---

IONIC: Open Platform for Information Technology in Intensive Care Units

Obtained/expected benefits:

IONIC is a complete computer based ICU data management information system. General features of the IONIC system may be summarised as follows:

• Ergonomic: Easy to use. Permits more time for patient care.
• Scalable: Grows up to the user´s needs.
• Custom made: to fit the particular ICU needs and traditional "way of working".
• Open: Adopts CEN European norms for networking medical devices
• Internet applications: Access via Web Browser
• Distributed: Integrated information can be accessed and entered from any computer in the network.
• Modular: Cost adaptable to selected modules.

This trial adopts IONIC, the first software application to use the new European norms to facilitate network interworking among medical devices from different manufacturers. The project has demonstrated the benefits of the system on seven beds, each with three different medical devices have been networked to the ICU's central nursing station.

The trial is the first step to demonstrating the benefits of an open system, accessible to any equipment manufacturer. Such an open system will force a step change in the take-up of technology in healthcare by stimulating competition among equipment suppliers, thereby reducing costs, and offering opportunities for niche specialists to provide components, thereby increasing functionality. Such components may be decision support systems, legacy device interface units, intelligent evidence based knowledge retrieval systems.

The trial has allowed joint evaluation of both the technological and the economic benefits of an open system. The application replaces the handwritten paper-based records, currently used at the hospitals, with a fully integrated computer-based open, non-proprietary system. The hospitals have experimented improvements in efficiency and quality of service.

A testimonial:

Dr. Angel Ayensa, Hospital "Virgen de la Salud" Toledo, Spain: "As physician in charge of the Intensive Care Unit , I have had the pleasure to directly collaborate in the different stages of  the IONIC project , working in close collaboration with the technical team, and explaining the needs that we "as users" have to achieve a complete and integrated Information System for our Department. As a result of the works carried out, the final results have -from my point of view- a number of advantages: First, I have the feeling that it has been built according to our specific needs, since it has been adapted to cope with the information handled in the Unit, and following the Operational procedures that we have always had with a paper based system. In second place, the automatic collection of data will no doubt let us capture the data generated by the Medical Devices in a more comfortable and secure way. 
The process of adaptation is taking place in a progressive way, and I am confident that the mentioned advantages, together with the connection to the HIS and the possibilities of statistical analysis will help us no doubt in our daily tasks. IONIC has become a very useful tool for our Intensive Care Unit."   

Dr. John Kinsella, Glasgow Royal Infirmary Hospital: "In the intensive care unit at Glasgow Royal Infirmary the project has had a number of practical consequences and has also generated a number of new issues. We identified the frequency of incorrectly transcribed laboratory data and the project has now enabled us to communicate electronically between the laboratories and the bed side computers and also to a mobile computer on a trolley via a wireless network link. Experience with this equipment did however produce the result that displaying information at the head of the bed, the traditional site for monitors and computers was less useful than displaying information at the foot of the bed where paperwork and notes are traditionally reviewed. The ability to take information from the ventilators and other equipment is clearly an advantage but the clinical utility will become more obvious as we move forward in the next six months with more integrated electronic charting. The project has also resulted in the capability to do this and we look forward to further developments in this area in the future."

Problem and market background:

Hospitals have invested in many sophisticated monitoring and medical devices, but typically these devices work as stand alone units. Integration has only been possible if devices originate from the same manufacturer.

Two new European norms for networking medical monitoring equipment have recently been developed: European Norm (standard) ENV 13734 "Vital signs information representation" and ENV 13735 "Interoperability of patient connected medical devices".

IONIC has succeeded in providing a technical approach to use legacy devices, so the norms can be already used with external adapters, and current devices do not need any adaptation. This reduces the time to market in 5 years, and helps to speed up the deployment of the new technology. Separate market researches of independent companies indicate that there is a strong industrial market for the multipatient Central Computer as well as interface technologies ranging from the hardware and firmware to the software kernels needed in mobile devices and the 'receiving' computers.

It is expected that with the maturing of the mobile medical device market by the year 2007, new upper layer standards will have been developed for other, commercial and industrial, sectors using the object oriented approach of VITAL.

Technical details:

IONIC provides physicians and nurses with a greatly enhanced tool for managing the care of patients, by integrating:

• Monitoring and recording of patient parameters such as ECG, blood pressure, respiration from different vendors and manufacturers.
• Recording of medical device parameters e.g. those of infusion pumps to deliver appropriate doses of drugs, and those of ventilators.
• Scheduling and recording of nursing activities, care plans and charts.
• Recording of medical notes in an electronic patient record.
• Requesting laboratory services (e.g. blood chemistry) and retrieval of the results for display and storage.
• Integration of the ICU bedside with the hospital patient administration system.

The base module allows up to any number of beds to be handled, each equipped with Medical Devices of a selected type, which can be networked to a central nursing station for automatic data acquisition.

IONIC has been developed in a Multiplatform (Windows, LINUX, etc) environment and requires a minimum configuration of a standard Personal Computer for each workstation; a Server unit with UPS holds an SQL based Database and an additional CD recorder unit for data storage.

Consortium:

The IONIC system is the result of the joined cooperation of:

• Trends In Technology - Madrid (SPAIN) Technology supplier. The role of Trends in Technology in IONIC has been to collaborate in implementation tasks, to provide the expertise in areas such as software communication and medical device networking, to co-ordinate activities, to define system specifications and to implement the tasks, to deal with dissemination activities in support of European norms wide adoption and deployment and to provide commercial and exploitation capability.
• Glasgow Royal Infirmary - Glasgow (UK) Trial Site. Glasgow's role has been two-fold: first as an end-user and secondly as a source of technical expertise.
• Hospital Virgen De La Salud - Toledo (SPAIN) Trial Site. User organization, with high expectation of technological solutions.

Contact Point:

Esperanza Nolasco Trends in Technology, SL New Products Division c/ Basílica, 20; 2ºB, 28020 Madrid - SPAIN Tel: +34 91 5532623 Fax: +34 91 5351674 e-mail: pnolasco@trendsit.com

Trends in Technology, SL IT solutions throughout the continuum of healthcare.

IONIC is part of the cluster EUTIST-M ;
www.medicaltech.org