1. September, 2005What IHE Delivers 1 Presenter Maria Rudolph, American College of Cardiology Staff IHE Cardiology

2. 2 Why IHE Cardiology? Multiple locations  Office, in-patient, ED  Individual patient is seen in multiple locations – distributed patient record  Individual clinician practices in multiple locations – across organizational boundaries Multiple devices and modalities  Need to integrate data for comprehensive view of patient  Multiple specialists cooperating on single patient Chronic Disease  Long term patient care – persistent and evolving patient record Lots of hard data integration problems

3. 3 IHE Cardiology Organization Principal Sponsor : American College of Cardiology European Sponsor : European Society of Cardiology Specialty Society Sponsors : American Society of Echocardiography American Society of Nuclear Cardiology Heart Rhythm Society

4. 4 The Workflow Foundation Managing cardiology procedure workflow to ensure consistently identified and integrated data  Cardiac Catheterization Workflow Profile  Echocardiography Workflow Profile  Stress Testing Workflow Profile  Nuclear Medicine Image Profile (Cardiology option)

5. 5 Cath Lab Workflow 1 2 3 4 5 6 7 Multiple re-entry of Patient ID Error prone data entry Results fragmented across systems Results inconsistently time-tagged Custom solutions needed for data sharing Difficult to manage Uncoordinated with Hospital Information System Unidentified patients (emergency) Un-ordered cath exams Diagnostic and interventional procedures Ad hoc scheduling of cath labs Change of rooms during procedure 8 9 10 11 note: Cath Profile includes Electrophysiology lab

6. 6 Echo Workflow The “drive-by echo” – Cardiologist to sonographer in CCU: “While you’re here, do a TTE on bed 3”  Unordered, unscheduled exam  Machine disconnected from network Stress echo – After exam, sonographer creates new quad displays of stages and views  No intrinsic value add  Data is redundantly copied to storage

7. 7 Stress Workflow ~85% of stress tests are multi- modality (ECG + imaging) ~0% of current architectures manage ECG and imaging workflow and results in an integrated manner Poor adherence to ACC/ASNC nuclear image display requirements IHE Stress Testing Profile and IHE Nuclear Medicine Image Profile Trial Implementation

8. 8 Workflow Architecture Summary Cath, echo and stress workflows (and cardiac CT and MR) managed with a common architecture  HL7 Patient Demographics  HL7 Orders  DICOM Worklist Management  DICOM Object Management and Display Images, waveforms, measurements, procedure logs Modality specific requirements to improve workflow and clinical utility

9. 9 Getting results Consistent electronic methods for reporting on cardiology findings  Evidence Documents Profile (quantitative measurements) Cath and Echo options  Implantable Cardiac Device Observations Profile  Retrieve Information for Display Profile  Retrieve ECG for Display Profile

10. 10 Cath and Echo Evidence Documents Echocardiography Measurement Patient: Doe, John Technologist: der Payd, N Measurements: Mitral valve diameter 3.1cm - shown in image at [ ] Ventricular length, diastolic 5.97 cm - shown in image at [ ] Ventricular volume, diastolic 14.1 ml - inferred from [ ] - inferred from VLZ algorithm Current kludges: Measurements made on modality or workstation, and written onto a paper worksheet, then transcribed into a report Measurements output to a printer port, intercepted by an application that scrapes the values Screen capture of measurements sent to a reporting system, which uses OCR (optical character recognition) to reconstruct the original measurement names and numbers

11. 11 Implanted Device Observations Explosion in number of implantable cardioverter defibrillators Clinicians need to manage patients with a wide variety of devices in many contexts  ICDs, CRTDs, pacemakers, etc.  Implant, office follow up, home monitoring Need standard set of observations, communicated in standard messages  Therapy settings, events, device self-monitoring  Enables consistent presentation of data from all devices Trial Implementation

12. 12 Retrieve Information for Display How does the clinical workstation on the ward get the report from the cardiology department? How does the workstation in the cardiology department get a report from radiology, or a history and physical report from the outpatient department? IHE Retrieve Information for Display Profile using Web technology (HTTP, PDF, XML)

13. 13 Retrieve ECGs for Display Specialized use of RID Profile Web technology (HTTP, PDF, XML)  Integrated into client medical applications (clinical workstations – not free-standing Web browsers)  Vector PDF, XML list

14. 14 Beyond the Enterprise Sharing data between the office and in- patient environments, or on the regional or national level  Cross-Enterprise Document Sharing (XDS)  Cross-Enterprise Document Content from IHE IT Infrastructure, Patient Care Coordination, Laboratory and Radiology Domains

15. 15 Cardiology Document Sharing Use Cases Initial referral to cardiologist – family and social history, medications, test results ACS presentation at emergency dept – last ECG, meds, history of care Interventional report to referring physician – procedures performed, discharge summary many, many more … IHE XDS / XDR / XDM Profiles

16. 16 Document Content Profiles for Cardiology Medical Summary – encounter notes, discharge summary Imaging – exchange of image links Emergency Department Referral Pre-procedure History and Physical Scanned Documents Personal Health Records Basic Patient Privacy Consents Laboratory Reports

17. 17 What’s coming up! Evidence Content – structured measurement data for stress testing, electrophysiology lab, and CTA / MRA Displayable Reports Profile – workflow for graphics-rich reports in PDF New IHE Quality Domain – secondary use of clinical data for quality measures, outcomes research, pay for performance

18. 18 2007-2008 IHE Cardiology Events March – Year 3 demonstration at American College of Cardiology (New Orleans) April – release Year 4 profiles for public comment June – release Year 4 profiles for Trial Implementation September – Year 3 demonstration at European Society of Cardiology (Vienna) January 2008 – IHE Connectathon for Year 4

19. 19 Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings http://www.ihe.net

20. September, 2005What IHE Delivers 20