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IHE Cardiology ProfilesIHE Cardiology Profiles

Harry Solomon

Co-chair, IHE Cardiology Technical Committee

European Society of Cardiology 2004 Solomon – p. 2

Three profiles selcted for year 1Three profiles selcted for year 1

Cardiac Catheterization Workflow– Based on successful IHE Radiology Scheduled

Workflow and Patient Information Reconciliation Profiles

Echocardiography Workflow– Based on successful IHE Radiology Scheduled

Workflow and Patient Information Reconciliation Profiles

Retrieve ECG for Display– Based on successful IHE IT Infrastructure Retrieve

Information for Display Profile

European Society of Cardiology 2004 Solomon – p. 3

Why Why thesethese profiles? profiles?

High return on investment - important integration problems

Standards in place (DICOM, HL7, …)Leverage IHE Radiology and IT InfrastructureNo “political” challenges – just technicalRestricted scope for short year success

European Society of Cardiology 2004 Solomon – p. 4

Cath Lab WorkflowCath Lab Workflow

European Society of Cardiology 2004 Solomon – p. 5

The Multi-Modality Cath Lab ProblemThe Multi-Modality Cath Lab Problem

Multiple re-entry of Patient IDError proneResults fragmented across systemsCustom solutions needed for data sharingDifficult to manage

European Society of Cardiology 2004 Solomon – p. 6

Cath Workflow Cath Workflow Management Issues Management Issues

Un-ordered cath exams (emergency)Unidentified patientsUncoordinated with Hospital Information

SystemDiagnostic and interventional proceduresAd hoc scheduling of cath labsChange of rooms during procedure… and interactions between these issues!

European Society of Cardiology 2004 Solomon – p. 7

IHE Cardiac Cath WorkflowIHE Cardiac Cath Workflow

Management of cath exams (in-lab portion)– Similar to IHE-Radiology SWF– Multi-modality, multiple procedure steps

Reconciliation of patient information– Similar to IHE-Radiology PIR– Unscheduled cath is the norm, not the exception

Time synchronization– Modalities must support IHE-ITI Consistent Time

European Society of Cardiology 2004 Solomon – p. 8

Cardiac Cath – 8 use casesCardiac Cath – 8 use cases

All use cases must be supportedAll use cases must be supported

Case C1: Patient Registered at ADT and Procedure Ordered at the Order Placer

Case C2: Patient Registered at ADT and Procedure Ordered at DSS/OF

Case C3: Patient Registered at ADT and Procedure Not Ordered Case C4: Patient Registered at DSS/OF and Procedure Ordered Case C5: Patient Not Registered Case C6: Patient Updated During Procedure Case C7: Change Rooms During Procedure Case C8: Cancel Procedure

European Society of Cardiology 2004 Solomon – p. 9

Cardiac Cath - Out of scope year 1Cardiac Cath - Out of scope year 1

Pre-cath and post-cath activity Hemo waveforms and reports* Procedure logs QCA/QVA/IVUS reports* Final cath reports* Supply chain *Archives must support storage, but no actors specified for display

But on the 5-year roadmap!But on the 5-year roadmap!

European Society of Cardiology 2004 Solomon – p. 10

Integration Profile:Integration Profile:A Solution to an Integration ProblemA Solution to an Integration Problem

Actors cooperating

through TransactionsTransactions

to solve a specific problem

Pt. Registration [Rad-1] Patient Update [Rad-12]

Pt. Registration [Rad-1] Patient Update [Rad-12]

Placer Order Management [Rad-2] Filler Order Management [Rad-3]

ADT

Procedure Scheduled [Rad-4]

Procedure Updated [Rad-13]

Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]

Order PlacerDSS/ Order Filler

Patient Update [Rad-12]

European Society of Cardiology 2004 Solomon – p. 11

Cath actors and transactionsCath actors and transactions

Pt. Registration [Rad-1] Patient Update [Rad-12]

Pt. Registration [Rad-1] Patient Update [Rad-12]

Placer Order Management [Rad-2] Filler Order Management [Rad-3]

ADT

Query Images [Rad-14] Retrieve Images [Card-4]

Image Display

Modality Image/Evidence Stored [Card-2]

Storage Commitment

[Card-3]

Procedure Scheduled [Rad-4]

Procedure Updated [Rad-13]

Query Modality Worklist [Rad-5]

Performed Procedure

Step Manager

Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]

Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]

Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]

Order Placer

Acquisition Modality

ImageManager

Image Archive

DSS/ Order Filler

Patient Update [Rad-12]

European Society of Cardiology 2004 Solomon – p. 12

Echo WorkflowEcho Workflow

European Society of Cardiology 2004 Solomon – p. 13

Echo issuesEcho issues

Intermittently connected modality– Echo machine loaded with worklist at beginning of

shift, then goes mobile– During shift, sonographer gets verbal order for

exam (ad hoc); no network connection for worklist update (exam may or may not have been ordered)

Stress echo – Image labeling– Appropriate level for management of stages

Digital vs. videotape

European Society of Cardiology 2004 Solomon – p. 14

Echocardiography WorkflowEchocardiography Workflow

Management of echo exams (TTE, TEE, stress)– Similar to IHE-Radiology SWF– Handle intermittently connected modality– Handle multi-stage tests (stress echo)

Workflow management, image labeling, and display

– Handle multiframe and compressed images

Reconciliation of patient information– Similar to IHE-Radiology PIR

European Society of Cardiology 2004 Solomon – p. 15

Echo – 6 use casesEcho – 6 use cases Case E1: Patient Registered at ADT and Procedure Ordered Case E2: Intermittently Connected Modality Case E3: Intermittently Connected Modality with Ad Hoc

Procedure, Patient Registered, Scheduled Procedure Case E4: Intermittently Connected Modality with Ad Hoc

Procedure, Patient Registered, Unscheduled Procedure Case E5: Intermittently Connected Modality with Ad Hoc

Procedure, Patient Unregistered, Unscheduled Procedure Case E6: Stress Echo Staged Protocol

European Society of Cardiology 2004 Solomon – p. 16

Echo – Out of scope year 1Echo – Out of scope year 1

Preliminary and final reports– Sonographer and over-reading cardiologist

Counter-indication/clinical decision support Fetal and pediatric echo Combined echo/ECG stress acquisition

workflow

European Society of Cardiology 2004 Solomon – p. 17

Retrieve ECG for DisplayRetrieve ECG for Display

European Society of Cardiology 2004 Solomon – p. 18

ECG IssuesECG Issues

Need broad distribution of ECGs using ubiquitous technology (Web)

Avoid artifacts on zoomed ECGs– Vector images required (not rasterized)

Facilitate apps for serial comparison (side-by-side synchronized display)

European Society of Cardiology 2004 Solomon – p. 19

Retrieve ECG for DisplayRetrieve ECG for Display Provide ECGs and related reports to enterprise

– Extension to IHE-ITI RID Retrieve list of documents; retrieve single document

– ECGs served in ready-to-display format (PDF, SVG) Requirements on display format/quality

– Includes XML-based ECG/report list Derived from HL7 v3 Reference Information Model (RIM)

Out of scope year 1– ECG acquisition and reading workflow– ECG raw data interchange– Export of reports to external repository

European Society of Cardiology 2004 Solomon – p. 20

IHE Cardiology 5-year PlanIHE Cardiology 5-year PlanYear 1

(2005 demo)Year 2

(2006 demo)Year 3

(2007 demo)Year 4

(2008 demo)Year 5

(2009 demo)

Cath

Echo

ECG

Nuclear

EP

Card

iolo

gy T

echnical F

ramew

ork

IT In

frastructu

re TF

Infra

Security

Admin

EMR

Quality

MR/CT

Multi-modality workflow & imaging

Procedure log &reporting

Hemo waveform & measures, QCA/QVA

Supplies, inventory,& charge capture

Workflow & imaging,stress protocols

Reporting workflow

Retrieve ECGfor display

ECG/Stress/Holterorders

Workflow & imaging,stress protocols

Reporting workflow

Multi-modality labworkflow & reporting

Home healthmonitoring

Timesynchronization

Audit trail Enterprise userauthentication

Retrieve infofor display

Cross-enterprisedocument sharing

Retrieve guidelinesfor display

Retrieve structuredguidelines

Registry datasubmission

Cross-enterprisereferrals/orders

Workflow, reporting,& measurements

Risk factors forclinical decision supt

Patient care plan

Patient location& transport

Device auto-configuration

Precision timesynchronization

Implantable device parameters & events

Pediatric

Personnel white pages

Measurementinteroperability

ECG waveform interoperability

European Society of Cardiology 2004 Solomon – p. 21

For more info:For more info:

IHE Cardiology Techincal Framework version 1.0 for Trial Implementation at:– www.rsna.org/ihe– www.acc.org/quality/ihe.htm

Submit questions and comments to:– http://forums.rsna.org