September, 2005 What IHE Delivers

Integrating the Healthcare Integrating the Healthcare Enterprise -Enterprise -

IHE CardiologyIHE Cardiology

Summary of Profiles - 2008Summary of Profiles - 2008

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Why IHE Cardiology?Why IHE Cardiology?Multiple locations Office, in-patient, emergency department 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 Lots of hardhard data integration problems – data integration problems –and we need to take and we need to take actionaction

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Clinical Priority AreasClinical Priority Areas

Improve the performance of cardiology procedures – The Workflow Foundation

Facilitate the production of clinical reports – Getting Results

Share data across all locations of cardiac care – Beyond the Enterprise

Measure and improve practice – Quality

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The Workflow FoundationThe Workflow Foundation

Managing cardiology procedure workflow to ensure consistently identified data

1. Cardiac Catheterization Workflow Profile

2. Echocardiography Workflow Profile

3. Stress Testing Workflow Profile

4. Nuclear Medicine Image Profile (Cardiology option)

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Cath LabCath Lab

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23 4

56 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

IHE Cath Profile:IHE Cath Profile:managed workflowmanaged workflow

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Echo WorkflowEcho 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 in quad format

IHE Echocardiography ProfileIHE Echocardiography Profile

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Stress WorkflowStress 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 IHE Stress Testing Profile and IHE Nuclear Medicine and IHE Nuclear Medicine

Image ProfileImage Profile

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Workflow Architecture SummaryWorkflow Architecture Summary

Cath, echo and stress workflows managed with same common architecture as radiology 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

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Getting ResultsGetting Results

Consistent electronic methods for reporting on cardiology findings

5. Evidence Documents Profile (quantitative measurements) • Cath, Echo, Stress, CTA/MRA options

6. Device Enterprise Communication Profile

7. Displayable Reports Profile

8. Retrieve Information for Display Profile

A. Retrieve ECG for Display Profile

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Cardiology MeasurementsCardiology MeasurementsEchocardiography 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

Pick your current kludge:• 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

IHE Evidence Documents Profile:IHE Evidence Documents Profile:standard electronic measurement standard electronic measurement

transfer formatstransfer formats

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Patient Monitoring ObservationsPatient Monitoring Observations

Get monitoring data from bedsideinto enterprise level application Clinical Decision Support,

Electronic Medical Record (flowsheet), Clinical Data Repository

Shorten decision time, increase productivity, minimize transcription errors, increase contextual information

IHE Device Enterprise Communication ProfileIHE Device Enterprise Communication Profilefrom IHE Patient Care Devices Domainfrom IHE Patient Care Devices Domain

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Displayable ReportsDisplayable Reports

Cardiology reports typically PDF with lots of graphics – how to get them into an EMR?

IHE Displayable IHE Displayable Reports ProfileReports Profile

Submitting reports Submitting reports encapsulated in encapsulated in

HL7 v2 messagesHL7 v2 messages

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Display Information Display Information Outside the DepartmentOutside the Department

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 ProfileIHE Retrieve Information for Display Profileusingusing Web technology (HTTP, PDF, XML)Web technology (HTTP, PDF, XML)

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Display ECGs EverywhereDisplay ECGs Everywhere

Integrate ECG display into clinical workstation applications

IHE Retrieve ECG IHE Retrieve ECG for Display Profilefor Display Profile

usingusing Web technology Web technology (HTTP, PDF, XML)(HTTP, PDF, XML)

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Beyond the EnterpriseBeyond the EnterpriseSharing data between the office and in-patient environments, or on the regional or national level

10. Cross-Enterprise Document Sharing (XDS)

A. XDS for Imaging (XDS-I)

11. Cross-Enterprise Document Reliable Interchange (XDR)

12. Cross-Enterprise Document Media Interchange (XDM)

from IHE IT Infrastructure and from IHE IT Infrastructure and Patient Care Coordination DomainsPatient Care Coordination Domains

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Document Sharing Use CasesDocument 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 IHE XDS / XDR / XDM ProfilesProfiles

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Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Regional Health Information Organization (RHIO)

Document Registry

DocumentRepository

Cross-Enterprise Document SharingCross-Enterprise Document Sharing

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XDS Content ProfilesXDS Content Profiles

Medical Summary – encounter notes, discharge summary

Imaging – exchange of image lists, with additional transactions for image access

Emergency Department Referral

Pre-procedure History and Physical

Scanned Documents

Personal Health Records

Basic Patient Privacy Consents

Laboratory Reports

All from IHE Patient Care Coordination Domain, except All from IHE Patient Care Coordination Domain, except Imaging (Radiology) and Laboratory (Laboratory Domain)Imaging (Radiology) and Laboratory (Laboratory Domain)

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Cross-Enterprise Document Sharing – Cross-Enterprise Document Sharing – Ad-hoc SharingAd-hoc Sharing

XDR – Online network point-to-point, without shared document registry

XDM – “Off-line” point-to-point Email Physical media (CD, USB flash)

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QualityQuality

Efficiently collect various measures of clinical quality and performance for practice improvement and patient safety

13. X-ray Radiation Dose Report

14. Patient-Level Export of Quality Data (PEQD)• ACEI/ARB for LVSD after AMI

from IHE Radiology and Quality Domainsfrom IHE Radiology and Quality Domains

Coming Soon

Coming Soon

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