Integrating the Healthcare Enterprise - IHE Cardiology

1. Integrating the Healthcare Enterprise -IHE Cardiology Summary of Profiles - 2008

2. 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 hard data integration problems –and we need to take action

3. Clinical 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

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

5. Cath Lab • 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 7 6 5 8 10 9 11 4 3 2 1 IHE Cath Profile:managed workflow

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 in quad format IHE Echocardiography Profile

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

8. Workflow 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

9. Getting Results • Consistent electronic methods for reporting on cardiology findings • Evidence Documents Profile (quantitative measurements) • Cath, Echo, Stress, CTA/MRA options • Device Enterprise Communication Profile • Displayable Reports Profile • Retrieve Information for Display Profile • Retrieve ECG for Display Profile

10. Cardiology Measurements 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 IHE Evidence Documents Profile:standard electronic measurement transfer formats 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

11. Patient 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 Profilefrom IHE Patient Care Devices Domain

12. Cardiology reports typically PDF with lots of graphics – how to get them into an EMR? Displayable Reports IHE Displayable Reports ProfileSubmitting reports encapsulated in HL7 v2 messages

13. Display Information Outside 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 ProfileusingWeb technology (HTTP, PDF, XML)

14. Display ECGs Everywhere • Integrate ECG display into clinical workstation applications IHE Retrieve ECG for Display ProfileusingWeb technology (HTTP, PDF, XML)

15. Beyond the Enterprise • Sharing data between the office and in-patient environments, or on the regional or national level • Cross-Enterprise Document Sharing (XDS) • XDS for Imaging (XDS-I) • Cross-Enterprise Document Reliable Interchange (XDR) • Cross-Enterprise Document Media Interchange (XDM) from IHE IT Infrastructure and Patient Care Coordination Domains

16. 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

17. DocumentRepository Cross-Enterprise Document Sharing Regional Health Information Organization (RHIO) Document Registry Long Term Care Acute Care (Inpatient) Other Specialized Careor Diagnostics Services PCPs and Clinics (Ambulatory)

18. XDS 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 Imaging (Radiology) and Laboratory (Laboratory Domain)

19. Cross-Enterprise Document Sharing – Ad-hoc Sharing • XDR – Online network point-to-point, without shared document registry • XDM – “Off-line” point-to-point • Email • Physical media (CD, USB flash)

20. Quality • Efficiently collect various measures of clinical quality and performance for practice improvement and patient safety • X-ray Radiation Dose Report • Patient-Level Export of Quality Data (PEQD) • ACEI/ARB for LVSD after AMI Coming Soon from IHE Radiology and Quality Domains