september, 2005what ihe delivers integrating the healthcare enterprise - ihe cardiology summary of...
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September, 2005 What IHE Delivers
Integrating the Healthcare Integrating the Healthcare Enterprise -Enterprise -
IHE CardiologyIHE Cardiology
Summary of Profiles - 2008Summary of Profiles - 2008
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Why IHE Cardiology?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 Lots of hardhard data integration problems – data integration problems –and we need to take and we need to take actionaction
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Clinical Priority AreasClinical 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
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The Workflow FoundationThe 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)
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Cath LabCath Lab
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23 4
56 7 • 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
8 9 10 11
IHE Cath Profile:IHE Cath Profile:managed workflowmanaged workflow
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Echo WorkflowEcho 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 ProfileIHE Echocardiography Profile
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Stress WorkflowStress 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 IHE Stress Testing Profile and IHE Nuclear Medicine and IHE Nuclear Medicine
Image ProfileImage Profile
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Workflow Architecture SummaryWorkflow 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
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Getting ResultsGetting 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
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Cardiology MeasurementsCardiology MeasurementsEchocardiography 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
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:IHE Evidence Documents Profile:standard electronic measurement standard electronic measurement
transfer formatstransfer formats
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Patient Monitoring ObservationsPatient 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 ProfileIHE Device Enterprise Communication Profilefrom IHE Patient Care Devices Domainfrom IHE Patient Care Devices Domain
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Displayable ReportsDisplayable Reports
Cardiology reports typically PDF with lots of graphics – how to get them into an EMR?
IHE Displayable IHE Displayable Reports ProfileReports Profile
Submitting reports Submitting reports encapsulated in encapsulated in
HL7 v2 messagesHL7 v2 messages
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Display Information Display Information Outside the DepartmentOutside 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 ProfileIHE Retrieve Information for Display Profileusingusing Web technology (HTTP, PDF, XML)Web technology (HTTP, PDF, XML)
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Display ECGs EverywhereDisplay ECGs Everywhere
Integrate ECG display into clinical workstation applications
IHE Retrieve ECG IHE Retrieve ECG for Display Profilefor Display Profile
usingusing Web technology Web technology (HTTP, PDF, XML)(HTTP, PDF, XML)
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Beyond the EnterpriseBeyond the EnterpriseSharing data between the office and in-patient environments, or on the regional or national level
10. Cross-Enterprise Document Sharing (XDS)
A. XDS for Imaging (XDS-I)
11. Cross-Enterprise Document Reliable Interchange (XDR)
12. Cross-Enterprise Document Media Interchange (XDM)
from IHE IT Infrastructure and from IHE IT Infrastructure and Patient Care Coordination DomainsPatient Care Coordination Domains
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Document Sharing Use CasesDocument 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 IHE XDS / XDR / XDM ProfilesProfiles
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Acute Care (Inpatient)
PCPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Careor Diagnostics Services
Regional Health Information Organization (RHIO)
Document Registry
DocumentRepository
Cross-Enterprise Document SharingCross-Enterprise Document Sharing
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XDS Content ProfilesXDS 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 All from IHE Patient Care Coordination Domain, except Imaging (Radiology) and Laboratory (Laboratory Domain)Imaging (Radiology) and Laboratory (Laboratory Domain)
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Cross-Enterprise Document Sharing – Cross-Enterprise Document Sharing – Ad-hoc SharingAd-hoc Sharing
XDR – Online network point-to-point, without shared document registry
XDM – “Off-line” point-to-point Email Physical media (CD, USB flash)
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QualityQuality
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
from IHE Radiology and Quality Domainsfrom IHE Radiology and Quality Domains
Coming Soon
Coming Soon
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