Implantable Device Cardiac Observations (IDCO) Profile. Tim Becker, PhD Univ- Hospital Schleswig-Holstein, Campus Kiel. Implantable Cardiac Devices. Pacemakers – therapy for heart rate problems Defibrillators – therapy for life threatening heart rhythms - PowerPoint PPT Presentation
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IHE Workshop – Feb 2007
Tim Becker, PhDTim Becker, PhDUniv- Hospital Schleswig-Holstein, Campus KielUniv- Hospital Schleswig-Holstein, Campus Kiel
Electrophysiologists follow patients with implantable cardiac Electrophysiologists follow patients with implantable cardiac devices from multiple vendorsdevices from multiple vendors
For each patient follow-up information that is stored in the For each patient follow-up information that is stored in the implantable device is electronically collected by an implantable device is electronically collected by an “interrogating” device“interrogating” device
In-Clinic – ProgrammerIn-Clinic – Programmer Remote – Communicator / Data CollectorRemote – Communicator / Data Collector
Each “interrogating” device is vendor proprietaryEach “interrogating” device is vendor proprietary
The follow-ups can occur in-clinic or remotely in the home The follow-ups can occur in-clinic or remotely in the home healthcare environmenthealthcare environment
Access to follow-up information often requires clinicians to use Access to follow-up information often requires clinicians to use multiple vendor specific systems and interfaces, complicating multiple vendor specific systems and interfaces, complicating efficiency and quality of workflowsefficiency and quality of workflows
Most of the interrogation devices are (portable) stand-alone Most of the interrogation devices are (portable) stand-alone systems without network interfacesystems without network interface
Aggregation of data into a central EMR or device clinic Aggregation of data into a central EMR or device clinic management systems requires manual and paper processesmanagement systems requires manual and paper processes
6IHE Workshop – Feb 2007IHE Workshop – Feb 2007
IDCO Value PropositionIDCO Value Proposition
Enable management of follow-up information in a central system such as an Device Clinic Management System or EMR
Improve efficiency and quality of related clinical processes
Single point of access for information Automation of current manual processes for data collection,
aggregation and analysis Standardization of workflow processes Enabling of analytics
messaging standards ISO/IEEE 11073 Point of Care Medical Device Communication
Standards nomenclature
Define actors, transactions and constraints consistent with existing and evolving IHE profiles and contexts
Align with future EP Workflow and other related profiles
Keep it simple for first year – trial implementation
8IHE Workshop – Feb 2007IHE Workshop – Feb 2007
IDCO Profile Use CasesIDCO Profile Use Cases
In-Clinic Implants or Follow-ups Patients present themselves in-clinic for implantation or follow-ups Information is collected using vendor specific “programmers” Information is sent from interrogation system to a central Device
Clinic Management System or EMR
Remote Follow-ups Patients devices are interrogated in the home health care
environment Information is collected using vendor specific communication
devices and systems Information is sent from interrogation system to a central Device
Clinic Management System or EMR
9IHE Workshop – Feb 2007IHE Workshop – Feb 2007
IDCO Profile Use CasesIDCO Profile Use Cases
Case I1: In-Clinic Followup
Case I2: In-Clinic Followup with Networked Programmer that Translates Information
Case I3: Remote Followup
Case I4: Third Party Value-Added Services
10IHE Workshop – Feb 2007IHE Workshop – Feb 2007
IDCO ActorsIDCO Actors
Observation Processor
Observation Repository
Send Observation[CARD - 12]
Send Observation[CARD - 12]
PIX Consumer
ObservationCreator
PIX Consumer
Patient Demographics
Consumer
Observation Creator - A system that creates and transmits diagnostic or therapeutic observational data.
Observation Processor and Repository – Systems that receive clinical observations and further process them or store them for retrieval and display.
Grouped with PIX and PAM actors for patient identification and demographics management.
11IHE Workshop – Feb 2007IHE Workshop – Feb 2007
IDCO ActorsIDCO Actors
Alternative Actor configuration
HL7 Router - A system that receives HL7 messages, routes them to one or more configured actors, and handles transport level acknowledgements.
Router will manage patient identification cross-referencing
Observation Processor
Observation Repository
Send Observation[CARD - 12]
ObservationCreator
Patient Demographics
Consumer
HL7 RouterSend Observation
[CARD - 12]
Send Observation[CARD - 12]
PIX Consumer
12IHE Workshop – Feb 2007IHE Workshop – Feb 2007
Transaction CARD 12Transaction CARD 12
CARD-12 Unsolicited HL7 v2.5 ORU message OBX contains XML payload based on HL7 v3 IDC message XML payload coded using ISO/IEEE 11073.1.1.3 IDC
Options for standard v2.5 OBX and embedded PDF report Audit Trail and Node Authentication (ATNA) profile
recommended for remote follow-ups across non-trusted networks
Attention ! Changes in Year 4 OBX containing HL7 v2.5 will be required OBX containing HL7 v3 will be an option
13IHE Workshop – Feb 2007IHE Workshop – Feb 2007
I1: In-Clinic FollowupI1: In-Clinic Followup
Obvservation Creator
Device Programmer
Obvservation Processor
Translator
Proprietary Protocol
Obvservation Repository
Send Observation [CARD-12]
• No standardized communication between programmer and Observation Creator
Device
Proprietary Protocol
14IHE Workshop – Feb 2007IHE Workshop – Feb 2007
I2: In-Clinic Followup with Networked I2: In-Clinic Followup with Networked Programmer that Translates InformationProgrammer that Translates Information
Obvservation Creator
Device Programmer
Obvservation Processor
Translator
Obvservation Repository
Send Observation [CARD-12]
• Programmer assumes role of the Observation Creator
15IHE Workshop – Feb 2007IHE Workshop – Feb 2007
I3: Remote FollowupI3: Remote Followup
Obvservation Creator
Obvservation Processor
Translator
Obvservation Repository
Send Observation [CARD-12]
• Use of ATNA to secure communication for remote followup
Clinic A
Clinic B
ATNA: Secure Node
ATNA: Secure Node
ATNA: Secure Node
untrusted network
16IHE Workshop – Feb 2007IHE Workshop – Feb 2007
I4: Third Party Value-Added SystemsI4: Third Party Value-Added Systems
Obvservation Creator
Obvservation Processor
Translator
Obvservation Repository
Send Observation [CARD-12]incl. rendered data as PDF
• Observation Creator is implemented as a third party service (e.g. monitor service)
• Povides additional functions such as analysis, trending, statistical reports• Additional data can be sent as a PDF attachment
Implanted Device does not carry any information about patient identifikation
Make use of ITI – Patient Identifier Cross-referencing Profile
Patient Identy Source
Patient Identifier Cross Reference
Manager
Patient Identifier Cross Reference
Consumer
Obvservation Processor
Obvservation Repository
HL/ Message Router
PIX Query [ITI-9]
PIX Update Notification [ITI-10]
Patient Identity Feed [ITI-8]
Asigning Authority: Device Manufacturer
Patient Identifier: Model device model number + device serial number
19IHE Workshop – Feb 2007IHE Workshop – Feb 2007
Potential Extended Actor GroupingsPotential Extended Actor Groupings
ObservationRepository
Information Source
Display
Retrieve Document for Display [ITI - 12]
Retrieve Specific Info for Display [ITI - 11]
ObservationProcessor
ReportCreator
Report Manager
Encapsulated Report Submission [CARD - 7]
ObservationProcessor
EvidenceCreator
Image Manager
Storage Committment [CARD - 3]
Modality Images/Evidence Stored [CARD - 2]
Store Evidence Documents [RAD - 43]
Storage Committment [CARD - 7]
ObservationProcessor
Document Source
Document Repository
Provide and Register Document Set [ITI - 15]
Basic IDCO Report Display using Retrieve Information for Display Profile (RID)Basic IDCO Report Display using Retrieve Information for Display Profile (RID)
IDCO Data Incorporation into a Report using Displayable Reports Profile (DRPT)IDCO Data Incorporation into a Report using Displayable Reports Profile (DRPT)
IDCO Discrete Data Storage using Evidence Documents Profile (ED)IDCO Discrete Data Storage using Evidence Documents Profile (ED)
IDCO Submission to an EHR using Cross Domain Document Sharing Profile (XDS)IDCO Submission to an EHR using Cross Domain Document Sharing Profile (XDS)
21IHE Workshop – Feb 2007IHE Workshop – Feb 2007
What’s Next?What’s Next?
Waveforms
Workflows (Scheduling / Orders)
22IHE Workshop – Feb 2007IHE Workshop – Feb 2007
IHE Workshop – Feb 2007
Tim Becker, PhDTim Becker, PhDUniv- Hospital Schleswig-Holstein, Campus KielUniv- Hospital Schleswig-Holstein, Campus Kiel
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
ImageManager
ImageArchive
DSS/ Order Filler
Patient Update [RAD-12]
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Evidence Creator Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Instance Availability Notification [RAD-49]
Report Creator
Report Creator
Requires that Image Manager / Image Archive Requires that Image Manager / Image Archive and Image Display support images, and Image Display support images, waveforms and structured reportswaveforms and structured reports
28IHE Workshop – Feb 2007IHE Workshop – Feb 2007
Stress Workflow – Actors and OptionsStress Workflow – Actors and OptionsActor Option Name Optionality Vol & Section
Acquisition Modality Patient Based Worklist Query O RAD-TF 2: 4.5
Broad Worklist Query R (see note 1) RAD-TF 2: 4.5
PPS Exception Management O RAD-TF 2: 4.7
Stress ECG R (see note 2) CARD-TF 2: 4.2
Stress Echo R (see note 2) CARD-TF 2: 4.2
Nuclear Medicine (see note 3) R (see note 2) RAD-TF 2: 4.8