1. Sept 13-15, 2004 IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise Echocardiography Profile Cameron Brackett, Cerner Echo Profile co-editor, IHE Cardiology Technical & Planning Committee

2. Sept 13-15, 2004Cameron – p. 2IHE Educational Workshop 2004 Introduction Echo Profile  TTE, TEE, Stress Echo Cath Profile  Intravascular ultrasound (IVUS) and intracardiac echocardiography (ICE) are used in cardiac catheterization procedures, and are supported as modalities in the Cath Workflow, and not in the Echo Workflow.

3. Sept 13-15, 2004Cameron – p. 3IHE Educational Workshop 2004 High ROI—value added problem solutions Standards in place (DICOM & HL-7) No “political” challenges – just technical Restricted scope for a “quick win” Reuse successful Radiology profiles to meet similar needs Goal for Year 1

4. Sept 13-15, 2004Cameron – p. 4IHE Educational Workshop 2004 Reuse of similar IHE-Radiology Profiles  Scheduled Workflow (IHE-R SWF)  Patient Information Reconciliation (IHE-R PIR) Intermittently Connected Modality  Workflow  Acquisition Modality storage Stress Echo  Workflow  Staged Protocol Acquisition Modality (optional) Image Display (required) Digital vs. Videotape Year 1 Scope: Imaging Workflow

5. Sept 13-15, 2004Cameron – p. 5IHE Educational Workshop 2004 Echo – Out of scope year 1 Documentation/Reporting  Nursing (e.g. TEE)  Sonographer (e.g. measurements via DICOM SR)  Cardiologist (final report)  Medication administration Counter-indication/clinical decision support Fetal and pediatric echo Combined echo/ECG stress acquisition workflow

6. Sept 13-15, 2004Cameron – p. 6IHE Educational Workshop 2004 Echo Actors & Transactions    Pt. Registration [Rad-1]  Patient Update [Rad-12] Pt. Registration [Rad-1]  Patient Update [Rad-12]   Placer Order Management [Rad-2]  Filler Order Management [Rad-3] ADT  Query Images [Rad-14]  Retrieve Images [Card-4] Image Display Modality Image/Evidence Stored [Card-2] Storage Commitment [Card-3]  Procedure Scheduled [Rad-4]  Procedure Updated [Rad-13]  Query Modality Worklist [Rad-5] Performed Procedure Step Manager  Modality PS in Progress [Card-1]  Modality PS Completed [Rad-7]  Modality PS in Progress [Card-1]  Modality PS Completed [Rad-7]  Modality PS in Progress [Card-1]  Modality PS Completed [Rad-7] Order Placer Acquisition Modality Image Manager Image Archive DSS/ Order Filler  Patient Update [Rad-12]

7. Sept 13-15, 2004Cameron – p. 7IHE Educational Workshop 2004 Actors No new Actors Actors Using Cardiology Specific Transactions  Department System Scheduler/Order Filler (DSS/OF)  Performed Procedure Step Manager  Image Archive  Image Manager  Acquisition Modality  Image Display

8. Sept 13-15, 2004Cameron – p. 8IHE Educational Workshop 2004 Transactions Modality Procedure Step In Progress An Acquisition Modality notifies the Performed Procedure Step Manager of the start of a new Procedure Step and the PPS Manager informs the Department System Scheduler/Order Filler and Image Manager. [CARD-1, derived from RAD-6]  Intermittently connected workflows may send the MPPS “In Progress” immediately preceding the MPPS “Complete”

9. Sept 13-15, 2004Cameron – p. 9IHE Educational Workshop 2004Transactions Modality Images/Evidence Stored – An Acquisition Modality sends acquired or generated images, waveforms, or other evidence documents to the Image Archive. [CARD-2, derived from RAD-8 and RAD-43]  Echocardiography Option Image Archives must support: –JPEG Baseline (Process 1): Default Transfer Syntax for Lossy JPEG 8 Bit Image Compression for Ultrasound Multi-frame images –YBR_FULL_422 –The follow SOP classes: SOP Class UIDSOP Class Name 1.2.840.10008.5.1.4.1.1.7Secondary Capture Image Storage 1.2.840.10008.5.1.4.1.1.6.1Ultrasound Image Storage 1.2.840.10008.5.1.4.1.1.3.1Ultrasound Multi-frame Image Storage 1.2.840.10008.5.1.4.1.1.88.59Key Object Selection 1.2.840.10008.5.1.4.1.1.88.11Basic Text SR 1.2.840.10008.5.1.4.1.1.88.22Enhanced SR 1.2.840.10008.5.1.4.1.1.88.33Comprehensive SR

10. Sept 13-15, 2004Cameron – p. 10IHE Educational Workshop 2004Transactions Modality Images/Evidence Stored – cont’d  Stress Echo Option Acquisition Modality actors supporting the STRESS ECHO option are required to support a number of attributes in Multi-frame Ultrasound Images created for a stress echo procedure Attribute NameTagRequirement Performed Procedure Step Description(0040,0254)R+ Protocol Name(0018,1030)R+ Performed Protocol Code Sequence(0040,0260)R+ Number of Stages(0008,2124)R+ Number of Views in Stage(0008,212A)R+ Stage Code Sequence(0040,000A)R+ (note 2) Stage Number(0008,2122)R+ View Number(0008,2128)R+ (note 1) View Code Sequence(0054,0220)R+ (note 2)

11. Sept 13-15, 2004Cameron – p. 11IHE Educational Workshop 2004Transactions Modality Images/Evidence Stored – cont’d  Stress Echo Option Numbers: Stage Number & View Number Code Sequences: Stage Code Sequence & View Code Sequence Coding Scheme Designator (0008,0102) Code Value (0008,0100) Code Meaning (0008,0104) SRTP5-01201Image acquisition at baseline SRTP5-01202Pre-stress image acquisition SRTP5-01203Mid-stress image acquisition SRTP5-01204Peak-stress image acquisition SRTP5-01205Image acquisition during recovery Stage

12. Sept 13-15, 2004Cameron – p. 12IHE Educational Workshop 2004Transactions Modality Images/Evidence Stored – cont’d Coding Scheme Designator Code ValueCode Meaning SRTG-A19BApical two chamber SRTG-A19CApical four chamber SRTG-0395Apical long axis SRTG-0396Parasternal long axis SRTG-0397Parasternal short axis SRTG-0398Parasternal short axis at the aortic valve level SRTG-0399Parasternal short axis at the level of the mitral chords SRTG-039AParasternal short axis at the Mitral Valve level SRTG-039BParasternal short axis at the Papillary Muscle level SRTG-039CRight Ventricular Inflow Tract View SRTG-039DRight Ventricular Outflow Tract View SRTG-039ESubcostal long axis SRTG-039FSubcostal short axis SRTG-03A0Suprasternal long axis SRTG-03A1Suprasternal short axis View

13. Sept 13-15, 2004Cameron – p. 13IHE Educational Workshop 2004 Transactions Storage Commitment – A requestor (Acquisition Modality) requests that the Image Manager confirm ownership for the specified DICOM objects (images, waveforms, evidence documents, or any combination thereof) that the requestor stored in the Image Archive, thus allowing the sender to delete those objects now owned by the Image Manager. [CARD-3, derived from RAD-10]  This option requires the Image Manager to send the N-Event Report message to the mobile modality at the time that reconnects to the Image Manager.

14. Sept 13-15, 2004Cameron – p. 14IHE Educational Workshop 2004 Transactions Retrieve Images – An Image Display requests and retrieves a particular image or set of images from the Image Archive. [CARD-4, derived from RAD-16] Image Display  JPEG Baseline (Process 1): Default Transfer Syntax for Lossy JPEG 8 Bit Image Compression for Ultrasound Multi-frame images  YBR_FULL_422  May organize and present multiple images for stress echo

15. Sept 13-15, 2004Cameron – p. 15IHE Educational Workshop 2004 Use Cases Case E1: Patient Registered at ADT and Procedure Ordered Case E2: Intermittently Connected Modality Case E3: Intermittently Connected Modality with Ad Hoc Procedure, Patient Registered, Scheduled Procedure Case E4: Intermittently Connected Modality with Ad Hoc Procedure, Patient Registered, Unscheduled Procedure Case E5: Intermittently Connected Modality with Ad Hoc Procedure, Patient Unregistered, Unscheduled Procedure Case E6: Stress Echo Staged Protocol

16. Sept 13-15, 2004Cameron – p. 16IHE Educational Workshop 2004 Use Case E2: Intermittently Connected Modality Clinical Context  Echo system has gone mobile to perform procedures  TTE, TEE IHE Context  MPPS in Progress  Storage Commitment

17. Sept 13-15, 2004Cameron – p. 17IHE Educational Workshop 2004 Query Modality Worklist [RAD-5] ADT Order Placer RegisterJ.Doe Acquisition Modality Placer Order Management– New [RAD-2] Patient Reconciliation Department System Scheduler/ Order Filler Schedule Procedure Scheduled [RAD-4] Modality Procedure Step Completed [RAD-7] J.Doe-> J.Smith Patient Update/ Merge [RAD-12] Modality Procedure Step Completed [RAD-7] Patient Registration [RAD-1] Patient Update/ Merge [RAD-12] Modality Procedure Step In Progress [CARD-1]- Modality Procedure Step In Progress [CARD-1]- Perform Acquisition Filler Order Mgmt-Status Update [RAD-3] Filler Order Mgmt-Status Update [RAD-3] Image Manager/ PPS Manager Filler Order Management- New [RAD-3] One or the other methods of creating an order is used Query Modality Worklist [RAD-5] ADT Order Placer RegisterJ.Doe Acquisition Modality Placer Order Management– New [RAD-2] Patient Reconciliation Department System Scheduler/ Order Filler Schedule Procedure Scheduled [RAD-4] Modality Procedure Step Completed [RAD-7] J.Doe-> J.Smith Patient Update/ Merge [RAD-12] Modality Procedure Step Completed Patient Registration [RAD-1] Patient Update/ Merge [RAD-12] Modality Procedure Step In Progress - Modality Procedure Step In Progress Perform Acquisition Filler Order Mgmt-Status Update [RAD-3] Filler Order Mgmt-Status Update [RAD-3] Image Manager/ PPS Manager Filler Order Management- New [RAD-3] One or the other methods of creating an order is used [CARD-3]- Storage Commitment - Use Case E2: Intermittently Connected Modality

18. Sept 13-15, 2004Cameron – p. 18IHE Educational Workshop 2004 More information…. IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htmhttp://www.acc.org/quality/ihe.htm. Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0 Technical Framework Supplements - Trial Implementation May 2004: Radiology August 2004: Cardiology, IT Infrastructure Non-Technical Brochures : Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements