User Needs for Waveforms in IDCO messages

Use Case – In clinic follow-up UC 1 – In-clinic follow-up –Episode data reviewed through vendor programmer –End of session data saved to EHR –What waveform data do you need saved? What waveforms? What information about each waveform?

Use Case – Remote Follow-up UC 2 – Scheduled remote follow-up –Episode data reviewed through vendor website –Data saved to EHR –What waveform data do you need saved? What waveforms? What information about each waveform? Anything different from an in-clinic follow-up using a programmer??

Use Case – Non-scheduled notification UC 3 – Non-scheduled notification –Remote data uploaded via a non-scheduled event Patient initiated or detected by the system –Episode data reviewed through vendor website –Data saved to EHR –What waveform data do you need saved? What waveforms? What information about each waveform?

What episodes need to be in the EHR? Should all episodes collected by remote systems/programmers be uploaded into the EHR? –If not, which are needed? –How much control is a requirement? Should episodes be grouped by “encounter” or be longitudinal? –By encounter may mean duplicate episodes within nearby IDC – Observations

“Waveform” Content Metadata –Stored information about an episode Reason for capture Onset criteria Therapy delivery and outcomes Overall statistics (durations, rates, etc.) Note that the available details may vary by vendor Waveform data –Multiple channels of captured signals Including markers

Episode Data already in IDCO Reference ID Prepend MDC_IDC_ Display NameDefinitionTypeFor­ mat Unit of Measure Enumerator ID Prepend _MDC_IDC_ EPISODEEpisodeThe group of episodes.GROUP--- EPISODE _IDEpisode IdentifierThe unique identifier for the episode.String100-- EPISODE _DTMEpisode Date TimeThe detection date and time of the episode.DateTimeN/A-- EPISODE _TYPEEpisode Type CategoryThe generic type of the episode being reported.EnumN/A-ENUM _EPISODE _TYPE EPISODE _TYPE _INDUCEDEpisode Type Induced FlagThe indication of whether the episode has been induced or not. EnumN/A-ENUM _EPISODE _TYPE _INDUCED EPISODE _VENDOR _TYPEEpisode Vendor Type CategoryThe vendor type of the episode being reported.EnumN/A-ENUM _EPISODE _VENDOR _TYPE EPISODE _ATRIAL _INTERVAL _AT _DETECTIONEpisode Detection Interval AtrialThe atrial interval at the time of detection.NumericF4.0ms- EPISODE _ATRIAL _INTERVAL _AT _TERMINATIONEpisode Termination Interval AtrialThe atrial interval at the time of termination.NumericF4.0ms- EPISODE _VENTRICULAR _INTERVAL _AT _DETECTIONEpisode Detection Interval VentricularThe ventricular interval at the time of detection.NumericF4.0ms- EPISODE _VENTRICULAR _INTERVAL _AT _TERMINATION Episode Termination Interval Ventricular The ventricular interval at the time of termination.NumericF4.0ms- EPISODE _DETECTION _THERAPY _DETAILSEpisode Detection And Therapy Details A text describing details about the detection and therapy delivered. String100-- EPISODE _THERAPY _RESULTEpisode Therapy ResultThe indicator of therapy success.EnumN/A-ENUM _EPISODE _THERAPY _RESULT EPISODE _DURATIONEpisode DurationThe duration of the episode in seconds.NumericF8.0s- MDC_IDC_ENUM_ZONE_TYPEZone_VFVF Zone_VTVT Zone_ATAFAT/AF Zone_OtherOther Vendor Episode Type maps to the detailed episode types unique to each vendor

What would you want to search on in the EMR? Rates? Zones –By vendor zone? Date ranges? Other values? –Vendor-specific, or with universal semantics?

Stored EGM Options Summary PDF reports IDCO meta-data with per-episode URL link-backs to vendor system IDCO meta-data with per-episode PDFs containing the waveform data IDCO meta-data with digitized waveform data –Potentially leveraging the IHE PCD Waveform Content Message (still in development)

PDFs versus digitized data PDFs Pros –Simple to implement –Most EMRs already support –Familiar visualization Cons –Cannot rescale –Resolution fixed –Can’t further process waveform details Digitized waveforms Pros –Analyzable –Scalable Cons –Much more complex standards effort to align among vendors –EMR support likely to be slower