IHE s Contribution to Telecardiology. Nick Gawrit, heartbase Antje Schroeder, Siemens Healthcare Paul Dow, ACC Charles Parisot, GE

Transcription

1 IHE s Contribution to Telecardiology Nick Gawrit, heartbase Antje Schroeder, Siemens Healthcare Paul Dow, ACC Charles Parisot, GE

2 Interoperability: From a problem to a solution Base Standards IETF Profile Development & testing ehealth Projects IHTSDO Project Specific Extensions Profiling Organizations are well established 11

3 IHE: Connecting Standards to Care Healthcare professionals work with industry Coordinate implementation of standards to meet clinical and administrative needs Clinicians and HIT professionals identify the key interoperability problems they face Providers and industry work together to develop and make available standards-based and tested specifications Implementers follow common guidelines in purchasing and integrating effective systems IHE: A forum for agreeing on how to implement standards and processes for making it happen 2

4 Standards Adoption Process IHE International Develop technical specifications Identify available standards (e.g. HL7, DICOM, IETF, OASIS) Testing at Connectathons IHE Demonstrations IHE Europe & IHE National Products with IHE Profiles Document Use Case Requirements Timely access to information Easy to integrate products 3

5 Stakeholder Benefits Healthcare providers and health authorities Improved workflows Information whenever and wherever needed Reduced implementation costs Vendors Align product interoperability with industry consensus Decreased cost and complexity of interface installation and management Focus competition on functionality/service not information transport SDOs Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoption 4

6 Cardiology Domain Key Trends Care Coordination o Consistent use of HL7 Clinical Document Architecture across all clinical domains o Common standards based nomenclature Expanded use of Electronic Health Record Systems in both the inpatient and ambulatory environments o Need to access, exchange, and incorporate cardiology images and imaging information Registries, quality improvement programs, and research o Profiling of standard data elements for both clinical and secondary use

7 Cardiology Domain Recent Focus Discrete data capture and codification profiles leveraging clinical guidelines and CDA: 2013/14 Electrophysiology Report Content Implant/Explant (EPRC-IE) 2013/14 Registry Content Submission - CathPCI (RCS-C) 2012 Cath Report Content (CRC) updated (Rev 1.3) in Cardiac Imaging Report Content (CIRC) Cardiology workflow profiles with best practice in general imaging: Cath/Echo/Nuclear-Medicine/ECG specializations to existing imaging workflow and evidence gathering profiles. Displayable Reports (DRPT) Image Enabled Office (IEO)

8 Hospital A Using IHE Cardiology profiles for the in-patient environment to acquire and store images Using XDS-I infrastructure for sharing images with Reporting Facility Using XDS infrastructure to retrieve final report created by Reporting Facility RIS Telecardiology Using Existing CARD and Other Profiles Hospital A Shared IT Infrastructure PACS Images, Reports Query / retrieve Images Reporting Workstation Store Report Reporting Facility Scheduling / Worklist Modality Store Images PACS Images, Reports XDS-I Reporting Facility Using XDS-I infrastructure to retrieve images Using IHE Cardiology for Report Creation (CIRC, CRC, EPRC-IE) Using DRPT to manage reports on site Using XDS infrastructure for sharing report with Hospital A

9 Telecardiology using the Imaging Information Sharing profile Hospital A Reading Facility 1 Hospital A and Hospital B Submit a remote reading request using the Remote Reading for Radiology Profile Distribute image data (e.g using XDS-I) Retrieve reports (e.g using XDS-I) Hospital B Shared Remote Reading Infrastructure Reading Facility 2 Reading Facility 3 Remote Reading Infrastructure Receives remote read requests from multiple sites (Remote Read for Radiology) and assigns them to appropriate Reading Facility Provides Image Data necessary for Remote read (e.g. through XDS-I) Receives reports and makes them available Reading Facilities Receive remote read requests using Remote Read for Radiology and underlying image data (e.g through XDS-I) Perform remote read provide report (e.g through XDS-I)

10 IHE Europe Case Study Cardiology Network Friesland Cardiologist from the Friesland region refer patient for Percutaneous Coronary Intervention or open heart surgery to the Medical Center of Leeuwarden Participating providers are connected using the following IHE profiles for communication of relevant information XDS-I for sharing patient records and images PIX/PDQ for identifying patients across institution, which did not use the Dutch Citizen Service Number (BSN) XUA for Cross Enterprise User Assertion This resulted in a speed up in the referral process, improved diagnostics and an average reduction in length-of-stay of about 1 to 2 days More information can be found at Success-Story-FRIESLAND_Final.pdf

11 Hospital Cardiology Workflow Workflow in the in-patient environment Profiles aligned with IHE Radiology workflow Scheduled and unscheduled cardiac imaging exams, including multimodality Management of data, demographic and procedure identifiers Cardiovascular Information Systems, PACS, imaging and waveform modalities: X-ray and hemo (cath lab), Echo, Nuclear imaging analysis and reporting workstations Consistent, robust workflow minimizes manual procedure management tasks Cardiac Catheterization Workflow Echocardiography Workflow Stress (ECG + imaging) Workflow Evidence Documents (cardiology specialization) Displayable Reports Workflow Intravascular Imaging Option for Cardiac Catheterization Workflow

12 Outpatient Cardiology Scenarios Image-Enabled Office (IEO) Bi-directional integration of medical imaging equipment and office EHR Not limited to cardiology applies to orthopedics, women s health, gastroenterology, even primary care Ambulatory office EHRs, mini- PACS (or cloud PACS), imaging modalities

13 Displayable Report Workflow (DRPT) Cardiology reports typically include lots of graphics Addresses workflow between a reporting application and the departmental info system and/or the EMR Possible report archiving to PACS Report format may be PDF or HL7 CDA Applicable to other clinical domains! Cross-Enterprise Profiles Reporting Report Content: CDA structured report (XML) to facilitate consistency, accuracy, and semantic interoperability of imaging findings: Cardiac Imaging Report Content (CIRC) Based on ACC/AHA 2008 Key Data Elements for Cardiac Imaging Cath Report Content (CRC) Based on ACC/AHA 2008 Cardiac Catheterization Report Prototype and ACC-NCDR CathPCI Registry v4.4 Coder s Data Dictionary Electrophysiology Report Content Based on 2011 Cardiac EP Key Data Elements white paper published in 2011 Registry Content Submission Cath/PCI (RCS-C)

14 Thank you for your attention! Questions?