Thursday, 12 May 2016

TRIVENI: A remote patient monitoring solution via @msharmas - Part 1



TRIVENI, a remote patient monitoring solution that is a confluence of three aspects of patient information: 

Data | Medical Devices | Connectivity

Introduction

Just the other day we heard the SpaceX rocket zoom off to the space to deliver a satellite to the geospatial orbit, Rosberg won the 2016 russian grand prix & Mars rover continuously transmitted the images and vital parameters from millions of miles away in the space

The above three scenarios present the ability to stream data in realtime to a base station providing the ability to remotely monitor the performance of a space-craft, a formula 1 car and a remote autonomous vehicle.

Similarly consider the following use cases in relation to a patient in a Healthcare setting:

  • patient information in a Hospital
  • patient in an ambulance or
  • patient under homecare
presents use cases that require remote monitoring of patient information. 

The existing technological paradigms such as IoT, data streaming analytics, connectivity & interoperability allow for a framework to allow for remote patient monitoring in each of the three Healthcare use cases

TRIVENI

I would like to propose TRIVENI, a remote patient monitoring solution that is a confluence of three aspects of patient information
  • DATA
  • MEDICAL DEVICES
  • CONNECTIVITY
Triveni proposes to implement a plug-n-play framework that will allow for easy connectivity between healthcare information sources.

The etymology of the word TRIVENI in Sanskrit means “where three rivers meet”. Similarly, the three aspects of Patient Information need to be integrated to meet the requirements of a remote patient monitoring solution

Focus areas of TRIVENI

Initially to showcase the Proof-Of-Concept for the solution, the above three focus areas will be considered to present as the use cases. Each of the three focus areas present the ability to test the confluence of three aspects of Patient Information defined above
  • Cardiology
    • MI
    • Chest pain
  • Neurology
    • Stroke
    • Head Injury
    • Epilepsy
  • Emergency Services
    • Trauma

Need for TRIVENI

The Tower of Babel (Pieter Bruegel the Elder, c. 1563), a metaphor for the challenges existing in medical device semantic interoperability today

Current Landscape

  • Piecemeal integration creating information silos; leading to difficulty in sharing patient information
  • Silos unable to deliver real-time patient data reliably; leading to lack of data synchronization to ensure latest  time-aligned data
  • Vendor Dependent solutions; leading to internal battlegrounds
  • Lack of semantic interoperability between systems; leading to a tower of babel situation in medical device semantic interoperability
  • Captive investments by healthcare facilities in existing medical devices leading to a long time before the medical devices can be replaced with newer systems with easier connectivity features

The Remote Patient Monitoring Process Flow

 
Typical Remote Patient Monitoring process (adapted from Center for Technology and Aging)


The Center for Technology and Aging indicates a 5 - Step process for Remote Patient Monitoring. The 5 steps are essential to deliver a continuous flow of patient related information to the remote base station monitoring a patient(s) in any of the use cases or the focus areas presented earlier

The Remote Patient Monitoring Process Flow Mapped with TRIVENI Framework Components


It becomes imperative for the solution to incorporate these founding principles of a remote monitoring process into any framework/ product of such a nature. The process steps get implemented in the TRIVENI framework, allowing for the continuous monitoring of patient information from the various connected systems.

The processes allow for a modular approach to the Product Definition of the TRIVENI framework, with the ability for each component of the platform to evolve as dictated by its internal technology and thus enables each component to incorporate newer technology paradigms as and when they present themselves

The TRIVENI Components are

  1. TRIVENI Connect ®
    1. A programmable Connector that allows the transmission of data from the connected medical device
    2. Supports BLE, Wireless technologies
  2. TRIVENI  Hub ®
    1. A Medical Device Data Aggregator that has the ability to receive data from the TRIVENI Connect and transmit the patient vital data streams to the TRIVENI Exchange
    2. Supports 2G, 3G, Wifi, 4G networks
  3. TRIVENI  Exchange ®
    1. TRIVENI Exchange is a secure, reliable patient vital data store that can seamlessly transmit data received from TRIVENI Hub to TRIVENI Apps
    2. SSL Security, supports interoperability, Data Delivery to TRIVENI Apps or Connected EHR Systems (via HL7)
  4. TRIVENI Apps ®
    1. TRIVENI Apps have the ability to securely receive identified patient’s Medical Data from the TRIVENI Exchange
    2. TRIVENI Apps are delivered on Android, iOS, Web-based platforms






TRIVENI Connect


The TRIVENI Connect is a device that acts as a converter that allows any medical device to connect to the TRIVENI system. The Connect device for instance will be connected to a Patient Monitor via the RJ45, RS232-to-USB converter.
Once connected, the TRIVENI Connect will automatically download the relevant driver from the TRIVENI HUB, that allows for the Patient Data Stream from the Monitor to be streamed. Additional features of the TRIVENI Connect are: 

  • Has the ability to Fetch Data from the connected Device
    • No. of Manufacturers
    • No. of Devices
    • One TRIVENI Connect per Device
  • Convert Data from Device by encoding Device Data with Following information
    • Device ID, Manufacturer ID
    • Device Type
    • Patient ID
    • Ambulance ID/ Hospital ID
  • The TRIVENI Device Should be configurable with the above data. Additional capabilities of the TRIVENI Connect are:
    • Allow for Access Point Configuration
    • Via PC/ Via mobile device
    • Configure the TRIVENI Exchange IP
    • Send Data to TRIVENI Exchange
  • Software Upgrade:
    • Via PC
    • Over the Air
  • Linux Based, WiFi USB Dongle with a RS232 – USB Converter

TRIVENI HUB

The TRIVENI HUB is a device that acts as a data aggregator device at the remote location. All the Patient Data streams from various connect devices are routed to the HUB.

The HUB can be configured via a mobile app. Using the mobile app the users will be able to configure various aspects of the TRIVENI HUB like the internet connectivity, TRIVENI Connect linked to the HUB, Username and password configuration of the HUB & Connect devices, Store and forward configuration to name a few.
 

The HUB device has the following features: 
  • Is a WiFi Router + Cellular Modem
  • Has the functionality to work as a patient data stream aggregator with a store and forward feature
  • Has multiple SIM slots or Multiple USB ports for Broadband Connectivity
  • In Ambulance:
    • Will Work as a WiFi Router Access Point for the TRIVENI Connect
    • Will work as a Cellular Modem for Transmitting the data to the TRIVENI Exchange
  • In Hospital:
    • Will work as a WiFi Router Access Point for the TRIVENI Connect
    • Will connect with the Hospital LAN to connect to the Internet
  • Has the ability to store and forward patient data
  • Data streams will be prioritized based on the QoS of network connection
  • Ability to send data packets over multiple networks to reduce packet loss
  • Data aggregation from multiple types of sources other than TRIVENI Connects
  • Maintains the security of the data-on-move over wire and when data-stationary when within the TRIVENI Hub by enabling security protocols (SSL) and encryption of data

TRIVENI EXCHANGE

The TRIVENI EXCHANGE is a Medical Data+Media Server that can be configured as a Virtual / Physical Server. The EXCHANGE has RTP/ RTSP/ RTCP Capabilities for Live Streaming of the Patient Data Streams from each of the HUBs connected to the EXCHANGE. 
The features of the TRIVENI Exchange are 
  • Site Configuration: Allows the Creation of an Identity for a Client (Ambulance Services/ Hospital Provider)
  • Identification/ Allocation of IP Address (Destination IP for Medical Data Streams) for the TRIVENI Exchange
  • Allows the configuration of the TRIVENI Connect’s to stream data to the Identified IP Address
  • Has the ability to update the TRIVENI Connect / TRIVENI Exchange Firmware OTA
  • Has the ability to receive Voice and Data Streams
  • Has the ability to enable Live Streaming of Data, Video and Voice to TRIVENI Apps
  • Linux Based system
  • Virtual/ Physical Server
  • 128-bit Encryption, https, 2-factor authentication enabled
  • Can be Configured for each client in a multi-tenant server configuration.
  • Has a Medical Data Controller module to identify the source and destination of the medical data streams
  • Ability to allow store and forward data on demand
  • Allows data push or pull configurations for the TRIVENI Components
  • Maintains the “device” drivers for various types of patient sources

TRIVENI APPs

The TRIVENI APP is an android or iOS based app. There are two APPs that come with the TRIVENI framework. One APP is for configuring the remote configuration for the connect and the hub devices at the location for the client
Another APP is for configuring the Exchange and for viewing the data being streamed from the various devices connected to the patients in the remote locations
  • Enables Care Anywhere
  • Web-based, Android or iOS based apps
  • Allows for a two way communication between devices
  • Free to download app on the App Store
  • Allows the user to authenticate her credentials
  • Allows two way communication between the Apps between two users
  • Ensures the reliability of the data
  • Security enabled to ensure patient data authenticity
  • TRIVENI Apps will be developed as web-based and subsequently as native apps
  • TRIVENI apps will incorporate the usability guidelines for the healthcare based apps
  • TRIVENI apps can be configured for data push or pull options
  • TRIVENI apps enabled with security and data encryption profiles
  • There are two types of TRIVENI Apps: TRIVENI HUB & TRIVENI EXCHANGE apps to configure remote and base components

Interoperability Considerations for Medical Peripherals

If one was to trace the progression of delivery of printer drivers, it presents an interesting case study regarding how hardware-software interoperability has progressed over the years in the IT industry. And studying these aspects help us to, hopefully in the future define the way Interoperability in the Healthcare Industry should be handled.

Printers have been essential hardware devices that are connected to the software platform (OS) via various types of connectivity platforms, and service the productivity needs of the organisation.

Lets consider the various Printer installation processes we have seen in the past

  1. CD with OS compatible drivers: Printers started out as peripherals that required a specific driver to be installed on the system (PC/ Laptop/ Server) that was going to be connected to the printer, via a printer cable
  2. OS with Pre-installed Printer Drivers: Then we progressed to the OS itself having a list of compatible drivers that enabled the OS to auto-detect the type of printer or peripheral that was connected to the system. This also allowed for network printers to be installed in the network and allowed for the print server to have all the relevant drivers installed just on that server. PCs in the network wanting to use the printer resource, just needed to send the document to the print server.
  3. Cloud Printers: Now a days, it is possible to connect the printer to the cloud via HP-ePrint or google printer services and access the printer from anywhere in the world.

Device & Software Interoperability

Taking learning from the way peripherals interoperability has been handled in the IT industry, Healthcare Interoperability should be a de-facto feature that should be present in most systems
Interoperability needs to be made as a plug-n-play feature in the Healthcare Services and Solutions. What are the various “Peripherals” that need to be connected in the Healthcare Industry?

  •     Healthcare Information Management Systems
  •     Medical Devices
  •     Laboratory Devices
  •     Radiology Devices
  •     Medical Apps

Additional Thoughts on Interoperability

Now the idea for defining the progression of a hardware connectivity w.r.t. The Printer device, is to try and define how medical device connectivity & interoperability should be enabled in the future
Currently, Interoperability is a “Service” that is offered as part of the implementation process by the system integrator or the vendor of the healthcare software. The point is, why should the customer bear the cost of “connecting” the hardware and software OR two software's within an organisation
In Healthcare we are working towards providing such seamless and plug-n-play connectivity between EMRs, medical devices and now a days, additionally the  mobile health applications.

Suggested Reading

  1. Unlocking the potential of the Internet of Things | McKinsey on Healthcare - http://ow.ly/ykoy300oNJp
  2. 10 most in-demand Internet of Things Skills - CIO - Slideshow - http://www.cio.com/article/3072132/it-skills-training/10-most-in-demand-internet-of-things-skills.html#slide1
  3. 12 Quantified Self Public Health symposium 2014 report: http://quantifiedself.com/symposium/Symposium-2014/QSPublicHealth2014_Report.pdf  (PDF)
  4. Remote Patient Monitoring Lets Doctors Spot Trouble Early - WSJ http://ow.ly/3rHJ10099JP 
  5. What's New In Indian Hospitals: A Hi-Tech ICU And How It's Saving http://ow.ly/oPoV300zlpo 
  6. Study: Remote Patient Monitoring Saves $8K Per Patient Annually http://ow.ly/gqy3301Agwh 
  7. Lantronix on “Why Every Healthcare Device Should be Connected to the Internet of Things” | Symmetry Electronics - http://bit.ly/1XC2V0b
  8. #IoT software development requires an integrated DevOps platform - http://ow.ly/eg6p1006N
  9. Remote patient monitoring technology becoming imperative for providers http://ow.ly/xMK4100cAXH #IoT #HITsmIND
  10. Remote patient monitoring: What CIOs can do to make it happen - Health IT Pulse http://ow.ly/w7W3100cAY0 #IoT #HITsmIND
  11. Remote #Patient Monitoring: 8 Trending #Healthcare Infographics https://t.co/drZJmP0fVk
  12. Five innovative examples of #mHealth and #telehealth technologies http://ow.ly/WMFn100cAYk
  13. Big data fuels #telemedicine, remote patient monitoring http://ow.ly/rg3n100cAZ4 
  14. OpenICE - Open-Source Integrated Clinical Environment https://www.openice.info/
  15. Fundamentals of Data Exchange | Continua http://www.continuaalliance.org/node/456
  16. Global Patient Monitoring Devices Market Analysis & Trends - Industry Forecast to 2025 - http://www.researchandmarkets.com/publication/mf3oj2t/3757021

I am looking for partnerships, sponsors to develop this solution. If interested kindly get in touch via email: manish.sharma@hcitexpert.com
Author
Manish Sharma


Founder HCITExpert.com, Digital Health Entrepreneur.

Additional Articles by the Author
  1. Health ID as Patient IDs unifier in India  by Manish Sharma  
  2. 5 Steps towards an Integrated Digital Health Experience in Indian Healthcare in 2016 
  3. Top Healthcare & Digital Health Predictions for 2016
  4. Zen Clinicals: An Activity & Workflow based solution (1 of 3)
  5. RFID in Healthcare: Usecases from Hospitals
  6. 10 Solutions for the Healthcare IT Fringes

No comments:

Post a Comment