1

Buzzword BingoBuzzword Bingo

September, 2005 What IHE Delivers

Retrieve ECG for DisplayRetrieve ECG for Display

ACCA IHE Workshop 2007ACCA IHE Workshop 2007Jon Elion MD, FACCJon Elion MD, FACC

Associate Professor of Medicine, Brown UniversityAssociate Professor of Medicine, Brown University

Co-Chair, IHE-Cardiology Planning CommitteeCo-Chair, IHE-Cardiology Planning Committee

3

ECG NeedsECG Needs

ECGs Accessible Everywhere!ECGs Accessible Everywhere!

Need broad distribution of ECGs using Need broad distribution of ECGs using ubiquitous technology (Web).ubiquitous technology (Web).

Allow medical applications to easily retrieve Allow medical applications to easily retrieve and display ECGs in a platform/vendor neutral and display ECGs in a platform/vendor neutral way.way.

High-quality ECG documents. Avoid artifacts on High-quality ECG documents. Avoid artifacts on zoomed ECGs and arbitrary display geometries.zoomed ECGs and arbitrary display geometries.

Vector images required (not rasterized)Vector images required (not rasterized)

Facilitate apps for serial comparison (side-by-Facilitate apps for serial comparison (side-by-side synchronized display).side synchronized display).

4

ECG for Display Profile ScopeECG for Display Profile Scope

Reused IHE-ITI RID as it existed:Reused IHE-ITI RID as it existed:Retrieve list of cardiology documents, including Retrieve list of cardiology documents, including

ECGs in ready-to-display format (HTML)ECGs in ready-to-display format (HTML)Retrieve single document, including an ECGRetrieve single document, including an ECGECGs served in displayable format (PDF, SVG)ECGs served in displayable format (PDF, SVG)Compatibility with existing RID clientsCompatibility with existing RID clients

5

ECG for Display Profile ScopeECG for Display Profile Scope

Make ECG-specific extensions to RIDMake ECG-specific extensions to RIDPlace requirements on ECG source to ensure Place requirements on ECG source to ensure

high-quality ECG documents.high-quality ECG documents.Add ECG-specific request for list of ECGs to be Add ECG-specific request for list of ECGs to be

returned as XML allowing more client flexibility.returned as XML allowing more client flexibility.Add SVG (vector graphics) as allowed ECG Add SVG (vector graphics) as allowed ECG

document format.document format.

6

PDFPDF

ECG Source required to support PDF so it ECG Source required to support PDF so it is compatible with existing RID clients.is compatible with existing RID clients.

PDF is a common document type and PDF is a common document type and most computers already have a viewer.most computers already have a viewer.

ECG Source required to use vector ECG Source required to use vector graphics for waveforms in PDF.graphics for waveforms in PDF. Gives high quality line drawings at any screen Gives high quality line drawings at any screen

resolution and zoom factor.resolution and zoom factor. Rasterized (e.g. scanned, bitmapped) ECG Rasterized (e.g. scanned, bitmapped) ECG

“images” not allowed.“images” not allowed.

7

Example ECG (PDF)Example ECG (PDF)

8

Example 1200x Zoom ECG (PDF)Example 1200x Zoom ECG (PDF)

9

ECG Profile ECG Profile ActorsActors

DisplayDisplay – A system that can request and – A system that can request and display preformatted (“presentation-ready”) display preformatted (“presentation-ready”) data using Web technologies.data using Web technologies.

Information SourceInformation Source – A system that responds – A system that responds to requests for patient-related ECG data by to requests for patient-related ECG data by encoding it in a presentation-ready format encoding it in a presentation-ready format using Web technologies.using Web technologies.

Same actors as RID ProfileSame actors as RID Profile

10

ECG ProfileECG ProfileTransaction DiagramTransaction Diagram

DisplayInformation

Source

Retrieve Specific Info for Display [ITI-11]Retrieve ECG List [CARD-5]

Retrieve ECG Document for Display [CARD-6]

11

ECG List XML ExampleECG List XML Example

12

ECG List XML ExampleECG List XML ExampleFormatted with Style sheetFormatted with Style sheet

13

Use Case D1: Simple DisplayUse Case D1: Simple Display

Display actor requests list of ECG Display actor requests list of ECG documents for a specific patient ID.documents for a specific patient ID. RID profile SUMMARY-CARDIOLOGY request RID profile SUMMARY-CARDIOLOGY request

returns list as HTML.returns list as HTML. ECG profile SUMMARY-CARDIOLOGY-ECG ECG profile SUMMARY-CARDIOLOGY-ECG

request returns list as XML with stylesheet.request returns list as XML with stylesheet.

Display actor requests a specific ECG Display actor requests a specific ECG document using a unique document ID.document using a unique document ID. The ID of the requested document may not have The ID of the requested document may not have

been obtained from the previously retrieved list.been obtained from the previously retrieved list.

14

Example List as HTMLExample List as HTML

15

Implications for RFP’sImplications for RFP’s

ECG Management Systems –ECG Management Systems –

Clinical “Portals” –Clinical “Portals” –

Remote Access –Remote Access –

Local Printing –Local Printing –

16

September, 2005 What IHE Delivers

Nuclear CardiologyNuclear Cardiology

ACCA IHE Workshop 2007ACCA IHE Workshop 2007Jon Elion MD, FACCJon Elion MD, FACC

Associate Professor of Medicine, Brown UniversityAssociate Professor of Medicine, Brown University

Co-Chair, IHE-Cardiology Planning CommitteeCo-Chair, IHE-Cardiology Planning Committee

18

Nuclear CardiologyNuclear Cardiology

Image formatsImage formats Stress and Rest raw data reviewStress and Rest raw data review Stress and Rest processed dataStress and Rest processed data Gated SPECT dataGated SPECT data Quantitative dataQuantitative data Screen captures, “snap shots” Screen captures, “snap shots”

Color mapsColor maps Gray scale is defaultGray scale is default Color overlays can be appliedColor overlays can be applied

19

Raw Data ImagesRaw Data Images

20

Perfusion DisplayPerfusion Display

Standard perfusion Standard perfusion displaydisplay

Stress/RestStress/Rest Short axisShort axis Horizontal long axisHorizontal long axis Vertical long axisVertical long axis

21

Perfusion Display - ColorPerfusion Display - Color

Standard perfusion Standard perfusion displaydisplay

Stress/RestStress/Rest Short axisShort axis Horizontal long axisHorizontal long axis Vertical long axisVertical long axis

Color map can be Color map can be overlaid on the imageoverlaid on the image

22

Gated SPECT DisplayGated SPECT Display

Apical, mid and basal Apical, mid and basal short axis slicesshort axis slices

Mid-ventricle vertical Mid-ventricle vertical and horizontal long and horizontal long axis slicesaxis slices

23

Gated SPECT DisplayGated SPECT Display

The whole The whole screen can be screen can be gated as an gated as an optionoption

24

Quantitative DisplayQuantitative Display

Output Output from 3from 3rdrd party party quantitative quantitative perfusion perfusion software software can be can be displayed displayed

25

Quantitative DisplayQuantitative Display

Output Output from 3from 3rdrd party party quantitative quantitative gated gated software software can be can be displayed displayed

26

Screen CapturesScreen Captures

Screen Screen captures captures can be can be displayed displayed to show to show important important imagesimages

27

Implications for RFP’sImplications for RFP’s

Departmental and enterprise display systems –Departmental and enterprise display systems –

Cardiology PACS – Cardiology PACS –

28

September, 2005 What IHE Delivers

Implantable Device Cardiac Implantable Device Cardiac Observations (IDCO) ProfileObservations (IDCO) Profile

ACCA IHE Workshop 2007ACCA IHE Workshop 2007Jon Elion MD, FACCJon Elion MD, FACC

Associate Professor of Medicine, Brown UniversityAssociate Professor of Medicine, Brown University

Co-Chair, IHE-Cardiology Planning CommitteeCo-Chair, IHE-Cardiology Planning Committee

30

Device InterrogationsDevice Interrogations

Implant

Clinic

Home

The act of retrieving data The act of retrieving data from implanted cardiac from implanted cardiac devices. Done at implant or devices. Done at implant or during patient follow-ups.during patient follow-ups.

Information includes Patient and Information includes Patient and Device Observations, andDevice Observations, andTherapy SettingsTherapy Settings

31

Implantable Cardiac Device Follow-up Implantable Cardiac Device Follow-up Problems and OpportunitiesProblems and Opportunities

Electrophysiologists follow patients with implantable Electrophysiologists follow patients with implantable cardiac devices from multiple vendorscardiac devices from multiple vendors

Information stored in the device is collected by an Information stored in the device is collected by an “interrogating” device (vendor proprietary)“interrogating” device (vendor proprietary) In-Clinic – ProgrammerIn-Clinic – Programmer Remote – Communicator / Data CollectorRemote – Communicator / Data Collector

Access to follow-up information often requires Access to follow-up information often requires clinicians to use multiple vendor specific systems, clinicians to use multiple vendor specific systems, complicating efficiency and quality of workflowscomplicating efficiency and quality of workflows

Aggregation of data into a clinical management system Aggregation of data into a clinical management system or EMR requires manual (paper) processesor EMR requires manual (paper) processes

32

IDCO Value PropositionIDCO Value Proposition

Enable management of follow-up Enable management of follow-up information in a central system such as an information in a central system such as an Device Clinic Management System or EMRDevice Clinic Management System or EMR

Improve efficiency and quality of related Improve efficiency and quality of related clinical processesclinical processes Single point of access for informationSingle point of access for information Automation of current manual processes for data Automation of current manual processes for data

collection, aggregation and analysiscollection, aggregation and analysis Standardization of workflow processesStandardization of workflow processes Enabling of analyticsEnabling of analytics

33

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

I ON

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

34