European Society of Cardiology IHE Cardiology Profiles Harry Solomon Co-chair, IHE Cardiology Technical Committee

European Society of Cardiology 2004Solomon – p. 2 Three 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 2004Solomon – p. 3 Why these 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 2004Solomon – p. 4 Cath Lab Workflow

European Society of Cardiology 2004Solomon – p. 5 The 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 2004Solomon – p. 6 Cath Workflow 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 2004Solomon – p. 7 IHE 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 2004Solomon – p. 8 Cardiac Cath – 8 use cases All 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 2004Solomon – p. 9 Cardiac 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!

European Society of Cardiology 2004Solomon – p. 10 Cath 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 Image Manager Image Archive Dept. System Scheduler / Order Filler  Patient Update [Rad-12]

European Society of Cardiology 2004Solomon – p. 11 Cath 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 Image Manager Image Archive Dept. System Scheduler / Order Filler  Patient Update [Rad-12] Many actors cooperating in a complete end-to-end workflow Documented in the Technical Framework

European Society of Cardiology 2004Solomon – p. 12 Echo Workflow

European Society of Cardiology 2004Solomon – p. 13 Echocardiography 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 2004Solomon – p. 14 Echocardiography 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 2004Solomon – p. 15 Echo – 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 2004Solomon – p. 16 Echo – 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 2004Solomon – p. 17 Retrieve ECG for Display

European Society of Cardiology 2004Solomon – p. 18 ECG 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 2004Solomon – p. 19 Retrieve 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 2004Solomon – p. 20 IHE Cardiology 5-year Plan

European Society of Cardiology 2004Solomon – p. 21 For more info: IHE Cardiology Technical Framework version 1.0 for Trial Implementation at: – – Submit questions and comments to: –

European Society of Cardiology 2004Solomon – p. 22 This is your cardiologist in healthcare Any Questions? This is healthcare