To play in the EHR, data must be managed and properly identified There is a saying in the computer industry…..garbage in = garbage out So, this is where we started beginning in Year 1 of IHE-Cardiology (back in 2003) – lay the foundation
Anybody recognize this? Unfortunately it’s frighteningly familiar ! It is a typical cath lab control room. I count at least 11 monitors (there are some more in the lab room). These represent a half dozen different systems. On each one you need to enter the patient name and ID – the same each time (yeah, right …) The non-integration issues are not just within the lab, but between the lab and the hospital information systems Takeaway – we tackled this mess and defined the interfaces necessary to manage the cath workflow. This one profile doesn’t solve all the cath lab data integration problems, but it is a huge step forward to get it under control.
Echo presents a different type of workflow problem. What’s wrong with this picture? It’s the wheels! Echo machines go to the point of care, and they get disconnected from the network. This creates the common “drive-by echo” scenario – Even if there were a new order for a stat exam, the machine may not get it. Stress echo – A second issue is in stress echo, where a non-productive step is required to blend images into a quad view. Takeaway – IHE addresses both these issues with the Echo Workflow Profile, with a complete scenario for managing post-hoc updates, and accurate stress image labeling by the modality.
All these workflows use the same standards-based architecture – which means that we can start moving away from the silos of non-integrated information But in going to a common architecture we do not abandon the very real requirements of the separate modalities. We do specify how echo and nuc images are labeled and displayed – to improve workflow and to improve the consistency of clinically appropriate user interfaces. In fact, by combining these specialized requirements into a common framework, we push the availability of those clinically appropriate user interfaces into the general workstation space.
Measurements have historically been printed to paper and inserted into a patient’s folder. To use the measurements, a cardiologists or technologist typically has to retype the information into a separate reporting system. There have been several kludges, none of which work well. Takeaway - IHE Evidence Documents provides for the accurate electronic exchange of cath and echo measurements, including standard measurement definitions and structure. Thus, e.g., preliminary measurements can be made on the echo machine by the sonographer, and transferred to the reporting application for final cardiologist review. Ask an echocardiographer how important this is – especially since the standard measurement set implements the ASE recommendations for reporting data. Profile can also be used for cath procedure logs, hemo measurements, QCA/QVA measurements, IVUS, etc.
ECGs have been digital for, what?, 20 years? Why are they not ubiquitously available to all clinical workstations, throughout the institution? Takeaway – IHE Cardiology has specialized the RID Profile use of Web technology so that any ECG management system will respond to a standard IHE query to access a high quality displayable ECG. That standard query can be built into any clinical workstation application.
Remember - our 1 st reason for “Why IHE Cardiology” is because the practice inherently extends across institutional boundaries. IHE is tackling the problem of effectively, and securely, sharing data. This IHE Profile is called Cross Enterprise Document Sharing, or commonly “XDS”, and has huge implications for cardiology. distribution beyond the boundaries of the healthcare institution. But here, IHE Cardiology is simply leveraging the excellent work being done in 4 other IHE domains
The document content profiles for cardiology are all the same as those need for the rest of medical care – since cardiology spans all care settings.
Presenter Maria Rudolph, American College of Cardiology Staff IHE Cardiology
Managing cardiology procedure workflow to ensure consistently identified and integrated data
Cardiac Catheterization Workflow Profile
Echocardiography Workflow Profile
Stress Testing Workflow Profile
Nuclear Medicine Image Profile (Cardiology option)
Cath Lab Workflow 1 2 3 4 5 6 7 Multiple re-entry of Patient ID Error prone data entry Results fragmented across systems Results inconsistently time-tagged Custom solutions needed for data sharing Difficult to manage Uncoordinated with Hospital Information System Unidentified patients (emergency) Un-ordered cath exams Diagnostic and interventional procedures Ad hoc scheduling of cath labs Change of rooms during procedure 8 9 10 11 note: Cath Profile includes Electrophysiology lab
Cath and Echo Evidence Documents Echocardiography Measurement Patient: Doe, John Technologist: der Payd, N Measurements: Mitral valve diameter 3.1cm - shown in image at [ ] Ventricular length, diastolic 5.97 cm - shown in image at [ ] Ventricular volume, diastolic 14.1 ml - inferred from [ ] - inferred from VLZ algorithm
Measurements made on modality or workstation, and written onto a paper worksheet, then transcribed into a report
Measurements output to a printer port, intercepted by an application that scrapes the values
Screen capture of measurements sent to a reporting system, which uses OCR (optical character recognition) to reconstruct the original measurement names and numbers