How a standard that enables devices to share data with EHRs could support ICU care

Demo at HIMSS shows how Service-oriented Device Connectivity architecture can help securely share device data in a bidirectional manner.

A relatively new standard that enables patient data from devices used to treat seriously ill patients to be recorded in electronic health records offers myriad opportunities for improving care within intensive care units.

The Service-oriented Device Connectivity standard is designed to ease interoperability among point-of-care medical devices as well as share device data with hospital information systems built on HL7 standards.

For example, SDC can be used to enable ICU devices, such as infusion pumps and instruments that measure patients’ vital signs, to seamlessly share data with each other devices as well as with external display monitors. This capability is crucial in caring for patients who need to be isolated, such as those with COVID-19 and other infectious diseases.

The SDC standard holds the promise of improving patient care, enabling the distribution of critical alarms to caregivers and automating the documentation of device readings in patients’ EHRs. The potential use of the standard in a mock ICU was demonstrated at a cooperative exhibit at the recent HIMSS22 Conference in Orlando.

The HIMSS22 demo is an example of “how ventilated patients in an ICU can continue to receive the same level of treatment with less effort and disruption.”

While the Food and Drug Administration has recognized the standard since 2019, it has not yet approved the use of SDC to enable remote adjustments in medical devices through interoperable information exchange. SDC is already approved for these uses in Europe.

Emphasis on secure data sharing

SDC, developed by the Institute of Electrical and Electronics Engineers, is part of a family of standards that enable devices to share data bi-directionally in an encrypted manner so that the communication is secure, says Hinrich Althoff, vice president for strategy and business development at Draeger, a German company that makes patient monitoring equipment.

The non-profit organization OR.NET developed the SDC infrastructure to enable data to be seamlessly shared. The organization encourages networking among industry specialists, doctors and researchers.

Draeger participated in the HIMSS demonstration with Ascom, an alarm distribution technology company, and Epic, the Verona, Wis.-based developer of EHR systems.

Enabling ‘remote control’

Using a standard to enable hospital devices to communicate with each other, and interact with communication tools such as monitors and alarm systems, can enable some “remote control” so that devices can make adjustments based on patients’ physiological responses. Patient alarm alerts can be sent to clinicians to warn them of changes in conditions, Althoff says.

The HIMSS demo provided an example of “how ventilated patients in an ICU can continue to receive the same level of treatment with less effort and disruption while at the same time increasing protection for medical staff,” says Daniel Fuckert, director of product management for Draeger.

SDC enables alarms to be distributed reliably and effectively, says Britta Hanley, head of strategic healthcare partners at Ascom. “Medical staff receive notifications about their patients on the mobile devices,” she says. “This allows staff to intervene right on time, and it also reduces the burden for medical staff, since they no longer have to put on and remove protective equipment as often.”

Including encryption and secure connections in SDC is important because it’s a “closed-loop” standard, Fuckert says. “We don’t want anyone, such as a hacker, to remotely control any of these devices ever,” he adds.

Recording key patient information

SDC’s ability to write patient vital sign measurement to an EHR is not only a convenience factor, but it can also better inform clinicians about patient changes over time and offer a more complete medical record.

One study found that 14 percent of isolated patients have incomplete histories of vital signs in their electronic records.

That’s important because studies have shown that care records for ICU patients – especially those who are kept isolated – is significantly less detailed than for non-isolated patients. One study published by the National Library of Medicine found that 14 percent of isolated patients have incomplete histories of vital signs in their electronic records, while 5 percent have records that are missing vital signs for entire days.

SDC is closely related to HL7’s Fast Healthcare Interoperability Resources (FHIR) standard, developed over a similar time frame, Althoff says. They use the same nomenclature standards, so “semantic interoperability between SDC and FHIR is a given, and that’s a huge advantage,” he says.

SDC complements FHIR, which “does not have some of the features that are required for medical devices,” he explains. So the use of SDC can provide a better record of information from devices.

The standard enables the bidirectional transfer of standardized data between systems in “medical-grade” quality.

SDC was designed primarily to aid bidirectional communication among medical devices, not to write information to an EHR, says Dan Kernan, interface engineers at Epic. At the HIMSS demo, Epic played the role of a “device observation consumer.” The demo showed how Epic’s system could receive messages that ultimately could be used to file data into the patient’s flowsheet.

“We’re able to take in the measurements, such as vitals, from these devices to better support clinicians, integration with hemodynamic monitors, ventilators and pumps,” he says. While Epic has been able to record vital signs and other device data for years using HL7 standards to support direct feeds, it’s now working to enable its systems to use SDC standards as a web-based approach to collect such data.

Kernan notes that medical devices in Europe and the U.S., within the ICU and in other care settings, have the ability to transmit data into an EHR via the Device Enterprise Communication standard from Integrating the Healthcare Enterprise. This standard can assist with communicating device data to enterprise applications, such as EHRs and data repositories, but it’s not a web-based approach.

Other potential uses

While the HIMSS demo of SDC showed how it can be used for patients in isolated environments, such as an ICU, there’s wide potential for increased use in other settings, particularly as more medical devices are designed to be smart and interconnected, and hospital room and bed technology can support this form of connected care, Draeger’s Althoff says.

SDC’s capabilities to enable the collection, aggregation and dissemination of data – particularly in the form of alarms – could also assist clinicians, who are increasingly called upon to treat more – and sicker – patients. For example, being able to monitor devices in isolation wards or ICUs could save them time and effort in donning protective personal equipment.

The standard enables the bidirectional transfer of standardized data between systems in “medical-grade” quality, Fuckert adds. It can support secure remote control of device functions, such as from an interactive display monitor outside a patient’s room. The U.S. FDA has yet to approve SDC for uses that would allow devices to interoperate without human intervention, and Althoff says such approval could be several years off.

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