Cross Domain Review Cardiology

1. Cross Domain Review Cardiology Cynthia Levy IHE Technical Committee

2. Domains used in Cardiology • Radiology • IT Infrastructure

3. IHE Cardiology Integration Profile Cardiac Catheterization Workflow • CATH establishes the continuity and integrity of basic patient data in the context of the cardiac catheterization procedure. This profile deals with consistent handling of patient identifiers and patient demographics data. Evidence creation may occur before the procedure begins. This profile deals with the coordination of data across a variety of imaging modalities. .

4. Cardiac Catheterization Workflow Features • Heavily based upon Radiology SWF • Features unique to Cardiac Catheterization • Scheduling and Coordination of procedure data across a variety of imaging , measurement and analysis systems • Procedure started with vague order or none at all • Start procedure from a non-modality actor • Current active case triggered by initial procedure in-progress • Room changes often occur • Procedures are grouped under a single Requested Procedure, which may result in multiple Reports; Billing may be separate. • Cath-specific data requirements • Raw data stored in various formats • Summary of procedure (Procedure Log) is stored separately from Hospital Medical Records (typically paper) • Support for modalities intermittently connected to the network

5. IHE Cardiology Integration Profile Echocardiography Workflow • ECHO describes the workflow associated with digital echocardiography. Like CATH, it deals with patient identifies, orders, scheduling status reporting multi-stage exams and data storage. Additionally, it addresses issues of acquisition modality devices that are only intermittently connect to the network. Echocardiography uses Intravascular ultrasound (IVUS) and intracardiac echocardiography (ICE). .

6. Echocardiography Workflow Features • Process and Information flow for Echocardiography is similar to Cath Workflow • Cases are the same as Cath, but typically they are not done as emergency cases. • Features unique to Echocardiography • Support for modalities intermittently connected to the network (typical) • Connectivity is typically established at the beginning and end of the shift. Modality Worklist obtained at this time, along with Performed Procedure Steps and Storage Commitment. • Procedures scheduled after Modality Worklist are handled as unscheduled. Reconciliation occurs by updating/canceling procedures and using Modality information. • Staged Acquisition – Stress Echo Views are acquired over an interval of distinct times.

7. IHE Cardiology Integration Profile Retrieve ECG for Display • ECG describes a mechanism for broad access to electrocardiogram (ECG) documents (especially 12-lead ECG) throughout the enterprise for review purposes. This profile allows display of this type of information without requiring specialized cardiology software or workstations.

8. Retrieve ECG for Display Features • Heavily based upon Radiology ED • Options to deal with Cath specific Evidence Documents. • Options to deal with Echo specific Evidence Documents.

9. IHE Cardiology Integration Profile Displayable Reports • DRPT describes a mechanism for displaying report documents throughout the enterprise for review purposes. This profile allows display of this type of information without requiring specialized workstations using PDF. NOTE: This Profile is currently not Published. It was pulled due to issues found during implementation.

10. IHE Cardiology Integration Profile Evidence Documents • ED describes a mechanism for recording data gathered during the course of carrying out a procedure step. This data can be archived, retrieved and presented displayed for use in developing the clinical report. Evidence Documents include non-imaging information such as measurements, CAD results and procedure logs.

11. Evidence Documents Features • Method to retrieve a list of ECG Documents for a specific Patient ID. • Method to request a uniquely identified ECG Document.

12. IHE Cardiology Actors • Cardiology introduces a number of IT Actors • Time Client – Synchronizes itself to a time server. This actor is not formally part of the workflow profiles, but is grouped with certain actors. • Display – A System that requests and displays preformatted data using Web technologies. • Information Source – A system that responds to requests for patient-related • Actors are extensively the same as Radiology • Acquisition Modality, ADT, Department System Scheduler/Order Filler, Evidence Creator, Image Archive, Image Display, Image Manager, Order Placer, Performance Procedure Step Manager, Report Creator

13. IHE Cardiology Transactions • Transactions are extensively the same as Radiology • Modality Procedure Step In Progress – • DSS/OF may be required to match Patient ID to ADT information previously received, for unscheduled Procedure. • DSS/OF may be required to create Requested Procedure and associated Scheduled Procedure Steps when first Acquisition Modality begins the procedure. • DSS/OF may be required to use the AE Title, Study UID and other information provided by the first Acquisition Modality. • Room change may need to occur during procedure • Original Requested Procedure is Completed/Discontinued • Restart using MWL and Appending to original Scheduled Procedure • Modality Images/evidence Stored • Support for Cath and Echo image/non-image types • Lossy JPEG 8-Bit image compression for Ultrasound • Support for Stress ECHO Staged Protocol Related Information

14. IHE Cardiology Transactions • Transactions are extensively the same as Radiology • Storage Commitment • Alleviate Modalities with intermittent connections from filling up their local storage • Retrieve Images/Evidence • Support for Cath and Echo image/non-image types including cath/echo specific attributes.

15. IHE Cardiology Transactions • Transactions that are derived from IT-Infrastructure • Retrieve ECG List – • Derived from Retrieve Specific Information for Display [ITI-11] • Query for ECG Documents primarily for presentation in XML Format • Retrieve ECG Document for Display– • Derived from Retrieve Document for Display [ITI-12] • Web Service to return document as pdf or xml. • Uses http protocol for request and response.

16. IHE Cardiology Transactions • Transactions that are the same as Radiology • Patient Registration, Placer Order Management, Filler Order Management, Procedure Scheduled, Query Modality Worklist, Modality Procedure step Completed, Patient Update, Procedure Update, Query Images, Query Evidence Documents, Instance Availability Notification

17. Standards Used in Cardiology

18. Summary of Cardiology

19. Key to Domain issues • Issue should result in CP in Radiology • Consider addition in Radiology • Conflict between Radiology and other Domain • Radiology Profile should be handed-off to other Domain • Gap has been identified that may result in New Opportunity

20. Trial Implementation Cardiology Profiles • The following IHE Cardiology Profiles are in Trial Implementation • Implantable Device Cardiac Observation Profile • Collection of information from an Implantable Device Cardiac Device. Key information to be stored as part of an EMR, etc. • Uses ITI PIX to reconcile the Patient ID information • Stress Testing Workflow • The Stress Profile defines a means of ordering and performing cardiac stress tests involving stress ECG, echocardiographic, and/or nuclear imaging components. • Uses ITI CT, RAD NM w/Cardiac Option, ECHO

21. Trial Implementation Cardiology Profiles • The following IHE Cardiology Profiles are in Trial Implementation • Implantable Device Cardiac Observation Profile • This profile specifies the use of a centralized information system that would allow clinicians, in an emergency, to submit patient information and retrieve device identification information that wouldallow the correct programmer to be identified without trial and error. • Uses ITI PDQ and ITI ATNA to query a central repository for Patient Device Information