Connected Medical Devices in the Internet of Things

Connected Medical Devices in the
Internet of Things
Emergency Response, Patient
Safety, Imaging, Surgery, Advanced Treatment

Your systems. Working as one.

“Last Mile problems”
Example - Infusion technology:
1. Decision support?
2. Prevent contra-indicated
infusion?
3. “Artificial pancreas”
Capabilities? (closed loop)
4. Consolidate all data for
adverse event analysis?
5. Check device
status, software version?
Recall?
6. Support Meaningful Use
#3?

© 2014 Real-Time Innovations, Inc.

SpO2 must be interpreted appropriately. Erroneous data points could be flagged/rejected
1. BP cuff inflation status is not recorded in EHR
2. Waveforms not recorded

NIBP-SpO2 Interaction


Problem – Pulse-rate counting error due to atypical plethysmogram.
Other monitor data could be used to detect and reject this error.
Waveforms could be recorded to enable manufacturers to improve device algorithms.

ECG data

ECG data

Pulse Ox data

EMR data
© 2014 Real-Time
Result: False alarms, incorrect data in Innovations, Inc. record.
permanent

What Can Change That?


The Internet of Things


2014 Top Tech Trends
• 1) Internet of Things
• The IoT promises to be the
most disruptive technological
revolution since the advent of
the World Wide Web.
Projections indicate that up to
100 billion uniquely
identifiable objects will be
connected to the Internet by
2020, with enormous
technical, socioeconomic,
political, and even spiritual
consequences.

What is the Internet of Things?
• Cisco “Internet of Everything”
– …the latest wave of the Internet -- connecting
physical objects…to provide better
safety, comfort, and efficiency

• IBM “Internet of Things”
– …a completely new world-wide web, one comprised
of the messages that digitally empowered devices
would send to one another. It is the same
Internet, but not the same Web.

• GE “Industrial Internet”
– …convergence of machine and intelligent data…to
create brilliant machines

• RTI “Your Systems. Working as One.”
– …an entirely new utility. As profound as the cell
network, GPS, or the Internet itself. The Internet of
Things and the Intelligent Systems it enables will
fundamentally change our world.

IoT Taxonomy
• Access
Web Services and Business Apps
Process

– Link sparse
endpoints
– XMPP

• Process
–
–
–
–

Access

Biz intelligence
Centralized/ESB
~100ms
MQ/AMQP

• Collect

Collect

–
–
–
–
Control

Devices and Intelligent Systems


Collect data
Hub & spoke
~10ms
MQTT/CoAP

• Control, distribute
– DataBus
– ~.01ms
– DDS

DDS: Distribute Device Data

Real-Time
Analytics &
Control

Operator HMI

Sensors

Actuators

Data Distribution Service (DDS)

Cloud
Integration

Core Nervous System for the IoT


Some Things that Things Can Do

DDS IoT Applications & Background


What Does DDS Middleware Do?
• Reliable Operation
• Deterministic
Performance
• Systems of Systems
• Flexible Transports
• Crisp Interface Design
• Easy Tech Upgrades
• Multi-Channel
Connections
• Open Architecture
• Wireless Links

•
•
•
•
•
•
•
•
•
•

Legacy Integration
Hardware in the Loop
Scalability
Database Integration
High Throughput
Reliable Uptime
Industry Interoperation
Small Device Connection
Large Fan In/Out
Real-Time and IT
Integration


Reliable Operation
• The LPD-17 Ship-Wide
Area Network (SWAN)
runs machinery, damage
control, steering,
magnetic signature,
mission control,
navigation,
communication
• DDS middleware supports
redundant networks, data
& sensors without servers
for non-stop reliability


Real-Time Delivery
• The Ship Self Defense
System is the “last line
of defense”
• SSDS coordinates highspeed radars, targets
defensive missiles, and
directs 1000+
rounds/sec at incoming
cruise missiles
• SSDS is at sea now
• DDS delivers messages
in real time


System-of-Systems Integration

• Raytheon uses RTI middleware to
control the new Zumwalt DDG 1000
destroyer
• RTI DDS coordinates and manages
complex, diverse onboard hardware
and software systems

• RTI connects hundreds of
computers, thousands of
applications, and more than 10m
publish-subscribe pairs
• RTI middleware extends real-time
scalability


Industry Interoperability
• Next-generation of
–
–
–
–
–
–

Aegis
DDG 1000
SSDS
LCS (both variants)
LPD-17
Many more, US and allies

• Highly distributed systems
include
radar, weapons, displays, contr
ols
• Standards-based, highperformance middleware
breaks vendor lock-in, drives
interoperability ,and futureproofs the architectural design

Legacy System Integration
• The VW Driver Assistance
and Integrated Safety
system combines
radars, laser range
finders, and video to assist
safe operation
• It helps avoid
obstacles, detect lane
departures, track eye
activity, and safely negotiate
bends
• Advanced safety systems
must connect to existing
hardware. RTI DDS
middleware bridges high
speed networking to the
CAN bus


Interoperable Distributed Testing
• A modern car contains
100+ CPUs
• Audi uses hardware-inthe-loop simulation to
feed realistic data to
components in a lab
for testing
• DDS middleware
enables a multi-vendor
test environment that
scales to work with
hundreds of devices


Real-Time High Fidelity Recording
• Light and strong
advanced composites
make advanced aircraft
quiet and efficient
• Lund Engineering uses
RTI to integrate the
composite inspection
system
• Critically, all data must
be saved for validation;
RTI’s database
integration saves all
data to permanent
storage
• Replay also supported

Interoperability Standards
• RTI leads in defining
a standard
architectures for
unmanned vehicles
and avionics
• RTI chairs the
architecture for UCS
(ground stations)
and is key at FACE
(avionics)
• DDS-based designs
match data models
for component
reuse.


24x7 Operation

RTI Connext DDS was selected
for its extensive compliance
with the Object Management
Group (OMG) DDS standard; its
high security rating; its wide
support of tools and
programming languages, and
its reputation for
performance, scalability, and
24/7 reliability.
– Sid Koslow, Chief
Technology Officer, NAV
CANADA.

Air Traffic Control for Canada
2nd largest ANSP in the world
80 sites


Safety-Critical Software
• RTI Connext Micro Cert
– Stringent SWaP
requirements
– Complete certification
evidence
– Full interoperability
with Connext product
line

• DO-178C Level A
– UAS & ATC integration
– Flight management
systems

• IEC 60601 class 3
– Medical devices


Scalable Networking
• Harmonic
transmission and
video switching
equipment delivers
worldwide video-ondemand
• RTI handles 1,000s of
clients, 1,000,000s of
messages
• DDS enables highperformance
scalability and future
extensibility


Harsh Environment Operations
• Joy Mining is the
world’s largest
mining equipment
manufacturer
• DDS connects the
controller, operator
GUI, and historian
• Reliable, fast
connectivity enables
control, debugging,
and system health
monitoring for
continuous mining


Real-Time & IT Integration
• Siemens Wind Power
fields farms of 500
turbines with 100m
blades
• DDS enables fast
control within
turbines and
distributed gust
mitigation across the
array
• RTI will also
integrate with
predictive
maintenance and
business diagnostics
• RTI melds real-time
with IT

How Networked Things Are
Changing Medicine

Real applications in connected medical devices


What is Your Application?
A.
B.
C.
D.
E.

Patient monitoring; Hospital/EMS integration
Imaging
Surgical systems
Other medical
I’m just curious or an RTI competitor


Fast Emergency Response

• Exelis (ITT) C4i provides command and control systems
for military and civilian agencies (fire/police/emergency
response)
• RTI Connext DDS connects GUIs to servers that route
voice and video
• RTI met the critical needs: scalability, routing, recording

EMS Device Integration Platform
• The largest EMS
equipment provider
will use RTI for their
entire product line…for
the next 20 years
• Provides emergency
response equipment
to 60% of the world’s
emergency vehicles
• DDS middleware
provides easy
connectivity, performa
nce, reliability, medical
certification option


EMS Cloud Integration
Connecting devices with hospitals to provide better treatment while en-route

4G/LTE


High Rate Distributed Control
• The Minimally
Invasive Robotic
Surgery (MIRS) system
at DLR coordinates
three robots to
perform delicate
heart surgery.
• The system closes a
distributed loop
between the robots
and the remote
surgeon’s control at
3kHz.
• RTI enables new
medical techniques


Hospital Patient Safety
• Hospital error is
the 6th leading
cause of
preventable death
• DocBox integrates
devices to
improve patient
safety
• RTI Connext ties
together
devices, services,
and displays in
real time

“RTI Connext DDS met all our needs – whether
we’re handling 12 patients, or 200.”
-- DocBox Founder, Tracy Rausch

Industry Interoperation
• The Integrated Clinical
Environment (ICE) standard
specifies interoperability for
medical devices
• All ICU & operating room
devices — from blood pressure
cuffs to intravenous pumps to
ventilators — could be
interconnected according to
the ICE standard
– Complete logging
– Automatic error detection
– Better care

• The DDS standard and RTI
middleware enables plug &
play interoperability across
manufacturers
ASTM F2761

Data Distribution Service for ICE
App

ADT

External
Interface

App

External
Interface

EMR

App

DDS Global Data Space
Data Logger

Device

Device

Device

Benefits offered by DDS
• Discovery / Presence
• Data-Centric Information Model / Type Safety (agree to data structure in advance)
(Distinct from underlying messaging)
• QoS Policy Compatibility Checking / Runtime Enforcement

Device Identity
UDI 🔑

string

Model Name string
Depiction

Icon
Numeric
UDI 🔑

string

Metric Id🔑 string
Value

float



Shared Information Model
Topic – What data is
exchanged?
Key – How are unique
instances identified?
Type – What is the data
structure?
QoS – Non-functional policies
for data propagation (next slide)
Data-Centric
• DDS standard for sharing data
• Supports any
OS, languages, transports
• Enforces QoS policies

Quality of Service
App

Example
Deadline Policy – Defines the maximum
interval between samples

Numeric
UDI 🔑

string

Metric Id🔑

string

Value

• “Match” only when requested and
offered policies are compatible
• Mis-matches reported at runtime
• Policy violations reported at runtime

float

Device

5 seconds Requested, 10 seconds
Offered
 NO Match [data is too old]
5 seconds Requested, 2 seconds
Offered
 Match [data is current]


ICE Platform Prototype uses this general approach …

OMG DDS + IEEE 11073 + ASTM F2761
IEEE 11073 Components

X73 DIM
Data Objects
X73 DIM
Data Object
Attribute
Groups

OMG DDS

DDS Topic

DDS IDL
Syntax

ASTM F2761
Supervisor
Functionality

Controller

Data Logger
X73
Nomenclature
+ Other

(a lot of work remains)

DDS IDL
Nomenclature
External
Interface

Patient Safety App Package

CDS
Algorithm
#1

Lab
Data

Patient
Hx

Supervisory
Services
Patient Mgmt
Device Mgmt
Systems Health
Interaction
Checking
Logging

Data Bus

SPO2

CO2

Infusion Pump
Measured
Values


Infusion Pump
Settings

IV Pump
Control

CIMIT ICE Interface

Center for Integration of Medicine and
Innovative Technology (CIMIT)
See MDPnP.org & docboxinc.com

Infusion Safety (PCA) App


Hospital Integration


Clinical Decision Support Systems
Administration

HL7/EMR Gateway, Enterprise, 3rd Party
Care Area

Workstations,
Storage, Historical
Room

Devices

Data Centricity
Administration

HL7/EMR Gateway, Enterprise, 3rd Party
Care Area

Location:
Room 247B

Workstations, Stor
age, Historical
Room


Data:
HomerSimpson

CDS System of Systems


Hospital Integration
• Hospital net challenge

• RTI DDS technology

– 1000s of patients, >100k
devices
– Wired/wireless/ISM
– Moving patients
– 100% uptime, security
– Real-time waveforms


–
–
–
–
–

Data centric addressing
Smart data filtering
Routed deployment
Optimized updates
Automated test harness

Medical Imaging
• RTI powers MRI & CT
• Imaging systems require massive
data flows and fast performance
– Any one of many MRI receivers
can saturate a 1Gbit network.
– CT machines require precise
distributed control

• DDS controls and optimizes
network use to handle
megabytes of load without
losing data
“RTI delivered great functionality at a low cost. Using
RTI middleware saved us a lot of money, time, and
effort compared to our previous in-house developed
solution.” -- Varian (Agilent) MRI


CT Data Challenges
• Coordination
–
–
–
–

Generator
Scanner
Power
Servo

• Burst image data
acquisition
• Control & monitoring
– Systems ready for scan
– Status during scan

• Operator interface
• Integration
– Many languages, OS,
data models
– Data archiving

MRI Data Challenges
• Gradient coil
coordination
• Excitation control
• Handle burst
imaging data
– Receiver data
throttling
– Coordinating
multiple
networks

• Patient
positioning
• Image transfer

Advanced Proton Therapy
• Mevion’s ProtonBeam Radiation
Therapy system zaps
tumors with
accelerated protons
• The treatment must
be continuous for 3040 days; downtime
endangers treatment
success

First patient treated Dec
2013, Siteman Cancer Center, St.
Louis

• With DDS, Mevion’s
PBRT delivers
dependable
treatment at low cost

Proton Beam Therapy
• Unlike Xrays, PBRT
precisely delivers
energy with little
tissue exposure
• Controlling exposure
requires positioning
patient in 3D


PBRT Data Challenges
• Superconducting
synchrocyclotron
control
• Coordinate
– Imaging
– Patient
positioning
– Treatment
– Machine
control
– Hazard
mitigation

How Can Things Do Those Things?

Technology


Evolution of Middleware
Point-to-Point

Client/Server

Publish/Subscribe

Data-Centric

Pub/Sub Messaging
Brokered
ESB
Daemon

Data-Centric
Publish/Subscribe (DCPS)

DataBus


DDS: The Software DataBus
• Data centric
– Like a database for
moving data

• Decouples modules
– Like SOA

• Plug and play flexibility
– Like a hardware bus

Data-Centric Messaging Bus
DataBus™

• Peer-to-peer
performance
– Like streaming protocols

• Standards-based
interoperability
– Like TCP/IP

Scalable, high performance, reliable infrastructure

Message Centric Approach
• Traditional middleware exchanges messages
• Infrastructure is unaware of the content
• Developers write applications that send messages
between participants

Popular standards: JMS API; AMQP wire spec

Data Centric Approach
• Data-centric middleware maintains state
• Infrastructure manages the content
• Developers write applications that read and update a
virtual global data space
Source
(Key)

Power

Phase

WPT1

37.4

122.0

-12.20

WPT2

10.7

74.0

-12.23

WPTN

50.2

150.07

-11.98

Persistence
Service

Recording
Service

Popular standards: DDS API, wire spec

Average Latency (Microseconds)

Performance Under Load
400

Number of Subscribers

350

1 (1 per CPU and NIC)
20 (1 per CPU and NIC)
40 (1 per CPU, 2 per NIC)

300
250
200
150

• Reliable multicast
• Fully meshed, reliable

100
50
0

Orders of
magnitude faster
Throughput (Messages per Seconds)

Comprehensive results online 2014 Real-Time Innovations, Inc.
at www.rti.com
©

than IT solutions
Fastest DDS solution

Reliable Multicast
Messages per Second
Per Subscriber (200 Bytes)

600,000
500,000

• Millions of data
elements
• .5m updates/sec
(batched)
• 10s µs latency
• 1000s of
consumers

400,000
300,000
200,000
100,000
0

0

200

400
1,000

600

800

Number of Subscribers

1  ~1000 subscribers, < 15% throughput decrease


The DDS Standard
• Data Distribution Service from
OMG
• OMG: world’s largest systems
software standards org
– 470+ members
– UML, DDS, SysML, MoDAF, DoDAF,
more

• DDS: open & cross-vendor
– Standard API enables choice of
middleware
– Standard wire spec enables
subsystem physical interoperability
– 11 implementations

Cross-vendor source portability

DDS API
Distribution Fabric
DDS-RTPS Protocol
Real-Time Publish-Subscribe

Cross-vendor interoperability

The DDS standard: a hotly contested market

OCI

ETRI

PrismTech


IBM

RTI

TwinOaks

Community (aka Help)

Forum Posts 950 426% increase
Downloads 2877 306% increase
Visitors 68567 452% increase
Unique 37636 412% increase
Grew just a bit in 2013…
©2014 Real-Time Innovations, Inc. Confidential

About RTI
• Market Leader
– Over 70% DDS mw market share1
– Largest embedded middleware vendor2
– 2013 Gartner Cool Vendor for technology
and Open Community Source model

• Standards Leader
– Active in 15 standards efforts
– OMG Board of Directors
– DDS authors, chair, wire spec, security, more

• Real-Time Pedigree
– Founded by Stanford researchers
– High-performance control, tools history

• Maturity Leader
– ~700 designs; by far the most-used DDS
– TRL 9
1Embedded

Market Forecasters
Report

2VDC Analyst


Critical Infrastructure Trusts RTI
•
•
•
•
•
•
•
•
•
•
•
•
•
•

World’s largest Wind Power company
World’s largest Underground Mining Equipment company
World’s largest Navy (all surface ships)
World’s largest Automotive company
World’s largest Emergency Medical System company
World’s largest Medical Imaging provider
World’s 2nd largest Patient Monitoring manufacturer
World’s 2nd largest Air Traffic control system
World’s largest Broadcast Video Equipment manufacturer
World’s largest Launch Control System
World’s largest Telescope (under construction)
World’s 5th-largest Oil & Gas company
World’s 6th-largest power plant (largest in US)
All of world’s top ten defense companies


Over $1 trillion
relies on RTI

Global Support and Distribution

2008


Before this Webinar, I Thought DDS
A. Is my dentist’s last name
B. Is a military technology
C. Is a research technology, not ready for prime
time
D. Enables the future of medicine
E. Is spelled wrong


After this Webinar, I Think DDS
A. Is amazingly flexible
B. Is used on many real-world applications
C. Is the main real-time protocol for the
Internet of Things
D. Enables the future of medicine
E. Is probably really expensive


Some Resources
• Papers, C+C, community: www.rti.com
• Wired article: http://blogs.rti.com/2013/11/18/aday-in-your-life-with-the-internet-of-things/
• EDN on patient safety:
http://electronicdesign.com/communications/int
ernet-things-can-save-50000-lives-year
• PBRT system:
http://www.barnesjewish.org/news/?id=5032&si
d=2&nid=3068
• Video: http://goo.gl/WnO5LE

Connected Medical Devices in the Internet of Things

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Connected Medical Devices in the Internet of Things