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Interoperability Standards for Healthcare Simulators

Interoperability Standards for Healthcare Simulators. Rachel Ellaway 1 , Brian Goldiez 2 1 Northern Ontario School of Medicine, 2 University of Central Florida. MedBiquitous 2012. Conflict of interest.

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Interoperability Standards for Healthcare Simulators

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  1. Interoperability Standards for Healthcare Simulators Rachel Ellaway1, Brian Goldiez2 1Northern Ontario School of Medicine, 2University of Central Florida MedBiquitous 2012

  2. Conflict of interest We have no involvement with industry that constitutes a conflict of interest to disclose with respect to this workshop

  3. Where is now?

  4. Simulation-based Education (SBE) Simulation – what you do Simulator – what you use: Mannequins Part task trainers Haptics Appendages (moulage) Virtual worlds Virtual patients Simulated patients, HPs and others Simulated environments

  5. Healthcare Simulation Industry • 200+ vendors • Systems • Components • Mannequins • Part task trainers • Human appended devices (egmoulage) • Haptic devices • Virtual devices • Virtual environments • Supplies

  6. Healthcare Simulator Users • The military • Emergency services • Hospitals • Regional simulation centers • College programs • University programs • Medical schools • First aid training • Major investment and expansion

  7. Issues Proliferation of simulation and simulators Where does a device fit into education, training and assessment? How is usage maximized? How are efficiency and utility maximized? How do we rip, mix burn while allowing providers to sustain and innovate

  8. S&S Targets Scenarios and profiles State data - vital signs, algorithms, interactions, progress Algorithms Report data and inject into reporting stream HW-HW, HW-SW, SW-SW Vocabularies Typologies Operating systems and abstractions Sensors, scutters and non-medical data

  9. Approaching S&S • What problems need to be addressed? • What systems are out there? • What systems are in the pipeline? • Who (if anyone) “owns the space”? • Where is there leverage? • Where are the communities? • SSH • MedBiquitous • SISO

  10. What Standards Already Exist? IEEE 1278 (Distributed Interactive Simulation - DIS) - Simulator Interoperability Standards Organization (SISO) IEEE 1516 (High Level Architecture - HLA) via SISO ANSI VP.10.1-2010 (aka MedBiquitous VP) Health Level 7 (HL7) via ANSI & ISO Picture ArChiving System (PACS) Digital Imaging & COmmunication in Medicine (DICOM)

  11. ANSI VP.10.1-2010 MedBiquitous Virtual Patient • XML-based • 4 components: • Activity Model • Virtual Patient Data • Media Resources • Data Availability Model • For system-system transport • Limited rendering into runtime – player dependent • No state modeling or intra-system comms or interop

  12. IEEE 1278 Distributed Interoperable Simulation (DIS) • Supports a variety of connection strategies • No middleware • Self-developed middleware • COTS middleware • Arguably provides a relatively simple implementation for the medical and non-DoD communities • Consistent with portions of MedBiquitous Virtual Patient • Nevertheless very DoD-focused • No XML – short live binary data exchanges(1.5k max per message)

  13. Medical Coding Systems International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM) 16,000 codes in Diagnosis & Procedures International Classification of Diseases, Clinical Modifications, 10th Revision (ICD-10-CM/PCS) 140,000 codes Systemized Nomenclature of Medicine, Clinical Terms (SNOMED-CT) 350,000+ terminologies Current Procedural Terminology (CPT) 7800 codes Diagnostic Related Groups (DRG) 500 medical/surgical groups, 1,200 subclasses

  14. Where is next?

  15. Open for business? • Limited by simulator complexity and proprietary control • CAE-METI – systems closed • Gaumard – limited computer capabilities • Laerdal SimMan 3G API closest to open access but limited functionality • Other providers closed systems and no standards to work to • Options? DIY beyond most of us • … so we hack

  16. DIS to SimMan 3G • Virtual mannequin created with Laerdal simulator Software Development Kit (SDK) • Send & receive healthcare PDUs (Protocol Data Unit): • Variable Parameter (VP) record (PCR 223) • Medical Attribute PDU (PCR 224) • Ethernet network for messages (wifi used for laptop-mannequin – interface computer needs multiple NICs)

  17. HSVO to SimMan 3G Laerdal SimMan SDK = .NET tech Limitations to what it can do in a live situation Laerdal: “If you want to transfer mannequin state, why not simply use the existing functionality – save the session to a file, transfer the file to the Instructor Workstation for the next mannequin, and then start that mannequin from that file.” Multi-mannequin remote/distributed simulation activities

  18. HSVO to SimMan 3G HSVO hub loads a VNC client for each mannequins’ Instructor Workstations and Patient Monitors on VNC Remote operators could reliably switch between mannequins, controlling them one at a time Remote students at sites can watch each others’ Patient Monitors State and management data transferred between remote mannequins

  19. Conclusions Big money in simulation Driven by large centres and vendors Very limited capacity for interoperability Nevertheless a growing interest and opportunity A number of standards for and adjacent to simulation already in place Core mainstream simulation interop still to be resolved, claimed Many labs, projects, researchers pushing boundaries …

  20. Simulation Interop Space military/aerospace Vendors Educational interop Administration and reporting Educational researchers Clinical systems

  21. Simulation Interop Space Vendors military/aerospace Educational interop Administration and reporting Educational researchers Clinical systems

  22. Where is next? Great potential but immature technology space Agencies and societies (SSH, MedBiq, SISO) identify and pursue low hanging fruit Vendor leverage Complexity but opportunity in bringing domains into a common siminterop space Sim<>other med-ed connectors Explore what siminterop means Explore what value siminterop brings

  23. Contact and Acknowledgements rachel.ellaway@nosm.ca bgoldiez@ist.ucf.edu DrEllaway’s work was funded in part by CANARIE Inc, Canada DrGoldiez’ work was funded, in part, by the US Army Research Laboratory under W91CRB-10-C-0046 and PEO STRI SE CORE Contractors

  24. Interoperability Standards for Healthcare Simulators Rachel Ellaway1, Brian Goldiez2 1Northern Ontario School of Medicine, 2University of Central Florida MedBiquitous 2012

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