Building open source safety-critical medical device platforms and Meaningful Use EHR gateways Inherent connectivity creates significant opportunities in medical science

NETSPECTIVE www.netspective.com 2 Who is Shahid? • 20+ years of software engineering and multi-site healthcare system deployment experience • 12+ years of healthcare IT and medical devices experience (blog at http://healthcareguy.com) • 15+ years of technology management experience (government, non-profit, commercial) • 10+ years as architect, engineer, and implementation manager on various EMR and EHR initiatives (commercial and non- profit) Author of Chapter 13, “You’re the CIO of your Own Office”

NETSPECTIVE www.netspective.com 3 What’s this talk about? Health IT / MedTech Landscape • Data has potential to solve some hard healthcare problems and change how medical science is done. • The government is paying for the collection of clinical data (Meaningful Use or “MU”). • All the existing MU incentives promote the wrong kinds of data collection: unreliable, slow, and error prone. Key Takeaways • Medical devices are the best sources of quantifiable, analyzable, and reportable clinical data. • New devices must be designed and deployed to support inherent connectivity. • OSS is ideal for next generation and innovative medical devices and gateways

NETSPECTIVE www.netspective.com 4 What if we had access to all this data? Source: Jan Whittenber, Philips Medical Systems • Cardiac output monitors • Defibrillators • Fetal monitors • Electrocardiographs • Infant incubators • Infusion pumps • Intelligent medical device hubs • Interactive infusion pumps • MRI machines • X-Ray machines • Physiologic monitors • Ventilators • Vital signs monitors

NETSPECTIVE www.netspective.com 5 What problems can data help solve? Cost per patient per procedure / treatment going up but without ability to explain why Cost for same procedure / treatment plan highly variable across localities Unable to compare drug efficacy across patient populations Unable to compare health treatment effectiveness across patients Variability in fees and treatments promotes fraud Lack of visibility of entire patient record causes medical errors

NETSPECTIVE www.netspective.com 6 Data changes the questions we ask Simple visual facts Complex visual facts Complex computable facts

NETSPECTIVE www.netspective.com 7 Data can change medical science The old way Identify problem Ask questions Collect data Answer questions The new way Identify data Generate questions Mine data Answer questions

NETSPECTIVE www.netspective.com 8 Evidence-based medicine is our goal Eminence • Trust me Evidence • Prove it

NETSPECTIVE www.netspective.com 9 Types of medical data we care about Proteome is our set of proteins expressed by our genome and changes regularly over time Proteomics is the study of the proteome Proteome Genotype is the entirety of our hereditary information (DNA, RNA, etc.) Genetics is the study of the genome Genome Phenotype is a composite of our observable characteristics or traits This is what we’ve been studying for centuries Phenome

NETSPECTIVE www.netspective.com 10 Unstructured patient data sources Patient Health Professional Labs & Diagnostics Medical Devices Biomarkers / Genetics Source Self reported by patient Observations by HCP Computed from specimens Computed real- time from patient Computed from specimens Errors High Medium Low Time Slow Slow Medium Reliability Low Medium High Data size Megabytes Megabytes Megabytes Data type PDFs, images PDFs, images PDFs, images Availability Common Common Common Uncommon Uncommon

NETSPECTIVE www.netspective.com 11 Structured patient data sources Patient Health Professional Labs & Diagnostics Medical Devices Biomarkers / Genetics Source Self reported by patient Observations by HCP Specimens Real-time from patient Specimens Errors High Medium Low Low Low Time Slow Slow Medium Fast Slow Reliability Low Medium High High High Discrete size Kilobytes Kilobytes Kilobytes Megabytes Gigabytes Streaming size Gigabytes Gigabytes Availability Uncommon Common Somewhat Common Uncommon Uncommon

NETSPECTIVE www.netspective.com 12 Predictions for Device Hardware Thick Devices Thin Devices Virtual Devices Sensors Only with Built-in Wireless Consumerization of Devices Sensors on mobile phones, platforms

NETSPECTIVE www.netspective.com 13 Predictions for Device Software Software for algorithms Software for functionality Software for connectivity Software only Consumerization of Apps

NETSPECTIVE www.netspective.com 14 Predictions for Device Connectivity Stand-alone and monolithic Connectivity within own organization Multi-vendor connectivity System of Systems (SoS) Consumerization of IT

NETSPECTIVE www.netspective.com 15 Predictions for Gateways Single-purpose devices standalone Multi-purpose standalone Multi-purpose with documentation connectivity Multi-purpose with cooperating connectivity Multi-purpose with analytical connectivity Changes in Practice Models

NETSPECTIVE www.netspective.com 16 Predictions for Self-Management Physicians manage paper “charts” independently Physicians and Hospitals manage paper charts together Electronic Health Records (EHRs) manage data in systems Health Information Exchange allow coordination Patients manage their own data The Patient is in charge

NETSPECTIVE www.netspective.com 17 Implications Make sure the patient is in the middle Move from hardware to software focus Move to algorithms and analytics Understand system of systems (SoS) Plan for integration and coordination Start building simulators

NETSPECTIVE www.netspective.com 18 OSS revolution in device design Device Components 3rd Party Plugins App #1 App #2 Security and Management Layer Device OS (QNX, Linux, Windows) Sensors Storage Display Plugins Web Server, IM Client Connectivity Layer (DDS, HTTP, XMPP) • Presence • Messaging • Registration • JDBC, Query Plugin Container Event Architecture Location Aware 1 2 3 4 5 6 7

NETSPECTIVE www.netspective.com 19 OSS revolution in device capabilities Most obvious benefit Least attention Most promising capability

NETSPECTIVE www.netspective.com 20 OSS revolution in Gateways Corporate Gateway (ESB) Service DB Management Services Security Firewall HTTPS, REST, SOAP SFTP, SCP, HL7, X.12 SMTP, XMPP, DDS HTTPS, SOAP, REST, HTTP SFTP, SCP, HL7, X.12 SMTP, XMPP, DDS Customers & Partners Apps MQs Services Apps Services Corporate Cloud (Data Center) Development App DB Central DB Registry Remote Facilities VPN NOTE: Initial design is for a non-federated backbone. If performance or security demands require it, a federated solution will be deployed.

NETSPECTIVE www.netspective.com 21 OSS revolution in integration Cloud Services Management Dashboards Data Transformation (ESB, HL7) Device Gateway (DDS, XMPP, ESB) Enterprise Data Inventory Cross Device App Workflows Alarm Notifications Patient Context Monitoring Device Teaming Device Management Report Generation HIT Integration Remote Surveillance Device Data SSL VPN Patient Self-Management Platforms

NETSPECTIVE www.netspective.com 22 OSS revolution in manageability Security • Is the device authorized? Inventory • Where is the device? Presence • Is a device connected? Teaming • Device grouping

NETSPECTIVE www.netspective.com 23 Key OSS questions Will the FDA accept open source in safety-critical systems? Is open source safe enough for medical devices?

NETSPECTIVE www.netspective.com 24 Simple answers Will the FDA accept OSS in safety- critical systems? Is OSS safe enough for medical devices? Yes Yes but you must prove it

NETSPECTIVE www.netspective.com 25 It’s not as hard as we think… • Modern real-time operating systems (open source and commercial) are reliable for safety- critical medical-grade requirements. • Open standards such as TCP/IP , DDS, HTTP , and XMPP can pull vendors out of the 1980’s and into the 1990’s.  • Open source and open standards that promote enterprise IT connectivity can pull vendors into the 2010’s and beyond.

NETSPECTIVE www.netspective.com 26 But it’s not easy either…we need Risk Assessments Hazard Analysis Design for Testability Design for Simulations Documentation Traceability Mathematical Proofs Determinism Instrumentation Theoretical foundations

NETSPECTIVE www.netspective.com 27 OSS / open standards applicability Project / Standard Subject area D G Comments Linux or Android Operating system   Various distributions OMG DDS (data distribution service) Publish and subscribe messaging   Open standard with open source implementations AppWeb, Apache Web/app server   OpenTSDB Time series database  Open source project Mirth HL7 messaging engine  Built on Mule ESB Alembic Aurion HIE, message exchange  Successor to CONNECT HTML5, XMPP , JSON Various areas   Don’t reinvent the wheel SAML, XACML Security and privacy   DynObj, OSGi, JPF Plugin frameworks   Build for extensibility

Conclusion and Questions Thank you @ShahidNShah [email protected] www.HealthcareGuy.com