International Telecommunication Union
Interoperability & QoS
Implications of
ISO TC215 WG2.1
Todd Cooper
(t.cooper@ieee.org)
Chairman, IEEE 1073
Technical Director, MDCIG / IEEE-ISTO
President, Breakthrough Solutions
Workshop on Standardization in E-health
Geneva, 23-25 May 2003
Overview
ITU-T
 ISO TC215 Interoperability & QoS
 TC215 WG 2.1 X73 Standards
 QoS for Point-of-Care Medical Device
Communication
23-25 May 2003
Workshop on Standardization in E-health
2
ISO TC 215 Interoperability
ITU-T
o Interoperability : ability of two or more systems
or components to exchange information and
to use the information that has been exchanged.
source : IEEE Standard Computer Dictionary : A
Compilation of IEEE Standard Computer
Glossaries, IEEE, 1990
o Functional interoperability
Shared Architectures, Methods & Frameworks
o Semantic interoperability
Shared data types, terminologies, codings
23-25 May 2003
Workshop on Standardization in E-health
3
ISO TC 215 Interoperability
ITU-T
23-25 May 2003
o
WG 1: EHR architecture and modeling
o
WG 2: Messaging architecture & methods
o
WG 3: Terminology Methods
o
WG 4: Shared security architecture
o
WG 5: Shared health card framework
Workshop on Standardization in E-health
4
ISO TC 215 Interoperability
ITU-T
o
For Quality of Service :
WG 1 - Health indicators conceptual framework
WG 2 - Quality indicators for health
information made available on the
Internet
23-25 May 2003
Workshop on Standardization in E-health
5
ISO TC215 Health Informatics
ITU-T
ISO/OSI Level 7: Application
o
Focus is primarily
on Level 7
Interoperability
ISO/OSI Level 6: Presentation
ISO/OSI Level 5: Session
ISO/OSI Level 4: Transport
o
Medical Device
Communications
covers all 7 layers.
ISO/OSI Level 3: Network
ISO/OSI Level 2: Datalink
ISO/OSI Level 1: Physical
23-25 May 2003
Workshop on Standardization in E-health
6
ISO TC215 Health Informatics
ITU-T
WG1:
Models and
Messages
WG2:
Terminology
WG4:
Technology
for
Interoperability
WG3:
Security
CEN TC251
International
National
Standards
Bodies
e.g USA (ANSI)
European
National
Standards
Bodies
WG1:
Models
WG2:
Messages and
Communications
M OU
HL7
ASTM
IEEE
DICOM
NCCLS
"Pilot Proce s s
"Pilot Proce s s
Type A Liais on
WG3:
Terminology
WG5:
Cards
WG4:
Security
ISO TC215
23-25 May 2003
Workshop on Standardization in E-health
7
ISO/IEEE/CEN X73 Process
ITU-T
Establish Work Plan for Standard
(incl. resolution of all issues between IEEE, ISO, and CEN)
Completed
Published
Standard
Develop and Ballot Draft Using IEEE Process
Draft passes IEEE ballot
Ballot Approved IEEE Document
Using ISO Process (DIS/FDIS)
Standard
fails ISO
DIS/FDIS
ballot
Draft passes ISO DIS/FDIS ballots
Publish ISO/IEEE/CEN Standard
23-25 May 2003
Workshop on Standardization in E-health
8
ISO/IEEE 11073 Standards
ITU-T
X73 Charter:
 Provide real-time plug-n-play interoperability
for patient-connected medical devices
 Facilitate the efficient exchange of vital signs
and medical device data, acquired at the
point-of-care, in all health care environments
…leveraging off-the-shelf technologies, scaling
across a wide range of system complexities, and
supporting commercially viable implementations.
23-25 May 2003
Workshop on Standardization in E-health
9
ISO/IEEE 11073 Standards
ITU-T
Primary focus is on…
 Point-of-Care (POC)…
 Medical Device…
 Communications
ISO/IEEE 11073 Health informatics –
Point-of-care medical device
communications - …
23-25 May 2003
Workshop on Standardization in E-health
10
ISO/IEEE 11073 Standards
ITU-T
X73’s architecture ensures…
 True interoperability across all 7-layers:
From the connector to the end application!
 QoS mechanisms designed to support the strong
requirements placed on regulated medical
devices
 Maintainability as communications technology
and applications change
23-25 May 2003
Workshop on Standardization in E-health
11
ISO/IEEE 11073 Standards
ITU-T
23-25 May 2003
1073.1.x
Device Data & Services
1073.2.x
General Application Services
1073.3.x
Transport & Physical Layers
1073.5.x
Internetworking Support
1073.6.x
Application Gateways
Workshop on Standardization in E-health
12
ISO/IEEE 11073 Standards
ITU-T
1073.1.x
Device Data & Services
Medical Device Data Language (MDDL):
Semantics needed to communicate a device’s
application status and control information.
Consists of three main components:
 Nomenclature (1073.1.1.1)
 Domain Information Model (DIM) (1073.1.2.1)
 Device Specializations (1073.1.3.x)
23-25 May 2003
Workshop on Standardization in E-health
13
ISO/IEEE 11073 Standards
ITU-T
Nomenclature:
A set of numeric codes that identify every
item that is communicated between systems.
Codeblock Number (Hi-order 16 bits)
1
2
3
4
Object-Oriented (OO)
Supervisory Control and Data
Acq’n (SCADA)
Events
Dimensions (Units of Msmt)
5
Virtual Attributes
6
Parameter Groups
7
[Body] Sites
8
Infrastructure
…
256 External Nomenclature Ref's
…
1024 Private
Context-sensitive parts
Term Code (Lo-order 16 bits)
31 . . . . . . 23 . . . . . . . 15 . . . . . . . 7 . . . . . .
0
msb
lsb
Context-free code
23-25 May 2003
Workshop on Standardization in E-health
14
ISO/IEEE 11073 Standards
ITU-T
Domain Information Model:
An object oriented data model that specifies objects, attributes,
attribute groups, event reports, and services that may be used to
communicate device data and to control / configure the reporting of
information.
23-25 May 2003

Does not imply a specific implementation technology

Objects include Medical Device System, Virtual Medical
Device, Numeric, Enumeration, Real-Time Sample Array,
Battery, Scanners, Alert Monitor, …
Workshop on Standardization in E-health
15
ISO/IEEE 11073 Standards
Top
ITU-T
Domain
Information
Model
Subject
Areas
Archival
PatientArchive
Patient
SessionArchive
Patient
Demographics
.9
.10
System
Extended Services
Scanner
MDS
.7
.5
Communication
Medical
Communication
Controller
.8
VMD
Alert
Control
Alert
.4
Service+
Control
Channel
.6
Metric
.3
23-25 May 2003
Workshop on Standardization in E-health
16
ISO/IEEE 11073 Standards
ITU-T
VMO
Session-Test
(from Archival)
MDS
(from System)
0..1
0..n
1
VMD
0..1
1
0..n
Channel
0..1
1
0..n
0..n
0..n
Metric
0..n
PM-Store
0..n
1
1..n
Numeric
Time-SA
23-25 May 2003
Sample Array
Distribution-SA
0..n
Enumeration
Complex Metric
0..n
0..n
PM-Segment
RealTime-SA
Workshop on Standardization in E-health
17
ISO/IEEE 11073 Standards
ITU-T
1073.2.x
General Application Services
Generalized application profile standards …
 A generic (non-device specific) set of data and services
needed to initiate, configure, and maintain
communication.
 Connect ~ Disconnect, Create ~ Delete, Get ~ Set, Event
Report, Invoke, etc.
 Standard Services: ACSE, ROSE, CMISE, ASN.1, MDER
(based on BER+), Etc.
 Beginning work on XML & Web Services profile
23-25 May 2003
Workshop on Standardization in E-health
18
ISO/IEEE 11073 Standards
ITU-T
23-25 May 2003
Domain
Information
Model
‘On-the-Wire’
Format
Abstract
Syntax
(ASN.1)
Transfer
Syntax
(MDER)
Workshop on Standardization in E-health
19
ISO/IEEE 11073 Standards
ITU-T
Generalized application profile standards …
 Profiles:
• Specific set of capabilities tailored for a
class of communication needs /
architectures
• Limits the options that are available
• Remaining options must be discovered and in
some cases negotiated when a connection is
made (enabling plug-n-play
interoperability!)
23-25 May 2003
Workshop on Standardization in E-health
20
ISO/IEEE 11073 Standards
ITU-T
23-25 May 2003
Workshop on Standardization in E-health
21
ISO/IEEE 11073 Standards
ITU-T
1073.3.x
Transport & Physical Layers
Available (point-to-point) transport standards…
 IrDA-Based Cable Connected (1073.3.2)
 IrDA-Based Infrared Wireless (1073.3.3)
Transport standards (LANs) under consideration…
 RF Wireless – high emphasis on QoS!
 IP-Based (Ethernet)
Key: Shared IT infrastructure with guaranteed QoS
23-25 May 2003
Workshop on Standardization in E-health
22
ISO/IEEE 11073 Standards
ITU-T
1073.5.x
Infusion Pump
Ventilator
Pulse-Oximeter
1073
Agent
Device
Examples:
23-25 May 2003
Internetworking Support
1073
Agent
Device
1073.3.x
Transport
1073.3.x
Transport
1073.5
Internetworking
1073
Manager
System
Patient Monitor
Device Manager
1073.3.x
Transport
1073
Manager
System
LAN Access Points,
Wired-to-Wireless Transport Gateways,
Workshop on Standardization in E-health
23
ISO/IEEE 11073 Standards
ITU-T
1073.6.x
Application Gateways
Objective: Interoperability between different
application-layer protocols
+
Bi-Directional Transparency
1073
System
(Agent/
Manager)
1073.3.x
Transport
1073.6 Gateway
(poss. 1073.5 Internetworking)
1073.3/.5
Transport
non-VITAL
Application
Example:
HL7 / IEEE Gateway: IEEE 1073.6.1.1 …
HL7 - Observation Reporting Interface!
23-25 May 2003
Workshop on Standardization in E-health
24
ISO/IEEE 11073 Standards
ITU-T
1073
System
1073
Network
HL7/1073
Gateway
1073
System
HL7
Network
HL7
System
HL7
System
HL7-IEEE JWG Project Scope:
Identification and definition of interfaces to support
interoperability between HL7 and 11073 based systems for
Point-Of-Care testing / monitoring use cases.
23-25 May 2003
Workshop on Standardization in E-health
25
ISO/IEEE 11073 Standards
ITU-T
o
o
23-25 May 2003
X73 – Real-time
plug-n-play
interoperability
across all 7-layers
ISO/OSI Level 7: Application
From
Device-to-device
up to
Device-to-EMR
ISO/OSI Level 4: Transport
ISO/OSI Level 6: Presentation
ISO/OSI Level 5: Session
ISO/OSI Level 3: Network
ISO/OSI Level 2: Datalink
ISO/OSI Level 1: Physical
Workshop on Standardization in E-health
26
ISO/IEEE 11073 Standards
ITU-T
X73 includes QoS management support:
 Negotiated Bandwidth at association
 Start-up configuration minimizes network usage
to that which is needed for client applications.
 Management Information Bases (MIBs) provide
dynamic visibility to communications
performance
 State models and confirmed delivery provide a
high level of reliability for medical data transfer
23-25 May 2003
Workshop on Standardization in E-health
27
ISO/IEEE 11073 Standards
ITU-T
Drivers of X73 QoS:
 Regulated industry: “Safe & Effective”
 Clinical Use Cases for devices – esp. real-time
requirements: User needs & expectations!
 Transport and service profile technologies (LAN
based vs. point-to-point)
 System wide topologies (local vs. wide area)
 Non-clinical stakeholders (…finance)
23-25 May 2003
Workshop on Standardization in E-health
28
ISO/IEEE 11073 Standards
ITU-T
Key X73 QoS considerations:
 Reliability – FMEA, error detection & mitigation
 Latency – from device detection to end
annunciation for the data client
 Priority – Not all medical device data has the
same communications priority
 Bandwidth – Allocation and dynamic management
23-25 May 2003
Workshop on Standardization in E-health
29
ISO/IEEE 11073 Standards
ITU-T X73 Data Categorization:
 Alerts (both physiological & technical)
 Real-time Waveforms
 Real-time Parameters (Breath-to-breath)
 Non-RT Parameters (battery level, metric label)
 Non-RT Event (low battery)
 Controls
 History / Archival
 Web Browsing
23-25 May 2003
Workshop on Standardization in E-health
30
ITU-T
23-25 May 2003
Data Type
Bandwidth Priority Reliability Latency
Alerts
Lo (64B/Al.),
Intermittent
Highest
Hi
3 sec
RT-Waves
Hi (120 to
4KB/s/chan)
Predictable
High
Hi
<RT> or
CS=3 sec
RT-Param’s
Lo-Med,
Predictable
High
Hi
3 sec
Non-RT
Param’s
Lo (20B/p),
Unpredict.
High
Hi
---
Non-RT
Events
Lo-Med,
Unpredict.
Medium
Hi
PoC: 3 sec
CS: 5 sec
Controls
Lo,
Unpredict.
Medium
Hi
PoC: 3 sec
CS: 5 sec
History /
Archive
Hi, Bursty,
Unpredict.
Low
Med->Hi
Push: >5
sec; Pull:
< 5 sec
Web
Browsing
Hi, Bursty,
Unpredict.
Low
Med->Hi
3-5 sec
Workshop on Standardization in E-health
31
ISO/IEEE 11073 Standards
ITU-T X73 QoS Issues:
 Latency:
Prioritization support
Shared Bandwidth management architecture
(across multiple manufactures / devices)
 Reliability:
Prioritization policies – guaranteed B/W
Network fault detection & Annunciation
 Graceful system performance degradation
 Co-existence Management (esp. RF wireless)
23-25 May 2003
Workshop on Standardization in E-health
32
ISO/IEEE 11073 Standards
ITU-T
And what about…
 Remote Control: a virtual plug-n-play remote
control network!
 Global access: Real-time vital signs viewing
across the world (w/security, authentication, …)
23-25 May 2003
Workshop on Standardization in E-health
33
ISO/IEEE 11073 Standards
ITU-T Conclusions…
 X73 are the only comprehensive point-of-care
medical device communication standards on the
horizon!
 Need additional pilot projects to show
capabilities of X73 protocols
 Health care providers and management
organizations must demand medical device
interoperability using X73
 We welcome support in adding security, web
services, and rigorous LAN-based QoS support to
our standards
23-25 May 2003
Workshop on Standardization in E-health
34