Retrieve ECG for Display Profile Retrieve ECG for Display Profile John Donnelly IHE-Cardiology Planning Committee

June 28-29, 2005Interoperability Strategy Workshop2 ECG Needs ECGs Accessible Everywhere! Need broad distribution of ECGs using ubiquitous technology (Web). –Allow medical applications to easily retrieve and display ECGs in a platform/vendor neutral way. High-quality ECG documents. Avoid artifacts on zoomed ECGs and arbitrary display geometries. –Vector images required (not rasterized) Facilitate apps for serial comparison (side-by-side synchronized display).

June 28-29, 2005Interoperability Strategy Workshop3 ECG Profile Abstract / Scope Provide ECGs and related documents to enterprise Reuse IHE-ITI RID –Retrieve list of documents; retrieve single document –ECGs served in ready-to-display format (PDF, SVG) Limited extension for ECG-specific needs –Add requirements on display format and quality –Include XML-based ECG report list

June 28-29, 2005Interoperability Strategy Workshop4 Out of Scope ECG acquisition and reading workflow. ECG raw data interchange. Export of reports to external repository. Central management and configuration of ECG devices.

June 28-29, 2005Interoperability Strategy Workshop5 ECG Profile Value Proposition Use ubiquitous HTTP Get mechanism as defined in IHE-ITI RID –Standardized URLs Use PDF for easy integration with existing display applications PDF vector graphics supports scalable waveforms XML list of ECGs for serial comparison apps

June 28-29, 2005Interoperability Strategy Workshop6 Example ECG in PDF Format Example ECG in PDF Format

June 28-29, 2005Interoperability Strategy Workshop7 Example ECG in SVG Format Example ECG in SVG Format

June 28-29, 2005Interoperability Strategy Workshop8 ECG Profile Transaction Diagram Display Information Source Retrieve Specific Info for Display [ITI-11] Retrieve ECG List [CARD-5] Retrieve ECG Document for Display [CARD-6]

June 28-29, 2005Interoperability Strategy Workshop9 ECG Profile Actors DisplayDisplay – A system that can request and display preformatted (presentation-ready) data using Web technologies. Information SourceInformation Source – A system that responds to requests for patient-related ECG data by encoding it in a presentation-ready format using Web technologies. Same actors as RID Profile

June 28-29, 2005Interoperability Strategy Workshop10 ECG Profile Standards Used HTTPHTTP – Query/response XHTMLXHTML – Response list format XMLXML – Alternate response list format (processable) PDFPDF – ECG content format SVGSVG – Alternate ECG content format –A W3C Standard (XML meets graphics) –Allows scripting for embedded client side controls

June 28-29, 2005Interoperability Strategy Workshop11 ECG Profile Transactions Retrieve Specific Info for Display [ITI-11] –Uses HTTP Get query parameters SUMMARY or SUMMARY- CARDIOLOGY –Response list of documents (including ECGs) in ready-to-display format (XHTML) Retrieve ECG List [CARD-5] –Uses HTTP Get query parameter SUMMARY-CARDIOLOGY- ECG –Response list of ECGs in processable format (HL7 RIM-derived XML) Retrieve ECG Document for Display [CARD-6] –Response ECG served in PDF –SVG allowed if Display actor asks for it and Information Source supports it

June 28-29, 2005Interoperability Strategy Workshop12 ECG XML List based on HL7 V3 R-MIM

June 28-29, 2005Interoperability Strategy Workshop13 ECG XML List Schema

June 28-29, 2005Interoperability Strategy Workshop14 ECG PDF Content Requirements ECG PDF Content Requirements Waveform as vector graphics –Gives high quality line drawings at any screen resolution and zoom factor –Rasterized (e.g. scanned, bitmapped) ECG images not allowed Minimum context –Patient Name and ID –Date/time of recording –Confirmation status of interpretation Waveform technical content –Standard calibration pulse 1 mv x 200 ms –Nominal 1 mm grid –Lead labels –Frequency response

June 28-29, 2005Interoperability Strategy Workshop15 Use Case D1: Simple Display Display actor requests list of ECG documents for a specific patient ID. –RID profile SUMMARY-CARDIOLOGY request returns list as HTML. –ECG profile SUMMARY-CARDIOLOGY-ECG request returns list as XML with stylesheet. Display actor requests a specific ECG document using a unique document ID. –The ID of the requested document may not have been obtained from the previously retrieved list.

June 28-29, 2005Interoperability Strategy Workshop16 Example List as HTML

June 28-29, 2005Interoperability Strategy Workshop17 Use Case D2: Advanced Display Use Case D2: Advanced Display Display actor requests list of ECG documents for a specific patient ID using ECG profile request type. –List of ECGs returned as structured XML. Display actor parses structured document list to select related ECGs for serial comparison, for example. Display actor requests the specific ECG documents using the unique document IDs obtained in structured list above. Display actor displays the ECGs in a meaningful way.

June 28-29, 2005Interoperability Strategy Workshop18 ECG XML List Example

June 28-29, 2005Interoperability Strategy Workshop19 ECG List XML Example Formatted with Stylesheet ECG List XML Example Formatted with Stylesheet

June 28-29, 2005Interoperability Strategy Workshop20 ECG List XML Example Simple Serial Comparison App.

June 28-29, 2005Interoperability Strategy Workshop21 Serial Comparison Example 23-April :45:02 23-April :47:45

June 28-29, 2005Interoperability Strategy Workshop22 More information…. Web site: Technical Frameworks, Supplements Cardiology Technical Framework IT Infrastructure Technical Framework ECG XML List Schema and examples 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, 2005Interoperability Strategy Workshop23 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