September, 2005 Cardio - June 2007

Displayable Reports Displayable Reports (DRPT)(DRPT)

IHE Workshop 2007IHE Workshop 2007

Harry Solomon, GE HealthcareHarry Solomon, GE Healthcare

IHE-Cardiology Technical & Planning CommitteesIHE-Cardiology Technical & Planning Committees

2Cardio - June 2007

Typical Cardiology ReportsTypical Cardiology Reports

3Cardio - June 2007

Typical Report Supported by EMRTypical Report Supported by EMRHistory:35 yo white female with a history of inappropriate sinus tachycardia presents for sinus node modification. Mrs. Edmonds has had a history of a rapid heart rate for the past three to four years which is usally initiated by activity/exercise. These episodes of rapid heart rate have occassionally been associated with presyncope/dizzy spells. The patient has not suffered any injuries from these episodes. She has previously been evaluated by Dr. Schutzman with the Care Group - who has attempted control of her heart rate with multiple medical regiments including beta-blockers and calcium channel blockers. The patient could not tolerate either of the classes of medications. The patient had a normal ECHO and an unremarkable Holter Monitor. She subsequently had a an Event Monitor which showed several episodes of sinus tachycardia up to rate of 150 bpm. She then underwent a Tilt Table Test on October 3, 2006 to differentiate between inappropriate sinus tachycardia and postural tachycardia syndrome. Her Tilt was postive for NCS without any evidence of POTS. Past medical history significant for gallbladder and thyroid surgery - not on synthroid currently. Informed consent detailing risks and benefits of the procedure was obtained from the patient and witnessed on the day of the procedure.Physical:Normal cardiovascular exam, without evidence of congestive heart failure. Normal jugular venous pressure and carotids, regular rhythm with no murmur, no gallop. Normal symmetrical pulses, no edema. Lab Data:No significant abnormalities.Procedure:After prepping and draping and effecting local anesthesia with lidocaine, catheters were inserted as follows:A 5F quadripolar catheter was advanced from the left femoral vein (TriPort) to the high right atrium.A 6F deflectable quadripolar catheter was advance from the left femoral vein (TriPort) to the A-V junction (His bundle).A 5F quadripolar catheter was advanced from the left femoral vein (TriPort) to the right ventricular apex.A 7F deflectable decapolar catheter was placed from the right femoral vein to the coronary sinus.A 7F EPT ablation catheter was advanced from the right femoral vein for mapping and ablation.A 4F sheath was placed into the left femoral artery for blood pressure monitoring.Twelve surface ECG leads and intracardiac electrograms from the above locations were recorded during the study.Medications administered:propofol, total 1341 mg IVfentanyl, total 100 mcg IVpromethazine, total 25 mg IVisoproterenol, up to 2.5 mcg/min infusionAt the end of the study, the catheters were removed and hemostasis achieved using direct pressure.Results:The spontaneous rhythm was sinus with ventricular cycle length 968 ms. The P wave duration was 79 ms (nl <100), with no atrial abnormality; the PR interval was 151 ms (nl 120-200); the QRS duration was 71 ms (nl, 80-120), showing no conduction disturbance with an axis of 45° and QT interval 368 ms (nl, 390-440); the corrected QT [Bazett’s formula] was 374 ms. There was no evidence of a previous MI or delta waves.

4Cardio - June 2007

How do we cross the chasm between the How do we cross the chasm between the graphically rich cardiology reports and graphically rich cardiology reports and

the limited capabilities of EMR systems?the limited capabilities of EMR systems?

How do we bring electronic reports to How do we bring electronic reports to environments that do not yet support environments that do not yet support

them at all?them at all?

5Cardio - June 2007

DRPT PremisesDRPT Premises

PDF is a prevalent output format for PDF is a prevalent output format for reporting applicationsreporting applications

Design must support independent Design must support independent reporting appsreporting apps

We can control (more or less) what We can control (more or less) what happens in the departmenthappens in the department

Provide a variety of mechanisms for Provide a variety of mechanisms for integration to systems outside the integration to systems outside the department (since we can’t control them)department (since we can’t control them)

6Cardio - June 2007

Displayable Reports ProfileDisplayable Reports ProfileTransaction DiagramTransaction Diagram

Encapsulated Report

Report Repository

ReportManager

Enterprise Report

Repository

Encapsulated Report QueryEncapsulated Report Retrieve

Imaging Workstation

Report Reader

Report Creator

Encapsulated Report

Storage Commitment

Retrieve Document for Display

InformationSource

Report Reference

Web DisplayPatient

Demographics Source

Patient Identity Feed Patient Demographics

Consumer

Dept Scheduler /Order Filler

Encapsulated Report or

Report Completion Notify

7Cardio - June 2007

Displayable Reports ProfileDisplayable Reports ProfileActorsActors

Report CreatorReport Creator – A system that generates and transmits – A system that generates and transmits clinical reports clinical reports (the reporting app)(the reporting app). .

Report ManagerReport Manager – A system that manages the status of – A system that manages the status of reporting, and distributes reports to report repositories reporting, and distributes reports to report repositories (the (the department info system)department info system). .

Report RepositoryReport Repository – A departmental system that receives – A departmental system that receives reports and stores them for long-term access reports and stores them for long-term access (may leverage the (may leverage the PACSPACS..

Enterprise Report RepositoryEnterprise Report Repository – A system that receives – A system that receives reports and/or references (pointers) to reports, and stores them reports and/or references (pointers) to reports, and stores them for access throughout the healthcare enterprise for access throughout the healthcare enterprise (the EMR)(the EMR). .

Report ReaderReport Reader – A system that can query/retrieve and view – A system that can query/retrieve and view reports encoded as DICOM objects reports encoded as DICOM objects (an imaging workstation)(an imaging workstation)..

8Cardio - June 2007

Displayable Reports ProfileDisplayable Reports ProfileStandards UsedStandards Used

Encapsulated Report

Report Repository

ReportManager

Enterprise Report

Repository

Encapsulated Report QueryEncapsulated Report Retrieve

Report Creator

Encapsulated Report

Storage Commitment

Retrieve Document for Display

InformationSource

Report Reference

Web DisplayPatient

Demographics Source

Patient Identity Feed Patient Demographics

Consumer

Dept Scheduler /Order Filler

Encapsulated Report or

Report Completion Notif

MSH|^~\$|… PID|1|0123456‑1||R… OBR|1|X89‑1501^…OBX|1|ED|11528-7^LN…

MSH|^~\$|… PID|1|0123456‑1||R… OBR|1|X89‑1501^…OBX|1|ED|11528-7^LN…

HL7

MSH|^~\$|… PID|1|0123456‑1||R… OBR|1|X89‑1501^…OBX|1|ED|11528-7^LN…

MSH|^~\$|… PID|1|0123456‑1||R… OBR|1|X89‑1501^…OBX|1|RP|11528-7^LN…

http://serv.hosp.org/app?requestType=DOCUMENT&documentUID=”1.2.3”&preferredContentType=”application/pdf”

HL7

(0008,0005) IR_100(0008,0012) 20061113(0008,0013) 1109(0008,0016) 1.2.8401008.…

DICOM HTTP

Imaging Workstation

Report Reader

9Cardio - June 2007

Implications for RFPsImplications for RFPs

Reporting apps – Reporting apps –

Department info systems –Department info systems –

Cardiology PACS –Cardiology PACS –

Imaging workstations –Imaging workstations –

EMR and clinical workstations – EMR and clinical workstations –

10Cardio - June 2007