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Displayable Reports (DRPT)

Displayable Reports (DRPT). ACCA IHE Workshop 2007: Changing the Way Healthcare Connects. Typical Cardiology Reports. Typical Report Supported by EMR. History:

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Displayable Reports (DRPT)

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  1. Displayable Reports (DRPT) ACCA IHE Workshop 2007: Changing the Way Healthcare Connects

  2. Typical Cardiology Reports

  3. Typical Report Supported by EMR History: 35 yo white female with a history of inappropriate sinus tachycardia presents for sinus node modification. Mrs. Edmonds has had a history of a rapid heart rate for the past three to four years which is usally initiated by activity/exercise. These episodes of rapid heart rate have occassionally been associated with presyncope/dizzy spells. The patient has not suffered any injuries from these episodes. She has previously been evaluated by Dr. Schutzman with the Care Group - who has attempted control of her heart rate with multiple medical regiments including beta-blockers and calcium channel blockers. The patient could not tolerate either of the classes of medications. The patient had a normal ECHO and an unremarkable Holter Monitor. She subsequently had a an Event Monitor which showed several episodes of sinus tachycardia up to rate of 150 bpm. She then underwent a Tilt Table Test on October 3, 2006 to differentiate between inappropriate sinus tachycardia and postural tachycardia syndrome. Her Tilt was postive for NCS without any evidence of POTS. Past medical history significant for gallbladder and thyroid surgery - not on synthroid currently. Informed consent detailing risks and benefits of the procedure was obtained from the patient and witnessed on the day of the procedure. Physical: Normal cardiovascular exam, without evidence of congestive heart failure. Normal jugular venous pressure and carotids, regular rhythm with no murmur, no gallop. Normal symmetrical pulses, no edema. Lab Data: No significant abnormalities. Procedure: After prepping and draping and effecting local anesthesia with lidocaine, catheters were inserted as follows: A 5F quadripolar catheter was advanced from the left femoral vein (TriPort) to the high right atrium. A 6F deflectable quadripolar catheter was advance from the left femoral vein (TriPort) to the A-V junction (His bundle). A 5F quadripolar catheter was advanced from the left femoral vein (TriPort) to the right ventricular apex. A 7F deflectable decapolar catheter was placed from the right femoral vein to the coronary sinus. A 7F EPT ablation catheter was advanced from the right femoral vein for mapping and ablation. A 4F sheath was placed into the left femoral artery for blood pressure monitoring. Twelve surface ECG leads and intracardiac electrograms from the above locations were recorded during the study. Medications administered: propofol, total 1341 mg IV fentanyl, total 100 mcg IV promethazine, total 25 mg IV isoproterenol, up to 2.5 mcg/min infusion At the end of the study, the catheters were removed and hemostasis achieved using direct pressure. Results: The spontaneous rhythm was sinus with ventricular cycle length 968 ms. The P wave duration was 79 ms (nl <100), with no atrial abnormality; the PR interval was 151 ms (nl 120-200); the QRS duration was 71 ms (nl, 80-120), showing no conduction disturbance with an axis of 45° and QT interval 368 ms (nl, 390-440); the corrected QT [Bazett’s formula] was 374 ms. There was no evidence of a previous MI or delta waves.

  4. How do we cross the chasm between the graphically rich cardiology reports and the limited capabilities of EMR systems? How do we bring electronic reports to environments that do not yet support them at all?

  5. DRPT Premises • PDF is a prevalent output format for reporting applications • Design must support independent reporting apps • We can control (more or less) what happens in the department • Provide a variety of mechanisms for integration to systems outside the department (since we can’t control them)

  6. Displayable Reports ProfileTransaction Diagram Report Creator Encapsulated Report Encapsulated Report or Enterprise Report Repository Report Manager Dept Scheduler / Order Filler Report Completion Notify Report Reference Encapsulated Report Storage Commitment Report Repository Patient Identity Feed Patient Demographics Source Patient Demographics Consumer Information Source Web Display Retrieve Document for Display Encapsulated Report Query Encapsulated Report Retrieve Report Reader

  7. Displayable Reports ProfileActors • Report Creator – A system that generates and transmits clinical reports (the reporting app). • Report Manager – A system that manages the status of reporting, and distributes reports to report repositories (the department info system). • Report Repository – A departmental system that receives reports and stores them for long-term access (may leverage the PACS. • Enterprise Report Repository – A system that receives reports and/or references (pointers) to reports, and stores them for access throughout the healthcare enterprise (the EMR). • Report Reader – A system that can query/retrieve and view reports encoded as DICOM objects (an imaging workstation).

  8. MSH|^~\$|… PID|1|0123456‑1||R… OBR|1|X89‑1501^… OBX|1|ED|11528-7^LN… MSH|^~\$|… PID|1|0123456‑1||R… OBR|1|X89‑1501^… OBX|1|ED|11528-7^LN… HL7 HL7 MSH|^~\$|… PID|1|0123456‑1||R… OBR|1|X89‑1501^… OBX|1|RP|11528-7^LN… http://serv.hosp.org/app?requestType=DOCUMENT&documentUID=”1.2.3”&preferredContentType=”application/pdf” MSH|^~\$|… PID|1|0123456‑1||R… OBR|1|X89‑1501^… OBX|1|ED|11528-7^LN… HTTP DICOM (0008,0005) IR_100 (0008,0012) 20061113 (0008,0013) 1109 (0008,0016) 1.2.8401008.… Displayable Reports ProfileStandards Used Report Creator Encapsulated Report Encapsulated Report or Enterprise Report Repository Report Manager Dept Scheduler / Order Filler Report Completion Notif Report Reference Encapsulated Report Storage Commitment Report Repository Patient Demographics Source Patient Identity Feed Patient Demographics Consumer Information Source Web Display Retrieve Document for Display Encapsulated Report Query Encapsulated Report Retrieve Report Reader

  9. Profile Status • Demonstrated in 2006 • Currently being reworked to use most recent HL7 message definitions • Re-release for trial implementation in June 2007

  10. Implications for RFPs • Reporting apps – • Department info systems – • Cardiology PACS – • Imaging workstations – • EMR and clinical workstations –

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