1. IHE Cardiology Cardiac electrophysiology admission discharge summary for the referring cardiologist Nicholas Steblay 11/7/2005 0.1

2. IHE Cardiology Page 2 Cardiac Discharge Summary Problem Statement Patients are referred to cardiac electro-physiologists often for elective procedures that require hospitalizations. During the hospitalization, detailed information is acquired from many sources, which can include an EP study, echocardiogram, x-rays, blood tests, etc. At present, there is no simple mechanism for transferring the information back to the primary cardiologist. In addition, most of the reports generated by the electrophysiology procedures are too detailed and contain far too much information for the primary cardiologist’s use. What needs to be created is a simple summary of the key procedures, outcomes, and recommendations.

3. IHE Cardiology Page 3 Use Case Scenarios EP Study / Ablation Referral Referring cardiologist recommends elective EP Study and possible ablation for a patient Patient is scheduled and admitted to hospital EP Study is executed, generating significant technical data Ablation is performed, generating more technical data Other diagnostics may be performed such as x-rays, blood tests, or an echocardiogram The patient is discharged with medications and final recommendations Final summary report is delivered to cardiologist from hospital containing key information The patient returns to the referring cardiologist

4. IHE Cardiology Page 4 Another Use Case Scenario ICD or Pacemaker Implant Referring cardiologist recommends elective EP Study and possible implant for a patient Patient is scheduled and admitted to hospital EP Study is executed, generating significant technical data Implant is performed, generating more technical data Other diagnostics may be performed such as x-rays, blood tests, or an echocardiogram The patient is discharged with medications and final recommendations Final summary report is delivered to cardiologist from hospital containing key information The patient returns to the referring cardiologist

5. IHE Cardiology Page 5 Objective Share Summary Reports Effectively Automation of transfer across enterprises. Includes only key elements of initial consultation, procedures, and surgical reports. Also includes other testing such as x-rays, echocardiogram, or blood tests. Also includes medications and final recommendations.

6. IHE Cardiology Page 6 Analysis Similar to Existing Profile Cross Document Sharing – Medical Summary (XDS-MS) addresses fundamental needs Multi-institutional sharing model is appropriate for cardiology environment where patients may be seen by a variety of care specialists in a variety of institutional contexts CDA Care Record Summary CDA Care Record Summary Implementation Guide contains data structures to facilitate the summary reports (consultation report, discharge report, follow-up and encounter reports) Reports section can include references to all studies and procedures conducted, including ablation, implant, x-rays, echocardiograms and blood tests Medications section can delineate the discharge medications Care Plan section is especially important to use cases in EP, where there will always be on going follow-up Care Record Summary can label certain portions of medical record as being useful to the general cardiologist, yet specialist can navigate to details if needed.

7. IHE Cardiology Page 7 Analysis EP Specific Use Case Needs Identification of and agreement on the format of the various study and procedure reports that will be referenced –Example: The detailed ablation or implant procedure report could be referenced with a document hyperlink, but would not typically be accessed by the referring physician looking at the discharge summary. However, a following electro-physiologist, not necessarily the ablation or implant performer, would want to access the procedure details. The format for that report needs to be set by the IHE EP domain. Ensure coverage of specific EP actors by Cardiology Technical Framework or other IHE Technical Frameworks –Cardiac Cath Workflow for Cath Lab Information –Cardiac EP Workflow for EP Lab Information –Echocardiography Workflow for Echo Information –Retrieve ECG for Display for ECG Information –Laboratory Scheduled Workflow for blood test information

8. IHE Cardiology Page 8 Actors and Transactions for XDS-MS

9. IHE Cardiology Page 9 Actors and Transactions for XDS-MS ActorsTransactionsSection in Vol. Document ConsumerQuery RegistryITI TF-2: 3.16 Retrieve DocumentITI TF-2: 3.17 PCC TF-1: 3.4.1 Document SourceProvide and Register Document SetITI TF-2: 3.15 PCC TF-1: 3.4.2 Document RepositoryProvide and Register Document SetITI TF-2: 3.15 Register Document SetITI TF-2: 3.14 Retrieve DocumentITI TF-2: 3.17 Document RegistryRegister Document SetITI TF-2: 3.14 Query RegistryITI TF-2: 3.16 Patient Identity FeedITI TF-2: 3.8 Patient Identity SourcePatient Identity FeedITI TF-2: 3.8 Notification SenderSend NotificationITI TF-2: 3.25 Receive AcknowledgmentITI TF-2: 3.28 Notification ReceiverReceive NotificationITI TF-2: 3.26 Send AcknowledgmentITI TF-2: 3.27

10. IHE Cardiology Page 10 In Scope / Out of Scope Sharing EP summary report with referring cardiologist. FeatureIn/Out Cross Enterprise Document SharingIn Medical Summary Document ContentIn Note: list functionality especially at borders of what is included/excluded – i.e., included features that could reasonably be descoped by the Technical Committee, or excluded fetures that could be included

11. IHE Cardiology Page 11 Phased Approach TBD

12. IHE Cardiology Page 12 Open Issues 1. Incorporation of this profile into the XDS-MS 2. Identification of dependencies on other profiles 3. CDA content profile for this specific use case