1. Rev 2.11 IHE Cardiology 5-year Roadmap Roadmap subcommittee: Bill Weintraub wweintr@emory.edu Andrew Kelleramk5@columbia.edu Kenneth Queensberrykqueensb@acc.org Harry Solomonharry.solomon@med.ge.com Bryan Schnepf bryan.schnepf@philips.com Jon Elion jle@heartlab.com Joe Biegel joe.biegel@agfa.com David Croke david_croke@idx.com Ruediger Simon simon@cardio.uni-kiel.de Ashwin Patel apatel@acc.org

2. Rev 2.12 Principles Cardiology profiles addressing clinical user needs to be developed by IHE Cardiology committees –Prioritization by Planning Committee –Refinement and technical definition by Technical Committee IT Infrastructure profiles addressing general healthcare needs available to be demo’ed in the cardiology domain ~1-2 years after adoption by IT Infrastructure committees –Vetting by Planning Committee for applicability to critical cardiology need –Recommendations to IT Infrastructure for new profiles in that domain

3. Rev 2.13 Timeline 20 months from concept to demo DatemonthsEvent July-20Roadmap Subcommittee develops proposed 2/3/5 year plan concepts (year 1 already set) September -18Planning Committee review of concept proposals, assignment for further development within Planning Committee January -14Planning Committee initial selection of profiles, assignment for feasibility assessment by Technical Committee March-12Technical Committee feasibility assessment, Planning Committee downscopes profiles to demonstration set June-9Technical Committee publishes Technical Framework detailed profiles for comment; Planning Committee publishes demo plan July-8Technical Committee publishes Technical Framework detailed profiles for Trial Implementation January-2Connectathon tests implementation of Profiles March!ACC Demonstration of Profiles

4. Rev 2.14 2/3/5 year plan Year 2 should be highest clinical priority –Including items deferred from current year Year 3 should be high priority items that will require >1 year vendor development –Need complete definitions of concepts, so that vendors can start planning Years 4-5 are conceptual

5. Rev 2.15 Year 1 (2005 demo) Year 2 (2006 demo) Year 3 (2007 demo) Year 4 (2008 demo) Year 5 (2009 demo) Cath Echo ECG Nuclear EP Cardiology Technical Framework IT Infrastructure TF Infra Security Admin EMR Quality MR/CT Multi-modality workflow & imaging Procedure log & reporting Hemo waveform & measures, QCA/QVA Supplies, inventory, & charge capture Workflow & imaging, stress protocols Reporting workflow Retrieve ECG for display ECG/Stress/Holter orders Workflow & imaging, stress protocols Reporting workflow Multi-modality lab workflow & reporting Home health monitoring Time synchronization Audit trailEnterprise user authentication Retrieve info for display Cross-enterprise document sharing Retrieve guidelines for display Retrieve structured guidelines Registry data submission Cross-enterprise referrals/orders Workflow, reporting, & measurements Risk factors for clinical decision supt Patient care plan Patient location & transport Device auto- configuration Precision time synchronization Implantable device parameters & events Pediatric Personnel white pages Measurement interoperability ECG waveform interoperability

6. Rev 2.16 Cardiology Year 1 Profiles (2005 demo) Cath lab workflow - including coordination of the multi- modality environment, access to patient demographics, and storage and display of images Echo workflow - including scheduling and management of digital echo exams, including multi-stage stress exams, and storage and display of images Retrieve ECGs for display - access to ECGs for display using web technology

7. Rev 2.17 IT Infrastructure Profiles for Cardiology Year 1 (2005 demo) Consistent time - specifies time synchronization to better than 1 second accuracy using NTP; supports cath lab workflow (ITI 2004) Retrieve info for display - access to a variety of patient info for display using web technology; supports cross- department access to data (ITI 2004)

8. Rev 2.18 Cardiology Year 2 Profiles (2006 demo) Cath lab reporting workflow– distributed creation of procedure log, reporting workflow, outbound reports Echo reporting workflow - reporting workflow, including sonographer preliminary reports and cardiologist over- reading Nuclear medicine - image content profile for NM, including cardiac (from IHE Radiology 2004) Registry data submission – standard formats for ACC NCDR 3 / ESC CARD

9. Rev 2.19 IT Infrastructure Profiles for Cardiology Year 2 (2006 demo) Audit trail - centralized logging of system security events and user access of patient data (ITI 2004) Cross-enterprise document sharing – repositories for clinical documents accessible across institutional boundaries, including ECGs and reports (ITI 2005) Personnel white pages – centralized directory of healthcare staff information (ITI 2005)

10. Rev 2.110 Cardiology Year 3 Profiles (2007 demo) Cath lab content – creation and display of interoperable QCA/QVA, hemo waveforms, and hemo measurements Echo measurements - creation and display of interoperable echo measurements Nuclear medicine reporting workflow - measurements and reporting EP lab workflow – adapted cath lab workflow, storage and display of images, waveforms and measurements; reporting MR/CT angiography – adapted radiology workflow, storage and display of images and measurements; reporting Retrieve guidelines for display – keyword-based retrieval of guidelines

11. Rev 2.111 IT Infrastructure Profiles for Cardiology Year 3 (2007 demo) Cross-enterprise referrals and orders – Referrals and Orders from physician office to specialty diagnostic facility, with clinical attachments (recommend to ITI) Enterprise user authentication – centralized user account management and authentication (ITI 2004)

12. Rev 2.112 Evaluation Do these represent the highest clinical priorities? Do we have the proper services to support clinical information needs for addressing patients presenting with caridac disease/syndromes? –ACS, MI, HF, Afib, hypertension, etc.

13. Rev 2.113 Potential future IHE/Cardiology profiles (December 2003 brainstorming) Cath Workflow Procedure Logging and Reporting Cath Hemodynamics Report and Waveform Display Cath Lab Precision Mutli-Modality Synchronization Echo Workflow Reporting Nuclear Cardiology workflow Electrophysiology workflow, waveforms, measurements, reports, device parameters Non-invasive Angiography workflow (MRA/CTA) Evidence Reporting and Display (QCA/QVA, MRA/CTA) Workflow step prerequisite checking (labs, drugs, insurance) Cath lab inventory management Charge capture Retrieve Guidelines for Display Retrieve Structured/Actionable Guidelines Outpatient imaging workflow Patient care plan Outbound Reports (to longitudinal record) (IHE IT Infrastructure) Cross-Enterprise Patient ID Cross- Reference (Cardiology practice / multiple hospitals) Cross-Enterprise Ordering and Referral Cross-Enterprise Clinical Document Sharing (IHE IT Infrastructure) Registry Data submission (ACC NCDR 3 / ESC CARD) Scheduling (room/equipment; physician/staff) Summary report – discharge Cardiac Risk Factors extract from Longitudinal Record Critical value alarms Patient location tracking / transport management … and all IHE IT Infrastructure profiles!