The overall solution of EMRGateway is based on IHE architecture which consists of Device Observation Reporter (DOR), Device observation Filter (DOF) and Device observation Consumer (DOC)
DOR is responsible for connecting to various devices and collect the data and send to DOF or DOC, based on the defined workflow.
DOF takes the filter configuration from medical devices and accordingly construct the data which it receives from DOR and send to DOC.
DOC collects the data either directly from DOR or through DOF based on the filter setup given by the external clinical systems which makes use of the data coming from DOC
In the above architecture diagram, DOR and DOF components are defined and the subscriber manager acts as a Device Observation Consumer (DOC)
Device Manager Component is responsible for maintain the devices which are connected to EMRGateway using serial/USB/Bluetooth etc and collect the data from those devices and pass it to underlying components.
Interface library module maintains the libraries/plug-ins for various devices, gateway systems (GE Aware gateway, Philips IntelliVue Information center etc) and X73 manager components
The devices gets registered and the plug-in and profile of the devices will be maintained in Device registry. Whenever the device gets connected to this system, Device manager gets the notification from the device. The device registry checks the availability of the profile of that device and initiates I/O abstraction layer to initiate the communication based on the mode of connectivity (serial/USB etc).
If the connected device is X73 enabled, the X73 manager gets initiated to acknowledge the association request from the X73 Agent and gets the device profile through context scanner response from the device. Based on the device configuration, the X73 manager starts getting the device data and sends it to data consolidator
The data consolidator module is responsible for manipulate the collected data from the devices based on the data type. (For example, the digital data of ECG should get converted into equivalent voltage value to display it in a chart).it also performs the data validation based on the rules defined in XSD’s or rules engine. The patient ID will be mapped to the device data during the data consolidation process
The device data temporarily stored as flat files to enable consolidation of data and grouping of messages based on devices or patient
HL7 (Health Level 7) is the standard for the exchange, integration, sharing and retrieval of electronic health information. EMRGateway convert the medical data into HL7 format and send it to various clinical systems.
Following are the functionalities provide by configurator module
- UI screens to register Devices, Gateway applications and device association to the clinic/patient
- Patient Information will be manually entered to generate patient Id and associate with respective device/device data
- UI screens will be available to enter the clinical system details, Filter conditions etc Filter
Many medical devices don’t have a provision to enter the patient details. So the association of patientID with the devices is very critical. The Patient Binder module gets the information entered in various Configurator screens, track and associate the patient details into device data during data consolidation and message store process.
Filter module acts as a Device Observation Filter according to IHE architecture. Clinical systems defines various criteria for medical data collection to each patient.This module is responsible to collect and maintain those filtering details and send it to corresponding modules for proper data consolidation and transfer.
Any of the following Filter Criteria will be defined by each Subscriber
- Medical Record Number
- Device Class
- Update Interval
- Patient Location
- Parameter Class
- Subscription Start and End Times
Subscriber manager acts as an interface between external clinical systems and EMRGateway for data transfer. This component consists of Interface library and registry.Clincial systems can be communicated to the EMRGateway using web services, FTP, wrapper API’s or through active-X controls.
This module maintains the interface components for various clinical systems and public data store like Google Health and MS Health Vault servers.
Clinical Systems Registry
The applications, clinical systems which required patient medical data get registered into CS Registry modules. it supports web-based and standalone applications.
Following are the devices that will be supported by EMRGateway.Based on the manufacturer the protocol and data format will varry.The device manager module will have plug-ins to support all type of devices
Vital Signs or Diagnostics devices, Infusion Pumps, Dialysis devices, Anesthesia machines, EKG and EEG devices, Endoscopy devices, Glucometers, Urimeters, Bedside devices, Oximeters with Patient Monitoring and Alarm Systems, Ventilators, Ultrasound devices, Stress testing devices
Key Features & Differentiator
- Pluggable device-specific interface library enabling easy support for varying device protocol and data formats
- I/O communication over Wi-Fi, Bluetooth, USB, FTP, Modem and Serial port based protocols
- Data format includes digital data(16 bit signed integer/2 byte), .DAT files (compressed flat files) and XML
- Encryption & decryption
- Support for Continua X73 Agent-Manager protocol
- Flexible clinical systems connectivity with system-specific data management interface library
- Enabling unified feed, frequency selection, parameter & unit mapping, unit conversion and data manipulation
- Data format support includes IHE/HL7 v2.x, CCR and Proprietary binary/text
- Clinical Application interface using Socket, FTP, ActiveX and web services
- Automatic device detection, connection and data acquisition without user intervention.
- Notification when device is unplugged or moved away from the radio range and automatic re-connection when device enters the range.
- Support for device enabled events. (Eg: When alert messages sent from the device, low battery, alarm etc).
- Can be integrated with health vault supported devices and upload data to HV server. Similarly can work with Google health.
- Solution can be extended to medical image acquisition and stored in archival server.
The Road Forward
The Medical devices practice, Wipro Technologies is proactively working on developing the EMRGateway solution.
The solution is being demonstrated to various medical devices OEM/healthcare customers and thought leaders. This will enable the team get the inputs from the industry which will help refine the final solution in order to address the needs of different OEM’s.
The EMRGateway solution would enable patient monitoring devices from different makes to talk to a single application running on a central server in the hospital environment and would communicate with various other hospital/healthcare applications which would use these data for better clinical results.
This would not only enable EMRGateway Application to accurately monitor and collect data from multiple devices attached to multiple patients but also saves lot of efforts of various people involved in managing the clinical environment.
The suggested EMRGateway solution would result in
- Reduction of manual labor for collecting data
- Real time detection of changes in a patient’s condition
- Continuous and intermittent assessment of critical physiological parameters;
- Improvement in patient outcomes
- Reduced costs