IHE Cardiology Profiles
Harry Solomon
Co-chair, IHE Cardiology
Technical Committee
1
Three profiles selcted 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 2004 Solomon – p. 2
Why these profiles?
High return on investment - important
integration problems
Standards in place (DICOM, HL7, …)
Leverage IHE Radiology and IT Infrastructure
No “political” challenges – just technical
Restricted scope for short year success
European Society of Cardiology 2004 Solomon – p. 3
Cath Lab Workflow
European Society of Cardiology 2004 Solomon – p. 4
The Multi-Modality Cath Lab Problem
Multiple re-entry of Patient ID
Error prone
Results fragmented across systems
Custom solutions needed for data sharing
Difficult to manage
European Society of Cardiology 2004 Solomon – p. 5
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 2004 Solomon – p. 6
IHE Cardiac Cath Workflow
Management of cath exams (in-lab portion)
– Similar to IHE-Radiology SWF
– Multi-modality, multiple procedure steps
Reconciliation of patient information
– 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 2004 Solomon – p. 7
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 2004 Solomon – p. 8
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 no actors specified for display
But on the 5-year roadmap!
European Society of Cardiology 2004 Solomon – p. 9
Integration Profile:
A Solution to an Integration Problem
Actors
cooperating ADT
through
Pt. Registration [Rad-1]
Patient Update [Rad-12] Pt. Registration [Rad-1]
Patient Update [Rad-12]
Placer Order M anagement [Rad-2]
Filler Order M anagement [Rad-3]
Transactions DSS/ Order Filler
M odality PS in Progress [Card-1] Procedure Scheduled [Rad-4]
Order Placer
M odality PS Completed [Rad-7] Patient Update [Rad-12]
to solve a Procedure Updated [Rad-13]
specific problem
European Society of Cardiology 2004 Solomon – p. 10
Cath actors and transactions
ADT
Pt. Registration [Rad-1]
Patient Update [Rad-12] Pt. Registration [Rad-1]
Patient Update [Rad-12]
Placer Order M anagement [Rad-2]
Filler Order M anagement [Rad-3]
DSS/ Order Filler Order Placer
M odality PS in Progress [Card-1] Procedure Scheduled [Rad-4]
M odality PS Completed [Rad-7] Patient Update [Rad-12]
Procedure Updated [Rad-13]
Image Display
Performed Query Images [Rad-14]
Procedure Retrieve Images [Card-4]
Step M anager
Image Image
M anager Archive
M odality PS in Progress [Card-1]
M odality PS Completed [Rad-7]
Storage M odality Image/Evidence
Commitment Stored [Card-2]
[Card-3]
M odality PS in Progress [Card-1]
M odality PS Completed [Rad-7]
Acquisition
M odality
Query M odality Worklist [Rad-5]
European Society of Cardiology 2004 Solomon – p. 11
Echo Workflow
European Society of Cardiology 2004 Solomon – p. 12
Echo issues
Intermittently connected modality
– Echo machine loaded with worklist at beginning of
shift, then goes mobile
– During shift, sonographer gets 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 2004 Solomon – p. 13
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 2004 Solomon – p. 14
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 2004 Solomon – p. 15
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 2004 Solomon – p. 16
Retrieve ECG for Display
European Society of Cardiology 2004 Solomon – p. 17
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 2004 Solomon – p. 18
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 2004 Solomon – p. 19
IHE Cardiology 5-year Plan
Year 1 Year 2 Year 3 Year 4 Year 5
(2005 demo) (2006 demo) (2007 demo) (2008 demo) (2009 demo)
Multi-modality Procedure log & Hemo waveform & Precision time Supplies, inventory,
Cath
workflow & imaging reporting measures, QCA/QVA synchronization & charge capture
Workflow & imaging, Reporting workflow Measurement Pediatric
Cardiology Technical Framework
Echo
stress protocols interoperability
Retrieve ECG ECG/Stress/Holter ECG waveform
ECG
for display orders interoperability
Workflow & imaging, Reporting workflow
Nuclear
stress protocols
Multi-modality lab Implantable device Home health
EP
workflow & reporting parameters & events monitoring
Workflow, reporting,
MR/CT
& measurements
Registry data Retrieve guidelines Retrieve structured
Quality
submission for display guidelines
Cross-enterprise Patient location
Admin
referrals/orders & transport
IT Infrastructure TF
Retrieve info Cross-enterprise Patient care plan Risk factors for
EMR
for display document sharing clinical decision supt
Time Personnel Device auto-
Infra
synchronization white pages configuration
Audit trail Enterprise user
Security
authentication
European Society of Cardiology 2004 Solomon – p. 20
For more info:
IHE Cardiology Techincal Framework
version 1.0 for Trial Implementation at:
– www.rsna.org/ihe
– www.acc.org/quality/ihe.htm
Submit questions and comments to:
– http://forums.rsna.org
European Society of Cardiology 2004 Solomon – p. 21