September, 2005What IHE Delivers Integrating the Healthcare Enterprise - towards the electronic patient record The IHE Cardiology Technical Framework Current status of IHE for cardiology

2 Disclosures Harry Solomon – employee of GE Healthcare (significant)

3 IHE Technical Framework Detailed implementation guides Standards-based data sharing Organized by clinical domain and use cases

4 IHE Annual Cycle – the Technical Framework 1.Cardiologists identify and prioritize clinical problems (Use Cases = Integration Profiles) 2.Engineers from industry define technical solutions using open standards (Technical Framework) 3.Vendors implement and test at “Connectathon” & demos 4.Vendors publish “Integration Statements”; users request in RFPs

5 The IHE Domains Radiology Cardiology IT Infrastructure Patient Care Coordination Laboratory Patient Care Devices Radiation Oncology Eye Care Pathology new domains

6 Clinical Priority Areas Improve the performance of cardiology procedures – The Workflow Foundation Facilitate the production of clinical reports – Getting Results Share data across all locations of cardiac care – Beyond the Enterprise

7 The Workflow Foundation Managing cardiology procedure workflow to ensure consistently identified and integrated data 1.Cardiac Catheterization Workflow Profile 2.Echocardiography Workflow Profile 3.Stress Testing Workflow Profile 4.Nuclear Medicine Image Profile (Cardiology option)

8 Cath Lab 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 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 IHE Cath Profile: managed workflow

9 Echo 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 in quad format IHE Echocardiography Profile

10 Stress 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 and IHE Nuclear Medicine Image Profile

11 Workflow 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

12 Getting Results Consistent electronic methods for reporting on cardiology findings 5.Evidence Documents Profile (quantitative measurements) Cath and Echo options 6.Implantable Cardiac Device Observations Profile 7.Displayable Reports Profile 8.Retrieve Information for Display Profile A.Retrieve ECG for Display Profile

13 Cardiology Measurements 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 Pick your current kludge: 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 IHE Evidence Documents Profile: standard electronic measurement transfer formats

14 Implanted Device Observations Explosion in number of implantable cardioverter defibrillators Clinicians need to manage patients with a wide 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 IHE Implantable Cardiac Device Observations Profile Trial Implementation

15 Displayable Reports Cardiology reports typically PDF with lots of graphics – how to get them into an EMR? IHE Displayable Reports Profile Submitting reports encapsulated in HL7 v2 messages Trial Implementation

16 Display Information Outside the Department 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 Profile using Web technology (HTTP, PDF, XML)

17 Display ECGs Everywhere Integrate ECG retrieval and display into clinical workstation applications IHE Retrieve ECG for Display Profile using Web technology (HTTP, PDF, XML)

18 Beyond the Enterprise Sharing data between the office and in- patient environments, or on the regional or national level 10.Cross-Enterprise Document Sharing (XDS) 11.Cross-Enterprise Document Reliable Interchange (XDR) 12.Cross-Enterprise Document Media Interchange (XDM) All from IHE IT Infrastructure Domain

19 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 Profiles

20 Acute Care (Inpatient) Primary Care and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Regional Health Information Organization (RHIO) Document Registry Document Repository Cross-Enterprise Document Sharing – with a Regional Organization

21 Cross-Enterprise Document Sharing – Ad-hoc Sharing XDR – Online network point-to-point, without shared document registry XDM – “Off-line” point-to-point   Physical media (CD, USB flash) Just released for Trial Implementation

22 XD* Content Profiles 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 Just released for Trial Implementation All from Patient Care Coordination Domain, except Imaging (Radiology) and Laboratory (Laboratory Domain)

23 Profiles in Development Data Harvesting – capture of clinical data for outcomes registries (CARDS, NCDR) Urgent identification of implanted device – emergency dept access for ICDs, CRTDs, etc. Device Enterprise Communication – real- time vital signs from patient monitors

24 IHE Web site: Join IHE Cardiology Users’ Group (web seminars) Frequently Asked Questions Integration Profiles in Technical Frameworks:  Cardiology  Radiology  IT Infrastructure  Patient Care Coordination  Patient Care Devices  Radiology  Laboratory Connectathon Results Vendor Products Integration Statements Participation in Committees & Connectathons

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