1. September, 2005Cardio - June 2007 Displayable Reports (DRPT) IHE Workshop 2007 Harry Solomon, GE Healthcare IHE-Cardiology Technical & Planning Committees

2. 2 Cardio - June 2007 Typical Cardiology Reports

3. 3 Cardio - June 2007 Typical Report Supported by EMR History: 35 yo white female with a history of inappropriate sinus tachycardia presents for sinus node modification. Mrs. Edmonds has had a history of a rapid heart rate for the past three to four years which is usally initiated by activity/exercise. These episodes of rapid heart rate have occassionally been associated with presyncope/dizzy spells. The patient has not suffered any injuries from these episodes. She has previously been evaluated by Dr. Schutzman with the Care Group - who has attempted control of her heart rate with multiple medical regiments including beta-blockers and calcium channel blockers. The patient could not tolerate either of the classes of medications. The patient had a normal ECHO and an unremarkable Holter Monitor. She subsequently had a an Event Monitor which showed several episodes of sinus tachycardia up to rate of 150 bpm. She then underwent a Tilt Table Test on October 3, 2006 to differentiate between inappropriate sinus tachycardia and postural tachycardia syndrome. Her Tilt was postive for NCS without any evidence of POTS. Past medical history significant for gallbladder and thyroid surgery - not on synthroid currently. Informed consent detailing risks and benefits of the procedure was obtained from the patient and witnessed on the day of the procedure. Physical: Normal cardiovascular exam, without evidence of congestive heart failure. Normal jugular venous pressure and carotids, regular rhythm with no murmur, no gallop. Normal symmetrical pulses, no edema. Lab Data: No significant abnormalities. Procedure: After prepping and draping and effecting local anesthesia with lidocaine, catheters were inserted as follows: A 5F quadripolar catheter was advanced from the left femoral vein (TriPort) to the high right atrium. A 6F deflectable quadripolar catheter was advance from the left femoral vein (TriPort) to the A-V junction (His bundle). A 5F quadripolar catheter was advanced from the left femoral vein (TriPort) to the right ventricular apex. A 7F deflectable decapolar catheter was placed from the right femoral vein to the coronary sinus. A 7F EPT ablation catheter was advanced from the right femoral vein for mapping and ablation. A 4F sheath was placed into the left femoral artery for blood pressure monitoring. Twelve surface ECG leads and intracardiac electrograms from the above locations were recorded during the study. Medications administered: propofol, total 1341 mg IV fentanyl, total 100 mcg IV promethazine, total 25 mg IV isoproterenol, up to 2.5 mcg/min infusion At the end of the study, the catheters were removed and hemostasis achieved using direct pressure. Results: The spontaneous rhythm was sinus with ventricular cycle length 968 ms. The P wave duration was 79 ms (nl <100), with no atrial abnormality; the PR interval was 151 ms (nl 120-200); the QRS duration was 71 ms (nl, 80-120), showing no conduction disturbance with an axis of 45° and QT interval 368 ms (nl, 390-440); the corrected QT [Bazett’s formula] was 374 ms. There was no evidence of a previous MI or delta waves.

4. 4 Cardio - June 2007 How do we cross the chasm between the graphically rich cardiology reports and the limited capabilities of EMR systems? How do we bring electronic reports to environments that do not yet support them at all?

5. 5 Cardio - June 2007 DRPT Premises PDF is a prevalent output format for reporting applications Design must support independent reporting apps We can control (more or less) what happens in the department Provide a variety of mechanisms for integration to systems outside the department (since we can’t control them)

6. 6 Cardio - June 2007 Displayable Reports Profile Transaction Diagram Encapsulated Report Report Repository Report Manager Enterprise Report Repository Encapsulated Report Query Encapsulated Report Retrieve Imaging Workstation Report Reader Report Creator Encapsulated Report Storage Commitment Retrieve Document for Display Information Source Report Reference Web Display Patient Demographics Source Patient Identity Feed Patient Demographics Consumer Dept Scheduler / Order Filler Encapsulated Report or Report Completion Notify

7. 7 Cardio - June 2007 Displayable Reports Profile Actors Report Creator – A system that generates and transmits clinical reports (the reporting app). Report Manager – A system that manages the status of reporting, and distributes reports to report repositories (the department info system). Report Repository – A departmental system that receives reports and stores them for long-term access (may leverage the PACS. Enterprise Report Repository – A system that receives reports and/or references (pointers) to reports, and stores them for access throughout the healthcare enterprise (the EMR). Report Reader – A system that can query/retrieve and view reports encoded as DICOM objects (an imaging workstation).

8. 8 Cardio - June 2007 Displayable Reports Profile Standards Used Encapsulated Report Report Repository Report Manager Enterprise Report Repository Encapsulated Report Query Encapsulated Report Retrieve Report Creator Encapsulated Report Storage Commitment Retrieve Document for Display Information Source Report Reference Web Display Patient Demographics Source Patient Identity Feed Patient Demographics Consumer Dept Scheduler / Order Filler Encapsulated Report or Report Completion Notif MSH|^~\$|… PID|1|0123456 ‑ 1||R… OBR|1|X89 ‑ 1501^… OBX|1|ED|11528-7^LN… MSH|^~\$|… PID|1|0123456 ‑ 1||R… OBR|1|X89 ‑ 1501^… OBX|1|ED|11528-7^LN… HL7 MSH|^~\$|… PID|1|0123456 ‑ 1||R… OBR|1|X89 ‑ 1501^… OBX|1|ED|11528-7^LN… MSH|^~\$|… PID|1|0123456 ‑ 1||R… OBR|1|X89 ‑ 1501^… OBX|1|RP|11528-7^LN… http://serv.hosp.org/app?req uestType=DOCUMENT&d ocumentUID=”1.2.3”&pref erredContentType=”applicat ion/pdf” HL7 (0008,0005) IR_100 (0008,0012) 20061113 (0008,0013) 1109 (0008,0016) 1.2.8401008.… DICOM HTTP Imaging Workstation Report Reader

9. 9 Cardio - June 2007 Implications for RFPs Reporting apps – Department info systems – Cardiology PACS – Imaging workstations – EMR and clinical workstations –

10. 10 Cardio - June 2007