IHE Cardiology Echo Profile Year 2

1. IHE CardiologyEcho Profile Year 2 2/20/2005 Version 2 Cameron Brackett (Cerner)

2. Echo Y2 Profile Problem Statement • The year two Echo profile addresses the need to create and track various reporting tasks for TTE, TEE, and Stress Echo. These reporting tasks include preliminary reporting, displaying of other reports and evidence, physician interpretation and documentation, and enterprise availability of final reports. • While there may be differences in Cardiology from Radiology, IHE-Rad’s RWF, ED, and SINR are applicable. Further, they provide a foundation to work from. Similar to year 1, a majority of this profile will a combination of several IHE-Rad profiles along with some adjustments to suite the Cardiology differences. IHE Cardiology

3. Echo Y2 Profile Diagram IHE Cardiology

4. Actors • ADT • Same as in current Radiology TF 1:2.2 • Order Placer • Same as in current Radiology TF 1:2.2 • DSS/OF • Same as in current Cardiology TF 1:2.3 • PPS Manager • Same as in current Cardiology TF 1:2.3 • Image Manager • Same as in current Cardiology TF 1:2.3 • Image Archive • Same as in current Cardiology TF 1:2.3 • Department Report Creator/Manager/Repository • Support for Cardiology transactions • Image/Evidence Display • Support for RID and Cardiology transactions • Enterprise Repository • Support for Cardiology transactions • Information Source • Same as in current Cardiology TF 1:2.3 • Acquisition Modality • Same as in current Cardiology TF 1:2.3 • Stress Monitor • Support for Cardiology transactions IHE Cardiology

5. Transactions • Patient Registration [Rad-1] • Same as in current Radiology TF 2:4.1 • HL-7 2.3.1 Chapters 2-4 • Patient Update [Rad-12] • Same as in current Radiology TF 2:4.12 • HL-7 2.3.1 Chapters 2-4 • Placer Order Management [Rad-2] • Same as in current Radiology TF 2:4.2 • HL-7 2.3.1 Chapters 2-4 • Filler Order Management [Rad-3] • Same as in current Radiology TF 2:4.3 • HL-7 2.3.1 Chapters 2-4 • Procedure Scheduled [Rad-4] • Same as in current Radiology TF 2:4.4 • HL-7 2.3.1 Chapters 2-4 • <Specializations or restrictions> • Procedure Update [Rad-13] • Same as in current Radiology TF 2:4.13 • HL-7 2.3.1 Chapters 2,4 • <Specializations or restrictions> • Order Mapping [Card-xx] • HL-7 2.3.1 Chapters 2-4 • ORMSIUID • Procedure Status [Card-xx] • HL-7 2.3.1 • ORUstatus • Define statuses • SR Export [Card-xx] • HL-7 2.3.1 • ORUPDF/CDA/ASCII • Modality Procedure Step In Progress [Card-1] • Same as in current Cardiology TF 2:4.1 • DICOM 2003 PS 3.4: Modality Performed Procedure Step SOP Class • Modality Procedure Step Completed/Discontinued [Rad-7] • Same as in current Radiology TF 2:4.7 • DICOM 2003 PS 3.4: Modality Performed Procedure Step SOP Class • DICOM 2003 PS 3.16: DCMR Context Groups (Normative) • <Specializations or restrictions> Transactions in Blue are new for Y2 IHE Cardiology

6. Transactions • Modality Image/Evidence Stored [Card-2] • Same as in current Cardiology TF 2:4.2 • DICOM 2003 PS 3.4 • Storage Commitment [Card-3] • Same as in current Cardiology TF 2:4.3 • DICOM 2003 PS 3.4: Storage Commitment Push Model SOP Class • <Specializations or restrictions> • Instance Availability Notification [xxx-xx] • DICOM 2003 PS 3.4: Instance Availability Notification SOP Class • <Specializations or restrictions> • Query Images [Rad-14] • Same as in current Radiology TF 2:4.14 • Retrieve Images [Card-4] • Same as in current Cardiology TF 2:4.4 • Query Evidence [Rad-44] • Same as in current Radiology TF 3:4.44 • Retrieve Evidence [Rad-45] • Same as in current Radiology TF 3:4.45 • Retrieve Specific Information for Display [IT-11] • Retrieve Document for Display [IT-12] Transactions in Blue are new for Y2 IHE Cardiology

7. Echo Y2 Profile Scenarios: TTE The study is ordered by a physician, either inside the performing institution, or by referral from outside the institution. The study is scheduled for the patient, transportation is arranged if the patient is an inpatient, equipment is scheduled. The TTE procedure is performed by a sonographer who takes a series of images and measurements throughout the procedure. Upon completing the procedure, the sonographer will send the images and measurements to the Image Archive. Next, the Image Archive will notify the Report Manager of the availability of the study so that the cardiologist may view the images and evidence on the Display. At this point, the cardiologist can now create his report. Once he has completed the report he may signed it so that the report is exported to the Enterprise Report Repository to be made available throughout the enterprise. NOTE: The evidence object (DICOM SR from the Echo machine) serves as the preliminary report. However, this would be a part of the permanent record in the Image Archive, though not included in the EMR. It would only be the cardiologist’s report that appears in the Enterprise Report Repository. IHE Cardiology

8. Echo Y2 Profile Scenarios: TEE The study is ordered by a physician, either inside the performing institution, or by referral from outside the institution. The study is scheduled for the patient, transportation is arranged if the patient is an inpatient, equipment is scheduled. This procedure is performed by the cardiologist with support clinical staff. Prior to beginning the procedure, a nurse prepares the patient and records various information in a nursing note (e.g. H&P, LOS, meds, etc.). Nursing notes will not be treated as evidence documents, but as a separate and distinct report generated on the report creator to be sent to the Enterprise Report Repository. Once the procedure has ended the physician can review the images and generate a report. Some information on the nursing note may need to be included in the physician report. However, year 2 will only address the ability to query the nursing note from the Information Source for display and not for mapping. IHE Cardiology

9. Echo Y2 Profile Scenarios: Stress Echo • The study is ordered by a physician, either inside the performing institution, or by referral from outside the institution. The study is scheduled for the patient, transportation is arranged if the patient is an inpatient, equipment is scheduled. • The study is performed by a physician or trained professional (such as a nurse, physicians assistant, or trained exercise technician). Prior to beginning the stress phase of the procedure, echo images of the heart are taken at rest. After completing the resting images, the patient is subjected to increasing stages (levels) of exercise on the treadmill or by pharmaceuticals, and the equipment collects ECG waveforms, patient performance (symptoms, heart rate, blood pressure), and equipment settings (speed, elevation, duration). A typical exercise examination goes through progressive stages until a clinical end-point is reached, such as achieving a pre-determined heart rate or emergence of symptoms preventing the patient from continuing (arrhythmia, hypotension, angina, fatigue, etc.). A procedure may be complete, even though fewer than the full number of planned stages have been acquired. Once the stress end-point has be reached, the patient undergoes another wave of imaging taking the same views, but now at stress. • The exercise study is interpreted by a physician, and the results reported. If there is an imaging component to the study, it may be interpreted separately by a different physician; the IHE profile must address the combination of interpretations from multiple physicians. The results, including the supporting evidence (ECGs, images) must be distributed electronically to the referring physician, who may not be located within the performing institution. • An additional use case is exemplified by the use of a pharmacologic agent for stress. In this case a patient is brought to the laboratory for perfusion testing using a pharmacologic product like adenosine or dipyridamole. The patient is infused the agent while the heart rate and blood pressure are monitored and recorded, and the ECG is monitored. The study is accompanied by an imaging modality, and reported in a similar fashion that exercise testing is reported. The stress test can use many techniques for inducing cardiac stress, each noted in the table below, and may or may not use an additional imaging modality --Adapted from the Stress ECG Profile IHE Cardiology

10. Notes &Open Issues • Key Image Notes can be treated as other evidence objects. Support should be included as optional • Combined Report Creator, Manager, and Archive was discussed at the 2005 Chicago Connect-a-thon, is this still on the table? If not, additional transactions among those actors needs to be defined. IHE Cardiology