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October 28, 2017

Making medical devices interoperable

The screen next to a patient’s hospital bed that displays the heart rate, oxygen level, and other moving charts is the definition of a dumb display. How dumb is it, you ask? If the clip on a patient’s finger falls off, the display thinks the patient is no longer breathing and will sound an alarm…even though it’s displaying outputs from other sensors that show that, no, the patient isn’t about to die.

The problem, as explained by David Arney at an open house for MD PnP, is that medical devices do not share their data in open ways. That is, they don’t interoperate. MD PnP wants to fix that.

The small group was founded in 2004 as part of MIT’s CIMIT (Consortia for Improving Medicine with Innovation and Technology). Funded by grants, including from the NIH and CRICO Insurance, it currently has 6-8 people working on ways to improve health care by getting machines talking with one another.

The one aspect of hospital devices that manufacturers have generally agreed on is that they connect via serial ports. The FDA encourages this, at least in part because serial ports are electrically safe. So, David pointed to a small connector box with serial ports in and out and a small computer in between. The computer converts the incoming information into an open industry standard (ISO 11073). And now the devices can play together. (The “PnP” in the group’s name stands for “plug ‘n’ play,” as we used to say in the personal computing world.)

David then demonstrated what can be done once the data from multiple devices interoperate.

  • You can put some logic behind the multiple signals so that a patient’s actual condition can be assessed far more accurately: no more sirens when an oxygen sensor falls off a finger.

  • You can create displays that are more informative and easier to read — and easier to spot anomalies on — than the standard bedside monitor.

  • You can transform data into other standards, such as the HL7 format for entry into electronic medical records.

  • If there is more than one sensor monitoring a factor, you can do automatic validation of signals.

  • You can record and perhaps share alarm histories.

  • You can create what is functionally an API for the data your medical center is generating: a database that makes the information available to programs that need it via publish and subscribe.

  • You can aggregate tons of data (while following privacy protocols, of course) and use machine learning to look for unexpected correlations.

MD PnP makes its stuff available under an open BSD license and publishes its projects on GitHub. This means, for example, that while PnP has created interfaces for 20-25 protocols and data standards used by device makers, you could program its connector to support another device if you need to.

Presumably not all the device manufacturers are thrilled about this. The big ones like to sell entire suites of devices to hospitals on the grounds that all those devices interoperate amongst themselves — what I like to call intraoperating. But beyond corporate greed, it’s hard to find a down side to enabling more market choice and more data integration.

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