IHE Echo Workflow June05 v2

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Echo Workflow Echo Workflow

Neal Grotenhuis

Philips Medical Systems

IHE Cardiology Planning Committee



June 28-29, 2005 IHE Workshop2

Source: 16th Annual HIMSS Leadership Survey sponsored by Superior Consultant Company/ACS Healthcare Solutions.




Business I ssues Business I ssues

IT Ba rr ie r s IT Ba rr ie r s

1. Lack of adequate financial support for IT

2. Vendors¶ inability to satisfactorily deliver products and services3. Lack of staffing resources

4. Difficulty proving ROI

5. Lack of clinical leadership

16 th Annual HIMSS Leadership Survey

sponsored by Superior Consultant Company/

ACS Healthcare Solutions.




I nt rod u c ti o n I nt rod u c ti o n

Echo Profile

TTE

TEE

Stress Echo

Cath Profile

Intravascular ultrasound (IVUS)

Intracardiac echo (ICE) are used in cardiaccatheterization procedures, and are supported asmodalities in the Cath Workflow, and not in theEcho Workflow.




IHE is dr iving inte rop e r abi l ity in Echo

IHE is dr iving inte rop e r abi l ity in Echo




IHE T e rm in olo gy IHE T e rm in olo gy

Ultrasound system = ³Image Acquisition Modality´

Images & reports = ³Evidence Documents´

IHE Demo person = ³Docent´

PACS = ³Image Archive´ and/or ³Image Manager actors´




High ROI²value added problem solutions

Standards in place (DICOM & HL-7)

No ³political´ challenges ± just technical Restricted scope for a ³quick win´

Reuse successful Radiology profiles to meet

similar needs

G o a l s For IHE c a rd i olo gy G o a l s For IHE c a rd i olo gy




Reuse of similar IHE-Radiology Profiles ± Scheduled Workflow (IHE-R SWF)

± Patient Information Reconciliation (IHE-R PIR)

Intermittently Connected Modality ± Workflow

± Acquisition Modality storage

Stress Echo ± Workflow

± Staged Protocol Acquisition Modality ( optional)

Image Display ( required)

Digital vs. Videotape ± A-D workflow, training issues

Echo Prof i l e Scop e:

Im aging Workflow

Echo Prof i l e Scop e:

Im aging Workflow




U se C ases U se C ases

Case E1: Patient Registered at ADT and Procedure Ordered

Case E2: Intermittently Connected Modality

Case E3: Intermittently Connected Modality with Ad HocProcedure, Patient Registered, Scheduled Procedure

Case E4: Intermittently Connected Modality with Ad HocProcedure, Patient Registered, Unscheduled Procedure

Case E5: Intermittently Connected Modality with Ad HocProcedure, Patient Unregistered, Unscheduled Procedure

Case E6: Stress Echo Staged Protocol

Case E7: Echo Measurements




U se C ase E4 : I nte rm ittent l y

Co nne c te d Mod a l ity

U se C ase E4 : I nte rm ittent l y

Co nne c te d Mod a l ity

³Could you scan this patient right now since you have

a cart in the CCU anyway?´

Clinical Use Cases: ± Lost and unbilled echo exams because carts are constantly on the move

± Patient and order info manually entered (potential for errors) or not at all

± Measurements are transferred

Benefits: ± Accurate and automatic demographic and order reconciliation

± Verify all images are securely archived

± Improved workflow




oo

qPt. Registra tion [RAD-1]qPatient Update [RAD-12]

Pt. Registra tion [RAD-1] q

Patient Update [RAD-12] q

nPlacer Order Management [RAD-2]pFiller Order Management [RAD-3]

ADT

qQuery Images [RAD-14]qRetrieve Images/Evidence [CARD4]

ImageDisplay

Modality Image/Evidence

Stored [CARD2]

StorageCommitment

[CARD3]

q Procedure Scheduled [RAD-4]

q Procedure Updated [RAD-13]

nQuery Modality Worklist [RAD-5]

Performed

Procedure

Step Mgr

oModality PS in Progress [CARD1]-oModality PS Completed [RAD-7]

p Modality PS in Progress [CARD1]p Modality PS Completed [RAD-7]

n

nModality PS Completed [RAD-7]

Order Placer

Acquisition

Modality

Image

Manager

Image

Archive

DSS/ Order Filler

qPatient Update [RAD-12]

Modality Image/EvidenceStored [CARD2]

StorageCommitment

[CARD3]

qq

Evidence

CreatornModality PS in Progress [CARD1]nModality PS Completed [RAD-7]

qQuery Evidence [RAD-44]

Instance Availability Notification [RAD-49]o

Echo Ac t or s & Tr ansa c ti o ns Echo Ac t or s & Tr ansa c ti o ns

Modality PS in Progress [CARD1]




Ac t or s Ac t or s

Echo profile uses existing actors that usecardiology specific transactions

± Department System Scheduler/Order Filler (DSS/OF)

± Order Placer

± Performed Procedure Step Manager

± Image Archive

± Image Manager

± Acquisition Modality ± Image Display

± Evidence Creator




Tr ansa c ti o ns Tr ansa c ti o ns

StorageCommitment ± A requestor (Acquisition Modality) requeststhat the Image Manager confirm ownership for the specified DICOM

objects (images, waveforms, evidence documents, or any combination

thereof) that the requestor stored in the Image Archive, thus allowing

the sender to delete those objects now owned by the Image Manager.

± This option requires the Image Manager to send the N-Event Report

message to the mobile modality at the time that reconnects to the Image

Manager.

Local

storage

³I¶m sending images´

³Will you commit to store these?´

³Yes, you can delete your copy now´

³I received them´




Modality Procedure Step In Progress: Informs the PPS Manager of the start of a newProcedure Step, PPS Manager informs the Department System Scheduler/Order Filler and

Image Manager.

R etrieve Images: An Image Display requests and retrieves a particular set of images from

the Image Archive. Echo option requires ability to retrieve Echo Evidence.

Modality Images/Evidence Stored

An Acquisition Modality sends acquired or generated images, waveforms, or other

evidence documents to the Image Archive.

Echocardiography Options

Image Archives & Image Displays must support:

± JPEG Baseline

± YBR_FULL_422 ± Certain defined SOP classes

Echo Evidence





Support for lossy JPEG images

Handling of intermittently connecteddevices

Bene f its Bene f its

RLE? Sorry.

Uncompressed? Yes, but«JPEG?




ViewsApical two chamber

Apical four chamber

Apical long axis

Parasternal long axis

Parasternal short axis

Parasternal short axis at the aortic valve level

Parasternal short axis at the level of the mitral chords

Parasternal short axis at the Mitral Valve level

Parasternal short axis at the Papillary Muscle level

R ight Ventricular Inflow Tract View

R ight Ventricular Outflow Tract View

Subcostal long axis

Subcostal short axis

Suprasternal long axis

Suprasternal short axis


Modality Images/Evidence Stored ± cont¶d

± Stress Echo Option

Stage Number & View Number

Stage Code Sequence & View Code

Sequence

Coding

Scheme

Designator

(0008,0102)

Code Value

(0008,0100)Code Meaning (0008,0104)

SRT P5-01201 Image acquisition at baseline

SRT P5-01202 Pre-stress image acquisition

SRT P5-01203 Mid-stress image acquisition

SRT P5-01204 Peak -stress image acquisition

SRT P5-01205 Image acquisition during recovery




Bene f it: S t r ess Echo

V ie w ing Co nsisten c y

Bene f it: S t r ess Echo

V ie w ing Co nsisten c y




R esu l ts R esu l ts

Improved patient safety/reduce medical errorsImproved interoperability & workflow

Customers can choose best-in-class equipment

based on clinical features, not based on whether it

connects

Vendor X




Mor e in form ati o n«.Mor e in form ati o n«.

IHE Web sites: www.ihe.net Technical Frameworks, Supplements

Cardiology Technical Framework

IT Infrastructure Technical Framework

Displayable R eports Supplement

Non-Technical Brochures : Calls for Participation

IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers

IHE Connect-a-thon R esults

Vendor Products Integration Statements




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

Pro viders and Vendors

Worki ng T ogether to Deliv er Int eroper able Heal th Inf ormat ion S yst ems

In the Ent erpr is e

and Ac ross Car e Sett ings

IHE Echo Workflow June05 v2

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