cardiology workflow
DESCRIPTION
Cardiology WorkflowTRANSCRIPT
1September, 2005 What IHE Delivers
Cardiology Workflow & Cardiology Workflow & Display RequirementsDisplay Requirements
ACCA IHE Workshop 2007ACCA IHE Workshop 2007
Bob Baumgartner, BSN, MBA McKesson CorporationBob Baumgartner, BSN, MBA McKesson Corporation
IHE-Cardiology Planning Committee Administrative Co-ChairIHE-Cardiology Planning Committee Administrative Co-Chair
2
AgendaAgenda
Cardiology Workflows GeneralCardiology Workflows General Cath WorkflowCath Workflow Echo WorkflowEcho Workflow Stress Workflow Stress Workflow
Content Display RequirementsContent Display Requirements Stress EchoStress Echo StressStress
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Cardiology WorkflowsCardiology Workflows
CardiologyCardiology: :
the study of the the study of the
heart heart its action its action and diseasesand diseases
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The ProblemThe Problem
This is an example This is an example of a cardiology of a cardiology workflow.workflow.
Any questions!Any questions!
Workflow is the Workflow is the linchpin to data linchpin to data
integrityintegrity
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General WorkflowGeneral Workflow
Pt. Registration [RAD-1] Patient Update [RAD-12]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Placer Order Management [RAD-2] Filler Order Management [RAD-3]
ADT
Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]
Image Display
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Procedure Scheduled [RAD-4]
Procedure Updated [RAD-13]
Query Modality Worklist [RAD-5]
Performed Procedure
Step Manager
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
ImageManager
ImageArchive
DSS/ Order Filler
Patient Update [RAD-12]
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Evidence Creator Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Instance Availability Notification [RAD-49]
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AgendaAgenda
Cardiology Workflows GeneralCardiology Workflows General
Cath WorkflowCath Workflow Echo WorkflowEcho Workflow Stress Workflow Stress Workflow
Content Display RequirementsContent Display Requirements Stress EchoStress Echo StressStress
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Cath LabCath Lab
•Multiple re-entry of Patient ID
•Error prone
•Results fragmented across systems
•Results inconsistently time-tagged
1
23 4
56 7
8 9 10 11
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Administrative Process FlowAdministrative Process Flow
ADTOrder Placer
ImageManager
Acquisition Modality
Placer Order Mgmt - New [Rad-2]
Department System Scheduler/ Order Filler
Procedure Scheduled [Rad-4]
Register/Admit Patient
Create Order
Schedule Procedure
PatientRegistration [Rad-1]
Select Patient
Query Modality Worklist [Rad-5]
Start Procedure
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Procedure Performance Process FlowProcedure Performance Process Flow
ImageManager/
Image Archive
Acquisition Modality
Department System Scheduler/ Order
Filler
Modality Procedure
Perform Acquisition
Modality Images/ Evidence Stored [Card-2]
Storage Commitment [Card-3]
Modality Procedure Step In Progress [Card-1]
Modality Procedure Step Completed [Rad-7]
Modality Procedure Step In Progress [Card-1]
Order Placer
Order Status Update [Rad-3]
UpdateSchedule
Acquisition Modality n
Query Modality Worklist [Rad-5]
Modality Procedure Step In Progress [Card-1]
Modality Procedure Step In Progress [Card-1]
Perform Acquisition Modality Images/Evidence Stored
[Card-2]
Step Completed [Rad-7]
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Use CasesUse Cases Case C1:Case C1: Patient Registered at ADT and Procedure Patient Registered at ADT and Procedure
Ordered at the Order PlacerOrdered at the Order Placer Case C2:Case C2: Patient Registered at ADT and Procedure Patient Registered at ADT and Procedure
Ordered at DSS/OFOrdered at DSS/OF Case C3:Case C3: Patient Registered at ADT and Procedure Patient Registered at ADT and Procedure
Not OrderedNot Ordered Case C4:Case C4: Patient Registered at DSS/OF and Patient Registered at DSS/OF and
Procedure Procedure OrderedOrdered Case C5:Case C5: Patient Not RegisteredPatient Not Registered Case C6:Case C6: Patient Updated During ProcedurePatient Updated During Procedure Case C7:Case C7: Change Rooms During ProcedureChange Rooms During Procedure Case C8:Case C8: Cancel ProcedureCancel Procedure Case C9:Case C9: Post-Procedure Evidence CreationPost-Procedure Evidence Creation Case C10: Case C10: EP Ablation / Implantation LabEP Ablation / Implantation Lab
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Case C1: Patient Registered at ADT and Case C1: Patient Registered at ADT and Procedure Ordered at the Order PlacerProcedure Ordered at the Order Placer
Clinical ContextClinical Context
Corresponds to traditional Radiology workflowCorresponds to traditional Radiology workflowOrder placed in central systemOrder placed in central systemAlso deals with case where emergency Also deals with case where emergency
identifier has been createdidentifier has been createdCommon identifiers known ahead of timeCommon identifiers known ahead of time
IHE ContextIHE Context
MPPS in Progress from first modality used to MPPS in Progress from first modality used to update worklists for othersupdate worklists for others
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Case C2: Patient Registered at ADT and Case C2: Patient Registered at ADT and Procedure Ordered at DSS/OFProcedure Ordered at DSS/OF
Clinical ContextClinical Context Slight difference to Case 1Slight difference to Case 1 Order placed NOT in central system but in departmentOrder placed NOT in central system but in department Department system provides info to Central ordering Department system provides info to Central ordering
system system Typical of many institutes, relieves need for HIS terminal Typical of many institutes, relieves need for HIS terminal
in labin lab
IHE ContextIHE Context Filler Order Management (New Order) transaction [RAD-3] Filler Order Management (New Order) transaction [RAD-3]
is sent from Department System Scheduler/Order Filler to is sent from Department System Scheduler/Order Filler to the Order Placer.the Order Placer.
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Case C3: Patient Registered at ADT and Case C3: Patient Registered at ADT and Procedure Not OrderedProcedure Not Ordered
Clinical ContextClinical Context Slight difference to Case 2Slight difference to Case 2 Procedural information is NOT entered at the departmental Procedural information is NOT entered at the departmental
systemsystem The first modality must initiate the process of creating common The first modality must initiate the process of creating common
procedure identifiers (usually hemo)procedure identifiers (usually hemo) The common procedure identifiers are created by the The common procedure identifiers are created by the
departmental system based on the information available from departmental system based on the information available from the first modalitythe first modality
Can generate a “generic cath procedure” if no coded procedural Can generate a “generic cath procedure” if no coded procedural type is availabletype is available
IHE ContextIHE Context Upon receiving the first MPPS the DSS/OF will auto generate a Upon receiving the first MPPS the DSS/OF will auto generate a
Requested Procedure and its associated Scheduled Procedure Requested Procedure and its associated Scheduled Procedure Steps utilizing the Study UID provided in the first MPPS. All Steps utilizing the Study UID provided in the first MPPS. All other modalities use the Query Modality Worklist transaction.other modalities use the Query Modality Worklist transaction.
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Case C4: Patient Registered at DSS/OF and Case C4: Patient Registered at DSS/OF and Procedure OrderedProcedure Ordered
Clinical ContextClinical Context This case accommodates the emergency case where there is This case accommodates the emergency case where there is
not enough time to register the patient on ADT systemnot enough time to register the patient on ADT system A temporary patient identifier is created at the department levelA temporary patient identifier is created at the department level The order placer is notified only after the patient is registered The order placer is notified only after the patient is registered
and manually reconciled on the department system and manually reconciled on the department system
IHE ContextIHE Context The DSS/OF assigns a temporary Patient ID with a temporary The DSS/OF assigns a temporary Patient ID with a temporary
name and schedules the required proceduresname and schedules the required procedures The DSS/OF does not send the Filler Order Management (New The DSS/OF does not send the Filler Order Management (New
Order) transaction to the Order Placer until the patient is Order) transaction to the Order Placer until the patient is registered on the ADT system and reconciliation occurs on the registered on the ADT system and reconciliation occurs on the DSS/OF. DSS/OF.
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Case C5: Patient Not RegisteredCase C5: Patient Not Registered
Clinical ContextClinical Context This is the Emergent Case where the patient information is not This is the Emergent Case where the patient information is not
known or there is not enough time to enter the informationknown or there is not enough time to enter the information A temporary ID is assigned by the department and entered at the first A temporary ID is assigned by the department and entered at the first
modality and forwards that information to the departmental system to modality and forwards that information to the departmental system to be shared with the other modalitiesbe shared with the other modalities
Like in C4 information is sent to the Order Placer post patient Like in C4 information is sent to the Order Placer post patient registration and reconciliation on the departmental systemregistration and reconciliation on the departmental system
IHE ContextIHE Context Patient ID and name are selected based upon locally (usually Patient ID and name are selected based upon locally (usually
department) base rulesdepartment) base rules The first modality will send an MPPS with the appropriate information The first modality will send an MPPS with the appropriate information
to the DSS/OF which will in turn generate the appropriate requested to the DSS/OF which will in turn generate the appropriate requested procedure(s) using the Study UID assigned by the first modalityprocedure(s) using the Study UID assigned by the first modality
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Case C6: Patient Updated During ProcedureCase C6: Patient Updated During Procedure
Clinical ContextClinical Context An unidentified patient may have been registered at the ADT An unidentified patient may have been registered at the ADT
and brought into the cath lab with the temporary IDand brought into the cath lab with the temporary ID During the procedure the patient information is updated on the During the procedure the patient information is updated on the
ADT which sends the patient update informationADT which sends the patient update information This can results is some of the information been associated with This can results is some of the information been associated with
the temp ID and the rest with the permanent IDthe temp ID and the rest with the permanent ID The case defines how the reconciliation occurs.The case defines how the reconciliation occurs.
IHE ContextIHE Context The modality may have requested information from the DSS/OF The modality may have requested information from the DSS/OF
prior the patient updateprior the patient update The Image Manager needs to update the items stored to Image The Image Manager needs to update the items stored to Image
Archive as well as any subsequent items receivedArchive as well as any subsequent items received..
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Case C7: Change Rooms During ProcedureCase C7: Change Rooms During Procedure
Clinical ContextClinical Context
This is the case when the patient is moved due to any of the This is the case when the patient is moved due to any of the following reasons:following reasons:
The change from a diagnostic to interventional procedureThe change from a diagnostic to interventional procedure The need to use the current room for another patientThe need to use the current room for another patient Equipment failureEquipment failure
NOTE: This case does not cover the scenario where a patient is NOTE: This case does not cover the scenario where a patient is moved to the holding area from a procedure room. moved to the holding area from a procedure room.
IHE ContextIHE Context
Each modality will issue a MPS (Completed or Discontinued)Each modality will issue a MPS (Completed or Discontinued) The DSS/OF will reassign the requested procedure to the new roomThe DSS/OF will reassign the requested procedure to the new room In the event the DSS/OF does not reassign, each modality in the In the event the DSS/OF does not reassign, each modality in the
new room would use the broad Modality Worklist Querynew room would use the broad Modality Worklist Query This insures consistency of the Study UID for all informationThis insures consistency of the Study UID for all information
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Image Manager Acquisition
Modality Room 1
Department System Scheduler/ Order Filler
Modality Procedure Step Discontinued [Rad-7]
Modality Procedure Step Discontinued [Rad-7]
Modality Procedure Step In Progress [Card-1]
Modality Procedure Step In Progress [Card-1]
AcquisitionModality n
Room 1
Query Modality Worklist [Rad-5]
Perform Acquisition
Perform Acquisition
AcquisitionModality Room 2
AcquisitionModality n Room 2
Query Modality Worklist [Rad-5]
Modality Procedure Step In Progress [Card-1]
Modality Procedure Step In Progress [Card-1]
Modality Procedure Step In Progress [Card-1]
Modality Procedure Step In Progress [Card-1]
Query Modality Worklist [Rad-5]
Perform Acquisition
Perform Acquisition
Query Modality Worklist [Rad-5]
Modality Procedure Step In Progress [Card-1]
Modality Procedure Step In Progress [Card-1]
Reassign Procedure
UpdateSchedule
UpdateSchedule
Case 7: Change Rooms During ProcedureCase 7: Change Rooms During Procedure
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Case C8: Cancel ProcedureCase C8: Cancel Procedure
Clinical ContextClinical Context This case allows for the information systems to keep track of This case allows for the information systems to keep track of
cancelled procedures allowing the cath lab staff to appropriately cancelled procedures allowing the cath lab staff to appropriately respond to queries regarding that patient.respond to queries regarding that patient.
IHE ContextIHE Context When the procedure is cancelled within the department the When the procedure is cancelled within the department the
DSS/OF notifies the Order Placer system and Image ManagerDSS/OF notifies the Order Placer system and Image Manager The length of time this procedural information is maintained is The length of time this procedural information is maintained is
determined by local policy.determined by local policy.
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Case C9: Post-Procedure Evidence CreationCase C9: Post-Procedure Evidence Creation
Clinical ContextClinical Context Allows for imaging and other procedural data to be analyzed Allows for imaging and other procedural data to be analyzed
post-procedure using specialized software (e.g., QCA, QLV, post-procedure using specialized software (e.g., QCA, QLV, derived images)derived images)
This case does NOT apply to core lab analysis for clinical trials This case does NOT apply to core lab analysis for clinical trials or outcome analysisor outcome analysis
IHE ContextIHE Context This analysis must be performed on a station that groups the This analysis must be performed on a station that groups the
Image Display and Evidence Creator ActorsImage Display and Evidence Creator Actors The Evidence Creator notifies the IM/IA and DSS/OF of the The Evidence Creator notifies the IM/IA and DSS/OF of the
activity via the MPPS In Progress and Complete transactionsactivity via the MPPS In Progress and Complete transactions The Evidence Creator stores its evidence to the IM/IA via the The Evidence Creator stores its evidence to the IM/IA via the
Storage Commit Transaction.Storage Commit Transaction.
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Case C10: Case C10: EP Ablation / Implantation LabEP Ablation / Implantation Lab
Clinical ContextClinical Context Allows for the wide array of specialized equipment used in the Allows for the wide array of specialized equipment used in the
EP labEP lab Provides demographic and time synchronizationProvides demographic and time synchronization
IHE ContextIHE Context Initial implementation is an extension of the CATH profileInitial implementation is an extension of the CATH profile Support for use cases C1 – C9 Support for use cases C1 – C9 Emergency use cases C3 and C5 are highly unusual in the EP Emergency use cases C3 and C5 are highly unusual in the EP
lab.lab.
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AgendaAgenda
Cardiology Workflows GeneralCardiology Workflows General Cath WorkflowCath Workflow
Echo WorkflowEcho Workflow Stress Workflow Stress Workflow
Content Display RequirementsContent Display Requirements Stress EchoStress Echo StressStress
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Use CasesUse CasesCase E1:Case E1: Patient Registered at ADT and Procedure Ordered Patient Registered at ADT and Procedure Ordered
Case E2:Case E2: Intermittently Connected Modality Intermittently Connected Modality
Case E3:Case E3: Intermittently Connected Modality with Ad Hoc Intermittently Connected Modality with Ad Hoc
Procedure, Patient Registered, Scheduled ProcedureProcedure, Patient Registered, Scheduled Procedure
Case E4:Case E4: Intermittently Connected Modality with Ad Hoc Intermittently Connected Modality with Ad Hoc
Procedure, Patient Registered, Unscheduled ProcedureProcedure, Patient Registered, Unscheduled Procedure
Case E5:Case E5: Intermittently Connected Modality with Ad Hoc Intermittently Connected Modality with Ad Hoc
Procedure, Patient Unregistered, Unscheduled ProcedureProcedure, Patient Unregistered, Unscheduled Procedure
Case E6:Case E6: Stress Echo Staged Protocol Stress Echo Staged Protocol
Case E7:Case E7: Echo Measurements Evidence Creation Echo Measurements Evidence Creation
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CaseCase E1: E1: Patient Registered at ADT and Patient Registered at ADT and Procedure OrderedProcedure Ordered
Clinical ContextClinical Context Corresponds to traditional Radiology workflowCorresponds to traditional Radiology workflow Order placed in central systemOrder placed in central system Also deals with case where emergency identifier Also deals with case where emergency identifier
has been createdhas been created Common identifiers known ahead of timeCommon identifiers known ahead of time
IHE ContextIHE Context The Scheduled Procedure Steps are obtained by The Scheduled Procedure Steps are obtained by
the modality through Query Modality Worklist, the the modality through Query Modality Worklist, the acquisition is performed and statused thought acquisition is performed and statused thought Modality Performed Procedure Step.Modality Performed Procedure Step.
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Case E2:Case E2: Intermittently Connected Modality Intermittently Connected Modality
Clinical ContextClinical Context Allows for the mobile workflow typical of TTE and TEEAllows for the mobile workflow typical of TTE and TEE Assumes the modality is only intermittently connected to the Assumes the modality is only intermittently connected to the
networknetwork Also covers the case of the modality being turned offAlso covers the case of the modality being turned off
IHE ContextIHE Context Process flow identical to Case E1Process flow identical to Case E1 Must be paired with an Image Manager/Image Archive that Must be paired with an Image Manager/Image Archive that
also supports Intermittent Connectivityalso supports Intermittent Connectivity MPPS are stored and sent when connection establishedMPPS are stored and sent when connection established Image Manage must queue N-Event Report messages for Image Manage must queue N-Event Report messages for
storage commitment storage commitment
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Case E3:Case E3: ICM with Ad Hoc Procedure, Patient ICM with Ad Hoc Procedure, Patient Registered, Scheduled ProcedureRegistered, Scheduled Procedure
Clinical ContextClinical Context This extends Case E2 to allow for a scheduled procedure This extends Case E2 to allow for a scheduled procedure
but the modality can’t query the worklist since it is not but the modality can’t query the worklist since it is not connected to the networkconnected to the network
IHE ContextIHE Context The modality will treat this as unscheduled procedureThe modality will treat this as unscheduled procedure The patient ID and demographics must be manually enteredThe patient ID and demographics must be manually entered The modality must create the Study Instance UIDThe modality must create the Study Instance UID Manual matching process at DSS/OF to reconcile the Manual matching process at DSS/OF to reconcile the
scheduled and performed procedure informationscheduled and performed procedure information Post match the DSS/OF will reconcile with the Image Post match the DSS/OF will reconcile with the Image
Manager to correct for the Study Instance UIDManager to correct for the Study Instance UID
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Case E4:Case E4: ICM with Ad Hoc Procedure, Patient ICM with Ad Hoc Procedure, Patient Registered, Unscheduled ProcedureRegistered, Unscheduled Procedure
Clinical ContextClinical Context This is the drive by echo or Stat echo performed without an This is the drive by echo or Stat echo performed without an
order placed in the systemorder placed in the system
IHE ContextIHE Context This case is identical to other unscheduled procedure casesThis case is identical to other unscheduled procedure cases Modality creates the Study Instance UIDModality creates the Study Instance UID When connected the modality will send a MPPS in ProgressWhen connected the modality will send a MPPS in Progress DSS/OF will generate an exception for reconciliationDSS/OF will generate an exception for reconciliation Patient demographic reconciliation should occur Patient demographic reconciliation should occur
automatically based on patient IDautomatically based on patient ID The Image Manager will use the Patient Update transaction The Image Manager will use the Patient Update transaction
to update the demographicsto update the demographics
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Case E5:Case E5: ICM with Ad Hoc Procedure, Patient ICM with Ad Hoc Procedure, Patient Unregistered, Unscheduled ProcedureUnregistered, Unscheduled Procedure
Clinical ContextClinical Context This case is similar to Case E4 except the patient is not yet This case is similar to Case E4 except the patient is not yet
registered. (Emergency Admit)registered. (Emergency Admit)
IHE ContextIHE Context Temporary Name and ID entered into the modalityTemporary Name and ID entered into the modality DSS/OF will generate an exceptionDSS/OF will generate an exception Manual match of the temporary ID with the Patient Manual match of the temporary ID with the Patient
Registration informationRegistration information Patient Update sent to the Image ManagerPatient Update sent to the Image Manager
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Case E6:Case E6: Stress Echo Staged Protocol Stress Echo Staged Protocol
Clinical ContextClinical Context Allows for appropriate identification of Stages and Views Allows for appropriate identification of Stages and Views
during a stress echoduring a stress echo
IHE ContextIHE Context Similar to Case E1Similar to Case E1 Type of stress protocol is specified in the Scheduled Type of stress protocol is specified in the Scheduled
Protocol Code Sequence or Scheduled Step DescriptionProtocol Code Sequence or Scheduled Step Description Within the “perform acquisition” activity there are several Within the “perform acquisition” activity there are several
stages but typically considered the same procedure stepstages but typically considered the same procedure step A status of “Discontinued” can indicate technical failure to A status of “Discontinued” can indicate technical failure to
reach the end point of the exam.reach the end point of the exam.
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Case E7:Case E7: Echo Measurements Evidence Echo Measurements Evidence CreationCreation
Clinical ContextClinical Context Measurements are normally obtained during the Measurements are normally obtained during the
acquisition on the modality. acquisition on the modality. This case supports the ability to obtain additional This case supports the ability to obtain additional
measurements on the clinical workstation post measurements on the clinical workstation post acquisition and update the study data.acquisition and update the study data.
IHE ContextIHE Context This case is similar to Cath C9This case is similar to Cath C9 The actor participates in both the ECHO and ED The actor participates in both the ECHO and ED
profilesprofiles Generation of a DICOM SR with reference to originalGeneration of a DICOM SR with reference to original
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AgendaAgenda
Cardiology Workflows GeneralCardiology Workflows General Cath WorkflowCath Workflow Echo WorkflowEcho Workflow
Stress WorkflowStress Workflow
Content Display RequirementsContent Display Requirements Stress EchoStress Echo StressStress
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Stress TestingStress Testing
Image Intensive…Image Intensive…multiple samples of 12 multiple samples of 12 lead ECG during the lead ECG during the protocolprotocol
Summary report Summary report usually one page in usually one page in lengthlength
Physician will do Physician will do comparisons to comparisons to previous studiesprevious studies
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Stress OptionsStress Options
Stress EchoStress Echo Began in the early – mid 1990’sBegan in the early – mid 1990’s Observation of wall motion and ejection fractions with the Observation of wall motion and ejection fractions with the
heart under stressheart under stress High specificity for correlating ischemia to functional High specificity for correlating ischemia to functional
abnormalitiesabnormalities Can be done with exercise but mainly chemicalCan be done with exercise but mainly chemical
Nuclear StressNuclear Stress Most often combined with exercise or chemical stress Most often combined with exercise or chemical stress
testingtesting Use of radioisotope to detect presence and resolution of Use of radioisotope to detect presence and resolution of
ischemic regions of the heartischemic regions of the heart Scan immediately post Scan immediately post Scan 4 hours to 1 day laterScan 4 hours to 1 day later Resolution of ischemic area determines viability of muscleResolution of ischemic area determines viability of muscle
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Stress Workflow DiagramStress Workflow Diagram
Pt. Registration [RAD-1] Patient Update [RAD-12]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Placer Order Management [RAD-2] Filler Order Management [RAD-3]
ADT
Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]
Image Display
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Procedure Scheduled [RAD-4]
Procedure Updated [RAD-13]
Query Modality Worklist [RAD-5]
Performed Procedure
Step Manager
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]
Order Placer
Acquisition Modality
ImageManager
ImageArchive
DSS/ Order Filler
Patient Update [RAD-12]
Modality Image/Evidence Stored [CARD-2]
Storage Commitment
[CARD-3]
Evidence Creator Modality PS in Progress [CARD-1]
Modality PS Completed [RAD-7]
Instance Availability Notification [RAD-49]
Report Creator
Report Creator
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Stress Workflow – Actors and OptionsStress Workflow – Actors and OptionsActor Option Name Optionality Vol & Section
Acquisition Modality Patient Based Worklist Query O RAD-TF 2: 4.5
Broad Worklist Query R (see note 1) RAD-TF 2: 4.5
PPS Exception Management O RAD-TF 2: 4.7
Stress ECG R (see note 2) CARD-TF 2: 4.2
Stress Echo R (see note 2) CARD-TF 2: 4.2
Nuclear Medicine (see note 3) R (see note 2) RAD-TF 2: 4.8
Image Manager/ Image Archive PPS Exception Management O RAD-TF 2: 4.7
Intermittently Connected Modality R CARD-TF 2: 4.3
Stress ECG R CARD-TF 2: 4.2
Echocardiography R CARD-TF 2: 4.2
Nuclear Medicine (see note 3) R RAD-TF 2: 4.8
Availability of PPS-Referenced Instances O RAD-TF 3: 4.49
Image Display Stress ECG R CARD-TF 2: 4.4
Stress Echo R CARD-TF 2: 4.2
Cardiac NM (see notes 3, 4) R RAD-TF 2: 4.16
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Use CasesUse CasesCase S1:Case S1: Cardiac Stress Test, ECG Only Cardiac Stress Test, ECG Only
Limited use with lower sensitivities and specificitiesLimited use with lower sensitivities and specificities
Screening tool onlyScreening tool only
Case S2:Case S2: Cardiac Stress Test with Imaging Cardiac Stress Test with Imaging
More common use caseMore common use case• Echocardiography – requires Consistent Time to combine clinical Echocardiography – requires Consistent Time to combine clinical
data from Stress Monitor and Echo Modalitydata from Stress Monitor and Echo Modality
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AgendaAgenda
Cardiology Workflows GeneralCardiology Workflows General Cath WorkflowCath Workflow Echo WorkflowEcho Workflow Stress Workflow Stress Workflow
Content Display RequirementsContent Display Requirements
Stress EchoStress Echo StressStress
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ViewsViewsApical two chamber
Apical four chamber
Apical long axis
Parasternal long axis
Parasternal short axis
Parasternal short axis at the aortic valve level
Parasternal short axis at the level of the mitral chords
Parasternal short axis at the Mitral Valve level
Parasternal short axis at the Papillary Muscle level
Right Ventricular Inflow Tract View
Right Ventricular Outflow Tract View
Subcostal long axis
Subcostal short axis
Suprasternal long axis
Suprasternal short axis
Stage and ViewsStage and ViewsStage and ViewsStage and Views
Stress Echo OptionStress Echo Option• Stage Number & View Stage Number & View
NumberNumber• Stage Code Sequence & Stage Code Sequence &
View Code SequenceView Code Sequence
Coding
Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning (0008,0104)
SRT P5-01201 Image acquisition at baseline
SRT P5-01202 Pre-stress image acquisition
SRT P5-01203 Mid-stress image acquisition
SRT P5-01204 Peak-stress image acquisition
SRT P5-01205 Image acquisition during recovery
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Benefit: Stress Echo Viewing Benefit: Stress Echo Viewing ConsistencyConsistency
Benefit: Stress Echo Viewing Benefit: Stress Echo Viewing ConsistencyConsistency
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AgendaAgenda
Cardiology Workflows GeneralCardiology Workflows General Cath WorkflowCath Workflow Echo WorkflowEcho Workflow Stress Workflow Stress Workflow
Content Display RequirementsContent Display Requirements Stress EchoStress Echo
StressStress
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Stress: Protocol and StageStress: Protocol and Stage
ProcedureProcedure
ProtocolProtocol
StagesStages
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Stress: Protocol and StageStress: Protocol and Stage
Procedure : Exercise StressProcedure : Exercise Stress
Protocol: BruceProtocol: Bruce
Stages:Stages: Standard Bruce has 7 stagesStandard Bruce has 7 stages
• Stage 1: 1.7 mph @ 10 % gradeStage 1: 1.7 mph @ 10 % grade• Stage 7: 6.0 mph @ 22 % gradeStage 7: 6.0 mph @ 22 % grade
Important Note: A procedure can be Important Note: A procedure can be considered complete irrespective of the considered complete irrespective of the
protocol being complete!protocol being complete!
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Attribute SummaryAttribute Summary
Concept Modality Worklist Echo ECG NM
Requested Procedure
Requested Procedure Code Sequence (0032,1064)
Procedure Code Sequence (0008,1032)
Procedure Code Sequence (0008,1032)
Procedure Code Sequence (0008,1032)
Protocol Scheduled Protocol Code Sequence (0040,0008)
Performed Protocol Code Sequence (0040,0260)
CID 12001*
Performed Protocol Code Sequence (0040,0260)
CID 3261
Performed Protocol Code Sequence (0040,0260)
CID 3261**
Protocol Stage Number
Acquisition Context Sequence (0040,0555) >(109055, DCM, “Protocol Stage”)
Patient State Stage Number (0008,2122)
Stage Code Sequence (0040,000A)
CID 12002*
Acquisition Context Sequence (0040,0555) >(109054, DCM, “Patient State”)
CID 3262
Acquisition Context Sequence (0040,0555) >(109054, DCM, “Patient State”)
CID 3101
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