For the last 25-30 years, physicians and engineers around the world have been envisaging an interconnected medical network, of which every device is a part. That is what the standards of DICOM and PACS work towards - making the data from different unite created by different companies to different standards, compatible.

But what about going further? Not just making the data compatible, but the devices themselves? Set up a network area around each patient, then, wheel a new piece of equipment in, and as soon as it is in the zone, it starts communicating with the other devices, pulling data from them, and contributing its own back. Hook the patient up to it, or just have it access sensors attached to the patient already.

Sounds like a dream doesn't it? One of those things every instinct screams that we should have by now, but don't.

Yet, perhaps the medical interlink standards are not as far away as all that. In September 2009, a Boston research group came up with a software platform for sharing information among gadgets ranging from blood-pressure cuffs to heart-lung machines. Its not quite the 'anything talks to anything else' standard, but it is a strong start.

In the picture shown here, two pulse oximeters, which measure blood oxygen levels, are linked with hardware that uses data from either device to control a third device from a separate manufacturer, that delivers drugs intravenously when required. With this level of simple programming logic working across medical devices of different standards and countries of origin, true 'smart' patient care becomes possible, reacting to changes in condition instentaneously, such that treatment has already started, before the first doctor is on the scene.

Another example would be the disconnection of a heart-lung machine after heart surgery. When the machine is disconnected, the physicians have to to turn on the ventilator quickly, or the patient will suffer brain damage. Using current methods, there is is no way for the heart-lung machine to sense whether the ventilator was switched on correctly and keep running if it wasn't. With such a plug and play network as the Boston group have created, the two machines are talking to one another, and know when either of them stop working - they also talk to the machine monitoring the patient's vitals, and can see undesirable changes, commanding one another to counteract them.

The new standards to go with the plug and play medical room, have been drafted by the Centre for Integration of Medicine and Innovative Technology, as the Boston group is known - CIMIT for short. The standards themselves are known as the Integrated Clinical Environment (ICE) standards. These include essential equipment not normally considered part and parcel of a hospital's manifest.

One of these pieces of equipment is a black box machine that is connected to every patient network, and continuously records every action taken by the other machines. In a hospital running ICE networks, they would have stacks of such machines.

The standard also says that there must be only one overarching algorithm that interprets data from all connected machines to avoid conflicting instructions or warnings; and that if one piece fails, the failure must not be able to spread to other parts of the system.

CIMIT are also investigating using ICE in other areas of the hospital. For example, a single ICE network governing each surgical suite. As soon as any equipment enters - sensors attached to the patient, or a telesurgery unit, it immediately becomes part of the network, and when it leaves the room, is disconnected from that network, perhaps joining another one in the corridor.

As a side-effect of ICE, if anyone tried to steal a medical device, the system would be able to track its movement in the hospital, from local network to local network, simply by virtue of which ones it passed too near to. Should that unit find itself in another hospital's ICE network, it would be possible to immediately trace where it originated from.

References

Plug-and-Play Medicine

CIMIT

LiveData Utilizing TATRC Grant in Support of Medical Device Plug-and-Play Interoperability

Clinical Systems Innovation: Medical Device Plug-and-Play Interoperability

Clinical Systems Innovation: The Operating Rooms Of The Future