IHE Cardiology Office Based Pacemaker and ICD Follow-up

1. IHE CardiologyOffice Based Pacemaker and ICD Follow-up Dave Shute November 13,2005 Rev 0.1

2. Office Based Pacemaker and ICD Follow-up Problem Statement • Ubiquitous access to patient specific, device specific and historical data is critical. Computer based systems to which complete and reliable interrogated data can be easily, rapidly and reliably transferred is needed. • This proposed IHE profile will describe: • How patients are registered and/or updated (including the printing of the necessary forms) • How interrogated data from the programmers of the implantable devices can be easily, rapidly and reliably transferred to the computer • How and where comments and analysis, progress notes, analysis, etc. can be captured • How appointments are scheduled • How billing is managed • Remote capabilities that allow the physician to assess a patient’s status anytime anywhere and provide the necessary care IHE Cardiology

3. Office Based Pacemaker and ICD Follow-up Scenario • A patient calls her physician after receiving a shock from her ICD. The physician reviews the patient’s information remotely. The physician looks for availability in tomorrow’s schedule, since the patient is stable the physician tells her to come into the office the next day at 1pm . • At the clinic the patient registers with the admitting office to ensure up-to-date insurance information. • A nurse interrogates the device and the data is electronically transferred to the device data repository. The physician then examines the patient and programming changes are made. The device is again interrogated and the data is again electronically transferred to the device data repository. The nurse then verifies the data in the computer system. • The physician reviews the patient’s online file adding the appropriate comments and progress notes. The desired forms and necessary labels are printed. Billing information is sent to the billing management system. • Before leaving the clinic the patient schedules her next appointment. IHE Cardiology

4. Office Based Pacemaker and ICD Follow-up Diagram IHE Cardiology

5. Actors • Scheduler – A system that allows time and place assignments for the in office device interrogation. • Programmer Integrator Interface – A system responsible for collecting the interrogated data from multiple vendor devices. The system will collect data automatically via wired and wireless interfaces automatically decipher the data and deliver it to the device data repository. • Device data repository - A system the receives device data and stores the data for reporting, billing, and all other access throughout the enterprise. • Physician/Clinician Viewer – A system that allows access to device data and reports throughout the healthcare enterprise and external to the healthcare enterprise with increased security. • Report/Letter Generation - A system that creates needed reports and letters to communicate device information from the interrogation sessions. These artifacts can be stored in the device data repository if needed. IHE Cardiology

6. Actors • Billing – A system that does all financial activities surrounding the interrogation event. • Registration - A system that maintains demographic and ADT information for a patient. The system may be an EMR that communicates with other systems in the healthcare enterprise. IHE Cardiology

7. In Scope / Out of Scope • The problem addressed is the workflow in the electrophysiology laboratory for the two types of procedures: electrophysiology/ablation procedures and implantation of cardiac devices. Note: list functionality especially at borders of what is included/excluded – i.e., included features that could reasonably be descoped by the Technical Committee, or excluded futures that could be included IHE Cardiology

8. Phased Approach • YEAR 1: • Case C1: Scheduler • Case C2: Programmer Interrogator Interface • Case C3: Device Data Repository • Case C4: Clinician/Physician Viewer • Case C5: Report/Letter Generation • Case C6: Billing • YEAR 2: • Integration of Laboratory Analysis data • Integration of History and Physical data • Creating standardized output • Creating CMS ICD Implant form • Beyond… • Consolidated EMR of EP procedure (all data from each device) • Consolidated procedure log across devices during the procedure IHE Cardiology