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