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ISOLATE: Isolation System with OpenICE Leveraging Amalgamated Treatments for Ebola

A remote-controllable critical care unit would greatly improve the safety of caregivers and patients. Devices such as patient sensors, monitors, ventilators and infusion pumps could all be remotely accessed and viewable. This would reduce the number of times a caregiver needs to enter or leave a quarantine area. Remote control of medical actuators would also save time in response to a patient's sudden physiological changes. Furthermore, interoperable technologies would improve monitoring and diagnosis for patients in quarantined areas via sensor integration and better data acquisition. http://www.bostonglobe.com/metro/2014/11/06/mass-general-team-builds-remote-devices-that-could-aid-ebola-treatment/tkKRMxROXlLiPjglYRnQfI/story.html

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We aim to reduce the number of times that caregivers are required to enter isolation rooms in the hospital. This will improve caregiver and patient safety. Isolation rooms are used to care for patients who are infected with highly contagious diseases while reducing the risk of spreading these diseases to caregivers, other patients, and the general population. They typically have sophisticated air-handling systems to separate them from the rest of the hospital.
 
Before clinicians can enter these rooms, they must don personal protective equipment (PPE). This can a long time to put on, particularly for inexperienced personnel, and makes manipulation of equipment and interaction with the patients more difficult. After the caregivers leave the room, they must carefully remove the PPE and go through a lengthy decontamination process. Errors in following these complicated processes, which must be done perfectly every time, or failures of PPE, can lead to exposures requiring the caregivers to be quarantined or to actual infection of staff, other patients, or the general public.
 
When patients in isolation rooms require treatment with medical devices, there are two options. The devices can be in the room with the patient, or outside the room and connected via extra-long leads and tubing sets. For instance, a ventilator could be located outside of the isolation room and be connected to the patient via a very long tubing set that goes through a taped-up hole in the wall. Infusion pumps are often used in this way, utilizing existing 20-foot-long infusion sets intended for MRI room use. This requires running leads and tubes through openings in the isolation room walls, creating additional opportunities for leaks that would compromise isolation. The very long tubing sets also complicate properly setting and managing ventilators and pumps. The advantage of having the equipment outside is that caregivers can adjust settings, respond to alarms, and change medications immediately without having to suit up and enter the room, thus decreasing the time necessary to react to a patient’s vital sign changes.
 
We believe that the best approach is to place the devices inside the room, where they will operate correctly with normal tubing sets and leads, and to remove the need to enter the room to adjust settings or silence alarms by allowing for remote operation of the devices.
Initially, this would be done via a dedicated computer located immediately outside of the room and tied to the specific devices in that room. This reduces network security risks by using a separate, ‘air-gapped’ network, and reduces the risk of controlling the wrong device by tying the control station to one specific room. We are interested in research to support fully network integration and remote control in the future, but this limited step would allow for rapid deployment of a useful system.
 
Medical device manufacturers commonly create remote-control interfaces for their devices to support internal R&D and testing. We leveraged some of these interfaces for our November 7th demo. An initial phase of implementation could involve equipping an isolation room or similar ICU room at MGH with some of these R&D devices for the purpose of evaluating their suitability for treating isolated patients. This initial phase could be followed by a phase where we adapt the proprietary interfaces to interface with OpenICE, creating a platform for coordinated care of isolated patients. 

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