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8/8/2019 IHE Echo Workflow June05 v2
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Echo Workflow Echo Workflow
Neal Grotenhuis
Philips Medical Systems
IHE Cardiology Planning Committee
8/8/2019 IHE Echo Workflow June05 v2
http://slidepdf.com/reader/full/ihe-echo-workflow-june05-v2 2/20
June 28-29, 2005 IHE Workshop2
Source: 16th Annual HIMSS Leadership Survey sponsored by Superior Consultant Company/ACS Healthcare Solutions.
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop3
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.
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop4
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.
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop5
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
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop6
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´
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop7
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
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop8
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
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop9
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
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop10
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
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop11
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]
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]
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop12
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
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop13
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´
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop14
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
Tr ansa c ti o ns Tr ansa c ti o ns
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop15
Support for lossy JPEG images
Handling of intermittently connecteddevices
Bene f its Bene f its
RLE? Sorry.
Uncompressed? Yes, but«JPEG?
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop16
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
Tr ansa c ti o ns Tr ansa c ti o ns
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
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop17
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
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop18
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
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June 28-29, 2005 IHE Workshop19
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
8/8/2019 IHE Echo Workflow June05 v2
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June 28-29, 2005 IHE Workshop20
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