Echo Workflow - IHE by shuifanglj

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									Integrating the Healthcare Enterprise

                Echocardiography Profile

                     Cameron Brackett, Cerner
                       Echo Profile co-editor,
           IHE Cardiology Technical & Planning Committee


  Sept 13-15, 2004              1                IHE Interoperability Workshop
                   Introduction

  Echo Profile
    TTE, TEE, Stress Echo


  Cath Profile
    Intravascular ultrasound (IVUS) and intracardiac
       echocardiography (ICE) are used in cardiac
       catheterization procedures, and are supported as
       modalities in the Cath Workflow, and not in the
       Echo Workflow.



Sept 13-15, 2004   IHE Educational Workshop 2004   Cameron – p. 2
                   Goal for Year 1

  High ROI—value added problem solutions
  Standards in place (DICOM & HL-7)
  No ―political‖ challenges – just technical
  Restricted scope for a ―quick win‖
  Reuse successful Radiology profiles to
  meet similar needs



Sept 13-15, 2004    IHE Educational Workshop 2004   Cameron – p. 3
Year 1 Scope: Imaging Workflow
  Reuse of similar IHE-Radiology Profiles
    Scheduled Workflow (IHE-R SWF)
    Patient Information Reconciliation (IHE-R PIR)
  Intermittently Connected Modality
    Workflow
    Acquisition Modality storage
  Stress Echo
    Workflow
    Staged Protocol
      • Acquisition Modality (optional)

      • Image Display (required)

  Digital vs. Videotape



Sept 13-15, 2004     IHE Educational Workshop 2004    Cameron – p. 4
   Echo – Out of scope year 1
  Documentation/Reporting
    Nursing (e.g. TEE)
    Sonographer (e.g. measurements via DICOM SR)
    Cardiologist (final report)
    Medication administration
  Counter-indication/clinical decision support
  Fetal and pediatric echo
  Combined echo/ECG stress acquisition workflow




Sept 13-15, 2004    IHE Educational Workshop 2004   Cameron – p. 5
  Echo Actors & Transactions
                                                               ADT
               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]
                              DSS/ Order Filler                                                Order Placer

                Modality PS in Progress [Card-1]           Procedure Scheduled [Rad-4]
                Modality 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 Manager

                                                                                Image         Image
                                                                               Manager        Archive
                    Modality PS in Progress [Card-1]
                    Modality PS Completed [Rad-7]

                                                                           Storage            Modality Image/Evidence
                                                                       Commitment             Stored [Card-2]
                                                                          [Card-3]
                    Modality PS in Progress [Card-1]
                    Modality PS Completed [Rad-7]
                                                                                     Acquisition
                                                                                      Modality
                    Query Modality Worklist [Rad-5]




Sept 13-15, 2004                     IHE Educational Workshop 2004                                                    Cameron – p. 6
                           Actors
No new Actors
Actors Using Cardiology Specific Transactions
 Department System Scheduler/Order Filler (DSS/OF)
 Performed Procedure Step Manager
 Image Archive
 Image Manager
 Acquisition Modality
 Image Display




 Sept 13-15, 2004   IHE Educational Workshop 2004   Cameron – p. 7
                    Transactions
Modality Procedure Step In Progress An
Acquisition Modality notifies the Performed
Procedure Step Manager of the start of a new
Procedure Step and the PPS Manager informs
the Department System Scheduler/Order Filler
and Image Manager. [CARD-1, derived from
RAD-6]
 Intermittently connected workflows may send the MPPS
  “In Progress” immediately preceding the MPPS
  “Complete”



 Sept 13-15, 2004   IHE Educational Workshop 2004   Cameron – p. 8
                                Transactions
Modality Images/Evidence Stored – An Acquisition Modality
sends acquired or generated images, waveforms, or other
evidence documents to the Image Archive. [CARD-2,
derived from RAD-8 and RAD-43]
 Echocardiography Option
   • Image Archives must support:

          – JPEG Baseline (Process 1): Default Transfer Syntax for Lossy JPEG 8 Bit
            Image Compression for Ultrasound Multi-frame images
          – YBR_FULL_422
          – The follow SOP classes:
                          SOP Class UID                           SOP Class Name
                 1.2.840.10008.5.1.4.1.1.7       Secondary Capture Image Storage

                 1.2.840.10008.5.1.4.1.1.6.1     Ultrasound Image Storage

                 1.2.840.10008.5.1.4.1.1.3.1     Ultrasound Multi-frame Image Storage

                 1.2.840.10008.5.1.4.1.1.88.59   Key Object Selection
                 1.2.840.10008.5.1.4.1.1.88.11   Basic Text SR

                 1.2.840.10008.5.1.4.1.1.88.22   Enhanced SR

                 1.2.840.10008.5.1.4.1.1.88.33   Comprehensive SR



  Sept 13-15, 2004                  IHE Educational Workshop 2004                       Cameron – p. 9
                           Transactions
  Modality Images/Evidence Stored – cont’d
    Stress Echo Option
      • Acquisition Modality actors supporting the STRESS ECHO option

         are required to support a number of attributes in Multi-frame
         Ultrasound Images created for a stress echo procedure
                   Attribute Name                            Tag        Requirement

                   Performed Procedure Step Description   (0040,0254)       R+

                   Protocol Name                          (0018,1030)       R+
                   Performed Protocol Code Sequence       (0040,0260)       R+
                   Number of Stages                       (0008,2124)       R+
                   Number of Views in Stage               (0008,212A)       R+
                   Stage Code Sequence                    (0040,000A)   R+ (note 2)
                   Stage Number                           (0008,2122)       R+
                   View Number                            (0008,2128)   R+ (note 1)
                   View Code Sequence                     (0054,0220)   R+ (note 2)




Sept 13-15, 2004              IHE Educational Workshop 2004                           Cameron – p. 10
                         Transactions
  Modality Images/Evidence Stored – cont’d
    Stress Echo Option
      • Numbers: Stage Number & View Number

      • Code Sequences: Stage Code Sequence & View Code

         Sequence

                                         Stage
         Coding Scheme     Code Value                         Code Meaning (0008,0104)
           Designator      (0008,0100)
           (0008,0102)

              SRT           P5-01201      Image acquisition at baseline

              SRT           P5-01202      Pre-stress image acquisition

              SRT           P5-01203      Mid-stress image acquisition

              SRT           P5-01204      Peak-stress image acquisition

              SRT           P5-01205      Image acquisition during recovery




Sept 13-15, 2004         IHE Educational Workshop 2004                           Cameron – p. 11
                       Transactions
  Modality Images/Evidence Stored – cont’d

                                       View
       Coding Scheme      Code Value                                    Code Meaning
         Designator


           SRT             G-A19B             Apical two chamber
           SRT             G-A19C             Apical four chamber
           SRT              G-0395            Apical long axis
           SRT              G-0396            Parasternal long axis

           SRT              G-0397            Parasternal short axis
           SRT              G-0398            Parasternal short axis at the aortic valve level
           SRT              G-0399            Parasternal short axis at the level of the mitral chords
           SRT             G-039A             Parasternal short axis at the Mitral Valve level
           SRT             G-039B             Parasternal short axis at the Papillary Muscle level
           SRT             G-039C             Right Ventricular Inflow Tract View
           SRT             G-039D             Right Ventricular Outflow Tract View
           SRT             G-039E             Subcostal long axis
           SRT             G-039F             Subcostal short axis
           SRT             G-03A0             Suprasternal long axis
           SRT             G-03A1             Suprasternal short axis



Sept 13-15, 2004       IHE Educational Workshop 2004                            Cameron – p. 12
                   Transactions
  Storage Commitment – A requestor (Acquisition
  Modality) requests that the Image Manager
  confirm ownership for the specified DICOM
  objects (images, waveforms, evidence
  documents, or any combination thereof) that the
  requestor stored in the Image Archive, thus
  allowing the sender to delete those objects now
  owned by the Image Manager. [CARD-3, derived
  from RAD-10]
    This option requires the Image Manager to send the N-Event
       Report message to the mobile modality at the time that
       reconnects to the Image Manager.



Sept 13-15, 2004     IHE Educational Workshop 2004    Cameron – p. 13
                   Transactions
  Retrieve Images – An Image Display
  requests and retrieves a particular image
  or set of images from the Image Archive.
  [CARD-4, derived from RAD-16]


  Image Display
    JPEG Baseline (Process 1): Default Transfer
     Syntax for Lossy JPEG 8 Bit Image Compression
     for Ultrasound Multi-frame images
    YBR_FULL_422
    May organize and present multiple images for
     stress echo

Sept 13-15, 2004   IHE Educational Workshop 2004   Cameron – p. 14
                   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




Sept 13-15, 2004   IHE Educational Workshop 2004   Cameron – p. 15
      Use Case E2: Intermittently
         Connected Modality
 Clinical Context
   Echo system has gone mobile to perform procedures
   TTE, TEE


 IHE Context
   MPPS in Progress
   Storage Commitment




Sept 13-15, 2004   IHE Educational Workshop 2004   Cameron – p. 16
       Use Case E2: Intermittently
          Connected Modality
                                     Order           Department System          Image
               ADT                                                                                    Acquisition
                                     Placer             Scheduler/             Manager/
                                                        Order Filler                                   Modality
                                                                              PPS Manager
                        Register J.Doe

               Patient
               Registration [RAD-1]
                                              Placer Order
                                              Management–
                   One or the                 New [RAD-2]
                   other methods
                   of creating an
                   order is used              Filler Order
                                              Management -        Schedule
                                              New [RAD-3]         Procedure

                                                               Procedure
                                                               Scheduled [RAD-4]

                                                                   Query Modality Worklist [RAD -5]
                                                              Modality Procedure     Modality Procedure
                                           Filler Order       Step In Progress       Step In Progress          Perform
                                           Mgmt - Status      [CARD-1]-              [CARD-1]-                 Acquisition
                                           Update [RAD-3]


                                                              Modality Procedure       Modality Procedure
              Patient Reconciliation       Filler Order       Step Completed           Step Completed
                       J.Doe ->            Mgmt - Status      [RAD-7]                  [RAD-7]
                       J.Smith             Update [RAD-3]

                                                                                     Storage Commitment
                      Patient Update/                                                        -
                                                                                       [CARD-3]
                      Merge [RAD-12]                          Patient Update/
                                                              Merge [RAD-12]




Sept 13-15, 2004                         IHE Educational Workshop 2004                                          Cameron – p. 17
                More information….
IHE Web sites:
     http://www.himss.org/IHE
     http://www.rsna.org/IHE
     http://www.acc.org/quality/ihe.htm.
Technical Frameworks:
     •   ITI V1.0, RAD V5.5, LAB V1.0
Technical Framework Supplements - Trial Implementation
     •   May 2004: Radiology
     •   August 2004: Cardiology, IT Infrastructure
Non-Technical Brochures :
     •   Calls for Participation
     •   IHE Fact Sheet and FAQ
     •   IHE Integration Profiles: Guidelines for Buyers
     •   IHE Connect-a-thon Results
     •   Vendor Products Integration Statements
 Sept 13-15, 2004      IHE Educational Workshop 2004       Cameron – p. 18

								
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