IHE Cardiology Discussion with EP Subcommittee Harry

IHE Cardiology – Discussion with EP Subcommittee Harry Solomon, co-chair IHE Cardiology Tech Cttee 12 August 2005

Why IHE? Cardiology has hard system and data integration problems • Multiple locations (office, in-patient, ED …) • Multiple devices and modalities • Long term patient care by many care providers Data integration is essential to quality patient care Care providers must work with industry to develop solutions to meet their needs • Implementations must be based on open standards 2 Harry Solomon 12 August 2005

What is IHE? An initiative to improve systems integration and interoperability for a multi-vendor Enterprise A process for coordinated adoption of standards • Clinicians define their highest priority integration problems • Vendor committees develop solutions and produce a Technical Framework • Industry adopts and implements solutions in products • Professional Society sponsors supervise documentation, testing, demonstration and promotion 3 Harry Solomon 12 August 2005

Goals of IHE Accelerate standards-based healthcare data integration Improve clinical and administrative workflow Improve data flow – where it’s needed, when it’s needed Improve the efficiency and effectiveness of clinical practice Advance the healthcare IT market 4 Harry Solomon 12 August 2005

Who is IHE? IHE is a joint initiative of: • American College of Cardiology (ACC) • Radiological Society of North America (RSNA) • Healthcare Information and Management Systems Society (HIMSS) Vendors/manufacturers in major supporting role Local sponsorship internationally • IHE-Europe and IHE-Asia/Oceania IHE-Cardiology additional participating societies • ASE, ASNC, HRS, SCAI and more • IHE-Cardiology in Europe sponsored by European Society of Cardiology (ESC) 5 Harry Solomon 12 August 2005

What IHE is NOT! SDO NOT a standards development organization • Profiles use of established standards (HL 7, DICOM, IETF, others) to address specific clinical needs • Standards promotion organization - complementary to SDOs NOT a product certification organization • Interoperability testing supervised by Professional societies with vendor-independent test tools • Vendor self-certification based on test results NOT simply a demonstration project • Demos only one means to the end: adoption 6 Harry Solomon 12 August 2005

IHE and Standards are necessary… but not sufficient – Why ? • Multiple standards and domains - overlap and redundancy – Conflict because domain boundaries are unclear and information models are different • Standards are broad, abstract and flexible – Room for interpretation in implementation hinders interoperability • Standards deal with getting data from A to B… but do not define full end-to-end user workflow across points A, B, C & D • Different techniques for standards development vs. deployment 7 Harry Solomon 12 August 2005

The IHE Value Proposition Users get a comprehensive, end-to-end workflow • Uniting multiple systems and multiple standards • Improving cost-effectiveness and quality of patient care Products can rely on other vendors’ products providing critical information in a consistent manner • Reducing development, validation, and integration costs • Avoiding chicken-and-egg adoption problem Integration occurs proactively in controlled environment with defined timetable, not reactively at customer site Common approach creates the market in which vendors can sell and users can buy with confidence “We each succeed when we all succeed” 8 Harry Solomon 12 August 2005

IHE Process Users and vendors work together to identify and design solutions for integration problems Intensive process with annual cycles: • Identify key healthcare workflows and integration problems • Research & select standards to specify a solution • Write, review and publish IHE Technical Framework • Perform cross-testing at “Connectathon” • Demonstrations at trade shows Yearly cycle focuses on most important tractable problems 9 Harry Solomon 12 August 2005

IHE Organizational Structure IHE Strategic Development Committee Regional Deployment IHE North America Global Development IHE Asia-Oceania Radiology Planning Committee Japan Canada Taiwan Netherlands Germany Spain Italy UK Sweden Professional Societies / Sponsors ACC GMSIH 10 HIMSS Harry Solomon SFR RSNA 12 August 2005 SFIL Cardiology Planning Committee IT Infrastructure Technical Committee Cardiology Technical Committee Korea IHE Europe France IT Infrastructure Planning Committee Radiology Technical Committee USA Laboratory Planning and Technical Committee Pharmacy Exploratory Committee Norway COCIR SIRM ESC EAR-ECR BIR DRG Euro. Rec JAHIS JIRA JRS METI MEDIS-DC JAMI Contributing and participating Vendors

Achievements and expanding scope 15 Active national chapters on 4 continents 4 Technical Frameworks 39 Integration Profiles, Testing at yearly Connectathons, Demonstrations at major exhibitions world-wide 1 Integration Profile IHE Patient Care Coordination EHR IHE IT Infrastructure IHE Radiology 13 Integration Profiles 16 Integration Profiles IHE Laboratory 5 Integration Profiles 11 Harry Solomon 12 August 2005 IHE Cardiology 4 Integration Profiles New IHE Domains Eye care, Pathology, Intensive care devices, etc. IHE Radiation Oncology

Timeline 20 months from concept to demo Date months Event July -20 Roadmap Subcommittee develops proposed 2/3/5 year plan concepts (year 1 already set) September -18 Planning Committee review of concept proposals, assignment for further development within Planning Committee January -14 Planning Committee initial selection of profiles, assignment for feasibility assessment by Technical Committee March -12 Technical Committee feasibility assessment, Planning Committee downscopes profiles to demonstration set April -11 Technical Committee publishes Technical Framework detailed profiles for comment; Planning Committee publishes demo plan June -9 Technical Committee publishes Technical Framework detailed profiles for Trial Implementation December -3 Vendor implementations pass MESA unit (standalone) transaction tests January -2 Connectathon tests interoperability implementation of Profiles March 12 Harry Solomon 12 August 2005 ! Demonstration of Profiles

Overlapping yearly cycles Tech Frmwk Developmt July Pub Rvw Oct Jan Vendor Implementation Roadmap Profile Proposals Apr July Oct Tech Frmwk Developmt Pub Rvw Vendor Implementation Roadmap 13 Harry Solomon 12 August 2005 Profile Proposals Jan Apr Demo Profile Proposals Apr Connectathon Roadmap Jan Demo Oct Connectathon July Tech Frmwk Developmt

Integration Profile: A Solution to an Integration Problem Actors cooperating through Transactions to solve a specific problem 14 Harry Solomon 12 August 2005 Report Creator 24: Report Submission Report Manager 25: Report Issuing Structured Report Export: 28 Enterprise Report Repository 26: Query Reports 27: Retrieve Reports Report Reader External Report Repository Access

Key IHE Concepts Generalized Systems -> Actors Interactions between Actors -> Transactions Problem/Solution Scenarios -> Integration Profiles For each Integration Profile: • the context is described (which real-world problem) • the actors are defined (what systems are involved) • the transactions are defined (what must they do) 15 Harry Solomon 12 August 2005

IHE Technical Frameworks Detailed standards implementation guides • Cardiology • IT Infrastructure • Lab • Radiology • Patient Care Coordination 16 Harry Solomon 12 August 2005

Connectathon Weeklong interoperability testing event Validation of the participants’ integration work • Prerequisite testing with MESA tools • Test all transactions under all profiles • 100 s products, 1000 s connections, 10000 s messages Primary IHE benefit for vendors • Test against all other players in one week, in one location (not at customer installation sites!) 17 Harry Solomon 12 August 2005

Demonstrations Part of the IHE marketing effort to end-users and system purchasing decision makers Involve educational sessions, handouts, and interoperating systems demos Structured to be fair to all participating vendors Prerequisite is successful completion of Connectathon 18 Harry Solomon 12 August 2005

IHE Cardiology – where we have been Year 1 – three profiles with “success path”, addressing broad range of integration problems • Workflow management in a Cath Lab, including angio, hemo, and IVUS, especially for emergent cases • Workflow management in Echocardiography, including mobile echo • Ability to view an ECG from many locations - quickly and easily integrated into other applications Broad participation in North America and Europe Connectathons and demos 19 Harry Solomon 12 August 2005

Cath Lab Multiple re-entry of Patient ID Error prone 2 1 6 7 5 8 9 10 11 3 4 Results fragmented across systems Results inconsistently time-tagged Custom solutions needed for data sharing Difficult to manage Uncoordinated with Hospital Information System Un-ordered cath exams (emergency) Unidentified patients Diagnostic and interventional procedures Ad hoc scheduling of cath labs Change of rooms during procedure 20 Harry Solomon 12 August 2005

Echo Workflow The “drive-by echo” Cardiologist to sonographer in CCU: “While you’re here, do a TTE on bed 3” • Unordered, unscheduled exam • Modality not on network 21 Harry Solomon 12 August 2005 Stress echo – After exam, sonographer creates new quad displays of stages and views • No intrinsic value add • Data is redundantly copied to storage

IHE Cardiology – where we are now Year 2 – enhance profiles to address measurement gathering, and production of final reports • Evidence Document options in Cath and Echo, including procedure log, QCA/QVA, hemo, IVUS measurements • PDF-based Displayable Reports production, archive, and distribution • Demonstration of Cross-Enterprise Document Sharing between inpatient and ambulatory settings (RHIO) 22 Harry Solomon 12 August 2005

Evidence Documents Echocardiography Measurement Patient: Doe, John Technologist: der Payd, N Measurements: Mitral valve diameter 3. 1 cm - 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 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 23 Harry Solomon 12 August 2005

Displayable Report Management 24 Harry Solomon 12 August 2005

Cross-enterprise document sharing problem Long Term Care Acute Care (Inpatient) Other Specialized Care (incl. Diagnostics Services) GPs and Clinics (Ambulatory) Typically, a patient goes through a sequence of encounters in different Care Settings 25 Harry Solomon 12 August 2005

Long Road Ahead – 5 yr Roadmap Year 2 (2006) Year 3 (2007) Year 4 (2008) Cath Cardiology Technical Framework Year 1 (2005) Multi-modality workflow & imaging Procedure log, measurements Hemo waveform Supplies, inventory, & charge capture Echo Workflow & imaging, stress protocols Measurements ECG Retrieve ECG for display 26 Harry Solomon 12 August 2005 ECG waveform interoperability Workflow & imaging, stress protocols EP Quality Pediatric Stress testing workflow Nuclear Reports 4 -D imaging Year 5 (2009) Reporting & distribution Lab workflow, device params & events Retrieve guidelines for display Device registries Registry data harvesting Home health monitoring Retrieve structured guidelines

For more information www. ihe. net – overviews, presentations, etc. ftp: //iheyr 1: iheyr 1@ftp. rsna. org/IHE/Cardio/EP - file server for EP sub-committee harry. solomon@med. ge. com – e-mail me if you’re stuck! 27 Harry Solomon 12 August 2005