrom Ventilator

HIMSS 2009 Paul Schluter, Robert Flanders, and Ken Marks

[Joe is about to be brought into the ICU or Admitted in the ICU]

As you will recall, Joe was admitted to the OR in a hypotensive state, and we would like to continue monitoring his response to the Dopamine that was given to him earlier as well as his other vital signs.

Prior to Joe’s arrival in the ICU, the nurse admits Joe by using a picklist on the GE CARESCAPE™ CIC Pro or enters her name on the Solar 8000i patient monitor.

Once Joe arrives in the ICU, the nurse connects an ECG and arterial line using the CARESCAPE Patient Data Module that can travel with the patient. It connects to both the Solar bedside monitor and Transport Pro, displaying real-time data throughout the entire care period and saving the information to provide a continuous record of Joe’s response to his treatment.

The Solar 8000i and Patient Data Module automatically collect Joe’s vital signs information, including waveforms and alarm data. The nurse can evaluate Joe’s response to the Dopamine that was initiated by the OR staff. This can be done by viewing Joe’s vital sign trends on the Solar 8000i bedside monitor or CIC Pro. For example, we can look at the trend of arterial systolic and diastolic pressure to verify that the Dopamine has reversed the hypotension that was observed earlier in the OR.

Meanwhile, the information from the Solar 8000i monitor is also being sent to the GE Aware Gateway using the GE ‘Unity’ real-time protocol that supports waveforms, numerics and alarm information. Additional devices, such as the GE Engstrom Ventilator at the foot of the bed, can also connect to the Unity network using the Unity-ID interface you see here.

The Aware Gateway accepts the real-time information and transmits the numeric information as a ‘Device Observation Reporter’ (DOR) to the Enterprise using the IHE PCD-01 transaction that uses HL7 V2.5 and a standardized nomenclature based on the ISO/IEEE 11073-10101 nomenclature standard.

This information is being sent to several ‘Device Observation Consumers’ (DOCs), such as the Philips Intellivue System and EPIC Inpatient EMR System, in a standardized plug-and-play manner. [thumbs up!] The fact that we have nine major vendors exchanging data this way is a very real accomplishment of the PCD Domain, now in its third year.

[Respiratory Therapist by Ken Marks, GE Healthcare Life Support System]

As we can see, Joe has had a pretty rough time of it so far. He has been stabilized but his breathing remains somewhat erratic. Since he was already intubated in the OR, I will continue to bag her with 100% O2 prior to putting her on a ventilator to assist her in breathing.

So now Joe’s breathing is being assisted by the GE Engstrom Ventilator. The ‘Engstrom’ provides for the standard Volume controlled and Pressure controlled ventilation modes, along with Synchronized Intermittent Mandatory Ventilation (SIMV) for Volume and Pressure control and also Pressure controlled Volume Guarantee modes.

Since Joe has labored breathing, but is able to spontaneously breath on his own, I will set the ‘Engstrom’ to a Bi-Level ventilation mode and turn up the O2 to ~70% in order to further stabilize him. This way the ventilator can assist Joe in his breathing by providing a pressure backup if he is unable to initiate his own breaths.

The ‘Engstrom’ is sending pressure, flow, and volume waveforms, along with standard respiratory numerics such as spontaneous and total respiration rate, fractional inspired O2, and end tidal CO2 to the GE Aware Gateway via the Unity-ID interface.

The Aware Gateway accepts the real-time information and transmits the numeric respiratory information to the Enterprise using the IHE PCD-01 transaction that uses HL7 V2.5 and a standardized nomenclature based on the ISO/IEEE 11073-10101 nomenclature standard.

The respiratory information along with Joe’s demographic information is being sent to the Philips Intellivue System and then the EPIC Inpatient EMR System.

3

4

5

B Braun, Scott Zaffrin

• Hello, my name is xxxxxxx with B. Braun Medical • In this scenario we will be demonstrating the use of PCD03 / PIV transactions as defined by the IHE Patient Care Devices domain. This transaction defines the wireless transmission of infusion data from a Bedside Computerized Medication Administration System, also called a BCMA, to program the infusion device. • We will also be demonstration 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, Cerner and Philips. PCD02 allows for filtering of the data to make it more specific to the general need. • The patient had a successful surgical procedure and has been transferred to the ICU. • Dopamine has been ordered for the patient. • The order information will be sent to the Outlook 400 infusion pump via the hospital wireless network • The Outlook 400 includes a wireless network card allowing infusion data to be sent to and from the pump. This ensures that the right patient is receiving the medication, and order programming to reduce errors • The Medication order is received from the Cerner/Epic bedside medication administration system after the 5 Rights scanning process has been completed • Demonstrate PIV to program the pump in coordination with 5 Rights scanning process o The Outlook pump receives the following data from the BCMA;  Patient ID  Drug name  Concentration  Rate or Dosage  Patient Weight/Height, depending on medication  Nurse ID • The infusion order has been received; the Nurse validates the data and will now start the infusion. • The Outlook Pump is also 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 Cerner and Philips • 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.

Hi, I’m ______________. With Alaris Systems

Today I’d like to show you how the Alaris System contributes to patient safety.

The Alaris System uses IHE Patient Care Device messages to seamlessly communicate IV infusion and other medical device information to clinicians. The PCD-01 communicates infusion data from the pump to hospital systems, in this case GE Centricity Enterprise and Epic EMR systems. Just about everyone is aware of the importance of medication errors today. A few key facts to keep in mind include:

• Despite our heightened awareness of medication errors and efforts to prevent them, they continue to occur and they are costly. Preventing Medication Errors: Quality Chasm Series, Institute of Medicine, July 2006

• 61% of the most serious and costly medication errors are IV-related Communication with D.W. Bates, M.D., M.Sc. of Brigham & Women's Hospital in Boston, October 2001

So we’ll be showing you how you can improve IV medication delivery safety.

Our patient a 65 year old male is being prepped for a gastrectomy and distal transabdominal esophagectomy.

The surgery protocol calls for:

Dextrose 5%W 1000ml at 75mL/hr

Propofol 100mcg/kg/min

Morphine 100mg/D5w 100ml

The pump based barcode reader provides patient, medication and pump connection confirmation. The pump based reading of solution barcodes populates the pump with initial infusion parameters:

• Scan patient id – confirming correct patient

• Scan solution

• Select medication.

• Enter program parameters.

• Confirm pump entry.

• Start infusion.

• Infusion info can be confirmed on monitor. (PCD-01 message)

6 Summary script Welcome back to Epic where we will now play the role of IOP (Infusion Order Programmer). From the EMR we will place an order and verify the administration with the 5-rights checking. For the purpose of this demo an order for <medication> has been placed and verified in the background. I will now scan the patient wristband, medication bar code and then the device bar code to associate the infusion device with the order in Epic. After the nurse has reviewed and accepts the administration, an interface message based on the PIV profile is sent to the Infusion vendor.

Cerner, Rita Brahmbhatt

Hello, my name is X and I’m with Cerner. We are demonstrating the interoperability of our CareAware™ device connectivity architecture as defined by the IHE Patient Care Devices domain. CareAware contributes to interoperability by providing an open framework to connect medical devices to any electronic medical record (EMR). A core component of this architecture is the MDBus. The CareAware MDBus facilitates bi-directional plug-and-play connectivity that you will see in both the ICU and step down unit scenarios.

1. In this ICU scenario CareAware, specifically the MDBus, connects an infusion pump – Hospira, B Braun, Cardinal/Alaris – to an EMR provided by Epic or GE. CareAware also connects CareMobile, a Cerner point-of-care medication device and software solution, to act as an Infusion Order Programmer (IOP), using the PCD03 transaction.
2. The patient had a successful surgical procedure and is transferred to the ICU. Using the PIV profile, the nurse uses bar-code medication administration (BCMA) to send Dopamine to the pump to aid kidney perfusion.
3. The role of the MDBus is to associate the patient to the pump. CareMobile, using the MDBus, utilizes patient-to-device association (P2DA) to scan the patient identifier and scan the pump. The clinician then verifies the information is correct and begins to administer the Dopamine drip.
4. Via the PCD01 transaction, the information from the pump is communicated through the MDBus into an EMR. The nurse can view this information in the patient’s chart. Additionally, the infusion statistics from one – or many – pumps are viewed on the CareAware iAware infusion dashboard. This dashboard provides a comprehensive view of pumps for both clinicians and pharmacy to ensure IV bags are full and appropriately administered.
5. P2DA helps to ensure the 5 Rights are conducted and medication safety is adhered to at each step. The MDBus quickly associates the patient to the device in order to save time for the nurse.
6. The patient is now discharged to the step down unit after 36 hours of intubation in the ICU.
   

7

8

9

10

Step Down Unit (SD)

1

2

3 Cerner, Rita Brahmbhatt

Hello, my name is X and I’m with Cerner. We are demonstrating the interoperability of our CareAware™ device connectivity architecture as defined by the IHE Patient Care Devices domain. CareAware contributes to interoperability by providing an open framework to connect medical devices to any electronic medical record (EMR). A core component of this architecture is the MDBus. The CareAware MDBus facilitates bi-directional plug-and-play connectivity that you will see in both the ICU and step down unit scenarios.

1. In the Step Down Unit the MDBus acts as a DOR between the bed and the EMR. A similar procedure is followed to associate the bed with the patient.
2. The patient identifier is scanned using the MDBus P2DA solution. The patient is now associated to the bed. Once associated, the MDBus sends data, via the PCD01 transaction, that can be used by Epic, GE or any HCIT vendor to populate an EMR.
3. Examples of relevant bed data important to a comprehensive medical record – both for the patient and the clinician – includes, but is not limited to, weight, head rail angle, the status of the bedrail (up or down), breaks (on or off) and if the bed is elevated. This information is also key to ensuring safe care of the patient during their stay, informing clinicians of risks and changes in health status.
4. The patient is now discharged to go home with a complete medical record. The nurse, having had the ability to quickly associate the patient to any device – IV and bed in this scenario – is able to provide safer, direct care with less manual charting.

4

5

6

• Hello, my name is xxxxxxx with B. Braun Medical

• Hello, my name is xxxxxxx with B. Braun Medical • In this scenario we will be demonstrating the use of PCD03 / PIV transactions as defined by the IHE Patient Care Devices domain. This transaction defines the wireless transmission of infusion data from a Bedside Computerized Medication Administration System, also called a BCMA, to program the infusion device. • We will also be demonstration 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, Draeger and Hospira. PCD02 allows for filtering of the data to make it more specific to the general need. • The patient survived their ICU experience and has been transferred to Step Down Unit. • Antibiotic XX has been ordered for the patient • The order information will be sent to the Outlook 400 infusion pump via the hospital wireless network • This model includes a wireless network card allowing infusion data to be sent to and from the pump. This ensures that the right patient is receiving the medication, and order programming to reduce errors • The Medication order is received from the GE/Hospira bedside medication administration system after the 5 Rights scanning process has been completed • Demonstrate PIV to program the pump in coordination with 5 Rights scanning process o The Outlook pump receives the following data from the BCMA;  Patient ID  Drug name  Concentration  Rate or Dosage  Patient Weight/Height, depending on medication  Nurse ID • The infusion order has been received; the Nurse validates the data and will now start the infusion. • The Outlook Pump is also 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 Draeger and Hospira • 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.

Hi, I’m ______________. With Alaris Systems

Today I’d like to show you how the Alaris System contributes to patient safety.

The Alaris System uses IHE Patient Care Device messages to seamlessly communicate IV infusion and other medical device information to clinicians. The PCD-01 communicates infusion data from the pump to hospital systems, in this case GE Centricity Enterprise and Epic EMR systems. Just about everyone is aware of the importance of medication errors today. A few key facts to keep in mind include:

• Despite our heightened awareness of medication errors and efforts to prevent them, they continue to occur and they are costly. Preventing Medication Errors: Quality Chasm Series, Institute of Medicine, July 2006

• 61% of the most serious and costly medication errors are IV-related Communication with D.W. Bates, M.D., M.Sc. of Brigham & Women's Hospital in Boston, October 2001

So we’ll be showing you how you can improve IV medication delivery safety.

Our patient a 65 year old male is being prepped for a gastrectomy and distal transabdominal esophagectomy.

The surgery protocol calls for:

Dextrose 5%W 1000ml at 75mL/hr

Propofol 100mcg/kg/min

Morphine 100mg/D5w 100ml

The pump based barcode reader provides patient, medication and pump connection confirmation. The pump based reading of solution barcodes populates the pump with initial infusion parameters:

• Scan patient id – confirming correct patient

• Scan solution

• Select medication.

• Enter program parameters.

• Confirm pump entry.

• Start infusion.

• Infusion info can be confirmed on monitor. (PCD-01 message)

7

8

9

10

Parameters and Data

Operating Room

Following are typical parameters that would be received from devices in the OR and captured in the anesthesia documentation system.

• Patient Monitor

Heart Rate

Non-invasive BP Systolic

Non-invasive BP Diastolic

Non-invasive BP Mean

Temp

% SpO2

SvO2

Invasive BP

Inspired CO2

Expired CO2

Inspired CO2 %

CO2 Resp Rate

• Anesthesia System

Peak Pressure

PEEP

Plateau Pressure

Inspired Tidal Volume

Expired Tidal Volume

Flow Resp Rate

• Infusion Pump

Drug name

Drug concentration

Dose rate

Fluid flow rate

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