Echo Workflow Neal Grotenhuis Philips Medical Systems IHE Cardiology Planning Committee

June 28-29, 2005IHE Workshop2 Source: 16th Annual HIMSS Leadership Survey sponsored by Superior Consultant Company/ACS Healthcare Solutions.

June 28-29, 2005IHE Workshop3 Business Issues IT Barriers 1.Lack of adequate financial support for IT 2.Vendors inability to satisfactorily deliver products and services 3.Lack of staffing resources 4.Difficulty proving ROI 5.Lack of clinical leadership 16th Annual HIMSS Leadership Survey sponsored by Superior Consultant Company/ ACS Healthcare Solutions.

June 28-29, 2005IHE Workshop4 Introduction Echo Profile TTE TEE Stress Echo Cath Profile Intravascular ultrasound (IVUS) Intracardiac echo (ICE) are used in cardiac catheterization procedures, and are supported as modalities in the Cath Workflow, and not in the Echo Workflow.

June 28-29, 2005IHE Workshop5 IHE is driving interoperability in Echo

June 28-29, 2005IHE Workshop6 IHE Terminology Ultrasound system = Image Acquisition Modality Images & reports = Evidence Documents IHE Demo person = Docent PACS = Image Archive and/or Image Manager actors

June 28-29, 2005IHE Workshop7 High ROIvalue 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 Goals For IHE cardiology

June 28-29, 2005IHE Workshop8 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 –A-D workflow, training issues Echo Profile Scope: Imaging Workflow

June 28-29, 2005IHE Workshop9 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 Case E7: Echo Measurements

June 28-29, 2005IHE Workshop10 Use Case E4: Intermittently Connected Modality Could you scan this patient right now since you have a cart in the CCU anyway? Clinical Use Cases: –Lost and unbilled echo exams because carts are constantly on the move –Patient and order info manually entered (potential for errors) or not at all –Measurements are transferred Benefits: –Accurate and automatic demographic and order reconciliation –Verify all images are securely archived –Improved workflow

June 28-29, 2005IHE Workshop11 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] ADT Query Images [RAD-14] Retrieve Images/Evidence [CARD4] Image Display Modality Image/Evidence Stored [CARD2] Storage Commitment [CARD3] Procedure Scheduled [RAD-4] Procedure Updated [RAD-13] Query Modality Worklist [RAD-5] Performed Procedure Step Mgr Modality PS in Progress [CARD1]- Modality PS Completed [RAD-7] Modality PS in Progress [CARD1] Modality PS Completed [RAD-7] Modality PS Completed [RAD-7] Order Placer Acquisition Modality Image Manager Image Archive DSS/ Order Filler Patient Update [RAD-12] Modality Image/Evidence Stored [CARD2] Storage Commitment [CARD3] Evidence Creator Modality PS in Progress [CARD1] Modality PS Completed [RAD-7] Query Evidence [RAD-44] Instance Availability Notification [RAD-49] Echo Actors & Transactions Modality PS in Progress [CARD1]

June 28-29, 2005IHE Workshop12 Actors Echo profile uses existing actors that use cardiology specific transactions –Department System Scheduler/Order Filler (DSS/OF) –Order Placer –Performed Procedure Step Manager –Image Archive –Image Manager –Acquisition Modality –Image Display –Evidence Creator

June 28-29, 2005IHE Workshop13 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. –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. Local storage Im sending images Will you commit to store these? Yes, you can delete your copy now I received them

June 28-29, 2005IHE Workshop14 Modality Procedure Step In Progress: Informs the PPS Manager of the start of a new Procedure Step, PPS Manager informs the Department System Scheduler/Order Filler and Image Manager. Retrieve Images: An Image Display requests and retrieves a particular set of images from the Image Archive. Echo option requires ability to retrieve Echo Evidence. Modality Images/Evidence Stored An Acquisition Modality sends acquired or generated images, waveforms, or other evidence documents to the Image Archive. Echocardiography Options Image Archives & Image Displays must support: –JPEG Baseline –YBR_FULL_422 –Certain defined SOP classes Echo Evidence Transactions

June 28-29, 2005IHE Workshop15 Support for lossy JPEG images Handling of intermittently connected devices Benefits RLE? Sorry. Uncompressed? Yes, but… JPEG?

June 28-29, 2005IHE Workshop16 Views Apical two chamber Apical four chamber Apical long axis Parasternal long axis Parasternal short axis Parasternal short axis at the aortic valve level Parasternal short axis at the level of the mitral chords Parasternal short axis at the Mitral Valve level Parasternal short axis at the Papillary Muscle level Right Ventricular Inflow Tract View Right Ventricular Outflow Tract View Subcostal long axis Subcostal short axis Suprasternal long axis Suprasternal short axis Transactions Modality Images/Evidence Stored – contd –Stress Echo Option Stage Number & View Number Stage Code Sequence & View Code Sequence Coding Scheme Designator (0008,0102) Code Value (0008,0100) Code Meaning (0008,0104) SRTP Image acquisition at baseline SRTP Pre-stress image acquisition SRTP Mid-stress image acquisition SRTP Peak-stress image acquisition SRTP Image acquisition during recovery

June 28-29, 2005IHE Workshop17 Benefit: Stress Echo Viewing Consistency

June 28-29, 2005IHE Workshop18 Results Improved patient safety/reduce medical errors Improved interoperability & workflow Customers can choose best-in-class equipment based on clinical features, not based on whether it connects Vendor X

June 28-29, 2005IHE Workshop19 More information…. IHE Web sites: Technical Frameworks, Supplements Cardiology Technical Framework IT Infrastructure Technical Framework Displayable Reports Supplement 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

June 28-29, 2005IHE Workshop20 W W W. I H E. N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings