1September, 2005 What IHE Delivers

PresenterPresenter

Maria Rudolph,Maria Rudolph,American College of Cardiology StaffAmerican College of Cardiology Staff

IHE CardiologyIHE Cardiology

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Why IHE Cardiology?Why IHE Cardiology?Multiple locations Office, in-patient, ED Individual patient is seen in multiple locations – distributed

patient record Individual clinician practices in multiple locations – across

organizational boundaries

Multiple devices and modalities Need to integrate data for comprehensive view of patient Multiple specialists cooperating on single patient

Chronic Disease Long term patient care – persistent and evolving patient record

Lots of hard data integration problemsLots of hard data integration problems

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IHE Cardiology OrganizationIHE Cardiology Organization

Principal Sponsor : American College of Cardiology

European Sponsor : European Society of Cardiology

Specialty Society Sponsors : American Society of EchocardiographyAmerican Society of Nuclear CardiologyHeart Rhythm Society

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The Workflow FoundationThe 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)

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Cath Lab WorkflowCath Lab Workflow

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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

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note: Cath Profile includes note: Cath Profile includes Electrophysiology labElectrophysiology lab

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Echo WorkflowEcho 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

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Stress WorkflowStress 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 IHE Stress Testing Profile and IHE Nuclear Medicine and IHE Nuclear Medicine

Image ProfileImage Profile

Trial Implementation

Trial Implementation

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Workflow Architecture SummaryWorkflow 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

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Getting resultsGetting results

Consistent electronic methods for reporting on cardiology findings Evidence Documents Profile (quantitative

measurements) • Cath and Echo options

Implantable Cardiac Device Observations Profile Retrieve Information for Display Profile

Retrieve ECG for Display Profile

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Cath and Echo Evidence DocumentsCath and Echo Evidence Documents

Echocardiography Measurement

Patient: Doe, John Technologist: der Payd, N

Measurements:

Mitral valve diameter 3.1cm

- shown in image at [ ]

Ventricular length, diastolic 5.97 cm

- shown in image at [ ]

Ventricular volume, diastolic 14.1 ml

- inferred from [ ]

- inferred from VLZ algorithm

Current kludges:• 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

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Implanted Device ObservationsImplanted 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 presentation of data from all devices

Trial Implementation

Trial Implementation

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Retrieve Information for DisplayRetrieve Information for Display

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 ProfileIHE Retrieve Information for Display Profileusingusing Web technology (HTTP, PDF, XML)Web technology (HTTP, PDF, XML)

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Retrieve ECGs for DisplayRetrieve ECGs for Display

Specialized use of RID Profile Web technology (HTTP, PDF, XML) Integrated into client

medical applications (clinical workstations – not free-standing Web browsers)

Vector PDF, XML list

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Beyond the EnterpriseBeyond the Enterprise

Sharing data between the office and in-patient environments, or on the regional or national level Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Content

from IHE IT Infrastructure,from IHE IT Infrastructure,Patient Care Coordination, Patient Care Coordination, Laboratory and Radiology DomainsLaboratory and Radiology Domains

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Cardiology Document Sharing Use CasesCardiology 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 IHE XDS / XDR / XDM ProfilesProfiles

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Document Content Profiles for CardiologyDocument Content Profiles for Cardiology

Medical Summary – encounter notes, discharge summary

Imaging – exchange of image links

Emergency Department Referral

Pre-procedure History and Physical

Scanned Documents

Personal Health Records

Basic Patient Privacy Consents

Laboratory Reports

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What’s coming up!What’s coming up!

Evidence Content – structured measurement data for stress testing, electrophysiology lab, and CTA / MRA

Displayable Reports Profile – workflow for graphics-rich reports in PDF

New IHE Quality Domain – secondary use of clinical data for quality measures, outcomes research, pay for performance

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2007-2008 IHE Cardiology Events2007-2008 IHE Cardiology Events

March – Year 3 demonstration at American College of Cardiology (New Orleans)

April – release Year 4 profiles for public comment

June – release Year 4 profiles for Trial Implementation

September – Year 3 demonstration at European Society of Cardiology (Vienna)

January 2008 – IHE Connectathon for Year 4

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Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings

http://www.ihe.nethttp://www.ihe.net

20September, 2005 What IHE Delivers