TRIVENI, a remote patient monitoring solution that is a confluence of three aspects of patient information:

Data | Medical Devices | Connectivity

Introduction

Just the other day we heard the SpaceX rocket zoom off to the space to deliver a satellite to the geospatial orbit, Rosberg won the 2016 russian grand prix & Mars rover continuously transmitted the images and vital parameters from millions of miles away in the space

The above three scenarios present the ability to stream data in realtime to a base station providing the ability to remotely monitor the performance of a space-craft, a formula 1 car and a remote autonomous vehicle.

Similarly consider the following use cases in relation to a patient in a Healthcare setting:

patient information in a Hospital
patient in an ambulance or
patient under homecare

presents use cases that require remote monitoring of patient information.

The existing technological paradigms such as IoT, data streaming analytics, connectivity & interoperability allow for a framework to allow for remote patient monitoring in each of the three Healthcare use cases

TRIVENI

I would like to propose TRIVENI, a remote patient monitoring solution that is a confluence of three aspects of patient information

DATA
MEDICAL DEVICES
CONNECTIVITY

Triveni proposes to implement a plug-n-play framework that will allow for easy connectivity between healthcare information sources.

The etymology of the word TRIVENI in Sanskrit means “where three rivers meet”. Similarly, the three aspects of Patient Information need to be integrated to meet the requirements of a remote patient monitoring solution

Focus areas of TRIVENI

Initially to showcase the Proof-Of-Concept for the solution, the above three focus areas will be considered to present as the use cases. Each of the three focus areas present the ability to test the confluence of three aspects of Patient Information defined above

Cardiology

MI
Chest pain

Neurology

Stroke
Head Injury
Epilepsy

Emergency Services

Trauma

Need for TRIVENI

The Tower of Babel (Pieter Bruegel the Elder, c. 1563), a metaphor for the challenges existing in medical device semantic interoperability today

Current Landscape

Piecemeal integration creating information silos; leading to difficulty in sharing patient information
Silos unable to deliver real-time patient data reliably; leading to lack of data synchronization to ensure latest time-aligned data
Vendor Dependent solutions; leading to internal battlegrounds
Lack of semantic interoperability between systems; leading to a tower of babel situation in medical device semantic interoperability
Captive investments by healthcare facilities in existing medical devices leading to a long time before the medical devices can be replaced with newer systems with easier connectivity features

The Remote Patient Monitoring Process Flow

Typical Remote Patient Monitoring process (adapted from Center for Technology and Aging)

The Center for Technology and Aging indicates a 5 – Step process for Remote Patient Monitoring. The 5 steps are essential to deliver a continuous flow of patient related information to the remote base station monitoring a patient(s) in any of the use cases or the focus areas presented earlier

The Remote Patient Monitoring Process Flow Mapped with TRIVENI Framework Components

It becomes imperative for the solution to incorporate these founding principles of a remote monitoring process into any framework/ product of such a nature. The process steps get implemented in the TRIVENI framework, allowing for the continuous monitoring of patient information from the various connected systems.

The processes allow for a modular approach to the Product Definition of the TRIVENI framework, with the ability for each component of the platform to evolve as dictated by its internal technology and thus enables each component to incorporate newer technology paradigms as and when they present themselves

The TRIVENI Components are

TRIVENI Connect ®

A programmable Connector that allows the transmission of data from the connected medical device
Supports BLE, Wireless technologies

TRIVENI Hub ®

A Medical Device Data Aggregator that has the ability to receive data from the TRIVENI Connect and transmit the patient vital data streams to the TRIVENI Exchange
Supports 2G, 3G, Wifi, 4G networks

TRIVENI Exchange ®

TRIVENI Exchange is a secure, reliable patient vital data store that can seamlessly transmit data received from TRIVENI Hub to TRIVENI Apps
SSL Security, supports interoperability, Data Delivery to TRIVENI Apps or Connected EHR Systems (via HL7)

TRIVENI Apps ®

TRIVENI Apps have the ability to securely receive identified patient’s Medical Data from the TRIVENI Exchange
TRIVENI Apps are delivered on Android, iOS, Web-based platforms

TRIVENI Connect

The TRIVENI Connect is a device that acts as a converter that allows any medical device to connect to the TRIVENI system. The Connect device for instance will be connected to a Patient Monitor via the RJ45, RS232-to-USB converter.
Once connected, the TRIVENI Connect will automatically download the relevant driver from the TRIVENI HUB, that allows for the Patient Data Stream from the Monitor to be streamed. Additional features of the TRIVENI Connect are:

Has the ability to Fetch Data from the connected Device

No. of Manufacturers
No. of Devices
One TRIVENI Connect per Device

Convert Data from Device by encoding Device Data with Following information

Device ID, Manufacturer ID
Device Type
Patient ID
Ambulance ID/ Hospital ID

The TRIVENI Device Should be configurable with the above data. Additional capabilities of the TRIVENI Connect are:

Allow for Access Point Configuration
Via PC/ Via mobile device
Configure the TRIVENI Exchange IP
Send Data to TRIVENI Exchange

Software Upgrade:

Via PC
Over the Air

Linux Based, WiFi USB Dongle with a RS232 – USB Converter

TRIVENI HUB

The TRIVENI HUB is a device that acts as a data aggregator device at the remote location. All the Patient Data streams from various connect devices are routed to the HUB.

The HUB can be configured via a mobile app. Using the mobile app the users will be able to configure various aspects of the TRIVENI HUB like the internet connectivity, TRIVENI Connect linked to the HUB, Username and password configuration of the HUB & Connect devices, Store and forward configuration to name a few.

The HUB device has the following features:

Is a WiFi Router + Cellular Modem
Has the functionality to work as a patient data stream aggregator with a store and forward feature
Has multiple SIM slots or Multiple USB ports for Broadband Connectivity
In Ambulance:

Will Work as a WiFi Router Access Point for the TRIVENI Connect
Will work as a Cellular Modem for Transmitting the data to the TRIVENI Exchange

In Hospital:

Will work as a WiFi Router Access Point for the TRIVENI Connect
Will connect with the Hospital LAN to connect to the Internet

Has the ability to store and forward patient data
Data streams will be prioritized based on the QoS of network connection
Ability to send data packets over multiple networks to reduce packet loss
Data aggregation from multiple types of sources other than TRIVENI Connects
Maintains the security of the data-on-move over wire and when data-stationary when within the TRIVENI Hub by enabling security protocols (SSL) and encryption of data

TRIVENI EXCHANGE

The TRIVENI EXCHANGE is a Medical Data+Media Server that can be configured as a Virtual / Physical Server. The EXCHANGE has RTP/ RTSP/ RTCP Capabilities for Live Streaming of the Patient Data Streams from each of the HUBs connected to the EXCHANGE.

The features of the TRIVENI Exchange are

Site Configuration: Allows the Creation of an Identity for a Client (Ambulance Services/ Hospital Provider)
Identification/ Allocation of IP Address (Destination IP for Medical Data Streams) for the TRIVENI Exchange
Allows the configuration of the TRIVENI Connect’s to stream data to the Identified IP Address
Has the ability to update the TRIVENI Connect / TRIVENI Exchange Firmware OTA
Has the ability to receive Voice and Data Streams
Has the ability to enable Live Streaming of Data, Video and Voice to TRIVENI Apps
Linux Based system
Virtual/ Physical Server
128-bit Encryption, https, 2-factor authentication enabled
Can be Configured for each client in a multi-tenant server configuration.
Has a Medical Data Controller module to identify the source and destination of the medical data streams
Ability to allow store and forward data on demand
Allows data push or pull configurations for the TRIVENI Components
Maintains the “device” drivers for various types of patient sources

TRIVENI APPs

The TRIVENI APP is an android or iOS based app. There are two APPs that come with the TRIVENI framework. One APP is for configuring the remote configuration for the connect and the hub devices at the location for the client

Another APP is for configuring the Exchange and for viewing the data being streamed from the various devices connected to the patients in the remote locations

Enables Care Anywhere
Web-based, Android or iOS based apps
Allows for a two way communication between devices
Free to download app on the App Store
Allows the user to authenticate her credentials
Allows two way communication between the Apps between two users
Ensures the reliability of the data
Security enabled to ensure patient data authenticity
TRIVENI Apps will be developed as web-based and subsequently as native apps
TRIVENI apps will incorporate the usability guidelines for the healthcare based apps
TRIVENI apps can be configured for data push or pull options
TRIVENI apps enabled with security and data encryption profiles
There are two types of TRIVENI Apps: TRIVENI HUB & TRIVENI EXCHANGE apps to configure remote and base components

Interoperability Considerations for Medical Peripherals

If one was to trace the progression of delivery of printer drivers, it presents an interesting case study regarding how hardware-software interoperability has progressed over the years in the IT industry. And studying these aspects help us to, hopefully in the future define the way Interoperability in the Healthcare Industry should be handled.

Printers have been essential hardware devices that are connected to the software platform (OS) via various types of connectivity platforms, and service the productivity needs of the organisation.

Lets consider the various Printer installation processes we have seen in the past

CD with OS compatible drivers: Printers started out as peripherals that required a specific driver to be installed on the system (PC/ Laptop/ Server) that was going to be connected to the printer, via a printer cable
OS with Pre-installed Printer Drivers: Then we progressed to the OS itself having a list of compatible drivers that enabled the OS to auto-detect the type of printer or peripheral that was connected to the system. This also allowed for network printers to be installed in the network and allowed for the print server to have all the relevant drivers installed just on that server. PCs in the network wanting to use the printer resource, just needed to send the document to the print server.
Cloud Printers: Now a days, it is possible to connect the printer to the cloud via HP-ePrint or google printer services and access the printer from anywhere in the world.

Device & Software Interoperability

Taking learning from the way peripherals interoperability has been handled in the IT industry, Healthcare Interoperability should be a de-facto feature that should be present in most systems

Interoperability needs to be made as a plug-n-play feature in the Healthcare Services and Solutions. What are the various “Peripherals” that need to be connected in the Healthcare Industry?

Healthcare Information Management Systems
Medical Devices
Laboratory Devices
Radiology Devices
Medical Apps

Additional Thoughts on Interoperability

Now the idea for defining the progression of a hardware connectivity w.r.t. The Printer device, is to try and define how medical device connectivity & interoperability should be enabled in the future

Currently, Interoperability is a “Service” that is offered as part of the implementation process by the system integrator or the vendor of the healthcare software. The point is, why should the customer bear the cost of “connecting” the hardware and software OR two software’s within an organisation

In Healthcare we are working towards providing such seamless and plug-n-play connectivity between EMRs, medical devices and now a days, additionally the mobile health applications.

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TRIVENI: A remote patient monitoring solution via @msharmas – Part 1

Data | Medical Devices | Connectivity