“The Intelligent Hospital”Adaptive Information Management

Paul, H. Frisch, PhD. FHIMSSAttending Department of Medical Physics Chief, Biomedical Physics & Engineering

Memorial Sloan-Kettering Cancer Center. New York, NY

Dec 8-11, 2013 , Washington DC mHealth Summit

PhysiologicData Manager

(Connectivity)

Directed Communications

Nurse CallApplication Server

VentilatorManagementApplication

PhysiologicalMonitoring

Pump Medication

Management

Hospital GatewayRTLS

Hospital Backbone

Alarm & Physiologic Data Manager

Nurse Hands Free Wireless Devices

Intelligent Hospital

CISCOAccess Point

Outside of RoomDome Indicator

Patient Station

Toilet Emergency

Code Blue

Router

Room HUB

Hub

(Emergin)

(Vocera)

RFID

Room Level Devices

Medication Administration

Sample Collection RTLS EMR

Archiving

Objective: Design of an Integrated Intelligent Hospital

Increased Data Accuracy & Availability Electronic Medical Records Shared Medical Device Interconnectivity and Integration Global View of the Patient / Unit

Rapid Information Dissemination & Response Physiological Data Alarm Event Management Advanced Communication Platforms (PDA, iPhone, etc.) Location Content

Enhanced Error Checking & Validation Identification & Association Location Content Correct Information

Optimization of Workflow & Resource Management

Hospital Environment

OR Acute Care (ICU) Emergency

Department General Patient Care

Areas Outpatient Specialty Areas

Radiology Radiation Oncology Cardiology Suite

Pharmacy Central Supply War Room Data Center Biomedical

Engineering Information

Technology

Patient Treatment & Care

Supporting Operations

Real Time Information DeliveryDemographicsStatus , ETA Field AssessmentAllergiesPhysiological Data

GPS Treatment PlanningStaffing / AssessmentRapid Routing OR , Cath LabNecessary Supplies

Time Sync. ClocksMedical Devices & Connectivity (Barcode & RFID)RFID Hand Hygiene ComplianceRFID Coupled Patient / Staff TrackingPatient Identification generate wristband @ bedside (Barcode, Passive & Active RFID)Label Scanners & Printers: Wristband, Sample CollectionRFID Coupled Bed / Patient Management System

RFIR Virtual Wall Emergency Room (ER)

Wall of Knowledge

Integrated Philips C-Arm

RFID Surgical Table

Video Camera

Drager Anesthesia System

2012 HIMSS Expo. RHCC Intelligent Hospital Pavilion

Wall of Knowledge - Routable Images

Minimally Invasive Surgery Boom

Device Control RFID Coupled Surgical

Instruments RFID Coupled Sponges OR RFID Couple Status Board RFID Coupled Supplies Interactive Consultation /

Education Robot Boom Mounted Video

Integrated Hybrid OR

ICU

2012 HIMSS Expo. RHCC Intelligent Hospital Pavilion

Intelligent Pharmacy

Environmental Metrics & Safety

TelemedicineAmbulance Data ER / OR Dashboards Bedside PC

Ventilator Management& Analytics

Alarm Management Physiological Data Bed Management

Education / Consultation

War RoomTactical Strategic (Business Intelligence)

Big Data Clinical Data

Physiological Parameters Physician Orders Laboratory Information Radiological Information

Alarm Management Alarms & Alerts Real Time Location Content

Workflow Resource Availability

Equipment & Supplies Staff

Environment of Care Temperature Humidity Fire Protection

Administrative / Management Information Business Intelligence

Real Time Information

Reports

Alarm Volume ICU (12 Bed Unit)

Physiological Monitoring Only 72 Hour Full Disclosure Results 36,000 Alarms 42 Alarms / Bed / Hour

Telemetry (90 beds) 72,397 Alarms over 20 days 3620 Alarms / Unit / Day

Filtering ThresholdingEscalation

Intelligent Alarm Processing

0

50

100

150

200

250

300

350

400

450

500

1406

*

1407

*

1410

A*14

10B*

1411

B*

1412

B*

1415

A*14

15B*

1417

A*

1417

B*

1417

C*

1417

D*

1420

A*14

20B*

1421

A*

1421

B*14

22A*

1422

B*

1424

A*

1424

B*

1425

A*14

25B*

1426

A*

1426

B*

1428

*14

29*

1430

*

1431

A*

1431

B*14

32A*

1433

A*

1433

B*

1435

A*14

35B*

1436

*

1437

*

1438

*

1439

*

Daily Average per bed

Telemetry SummaryTotal For 20 days

Daily Average for the whole Unit

Daily Average for one bed

All Alarms 72,397 3,620 86

Critical Alarms 5,194 260 6

Selective Filtering

Telemetry Ratio4:1 24 Alarms 2 / hr6:1 36 Alarms 1.5 /hr

0

10

20

30

40

50

60

70

80

ASYSTOLE LEADS FAIL PAUSE V BRADY V TACH VFIB/VTAC VT > 2

Critical Alarms Daily Average

Thresholding

Alarm on

t1 t2

Alarm # 1 Alarm # 2

SpO2 < 85 278 1.15 Alarms / Hr / NurseSpO2 < 80 198 .8 Alarms / Hr / NurseSpO2 <70 24 1.0 Alarm / Hr / Unit

Limit Adjustment Filtering

1406

*

1410

A*

1411

B*

1415

A*

1417

A*

1417

C*

1420

A*

1421

A*

1422

A*

1424

A*

1425

A*

1426

A* 14

28* 14

30*

1431

B*

1433

A*

1435

A* 14

36* 14

38*

0

5

10

15

20

25

30

35

40

45

VT>2VBradyVtachLeads OffAsystole

Patient Staff Ratio 4:1 64 Critical Alarms / HourCritical Event Every 11 minutes

Average Alarms Per Bed Per Shift

Connentivity & Point of Care Information Delivery

Handheld IP Phone Alarms Delivery Staff to Staff Communications

Handheld PCCan access all Hospital Applications Pagers

Dynamic Identification and Association

Equipment to Patient

Pharmaceutical

Frisch, P.H., Miodownik, S., Booth, P., Carragee, P., Dowling, M., Patient Centric Identification and Association. IEEE Engineering in Medicine and Biology Society, Proceedings of the 31th International Conference. 2009: 1722-5

Medical Devices & Systems Physiological Monitoring Bernoulli Ventilator Management Infusion Pump Systems Nurse Call

Alarm Management & Data Distribution Critical Alarms to the Point of Care Staff to Staff Communications

Medication Administration Sample Collection Electronic Medical Record

Active RFID Bar CodesPassive RFID

Processor

Applications

IdentificationAssociationData

RTLS, Network Clients, ADT, etc.

User Interface

Institutional RTLS Solution

• Item Level Identification• Shelf level Tracking• Validation of Supplies Check Expiration Serial #, Lot #• Update Inventory

Supply Chain

RFID Antenna Bar Code

2012 HIMSS Expo. RHCC Intelligent Hospital Pavilion

Surgical Applications - Retained Objects: • 1 in 5,000 open cavity surgeries result in a retained object• 40% of surgical cases are open cavity• 70% of retained objects are sponges

Ascension Health, Scott Lambert, Lead Partner, Engagements & Prototypes Transformational Development, 2008 Midwest Chapter HIMSS

• 764 Medicare incidents in 2006

• Tray Development • Validate Surgical Tray Content Before & After Procedure• Validate Sponge Counts• Confirm Cleaning & Sterilization Processes

Medication AdministrationRFID Coupled Dispenser

Hand Held Bar Code Reader

2012 HIMSS Expo. RHCC Intelligent Hospital Pavilion

Application Workstation: Integrates to Physician Order Entry Validate 5 Rights (Bar Code)

……….Station #1 #2 #3 #4

ID#1

If #1 and #2 and # 3 and #4 Good to Go

Antenna Network

Cleaning ProcessesLaboratory ProcessesDocument Transfer

Scope SterilizationHand Hygiene

Process Validation

Infusion Pump Server

Gateway RFID System

Device Location

Status

Formulary Version

Channels in Use

Operation Parameters

Alarms

RFID Coupled Device Status & Utilization

MSKCC – Carefusion- Aeroscout Collaboration

Programmable Events

Is Location Sufficient ?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Bo

bst 9

Bobs

t 14

Haup

t 1Ha

upt 2

Haup

t 3Ha

upt 4

Haup

t 5MP

1MP

2MP

6 M 1

M 10

M 11

M 12

M 14

M 15

M 16

M 17

M 19 M 4

M 5

M 6

M 7

M 8

M 9

Rad O

nc 2

Rad O

nc 3

Rad O

nc 4

Schw

artz 1

Schw

artz 2

Percentage Average Utilization by Care Unit

Percentage Utilization

EXCITER EXCITEREXCITER EXCITEREXCITER

EXCITER EXCITER EXCITER EXCITER

Synchronized RF-ID Tracking & Event Streaming “ Dynamic Workflow “

• Patient Wait Times

• Treatment Time

• Staff Presence By Specialty

• Time Sequence of Alarms & Events

• Utilization & Availability of Devices & Supplies

Workflow Metrics & Analytics

10:19 10:33 10:48 11:02 11:16 11:31 11:450

0.1

Tag #12Patient Alice Smith June 18, 2012

Registration

Check outFellow

RN

Room

MD

The Patient ExperienceWorkflow Metrics

Cautions & Considerations Lack of Strategic Vision & Planning ROI Based on Institutional Plan

Not Application Specific Network Impact Interference (EMI) Regulatory Issues Business Intelligence Management Application Development Simulation / Test Environment

Simulation Laboratory

Duplicates Environment of Care Infrastructure Devices Applications

Enables Test & Evaluation Upgrades to Infrastructure Wireless Network / AP’s Device Upgrades Application Changes New Technologies

Dynamic Training &Facilities Modeling

Automatic Patient Centric Identification

Bed Centric Identification

Envelope

Equipment to Patient

Pharmaceutical

Bed Embedded

RF Transmitter

Receiver

Embedded Bed / Nurse CallStaff Workstation

Middleware

Devices

EMR

PhysiologicData Manager

Directed Communications

Outside of RoomDome Indicator

Patient Station

Toilet Emergency

Code Blue

Router

Room HUB

Hub

Nurse CallApplication Server

VentilatorManageme

ntApplication

PhysiologicalMonitoring

Pump Medication

Management

Hospital Gateway

RFID

Hospital Backbone

Alarm & Physiologic Data Manager

Nurse Hands Free Wireless Devices

Biomedical Device Information System

CISCOAccess Point

(Emergin)

(Vocera)

RFID

Patient Centric Identification

Questions ?