RealRealReal---timetimetime ExecutiveExecutiveExecutive DashboardsDashboardsDashboards andandand VirtualVirtualVirtual Instrumentation:Instrumentation:Instrumentation: SolutionsSolutionsSolutions forforfor HealthcareHealthcareHealthcare SystemsSystemsSystems
presentedpresented toto 20022002 AnnualAnnual HIMSSHIMSS ConferenceConference andand ExhibitionExhibition
EricEric Rosow,Rosow, MSMS DirectorDirector ofof BiomedicalBiomedical Engineering,Engineering, HartfordHartford HospitalHospital CoCo--Founder,Founder, PremisePremise DevelopmentDevelopment CorporationCorporation Hartford,Hartford, CTCT USAUSA Presentation Objectives
• Virtual Instrumentation Defined • Business Intelligence and Decision Support Applications • Case Studies: – PIVIT: A Data Mining & Visualization Application – Real-Time Bed Management & Census Control – Physician/Network Assessment Tool • Clinical Applications • Q&A / Discussion “The“The mostmost meaningfulmeaningful wayway toto differentiatedifferentiate youryour companycompany fromfrom youryour competition,competition, thethe bestbest wayway toto putput distancedistance betweenbetween youyou andand thethe crowd,crowd, isis toto dodo anan outstandingoutstanding jobjob withwith information.information. HowHow youyou gather,gather, managemanage andand useuse informationinformation willwill determinedetermine whetherwhether youyou winwin oror lose.”lose.”
-- BillBill GatesGates BusinessBusiness atat thethe SpeedSpeed ofof ThoughtThought VirtualVirtual InstrumentationInstrumentation
IndustryIndustryIndustry---StandardStandardStandard ComputersComputersComputers EquippedEquippedEquipped withwithwith thethethe UserUserUser---friendlyfriendlyfriendly ApplicationApplicationApplication Software,Software,Software, CostCostCost---effectiveeffectiveeffective HardwareHardwareHardware andandand DriverDriverDriver SoftwareSoftwareSoftware thatthatthat TogetherTogetherTogether PerformPerformPerform thethethe FunctionsFunctionsFunctions ofofof TraditionalTraditionalTraditional Instruments.Instruments.Instruments.
Virtual Instrument Paradigm Shift
Traditional Instrument Virtual Instrument “vendor-defined” “user-defined” Elements of Virtual Instrumentation
AcquisitionAcquisition SignalsSignals andand AnalysisAnalysis PresentationPresentation ControlControl
• ECG • DAQ • Signal Processing • GUI • Pressure • GPIB • Digital Filtering • Hardcopy Output • Temperature • VXI • Statistics • File I/O • SaO2 • RS-232 • Array Operations • WWW (HTML) • Database • USB • Text-to-Speech • Spreadsheet • MIB (IEEE-1073) • Speech-Recognition • Images • Internet • PDA, Phone, Pager ComputerComputer--BasedBased MeasurementMeasurement andand AutomationAutomation ApplicationApplication SoftwareSoftware (Analysis(Analysis && Presentation)Presentation)
GPIBGPIB CorporateCorporate SerialSerial NetworkNetwork DAQDAQ
VXIVXI ImageImage AcquisitionAcquisition MotionMotion ControlControl PXI ProcessProcess PXI oror Unit Under Test Unit Under Test HardwareHardware && DriverDriver SoftwareSoftware (Acquisition(Acquisition andand Control)Control) Fundamentals of Virtual Instrumentation
Traditional Instruments Virtual Instruments u Vendor Defined u User Defined u Function-specific; stand-alone u Application oriented systems with systems with limited connectivity connectivity to networks peripherals, and applications u Hardware is key u Software is key u Expensive u Low-cost, reusable u Closed, fixed functionality u Open, flexible functionality leveraging off of familiar computer technology u Slow turn on technology u Fast turn on technology (5-10 year life cycle) (1-2 year life cycle) u Minimal economies of scale u Maximum economies of scale u High development and u Software minimizes development maintenance costs and maintenance Percentage of Ownership 100100 9090 8080 7070 6060 5050 4040 3030 2020 1010 00 120120 (1876)(1876) 110110 (1886)(1886) TelephoneTelephone AutomobileAutomobile 100100 9090 8080 (1873)(1873) ElectricityElectricity 7070 RadioRadio (1905)(1905) (1926)(1926) TelevisionTelevision 6060 5050 VCRVCR (1952)(1952) Years Since Introduction 4040 3030
(1975)(1975) InternetInternet PCPC (1953)(1953) 2020
(1975) (1975) MicrowaveMicrowave VIVI 1010 (1986)(1986) Technology Diffusion in the U.S. the in Diffusion Technology 11 00 9090 8080 7070 6060 5050 4040 3030 2020 1010 100100 Percentage of Ownership Convergence of Technologies
Internet Interapplication and Communication World Wide (SQL Toolkit) Web VirtualVirtual
InstrumentationInstrumentation
Advanced “Fuzzy Logic” DAQ & DSP Toolkit Multimedia Capabilities
• Intelligent “Agents” • Interactive Alarms • Text-to-Speech • Speech Recognition • Video and Animation • Web-Enabled Virtual Instrumentation Solutions
Bed Management Executive Dashboards Data Mining
Endoscope Testing Wound Measurement
Cardiovascular Analysis Real-Time Measurements Data Collection In the beginning... Biomechanical Analysis Physiological & Biomechanical Profiling (US Olympic Committee)
Technology as our “patient” Acquisition, Replacement and Asset Management System Pre-Purchase Request Planning Installation
PO# to Equipment Department Standards Materials Equipment Vendor Enters Request Committee Management Installed (Delivery) Program
Technical & Biomedical BME Tags BME BME Clinical Engineering & Inspects Evaluates Monitors Evaluation (Tech. Specs.) Equipment Static Risk Performance
Planned Maintenance Design Equipment Planned Maintenance Cycle
Equipment Equipment Equipment PM Pass No Unscheduled Enters PM Operational Due for PM Inspection Inspect? Maintenance Program Program Yes
SMWT & CE SMWT & CE BMET starts Return to 1. Rounds Assigns BMET Issue/Review ESR/EIR, Service 2. Service Calls & Sets PM Due/Over PM Inspects/PMs 3. “Walk-Ins”
Unscheduled Maintenance Equipment Evaluation and Repair
Remove Yes Defective Repair PMs Return to Equipment Repair? Equipment Service Equipment to BME Equipment No Self-Managed Work Team (SMWT) Process SMWT updates ESR SMWT completes ESR Notifies Department of Removal; applies Retirement Informs owner of status Informs owner of return defective tag on; reviews history, cost & plans Paperwork Repairs Unit Documents activities EnterpriseEnterprise--WideWide MonitoringMonitoring NetworkNetwork TheThe MedicalMedical InformationInformation BusBus (MIB)(MIB) [IEEE 1073] Application Review
• PIVIT™ (Performance Indicator Virtual Instrument Toolkit) • Bed Management/Census Control Dashboard • Executive Dashboards • Physician/Network Assessment Toolkit • BabySave™ • Cardiovascular Applications • The EndoTester™ • Wound Measurement System Demonstrations... DecisionDecision SupportSupport andand BusinessBusiness IntelligenceIntelligence ApplicationsApplications “Data Overload”
“We’re“We’re swimmingswimming inin data,data, butbut starvingstarving forfor information…”information…” Measurements Are the Foundation for Six Sigma PIVIT: Performance Indicator Virtual Instrument Toolkit
“Navigation“Navigation withwith Information”Information” Goal of PIVIT: ToTo createcreate anan intuitiveintuitive andand usefuluseful setset ofof “virtual“virtual instruments”instruments” availableavailable toto allall usersusers toto access,access, analyzeanalyze andand profileprofile andand distributedistribute clinical,clinical, financialfinancial andand qualityquality metrics.metrics. Bridging the gap...
• Databases: Ideal for extracting data and specific subsets--not generally suited for analysis
• Spreadsheets: Ideal for analyzing and graphing data--not easily configured to perform interactive and multivariate analysis PIVIT Main Menu Real-Time Statistical Process Control Pareto Analyses Real-Time Alerts and Warnings Biomedical Engineering’s Performance Dashboard Medical Technology Risk Classification Program 360-Degree Performance Review Instrument 360-Degree Performance Review Instrument Personnel Skills Assessment Tools Performance Indicator Wizard Trends and Projections Multidimensional Profiles and Analysis Financial Profiling Module Multi-Parameter Profiles Case Study: A Bed Management and Census Control Dashboard “Air Traffic Control Tower” -real-time & mission critical- -scheduled & emergency “landings”
•• ControlControl TowerTower == BedBed ManagementManagement •• TerminalTerminal == Unit/ServiceUnit/Service •• GateGate == RoomRoom •• PlanePlane == Patient/BedPatient/Bed Hartford Hospital Command Center: 9/11/01 Hartford Hospital Command Center: 9/12/01 “Bed Management Dashboard” Complements the Admission/Discharge/Transfer Systems
BillingBilling BedBed ManagementManagement DecisionDecision ADTADT SupportSupport SystemSystem Stakeholders Interviewed “Voice of Customer (VOC)”
• Admission Coordinator • Administration • Unit Directors • Physicians • ICU 2000 Task Force • “One-Stop” Dispatch • PriceWaterhouseCoopers • Central Transport • PAAs/PSAs • Patient Accounts • Evening Coordinators • Emergency Department • Information Technology • Operating Room • Health Info. Management • Network Affiliates “Problems & Solutions”
• Problem: ADT systems don’t provide sufficient clinical information for appropriate patient placement Solution: BMD integrates all required information in real-time
• Problem: Diversions, excessive wait times, and LWOTs Solution: Improved efficiency of patient flow
• Problem: Inefficient communication (units, admitting, etc.) Solution: Automated notification (dashboard, pager, e-mail, etc.)
• Problem: “23+ Hour Outpatients” (that occupy inpatient beds) Solution: 24x7 Alerts (intelligent agents, pagers, etc.)
• Problem: Difficulty accessing historical, current & predictive data Solution: BMD provides data mining & decision support tools Bed Management Dashboard System Diagram Scenario 1 - ED Patient Admission
ED Bliss 7I
Bed Management
Admitting Scenario 2 - Inter-Unit Transfer
Bliss 7I Bliss 8
Bed Management Scenario 3 - Direct Patient Admission
Physician Bliss 7I
Bed Management
Admitting “Digital Dashboard” Design Goals
• Easy-to-Use and “Friendly” • Complement ADT and Integrated with related systems • Graphical Displays and Reports to extract “information” from “data” • Multiple Views of the same data to meet different needs • Customized to meet specific needs of Hartford Hospital • Generic Design to accommodate other / future bed management models (via HL7 interface) “Digital Dashboard” Key Reporting Features
· Real-Time and Predictive Alerts · Triggered by Critical Situations (i.e. Low Available Beds, Excessive ED Bed Placement Times, etc.)
· Display and Reporting of Current Hospital Status · Hospital Summary · Unit/Service/Cluster-Level Summaries · Detail Listings of Patient and Bed Attributes
· Retrospective Reports with Histograms and Pareto charts · Occupancy Trending for Hospital, Service or Unit · Physician Admission & Discharge Time of Day Profiling · Patient Transport / Bed Cleaning Process Analysis “Digital Dashboard” Key System Features
· Process / Decision Screens Targeted to Specific Needs · Finding a Patient by any Known Identifier · Locating All Patients Sharing an Attribute(s) · Selecting a Unit / Bed for a Specific Patient
· Data Archive · Date/Time Stamped Audit Trail · Retrospective Reporting and Analysis · “Bed Turnover” Statistics
· Embedded Security System for HIPAA conformance Bed Management Dashboard – Executive Overview Bed Management Dashboard – Bed Criteria Module Bed Management Dashboard - Floorplan Display Bed Management Dashboard - Activity Profiler Retrospective Occupancy Trending Bed Management Components
• Process Improvements – Improved Efficiency of Patient Movement – Access to Current and Future Availability – Automated Alerts and Messages
• Decision Support – Retrospective Reports with Histograms and Pareto charts – Occupancy Trending for Hospital, Service or Unit – Physician Admission & Discharge Time of Day Profiling – Patient Transport / Bed Cleaning Process Analysis Executive Information Dashboards Business Intelligence and Decision Support Applications Easy to Use Claim Filters Easy to Use Invoice Filters Dynamic Profiling of Claims Dynamic Views of Claim History Detailed Drill Down of Invoices DataData ModelingModeling andand PredictivePredictive ToolsTools Injury Epidemiology Model (Falls Data from the State of CT) Clinical Management Pathways (Data Mining/Modeling Tool) Clinical & Physiological Measurement Virtual Instruments Physiological Data Acquisition
• Multiple Physiological Signals from various instruments • High Speed DAQ • File Management
• Custom software development & System Integration Vibrotacticle Stimulation System to Treat Apnea of Prematurity Overall Significance
• Apnea is among the major respiratory control disorders in premature neonates
• Incidence is high in premature infants of low birth weight & inversely related to age
– 80% of neonates born at < 30 weeks affected.
– 84 - 90% of infants < 1000 grams affected
• Significant factor associated with the mortality and morbidity of preterm infants System Design • Software / hardware interface designed to acquire: – ECG, heart rate, thoracic impedance, SpO2, pulse rate, nasal airflow and VTS and hand stimulation signals. • “Virtual Function Generator” is embedded in software application
This:
Instead of: System Block Diagram
Laptop Computer Patient Monitor Nasal Thermistor
BNC Connector Board
VTS Infrared Transducer Transmitter
Buffer / Filter SpO2
Infrared Infrared Receiver remote control Foot Pedal Software: Record Stimulus Data Cardiovascular Pressure-Dimension Analysis System Objectives
An easy-to-use data acquisition system which interfaces with various patient monitors (ECG and Pressure waveforms) and the Hewlett-Packard SONOS Ultrasound Machine to study pressure- volume relationships of the heart’s ventricles.
• Ejection Fraction (EF) • Stroke Work • Fractional Area Change (FAC) • Systole/Diastole • ESPDR & EDPDR • Emin. Emax. -dP/dt • PRSWI • Statistical Analyses Cardiovascular Pressure-Volume Analysis System Block Diagram
Macintosh/PC Patient Monitor(s) & HP Sonos Unit with LabVIEW Executable & an A/D Card ECG
Pressure
Area/Volume (AQ) Cardiovascular Pressure-Volume Analysis Cardiopulmonary Analysis Cardiopulmonary System (RAMS)
An easy-to-use data acquisition and analysis system which interfaces with mass spectrometers and/or any rapid responding multigas analyzer, and a flow/volume measurement device.
• Single-Breath DLCO • Total Lung Capacity (TLC) • Rebreathing DLCO • Residual Volume (RV)
• Cardiac Output (Qc) • Membrane DLCO (Dm)
• Oxygen Consumption (VO2) • Capillary Lung Volume (VC) Cardiopulmonary Measurement System Block Diagram
Macintosh/PC Mass Spectrometer with LabVIEW, •oxygen Mass Spectrometer •carbon monoxide A/D Card & •sample port selection •acetelyne a Relay Board •helium •nitrogen Breathing Valves •carbon dioxide •open/close Pneumotach •flow System Valves (Gas) •gas evacuation Spirometer •gas injection •volume Cardiopulmonary Measurement System MachineMachine VisionVision andand TestTest && MeasurementMeasurement VirtualVirtual InstrumentsInstruments The EndoTester™ Case Study: Quality Assurance of Endoscopes During Surgery
The Problem: QuantitativeQuantitative performanceperformance assessmentassessment ofof endoscopesendoscopes andand videovideo systemssystems isis oftenoften difficultdifficult inin thethe clinicalclinical setting.setting. The Solution: The EndoTester™
An easy-to-use “plug and play” endoscope quality assurance and performance measurement system (patented).
Ø specialized optical test bench Ø integrated software Ø real-time display and analysis Ø automated database to track performance history Applications
Objective performance measurement for:
Ø Routine clinical use Ø Equipment evaluation Ø Identifying faulty component(s) Ø Determining “useful life/throw-away threshold” Ø Pre/post repair evaluation and comparison Wound Evaluation System
• Easy-to-Use • Portable • Affordable • Accurate • Consistent • Non-Invasive Wound Evaluation System Block Diagram Analysis & Report Capabilities
Machine Vision & Motion Control System Computer Digital Image
Digital Image
Edge Detection, ROI, Volumes, etc.
3D/Contour Profiles
Color 3D and Machine Vision & Motion Contour Profiles Control System Computer -Custom Software -video frame grabber
Summary of Virtual Instruments •• UserUser--DefinedDefined •• EasyEasy--ToTo--UseUse •• RealReal--TimeTime DataData •• InteractiveInteractive •• MultidimensionalMultidimensional •• ScalableScalable A new way of doing things...
“At“At firstfirst peoplepeople refuserefuse toto believebelieve thatthat aa strangestrange newnew thingthing cancan bebe done;done; ThenThen theythey beginbegin toto hopehope itit cancan bebe done;done; ThenThen thethe seesee itit cancan bebe done;done; WhenWhen itit isis done,done, allall thethe worldworld wonderswonders whywhy itit wasn’twasn’t donedone thatthat wayway forfor centuries.”centuries.” -- TheThe SecretSecret GardenGarden ForFor moremore information,information, pleaseplease contact:contact:
Eric Rosow, MS Joseph Adam, MS Director, Biomedical Engineering President and CEO Hartford Hospital Premise Development Corporation 80 Seymour Street One Hartford Square West Hartford, CT 06102 Hartford, CT 06106 Phone: 860-545-3915 Phone: 860.246.3000 FAX: 860-545-5025 FAX: 860.246.3001 e-mail: [email protected] e-mail: [email protected] Internet: www.harthosp.org Internet: www.premisedev.com Questions???