European Society of Cardiology 2004

European Society of Cardiology 2004 1

IHE Cardiology ProfilesIHE Cardiology Profiles

Harry SolomonCo-chair, IHE Cardiology Technical Committee

European Society of Cardiology 2004 Solomon – p. 2

Three profiles selected for year 1Three profiles selected for year 1

Cardiac Catheterization Workflow

– Based on successful IHE Radiology Scheduled Workflow and Patient Information Reconciliation Profiles

Echocardiography Workflow

– Based on successful IHE Radiology Scheduled Workflow and Patient Information Reconciliation Profiles

Retrieve ECG for Display

– Based on successful IHE IT Infrastructure Retrieve Information for Display Profile


Why Why thesethese profiles? profiles?

High return on investment - important integration problems

Well-established standards (DICOM, HL7, …)

Leverage IHE Radiology and IT Infrastructure

No “political” challenges – just technical

Restricted scope for short year success


Cath Lab WorkflowCath Lab Workflow


The Multi-Modality Cath Lab ProblemThe Multi-Modality Cath Lab Problem

Multiple re-entry of Patient ID

Error prone

Results fragmented across systems

Results inconsistently time-tagged

Custom solutions needed for data sharing

Difficult to manage


Cath Workflow Cath Workflow Management Issues Management Issues

Un-ordered cath exams (emergency)

Unidentified patients

Uncoordinated with Hospital Information System

Diagnostic and interventional procedures

Ad hoc scheduling of cath labs

Change of rooms during procedure

… and interactions between these issues!


IHE Cardiac Cath WorkflowIHE Cardiac Cath Workflow

Management of cath exams (in-lab portion)

– Similar to IHE-Radiology SWF– Multi-modality, multiple procedure steps

Reconciliation of unknown/temporary patient info

– Similar to IHE-Radiology PIR– Unscheduled cath is the norm, not the exception

Time synchronization

– Modalities must support IHE-ITI Consistent Time


Cardiac Cath – 8 use casesCardiac Cath – 8 use cases

All use cases must be supportedAll use cases must be supported

Case C1: Patient Registered at ADT and Procedure Ordered at the Order Placer

Case C2: Patient Registered at ADT and Procedure Ordered at DSS/OF

Case C3: Patient Registered at ADT and Procedure Not Ordered

Case C4: Patient Registered at DSS/OF and Procedure Ordered

Case C5: Patient Not Registered

Case C6: Patient Updated During Procedure

Case C7: Change Rooms During Procedure

Case C8: Cancel Procedure


Cardiac Cath - Out of scope year 1Cardiac Cath - Out of scope year 1

Pre-cath and post-cath activity

Hemo waveforms and reports*

Procedure logs

QCA/QVA/IVUS reports*

Final cath reports*

Supply chain*Archives must support storage, but creation/display not required

But on the 5-year roadmap!But on the 5-year roadmap!


Cath actors and transactionsCath actors and transactions

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 [Card-4]

Image Display

Modality Image/Evidence Stored [Card-2]

Storage Commitment

[Card-3]

Procedure Scheduled [Rad-4]

Procedure Updated [Rad-13]

Query Modality Worklist [Rad-5]

Performed Procedure

Step Manager

Modality PS in Progress [Card-1] Modality PS Completed [Rad-7]



Order Placer

Acquisition Modality

ImageManager

Image Archive

Dept. System Scheduler / Order Filler

Patient Update [Rad-12]

Many actors cooperating in a complete Many actors cooperating in a complete end-to-end workflowend-to-end workflow

Documented in the Technical FrameworkDocumented in the Technical Framework


Echo WorkflowEcho Workflow


Echocardiography issuesEchocardiography issues

Intermittently connected modality

– Echo machine loaded with worklist at beginning of shift, then goes mobile

– During shift, sonographer receives verbal order for exam (ad hoc); no network connection for worklist update (exam may or may not have been ordered)

Stress echo

– Image labeling

– Appropriate level for management of stages

Digital vs. videotape


Echocardiography WorkflowEchocardiography Workflow

Management of echo exams (TTE, TEE, stress)

– Similar to IHE-Radiology SWF– Handle intermittently connected modality– Handle multi-stage tests (stress echo)

Workflow management, image labeling, and display

– Handle multiframe and compressed images

Reconciliation of patient information

– Similar to IHE-Radiology PIR


Echo – 6 use casesEcho – 6 use 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


Echo – Out of scope year 1Echo – Out of scope year 1

Preliminary and final reports

– Sonographer and over-reading cardiologist

Counter-indication/clinical decision support

Fetal and pediatric echo

Combined echo/ECG stress acquisition workflow


Retrieve ECG for DisplayRetrieve ECG for Display


ECG IssuesECG Issues

Need broad distribution of ECGs using ubiquitous technology (Web)

Avoid artifacts on zoomed ECGs

– Vector images required (not rasterized)

Facilitate apps for serial comparison (side-by-side synchronized display)


Retrieve ECG for DisplayRetrieve ECG for Display

Provide ECGs and related reports to enterprise

– Extension to IHE-ITI RID Retrieve list of documents; retrieve single document

– ECGs served in ready-to-display format (PDF, SVG) Requirements on display format/quality

– Includes XML-based ECG/report list Derived from HL7 v3 Reference Information Model (RIM)

Out of scope year 1

– ECG acquisition and reading workflow– ECG raw data interchange– Export of reports to external repository


IHE Cardiology 5-year PlanIHE Cardiology 5-year PlanYear 1

(2005 demo)Year 2

(2006 demo)Year 3

(2007 demo)Year 4

(2008 demo)Year 5

(2009 demo)

Cath

Echo

ECG

Nuclear

EP

Card

iolo

gy T

echnical F

ramew

ork

IT In

frastructu

re TF

Infra

Security

Admin

EMR

Quality

MR/CT

Multi-modality workflow & imaging

Procedure log &reporting

Hemo waveform & measures, QCA/QVA

Supplies, inventory,& charge capture

Workflow & imaging,stress protocols

Reporting workflow

Retrieve ECGfor display

ECG/Stress/Holterorders

Workflow & imaging,stress protocols

Reporting workflow

Multi-modality labworkflow & reporting

Home healthmonitoring

Timesynchronization

Audit trail Enterprise userauthentication

Retrieve infofor display

Cross-enterprisedocument sharing

Retrieve guidelinesfor display

Retrieve structuredguidelines

Registry datasubmission

Cross-enterprisereferrals/orders

Workflow, reporting,& measurements

Risk factors forclinical decision supt

Patient care plan

Patient location& transport

Device auto-configuration

Precision timesynchronization

Implantable device parameters & events

Pediatric

Personnel white pages

Measurementinteroperability

ECG waveform interoperability


For more info:For more info:

IHE Cardiology Technical Framework version 1.0 for Trial Implementation at:

– www.rsna.org/ihe– www.acc.org/quality/ihe.htm

Submit questions and comments to:

– http://forums.rsna.org


This is your cardiologist in healthcareThis is your cardiologist in healthcare

Any Questions?Any Questions?

This is healthcareThis is healthcare

European Society of Cardiology 2004

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