Buzzword Bingo

Retrieve ECG for Display ACCA IHE Workshop 2007 Jon Elion MD, FACC Associate Professor of Medicine, Brown University Co-Chair, IHE-Cardiology Planning Committee

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).

ECG for Display Profile Scope Reused IHE-ITI RID as it existed: Retrieve list of cardiology documents, including ECGs in ready-to-display format (HTML) Retrieve single document, including an ECG ECGs served in displayable format (PDF, SVG) Compatibility with existing RID clients

ECG for Display Profile Scope Make ECG-specific extensions to RID Place requirements on ECG source to ensure high-quality ECG documents. Add ECG-specific request for list of ECGs to be returned as XML allowing more client flexibility. Add SVG (vector graphics) as allowed ECG document format.

PDF ECG Source required to support PDF so it is compatible with existing RID clients. PDF is a common document type and most computers already have a viewer. ECG Source required to use vector graphics for waveforms in PDF. Gives high quality line drawings at any screen resolution and zoom factor. Rasterized (e.g. scanned, bitmapped) ECG “images” not allowed.

Example ECG (PDF)

Example 1200x Zoom ECG (PDF)

ECG Profile Actors Display – A system that can request and display preformatted (“presentation-ready”) data using Web technologies. Information 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

ECG Profile Transaction Diagram Retrieve ECG List [CARD-5] Retrieve Specific Info for Display [ITI-11] Information Display Source Retrieve ECG Document for Display [CARD-6]

ECG List XML Example

Formatted with Style sheet ECG List XML Example Formatted with Style sheet

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.

Example List as HTML

Implications for RFP’s ECG Management Systems – Clinical “Portals” – Remote Access – Local Printing –

Nuclear Cardiology ACCA IHE Workshop 2007 Jon Elion MD, FACC Associate Professor of Medicine, Brown University Co-Chair, IHE-Cardiology Planning Committee

Nuclear Cardiology Image formats Color maps Stress and Rest raw data review Stress and Rest processed data Gated SPECT data Quantitative data Screen captures, “snap shots” Color maps Gray scale is default Color overlays can be applied

Raw Data Images

Perfusion Display Standard perfusion display Stress/Rest Short axis Horizontal long axis Vertical long axis

Perfusion Display - Color Standard perfusion display Stress/Rest Short axis Horizontal long axis Vertical long axis Color map can be overlaid on the image

Gated SPECT Display Apical, mid and basal short axis slices Mid-ventricle vertical and horizontal long axis slices

Gated SPECT Display The whole screen can be gated as an option

Quantitative Display Output from 3rd party quantitative perfusion software can be displayed

Quantitative Display Output from 3rd party quantitative gated software can be displayed

Screen Captures Screen captures can be displayed to show important images

Implications for RFP’s Departmental and enterprise display systems – Cardiology PACS –

Implantable Device Cardiac Observations (IDCO) Profile ACCA IHE Workshop 2007 Jon Elion MD, FACC Associate Professor of Medicine, Brown University Co-Chair, IHE-Cardiology Planning Committee

Device Interrogations The act of retrieving data from implanted cardiac devices. Done at implant or during patient follow-ups. Implant Clinic Information includes Patient and Device Observations, and Therapy Settings Home

Implantable Cardiac Device Follow-up Problems and Opportunities Electrophysiologists follow patients with implantable cardiac devices from multiple vendors Information stored in the device is collected by an “interrogating” device (vendor proprietary) In-Clinic – Programmer Remote – Communicator / Data Collector Access to follow-up information often requires clinicians to use multiple vendor specific systems, complicating efficiency and quality of workflows Aggregation of data into a clinical management system or EMR requires manual (paper) processes

IDCO Value Proposition Enable management of follow-up information in a central system such as an Device Clinic Management System or EMR Improve efficiency and quality of related clinical processes Single point of access for information Automation of current manual processes for data collection, aggregation and analysis Standardization of workflow processes Enabling of analytics

IDCO Profile Systems Model