Retrieve ECG for Display Profile Retrieve ECG for Display Profile John Donnelly IHE-Cardiology Planning Committee.

Retrieve ECG for DisplayProfile

Retrieve ECG for DisplayProfile

John Donnelly

IHE-Cardiology Planning Committee

June 28-29, 2005 Interoperability Strategy Workshop2

ECG NeedsECG Needs

• ECGs Accessible Everywhere!• Need broad distribution of ECGs using ubiquitous

technology (Web).– Allow medical applications to easily retrieve and display

ECGs in a platform/vendor neutral way.

• High-quality ECG documents. Avoid artifacts on zoomed ECGs and arbitrary display geometries.– Vector images required (not rasterized)

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


ECG Profile ECG Profile Abstract / ScopeAbstract / Scope

• Provide ECGs and related documents to enterprise• Reuse IHE-ITI RID

– Retrieve list of documents; retrieve single document

– ECGs served in ready-to-display format (PDF, SVG)

• Limited extension for ECG-specific needs– Add requirements on display format and quality

– Include XML-based ECG report list


Out of ScopeOut of Scope

• ECG acquisition and reading workflow.• ECG raw data interchange.• Export of reports to external repository.• Central management and configuration of ECG

devices.


ECG ProfileECG ProfileValue PropositionValue Proposition

• Use ubiquitous HTTP Get mechanism as defined in IHE-ITI RID– Standardized URLs

• Use PDF for easy integration with existing display applications

• PDF vector graphics supports scalable waveforms• XML list of ECGs for serial comparison apps


Example ECG in PDF FormatExample ECG in PDF Format


Example ECG in SVG FormatExample ECG in SVG Format


ECG ProfileECG ProfileTransaction DiagramTransaction Diagram

Display InformationSource

Retrieve Specific Info for Display [ITI-11]Retrieve ECG List [CARD-5]

Retrieve ECG Document for Display [CARD-6]


ECG Profile ECG Profile ActorsActors

• DisplayDisplay – A system that can request and display preformatted (“presentation-ready”) data using Web technologies.

• Information SourceInformation Source – A system that responds to requests for patient-related ECG data by encoding it in a presentation-ready format using Web technologies.

• Same actors as RID Profile


ECG ProfileECG ProfileStandards UsedStandards Used

• HTTPHTTP – Query/response• XHTMLXHTML – Response list format• XMLXML – Alternate response list format (processable)• PDFPDF – ECG content format• SVG SVG – Alternate ECG content format

– A W3C Standard (XML meets graphics)

– Allows scripting for embedded client side controls


ECG ProfileECG ProfileTransactionsTransactions

• Retrieve Specific Info for Display [ITI-11]– Uses HTTP Get query parameters “SUMMARY” or “SUMMARY-

CARDIOLOGY”– Response list of documents (including ECGs) in ready-to-display

format (XHTML)

• Retrieve ECG List [CARD-5]– Uses HTTP Get query parameter “SUMMARY-CARDIOLOGY-

ECG”– Response list of ECGs in processable format (HL7 RIM-derived XML)

• Retrieve ECG Document for Display [CARD-6]– Response ECG served in PDF– SVG allowed if Display actor asks for it and Information Source

supports it


ECG XML List ECG XML List based on HL7 V3 R-MIMbased on HL7 V3 R-MIM

IHEDocumentListclassCode*: <= ACTmoodCode*: <= EVNcode*: CD CWE [1..1] <= ActCodeactivityTime: TS [0..1]

DocumentInformationclassCode*: <= ACTmoodCode*: <= EVNid*: II [1..1]code: CD CWE [0..1] <= ActCodetitle: ST [0..1]text: ED [0..1]statusCode: CS CNE [0..1]effectiveTime: TS [0..1]

0..* documentInformationtypeCode*: <= COMP

component

PatientclassCode*: <= PSNdeterminerCode*: <= INSTANCEname: PN [0..1]administrativeGenderCode: CE CWE [0..1] <= AdministrativeGenderbirthTime: TS [0..1]

0..1 patientPatient

0..1 providerOrganization

PatientRoleclassCode*: <= PATid*: II [1..1]

1..1 patient *

typeCode*: <= RCTrecordTarget

IHEDocumentList(AABB_RM444448)

This contains information about a set of documentsreturned from an IHE “Request List of ECGs” request.

DeviceclassCode*: <= DEVdeterminerCode*: <= INSTANCEid: II [0..1]code: CE CWE [0..1] <= EntityCodemanufacturerModelName: SC CWE [0..1] <= ManufacturerModelNamesoftwareName: SC CWE [0..1] <= SoftwareName

0..1 assignedDevice

AssignedAuthorclassCode*: <= ASSIGNEDid: II [0..1]

0..1 assignedAuthor

typeCode*: <= AUTnoteText: ED [0..1]

author

OrganizationclassCode*: <= ORGdeterminerCode*: <= INSTANCEid: II [0..1]name: ON [0..1]


ECG XML List SchemaECG XML List Schema


ECG PDF Content RequirementsECG PDF Content Requirements

• Waveform as vector graphics– Gives high quality line drawings at any screen resolution and zoom

factor– Rasterized (e.g. scanned, bitmapped) ECG “images” not allowed

• Minimum context– Patient Name and ID– Date/time of recording– Confirmation status of interpretation

• Waveform technical content– Standard calibration “pulse” 1 mv x 200 ms– Nominal 1 mm grid– Lead labels– Frequency response


Use Case D1: Simple DisplayUse Case D1: Simple Display

• Display actor requests list of ECG documents for a specific patient ID.– RID profile SUMMARY-CARDIOLOGY request returns

list as HTML.

– ECG profile SUMMARY-CARDIOLOGY-ECG request returns list as XML with stylesheet.

• Display actor requests a specific ECG document using a unique document ID.– The ID of the requested document may not have been

obtained from the previously retrieved list.


Example List as HTMLExample List as HTML


Use Case D2: Advanced DisplayUse Case D2: Advanced Display

• Display actor requests list of ECG documents for a specific patient ID using ECG profile request type.– List of ECGs returned as structured XML.

• Display actor parses structured document list to select related ECGs for serial comparison, for example.

• Display actor requests the specific ECG documents using the unique document IDs obtained in structured list above.

• Display actor displays the ECGs in a meaningful way.


ECG XML List ExampleECG XML List Example


ECG List XML Example Formatted ECG List XML Example Formatted with Stylesheetwith Stylesheet


ECG List XML ExampleECG List XML ExampleSimple Serial Comparison App.Simple Serial Comparison App.


Serial Comparison ExampleSerial Comparison Example

23-April-2004 13:45:02

23-April-2004 13:47:45


More information….More information….

• IHE Web site: www.ihe.netwww.ihe.net• Technical Frameworks, Supplements

• Cardiology Technical Framework • IT Infrastructure Technical Framework • ECG XML List Schema and examples

• Non-Technical Brochures :• Calls for Participation• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Products Integration Statements


W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsWorking Together to Deliver

Interoperable Health Information SystemsIn the Enterprise

and Across Care Settings

Retrieve ECG for Display Profile Retrieve ECG for Display Profile John Donnelly IHE-Cardiology Planning Committee.

Documents

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