Presenter

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IHE Cardiology

• Presenter
• Maria Rudolph,American College of Cardiology
  Staff

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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 problems
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IHE 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 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 Workflow
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-ordere
d 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 Electrophysiology lab
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Echo Workflow

• The drive-by echo Cardiologist to
  sonographer in CCU While youre 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 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
Trial Implementation
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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

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Getting 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 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 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
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Retrieve 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
Profileusing Web technology (HTTP, PDF, XML)
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Retrieve 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 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, Patient Care
Coordination, Laboratory and Radiology Domains
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Cardiology 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
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Document 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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Whats 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 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 Vendors
• Working Together to Deliver
• Interoperable Health Information Systems
• in the Enterprise
• and Across Care Settings

http//www.ihe.net
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