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Point of Care Engineering and Technology — an overview Blake W. Podaima1,2,3, Robert D. McLeod2,3 1. Virtuistix Inc., Winnipeg, Manitoba 2. TRLabs: Telecommunications Research Laboratory, Winnipeg, Manitoba 3. Department of Electrical and Computer Engineering, University of Manitoba Email: [email protected]; [email protected] © B. W. Podaima, 2006 CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Mission • Heightened demand for improvements in Patient Safety and Quality of Care at patient Point of Care (POC). • Errors and other adverse incidents are inevitable in complex systems. • The goal of Virtuistix is in mitigating medical errors through the use of technology and protocols via systems engineering. • Specifically, Smart RFID Enabled Medical Devices. CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC To Err is Human • Approximately 36% of adverse drug events occur at the patient POC while only 2% are intercepted. • Technology can be used in conjunction with human factors engineering to improve the accuracy and efficiency of protocols and practice with the objective of reducing errors. • Systems engineering implies the use of tools such as Failure Mode and Effects Analysis and Root Cause Analysis (FMEA and RCA). CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Costs • Estimated costs associated with adverse medical events have been estimated to be in the billions. – – – – – Mortality + human suffering Litigation Extended stay Complications Adverse drug interactions • Dissemination of Innovation: Costs of technology adoption. – Can we afford not to? CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Intervention • Technologies play a major role in modernizing and improving medical and health systems. • Those being considered utilize information and communication technology in mobile deployment: – Hand held mobile devices (PDAs) with integrated RFID readers; local wireless communication technologies, such as 802.11x; Wi-Fi Protected Access; ZigBee; Wireless USB; Infrared; integrated sensor based devices; Barcodes, and RFID tags. • Back-end information systems are replacing much of the paper storage and retrieval systems that still prevail in health care today. CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Implementation • The greatest benefit of an Electronic Records System, is that relevant patient information can be readily available to practitioners — whenever and wherever needed. (PDAs, wireless, ERS) • Sufficient security and standards will ensure reliable and secure management of sensitive medical records. (encryption, authentication, privacy) • Security is a problem of perception — one that needs to be addressed thoroughly and implemented properly to be effective as Clinical Grade Networks are developed and deployed. (properly implemented protocols) CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC RFID in Healthcare • Conventional RFID technology in healthcare – Primarily based upon identification. – Built around inventory tracking and control. – Extensions include pharmaceutical supply chain inventory and tracking for medical reconciliation. – Tied into a hospital management system, they have considerable potential to reduce adverse drug events at the patient POC. – This is accomplished through corroboration of the patient ID with the drug prescribed by the physician • “Smart” RFID Enabled Devices are new technologies that have the potential to improve patient safety and quality of care. CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Platform Medical Compliance Platform — POC Interaction Components: Preparation Central Medical Processing Unit Overseeing Physician Pharmacy (RFID) RFID Reader Disposal + Sterilization Care Provider Mobile PDA RFID Reader Hospital Information System RFID Reader Central Medical Supply Unit RFID Reader Monitoring Smart Medical Device Medical Content/ Apparatus Patient RFID + Interface (RFID) (RFID) CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart RFID Devices • What is Smart RFID Deployment? • A Smart RFID enabled device and its system of deployment include methods of identification and control for medical compliance. – Identification is accomplished with the aid of RFID. – Control is enabled through a mechanism that can be activated to prevent improper, erroneous, or unauthorized access. • Smart RFID enabled devices attempt to facilitate error-free dispensing and administration (of medication and/or medical supplies), and other clinical practices, to reduce or prevent adverse medical events, near misses, or sentinel events. CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC RFID Basics Basic RFID Near-Field Coupling and Telemetry: Freq. Extraction /32 (423.75KHz) Capacitor Data (e.g. ID) 25Kbps + IC De-mod BP Filter 13.98 MHz - Coil N-turns Data (e.g. ID) 25Kbps Modulates (sub carrier) Oscillating Magnetic field Manchester Data, OOK/FSK 13.56 MHz Modulation Capacitor ac Coil M-turns Oscillating Magnetic Field The impedance seen by the reader is modulated by the load. This is not particularly easy to decode. CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart RFID Devices • Incorporate an RFID enabled interface capable of controlling access, (providing actuation, and sensor information collection): smart medical containers, smart pumps, smart clamps, smart valves, smart syringes and pipettes, and smart bandages. • The RFID tags on these devices can be either passive or active, and the control and communication can be derived from the interaction of an RFID reader and tag in conjunction with the associated electronics and overseeing medical information management system. CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart RFID Devices Assorted Smart RFID Enabled Medical Devices: – Smart Clamps (mechanical and electromechanical) – Smart Valves (mechanical and electromechanical) – Smart Syringes (mechanical and electromechanical) CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart Clamp Smart Rotational Clamp (in-line or clam shell type — electromechanical instance): Visual/Audio Indicator Motor Drive Gear Override Key Tubing Internal Clock-wise (Restriction) Gear RFID Power Supply Motor Control [Pinched Off] CMBEC-29 RFID Enabled Lock/Unlock Mechanism and/or Position Sensor Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart Clamp Smart Roller-Actuator Clamp (electromechanical instance): Lock/Unlock Mechanism and/or Position Sensor RFID Visual/Audio Indicator Linear ActuatorMotor/Servo Tubing Unrestricted Flow Cap Power Supply Roller Pincer Tubing Restricted Flow Top View Override Keyhole (slot) Override Key Tubing Linear Actuator CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart Valve Smart Stop-cock [3-port] Valve (electromechanical instance): Port 1 Valve shown with throughway open Conduit Electronics RFID Top View Port 1 Electromechanical Cylinder Valve [Rotary] Override Key Port 3 Lock/Unlock Mechanism CMBEC-29 Port 3 Port 2 (into the page) not shown Port 2 Power Supply Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart Valve Smart Stop-cock [3-port, 4-way] Valve Flow Channels: Conduit Conduit Flow Flow Conduit Conduit Flow Note: Can stop flow entirely by offsetting the Stop-cock to 45 degrees. CMBEC-29 Flow Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart Valve Smart Butterfly Valve (mechanical and electromechanical instance): Butterfly Valve Cut away View Override Key Optional Lock/Unlock Mechanism Status Indicator RFID Electric Motor Electronics and Power Supply Lock/Unlock Mechanism RFID Status Butterfly Butterfly Flow Flow Mechanical (Split View) Butterfly Valve Closed CMBEC-29 Electromechanical (Split View) Butterfly Valve Partially Closed Butterfly Valve Open Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart Syringe Smart Syringe (Fail-safe - Control Mechanism at Finger-Flange): Finger Flange Typical Syringe Lock/Latch Mechanism (Grip/Release) RFID e.g. Keyed Stop e.g. Friction Grip Latch/Lock Latch/Lock Keyed Plunger Shaft RFID CMBEC-29 RFID Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart Syringe Smart Syringe (Fail-safe or Operator Responsible - Rotation and Push-pull Latch Mechanism): Typical Syringe Go/No-Go Indicator (Color Code) Push/Pull or Rotate to unlock RFID e.g. Push to unlock Plunger Shaft Cross Section e.g. Rotate to Unlock (Lock/Latch) Plunger Shaft RFID CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart Syringe Smart Syringe (Possible Position [Resolver] Sensors): Resistance Measurement Shaft Encoded Wheel (Friction) Reader Optical Read/Write Magnetic Strip CMBEC-29 Encoded Grating Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart Syringe Smart Syringe (Fail-safe - Intersticed control device): Typical Syringe RFID controlled valve Typical Syringe RFID Standard Coupler CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Smart Syringe Smart Syringe (Fail-safe - Motorized Control and Actuator Device): Typical Syringe RFID controlled Actuator Motorized Typical Syringe Plunger Motor RFID e.g. Motor Section Plunger Shaft Linear Actuation CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC Summary • POC engineering and technology are brought to bear on the medical community with the overall goal of improving patient safety and quality of care. • We ascertain the emerging field of RFID technology has the potential to improve medical compliance via human factors protocols and practice at the patient POC. • Within a ubiquitous or pervasive health computing environment, novel Smart RFID medical devices, in conjunction with wireless PDAs, are proposed to integrate identification, security, control, and actuation. • Various POC embodiments along these lines are currently under IP development and technology capture. CMBEC-29 Dept. of Electrical and Computer Engineering, University of Manitoba CMBES 2006: June 1-3, Vancouver, BC