Medical device system including information technology infrastructure having secure cluster domain supporting external domain

BACKGROUND

0001The present disclosure relates generally medical device systems and more particularly to the managing and running of an information technology ("IT") infrastructure with connection to external systems like clinic information systems ("CIS"), billing systems, laboratories, and the like.

0002IT connectivity for medical systems was introduced originally to only a selected set of medical providers and was strictly proprietary. Eventually, medical IT systems gradually started to rely on standardized solutions, which were considered advantageous from cost and development perspectives. On the downside, where responsibility resided before with the proprietary system providers, standardized solutions split the responsibility for the reliability of the IT systems onto several parties, the major responsibilities being delegated to the associated equipment manufacturer, the CIS manufacturer, and IT professionals.

0003The complexity involved in managing the infrastructure of a medical device IT system is considerable and, in general, only larger clinics may afford the cost and competence to setup and maintain such a system running with the reliability and availability required in a health care environment. The result is that progress in using IT-based support to increase the efficiency in medical device settings, such as dialysis clinics, has been slow. Indeed, many would say that little progress has been seen over the last thirty years in the health care environment when compared to the explosive development of today's personal computing and smart mobile communication devices.

0004The burden on the clinic is further increased by the fact that the clinic is ultimately responsible from a quality management and risk analysis perspective when combining all subsystems and equipment into a unit. The responsibility imposes expectations on the clinic to have access to qualified personnel for performing such quality and risk management evaluations, since most equipment and software manufacturers will refrain from assuming such responsibilities when their products are combined with other products, or integrated in a system in which the software manufacturers have no prior or upfront knowledge.

0005To summarize, most medical treatment settings (e.g., dialysis clinics) today recognize the potential of IT systems in reducing errors, documentation workload and other administration workload. The clinics also recognize the cost and complexity of managing different IT solutions and that off-the-shelf support for integrating such systems is very limited. That is, the clinics realize that they will shoulder the burden of implementing and maintaining an IT solution. Most clinics however do not have and cannot afford dedicated IT personnel.

0006While there is a widespread desire to use IT for therapy management, many electronic medical record systems in place do not meet the needs from either a data structure or a reporting perspective. Existing systems are accordingly perceived as lacking understanding for the medical user's needs in the context of clinic workflow management.

0007An improved IT solution for medical treatment settings, e.g., dialysis clinics, in which there is a large data management need but a relatively small IT budget, is needed accordingly.

0008Document <patcit id="pcit0001" dnum="US20160105402A"><text>US2016/0105402</text></patcit> discloses a healthcare system related to homomorphic encryption in a healthcare network environment including a data custodian executing in a cloud configured with a clinical operating system. Various data sources (e.g., hospitals, clinics, pharmacies, laboratories, patients, etc.) provide healthcare data to backend systems. Backend systems characterize (e.g., categorize, tag, extract, describe) the healthcare data from data sources. Data are entered into an encrypted database that comprises a distributed storage system storing its contents across various physical storage devices in a storage area network. The single database distributes its huge data content among several different storage media.

0009Document <patcit id="pcit0002" dnum="US20120158882A"><text>US2012/0158882</text></patcit> provides a distributed storage architecture that is highly scalable based on a parallel file system implemented across the distributed nodes. Host computers 104 communicate with laboratory workstation and medical practitioner workstation, as well as specialized systems, such as MRI system, through computer network. The distributed configuration further includes storage systems for storing data; users and computer programs store data on, and retrieve data from, storage system. The distributed system comprises application nodes having parallel file system interfaces to allow the application nodes to communicate with each other and with other components in the distributed system at file level through a parallel file system 218. The parallel file system (a distributed file/network system) is a file system that allows access and sharing of files from multiple computers in a network.

0010Document <patcit id="pcit0003" dnum="EP2080134A"><text>EP2080134</text></patcit> discloses a distributed network of wirelessly intercommunicating medical devices configured to monitor vital signs or other significant physiological parameters of a patient, provide controlled drug delivery to the patient and providing flow-controlled intravenous fluid delivery to the patient. It addresses in particular how detecting a compromised node and excluding it from the network.

0011<patcit id="pcit0004" dnum="US2011225008A1"><text>US 2011225008 A1</text></patcit> refers to a medical communication system that implements a self-similar nodal network to provide an efficient and highly scalable architecture for collecting, storing, transmitting, and retrieving personal medical-related information concerning patients that utilize the system. This information is collected using various types of patient sensors. A self-similar nodal network has a hierarchical data communication architecture composed of a plurality of communicatively interconnected nodes, each having a corresponding time-sequenced database (TSdB) and each being capable of receiving information from patient sensors directly and/or through other nodes. Data mirroring technique creates a backup of information residing on a node, or when there is intermittent connectivity between a child node and a parent node.

SUMMARY

0012The medical device information technology ("IT") system and methodology of the present disclosure is applicable to medical devices such as those for: hemodialysis ("HD"), hemofiltration ("HF") hemodiafiltration ("HDF"), and continuous renal replacement therapy ("CRRT") treatments. The medical device IT system described herein is also applicable to peritoneal dialysis ("PD"). These modalities may be referred to herein collectively or generally individually as medical fluid delivery. The medical devices may house components needed to deliver medical fluid, such as one or more pump, plural valves, a heater if needed, online medical fluid generation equipment, plural sensors, such as any one, or more, or all of pressure sensors, conductivity sensors, temperature sensors, air detectors, blood leak detectors, and the like, a user interface, and a control unit, which may employ one or more processor and memory to control the above-described equipment. The medical fluid delivery device may also include one or more filter, such as a dialyzer or hemofilter for cleansing blood and/or an ultrafilter for purifying water, dialysis fluid, or other fluid.

0013The medical device IT system and methodology of the present disclosure may be used with medical devices located in a clinic/hospital or with home-based medical devices. One suitable hemodialysis machine for a clinical setting is described in <patcit id="pcit0005" dnum="US8647290B"><text>U.S. Patent No. 8,647,290</text></patcit> entitled "Hemodialysis or Hemo(dia)filtration Apparatus and a Method for Controlling a Hemodialysis or Hemo(dia)filtration Apparatus". One suitable CRRT machine for a hospital or clinical setting is described in <patcit id="pcit0006" dnum="US8911390B"><text>U.S. Patent No. 8,911,390</text></patcit>, entitled "Multipart Fluid System And A System For Regional Citrate Anticoagulation In An Extracorporeal Blood Circuit". One suitable home system is described in <patcit id="pcit0007" dnum="US8029454B"><text>U.S. Patent No. 8,029,454</text></patcit>, entitled "High Convection Home Hemodialysis/Hemofiltration and Sorbent System". Another such home system is described in <patcit id="pcit0008" dnum="US8393690B"><text>U.S. Patent No. 8,393,690</text></patcit> entitled "Enclosure for a Portable Hemodialysis System". One suitable peritoneal dialysis system that may be used at home or in a clinic is described in <patcit id="pcit0009" dnum="US9248225B"><text>U.S. Patent No. 9,248,225</text></patcit>, entitled "Medical Treatment System and Methods Using a Plurality of Fluid Lines".

0014Each of the above types of medical devices is a node in a cluster of multiple nodes, which share a common distributed database. Each node of the cluster shares its data (e.g., (i) data concerning its programmed operating parameters, (ii) data gathered from a treatment such as medical device output data, event data, and patient data, and (iii) any other relevant data) with each other node of the cluster. To share its data, the cluster is configured such that the nodes (i) push their data to each other, (ii) pull their data from each other, or (iii) push and pull data from each other. Further, to share its data, the cluster is configured such that (a) the nodes each send their data to each other node using (i), (ii) or (iii) or (b) one or more hub node may be provided that collects data from a subset of nodes, shares the data along with its own data within the subset, passes the collected data along with its own data to any other existing hub node for distribution within the other node's subset, and receives collected data from any other hub node for distribution within its own subset, using (i), (ii) or (iii).

0015Regardless of how information is shared within the cluster or distributed database, the information and information sharing is secure and complete. The information is secure for multiple reasons. First, only cluster compatible and certified nodes are connected to the cluster, and only these nodes may share data. Managed exceptions to this rule are described below. Second, software for the cluster is proprietary, so that outside devices not having the proprietary software cannot communicate with the nodes even if somehow connected to the same network as the nodes of the cluster. The proprietary software may have standardized components, e.g., may use open source software, but the overall software is proprietary.

0016The cluster is in one embodiment provided by the medical device manufacturers. The secure distributed database is deployed as part of each medical device participating as nodes in the cluster. The cluster compatible medical devices connect in a network and automatically form the shared or distributed database of the present disclosure, which is formed around a physical database (hard disk-based) residing in each physical medical device. Discussed below are many functions that the cluster of nodes may control. The cluster of devices (nodes) designed for running as cluster member nodes assumes the majority of the responsibility for handling the complexities associated with an open IT infrastructure and is accordingly an attractive option for clinics and any other medical device setting in which there is a large data management need but a relatively small IT budget. Some responsibility may still reside with the clinic, such as providing cabling and other hardware.

0017The cluster and its nodes form a cluster domain. It is expected that most if not all clinics or other medical device settings will have some sort of computer network upon which nurses, clinicians and technicians may use to run pertinent software, such as third party clinical software, billing software, accounting software, etc. Any of this software outside of the cluster domain may be said to form an external domain.

0018Some of the external domain software may have a need for at least some of the data shared within the distributed database. Additionally, depending upon what functions are handled within the cluster domain, there is a need for the distributed database to receive data from and deliver data to the external domain. To do so, it is contemplated to create or designate one or more nodes of the distributed data base as an access node. Each access node has an internal part and an external part, which may only communicate with each other through one or more controlled interface, such as a memory manager. The external part of the access node interfaces with the external domain, while internal part of the access node interfaces with the cluster domain. The cluster access nodes forms an interface domain between the open external domain and the internal cluster domain.

0019It is contemplated to provide three different types of access options. A first type of access option is an access node, which is a distributed database access node. This access node maintains the shared database formed between all the other nodes. The distributed database access node receives all data from all other nodes generating data and permanently storing the data. The distributed database access node enables a client device to receive data from the shared database and to add data to the shared database. While the access nodes are generally described as being different from the medical devices of the cluster, it is contemplated that a medical device may also provide access capabilities and therefore also form an access node.

0020A second type of access option is also an access node, but which is a conversion only node or non-distributed database access node. A non-distributed database access node does not contain the shared database and is instead limited to allowing a client device to interact functionally with a cluster node. For example, it may be desired to send from a weight scale a patient's weight data wired or wirelessly to the cluster via the non-distributed database access node. In an embodiment, the non-distributed database node connects to a distributed database node and transfers its information to that node. The transferred information is shared with the rest of the distributed database at the next distributed database update. The weight data along with a patient identifier may then be recalled by whichever node or medical device has need for the weight data, e.g., the node or medical device treating the patient that day. The conversion only access node enables a secure transfer of the weight data to the cluster of nodes but does not itself contain the distributed database.

0021Besides the two types of physical access nodes, it is contemplated to provide a third type of interface between the distributed database domain and the external domain, which may be referred to as a virtual access node. The access node is considered virtual because there is no additional hardware involved. The virtual node may for example be software in a doctor's or clinician's computer that runs in its own open network separated from the distributed database. The doctor or clinician's computer and the lab technician's computer may run software that needs to or benefits from sharing information with the distributed database. Such software might for example require data from the lab technician's computer, e.g., patient test results. While it is contemplated that the doctor or clinician's computer be able to send service requests via an access node to invoke operational routines running in the distributed database, it may alternatively be possible and perhaps desirable to enable the doctor's computer to access the distributed database virtually with the assurance that the doctor's computer is protected enough to do so. For example, the security may be provided via a virtual private network ("VPN") between the doctor's computer and the part of a virtual access node that resides inside a medical device.

0022The medical device IT system and methodology of the present disclosure reduces the overall complexity of managing and running an IT infrastructure, while offering full flexibility to connect to external systems (a CIS, billing systems, laboratories, etc.) deployed within or outside a medical device clinic. The IT system and methodology is hidden and controlled at a single responsible part (the cluster configuration and its associated distributed database) for critical areas like reliability, availability, security, safety and integrity, while at the same time providing access to services needed in the clinic from a process, staff and patient perspective. The IT system and methodology is able to integrate patient related medical information stored in the distributed database with the clinic's overall medical record system and with information used and produced by equipment at the patient's bedside, before, during and/or after treatment.

0023The medical device IT system and methodology of the present disclosure enables data to flow both ways, in real time, e.g., between outside medical equipment and the medical devices of the cluster, enabling, for example, correct dialysis equipment setup prior to treatment based on physician's prescriptions and on information generated at the bedside, e.g., under the guidance of nurses and other dialysis caregiver staff, before, during and/or after treatment. Conversely, it may be desired that actual treatment result information from medical equipment, e.g., events (e.g., alarms, alerts) generated and documented on the equipment, and nurse's notes or inputs associated with a treatment be transmitted back to the CIS for short and/or long term medical evaluation.

0024The complexity of running current "open" IT structures in the clinics originates from maintaining an infrastructure of application servers with server software, database servers, backup servers (physically separated from the servers), IT network (wired or wireless, cabling and routers) and client computers with client software. Integrating such infrastructure within medical device equipment to collectively form a distributed database, in combination with supporting proprietary connectivity equipment (access nodes), in a "closed" cluster configuration with access to/from external systems (e.g. a CIS or any other information management system) causes the main responsibility for the overall reliability of such an infrastructure to be limited and confined within the well-controlled realm of the medical equipment and its integrated distributed database.

0025The advantages of the medical device IT system and methodology of the present disclosure are applicable to home treatment and other external scenarios as well. There may for example be a separate cluster of nodes forming a virtual network of, e.g., home dialysis machines, or a mixture of in-center and home dialysis machines. The clinic responsible for the home-based medical devices may still benefit from the synchronization mechanisms and other services offered by the cluster. The main exception is the control of the transport infrastructure, which in case of home patients cannot be claimed to be under the control of the cluster configuration. This may affect availability and performance since disturbances in such infrastructure is beyond control from the cluster. However, most other benefits of the cluster configuration in addition to synchronization will still be available, e.g. safety, security, integrity and information exchange will still be available, albeit subject to data rates offered by the transport chain between clinic and the patient home environment.

0026Cluster inclusion of medical devices external to a clinic or hospital may be valuable in a situation in which a patient normally treated in a clinic is instead treated temporarily outside the clinic (e.g., home, work trip or vacation). The system of the present disclosure may ensure that all medical devices belonging to a clinic are configured in the same way (e.g., technically), regardless if they are used inside or outside of the clinic. In an embodiment, medical devices or nodes used at the patient's home location are given restricted access to the shared database, so that the patient may only see his or her own data and the information needed to setup and run a treatment. The data generated by the external treatment is added to the shared database. The device is therefore not necessarily operating "offline" from the database when operating outside of the hospital or clinic.

0027In a third aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the at least one access node is provided with one the medical devices.

0028In a fourth aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the at least one access node does not host the distributed database.

0029In a fifth aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the at least one external equipment is a first external equipment, and which further includes a virtual access node of the cluster formed via a second external equipment, the virtual access node providing a secure data exchange environment so as to ensure security of the cluster operating with the second external equipment.

0030In a sixth aspect of the present disclosure, which may be combined with the fifth aspect in combination with any other aspect listed herein unless specified otherwise, the secure data exchange environment includes a secure channel such as a virtual private network.

0031In a seventh aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the at least one external equipment is configured to deliver data to the distributed database, the data used by one of the medical devices implementing one of the nodes for treatment.

0032In an eighth aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the plurality of medical devices are of a same treatment type.

0033In a ninth aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the plurality of medical devices are treating a same patient.

0034In a tenth aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, the distributed database is populated by (i) each of the nodes that produces data pushing its data to other nodes, (ii) each of the nodes having distributed database pulling data from other nodes, or (iii) a combination of (i) and (ii).

0035In an eleventh aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, a medical device system includes: a cluster including a plurality of nodes; each of a set of the nodes implemented by a medical device; a distributed database hosted by each of the medical devices; at least one first access node that hosts the distributed database; at least one second access node provided separately from the distributed database; and at least one external equipment outside of the cluster, the at least one external equipment able to at least one of (i) write to, or (ii) read from, the distributed database via the at least one first access node or the at least one second access node.

0036In a twelfth aspect of the present disclosure, which may be combined with the eleventh aspect in combination with any other aspect listed herein unless specified otherwise, the at least one first access node and the at least one second access node are separate from the medical devices.

0037In a thirteenth aspect of the present disclosure, which may be combined with the eleventh aspect in combination with any other aspect listed herein unless specified otherwise, the at least one first access node and the at least one second access node are provided with or operate with a user interface.

0038In a fourteenth aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, a medical device system includes: a cluster including a plurality of nodes; a plurality of medical devices implementing at least some of the nodes; at least one of the nodes being an access node including an external part and an internal part; a distributed database provided along the cluster and hosted by at least some of the nodes, the distributed database, if stored by the at least one access node, associated with the internal part of the access node; and at least one external equipment outside the cluster, the at least one external equipment able to at least one of (i) write to, or (ii) read from, at least some of the distributed database via the external part of access node.

0039In a fifteenth aspect of the present disclosure, which may be combined with the fourteenth aspect in combination with any other aspect listed herein unless specified otherwise, the external part and the internal part are separated by a processing and memory manager that knows how to (i) place data into the external part coming from the internal part and (ii) place data into the internal part coming from the external part.

0040In a sixteenth aspect of the present disclosure, which may be combined with any other aspect listed herein unless specified otherwise, a medical device system includes: a cluster including a plurality of nodes; a plurality of medical devices implementing at least some of the nodes, each medical device including processing and memory configured to perform a medical procedure; and a distributed database shared along the cluster by at least some of the nodes, the distributed database deployed on the plurality of medical devices, the distributed database separated from the processing and memory configured to perform the medical procedure by a processing and memory manager that knows how to (i) place data into the processing and memory configured to perform the medical procedure coming from the distributed database and (ii) place data into the distributed database coming from the processing and memory configured to perform the medical procedure.

0041In a seventeenth aspect of the present disclosure, which may be combined with the sixteenth aspect in combination with any other aspect listed herein unless specified otherwise, the processing and memory configured to perform the medical procedure are configured to initiate communication with the distributed database via the processing and memory manager.

0042In an eighteenth aspect of the present disclosure, which may be combined with the sixteenth aspect in combination with any other aspect listed herein unless specified otherwise, the distributed database is located in a cluster control part of the medical device that is separate from the processing and memory configured to perform the medical procedure located in a therapy control part of the medical device, the cluster control part separated from the therapy control part by the processing and memory manager.

0043In light of the present disclosure, it is therefore an advantage of the present disclosure to provide an improved medical information technology ("IT") system in which connectivity is integrated into the associated medical devices.

0044It is another advantage of the present disclosure to reduce the clinic's cost of ownership for an IT connectivity solution in a health care environment, and wherein responsibility for operation is centralized around a cluster of nodes having a well defined scope.

0045It is a further advantage of the present disclosure to improve reliability, availability and correctness of an IT connectivity solution in a health care environment.

0046It is still another advantage of the present disclosure to provide an IT connectivity solution in a health care environment that is easy for caregiver staff, e.g., nurses and technicians, to use, and which reduces overhead work.

0047It is still a further advantage of the present disclosure to provide an IT connectivity solution in a health care environment that promotes and supports the needs of at least one of a care giver (remote alarms, instant access, bidirectional information flow), a physician, whose primary concerns are the welfare of and benefits for the patient (prescription updates, access to information even if the medical devices belonging to the cluster are not available, real time retrieval of patient data), an IT technician (reduced IT complexity, responsibility held at least in part by the medical device maker), a service technician (software installs and updates may be cluster wide, historical data readily available, early warning diagnostics), and/or an administrator (easy to set and implement clinical preferences, run reports and obtain statistics, easy to schedule medical devices for treatments, easy to track patient data).

0048Further still, it is an advantage of the present disclosure to provide an IT connectivity solution that provides all updates, instantly, to all nodes, with low risk of distorted information.

0049It is yet another advantage of the present disclosure to provide an IT connectivity solution that is two-way between a secured, real time distributed medical device domain and an outside, open external domain, and which has malware immunity.

0050It is yet a further advantage of the present disclosure to provide scalability to a clinic or other medical device setting in which a cluster of medical devices may operate alone, with a lesser set of external devices upon installation, and with an expanded set of external databases in the future if desired.

0051Still a further advantage of the present disclosure is to provide an IT connectivity solution that enables a medical device node or access node that is temporarily disconnected (by choice or by accident) from the cluster of nodes to still have access to the distributed database as it existed at the time of disconnection and to be updated upon reconnection to the cluster of nodes.

0052Moreover, it is an advantage of the present disclosure to provide a medical device IT connectivity solution that provides good overall reliability regarding at least one of data availability, correctness, security, safety, integrity and/or usability.

0053The advantages discussed herein may be found in one, or some, and perhaps not all of the embodiments disclosed herein. Additional features and advantages are described herein, and will be apparent from, the following Detailed Description and the figures.

BRIEF DESCRIPTION OF THE FIGURES

0054<ul id="ul0001" list-style="none" compact="compact"><li><figref idref="f0001">Fig. 1</figref> is a schematic view illustrating one embodiment of a cluster of nodes sharing a distributed database of the present disclosure.</li><li><figref idref="f0002">Fig. 2</figref> is a schematic illustration of one embodiment of an overall medical device information technology ("IT") system including a cluster of nodes forming a cluster domain that communicates with an open external domain via an interface domain.</li><li><figref idref="f0003">Fig. 3</figref> is a schematic view of one embodiment of an overall medical device IT system that includes a cluster of nodes sharing a distributed database interfacing with plural external entities via multiple access nodes of the cluster.</li><li><figref idref="f0004">Fig. 4</figref> is a schematic view further illustrating examples of external information system equipment.</li><li><figref idref="f0005">Fig. 5</figref> is a schematic view further illustrating an example of presentation type external equipment.</li><li><figref idref="f0005">Fig. 6</figref> is a schematic view further illustrating an example of tablet and computer type external equipment.</li><li><figref idref="f0005">Fig. 7</figref> is a schematic view further illustrating an example of shared medical type external equipment.</li><li><figref idref="f0005">Fig. 8</figref> is a schematic view further illustrating an example of bedside medical type external equipment.</li><li><figref idref="f0006">Fig. 9</figref> is a schematic view illustrating one embodiment of a distributed database access node and an enlarged view of a medical device node of the cluster system of the present disclosure.</li><li><figref idref="f0007">Fig. 10</figref> is a schematic view further illustrating the isolation aspects of a medical device node of the cluster system of the present disclosure.</li><li><figref idref="f0008">Figs. 11</figref> and <figref idref="f0009">12</figref> are schematic views illustrating one embodiment of an enlarged view of a distributed database access node of the cluster system of the present disclosure.</li><li><figref idref="f0010">Fig. 13</figref> is schematic view illustrating one embodiment of an enlarged view of a non-distributed database access node of the cluster system of the present disclosure.</li><li><figref idref="f0011">Fig. 14</figref> is a schematic view illustrating one embodiment of how the cluster domain includes the cluster having the distributed database and a therapy control part of each medical device node.</li><li><figref idref="f0012">Fig. 15</figref> is a schematic view illustrating one embodiment of a virtual access node of the cluster system of the present disclosure.</li></ul>

DETAILED DESCRIPTION

0055The examples described herein are applicable to medical devices that deliver a medical fluid, such as blood, dialysis fluid, substitution fluid or an intravenous drug ("IV"). The examples are particularly well suited for kidney failure therapies, such as all forms of hemodialysis ("HD"), hemofiltration ("HF"), hemodiafiltration ("HDF"), continuous renal replacement therapies ("CRRT") and peritoneal dialysis ("PD"), referred to herein collectively or generally individually as renal failure therapy. The medical devices may have any one or more of: one or more pump, plural valves, a heater if needed, online medical fluid generation equipment, plural sensors, such as any one, or more, or all of pressure sensors, conductivity sensors, temperature sensors, air detectors, blood leak detectors, and the like, a user interface, and a control unit, which may employ one or more processor and memory to control the above-described equipment. The medical device may also include one or more filter, such as a dialyzer or hemofilter for cleansing blood and/or an ultrafilter for purifying water, dialysis fluid, or other fluid.

0056The medical devices in many instances include a reusable part operating with a disposable part. The reusable part may (e.g., online blood treatment dialysis machines) or may not (e.g., peritoneal dialysis machines, CRRT machines, drug and nutritional fluid delivery machines) carry treatment fluid. The disposable part may carry blood (blood treatment including CRRT machines) or treatment fluid (peritoneal dialysis machines, CRRT machines).

0057Referring now to the drawings and in particular to <figref idref="f0001">Fig. 1</figref>, a cluster of nodes 10 is illustrated. Cluster 10 includes a plurality of nodes 12a to 12h (referred to herein collectively as nodes 12 or generally individually as node 12). Nodes 12 may be represented by any of the medical devices described above. Any of nodes 12 may alternatively be a computer. Most of the nodes of cluster 10 share a common set of data or distributed database 14. As discussed in detail below, access node 12h does not possess or share distributed database 14.

0058Distributed database 14 is the combination of all data inputted to and generated at each of nodes 12, including data generated by non-distributed database node 12h. That is, even though node 12h does not share distributed database 14, data may still come in through non-distributed database node 12h or be generated by node 12h, which becomes part of distributed database 14 shared by nodes 12a to 12g.

0059In general each node 12 of cluster 10 shares its data (e.g., (i) data concerning its programmed operating parameters, (ii) data gathered from a treatment such as medical device output data, event data, and patient data, and (iii) any other relevant data) with each other node 12 of cluster 10, except certain access nodes, such as node 12h . To share its data, cluster 10 may be configured such that nodes 12 (i) push their data to each other, (ii) pull their data from each other, or (iii) push and pull data from each other. Further, to share its data, cluster 10 may be configured such that (a) nodes 12 each send their data to each other node using (i), (ii) or (iii) or (b) one or more hub node may be provided that collects data from a subset of nodes, shares the data along with its own data within the subset, passes the collected data along with its own data to any other existing hub node for distribution within the other node's subset, and receives collected data from any other hub node for distribution within its subset, using (i), (ii) or (iii).

0060The nodes of cluster 10 run on proprietary software and access to distributed database 14 is limited to that described below. The software may be built using off the shelf components, such as open source software, but the overall product is proprietary. Thus, even if cluster 10 is somehow improperly accessed or hacked, access to distributed database data 14 is difficult without the proprietary software (e.g., software developed in-house by the medical device manufacturer, which may use publically available software, such as open source software, but which itself is not publically available). Cluster 10 may therefore, within a closed environment, be trusted handle all aspects regarding the complexities associated with existing clinics running open IT infrastructures. Such complexities may include assuming: (i) required server (service) and synchronization roles, (ii) database deployment, (iii) network solutions on all levels (except perhaps on a physical and link layer level, where there is an option of either running on an existing/shared hardware infrastructure or running a virtual private network on existing clinic IT hardware solutions), and (iv) backup server roles as each node 12 having common set of data 14 acts as a backup device (except a requirement that a back-up server has to be physically separated from any other device).

0061By integrating information technology ("IT") infrastructure support within a medical device, in combination with supporting proprietary connectivity equipment, in a "closed" cluster configuration with limited access to/from cluster-external systems (e.g., a client information system ("CIS") or any other information system), the responsibility for the overall reliability of such IT infrastructure is restricted and confined within the well-controlled realm of the medical equipment, e.g., medical fluid delivery device nodes 12.

0062Referring now to <figref idref="f0002">Figs. 2</figref> and <figref idref="f0003">3</figref>, cluster 10 of <figref idref="f0001">Fig. 1</figref> is illustrated as being part of an overall medical device information technology ("IT") system 110. <figref idref="f0002">Fig. 2</figref> illustrates that system 110 includes an external domain 110a, a cluster domain 110b, and an interface domain 110c, which links external domain 110a to cluster domain 110b. In <figref idref="f0002">Fig. 2</figref>, cluster 10 of <figref idref="f0001">Fig. 1</figref> is illustrated as being part of cluster domain 110b. There may be multiple clusters 10 forming cluster domain 110b. For example, there may be different clusters 10 for the different types of medical devices described above at nodes 12.

0063Cluster domain 110b represents core functionality of the cluster database services and infrastructure. Cluster domain 110b handles the transfer and conversion of information flow in both cluster 10 inbound and outbound directions between it and external domain 110a. As discussed above, each node 12 (except node 12h) of cluster 10 holds shared data 14. Each node 12 of each cluster 10 (there may be more than one cluster 10 in domain 110b) of cluster domain 110b is mutually synchronized, which allows for arbitrary member nodes 12 to be shut down while still maintaining external access to the services and information of cluster 10.

0064Each cluster 10 of cluster domain 110b forms a protected space both in terms of network traffic and information access, incorporating a significant amount of redundancy, with a purpose to guarantee that cluster 10 is available at all times. Cluster 10 maintains a high degree of information integrity; implements secure ways of accessing information from clients external to the cluster, while meeting established security requirements associated with the connection of the medical devices of nodes 12 to outside equipment.

0065In one embodiment, if a medical device associated with a node 12 is for whatever reason accessed without using the node (e.g., via a virtual access discussed below), the medical device is subject to certain security requirements. For instance, if the medical device is to be connected, e.g., via a wired local area network ("LAN"), both to cluster 10 and to a piece of outside client equipment, then two separated LAN connectors are required in one embodiment, one connector reserved for cluster 10 connectivity and a second connector for open environment connectivity. In another embodiment, the LAN connectors may be shared for both the cluster and open environments but software isolation is employed. Separation within cluster 10 may therefore employ different combinations of hardware and software isolation between a cluster 10 LAN connection and the connection to the open environment. Providing such isolation and maintaining responsibility for quality, IT connectivity, and associated services inside a well confined cluster 10, where equipment is developed under a strict rigor associated with medical products, results in a redundant and highly stable system of operation.

0066One important application of cluster 10 is to support technical maintenance of the equipment occupying nodes 12. In the same way that nodes 12 replicate medical information, they may also replicate downloaded code (e.g., medical device software updates). By connecting, e.g., via a laptop or tablet device via an access node 12a or 12h (discussed below), a service technician may diagnose, configure and update software on the medical device, including the gathering of technical statistical information to promote preventive maintenance.

0067From a medical perspective, cluster 10 will assist in a multitude of areas, e.g., operational prescription management, treatment result assembly and storage, treatment session reporting, and medical record management and support. From an alarm perspective, cluster 10 constantly updates and distributes alarms and other real time events between nodes 12 of cluster 10, including medical equipment and access nodes 12.

0068Still another area in which cluster 10 may play an important role is for synchronization between different types of connected equipment. Multiple online dialysis fluid generation dialysis machines are connected fluidically to a central water supply loop that supplies purified water to the machines, which use the purified water to prepare dialysis fluid. The water supply loop needs to be cleaned periodically, e.g., via hot water disinfection. The custom software of cluster 10 is able to ascertain when each of the dialysis machine nodes 12 is available for having its portion of the water supply loop disinfected, so that a disinfection sequence may be commenced that efficiently and optimally cleans the entire water supply loop, including portions of the loop connecting the machines to the remainder of the water supply loop. Cluster 10 reports out that all relevant medical device nodes 12 (non-medical device access nodes being excluded) are available for a cleaning session, upon which a central water plant initiates a hot water loop disinfection. Note that initiation of a request for disinfection of the central water supply loop comes from (i) within cluster 10, the proprietary software is programmed to prompt when all medical device nodes 12 are at rest and at least a certain amount of time or total service hours have passed since the last disinfection or (ii) the central water plant, after at least a certain amount of time or total service hours have passed since the last disinfection. Other examples of where the medical devices of nodes 12 may synchronize with outside equipment includes software updates, where an update may be scheduled for the next time each of the medical device nodes 12 is at rest, at which time cluster 10 reports out that it is ready for the new software.

0069It is also contemplated that the collaboration between nodes 12 of cluster 10 not be limited to medical applications. For example, cluster 10 may store and synchronize information to support patient in-center entertainment preferences, such as, favorite websites, television and radio channels, movies, food and beverages. This information is available no matter which medical device of cluster 10 is used to treat a patient.

0070The clusters 10 of cluster domain 110b offer a powerful platform having high integrity for a multitude of application areas listed below. The below list is not exhaustive, but serves to exemplify the variety of services that benefit from the closed cluster domain 110b. Each of the entries of the following list in one way another benefits from the safety, security and quality aspects that cluster domain 110b provides, including: (i) clinic administration services, (ii) staff and patient administration services, (iii) attention services including information presentation services, staff assistance call services, medical device alarm distribution services, and staff reminder services, (iv) connectivity services including cluster node connectivity services, connectivity level services, and dialysis monitor connectivity services, (v) equipment services including dialysis monitoring services, and water purification system services, (vi) financial services including dialysis billing services, (vii) identification services including dialysis session identification services, medication identification services, dialysis station identification services, disposable identification services, equipment identification services, patient identification services, and staff identification services, (viii) information management services including clinic information services, and patient information services, (ix) inventory services including inventory consumption tracking services, product traceability services, and reuse traceability services, (x) scheduling services including equipment scheduling services, patient scheduling services, and staff scheduling services, (xi) security services including access control services, availability protection services, confidentiality protection services, encryption services, and integrity protection services, (xii) therapy services including assessment services, consultation services, dialysis session services, dialysis session record services, medical tests services, prescription services, and vascular access services, and (xiii) water purification services including distribution loops services, and water quality services.

0071In <figref idref="f0002">Fig. 2</figref>, external domain 110a is in one embodiment an open IT environment domain using standard off-the-shelf hardware and software. The only exception to the off-the-shelf architecture being software applications deployed on external domain 110a equipment for the purpose of interacting with cluster domain 110b via interface domain 110c. In many instances, external domain 110a equipment is not readily programmable and therefore will not receive custom software for interfacing with cluster 10. Instead, access nodes 12a and 12h contain the interfacing software to read the data entering from the external equipment. In the case of a doctor's or clinician's computer, however, there may be application software that is installed on the computer that has counterpart application software stored at nodes 12 or software for interfacing with the application software stored at nodes 12. External domain 110a equipment may include non-proprietary devices that are not designed for inclusion cluster domain 110b and therefore need additional equipment (interface domain 110c) to exchange information with the cluster domain 110b.

0072<figref idref="f0003">Fig. 3</figref> illustrates external domain 110a in more detail and operating with cluster domain 110b having access nodes 12a and 12h forming at least part of interface domain 110c. In the illustrated embodiment, external domain 110a is represented by the following classes or types of equipment: (i) external information systems 50a, which may be any information system external to cluster 10 that benefits from exchanging information with member nodes 12 of cluster 10, (ii) presentation equipment 50b, which may be any equipment primarily used for presenting information retrieved from cluster 10, e.g., display screens of all sizes and technologies (optionally of touch type), (iii) tablet and personal computer equipment 50c, which may be any keyboard- or touch-based user interface equipment used for exchanging information between external domain 110a and cluster domain 110c equipment, e.g., smartphones, smart pads, laptops, stationary personal computers ("PCs"), hybrids, and similar computer-based equipment, (iv) shared (e.g., medical) equipment 50d, which may be any equipment (medical or non-medical) used to support a medical device clinical process that is shared between patients as part of their pre- and/or post-registration activities during the presence at the clinic, e.g., patient pre/post treatment weight scale and registration stations, blood pressure stations, clinic arrival/departure registration and equipment deployed in the clinic for similar purposes (such shared equipment is normally equipped with, connected to and/or used with some kind of personal identification equipment), and (v) bedside (e.g., medical) equipment 50e, which may be any equipment (medical or non-medical) deployed at the patient's bedside and associated with (serving) a specific patient during part or full duration of treatment, e.g., water reverse osmosis units for dialysis fluid preparation, blood pressure meters, entertainment consoles and other equipment deployed at bedside for similar purposes.

0073While <figref idref="f0001">Figs. 1</figref> and <figref idref="f0003">3</figref> illustrate cluster 10 having both distributed database access node 12a and non-distributed database access node 12h, it should be appreciated that any cluster containing one or more nodes 12b-12g may have (i) one or more distributed database access node 12a only, (ii) one or more non-distributed database access node 12h only, (iii) one or more distributed database access node 12a and one or more non-distributed database access node 12h, (iv) a virtual access node 100 (described below) only, and (v) a virtual access node 100 in combination with any one or more of either or both distributed database access node 12a and non-distributed database access node 12h.

0074<figref idref="f0004">Fig. 4</figref> illustrates non-limiting examples of external information systems 50a. External information systems 50a may take many different forms from purely administrative ones, e.g., billing and reimbursement, to dedicated and specialized medically related systems, such as, laboratory analysis systems and clinic information systems. Examples listed in <figref idref="f0004">Fig. 4</figref> include, but are not limited to, local clinic information systems, cloud based clinic information systems, electronic medical record systems, health information systems, medical quality monitoring systems, laboratory analysis systems, national registry systems, billing and reimbursement systems, and inventory systems.

0075External information systems 50a in an embodiment connect to cluster 10 via wired or wireless connection to one or more distributed database access node 12a of interface domain 110c.

0076<figref idref="f0005">Fig. 5</figref> illustrates non-limiting examples of presentation equipment 50b. Presentation equipment 50b includes equipment, handheld or stationary (e.g. mounted on a wall), with a primary (but not exclusive) purpose of presenting information to staff and/or patients within a treatment clinic. Presentation equipment 50b in general does not generate data for input into the medical devices of cluster 10, however, they may optionally be used for input if, for example, they have touch support capability. Presentation equipment 50b may for example present patient information for guiding arriving patients through various steps during treatment. For example, the patient arriving at the clinic may have access to scheduling information including pre-post weight registration location/status and treatment station location for receiving treatment. Staff information screens may present patient preparation status, dialysis station occupancy and treatment progress, and alarm information for various treatment locations in the clinic.

0077Presentation equipment 50b in an embodiment connects to cluster 10 via wired or wireless connection to one or more distributed database access node 12a of interface domain 110c.

0078<figref idref="f0005">Fig. 6</figref> illustrates non-limiting examples of tablet and personal computer ("PC") equipment 50c. Tablet and PC equipment 50c may require more input intensive and advanced information exchange that what is at presently practical using handheld, e.g., smartphone or tablet, devices. However, the advancement of tablets and of hybrid tablet/PC technology brings both types of devices under equipment 50c. Software deployed on equipment 50c may range from very simple applications to highly advanced applications including a complete CIS interface and environment towards accessing the information stored within cluster 10. Such applications may present a user interface for clinic staff (physicians, nurses, technical service staff, and administrative staff, etc.) to access and update information or feature in service areas, such as, administration services, staff and patient attention services, connectivity services, equipment technical service and maintenance services, billing and reimbursement services, identification services, information management services, inventory services, scheduling services, security services, patient medication services, therapy services and water purification services.

0079Tablet and PC equipment 50c in an embodiment connects to cluster 10 via (i) wired or wireless connection to one or more distributed database access node 12a of interface domain 110c or (ii) virtual access connection without access node hardware. Mobile connections enable a physician to make bedside changes to the original operating parameter prescriptions, changes that are then immediately distributed into shared data 14 and that take effect at the appropriate medical device of a node 12. A laptop or stationary PC may be used alternatively where mobility is not a top priority, e.g., for longer sessions interacting with cluster 10.

0080<figref idref="f0005">Fig. 7</figref> illustrates non-limiting examples of shared, e.g., medical, equipment 50d. Shared, e.g., medical, equipment 50d includes equipment shared between patients present at the same time in a clinic. Shared equipment 50d may have medical or non-medical purposes. Although equipment for shared medical or medically related purposes is prevalent, a variety of other equipment, such as equipment that serves administrative purposes and/or supports the clinical therapy process, also falls under this category.

0081One example is patient weight pre-treatment and post-treatment registration. A weight scale may be shared by multiple patients in a clinic or other treatment setting. Each patient is identified at the time of weighing, e.g., by entering the patient's name or patient identification ("ID") into the weighing equipment or via, e.g., a patient ID card presented to equipment present at the weighing station. The registered and identified weight is then transferred to distributed database 14 of cluster 10 and stored for example in a weight file for that patient. The medical device of whichever node 12 that the patient is assigned to retrieves the patient's pre-treatment weight for that day and for example enters the weight into the machine for use with the patient's prescription. Pre-treatment weight may be used in combination with a known dry weight to determine how much excess blood water or ultrafiltration to remove from the patient undergoing a dialysis treatment. Other examples of shared equipment include blood pressure measurement equipment, glucose measuring equipment, and patient log-in and log-out equipment for registration when the patient enters and leaves the clinic.

0082Shared equipment 50d in various embodiments connects to cluster 10 via wired or wireless connection to one or more distributed database access node 12a or non-distributed database node 12h of interface domain 110c. Non-distributed database access node 12h may be used if the shared equipment 50d has no need for any data from distributed database 14.

0083<figref idref="f0005">Fig. 8</figref> illustrates non-limiting examples of bedside, e.g., medical, equipment 50e. Bedside equipment may, just like shared equipment 50d, have a medical or non-medical reason or purpose. Non-medical bedside or patient-dedicated equipment 50e may include, for example, personal communication, entertainment (e.g., HDMI connected televisions), patient work-related equipment, and patient identification equipment. Non-medical bedside or patient-dedicated equipment 50e may not need access to data from distributed database 14 and if so may connect to cluster 10 via wired or wireless connection to one or more non-distributed database node 12h of interface domain 110c. Shared data 14 may however benefit from interacting with non-medical bedside equipment 50e. In an example, distributed database 14 of cluster 10 may form a personal preferences file for each patient storing individual preferences with respect to favorite websites, television channels, radio stations, etc.

0084Bedside or patient-dedicated equipment 50e may of course be medical related. Certain clinics may provide blood pressure cuffs for each medical device of a node 12, so that blood pressure may be tracked during treatment. Another example is water purification equipment used to make dialysis fluid for dialysis. In either case, medical bedside or patient-dedicated equipment 50e may or may not need access to shared data 14 and therefore connect to cluster 10 via (i) wired or wireless connection to one or more distributed database access node 12a or one or more non-distributed database node 12h of interface domain 110c or (ii) a virtual access node as described herein.

0085Another example involves the delivery of drugs to the patient during a hemodialysis or other blood cleansing treatment, e.g., Epogen^™ for red blood cells or Venofer^™ for iron/sucrose. These drugs may be delivered by a dialysis machine pump of a node 12 or via an external pump. If provided by a dialysis machine pump, then drug delivery is already part of cluster 10. If by a separate pump, however, which for example is a floating pump used in the clinic as needed, the separate pump may access distributed database 14 via distributed database access node 12a or non-distributed database node 12h of interface domain 110c for two-way communication between the drug delivery pump and the dialysis machine of node 12. Dialysis machine of node 12 adds any desired drug delivery data to distributed database 14 of cluster 10, while the external drug delivery pump may record any desired data, such as patient response after delivery in the form of a blood pressure reading, a bioimpedance reading, hydration level reading, or a subjective response from the patient entered into the user interface of the dialysis machine. The drug delivery pump in an embodiment is part of its own cluster 10 of floating pumps and feeds data to its own distributed database 14.

0086A further example involves a hospital room or drug delivery setting in which a patient is receiving multiple drugs. Here, it is contemplated to implement one or more cluster 10. A first cluster 10 may be formed around the patient, where nodes 12 are formed by the different pumps or different channels of one or more pump along with any equipment analyzing the patient during drug delivery. The resulting distributed database 14 may be used for electronic medical records ("EMR"), billing and other purposes, and proprietary software may be written to achieve any goal for the shared data 14. For example, it may be desirable to (i) record any reactions to a delivered drug, e.g., blood pressure reading, a bioimpedance reading, hydration level reading, or a subjective response from the patient entered by a nurse or (ii) record any reactions to a combination of delivered drugs, e.g., blood pressure reading, a bioimpedance reading, hydration level reading, or a subjective response from the patient entered by a nurse. Time of drug delivery, dose, dose rate, etc., may also bee recorded for each drug.

0087A second cluster 10 may be formed around a particular drug where, for example, a drug manufacturer may find collective data concerning its drug to be very valuable. Here, nodes 12 reside at multiple bedsides, each delivering the drug to be analyzed. Proprietary software may be written to strip or simply not record any patient identification data but to record, for multiple patients, any reactions to the delivered drug, e.g., blood pressure reading, a bioimpedance reading, hydration level reading, or a subjective response from the patient entered by a nurse into distributed database 14. The proprietary software may be written to record patient type data, e.g., sex, age, race, ethnicity at distributed database 14. The software may also record data gleaned from the delivery of other drugs, e.g., any of the above reactions while the patient is receiving the manufacturer's drug in combination with one or more other drugs in distributed database 14. Here, such other drug information may come in through one or more access node 12a or 12h.

0088As noted above, both drug delivery clusters 10 just described may be run concurrently and simultaneously.

0089Referring now to <figref idref="f0002">Figs. 2</figref>, <figref idref="f0003">3</figref> and <figref idref="f0006">9</figref>, interface domain 110c is described in more detail. Cluster interface domain 110c acts as a façade to access the services of the cluster configuration without exposure of the internals of the actual cluster implementation, infrastructure and setup. As discussed above, access nodes 12a and 12h form part of interface domain 110c. Also discussed above, most of equipment 50a to 50e (referred to herein collectively as equipment 50 or generally individually as equipment 50) may be connected to distributed database via a distributed database access node 12a, a non-distributed database node 12h, or a virtual access node if the primary purpose of the access is information access only.

0090Distributed database access node 12a is a full-fledged member of cluster 10 and holds a replicated set of data 14 identical, in terms of content as well as service capabilities, to distributed database 14 hosted by medical equipment nodes 12b to 12g in <figref idref="f0001">Figs. 1</figref>, <figref idref="f0002">2</figref>, and <figref idref="f0006">9</figref>. Cluster 10 via access nodes 12a and 12h will therefore still be available for external access even if all other medical device nodes 12b to 12g of cluster 10 are switched off. In an embodiment, non-distributed database node 12h provides an interface conversion between equipment 50 of external domain 110a (e.g., arbitrary equipment not meeting cluster 10 infrastructure requirements) and internal (protected) infrastructure of cluster domain 110b. Non-distributed database node 12h for example allows data from arbitrary shared equipment 50d and bedside equipment 50e along with patient identify data from a patient identity device to be sent to distributed database 14 for patient medical record storage.

0091In terms of connectivity capabilities, distributed database access node 12a and non-distributed database node 12h are identical in one embodiment. Each may connect to any of the above-described types of equipment 50a to 50e.

0092<figref idref="f0002">Fig. 2</figref> illustrates that interface domain 110c includes a third type of access into distributed database 14 of domain 110b, namely, a virtual access node 100. Virtual access node 100 is virtual because there is no additional equipment representing a node, as is the case for access nodes 12a and 12h. Virtual access node 100 in an embodiment requires that responsibility for maintaining isolation between external domain 110a and cluster domain 110b be shared between the connected client equipment 50 and medical device nodes 12 of cluster 10. Client equipment 50 is in one embodiment connected to cluster domain 110b in such a way to guarantee the integrity of the information transferred to cluster 10. Secure connectivity may be provided via a virtual private network ("VPN") connection made directly to the cluster 10 environment. Virtual access node 100 may for example allow a doctor, clinician, or technician computer that is connected within the clinic or medical device setting via a VPN to access distributed database 14. Such computers may run device prescription software that develops operational routines for the medical devices of nodes 12. The computers via virtual access node 100 may operate to send and receive lab results, for example, to be entered into the prescription software. Once the prescription operation routine is completed, it may be deposited via virtual access node 100 onto distributed database 14 under a folder for the patient or patients for which the operational routine has been developed. Client computers may also use the protected virtual access node 100 to pull data from distributed database 14 of cluster 10, e.g., to review treatment results from one or more operational routine to see if it needs to be modified or replaced.

0093Referring now to <figref idref="f0006">Figs. 9</figref> and <figref idref="f0007">10</figref>, cluster compatible medical device nodes 12b to 12g ... 12n are illustrated in more detail. <figref idref="f0006">Fig. 9</figref> illustrates medical device nodes 12b to 12g ... 12n operating within cluster 10 and highlights medical device node 12f, while <figref idref="f0007">Fig. 10</figref> provides more detail on the distributed database 14 side of medical device node 12f. <figref idref="f0006">Figs. 9</figref> and <figref idref="f0007">10</figref> both illustrate that medical device node 12f includes two separate (separated by hardware and/or software) parts, namely, a therapy control part 28a and a cluster control part 28b. Therapy control part 28a in the illustrated embodiment includes a server interface hosted on middleware 16. Server interface and middleware 16 operates with medical device operating software 20, which may include any one or more of a main medical device control processor and memory, one or more safety processor and memory, a user interface processor and memory and one or more lower level controllers, such as, sensor boards, pump control boards, etc., for sensors and actuators 22 (<figref idref="f0007">Fig. 10</figref>). Any and all of the above functions may be combined alternatively on a single processor and memory.

0094Server interface and middleware 16 in the illustrated embodiment drives user interface 18 of medical device nodes 12. User interface 18 may, for example, display set-up screens, treatment screens, technical data, etc. If the patient wishes to view web pages from websites desired by the patient, e.g., via an internet connection provided by the hospital or clinic, the patient may do so at a user interface 18 of an access node, such as distributed database access node 12a, provided as part of cluster 14 in <figref idref="f0006">Fig. 9</figref>. Such websites may be stored in a preferences file for the patient in distributed database 14, so that the preferred website is known regardless of which access node of cluster 10 the patient uses next. An access node 12a, 12h may be placed at each medical device node 12b to 12g ... 12n to provide internet access for use by the patient and/or caregiver.

0095Cluster control part 28b houses replicated database 14, which in <figref idref="f0006">Fig. 9</figref> is shared by medical devices at nodes 12a to 12g and 12n-2 to 12n of cluster 10. Cluster control part 28b is structured carefully to meet requirements for security, safety, availability, integrity and others for the protected internal cluster infrastructure. Additionally, because therapy control part 28a runs treatments, it is responsible for the patient's safety and therefore should not face competition over resources (clock cycles, memory consumption, etc.) with distributed database 14. A processing and memory manager 120 is therefore applied between therapy control part 28a and cluster control part 28b of medical device node 12f. Processing and memory manager 120 may for example be supported by a Linux^™ operating system or other operating system capable of handling hardware-supported processing and memory protection and virtualization. Processing and memory manager 120 in an embodiment copies (i) data originating from the therapy control part 28a into cluster control part 28b and (ii) data that originates from cluster control part 28b into therapy control part 28a, in a way that preserves isolation between parts 28a and 28b (e.g., parts 28a and 28b never share or see each other's memory areas).

0096In one embodiment, server interface and middleware 16 of therapy control part 28a knows when it is free to share data with distributed database 14 and is therefore given the responsibility of initiating a data transfer with internal part 112b. Server interface and middleware 16 of therapy control part 28a sends data to cluster control part 28b via memory processing and memory manager 120 when it has data to send and opens itself to receiving data from distributed database 14 when it is ready.

0097<figref idref="f0007">Fig. 10</figref> illustrates cluster control part 28b in more detail. Besides distributed database 14, cluster control part 28b includes a cluster database manager 24 and a cluster communication interface 26. Cluster database manager 24 and cluster communication interface 26 may be separate pieces of software, in which cluster database manager 24 is responsible for receiving data from middleware software 16 via processing and memory manager 120 and securely converting the data into a storage format suitable for distributed database 14. Cluster database manager 24 is also responsible for securely converting data retrieved from distributed database 14 into a form suitable for middleware software 16 and medical device operating software 20 of therapy control part 28a.

0098Cluster communication interface 26 in an embodiment is a messaging supervisor for controlling how data is to be sent to and received from other nodes 12 of cluster 10. Discussed above are many different ways that data may be distributed between the different nodes 12 of cluster 10. Cluster communication interface 26 knows the selected data transport configuration and causes its node 12f to send and/or receive data, securely and completely, at the appropriate time and/or in the appropriate order with other nodes 12.

0099Referring now to <figref idref="f0008">Figs. 11</figref> and <figref idref="f0009">12</figref>, distributed database access node 12a is illustrated in more detail. Distributed database node 12a includes and is part of distributed database 14 and interacts with external equipment 50 as has been discussed herein. Distributed database node 12a includes its own server interface and middleware 116 hosted operating with cluster access node logic 118 (operating software for the access node). Distributed database access node 12a, similar to medical device nodes 12b to 12g and 12n-2 to 12n, includes an external part 112a and an internal part 112b separated by processing and memory manager 120 as described above, so that a clear and distinct separation between distributed database 14 and server interface and middleware 116 is established. Distributed database access node 12a is able to retrieve and send information from distributed database 14 to external equipment 50. Distributed database access node 12a receives and stores in shared distributed database 14 data from external equipment 50, such as the CIS, and server clients such as a computer, a display device, a handheld smart device, such as a smartphone or smart tablet, and/or medical equipment, such as a weight scale.

0100Connectivity between external part 112a and external equipment 50 may for example be via wired local area network ("LAN"), wireless local area network ("WLAN"), or Bluetooth technology, etc. If connection is made via a physical LAN cable between external equipment 50 and distributed database access node 12a, the cable may be a separate cable from any other external equipment cable and be connected to a dedicated port of the access node 12a.

0101<figref idref="f0008">Figs. 11</figref> and <figref idref="f0009">12</figref> illustrate that distributed database access node 12a may include its own user interface 18, which operates with server interface and middleware 116. As discussed above, user interface 18 of distributed database access node 12a may display internet sites to a patient undergoing treatment or to a caregiver, e.g., needing assistance. User interface 18 may also display set-up screens, treatment screens, technical data, etc., to the patient or caregiver. Again, the selection of any external content by the patient or caregiver may be stored in a preferences file in shared database 14.

0102Data transfer between external equipment 50 and distributed database 14 may occur without application interference directly via cluster access node logic 118. Access node interface and middleware 116 and access node logic 118 may host access node configuration software and applications, e.g., web clients (internet explorer, google chrome, etc.), for user interaction via a user interface 18 integrated or externally connected to access node 12a. Cluster access node logic 118 may error check the data and if needed combine data into a form useable with distributed database 14. For example, there may be a first external equipment 50 that provides a treatment operating prescription to distributed database access node 12a and a second external equipment 50 that provides patient weight data. Cluster access node logic 118 may assist in sorting and assembling related data, e.g., data associated with a same patient ID, and route the to a particular entry in distributed database 14.

0103<figref idref="f0008">Figs. 11</figref> and <figref idref="f0009">12</figref> further illustrate that distributed database access node 12a may however store different external device/system interface software, e.g., software 150a and 150e (referred to herein collectively as external device/system interface software 150 or generally individually as external device/system interface software 150) for different external equipment, e.g., 50a and 50e, respectively. External device/system interface software 150 is provided for certain external equipment 50 to send and receive information to and from distributed database 14. The interplay between external device/system interface software 150 and cluster access node logic 118 provides a first layer of isolation (as indicated by upper dotted line in external part 112a in <figref idref="f0009">Fig. 12</figref>). The purpose of this first isolation is to prevent erroneous or malicious external devices from affecting access node logic 118.

0104Internal part 112b, separated by processing and memory manager 120 from external part 112a, of distributed database access node 12a operates in the same manner as cluster control part 28b described above for medical device node 12f. In particular, database manager 24 may be responsible for receiving data from cluster access node logic 118 via processing and memory manager 120 and securely converting the data into a form suitable for distributed database 14. Cluster communication interface 26 is again a messaging supervisor for knowing how data is to be sent to and received from different nodes 12 of cluster 10. Processing and memory manager 120 provides a second layer of isolation to distributed database access node 12a.

0105Referring now to <figref idref="f0010">Fig. 13</figref>, non-distributed database access node 12h is illustrated in more detail. Non-distributed database node 12h does not have its own memory storage for distributed database 14 but does interact with external equipment 50 as has been discussed herein. Non-distributed database node 12h may send and receive data to and from distributed database 14, respectively, and data from distributed database 14 may be displayed on its user interface 18. But distributed database 14 is not resident at non-distributed database node 12h and therefore may not be accessed without access to other nodes. With distributed database access node 12a, on the other hand, database 14 is accessible even if access node 12a is the only available node 12 of cluster 10.

0106External device/system interface software 150, server interface and middleware 116, cluster access node logic 118, processing and memory manager 120, database manager 24 and cluster communication interface 26 of non-distributed database access node 12h operate the same in one embodiment as described or referenced above for distributed database access node 12a.

0107In the above embodiments, therapy control part 28a/external part 112a may be provided on its own one or more processor and memory separate from one or more processor and memory used for cluster control part 28b/internal part 112b. In an alternative embodiment therapy control part 28a/external part 112a may be provided on the same processor and memory as cluster control part 28b/internal part 112b, but be maintained on different parts of the memory and still be separated by processing and memory manager 120.

0108Moreover, while access nodes 12a and 12h have been described as being physically separate from medical device nodes 12b to 12g and 12n-2 to 12n of cluster 10, the additional structure and functionality of access nodes 12a and 12h may be provided alternatively as a separate node housed in a common housing with one of the medical device nodes 12b to 12g and 12n-2 to 12n. In particular, server interface and middleware 116, cluster access node logic 118, and external device/system interface 150 may be added as an external part 112a, as described above, that operates alongside the therapy control part 28a of medical device node 12b to 12g and 12n-2 to 12n. In an embodiment, both control part 28a and external part 112a are separated from cluster database 14, cluster database manager 24 and cluster communications interface 26 via processing and memory manager 120 in the manner described herein. The access node 12a within the medical device is a separate node from the medical device node 12b to 12g and 12n-2 to 12n in one embodiment. It operates independent of the medical device node even though the two nodes share the same housing and may share cluster database manager 24 and cluster communications interface 26. Information received by the access node 12a is not necessarily intended for its host medical device and may be information needed by another medical device of cluster 10. The information is stored on distributed database 14. Likewise, access node 12a located within the medical device may pull data from distributed database 14 and send it to outside equipment 50 regardless of whether the information has been generated by the host medical device or another medical device of cluster 10.

0109Referring now to <figref idref="f0011">Fig. 14</figref>, the therapy control part 28a and cluster control part 28b of medical device nodes 12b to 12e and the external part 112a and internal part 112b of distributed database access node 12a of <figref idref="f0006 f0007 f0008 f0009 f0010">Figs. 9 to 13</figref> are illustrated together with the external domain 110a, cluster domain 110b, and interface domain 110c of <figref idref="f0002">Fig. 2</figref>. <figref idref="f0011">Fig. 14</figref> represents cluster 10 via a circle and shows that cluster domain 110b includes cluster 10. Additionally, cluster domain 110b includes therapy control parts 28a of medical device nodes 12b to 12e. <figref idref="f0011">Fig. 14</figref> reiterates that external domain 110a includes external equipment 50.

0110<figref idref="f0011">Fig. 14</figref> also illustrates that cluster 10 includes cluster control parts 28b of medical device nodes 12b to 12e and internal part 112b (including distributed database 14) of distributed database access node 12a (would also include internal part 112b of non-distributed database access node 12h). External part of distributed database access node 12a in the illustrated embodiment is not part of cluster domain 110b and instead forms interface domain 110c along with the external parts 112a of any other access nodes of cluster 10. <figref idref="f0002">Figs. 2</figref> and <figref idref="f0003">3</figref> illustrate distributed database access node 12a having distributed database 14 within interface domain 110c. Distributed database 14 is shown this way in <figref idref="f0002">Figs. 2</figref> and <figref idref="f0003">3</figref> to differentiate distributed database access node 12a from non-distributed database access node 12h. It should be appreciated from <figref idref="f0011">Fig. 14</figref>, however, that distributed database 14 of full access node 12a belongs within cluster 10 of cluster domain 110b.

0111Referring now to <figref idref="f0012">Fig. 15</figref>, one embodiment for virtual access node 100 is illustrated. Virtual access node 100 in the illustrated embodiment includes an interface between a medical device node, such as medical device node 12f and a piece of external (open side) equipment 50, such as an external computer (doctor, nurse or technician computer). Medical device node 12f is provided with each of the structures and associated functionality described above in connection with <figref idref="f0007">Fig. 10</figref> for middleware 16, user interface 18, server interface 20, actuators 22, distributed database 14, cluster database manager 24, and cluster communications interface.

0112Computer 50 in the illustrated embodiment has installed thereon third party application software 114, such as software for developing treatment operating prescriptions. Third party application software 114 may for example receive data from distributed database 14 and use it to analyze or form new treatment operating prescriptions. If the desired third party application software 114 does not exist or the hospital or clinic does not own such software, it is contemplated to provide virtual access node 100 with proprietary data handling software 102 that performs the same and/or additional functions as third party application software 114 using the data retrieved from distributed database 14. In either case, proprietary data handling software 102 and third party application software 114 may in turn create data that is stored at distributed database 14.

0113A third party system interface 104 converts data from third party application software 114 into a form required by a secure communication channel, e.g., a virtual private network ("VPN") 106, present between medical device virtual access node interface 108a and an external equipment virtual access node interface 108b. VPN 106 is in essence an encrypted bridge between medical device node 12f and external equipment 50. VPN 106 may be provided and installed by the installer of cluster 10. Proprietary data handling software 102 in the illustrated embodiment, after conversions performed by third party system interface 104, is structured to communicate directly over VPN 106 between medical device virtual access node interface 108a and an external equipment virtual access node interface 108b.

0114Once inside medical device node 12f, data from external equipment virtual access node interface 108b is sent securely from therapy control part 28a to cluster control part 28b via processing and memory manager 120, is made available to distributed database 14 via cluster database manager 24, and is sent to other nodes via cluster communications interface 26 in a manner described above. Data from distributed database 14 may be converted via cluster database manager 24 and be sent securely from cluster control part 28b to therapy control part 28a via processing and memory manager 120, sent from interface 108a to interface 108b over VPN 106 and from there to one or both proprietary data handling software 102 and/or third party application software 114 via conversion at third party system interface 104.