European Society of Cardiology 2004
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Transcript of 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
European Society of Cardiology 2004 Solomon – p. 3
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
European Society of Cardiology 2004 Solomon – p. 4
Cath Lab WorkflowCath Lab Workflow
European Society of Cardiology 2004 Solomon – p. 5
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
European Society of Cardiology 2004 Solomon – p. 6
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!
European Society of Cardiology 2004 Solomon – p. 7
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
European Society of Cardiology 2004 Solomon – p. 8
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
European Society of Cardiology 2004 Solomon – p. 9
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!
European Society of Cardiology 2004 Solomon – p. 10
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]
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
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
European Society of Cardiology 2004 Solomon – p. 11
Echo WorkflowEcho Workflow
European Society of Cardiology 2004 Solomon – p. 12
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
European Society of Cardiology 2004 Solomon – p. 13
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
European Society of Cardiology 2004 Solomon – p. 14
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
European Society of Cardiology 2004 Solomon – p. 15
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
European Society of Cardiology 2004 Solomon – p. 16
Retrieve ECG for DisplayRetrieve ECG for Display
European Society of Cardiology 2004 Solomon – p. 17
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)
European Society of Cardiology 2004 Solomon – p. 18
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
European Society of Cardiology 2004 Solomon – p. 19
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
European Society of Cardiology 2004 Solomon – p. 20
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
European Society of Cardiology 2004 Solomon – p. 21
This is your cardiologist in healthcareThis is your cardiologist in healthcare
Any Questions?Any Questions?
This is healthcareThis is healthcare