1. Buzzword Bingo

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

3. 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).

4. 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

5. 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.

6. 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.

7. Example ECG (PDF)

8. Example 1200x Zoom ECG (PDF)

9. 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

10. 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]

11. ECG List XML Example

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

13. 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.

14. Example List as HTML

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

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

18. 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

19. Raw Data Images

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

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

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

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

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

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

26. Screen Captures
Screen captures can be displayed to show important images

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

29. 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

30. 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

31. 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

32. 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

33. IDCO Profile Systems Model