How Networked Things are Changing Medicine
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The document discusses how networked medical devices are transforming the healthcare landscape by enhancing diagnosis, safety, and patient outcomes through improved device integration and data interoperability. It highlights the use of RTI's DDS middleware for connecting various medical devices, enabling real-time data monitoring and communication that can assist in making informed clinical decisions. The emphasis is placed on improved collaboration among healthcare systems and the potential for better patient care through technological advancements.
How Networked Things are Changing Medicine
- 1. Your systems. Working as one. How Networked Things Are Changing Medicine Real applications in connected medical devices © 2014 Real-Time Innovations, Inc.
- 2. •Bettina Swynnerton •[email protected] •RTI Focus: Industrial Internet of Things © 2014 Real-Time Innovations, Inc.
- 3. RTI Named Most Influential IIoT Company © 2014 Real-Time Innovations, Inc. Confidential.
- 4. RTI solves problems like ©2014 Real-Time Innovations, Inc. Room Domain Central Domain Admin Domain (Cloud) Workstations, Storage, Historian Gateway, IX, Enterprise, 3rd Party
- 5. Small scale, large scale ©2014 Real-Time Innovations, Inc.
- 6. Systems as a sum of their parts ©2014 Real-Time Innovations, Inc. Data Bus Supervisory Services Patient Mgmt Device Mgmt Systems Health Interaction Checking Logging CDS Algorithm #1 Lab Data SPO2 CO2 Patient Hx Infusion Pump Settings IV Pump Control Infusion Pump Measured Values
- 7. How could connected things change medicine? © 2014 Real-Time Innovations, Inc.
- 8. Just some of the problems… © 2014 Real-Time Innovations, Inc.
- 9. Result: False alarms, incorrect data in permanent record. ECG data ECG data Pulse Ox data EMR data Or this… © 2014 Real-Time Innovations, Inc.
- 10. How could medicine change? •Improved diagnosis? •Delegated care? Delegated treatment? •Machine assisted diagnosis, care and treatment? •Improved safety? © 2014 Real-Time Innovations, Inc.
- 11. Three important drivers •Evolution from the stand-alone system to a distributed system •Connection of devices to improve patient outcome •The replacement of dedicated point-to-point wiring with networks
- 12. Ultrasound Imaging ”BK Medical is truly redefining Medical Ultrasound Imaging where the traditional single user / single system approach is being replaced with fully scalable and distributed multi-user systems This required a completely new way of gluing the individual components together. For this reason we selected the RTI DDS middleware as this gives us all the flexibility and the abstraction layer needed for the future of Analogic Ultrasound” -- Jesper Lomborg Manigoff, VP of Engineering, Analogic Global Ultrasound ©2014 Real-Time Innovations, Inc.
- 13. ©2014 Real-Time Innovations, Inc.
- 14. Surgical Robotics •The Minimally Invasive Robotic Surgery (MIRS) system at DLR coordinates three robots to perform delicate heart surgery. •The system closes a distributed loop between the robots and the remote surgeon’s control at 3kHz. •RTI enables new medical techniques ©2014 Real-Time Innovations, Inc.
- 15. Driver 2: Connect devices to improve patient outcome •IT problem: Patient records •M2M problem: Intensive care diagnostics •HMI problem: Enable staff to come to a safe diagnosis and safe decisions assisted by data correlation © 2014 Real-Time Innovations, Inc.
- 16. Device Connection for Patient Safety •Hospital error is the 6th leading cause of preventable death •DocBox integrates devices to improve patient safety •RTI Connext ties together devices, services, and displays in real time ©2014 Real-Time Innovations, Inc. “RTI Connext DDS met all our needs – whether we’re handling 12 patients, or 200.” -- DocBox Founder, Tracy Rausch
- 17. Industry Interoperation •The Integrated Clinical Environment (ICE) standard specifies interoperability for medical devices •All ICU & operating room devices — from blood pressure cuffs to intravenous pumps to ventilators — could be interconnected according to the ICE standard –Complete logging –Automatic error detection –Better care •The DDS standard and RTI middleware enables plug & play interoperability across manufacturers © 2014 Real-Time Innovations, Inc. ASTM F2761
- 18. © 2014 Real-Time Innovations, Inc.
- 19. Data Distribution Service for ICE DDS Global Data Space App App App Device Device Device Data Logger External Interface ADT EMR External Interface Benefits offered by DDS •Discovery / Presence •Data-Centric Information Model / Type Safety (agree to data structure in advance) (Distinct from underlying messaging) •QoS Policy Compatibility Checking / Runtime Enforcement © 2014 Real-Time Innovations, Inc.
- 20. ©2014 Real-Time Innovations, Inc.
- 21. Inter-Vehicle Communications •Exelis (ITT) C4i provides command and control systems for military and civilian agencies (fire/police/emergency response) •RTI Connext DDS connects GUIs to servers that route voice and video •RTI met the critical needs: scalability, routing, recording ©2014 Real-Time Innovations, Inc.
- 22. EMS Device Integration Platform •The largest EMS equipment provider supplies emergency response equipment to 60% of the world’s emergency vehicles •Uses RTI middleware for mobile device bus, in-vehicle platform, cloud connectivity ©2014 Real-Time Innovations, Inc.
- 23. EMS Cloud Integration © 2014 Real-Time Innovations, Inc. Connecting devices with hospitals to provide better treatment while en-route 4G/LTE
- 24. Hospital Integration © 2014 Real-Time Innovations, Inc.
- 25. Clinical Diagnostic System ©2014 Real-Time Innovations, Inc. Room Domain Central Domain Admin Domain (Cloud) Patient Monitoring Devices Workstations, Storage, Historian Gateway, IX, Enterprise, 3rd Party
- 26. CDS System of Systems ©2014 Real-Time Innovations, Inc.
- 27. Hospital Integration Data Challenges •Hospital net challenge –1000s of patients, >100k devices –Wired/wireless/ISM –Moving patients –100% uptime, security –Real-time waveforms •RTI DDS technology –Data centric addressing –Smart data filtering –Routed deployment –Optimized updates –Automated test harness © 2014 Real-Time Innovations, Inc.
- 28. Driver 3: Integration of intelligent machines •Point to point •Tightly coupled •Data-centric networks •Loosely coupled © 2014 Real-Time Innovations, Inc.
- 29. Surgical Operating Room Integration •Patient status –Waveforms –Data recording •Multi-channel video •Many recipients –Surgeon –Operating theater –Students & observers –Offsite ©2014 Real-Time Innovations, Inc. Image is for conceptual understanding only. This is not a current RTI application
- 30. Interventional Surgical Theatre ©2014 Real-Time Innovations, Inc. Operating Room Domain High-Speed DataBus Xray UltrSnd ProbeVid Image Fusion Instrument Integration Room Control Surgeon Display Data Storage EHR ECG PxR SpO2 Down Sample Graphics System GPU Graphics System GPU Tablet Tablet Tablet Remote Monitors Wireless DataBus
- 31. How Can Things Do Those Things? Technology © 2014 Real-Time Innovations, Inc.
- 32. What is interoperability? © 2012 Real-Time Innovations, Inc. 32 Level 0 No Interoperability Level 6 Conceptual Interoperability Level 5 Dynamic Interoperability Level 4 Pragmatic Interoperability Level 3 Semantic Interoperability Level 2 Syntactic Interoperability Level 1 Technical Interoperability Stand alone systems that have no interoperability Full assumptions and constraints of meaningful abstraction of reality. Fully specified but independent model Maintains state changes between systems during run time. Includes assumptions and constraints that effect data interchange Systems are aware of methods & procedures of other systems. Context is understood by all participating systems Meaning of data is exchanged through use of a common information model. The meaning of information is shared and unambiguously defined. Common structure or common data format for exchanging information. The format of the information exchange is unambiguously defined Communication protocol for exchanging data. Bits & Bytes are exchanged in an unambiguous manner Levels of Conceptual Interoperability Model (LCIM) for Systems Engineering VMASC (Virginia Modeling, analysis and simulation centre)
- 33. Open standards-based middleware? ©2014 Real-Time Innovations, Inc. Point-to-Point Client/Server Brokered ESB Daemon Publish/Subscribe Queuing Data-Centric
- 34. Data Centric Approach? •Data-centric middleware maintains state •Infrastructure manages the content •Developers write applications that read and update a virtual global data space ©2014 Real-Time Innovations, Inc. Persistence Service Recording Service Source (Key) Wind Power Phase WPT1 37.4 122.0 -12.20 WPT2 10.7 74.0 -12.23 WPTN 50.2 150.1 -11.98 Popular standards: DDS API, wire spec
- 35. De-coupled? •Verb-based: applications interact with each other •Noun-based: applications interact with data model © 2014 Real-Time Innovations, Inc. Set B3 to 27 B3
- 36. Managing State •Data centric –Single version of truth enables interoperation –Content-aware infrastructure eases integration –Clear rules for access, changes, updates tame complexity •Technologies –Database –Data-centric middleware ©2014 Real-Time Innovations, Inc.
- 37. QoS: Quality of Service QoS Policy QoS Policy DURABILITY USER DATA HISTORY TOPIC DATA READER DATA LIFECYCLE GROUP DATA WRITER DATA LIFECYCLE PARTITION LIFESPAN PRESENTATION ENTITY FACTORY DESTINATION ORDER RESOURCE LIMITS OWNERSHIP RELIABILITY OWNERSHIP STRENGTH TIME BASED FILTER LIVELINESS DEADLINE LATENCY BUDGET CONTENT FILTERS TRANSPORT PRIORITY © 2014 Real-Time Innovations, Inc. Volatility User QoS Delivery Presentation Redundancy Infrastructure Transport
- 38. 0 50 100 150 200 250 300 350 400 Average Latency (Microseconds) Throughput (Messages per Seconds) 1 (1 per CPU and NIC) 20 (1 per CPU and NIC) 40 (1 per CPU, 2 per NIC) Performance Under Load •Reliable multicast •Fully meshed, reliable Number of Subscribers Orders of magnitude faster than IT solutions Fastest DDS solution Comprehensive results online at www.rti.com © 2014 Real-Time Innovations, Inc.
- 39. Unit DataBus Unit DataBus End-to-End DataBus •Connect… –Fast –Seamless –QoS controlled –Secure –Data centric •…80 Platforms… –Micro controllers –Certified systems –Embedded –Mobile –Desktop –Cloud •…over 12 Transports –UDP or TCP –D/TLS (secure) –Wireless or wired –Shared memory –Backplane –Cloud virtual connect ©2014 Real-Time Innovations, Inc. Intelligent Machines Intelligent Systems Intelligent Industrial Internet Cloud DataBus Site DataBus Intelligent System of Systems Unit DataBus Sense Act Think HMI Machine DataBus Think HMI Machine DataBus Sense Act Think HMI Machine DataBus
- 40. Route to Build Complete Hierarchy •Routing Technology –Encapsulate subsystem data –Translate data models/formats –Match comm patterns © 2014 Real-Time Innovations, Inc. MQTT Web Field Busses AMQP JMS TCP Routing Service Pluggable Adapters Transformation Engine Database Historian DDS DataBus DDS DataBus
- 41. Strive For: One Logical Dataspace… © 2014 Real-Time Innovations, Inc. DDS DataBus Sensors Actuators Analytics & Control HMI/UI IT, Cloud & SoS Connectivity
- 42. …Hiding Complex Network Topologies © 2014 Real-Time Innovations, Inc. Actuators Sensors Analytics, control HMI Actuators Sensors Analytics, control HMI Actuators Sensors Analytics, control HMI Analytics, control HMI Centralized analytics Decentralized devices, streaming analytics and control
- 43. Choose DDS If… •Disaster if offline for 5 minutes? •Measure performance in ms or us? Or scale >100+ applications? Or 10k+ data values? •Code active lifetime >3 yrs? •2 or 3 => DDS ©2014 Real-Time Innovations, Inc. Control: DDS
- 44. Some Resources •Papers, evaluation downloads, community: www.rti.com •Wired article: http://blogs.rti.com/2013/11/18/a- day-in-your-life-with-the-internet-of-things/ •EDN on patient safety: http://electronicdesign.com/communications/internet-things-can-save-50000-lives-year •PBRT system: http://www.barnesjewish.org/news/?id=5032&sid=2&nid=3068 •Video: http://goo.gl/WnO5LE © 2014 Real-Time Innovations, Inc.