Resting ECG Workflow (REFW)

1. Resting ECG Workflow (REFW) Profile Overview

2. REWF Profile Scope In Scope Out of Scope Reporting workflow management Clinical trial workflow • Patient registration • Ordering and scheduling • Acquisition • Data storage • Data retrieval for reporting • Report distribution

3. Use Cases • Normal Priority, Scheduled ECGs • Patient is registered • ECG is ordered, scheduled, acquired, stored, reviewed, and reported • Urgent ECG, Unidentified Patient • Unordered ECG • Patient demographics reconciliation • Scheduled ECG While Offline • Order reconciliation • Other Cases Not Completely Covered • Patient Demographics for Unscheduled ECGs • Acquisition Modality should be grouped with PDQ Consumer • Clinical Trials • Much thought was given to clinical trial workflow, but it deserves its own profile in a future year • Physician Offices • ECGs are often (implicitly) ordered and acquired in a single step while a patient is being examined • The new Image Enabled Office profile covers office-based ECG workflow

4. Related Profiles • RAD SWF - Scheduled Workflow • Patient registration • Test ordering and scheduling • Acquisition and data storage • Data retrieval • RAD PIR - Patient Information Reconciliation • Urgent ECGs acquired on unknown patients • ITI CT - Consistent Time • Synch Acquisition Modality’s clock • ITI PDQ - Patient Demographics Query • Acquisition Modality can query for demographics • CARD DRPT - Displayable Reports • Distribute ECG reports • CARD IEO - Image Enabled Office • Workflow in an office environment

5. Highlights • Allows multi-vendor interoperability between 5 major subsystems: • Registration and ordering (HIS, CVIS) • ECG archival (PACS, ECG Management) • Acquisition devices (Electrocardiographs) • ECG analysis and reporting workstations (ECG or PACS Workstations) • ECG report consumers (EMR) • Uses HL7 transactions for HIS and EMR. • Uses DICOM transactions for acquisition devices and workstations • ECG waveforms stored as DICOM General ECG Waveform objects • ECG measurements and interpretations stored as DICOM Structured Reports • An “Integrated ECG Manager” actor makes it easier for traditional ECG management products to adopt this profile.

6. Actor / Transaction Diagram

7. Familiar Actors and Transactions • Actors reused from other profiles: • ADT (SWF) • Order Placer (SWF) • DSS/OF (SWF) • Image Manager / Image Archive (SWF) • PPS Manager (SWF) • Acquisition Modality (SWF) • Evidence Creator (SWF) • Image Display (SWF) • Time Client (CT) • Report Creator (DRPT) • Report Manager (DRPT)

8. “Integrated ECG Manager” Actor • Integrated ECG Manager is an optional integration of the actors in the “middle” • Makes it easier for traditional ECG management products to adopt this profile without having to expose transactions between the integrated actors • Individual actors are still present so traditional departmental management and archive products can treat Resting ECG Workflow like other scheduled workflows

9. New and Modified Transactions • CARD-2 Modality Images/Evidence Stored • Acquisition Modality and Image Archive actors must be able to store General ECG Waveform and Enhanced SR (ECG Report template) • CARD-4 Retrieve Images/Evidence • Report Creator and Image Display actors must be able to display General ECG Waveform and Enhanced SR (ECG Report template) • CARD-7 Encapsulated Report Submission • Specifies displayable Resting ECGs (PDFs) should meet minimum display requirements • Basic measurements and interpretation should be included as discrete data in OBX segments • New: CARD-12 Query Enhanced Modality Worklist • Patient queries can also match on Admission ID • Broad queries can also match on Scheduled Procedure Step Location • New: CARD-13 Query Cardiology Images/Evidence • Query returns Performed Protocol Step Code Sequence to distinguish General ECG Waveform objects used for resting ECG from other tests and monitoring sessions