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

Why IHE Cardiology? Multiple locations § Office, in-patient, emergency department § Individual patient is 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 2

Clinical Priority Areas Improve the performance of cardiology procedures – The Workflow Foundation Facilitate 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 3

The Workflow Foundation Managing cardiology procedure workflow to ensure consistently identified data 1. Cardiac The 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) 4

Cath Lab 7 2 6 5 8 9 10 11 3 4 1 • Cath Lab 7 2 6 5 8 9 10 11 3 4 1 • 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) IHE Cath Profile: managed workflow • Un-ordered cath exams • Diagnostic and interventional procedures • Ad hoc scheduling of cath labs • Change of rooms during procedure 5

Echo Workflow The “drive-by echo” – Cardiologist to sonographer in CCU: “While you’re here, 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 6

Stress Workflow ~85% of stress tests are multimodality (ECG + imaging) ~0% of current Stress Workflow ~85% of stress tests are multimodality (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 7

Workflow Architecture Summary Cath, echo and stress workflows managed with same common architecture as Workflow Architecture Summary Cath, echo and stress workflows managed with same common architecture as radiology § § HL 7 Patient Demographics HL 7 Orders DICOM Worklist Management DICOM Object Management and Display • Images, waveforms, measurements, procedure logs Modality specific requirements to improve workflow and clinical utility 8

Getting Results Consistent electronic methods for reporting on cardiology findings 5. Evidence Documents Profile Getting 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 9

Cardiology Measurements Echocardiography Measurement Patient: Doe, John Technologist: der Payd, N Measurements: Mitral valve Cardiology Measurements 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 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: standard electronic measurement transfer formats 10

Patient Monitoring Observations Get monitoring data from bedside into enterprise level application § Clinical Patient Monitoring Observations Get monitoring data from bedside into 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 Profile from IHE Patient Care Devices Domain 11

Displayable Reports Cardiology reports typically PDF with lots of graphics – how to get Displayable Reports Cardiology reports typically PDF with lots of graphics – how to get them into an EMR? IHE Displayable Reports Profile Submitting reports encapsulated in HL 7 v 2 messages 12

Display Information Outside the Department How does the clinical workstation on the ward get 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 Profile using Web technology (HTTP, PDF, XML) 13

Display ECGs Everywhere Integrate ECG display into clinical workstation applications IHE Retrieve ECG for Display ECGs Everywhere Integrate ECG display into clinical workstation applications IHE Retrieve ECG for Display Profile using Web technology (HTTP, PDF, XML) 14

Beyond the Enterprise Sharing data between the office and in-patient environments, or on the Beyond the Enterprise Sharing data between the office and in-patient environments, or on the regional or national level 10. Cross-Enterprise Document Sharing (XDS) XDS for Imaging (XDS-I) 11. Cross-Enterprise Document Reliable Interchange (XDR) 12. Cross-Enterprise Document Media Interchange (XDM) A. from IHE IT Infrastructure and Patient Care Coordination Domains 15

Document Sharing Use Cases Initial referral to cardiologist – family and social history, medications, 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 16

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

XDS Content Profiles Medical Summary – encounter notes, discharge summary Imaging – exchange of 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) 18

Cross-Enterprise Document Sharing – Ad-hoc Sharing XDR – Online network point-to-point, without shared document 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) 19

Quality Efficiently collect various measures of clinical quality and performance for practice improvement and Quality 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 n Soo g min Co from IHE Radiology and Quality Domains 20

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