1. Barry Brown 27-July-2010 Resting ECG Workflow (REFW) Profile Overview

2. REWF Profile Scope In Scope Patient registration Ordering and scheduling Acquisition Data storage Data retrieval for reporting Report distribution Out of Scope Reporting workflow management Clinical trial workflow

3. Use Cases Normal Priority, Scheduled ECGs –Patient is registered –ECG is ordered, scheduled, acquired, stored, reviewed, and reported Urgent ECG, Unidentified Patient –Unordered ECG –Patient demographics reconciliation Scheduled ECG While Offline –Order reconciliation Other Cases Not Completely Covered –Patient Demographics for Unscheduled ECGs Acquisition Modality should be grouped with PDQ Consumer –Clinical Trials Much thought was given to clinical trial workflow, but it deserves its own profile in a future year –Physician Offices ECGs are often (implicitly) ordered and acquired in a single step while a patient is being examined The new Image Enabled Office profile covers office-based ECG workflow

4. Related Profiles RAD SWF - Scheduled Workflow –Patient registration –Test ordering and scheduling –Acquisition and data storage –Data retrieval RAD PIR - Patient Information Reconciliation –Urgent ECGs acquired on unknown patients ITI CT - Consistent Time –Synch Acquisition Modality’s clock ITI PDQ - Patient Demographics Query –Acquisition Modality can query for demographics CARD DRPT - Displayable Reports –Distribute ECG reports CARD IEO - Image Enabled Office –Workflow in an office environment

5. Highlights Allows multi-vendor interoperability between 5 major subsystems: –Registration and ordering (HIS, CVIS) –ECG archival (PACS, ECG Management) –Acquisition devices (Electrocardiographs) –ECG analysis and reporting workstations (ECG or PACS Workstations) –ECG report consumers (EMR) Uses HL7 transactions for HIS and EMR. Uses DICOM transactions for acquisition devices and workstations ECG waveforms stored as DICOM General ECG Waveform objects ECG measurements and interpretations stored as DICOM Structured Reports An “Integrated ECG Manager” actor makes it easier for traditional ECG management products to adopt this profile.

6. Actor / Transaction Diagram

7. Familiar Actors and Transactions Actors reused from other profiles: –ADT (SWF) –Order Placer (SWF) –DSS/OF (SWF) –Image Manager / Image Archive (SWF) –PPS Manager (SWF) –Acquisition Modality (SWF) –Evidence Creator (SWF) –Image Display (SWF) –Time Client (CT) –Report Creator (DRPT) –Report Manager (DRPT)

8. “Integrated ECG Manager” Actor Integrated ECG Manager is an optional integration of the actors in the “middle” Makes it easier for traditional ECG management products to adopt this profile without having to expose transactions between the integrated actors Individual actors are still present so traditional departmental management and archive products can treat Resting ECG Workflow like other scheduled workflows

9. New and Modified Transactions CARD-2 Modality Images/Evidence Stored –Acquisition Modality and Image Archive actors must be able to store General ECG Waveform and Enhanced SR (ECG Report template) CARD-4 Retrieve Images/Evidence –Report Creator and Image Display actors must be able to display General ECG Waveform and Enhanced SR (ECG Report template) CARD-7 Encapsulated Report Submission –Specifies displayable Resting ECGs (PDFs) should meet minimum display requirements –Basic measurements and interpretation should be included as discrete data in OBX segments New: CARD-12 Query Enhanced Modality Worklist –Patient queries can also match on Admission ID –Broad queries can also match on Scheduled Procedure Step Location New: CARD-13 Query Cardiology Images/Evidence –Query returns Performed Protocol Step Code Sequence to distinguish General ECG Waveform objects used for resting ECG from other tests and monitoring sessions