Subscribe to RSS
Development and Validation of a Portable Platform for Deploying Decision-Support Algorithms in Prehospital Settings
16 April 2013
accepted: 13 August 2013
16 December 2017 (online)
Background: Advanced decision-support capabilities for prehospital trauma care may prove effective at improving patient care. Such functionality would be possible if an analysis platform were connected to a transport vital-signs monitor. In practice, there are technical challenges to implementing such a system. Not only must each individual component be reliable, but, in addition, the connectivity between components must be reliable.
Objective: We describe the development, validation, and deployment of the Automated Processing of Physiologic Registry for Assessment of Injury Severity (APPRAISE) platform, intended to serve as a test bed to help evaluate the performance of decision-support algorithms in a prehospital environment.
Methods: We describe the hardware selected and the software implemented, and the procedures used for laboratory and field testing.
Results: The APPRAISE platform met performance goals in both laboratory testing (using a vital-sign data simulator) and initial field testing. After its field testing, the platform has been in use on Boston MedFlight air ambulances since February of 2010.
Conclusion: These experiences may prove informative to other technology developers and to healthcare stakeholders seeking to invest in connected electronic systems for prehospital as well as in-hospital use. Our experiences illustrate two sets of important questions: are the individual components reliable (e.g., physical integrity, power, core functionality, and end-user interaction) and is the connectivity between components reliable (e.g., communication protocols and the metadata necessary for data interpretation)? While all potential operational issues cannot be fully anticipated and eliminated during development, thoughtful design and phased testing steps can reduce, if not eliminate, technical surprises.
- 1 Medical Device Interoperability: A ‘Wicked Problem’ of Our Time [Internet], [cited 2013 May 27]. Available from: http://www.psqh.com/january-february-2013/1536-medical-device-interoperability-a-wicked-problem-of-our-time.html.
- 2 Hoyt RW, Reifman J, Coster TS, Buller MJ. Combat medical informatics: present and future.. Proc AMIA Symp 2002: 335-339.
- 3 Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research.. Mil Med 1984; 149 (02) 55-62.
- 4 Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, Mallett O, Zubko T, Oetjen-Gerdes L, Rasmussen TE, Butler FK, Kotwal RS, Holcomb JB, Wade C, Champion H, Lawnick M, Moores L, Black-bourne LH.. Death on the battlefield (2001–2011): Implications for the future of combat casualty care.. J Trauma Acute Care Surg 2012; 73 (06) S431-S437.
- 5 Medical Device Plug-and-Play (MD PnP) Interoperability Program [Internet], [cited 2013 May 27]. Available from: http://www.mdpnp.org/uploads/Oct12_MD_PnP_White_Paper.pdf.
- 6 Chen L, McKenna TM, Reisner AT, Gribok A, Reifman J. Decision tool for the early diagnosis of trauma patient hypovolemia.. J Biomed Inform 2008; 41 (03) 469-478.
- 7 Reisner AT, Chen L, Reifman J. The association between vital signs and major hemorrhagic injury is significantly improved after controlling for sources of measurement variability.. J Crit Care 2012; 27 (05) 533e1-533e10.
- 8 Propaq Encore Monitors [Internet], [cited 2012 June 12]. Available from: http://www.welchallyn.com/apps/products/product.jsp?id=11-ac-100-0000000001101.
- 9 Rugged Ultra Mobile PC [Internet], [cited 2012 June 12]. Available from: http://www.gditronix.com index.cfm?page=Products:MR-1.
- 10 MATLAB [Internet], [cited 2012 June 12]. Available from: http://www.mathworks.com.
- 11 Chen L, McKenna TM, Reisner AT, Reifman J. Algorithms to qualify respiratory data collected during the transport of trauma patients.. Physiol Meas 2006; 27 (09) 797-816.
- 12 Yu C, Liu Z, McKenna TM, Reisner AT, Reifman J. A method for automatic identification of reliable heart rates calculated from ECG and PPG waveforms.. J Am Med Inform Assoc 2006; 13 (03) 309-320.
- 13 Reisner AT, Chen L, McKenna TM, Reifman J. Automatically-computed prehospital severity scores are equivalent to scores based on medic documentation.. J Trauma 2008; 65 (04) 915-923.
- 14 Holcomb JB, Gumbert S. Potential value of protocols in substantially bleeding trauma patients.. Curr Opin Anaesthesiol 2013; 26 (02) 215-220.
- 15 IBM Stream Computing [Internet], [cited 2013 May 27]. Available from: http://www-01.ibm.com/software/data/infosphere/stream-computing/.
- 16 Cardiopulmonary Corp (CPC) [Internet]. [cited 2013 May 27], Available from: http://www.cardiopulmonarycorp.com/Medical%20Device%20Integration.
- 17 DocBox [Internet], [cited 2013 May 27]. Available from: http://www.docboxinc.com.
- 18 Boston Children’s Hospital [Internet], [cited 2013 May 27]. Available from: http://www.childrenshospital.org/clinicalservices/Site880/mainpageS880P11.html.
- 19 Khitrov MY, Rutishauser M, Montgomery K, Reisner AT, Reifman J. A platform for testing and comparing of real-time decision-support algorithms in mobile environments.. Conf Proc IEEE Eng Med Bio Soc 2009: 3417-3420.
- 20 Kyriacou E, Pavlopoulos S, Berler A, Neophytou M, Bourka A, Georgoulas A, Anagnostaki A, Karayiannis D, Schizas C, Pattichis C, Andreou A, Koutsouris D. Multi-purpose healthcare telemedicine systems with mobile communication link support.. BioMedical Engineering OnLine 2003; 2 (07) 1-12.
- 21 Switchback Ultra-Rugged, Reconfigurable Field PC. [Internet], [cited 2012 June 12].. Available from: http://web.archive.org/web/20100429065634/http://www.bdatech.com/switchback.
- 22 Chen L, Reisner AT, Gribok A, McKenna TM, Reifman J. Can we improve the clinical utility of respiratory rate as a monitored vital sign?. Shock 2009; 31 (06) 574-580.
- 23 Kilbridge P. Computer crash-lessons from a system failure.. N Engl J Med 2003; 348 (10) 881-882.
- 24 Medical Device Integration: A Look Past the EHR [Internet], [cited 2013 May 27]. Available from: http://www.clinical-innovation.com/topics/technology-management/medical-device-integration-look-past-ehr?page=0%2C1.
- 25 Chen L, McKenna TM, Gribok A, Reifman J. LAM: A landscape matching algorithm for respiratory data alignment.. Conf Proc SPIE 2006; 6235: 1-10.
- 26 Melendez L. Integrating patient data: safety concerns limit functionality.. Biomed Instrum Technol 2012; 46 (01) 64-67.