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1IHE ITI – Dec 2006 What IHE Delivers
Nicholas SteblayNicholas Steblay
Implantable Device Cardiac Implantable Device Cardiac Observations (IDCO) ProfileObservations (IDCO) Profile
2IHE ITI – Dec 2006IHE ITI – Dec 2006
Implantable Cardiac DevicesImplantable Cardiac Devices
Pacemakers – therapy for heart rate problems
Defibrillators – therapy for life threatening heart rhythms
Cardiac Resynchronization – therapy for congestive heart failure
3IHE ITI – Dec 2006IHE ITI – Dec 2006
Device InterrogationsDevice Interrogations
Implant
Clinic
Home
The act of retrieving data from The act of retrieving data from implanted cardiac devices. implanted cardiac devices. Done at implant or during Done at implant or during patient follow-ups.patient follow-ups.
Information includes Patient and Information includes Patient and Device Observations, andDevice Observations, andTherapy SettingsTherapy Settings
4IHE ITI – Dec 2006IHE ITI – Dec 2006
Market StatisticsMarket StatisticsSudden Cardiac Death (SCD) is the leading single cause of death in the U.S. - estimates are 19% of all deaths.- 460,000 in 2005. 1
3 to 5% of Americans have atrial fibrillation. 2
About 5 million people in the United States have heart failure, and the number is growing. Each year, another 550,000 people are diagnosed for the first time. It contributes to or causes about 300,000 deaths each year. 3
From 1990 to 2002, 2.25 million pacemakers were implanted and 417,780 ICDs were implanted in the U.S. 4
Estimated total implantable cardiac device market for 2006 is 9.4 – 9.6 billion dollars. Project growth in the market through 2009 is 4 – 8%. 5
Numerous published clinical studies (COMPANION, MADIT, MADIT II, SCDHeft) have shown the efficacy of implanted cardiac rhythm management devices.
1 SCDHeft | 2 ACC | 3 NHLBI | 4 Jama1 SCDHeft | 2 ACC | 3 NHLBI | 4 Jama | | BSC BSC
5IHE ITI – Dec 2006IHE ITI – Dec 2006
Cardiology and EP WorkloadCardiology and EP Workload
According to Heart Rhythm Society studies 1
Electrophysiology is the fastest growing of all cardiovascular disciplines.
Demands for cardiologist and electrophysiologist time is projected to increase through 2020.
To manage workload EPs and device clinics are looking for more efficient ways of following patients with implantable devices.
1 HRS http://www.hrsonline.com1 HRS http://www.hrsonline.com
6IHE ITI – Dec 2006IHE ITI – Dec 2006
Clinical Process – Device Follow-upClinical Process – Device Follow-up
3.1 Schedule Follow-ups
3.2 Exam Patient & Interrogate Device
3.3 Analyze Information
3.1.1 Schedule In Clinic Follow-ups
3.1.2 Schedule Remote Follow-ups
3.2.1 Exam Patient (Physical & Lab Tests If Needed)
3.2.2 Interrogate Device In Clinic
3.2.3 Interrogate Device Remote
3.3.1 Review Exam and Interrogation Information
Determine New or Adjusted Therapies
3.4 Adjust Therapy and Configure Device
3.3.1 Pharmalogical3.3.2 Configure and
Test Pulse Generator
3.5 Update Medical Record
3.5.1 Record and Follow-up Process and Outcomes
3.5.2 Record Pertinent Data Concerning Device and Pharmalogical
3.5.4 Sign-Off Procedure
3.5.5 Create Follow-up Summary (Referral Letter) for Following Physician
1.0 Diagnosis
2.0 Implant
3.0 Device Follow-up
4.0Patient Follow-up
5.0 Acute Events
Explants
Level 0
Level 1
Level 2
7IHE ITI – Dec 2006IHE ITI – Dec 2006
Implantable Cardiac Device Follow-up Implantable Cardiac Device Follow-up Problems and OpportunitiesProblems and Opportunities
Device follow-up load is significant. ICD patients are typically followed 4 times a year, and Pacemaker patients 2 times a year.
The follow-ups can occur in-clinic or remotely in the home healthcare environment.
EPs follow patients with implantable cardiac devices from multiple vendors.
Each “interrogating” device is vendor proprietary.
Access to follow-up information often requires cardiologists and EPs to use multiple vendor specific systems and interfaces, complicating efficiency and quality of workflows.
Aggregation of data into a central EMR or device clinic management systems requires manual and paper processes.
8IHE ITI – Dec 2006IHE ITI – Dec 2006
IDCO Value PropositionIDCO Value Proposition
Enable management of follow-up information in a central system such as an EMR, Cardiology Information System or Device Clinic Management System
Improve efficiency and quality of related clinical processes Single point of access for information Automation of current manual processes for data
collection, aggregation and analysis Standardization of workflow processes Enabling of analytics
9IHE ITI – Dec 2006IHE ITI – Dec 2006
IDCO Profile ApproachIDCO Profile Approach
Rallied domain vendors around a profile that defines a standard approach to integrating implantable cardiac device follow-up information into a receiving clinic system
Enabled the needed systems integration by profiling the use of standard, domain applicable messaging protocols, structures and data semantics
HL7 Therapeutic Device Domain – Implantable Device Cardiac messaging standards
ISO/IEEE 11073 Point of Care Medical Device Communication Standards nomenclature
Defined actors, transactions and constraints consistent with existing and evolving IHE profiles and contexts
Aligning with future EP Workflow and other related profiles
IDCO ProfileIDCO ProfileSystems ModelSystems Model
Home Healthcare Environment
Inductive or RF Interrogation
In-Clinic Healthcare Environment
Inductive or RF Interrogation
IHE
TR
AN
SA
CT
ION
IHE TRANSACTION
IHE
TR
AN
SA
CT
ION
Programmer
Device Vendor Environment
IHE TRANSACTION
SecuredNetwork
Transmissions
SecuredNetwork
Transmissions
Another ClinicSecuredNetwork
Transmissions
EHR or DeviceManagement System
Vendo
r Dat
a Tra
nsfe
r
Device Data Information Management System
InterrogationDevice
11IHE ITI – Dec 2006IHE ITI – Dec 2006
EMR Interest in IDCO ProfileEMR Interest in IDCO Profile
Do any EMR vendors have plans in place to support the IDCO profile in future product?
What will it take to get EMR vendors interested in IDCO profile participation for 2008?
What factors drive potential participation?
How did EMR vendors decide to participate in their current portfolio of supported IHE profiles?
Who should be contacted within the EMR vendor companies to discuss this further?
12IHE ITI – Dec 2006IHE ITI – Dec 2006
EMR Interest continuedEMR Interest continued
Do EMR vendors need help from IMD device vendors to understand the domain and data mapping. Would that be useful and positive factor in decision making to support the profile?
If the IDCO message would be extended with nontrivial EGM waveforms and annotations data, histograms and trends data – what would EMR vendors like to parse XML document Discrete OBX segments DICOM objects?
13IHE ITI – Dec 2006IHE ITI – Dec 2006
HL7 v2 and v3HL7 v2 and v3
Current IDCO profile requires the use of an embedded HL7 v3 message structure within a HL7 v2 ORU message.
Current profile has specified an option for a standard HL7 v2 ORU message.
Would EMR vendors be more likely to participate if the IDCO profile specified compliance using a standard v2 ORU message?
14IHE ITI – Dec 2006 What IHE Delivers
AppendixAppendix
IDCO Profile - DetailsIDCO Profile - Details
15IHE ITI – Dec 2006IHE ITI – Dec 2006
IDCO Profile Use CasesIDCO Profile Use Cases
In-Clinic Implants or Follow-ups Patients present themselves in-clinic for implantation or
follow-ups Information is collected using vendor specific “programmers” Information is sent from interrogation system to a central
Device Clinic Management System or EMR
Remote Follow-ups Patients devices are interrogated in the home health care
environment Information is collected using vendor specific communication
devices and systems Information is sent from interrogation system to a central
Device Clinic Management System or EMR
16IHE ITI – Dec 2006IHE ITI – Dec 2006
IDCO Actors and TransactionIDCO Actors and Transaction
Observation Processor
Observation Repository
Send Observation[CARD - 12]
Send Observation[CARD - 12]
PIX Consumer
ObservationCreator
PIX Consumer
Patient Demographics
Consumer
17IHE ITI – Dec 2006IHE ITI – Dec 2006
IDCO ActorsIDCO Actors
Observation Processor
Observation Repository
Send Observation[CARD - 12]
Send Observation[CARD - 12]
PIX Consumer
ObservationCreator
PIX Consumer
Patient Demographics
Consumer
Observation Creator - A system that creates and transmits diagnostic or therapeutic observational data.
Observation Processor and Repository – Systems that receive clinical observations and further process them or store them for retrieval and display.
Grouped with PIX and PAM actors for patient identification and demographics management (not required first year).
18IHE ITI – Dec 2006IHE ITI – Dec 2006
IDCO ActorsIDCO Actors
Alternative Actor configuration
HL7 Router - A system that receives HL7 messages, routes them to one or more configured actors, and handles transport level acknowledgements.
Router will manage patient identification cross-referencing
Observation Processor
Observation Repository
Send Observation[CARD - 12]
ObservationCreator
Patient Demographics
Consumer
HL7 RouterSend Observation
[CARD - 12]
Send Observation[CARD - 12]
PIX Consumer
19IHE ITI – Dec 2006IHE ITI – Dec 2006
Potential ParticipantsPotential Participants
Observation Creator Implantable Cardiac Device Vendors
Observation Processor and Repository EMR or Device Clinic Management System
Vendors
HL7 Router Integration Engine Vendors
Others (?)
20IHE ITI – Dec 2006IHE ITI – Dec 2006
IDCO TransactionIDCO Transaction
Observation Processor
Observation Repository
Send Observation[CARD - 12]
Send Observation[CARD - 12]
PIX Consumer
ObservationCreator
PIX Consumer
Patient Demographics
Consumer
CARD-12
Unsolicited HL7 v2.5 ORU message OBX contains XML payload based on HL7 v3 IDC message XML payload coded using ISO/IEEE 11073.1.1.3 IDC nomenclature
containing Device Observations, Patient Observations, Device Therapy Settings
Options for standard v2.5 OBX and embedded PDF report Audit Trail and Node Authentication (ATNA) profile recommended
for remote follow-ups across non-trusted networks
21IHE ITI – Dec 2006IHE ITI – Dec 2006
Embedded XML Data Payload in OBXEmbedded XML Data Payload in OBXBased on v3 IDC RMIMBased on v3 IDC RMIM
Implantable Cardiac Device Summary(POTD_RM000001)
Description: Implantable Cardiac Device Summary report.This report contains a subset of current programmed settingsand device observations
ObservationclassCode*: <= OBSmoodCode*: <= EVNid*: SET<II> [1..*]code*: CD CWE [1..1] <=DeviceInterrogation (The capturing or reading out of datastored in the medical device)statusCode: CS CNE [0..1] <=ActStatuseffectiveTime*: TS [1..1]
CMET: (PAT) R_Patient
[identified/confirmable](COCT_MT050002)
0..1 roleName 1..1 patient *
typeCode*: <= RCTcontextControlCode: CS CNE [0..1] <= "OP"
recordTarget
DeviceTherapySettingclassCode*: <= OBSmoodCode*: <= EVNcode*: CE CWE [1..1] <= ImplantedCardiacDeviceControlVariable (Externally defined subset of IEEE 1073 vocabulary)text: ED [0..1]value: ANY [0..1]
1..* assignedEntity
typeCode*: <= AUTtime*: TS [1..1]signatureCode: CE CNE [0..1] <= XsignatureText: ED [0..1]
author
0..* assignedEntity
typeCode*: <= PRFperformer
CMET: (ASSIGNED) R_AssignedEntity
[identified/confirmable](COCT_MT090002)
0..1 roleName
0..1 externalCardiacInterrogationDevice
typeCode*: <= RDVreusableDevice
0..1 assignedInterrogationDevice
ExternalCardiacInterrogationDeviceclassCode*: <= ASSIGNEDid: II [0..1]code: CE CWE [0..1] <= DedicatedServiceDeliveryLocationRoleType
InterrogationDeviceclassCode*: <= DEVdeterminerCode*: <= INSTANCEid: II [0..1] (e.g. Serial Number)desc: ED [0..1]manufacturerModelName: SC CWE [0..1] <= ManufacturerModelNamesoftwareName: SC CWE [0..1] <= SoftwareName
OrganizerclassCode*: <= ORGANIZERmoodCode*: <= EVN
CMET: (ASSIGNED) R_AssignedDevice
[universal](COCT_MT090300)
0..1 roleName
Note:Participant who assists inperforming the interrogationof the implanted device
Note:Implantable CardiacDevice or identified lead
1..1 assignedDevice *
typeCode*: <= SBJcontextControlCode: CS CNE [0..1] <= "OP"
subject
PatientObservationclassCode*: <= OBSmoodCode*: <= EVNid: II [0..1]code*: CD CWE [1..1] <= CardiacDevicePatientObservationTypetext: ED [0..1]effectiveTime: IVL<TS> [0..1]value: ANY [0..1]interpretationCode: CE CNE [0..1] <= ObservationInterpretationNormality
1..1 patient
typeCode*: <= SBJcontextControlCode: CS CNE [0..1] <= OP "ContextControlOverriding"
subject
MedicalDeviceActclassCode*: <= ACTmoodCode*: <= EVNid: SET<II> [0..*]code*: CD CWE [1..1] <= MedicalDeviceActtext: ED [0..1]effectiveTime: TS [0..1]
0..* medicalDeviceAct
typeCode*: <= SUBJcontextControlCode: CS CNE [1..1] <= "ON"contextConductionInd: BL [0..1] "true"
subject
0..* deviceTherapySetting
typeCode*: <= CTRLVcontextControlCode: CS CNE [0..1] <= "AN"contextConductionInd: BL [0..1] "false"
controlVariable
1..1 assignedDevice
typeCode*: <= PPRFcontextControlCode: CS CNE [0..1] <= "OP"
primaryPerformer
0..* organizer
typeCode*: <= COMPcontextControlCode: CS CNE [0..1] <= "AN"contextConductionInd: BL [0..1] "true"
component1
DeviceTherapyclassCode*: <= PROCmoodCode*: <= EVNid: II [0..1]code*: CE CWE [1..1] <= ImplantedCardiacDeviceTherapy (IEEE 1073)text: ED [0..1]activityTime: TS [0..1]
DeviceObservationclassCode*: <= OBSmoodCode*: <= EVNcode*: CD CWE [1..1] <= CardiacDeviceSelfObservationType (IEEE1073)text: ED [0..1]effectiveTime: IVL<TS> [0..1]value: ANY [0..1]interpretationCode: CE CNE [0..1] <= ObservationInterpretationNormalitymethodCode: CE CWE [0..1] <= ObservationMethod (IEEE 1073)
0..* deviceObservation
typeCode*: <= COMPcontextControlCode: CS CNE [0..1] <= "ON"contextConductionInd: BL [0..1] "true"
component
0..* patientObservation
typeCode*: <= COMPcontextControlCode: CS CNE [0..1] <= "AN"contextConductionInd: BL [0..1] "true"
component2
0..* deviceTherapy
typeCode*: <= COMPcontextControlCode: CS CNE [0..1] <= "AN"contextConductionInd: BL [0..1] "true"
component3
Note:E.g.: Brady SettingsPacing Output SettingsAtrial Tachy SettingsVentricular Tachy Settings
OrganizationclassCode*: <= ORGdeterminerCode*: <= INSTANCEid: SET<II> [0..*]name: BAG<EN> [0..*]
Note:This ACT changes thesubject from patient tothe device.
0..1 encounter *
typeCode*: <= COMPcontextControlCode: CS CNE [1..1] <= "OP"contextConductionInd: BL [1..1] "false"
componentOf CMET: (ENC) A_Encounter
[universal](COCT_MT010000)
component
0..* deviceObservation
typeCode*: <= COMPcontextControlCode: CS CNE [1..1] <= ContextControlPropagating "AP"contextConductionInd: BL [0..1]sequenceNumber: INT [0..1]priorityNumber: INT [0..1]
component
0..* patientObservation
typeCode*: <= COMPcontextControlCode: CS CNE [0..1] <= ContextControlPropagating "AP"contextConductionInd: BL [0..1]sequenceNumber: INT [0..1]priorityNumber: INT [0..1]
component
0..* deviceTherapySetting
typeCode*: <= COMPcontextControlCode: CS CNE [0..1] <= ContextControlPropagating "AP"contextConductionInd: BL [0..1]sequenceNumber: INT [0..1]priorityNumber: INT [0..1]
Option for Standard OBX SegmentOption for Standard OBX SegmentELEMENT NAME SEQ COMP DT LEN USAGE CARD TBL# ITEM # Fixed Ex. Values
Set ID - OBX 1 SI 4 R [1..1] 00569 1
Value Type 2 ID 2 R [1..1] 0125 00570 DTM
Observation Identifier 3 CE 250 R [1..1] 00571
Identifier 1 ST 80 R [1..1] MDC_IDC_DEVICE_IMPLANT_DATE
Text 2 ST 256 R [1..1] The implant date of the device
Name of Coding System 3 ST 20 R [1..1] IEEE P10731.1.3
Observation Sub-ID 4 ST 20 C [1..1] 00572 3.1
Observation Value 5 varies * RE [0..1] 00573 20060317
Units 6 CE 250 RE [0..1]
Observation Result Status 11 ID 1 R [1..1] 0085 00579 Y F
Date/Time of the Observation 14 TS 26 RE [0..1] 00582
20060317170000+0006
Observation Method 17 CE 250 00936
Identifier 1 ST 80 R [1..1] MDC_IDC_SESSION_TYPE
Text 2 ST 256 R [1..1] In Clinic
Name of Coding System 3 ST 20 R [1..1] IEEE P10731.1.3
Equipment Instance Identifier 18 EI 256 O [0..*] 01479 Programmer XXXX
23IHE ITI – Dec 2006IHE ITI – Dec 2006
Observations Coded UsingObservations Coded UsingISO/IEEE 11073 IDC NomenclatureISO/IEEE 11073 IDC Nomenclature
IEEE 1073.1.1.3 IDC terms - nomenclatureDevice ObservationsPatient ObservationsDevice Therapy SettingsDevice TherapiesData TypesUnitsEnumerated Value TablesDiscriminators
Device Observations - [top]
Automatic Manual
1 Device Type MDC_IDC_DEVICE_TYPE The type of device
2 Device Manufacturer MDC_IDC_DEVICE_MANUFACTURER MDC_IDC_DEVICE_TYPE The manufacturer of the device
3 Device Name MDC_IDC_DEVICE_NAME MDC_IDC_DEVICE_TYPE The marketing name given to a device by the manufacturer
4 Device Model MDC_IDC_DEVICE_MODEL MDC_IDC_DEVICE_TYPE The model of a device
6 Device Serial Number MDC_IDC_DEVICE_SERIAL_NUMBER MDC_IDC_DEVICE_TYPE The serial number for a device
7 Device Implant Date MDC_IDC_DEVICE_IMPLANT_DATE MDC_IDC_DEVICE_TYPE The implant date of the device
8 Device Explant Date MDC_IDC_DEVICE_EXPLANT_DATE MDC_IDC_DEVICE_TYPE The explant date of the device
9 Device Abandon Date MDC_IDC_DEVICE_ABANDON_DATE MDC_IDC_DEVICE_TYPE The date the device was abandoned (still implanted but not functioning)
10 System Status MDC_IDC_SYSTEM_STATUS Overall status of the system
17 Lead State MDC_IDC_LEAD_STATE The state of lead
18 Lead Polarity Type MDC_IDC_LEAD_POLARITY_TYPE The type of lead polarity
20 Lead Heart Anatomy Location Modifier MDC_IDC_LEAD_ANOTOMICAL_LOCATION_MODIFIER
MDC_IDC_LEAD_ANOTOMICAL_LOCATION The site within the heart anatomy where the lead is fixated
26 Lead Pace Threshold at Implant Amplitude MDC_IDC_LEAD_PACE_THRESHOLD_IMPLANT_AMPLITUDE
MDC_IDC_LEAD_PACE_THRESHOLD_IMPLANT 1 The minimum Chamber Pulse Amplitude needed for capture
27 Lead Pace Threshold at Implant Pulse Width MDC_IDC_LEAD_PACE_THRESHOLD_IMPLANT_PULSE_WIDTH
MDC_IDC_LEAD_PACE_THRESHOLD_IMPLANT 2 The minimum Pulse Width needed for capture
29 Lead DFT at Implant MDC_IDC_LEAD_DFT_IMPLANT For each high voltage lead, the measured defibrillation threshold (DFT) at implant.
31 Date/Time of Communication Session MDC_IDC_SESSION_DATE_TIME Date of the current in-clinic or remote interrogation.
32 Previous Session Date MDC_IDC_PREVIOUS_SESSION_DATE_TIME Date of most recent in-clinic or remote interrogation.
33 Session Type MDC_IDC_SESSION_TYPE The type of device interaction that generated the current data set. If the specific cause of a remote data transmission is unknown, use the "Remote" value. If the specific cause is known, use the values of Remote-Scheduled, Remote-Patient Initiatied or Remote-Device Initiated.
# Display Name Reference ID Parent ID SeqNr Discriminator Description
19 Lead Heart Anatomy Location MDC_IDC_LEAD_ANOTOMICAL_LOCATION MDC_IDC_discriminator_LeadLocationType The heart anatomy where the lead is located
21 Lead Intrinsic Amplitude at Implant MDC_IDC_LEAD_INTRINSIC_AMPLITUDE_IMPLANT MDC_IDC_discriminator_HowMeasured Intrinsic Amplitude (P-Wave) measured during an Intrinsic Amplitude Test at implant
22 Lead Intrinsic Amplitude Configuration at Implant MDC_IDC_LEAD_INTRINSIC_AMPLITUDE_CONFIGURATION_IMPLANT
MDC_IDC_discriminator_ElectrodeType For each low voltage lead, the sensing configuration used during implant to measure the intrinsic amplitude
23 Lead Pace Impedance at Implant MDC_IDC_LEAD_PACE_IMPEDANCE_IMPLANT MDC_IDC_discriminator_HowMeasured Lead Impedance measured during a Lead Impedance Test at implant
24 Lead Pace Impedance Configuration at Implant MDC_IDC_LEAD_PACE_IMPEDANCE_CONFIGURATION_IMPLANT
MDC_IDC_discriminator_ElectrodeType For each low voltage lead, the pacing configuration used during implant to measure the lead impedance
25 Lead Pace Threshold at Implant Amplitude @ Pulse Width
MDC_IDC_LEAD_PACE_THRESHOLD_IMPLANT MDC_IDC_discriminator_HowMeasured The minimum electrical stimulation (pacemaker output pulse) required to consistently initiate chamber depolarization and cardiac contraction, as determined by a clinician-interpreted threshold test at implant.
28 Lead Pace Threshold Configuration at Implant MDC_IDC_LEAD_PACE_THRESHOLD_CONFIGURATION_IMPLANT
MDC_IDC_discriminator_ElectrodeType For each low voltage lead, the pacing configuration used during implant to measure the capture threshold
30 Lead DFT Configuration at Implant MDC_IDC_LEAD_DFT_CONFIGURATION_IMPLANT MDC_IDC_discriminator_ElectrodeType For each high voltage lead, the shock configuration used during defibrillation threshold (DFT) measurement at implant.
24IHE ITI – Dec 2006IHE ITI – Dec 2006
Example Transaction FlowExample Transaction FlowDevice Interrogator Observation Creator Observation Processor Observation Repository
Query Device (1)
Send Interrogation
Send Interrogation (2)
Validate and Review (3)
Translate Information (4)
Send Observation [CARD-12] (5)
Process Observation (7)
Send Observation [CARD-12] (8)
Store Observation (10)
PIX Manager
PIX Query [ITI-9] (6)
PIX Query [ITI-9] (9)
25IHE ITI – Dec 2006IHE ITI – Dec 2006
Potential Extended Actor GroupingsPotential Extended Actor Groupings
ObservationRepository
Information Source
Display
Retrieve Document for Display [ITI - 12]
Retrieve Specific Info for Display [ITI - 11]
ObservationProcessor
ReportCreator
Report Manager
Encapsulated Report Submission [CARD - 7]
ObservationProcessor
EvidenceCreator
Image Manager
Storage Committment [CARD - 3]
Modality Images/Evidence Stored [CARD - 2]
Store Evidence Documents [RAD - 43]
Storage Committment [CARD - 7]
ObservationProcessor
Document Source
Document Repository
Provide and Register Document Set [ITI - 15]
Basic IDCO Report Display using Retrieve Information for Display Profile (RID)Basic IDCO Report Display using Retrieve Information for Display Profile (RID)
IDCO Data Incorporation into a Report using Displayable Reports Profile (DRPT)IDCO Data Incorporation into a Report using Displayable Reports Profile (DRPT)
IDCO Discrete Data Storage using Evidence Documents Profile (ED)IDCO Discrete Data Storage using Evidence Documents Profile (ED)
IDCO Submission to an EHR using Cross Domain Document Sharing Profile (XDS)IDCO Submission to an EHR using Cross Domain Document Sharing Profile (XDS)
26IHE ITI – Dec 2006IHE ITI – Dec 2006