Interoperability
Standards for
Healthcare
Simulators
Rachel Ellaway1, Brian Goldiez2
1Northern
Ontario School of Medicine,
University of
2University
of Central Florida
Central Florida
MedBiquitous 2012
Conflict of interest
We have no involvement with industry
that constitutes a conflict of interest to
disclose with respect to this workshop
University of
Central Florida
Where is now?
University of
Central Florida
Simulation-based Education (SBE)
Simulation – what you do
Simulator – what you use:
• Mannequins
• Part task trainers
• Haptics
• Appendages (moulage)
• Virtual worlds
• Virtual patients
• Simulated patients, HPs and others
• Simulated environments
University of
Central Florida
Healthcare Simulation Industry
• 200+ vendors
– Systems
– Components
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University of
Central Florida
Mannequins
Part task trainers
Human appended devices (eg moulage)
Haptic devices
Virtual devices
Virtual environments
Supplies
Healthcare Simulator Users
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University of
Central Florida
The military
Emergency services
Hospitals
Regional simulation centers
College programs
University programs
Medical schools
First aid training
Major investment and expansion
Issues
• Proliferation of simulation and simulators
• Where does a device fit into education,
training and assessment?
• How is usage maximized?
• How are efficiency and utility maximized?
• How do we rip, mix burn while allowing
providers to sustain and innovate
University of
Central Florida
S&S Targets
University of
Central Florida
• Scenarios and profiles
• State data - vital signs, algorithms,
interactions, progress
• Algorithms
• Report data and inject into reporting stream
• HW-HW, HW-SW, SW-SW
• Vocabularies
• Typologies
• Operating systems and abstractions
• Sensors, scutters and non-medical data
Approaching S&S
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What problems need to be addressed?
What systems are out there?
What systems are in the pipeline?
Who (if anyone) “owns the space”?
Where is there leverage?
Where are the communities?
– SSH
– MedBiquitous
– SISO
University of
Central Florida
What Standards Already Exist?
• IEEE 1278 (Distributed Interactive Simulation DIS) - Simulator Interoperability Standards
Organization (SISO)
• IEEE 1516 (High Level Architecture - HLA) via
SISO
• ANSI VP.10.1-2010 (aka MedBiquitous VP)
• Health Level 7 (HL7) via ANSI & ISO
• Picture ArChiving System (PACS)
• Digital Imaging & COmmunication in Medicine
(DICOM)
University of
Central Florida
ANSI VP.10.1-2010 MedBiquitous
Virtual Patient
• XML-based
• 4 components:
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Activity Model
Virtual Patient Data
Media Resources
Data Availability Model
• For system-system transport
• Limited rendering into runtime – player
dependent
• No state modeling or intra-system comms or
interop
University of
Central Florida
IEEE 1278 Distributed Interoperable
Simulation (DIS)
University of
Central Florida
• Supports a variety of connection strategies
– No middleware
– Self-developed middleware
– COTS middleware
• Arguably provides a relatively simple
implementation for the medical and non-DoD
communities
– Consistent with portions of MedBiquitous
Virtual Patient
• Nevertheless very DoD-focused
• No XML – short live binary data exchanges
(1.5k max per message)
Medical Coding Systems
• International Classification of Diseases, Clinical
Modification, 9th Revision (ICD-9-CM) 16,000 codes
in Diagnosis & Procedures
• International Classification of Diseases, Clinical
Modifications, 10th Revision (ICD-10-CM/PCS)
140,000 codes
• Systemized Nomenclature of Medicine, Clinical
Terms (SNOMED-CT) 350,000+ terminologies
• Current Procedural Terminology (CPT) 7800 codes
• Diagnostic Related Groups (DRG) 500
medical/surgical groups, 1,200 subclasses
University of
Central Florida
Where is next?
University of
Central Florida
Open for business?
• Limited by simulator complexity and
proprietary control
– CAE-METI – systems closed
– Gaumard – limited computer capabilities
– Laerdal SimMan 3G API closest to open
access but limited functionality
– Other providers closed systems and no
standards to work to
– Options? DIY beyond most of us
– … so we hack
University of
Central Florida
DIS to SimMan 3G
• Virtual mannequin created with Laerdal
simulator Software Development Kit (SDK)
• Send & receive healthcare PDUs (Protocol
Data Unit):
– Variable Parameter (VP) record (PCR
223)
– Medical Attribute PDU (PCR 224)
• Ethernet network for messages (wifi used
for laptop-mannequin – interface computer
needs multiple NICs)
University of
Central Florida
HSVO to SimMan 3G
• Laerdal SimMan SDK = .NET tech
• Limitations to what it can do in a live situation
• Laerdal: “If you want to transfer mannequin state,
why not simply use the existing functionality – save
the session to a file, transfer the file to the Instructor
Workstation for the next mannequin, and then start
that mannequin from that file.”
• Multi-mannequin remote/distributed simulation
activities
University of
Central Florida
HSVO to SimMan 3G
• HSVO hub loads a VNC client for each mannequins’
Instructor Workstations and Patient Monitors on VNC
• Remote operators could reliably switch between
mannequins, controlling them one at a time
• Remote students at sites can watch each others’
Patient Monitors
• State and management data transferred between
remote mannequins
University of
Central Florida
Conclusions
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University of
Central Florida
Big money in simulation
Driven by large centres and vendors
Very limited capacity for interoperability
Nevertheless a growing interest and
opportunity
• A number of standards for and adjacent to
simulation already in place
• Core mainstream simulation interop still to be
resolved, claimed
• Many labs, projects, researchers pushing
boundaries …
Simulation Interop Space
Vendors
military/aerospa
ce
Educational
interop
Administration
and reporting
Educational
researchers
Clinical
systems
University of
Central Florida
Simulation Interop Space
Vendors
military/aerospa
ce
Educational
interop
Administration
and reporting
Educational
researchers
Clinical
systems
University of
Central Florida
Where is next?
• Great potential but immature technology space
• Agencies and societies (SSH, MedBiq, SISO)
identify and pursue low hanging fruit
• Vendor leverage
• Complexity but opportunity in bringing domains
into a common sim interop space
• Sim<>other med-ed connectors
• Explore what sim interop means
• Explore what value sim interop brings
University of
Central Florida
Contact and Acknowledgements
• [email protected][email protected]
• Dr Ellaway’s work was funded in part by CANARIE
Inc, Canada
• Dr Goldiez’ work was funded, in part, by the US Army
Research Laboratory under W91CRB-10-C-0046 and
PEO STRI SE CORE Contractors
University of
Central Florida
Interoperability
Standards for
Healthcare
Simulators
Rachel Ellaway1, Brian Goldiez2
1Northern
Ontario School of Medicine,
University of
2University
of Central Florida
Central Florida
MedBiquitous 2012