IHE Cardiology

1. IHE Cardiology • Domain Overview Harry Solomon 27-July-2010

2. Agenda • Domain Update • Overview of existing profiles • New profiles

3. Domain Update • Cardiology domain was established in 2004 • Successful profile development during years 1-4: • Echo and Cath Workflow • Retrieval and display of ECGs • Storage and exchange of evidence documents • Displayable reports • 2008 domain became dormant due to lack of funding • 2009 domain was re-established with new funding trough ACC, ASE, ASNC, HRS

4. Echo Workflow • Addresses ordering, scheduling, scheduling, storage and review of echo exams including: • TTE, TEE, Stress exams • Specifically deals with intermittently connected modality • Handling of compressed images

5. Cath Workflow • Deals with complex cardiac catheteterization Workflow: • Unordered exams • Coordination of imaging, reporting and hemodynamic data • Support for multi-modality workflow coordination • Coordination of diagnostic imaging and interventional procedure information

6. Access to ECGs from everywhere in the hospital: Resting ECGs, Holter ECGs Simplified and standardized access to ECGs and viewing process No need for ‘printed ECGs’ Retrieve ECG for Display

7. Evidence Documents • The IHE Radiology Evidence Documents Profile defines the storage, exchange, archival and display of clinical findings such as measurements, observations, and results created by acquisition modalities or workstations. • IHE Cardiology adds named options for each class of cardiac imaging evidence, with some specific content and display requirements.

8. Stress Testing Workflow • Provides ordering and collecting multi-modality (ECG and imaging) data during diagnostic cardiac stress testing procedures • Manages ECG and imaging workflow in an integrated manner • Adherence to ACC/ASNC display requirements

9. New Developments • Image Enabled Office • Address integration of medical imaging equipment into an office environment, in order to fulfill the meaningful use criteria for image integration in 2015 • Applicable to other domains • Resting ECG Workflow • Define a profile similar to Scheduled Workflow to address patient registration, ordering of a resting 12 lead ECG test, performing the test, reporting and storage of the ECG data in a standardized format • Major updates to Displayable Reports profile • Distributes “display ready” PDF/CDA (cardiology) clinical reports from the department to the enterprise. • The 2009-10 update includes support for CDA format reports, better alignment with HL7 conventions, clarifications for ECG usage and restructures actors to avoid options • Approach applicable to other domains

10. More Information • http://www.ihe.net/Events/webinars2010.cfm • IHE Webinar series 2010 • http://www.ihe.net/Technical_Framework/index.cfm • IHE Technical Frameworks and Supplements • http://wiki.ihe.net/index.php?title=Cardiology • Information on IHE Cardiology development activities • Weblink to TI versions ?? • TI versions from IHE ( will this be same as TF once we release to RSNA on July 21)

11. Resting ECG Workflow (REWF) Profile Overview Barry Brown 27-July-2010

12. 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

13. 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

14. 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

15. 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.

16. Actor / Transaction Diagram

17. 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)

18. “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

19. 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

20. Displayable Reports (DRPT) Profile Overview Harry Solomon 27-July-2010

21. Image enabled Office (IEO) Profile Overview Harry Solomon 27-July-2010

22. Scratchpad area

23. Resting ECG Workflow • Define a profile similar to Scheduled Workflow to address patient registration, ordering of a resting 12 lead ECG test, performing the test, reporting and storage of the ECG data in a standardized format • Key use case: • Similar workflows as described in scheduled workflow, but used for resting ECG • Existing Standards and Profiles • Based on actors and transactions of scheduled workflow. Intermittently connected acquisition device needs to be covered. • Key takeaways • Focus on resting ECG only • Use of DICOM General waveform object • Access to demographics outside of “scheduled workflow” • …….

24. Image Enabled Office • Address integration of medical imaging equipment into an office environment, in order to fulfill the meaningful use criteria for image integration in 2015 • Key use case: • Scheduling, Image acquisition, reporting, access to EMR, document exchange with referring physicians in an ambulatory cardiology office. • Existing Standards and Profiles • IHE workflow profiles like ECHO, CATH, SWF, STRESS • IHE Evidence Document and Key Image Note profiles • IHE XDS, XDS-I, XDS-MS, PIX, PDQ profiles for cross enterprise sharing of information • DICOM WADO • Key Takeaways • Generic approach useful for other domains – no specific cardiology restrictions • crucial for meaningful use criteria 2013/2015, it should be tested at Connectathon in 2011… • Leverages in-patient workflow concepts to minimize impact on imaging devices/infrastructure • Recognizes integrated EMR presence in office environment

25. Displayable Reports • Address distribution of “readable” clinical reports between the department and the enterprise • Key use case: • Distribute a display-ready cardiology clinical report outside the cardiology department. • Existing Standards and Profiles • IHE RID • PDF CDA • … • Key Takeaways • Generic mechanism applicable to other clinical domains • PDF and CDA supported • Previous actor list restructured to avoid options • ….