Peter Hu, MS, CNE, MSE

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Information Technology Innovation for Safe and
Quality Care Peter Hu, MS, CNE Chief
Technologist , Director of System Integration
R Adams Cowley Shock Trauma Center National
Study Center for Trauma and EMS Assistant
Professor Department of Anesthesiology
Program in Trauma University of Maryland School
of Medicine Senior Biomedical System Engineer
Department of Clinical Engineer, University of
Maryland Medical Center
6/2/06 V1.20
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• Information Technology Innovation for Safe
  Quality Care
• 1) Pre-Hospital Care
• Ambulance on the web
• Mass Casualty Response EPLEX field trial
• Local Area Defense Exercise
• Vital Signs Data Recorder (VSDR)
• MobiDoc
• 2) In-Hospital Care
• Shock Trauma Center TeleControl Room (Video Net)
• Video Buffering and Analysis
• Video Board system and Vital Signs Network
• Optimization and visualization
• OR of the Future
• Inter-Hospital Care and International
• ISDN link with Cumberland (Tele-Trauma) and St.
  Marys Hospital (Tele- Stroke)
• International linkage with Australia and Army
  Institute of Surgical Research TX, Tele-Orth
  program
• c) Many to One to Many Architecture
• Next Step The Future
• Problem Statement Key Technology Key
  projects Near to long term goals

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Patient Information Flow
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• Pre-Hospital Care
• Mobile-Wireless Telemedicine Systems
  Ambulance-on -the -Web

Mobile Wireless Communications

• Wireless transmission of Audio, Video, and Vital
  Sign data
• Integration of existing commercial technologies

• Modular, standards-based, open-system components
• Cost-sensitive approach

Ambulance Configuration
Hospital Configuration
NT Server
Data Lines In
Browser Java Applet
Hospital Intranet Secure Link
Digital Camera Microphone Speakerphone
TV VCR
Web Server

• Audio
• Video
• Patient Data
• Records
• Numerical VS
• Waveform VS
• Blood Chem

Push Server
Video and Communication Computer
Patient Vital Signs Monitor
SQL Database
Physicians Desktop Intuitive Interface
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Pre-Hospital Care Ambulance-on-the-Web
In-Hospital Physician Desktop User Interface --
Bi-Directional QoS Controls and Region of
Interest Selection
Mobile/Field Transmission User Interface
Dynamic ROI
Task specific modular component panels

• Wireless transmission of Audio, Video, Vital
  Signs data (numeric, waveform), and blood
  chemistry
• Real-time video and editing
• Turn-key operation
• Web user interface to video/patient data
• Cost-sensitive approach using public wireless
  phone / data networks

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Pre-Hospital Care Smaller Lighter Packaging
Briefcase Lightweight, self-contained,
ruggedized packaging
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Pre-Hospital Care Collaborative Field Trials
At-Scene
Collaborators Shock Trauma MIEMSS MEMA BWI
FR TRW
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The Applications Mass Casualty Response EPLEX
WMD HazMat Response
Two-Stage Data Transmission
Mobile contamination site two-stage transmission
from scene to Incident Scene Commander at EOC,
relayed to remote viewers at treatment facility
Miniature Wireless Digital Camera note smaller
than 9volt battery
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Local Area Defense (LAD) Exercise -- March 26th
2004
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Vital Signs Data Recorder (VSDR) Architecture V2.0
Pre-Hospital Helicopter Transfer ( Medical
Helicopters)
Post Data Analysis
At Shock Trauma Center (9 TRUs and 6 ORs)
Integrated VS visualization software for Pre, In
Hospital V.S and Event marker
Real-time In-Hospital V.S Server (Bed Master
V.S Recorder)
GE Marquette VS Monitor
TRU Bay / OR
PDA
Patient Outcome Statistics
DoD/TATRC
GE Marquette V.S Network Hub
Summary and Key Events
Propaq/204 Patient VS Monitor
VSDR Time Sync Server
Pre-Hospital V.S Server
V.S Data Pre-Process Cut to the CASE
Wireless Data Transfer
Summarized Case/ Session Data Files
Pre-Hospital Recorded Data Elements
At Shock Trauma Center TRU and ORs Recorded Data
Elements
Post Patient Outcome Data Recorded Data
Time Code
Time Code
V.S Waveform Data File
Patient Discharge Summary
Summary and Key Events
V.S Trend Data File
Pre-Hospital Key Events Marker File
TRU V.S Trend Data
TRU V.S Waveform Data
OR V.S Trend Data
OR V.S Waveform Data
Data Sent via Wireless connection
Pre-Hospital V.S Server
IN-Hospital V.S Server
Vital Signs Data Recorder (VDRS) Server
Summarized Case/ Session Data Files
DOE / Date / Time Bay / OR
VSDR Vital Signs Data Recorder V.S Vital Signs
TRU Trauma Resuscitation Unit OR Operating
Room Data link Key DOE / Date / Time Bay /
OR
Peter Hu VSDR-V12.0 07-07-05
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Pre-Hospital Care Ambulance Location, ETA
Tracking and Alert Activation System Architecture
Hospital Secured Intranet
Ambulance
Hospital Heart Center
Reggedized Computer Touch Screen Plat Display
GPS/ Wireless communication
Radio tower
Dedicated desktop browser w/ 21 monitor
Mobile PDA Access
UPS
LBS Server
University of Maryland Hospital Center
MobidocHWArchitecture100300 Peterhu V1.2
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Pre-Hospital Care MobiDocTo increase the
information reach of doctors
Paging looking-up
Live Ambulance status display
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In-Hospital Care Video Network at Shock Trauma
Center
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TeleControl Center Technologies Advanced
multimedia multi-purpose real-time telemedicine
control facilities Real-time audio-video and
data connections to all of the Operating Rooms
(ORs), Trauma Resuscitation Units (TRUs) and Post
Anesthesia Care Units (PACUs) at Shock Trauma
Center. Has 6 video, 4 audio, 4 data and 4
fiber-optic links simultaneously connected to
each ORs, TRUs and PACUs, and integrated with
hospital Intranet backbone and the Internet. Can
provides real-time two way tele-consultation
with real-time patient vital signs monitoring to
all the ORs, TRUs and PACUs at Shock Trauma
Center and major auditoria at University of
Maryland Medical System, and is capable of
transmiting real-time audio-video information
through secured intra-internet or ISDN/PRI
network all over the world Can display slow video
and real-time audio data transmitted from
ambulance based telemedicine systems (e.g.
ExpressCare Tele-Ambulances through digital
cellular systems).
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In-Hospital Video Buffering and Analysis
J-Video Analysis tool for display and sync
multiple channel video with time stamped events
coded by SMEs
Secured digital video buffering system capable of
buffering video from 6 ORs and 10 TRUs
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In-Hospital Care Video Board System
Automatic identification of OR Occupancy
Adjustable levels of details to match staff needs

• Easy to use no training needed
• Expandable capable of connecting to intranet
  delivery
• Demonstrated value in facilitating management of
  large operating room suites
• Scalable deployment
• Co-existing and integratable with other hospital
  information systems

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In-Hospital Care EYE-TRACKING STUDY OF REMOTE
DIAGNOSIS
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In-Hospital Care The day of surgery
visualization OR uncertainty
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In-Hospital Care Workflow optimizationTRU, OR,
PACU, X-ray, Ango flow visualization
At a Glance Order and Result
Notifications Enterprise Patient, Staff, and
Asset Tracking Enterprise-wide Capacity Alerts
Step Down and Planned Discharge Markers Patient
Safety Room Indicators Real-time Bed Turnover
Status
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In-Hospital Care OR of the Future UMMC OR(19)
Status visualization
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OR States (Integrated real-time Schedules,
Images, Vital Signs) secured distribution network
Installed Hardware
New OR (19) Cameras
OR Video Image Hub
Image Capture Computer
Video Switch/ Router
In Current ORoF Research Plan
Additions for Operation
OR States Schedules/ Image/ Video/ Vital
Signs Secured Intranet Pushing /Pulling Wir
ed/Wireless Distribution Server
STC OR(6) Cameras
Wired LAN Access
STC Schedule White Board Image
UMMC Secured OR Intranet
ORoF OR-Live Vital Signs
GE Vital Signs Secured Network
Integrated Real-time Vital Signs Capture Server
UMMS Secured Intranet/Internet
STC OR-Live Vital Signs
OR Wireless Network
UMMS Paging Network Two-Way Paging
Integrated Schedule real-time database
Real-time Input interface
One Day Surgery White Board (Gold-Team)
Wireless Mobile Access
OR Live Schedule
OR Schedule ESI
Real-time Interface
PACU Schedule White-Board
OR, PACU Schedule Access
OR Vital Signs Access
OR Image Access
Peter Hu 04-14-2003 V2.0
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• Inter-Hospital Care and International Programs
• Tertiary-Rural Hospital ISDN/PRI Based
  Telemedicine System

Tele-Console for Trauma Management between UM
Shock Trauma Center,MD. Royal Adelaide Hospital,
Australia and Institute of Surgical Research,
San Antonio TX
Telemedicine System at Cumberland Memorial
Hospital ED
TeleControl Center at UM Shock Trauma Center
St Marys Hospital ED, Maryland
State of Maryland Central Booking Center
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Many to One to Many (MOM) Telemedicine
Architecture
Telemedicine System I) Inter Hospital II)
Intra Hospital III) Remote / Home IV) Mobile V)
Integrated Care System Team Approach Clinical Hum
an factor Technical Integration
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• Next Step Digital Shock Trauma
• Information Technology Innovation for Safe
  Quality Care

I) Leadership and Support II) Advanced / Smart
Infrastructure Planning III) Essential Wireless
Communication Standard IV) Reliable, Open and
Integrated System V) Practice Better
Medicine VI) Outreach Regional, National and
International
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Information Technology Innovation for Safe
Quality Care Near ,meddle and long term view
Problem statement. How to leverage advances in
information technology to improve acute trauma
care in institutions. Opportunities for IT
include improving Team preparation/triage
Efficient use of bed/resources
Preparedness/awareness Smooth workflow
Flexible, responsive, resilient Related
Previous, Current Projects Mobile
telemedicine, en route at scene
GPS/ambulance auto ETA notification Field
vital signs auto captured EMS national
survey OR coordination technology testbed
Patient safety through video team training
Remote mentoring in ultrasound airway
Video teleconconsulting to Cumberland etc
ORF testbed Just in time guide to astronauts
Key technology Wireless video Pt.
monitor interface Video distribution
Auto paging GPS Status sensors
Natural user interfaces Video/VS processing
Teleconferencing for outreach Portable
telemed in a box Video buffering TRU
video testbed OR video STC/UMMC Key Digital
Shock Trauma projects TeamVista team
centric info/comm platform Resource/process
tracking/visualization Smart "workflow"
systems Multi-media field notification
2-way comm system Inter-facility resource
awareness system (OPEN ICU) Real-time
registry Bed-side decision support
Advanced training methodologies (sim, web,
video) Key performance, real-time status
dashboard systems Awareness/pt safety
systems Advanced learning systems (capture
performance)
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Trauma System for the future
The Four Fundamental Components 1) Injury
Prevention 2) Prehospital Care 3) Acute Care
Facilities 4) Post-hospital Care
Issues for an inclusive trauma care system for
the future. 1) Regionalization of Trauma
Care 2) Disaster Preparedness 3) Trauma as a
Disease Process 4) Continuum of Care 5) Trauma
Requires a Multidisciplinary Approach 6)
Improving Cost Effectiveness 7) Coordination of
Resources, Services and Special Populations 8)
Reimbursement, Funding and Legislation 9) The
Reality for Trauma and EMS in Rural, Remote, and
Wilderness Areas
Key infrastructure elements for comprehensive
trauma care system 1) Leadership 2)
Professional Resources 3) Education and
Advocacy 4) Information Management 5)
Finances 6) Research 7) Technology 8)
Disaster Preparedness and Response -
Conventional Unconventional
American Trauma Society Supported by the U.S.
Department of Transportation, National Highway
Traffic Safety Administration Oct 2002
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• The benefits of successful
• a reduction in deaths caused by trauma
• a reduction in the number and severity of
  disabilities caused by trauma
• an increase in the number of productive working
  years seen in America through reduction of death
  and disability
• a decrease in the costs associated with initial
  treatment and continued rehabilitation of trauma
  victims
• a reduced burden on local communities as well as
  the Federal government in support of disabled
  trauma victims
• a decrease in the impact of the disease on
  "second trauma" victims - families.

American Trauma Society Supported by the U.S.
Department of Transportation, National Highway
Traffic Safety Administration Oct 2002
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Trauma Center There will be a distributed system
of acute care facilities and trauma care systems
will be implemented across the country.
Research will be conducted to determine the
effectiveness of the current tiered resource
allocation guidelines. The appropriate volume
of patients with specific injuries that are
needed at the highest echelon of care will be
studied and clearly identified so that research
and treatment options can be continually
explored. Trauma systems will be linked on a
regional basis through databases and technology
to ensure efficient and effective patient care
nationwide. There will be consistent standards
for rural and urban trauma services, with the
goal of every community having access to a
consistent level of trauma care.All injury care
providers within a community will be recognized
as part of the system and will provide data to a
system-wide database, and injury care will be
monitored throughout the system. All facilities
that participate in the trauma system will
contribute to the national trauma database and
there will be a mechanism to fund such a trauma
database at the state and national levels. Most
facilities, whether small community hospitals or
large tertiary care centers, will have a
designated role to play in the trauma system and
the capacity to manage injured patients to one
degree or another. Each participating facility's
available resources will be catalogued and
capabilities defined to facilitate patient
management/movement decisions.Facilities in the
system will have multi-casualty
capabilities.The appropriate match of resources
will be identified for injured patients with
special needs, such as elderly, remote rural, or
pediatric patients. Innovative treatment
methods will be explored, including utilization
of mobile trauma units for rural areas.
American Trauma Society Supported by the U.S.
Department of Transportation, National Highway
Traffic Safety Administration Oct 2002
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Information Management A national database and
uniform data standards will be used to facilitate
hospital operations and provide regional and
national information regarding availability of
post-hospital care. Existing resources should
provide the foundation to be built upon.
Applicable data sets should be revised as
necessary and there should be increasing use of
computerized medical records. Trauma care will
be designated as a specific research area for
epidemiological study. Predictive models will be
developed regarding outcomes and will be used in
making funding and resource deployment
decisions. Pre-hospital and functional outcomes
will be tracked and used in a Total Quality
Management initiative to improve policies,
procedures, and processes throughout the trauma
continuum. Information will be used to develop
performance standards and measure system
performance against similar systems
(benchmarking). Information related to the
complete cycle of trauma-from prevention to
post-hospital care-will be collected, analyzed,
and made available to facilitate improvements in
injury prevention, response times, patient care,
and rehabilitation. Information systems should
be usable for multi-center studies. A
standardized training course will be used to
enable trauma registrars to collect and
categorize data in a consistent, comparable
manner. Clear evidence will exist to document
the contribution of an injury management system
(prevention and treatment) to a community's
overall health, and additional research will
demonstrate which components of a trauma system
provide the most value. Tools will be developed
and region-specific injury data will be available
to assist communities in making decisions about
their specific needs related to trauma system
development, particularly regarding which
components will best meet community health needs.
The culture of quality improvement will shift
from using data to blame individuals to using the
data to improve performance of the
system.Access to and appropriate protection of
patient records and quality improvement data will
be addressed through legislative and regulatory
changes at state and federal levels.Efforts to
enhance patient confidentiality should be
balanced with the need for strong research.
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Technology Automotive telematics systems and
GPS in motor vehicles will be used to locate
crashes, monitor vital signs, and determine
injury severity. GPS will also provide real-time
route navigation for ambulances. Access
technologies such as ACN and wireless E9-1-1 will
be fully developed. Various technological
innovations will be used to provide services
remotely. For example, video feeds will be used
to provide telemedicine to rural areas and will
enable remote providers to perform operative
procedures. EMS providers will have personal
communicators with direct contact to medical
providers. The Internet will be used to follow up
with patients and train health care
professionals. Robotic and diagnostic
intervention will be conducted via telemedicine,
and national teleconferencing will be used for
education, outreach, and policy
development. Monitoring devices will be used in
a variety of settings, including computer chip
implants to monitor patients and the use of
monitoring devices in a patient's home, which
would support injury prevention and rapid
response. Computer chips will enable automatic
transfer of sophisticated crash information and
will permit injury research databases to be
utilized to evaluate and improve auto design.
An artificial neural network will determine the
most appropriate site for patient care, given the
extent of a patient's injury. Access numbers
will be consolidated to eliminate confusion and
streamline access nationwide. Patient
simulation technology will be used for provider
education. Medical input will be sought early in
the design phase of future technologies to ensure
that these developments are coordinated with the
health care system and result in improved patient
outcome. Dedicated resources will be available
for technology analysis.
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Disaster Preparedness and Response -
Conventional Unconventional Trauma systems
will be an integral part of regional and state
disaster plans and will integrate with efforts of
the public health system to provide disaster
preparedness. Trauma and EMS systems will be
integrated with other resources through the
incident command system and will coordinate in
advance with other regional resources such as law
enforcement and public health. There will be
targeted education covering all weapons of mass
destruction (identification and response) for all
providers. Hospital-based decontamination will
be available in addition to more traditional
field decontamination. A nationwide network of
hospital and community surveillance systems will
enable rapid identification of all major health
threats, including those related to weapons of
mass destruction. EMS electronic data systems
will be an integral part of this surveillance
system. Emergency communications systems will
connect all levels of the response
infrastructure, and will be developed with
redundancy to assure backup when needed. The
public health infrastructure will be reinforced
to enable it to more effectively respond to
emerging threats. Medical command centers will
be an integral part of disaster incident command
or incident management systems, to ensure the
most appropriate medical response. There will be
an optimal resources document for the role of
trauma systems in disaster preparation and
response.
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Information Technology Innovation for Safe
Quality Care

• Competitive Advantage (Technology)
• Design Develop and deploy reliable system/
  network for Trauma care
• Apply / Integrate existing technology for use in
  Trauma Care
• Field studies in patient safety and technology
  use in hospital care
• Existing infrastructures / TestBed for OR related
  patient and physician flow study
• Pre-Hospital and in-Hospital telemedicine system
  design

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Information Technology Innovation for Safe and
Quality Care Peter Hu, MS, CNE Chief
Technologist , Director of System Integration
R Adams Cowley Shock Trauma Center National
Study Center for Trauma and EMS Assistant
Professor Department of Anesthesiology
Program in Trauma University of Maryland School
of Medicine Senior Biomedical System Engineer
Department of Clinical Engineer, University of
Maryland Medical Center
6/2/06 V1.20