Sept 13-15, 2004 IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise...

Sept 13-15, 2004 IHE Interoperability Workshop1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Echocardiography Profile

Cameron Brackett, Cerner

Echo Profile co-editor,

IHE Cardiology Technical & Planning Committee

Sept 13-15, 2004 Cameron – p. 2IHE Educational Workshop 2004

IntroductionIntroduction

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.


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 1Goal for Year 1


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 WorkflowYear 1 Scope: Imaging Workflow


Echo – Out of scope year 1Echo – 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


Echo Actors & TransactionsEcho 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]



Order Placer

Acquisition Modality

ImageManager

Image Archive

DSS/ Order Filler

Patient Update [Rad-12]


ActorsActorsNo 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


TransactionsTransactionsModality 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”


TransactionsTransactionsModality 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 UID SOP Class Name

1.2.840.10008.5.1.4.1.1.7 Secondary Capture Image Storage

1.2.840.10008.5.1.4.1.1.6.1 Ultrasound Image Storage

1.2.840.10008.5.1.4.1.1.3.1 Ultrasound Multi-frame Image Storage

1.2.840.10008.5.1.4.1.1.88.59 Key Object Selection

1.2.840.10008.5.1.4.1.1.88.11 Basic Text SR

1.2.840.10008.5.1.4.1.1.88.22 Enhanced SR

1.2.840.10008.5.1.4.1.1.88.33 Comprehensive SR


TransactionsTransactionsModality 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 Name Tag Requirement

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)


TransactionsTransactionsModality Images/Evidence Stored – cont’d Stress Echo Option

• Numbers: Stage Number & View Number• Code Sequences: Stage Code Sequence & View Code

Sequence

Coding SchemeDesignator(0008,0102)

Code Value(0008,0100)

Code Meaning (0008,0104)

SRT P5-01201 Image acquisition at baseline

SRT P5-01202 Pre-stress image acquisition

SRT P5-01203 Mid-stress image acquisition

SRT P5-01204 Peak-stress image acquisition

SRT P5-01205 Image acquisition during recovery

Stage


TransactionsTransactionsModality Images/Evidence Stored – cont’d

Coding SchemeDesignator

Code Value Code Meaning

SRT G-A19B Apical two chamber

SRT G-A19C Apical four chamber

SRT G-0395 Apical long axis

SRT G-0396 Parasternal long axis

SRT G-0397 Parasternal short axis

SRT G-0398 Parasternal short axis at the aortic valve level

SRT G-0399 Parasternal short axis at the level of the mitral chords

SRT G-039A Parasternal short axis at the Mitral Valve level

SRT G-039B Parasternal short axis at the Papillary Muscle level

SRT G-039C Right Ventricular Inflow Tract View

SRT G-039D Right Ventricular Outflow Tract View

SRT G-039E Subcostal long axis

SRT G-039F Subcostal short axis

SRT G-03A0 Suprasternal long axis

SRT G-03A1 Suprasternal short axis

View


TransactionsTransactionsStorage 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.


TransactionsTransactionsRetrieve 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


Use CasesUse 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


Use Case E2: Intermittently Use Case E2: Intermittently Connected Modality Connected Modality

Clinical Context Echo system has gone mobile to perform procedures TTE, TEE

IHE Context MPPS in Progress Storage Commitment


Query Modality Worklist [RAD-5]

ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure

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]

PatientRegistration [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]


ImageManager/

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

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure

Procedure Scheduled [RAD-4]

Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]

Modality Procedure Step In Progress

-

Modality Procedure Step In Progress Perform

Acquisition



ImageManager/

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 Use Case E2: Intermittently Connected Modality Connected Modality


More information….More information….IHE Web sites:

http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://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

Sept 13-15, 2004 IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise...

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