The COVID-19 pandemic has underscored the critical need for remote control capabilities in healthcare, particularly for managing ventilators. The ability to control these life-supporting devices from outside a patient’s room can significantly enhance response times, protect healthcare workers, and minimize the use of personal protective equipment (PPE). As remote control technology evolves, it becomes crucial to address challenges like communication failures and network disruptions that can impact the safety and effectiveness of these systems.
In response to these needs, the U.S. Army Telemedicine and Advanced Research Center (TATRC) launched the Technology in Disaster Environments (TiDE) initiative in 2020. This initiative aimed to accelerate the development of remote control technologies for ventilators and infusion pumps to support tele-critical care during the pandemic and enhance combat casualty care capabilities. As part of this initiative, Nihon Kohden OrangeMed, Inc., and DocBox, Inc. collaborated to create a prototype system for remote ventilator control.
The NK-DocBox system, a joint development by NK and DocBox, integrates the NKV-550 ventilator with advanced network communication protocols and essential software and hardware updates. This system is the focus of this study, enabling remote control of the NKV-550 ventilator from both the patient’s bedside and over the Internet.
The NK-DocBox System: Innovation in Remote Control
The NK-DocBox system integrates the NKV-550 critical care ventilator with advanced network communication protocols and software enhancements. This setup allows for remote operation both from the patient’s bedside and over the Internet. DocBox’s innovative software applications harness this protocol to ensure seamless remote control, addressing the needs of tele-critical care and enhancing clinical capabilities.
Testing for Reliability and Safety
To ensure the NK-DocBox system’s robustness and reliability, comprehensive testing was conducted. Two key methods were used:
- High-Frequency and Erroneous Command Testing: The system was tested using OpenICE, an open-source medical device interoperability platform, to simulate real-world communication failures. This involved sending high-frequency and erroneous commands to assess how the ventilator responded to potential failures.
- Network Quality of Service (QoS) Degradation Testing: A network emulator was used to introduce various types of network QoS degradations, including bandwidth throttling, delays, jitter, packet loss, and bit errors. This testing aimed to evaluate how these disruptions affect system usability and safety.
Key Findings
The results demonstrated that the NKV-550 ventilator performed reliably when remote-control commands were sent at intervals of up to once per second. The system effectively ignored erroneous commands and reset invalid parameters to default settings. However, when network conditions worsened-exceeding thresholds of 500 ms delay, 100 ms jitter, 1% data loss, 12 Mbps bandwidth, or 1e-6 bit error rate-the system experienced performance issues. These included delays in data transmission, visual inconsistencies in ventilator waveforms, and unstable connections between the ventilator and the remote-control application.
Ensuring Safe and Effective Remote Ventilator Control
The testing confirmed the NK-DocBox system’s resilience against high-frequency and erroneous commands and provided valuable insights into the network conditions required for safe operation. These findings are crucial for healthcare facilities relying on remote ventilator control, ensuring they can maintain the necessary network quality to deliver safe and effective patient care.
DocBox’s Clinician Assistance in Critical Care platform continues to lead the way in advancing remote control technology, addressing the challenges of communication failures and network disruptions. Our commitment to innovation and safety ensures that healthcare providers have access to cutting-edge tools that enhance patient care and improve clinical outcomes.
By leveraging these advancements, DocBox is dedicated to supporting healthcare professionals in delivering high-quality care, even in the most demanding environments.
Read more about the study here: Yi Zhang, Bragadeesh Aroulmozhi, David Arney, Mosa Al Zowelei, Michael B Jaffe, Julian M Goldman, Reliability and Safety Testing of a Ventilator Remote Control System Against Communication Failures and Network Disruptions, Military Medicine, Volume 189, Issue Supplement_3, September/October 2024, Pages 171–178, https://doi.org/10.1093/milmed/usae067
