Rev 2.1 1

IHE Cardiology

5-year RoadmapRoadmap subcommittee:Bill Weintraub wweintr@emory.eduAndrew Keller amk5@columbia.eduKenneth Queensberry kqueensb@acc.orgHarry Solomon harry.solomon@med.ge.comBryan Schnepf bryan.schnepf@philips.comJon Elion jle@heartlab.comJoe Biegel joe.biegel@agfa.comDavid Croke david_croke@idx.comRuediger Simon simon@cardio.uni-kiel.deAshwin Patel apatel@acc.org

Rev 2.1 2

Principles• Cardiology profiles addressing clinical user needs

to be developed by IHE Cardiology committees– Prioritization by Planning Committee– Refinement and technical definition by Technical

Committee• IT Infrastructure profiles addressing general

healthcare needs available to be demo’ed in the cardiology domain ~1-2 years after adoption by IT Infrastructure committees– Vetting by Planning Committee for applicability to

critical cardiology need– Recommendations to IT Infrastructure for new profiles

in that domain

Rev 2.1 3

Timeline20 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

June -9 Technical Committee publishes Technical Framework detailed profiles for comment; Planning Committee publishes demo plan

July -8 Technical Committee publishes Technical Framework detailed profiles for Trial Implementation

January -2 Connectathon tests implementation of Profiles

March ! ACC Demonstration of Profiles

Rev 2.1 4

2/3/5 year plan

• Year 2 should be highest clinical priority– Including items deferred from current year

• Year 3 should be high priority items that will require >1 year vendor development– Need complete definitions of concepts, so that

vendors can start planning

• Years 4-5 are conceptual

Rev 2.1 5

Year 1(2005 demo)

Year 2(2006 demo)

Year 3(2007 demo)

Year 4(2008 demo)

Year 5(2009 demo)

Cath

Echo

ECG

Nuclear

EP

Cardiology T

echnical Fram

ework

IT Infrastructure T

F

Infra

Security

Admin

EMR

Quality

MR/CT

Multi-modality workflow & imaging

Procedure log &reporting

Hemo waveform & measures, QCA/QVA

Supplies, inventory,& charge capture

Workflow & imaging,stress protocols

Reporting workflow

Retrieve ECGfor display

ECG/Stress/Holterorders

Workflow & imaging,stress protocols

Reporting workflow

Multi-modality labworkflow & reporting

Home healthmonitoring

Timesynchronization

Audit trail Enterprise userauthentication

Retrieve infofor display

Cross-enterprisedocument sharing

Retrieve guidelinesfor display

Retrieve structuredguidelines

Registry datasubmission

Cross-enterprisereferrals/orders

Workflow, reporting,& measurements

Risk factors forclinical decision supt

Patient care plan

Patient location& transport

Device auto-configuration

Precision timesynchronization

Implantable device parameters & events

Pediatric

Personnel white pages

Measurementinteroperability

ECG waveform interoperability

Rev 2.1 6

Cardiology Year 1 Profiles (2005 demo)

• Cath lab workflow - including coordination of the multi-modality environment, access to patient demographics, and storage and display of images

• Echo workflow - including scheduling and management of digital echo exams, including multi-stage stress exams, and storage and display of images

• Retrieve ECGs for display - access to ECGs for display using web technology

Rev 2.1 7

IT Infrastructure Profiles for Cardiology Year 1 (2005 demo)

• Consistent time - specifies time synchronization to better than 1 second accuracy using NTP; supports cath lab workflow (ITI 2004)

• Retrieve info for display - access to a variety of patient info for display using web technology; supports cross-department access to data (ITI 2004)

Rev 2.1 8

Cardiology Year 2 Profiles (2006 demo)

• Cath lab reporting workflow– distributed creation of procedure log, reporting workflow, outbound reports

• Echo reporting workflow - reporting workflow, including sonographer preliminary reports and cardiologist over-reading

• Nuclear medicine - image content profile for NM, including cardiac (from IHE Radiology 2004)

• Registry data submission – standard formats for ACC NCDR 3 / ESC CARD

Rev 2.1 9

IT Infrastructure Profiles for Cardiology Year 2 (2006 demo)

• Audit trail - centralized logging of system security events and user access of patient data (ITI 2004)

• Cross-enterprise document sharing – repositories for clinical documents accessible across institutional boundaries, including ECGs and reports (ITI 2005)

• Personnel white pages – centralized directory of healthcare staff information (ITI 2005)

Rev 2.1 10

Cardiology Year 3 Profiles (2007 demo)

• Cath lab content – creation and display of interoperable QCA/QVA, hemo waveforms, and hemo measurements

• Echo measurements - creation and display of interoperable echo measurements

• Nuclear medicine reporting workflow - measurements and reporting

• EP lab workflow – adapted cath lab workflow, storage and display of images, waveforms and measurements; reporting

• MR/CT angiography – adapted radiology workflow, storage and display of images and measurements; reporting

• Retrieve guidelines for display – keyword-based retrieval of guidelines

Rev 2.1 11

IT Infrastructure Profiles for Cardiology Year 3 (2007 demo)

• Cross-enterprise referrals and orders – Referrals and Orders from physician office to specialty diagnostic facility, with clinical attachments (recommend to ITI)

• Enterprise user authentication – centralized user account management and authentication (ITI 2004)

Rev 2.1 12

Evaluation

• Do these represent the highest clinical priorities?

• Do we have the proper services to support clinical information needs for addressing patients presenting with caridac disease/syndromes?– ACS, MI, HF, Afib, hypertension, etc.

Rev 2.1 13

Potential future IHE/Cardiology profiles(December 2003 brainstorming)

• Cath Workflow Procedure Logging and Reporting

• Cath Hemodynamics Report and Waveform Display

• Cath Lab Precision Mutli-Modality Synchronization

• Echo Workflow Reporting• Nuclear Cardiology workflow• Electrophysiology workflow, waveforms,

measurements, reports, device parameters• Non-invasive Angiography workflow

(MRA/CTA)• Evidence Reporting and Display

(QCA/QVA, MRA/CTA) • Workflow step prerequisite checking (labs,

drugs, insurance)• Cath lab inventory management• Charge capture• Retrieve Guidelines for Display• Retrieve Structured/Actionable Guidelines• Outpatient imaging workflow

• Patient care plan• Outbound Reports (to longitudinal record)

(IHE IT Infrastructure)• Cross-Enterprise Patient ID Cross-

Reference (Cardiology practice / multiple hospitals)

• Cross-Enterprise Ordering and Referral• Cross-Enterprise Clinical Document

Sharing (IHE IT Infrastructure)• Registry Data submission (ACC NCDR 3 /

ESC CARD)• Scheduling (room/equipment;

physician/staff)• Summary report – discharge• Cardiac Risk Factors extract from

Longitudinal Record• Critical value alarms• Patient location tracking / transport

management• … and all IHE IT Infrastructure profiles!