IHE Cardiology Profiles

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IHE Cardiology Profiles

• Harry Solomon
• Co-chair, IHE Cardiology Technical Committee

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Three profiles selected 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

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Why these profiles?

• High return on investment - important
  integration problems
• Well-established standards (DICOM, HL7, )
• Leverage IHE Radiology and IT Infrastructure
• No political challenges just technical
• Restricted scope for short year success

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Cath Lab Workflow
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The Multi-Modality Cath Lab Problem

• 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

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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!

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IHE Cardiac Cath Workflow

• Management of cath exams (in-lab portion)
• Similar to IHE-Radiology SWF
• Multi-modality, multiple procedure steps
• Reconciliation of unknown/temporary patient info
• Similar to IHE-Radiology PIR
• Unscheduled cath is the norm, not the exception
• Time synchronization
• Modalities must support IHE-ITI Consistent Time

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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

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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
  creation/display not required

But on the 5-year roadmap!
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Cath actors and 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
Dept. System Scheduler / Order Filler
Order Placer

Procedure Scheduled Rad-4

Modality PS in Progress Card-1


Patient Update Rad-12
Modality PS Completed Rad-7

Procedure Updated Rad-13

• Many actors cooperating in a complete end-to-end
  workflow
• Documented in the Technical Framework

Image Display
Performed

Query Images Rad-14
Procedure

Retrieve Images Card-4
Step Manager
Image Manager
Image Archive

Modality PS in Progress Card-1

Modality PS Completed Rad-7
Storage

Modality Image/Evidence Stored Card-2

Commitment Card-3

Modality PS in Progress Card-1

Modality PS Completed Rad-7
Acquisition
Modality

Query Modality Worklist Rad-5
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Echo Workflow
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Echocardiography issues

• Intermittently connected modality
• Echo machine loaded with worklist at beginning of
  shift, then goes mobile
• During shift, sonographer receives 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

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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

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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

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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

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Retrieve ECG for Display
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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)

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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

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IHE Cardiology 5-year Plan
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For more info

• IHE Cardiology Technical 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

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Any Questions?