echo workflow neal grotenhuis philips medical systems ihe cardiology planning committee

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Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

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Page 1: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

Echo WorkflowEcho Workflow

Neal GrotenhuisPhilips Medical Systems

IHE Cardiology Planning Committee

Page 2: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop2

Source: 16th Annual HIMSS Leadership Surveysponsored by Superior Consultant Company/ACS Healthcare Solutions.

Page 3: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop3

Business IssuesBusiness Issues

IT BarriersIT Barriers

1. Lack of adequate financial support for IT2. Vendors’ inability to satisfactorily deliver products and

services3. Lack of staffing resources 4. Difficulty proving ROI 5. Lack of clinical leadership

16th Annual HIMSS Leadership Surveysponsored by Superior Consultant Company/ACS Healthcare Solutions.

Page 4: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop4

IntroductionIntroduction

Echo Profile• TTE• TEE• Stress Echo

Cath Profile• Intravascular ultrasound (IVUS)• Intracardiac echo (ICE) are used in cardiac

catheterization procedures, and are supported as modalities in the Cath Workflow, and not in the Echo Workflow.

Page 5: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop5

IHE is driving interoperability in EchoIHE is driving interoperability in Echo

Page 6: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop6

IHE TerminologyIHE Terminology

• Ultrasound system = “Image Acquisition Modality”• Images & reports = “Evidence Documents”• IHE Demo person = “Docent”• PACS = “Image Archive” and/or “Image Manager

actors”

Page 7: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop7

• High ROI—value added problem solutions• Standards in place (DICOM & HL-7)• No “political” challenges – just technical• Restricted scope for a “quick win”• Reuse successful Radiology profiles to meet

similar needs

Goals For IHE cardiologyGoals For IHE cardiology

Page 8: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop8

• Reuse of similar IHE-Radiology Profiles– Scheduled Workflow (IHE-R SWF)– Patient Information Reconciliation (IHE-R PIR)

• Intermittently Connected Modality– Workflow– Acquisition Modality storage

• Stress Echo – Workflow– Staged Protocol

• Acquisition Modality (optional)• Image Display (required)

• Digital vs. Videotape– A-D workflow, training issues

Echo Profile Scope:Imaging WorkflowEcho Profile Scope:Imaging Workflow

                      

Page 9: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop9

Use CasesUse 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

• Case E7: Echo Measurements

Page 10: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop10

Use Case E4: Intermittently Connected Modality

Use Case E4: Intermittently Connected Modality

“Could you scan this patient right now since you have a cart in the CCU anyway?”

Clinical Use Cases: – Lost and unbilled echo exams because carts are constantly on the move

– Patient and order info manually entered (potential for errors) or not at all

– Measurements are transferred

Benefits:– Accurate and automatic demographic and order reconciliation

– Verify all images are securely archived

– Improved workflow

Page 11: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop11

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/Evidence [CARD4]

ImageDisplay

Modality Image/Evidence Stored [CARD2]

Storage Commitment

[CARD3]

Procedure Scheduled [RAD-4]

Procedure Updated [RAD-13]

Query Modality Worklist [RAD-5]

PerformedProcedureStep Mgr

Modality PS in Progress [CARD1]-Modality PS Completed [RAD-7]

Modality PS in Progress [CARD1] Modality PS Completed [RAD-7]

Modality PS Completed [RAD-7]

Order Placer

AcquisitionModality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]

Modality Image/Evidence Stored [CARD2]

Storage Commitment

[CARD3]

EvidenceCreator Modality PS in Progress [CARD1]

Modality PS Completed [RAD-7]

Query Evidence [RAD-44]

Instance Availability Notification [RAD-49]

Echo Actors & TransactionsEcho Actors & Transactions

Modality PS in Progress [CARD1]

Page 12: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop12

ActorsActors

• Echo profile uses existing actors that use cardiology specific transactions– Department System Scheduler/Order Filler (DSS/OF)– Order Placer– Performed Procedure Step Manager – Image Archive– Image Manager– Acquisition Modality– Image Display– Evidence Creator

Page 13: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop13

TransactionsTransactions

• Storage Commitment – A requestor (Acquisition Modality) requests that the Image Manager confirm ownership for the specified DICOM objects (images, waveforms, evidence documents, or any combination thereof) that the requestor stored in the Image Archive, thus allowing the sender to delete those objects now owned by the Image Manager. – This option requires the Image Manager to send the N-Event Report

message to the mobile modality at the time that reconnects to the Image Manager.

Localstorage

“I’m sending images”

“Will you commit to store these?”

“Yes, you can delete your copy now”

“I received them”

Page 14: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop14

Modality Procedure Step In Progress: Informs the PPS Manager of the start of a new Procedure Step, PPS Manager informs the Department System Scheduler/Order Filler and Image Manager.

Retrieve Images: An Image Display requests and retrieves a particular set of images from the Image Archive. Echo option requires ability to retrieve Echo Evidence.

Modality Images/Evidence Stored

• An Acquisition Modality sends acquired or generated images, waveforms, or other evidence documents to the Image Archive.

• Echocardiography Options• Image Archives & Image Displays must support:

– JPEG Baseline

– YBR_FULL_422

– Certain defined SOP classes

• Echo Evidence

TransactionsTransactions

Page 16: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop16

ViewsApical two chamber

Apical four chamber

Apical long axis

Parasternal long axis

Parasternal short axis

Parasternal short axis at the aortic valve level

Parasternal short axis at the level of the mitral chords

Parasternal short axis at the Mitral Valve level

Parasternal short axis at the Papillary Muscle level

Right Ventricular Inflow Tract View

Right Ventricular Outflow Tract View

Subcostal long axis

Subcostal short axis

Suprasternal long axis

Suprasternal short axis

TransactionsTransactions

Modality Images/Evidence Stored – cont’d– Stress Echo Option

• Stage Number & View Number

• Stage Code Sequence & View Code Sequence

CodingScheme

Designator(0008,0102)

Code Value(0008,0100)

Code Meaning (0008,0104)

SRT P5-01201 Image acquisition at baseline

SRT P5-01202 Pre-stress image acquisition

SRT P5-01203 Mid-stress image acquisition

SRT P5-01204 Peak-stress image acquisition

SRT P5-01205 Image acquisition during recovery

Page 17: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop17

Benefit: Stress EchoViewing ConsistencyBenefit: Stress EchoViewing Consistency

Page 18: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop18

ResultsResults

                                       

•Improved patient safety/reduce medical errors•Improved interoperability & workflow•Customers can choose best-in-class equipment based on clinical features, not based on whether it connects

Vendor X

Page 19: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop19

More information….More information….

• IHE Web sites: www.ihe.net• Technical Frameworks, Supplements

• Cardiology Technical Framework • IT Infrastructure Technical Framework • Displayable Reports Supplement

• Non-Technical Brochures :• Calls for Participation• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Products Integration Statements

Page 20: Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005 IHE Workshop20

W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsWorking Together to Deliver

Interoperable Health Information SystemsIn the Enterprise

and Across Care Settings