MDIRA: IEEE, IHE, and FHIR Clinical Device and Information Technology Interoperability Standards, bridging Home to Hospital to “Hospital-in-Home”

The Medical Device Interoperability Reference Architecture (MDIRA) Project is the latest evolution of device and information system integration based on long-standing IEEE 11073x, IHE DEC/ACM/PIV/SDPi, IHE Rosetta Mapping, and HL7 FHIR medical information interoperability projects that began over 20 years ago. The IEEE 11073.x standards provide semantic interoperability; the Rosetta Mapping provides vendor-specific semantic interoperability; the IHE DEC/ACM/PIV /SDPi standards provide device-device and device-system communication of clinical care, alerts, and device control messaging, and FHIR provides the formal, granular, Restful JSON or XML message framework for reliable, flexible communication. Since 2005, IHE has been developing the open-source device toolset for home and hospital use. More recently, the IHE SDPi standards have enabled device control capabilities, a capability accelerated during the COVID-19 Coronavirus pandemic to allow nurses/physicians to operate ventilators and infusion devices outside the contaminated patient room. The SDPi innovations are “just in time,” perhaps, because to support emerging “Hospital in Home” or “ICU in Home” programs, also accelerated by the desire to keep patients safely outside hospital full of COVID patients. Because global adoption of FHIR has been so strong, almost all IHE standards have been revised to support FHIR messaging, too. MDIRA represents a flexible architecture to support device-device or device-EHR communication using either Peer-to-Peer communication (IHE and IoT model), or Peer-to-Aggregator communication (e.g., Open-ICE or Continua). The result of the MDIRA project is the emergence of a standards-based medical communication architecture based on well proven, well documented, and well tested open-source standards