IHE Cardiology Technical Overview

1. IHE Cardiology Technical Overview Current profiles of IHEfor cardiology

2. Clinical Priority Areas • Improve the performance of cardiology procedures – The Workflow Foundation • Facilitate the production of clinical reports – Getting Results • Share data across all locations of cardiac care – Beyond the Enterprise • Measure and improve practice – Quality

3. The Workflow Foundation • Managing cardiology procedure workflow to ensure consistently identified and integrated data • Cardiac Catheterization Workflow Profile • Echocardiography Workflow Profile • Stress Testing Workflow Profile • Nuclear Medicine Image Profile (Cardiology option)

4. Cath Lab • Multiple re-entry of Patient ID • Error prone data entry • Results fragmented across systems • Results inconsistently time-tagged • Custom solutions needed for data sharing • Difficult to manage • Uncoordinated with Hospital Information System • Unidentified patients (emergency) • Un-ordered cath exams • Diagnostic and interventional procedures • Ad hoc scheduling of cath labs • Change of rooms during procedure 7 6 5 8 10 9 11 4 3 2 1 IHE Cath Profile:managed workflow

5. Echo Workflow • The “drive-by echo” – Cardiologist to sonographer in CCU: “While you’re here, do a TTE on bed 3” • Unordered, unscheduled exam • Machine disconnected from network • Stress echo –After exam, sonographer creates new quad displays of stages and views • No intrinsic value add • Data is redundantly copied to storage in quad format IHE Echocardiography Profile

6. Stress Workflow • ~85% of stress tests are multi-modality (ECG + imaging) • ~0% of current architectures manage ECG and imaging workflow and results in an integrated manner • Poor adherence to ACC/ASNC nuclear image display requirements IHE Stress Testing Profile and IHE Nuclear Medicine Image Profile Trial Implementation

7. Workflow Architecture Summary • Cath, echo and stress workflows (and cardiac CT and MR) managed with a common architecture • HL7 Patient Demographics • HL7 Orders • DICOM Worklist Management • DICOM Object Management and Display • Images, waveforms, measurements, procedure logs • Modality specific requirements to improve workflow and clinical utility

8. Getting Results • Consistent electronic methods for reporting on cardiology findings • Evidence Documents Profile (measurements) • Cath, Echo, Stress, CTA/MRA options • Implantable Cardiac Device Observations Profile • Device Enterprise Communication Profile • Displayable Reports Profile • Retrieve Information for Display Profile • Retrieve ECG for Display Profile

9. Cardiology Measurements Echocardiography Measurement Patient: Doe, John Technologist: der Payd, N Measurements: Mitral valve diameter 0.8 cm - shown in image at [ ] Ventricular length, diastolic 3.97 cm - shown in image at [ ] Ventricular volume, diastolic 14.1 ml - inferred from [ ] - inferred from VLZ algorithm IHE Evidence Documents Profile:standard electronic measurement transfer formats Pick your current kludge: • Measurements made on modality or workstation, and written onto a paper worksheet, then transcribed into a report • Measurements output to a printer port, intercepted by an application that scrapes the values • Screen capture of measurements sent to a reporting system, which uses OCR (optical character recognition) to reconstruct the original measurement names and numbers

10. Evidence Document Options • Cath – QCA, QVA, hemo, procedure log, IVUS • Echo – TTE/TEE/stress, vascular • Stress – combined ECG and imaging • CTA/MRA Trial Implementation

11. Implanted Device Observations • Explosion in number of implantable cardioverter defibrillators • Clinicians need to manage patients with awide variety of devices in many contexts • ICDs, CRTDs, pacemakers, etc. • Implant, office follow up, home monitoring • Need standard set of observations, communicated in standard messages • Therapy settings, events, device self-monitoring • Enables consistent collection of data from all devices IHE Implantable Cardiac Device Observations Profile Trial Implementation

12. Patient Monitoring Observations • Get monitoring data from bedsideinto enterprise level application • Clinical Decision Support, Electronic Medical Record (flowsheet), Clinical Data Repository • Shorten decision time, increase productivity, minimize transcription errors, increase contextual information IHE Device Enterprise Communication Profilefrom IHE Patient Care Devices Domain

13. Cardiology reports typically PDF with lots of graphics – how to get them into an EMR? Displayable Reports IHE Displayable Reports ProfileSubmitting reports encapsulated in HL7 v2 messages Trial Implementation

14. Display Information Outside the Department • How does the clinical workstation on the ward get the report from the cardiology department? • How does the workstation in the cardiology department get a report from radiology, or a history and physical report from the outpatient department? IHE Retrieve Information for Display ProfileusingWeb technology (HTTP, PDF, XML)

15. Display ECGs Everywhere • Integrate ECG retrieval and display into clinical workstation applications IHE Retrieve ECG for Display ProfileusingWeb technology (HTTP, PDF, XML)

16. Beyond the Enterprise • Sharing data between the office and in-patient environments, or on the regional or national level • Cross-Enterprise Document Sharing (XDS) • Content Profiles • XDS for Imaging (XDS-I) • Cross-Enterprise Document Reliable Interchange (XDR) • Cross-Enterprise Document Media Interchange (XDM) from IHE IT Infrastructure and Patient Care Coordination Domains

17. Document Sharing Use Cases • Initial referral to cardiologist – family and social history, medications, test results • ACS presentation at emergency dept – last ECG, meds, history of care • Interventional report to referring physician – procedures performed, discharge summary • many, many more … IHE XDS / XDR / XDM Profiles

18. DocumentRepository Cross-Enterprise Document Sharing – with a Regional Organization Regional Health Information Organization (RHIO) Document Registry Long Term Care Acute Care (Inpatient) Other Specialized Careor Diagnostics Services XDS Basis for HITSP Interoperability Specs Primary Care and Clinics (Ambulatory)

19. XDS Content Profiles • Medical Summary – encounter notes, discharge summary • Imaging – exchange of image lists, with additional transactions for image access • Emergency Department Referral • Pre-procedure History and Physical • Scanned Documents • Personal Health Records • Basic Patient Privacy Consents • Laboratory Reports All from IHE Patient Care Coordination Domain, except Imaging (Radiology) and Laboratory (Laboratory Domain)

20. Cross-Enterprise Document Sharing – Ad-hoc Sharing • XDR – Online network point-to-point, without shared document registry • XDM – “Off-line” point-to-point • Email • Physical media (CD, USB flash)

21. Quality • Efficiently collect various measures of clinical quality and performance for practice improvement and consumer empowerment • Patient-Level Export of Quality Data (PEQD) • ACEI/ARB for LVSD after AMI Coming Soon from IHE Quality Domain