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Interoperability in the ICU: Improving the efficiency and safety of the critical patient with the help of data

How important is the interoperability between different hardware and software systems in an ICU? What aspects should be taken into account? What are the benefits?

Interoperability in the ICU: Improving the efficiency and safety of the critical patient with the help of data

In an ICU it is common to find devices from different manufacturers intercommunicating with on other, but that do not allow the information being captured to be shared or exploited.

In the ICU environment, multidisciplinary professional teams work under tremendous stress every day. This stress is caused by a number of factors, including the critical condition of the patients they attend, the tight spaces in the majority of the boxes, and the overwhelming number of devices connected to the patients, generating noise and light pollution, to name just a few.

In an ICU it is common to find devices from different manufacturers intercommunicating with on other, but that do not allow the information being captured to be shared or exploited. Given the number of biomedical devices that monitor the critical patient, interoperability is key to maintaining diligence in these units. The communication between systems is an indispensable part of the optimization of processes in the ICU.

The manual collection of relevant data, as well as its volatility, entails a substantial loss of information required for ensuring the quality and safety of care. Therefore, good interoperability architecture in the Critical Medicine department should help reduce that gap.

What are the benefits of having interoperability architecture in the ICU?

The correct application of interoperability architecture can provide many important benefits to ICUs such as:

  • Fast, real-time and reliable access to all the critical patient information, ensuring data quality.
  • Improved accuracy of clinical decision-making through access to all the relevant information about the critical patient.
  • Storage of information obtained from all the critical patients. This permits its use in studies and research that will improve clinical practice and care protocols.

What systems can we connect in the ICU?

Software systems

It is advisable to connect the ICU software to the hospital’s Electronic Health Record system.
The most important data to be exchanged are:

  • Hospital management data. It allows you to maintain an updated inventory of ICU bed occupancy, a patient census, etc.
    Medical History. It allows the exchange of the complete record of allergies and medical history of each patient. This ensures safer patient care.
  • Pharmaceutical prescription system. Once the doctors have prescribed a series of drugs for the patient, they are mechanized in the pharmacy application and immediately available in the ICU system, which allows updated information on the pharmaceutical prescription to be displayed at all times.
  • Radiology and Laboratory systems. The integration of the ICU system with the Radiology and Laboratory systems allows health professionals to immediately access the radiology and laboratory results of critical patients.

Hardware systems

The majority of the hardware systems found in the UCI are good candidates for integration with the software systems, or receiving information, or for remote configuration. The most common devices that are interconnected in an ICU are usually:

  • Multiparametric monitor with invasive and non-invasive sensors. This device automatically registers the patients vital signs and integrates them in their Electronic Health Record, thus improving the quality and safety of care in the ICU.
  • Mechanical ventilation devices. It monitors the ventilation status of the device and also remotely changes the settings of some parameters.
  • Infusion pumps. With this integration, two fundamental objectives can be achieved. Knowing what medication is being infused to the patient at any time, as well as verifying that they correspond with the prescription logged in the pharmacy system, this way increasing the safety of the critical patient.

Secure and reliable technology based on interoperability standards

Correct interoperability architecture requires good definition of communication contracts between systems, based on clinical messaging standards such as HL7, ASTM, DICOM, CDA, etc. In other cases, contracts are regulated by proprietary communication protocols, which makes integration slightly difficult but not impossible. Depending on the use case that intended in each integration, one or another protocol will be used, or their varieties. For example, HL7 allows varieties of XML or ER7 syntaxes, as well as varieties of communication levels like MLLP or HTTP.

The choice of using one protocol or another varies depending on the syntax or level of communication required. Hence, there is some disparity as to whether the systems that are to be connected are going to exchange demographic information for the patient or are simply data extracted from a hardware system; whether it is real-time transmission of information or information with a certain delay; or, for example, whether it is a large volume of data maintained over time or a small set isolated over time.

To give an example, several use cases are listed:
Sending demographic data got a patient between software systems. It is recommended to use HL7 with XML format over HTTP. This allows a greater traceability of this information and the possibility of exploiting it more easily with any software that is capable of receiving messages via HTTP (usually integration via SOAP webservices).
Sending patient vital-signs data maintained over time through a software system. Integration through HL7 standard protocols would facilitate system integration. To reduce the size and latency of messaging it is recommended to use HL7 in its ER7 on TPC variety, also called MLLP (Most Lower Layer Protocol).
Sending data extracted from a hardware system that does not export via network messaging. In this case, the manufacturer proposes its own proprietary protocol that the system wishing to be integrated should implement to enable intercommunicate between both.
Taking into account all of the above, the vital importance of a correct definition of architectures and interoperability contracts cannot be emphasized strongly enough. This first phase is important for the success of each of the future integrations that are developed with the system in question.

What are the pillars of the information technology architecture in an ICU?

Adrian Molina Calvo, software architect, comments on the three innovative pillars of the technology behind the ehCOS SmartICU solution: The open and robust ehCOS technology platform, its interoperability with all devices, and the application of Big Data methods to handle the enormous amount data generated in the ICU.

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Adrián Molina Calvo

Systems Engineer Adrián Molina is engineer at everis, with experience in the development and interoperability of Healthcare systems. He is part of the development team of ICU solution ehCOS SmartICU.


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