Echo WorkflowEcho Workflow
Neal GrotenhuisPhilips Medical Systems
IHE Cardiology Planning Committee
June 28-29, 2005 IHE Workshop2
Source: 16th Annual HIMSS Leadership Surveysponsored by Superior Consultant Company/ACS Healthcare Solutions.
June 28-29, 2005 IHE Workshop3
Business IssuesBusiness Issues
IT BarriersIT Barriers
1. Lack of adequate financial support for IT2. Vendors’ inability to satisfactorily deliver products and
services3. Lack of staffing resources 4. Difficulty proving ROI 5. Lack of clinical leadership
16th Annual HIMSS Leadership Surveysponsored by Superior Consultant Company/ACS Healthcare Solutions.
June 28-29, 2005 IHE Workshop4
IntroductionIntroduction
Echo Profile• TTE• TEE• Stress Echo
Cath Profile• Intravascular ultrasound (IVUS)• Intracardiac echo (ICE) are used in cardiac
catheterization procedures, and are supported as modalities in the Cath Workflow, and not in the Echo Workflow.
June 28-29, 2005 IHE Workshop5
IHE is driving interoperability in EchoIHE is driving interoperability in Echo
June 28-29, 2005 IHE Workshop6
IHE TerminologyIHE Terminology
• Ultrasound system = “Image Acquisition Modality”• Images & reports = “Evidence Documents”• IHE Demo person = “Docent”• PACS = “Image Archive” and/or “Image Manager
actors”
June 28-29, 2005 IHE Workshop7
• High ROI—value added problem solutions• Standards in place (DICOM & HL-7)• No “political” challenges – just technical• Restricted scope for a “quick win”• Reuse successful Radiology profiles to meet
similar needs
Goals For IHE cardiologyGoals For IHE cardiology
June 28-29, 2005 IHE Workshop8
• Reuse of similar IHE-Radiology Profiles– Scheduled Workflow (IHE-R SWF)– Patient Information Reconciliation (IHE-R PIR)
• Intermittently Connected Modality– Workflow– Acquisition Modality storage
• Stress Echo – Workflow– Staged Protocol
• Acquisition Modality (optional)• Image Display (required)
• Digital vs. Videotape– A-D workflow, training issues
Echo Profile Scope:Imaging WorkflowEcho Profile Scope:Imaging Workflow
June 28-29, 2005 IHE Workshop9
Use CasesUse Cases
• Case E1: Patient Registered at ADT and Procedure Ordered
• Case E2: Intermittently Connected Modality
• Case E3: Intermittently Connected Modality with Ad Hoc Procedure, Patient Registered, Scheduled Procedure
• Case E4: Intermittently Connected Modality with Ad Hoc Procedure, Patient Registered, Unscheduled Procedure
• Case E5: Intermittently Connected Modality with Ad Hoc Procedure, Patient Unregistered, Unscheduled Procedure
• Case E6: Stress Echo Staged Protocol
• Case E7: Echo Measurements
June 28-29, 2005 IHE Workshop10
Use Case E4: Intermittently Connected Modality
Use Case E4: Intermittently Connected Modality
“Could you scan this patient right now since you have a cart in the CCU anyway?”
Clinical Use Cases: – Lost and unbilled echo exams because carts are constantly on the move
– Patient and order info manually entered (potential for errors) or not at all
– Measurements are transferred
Benefits:– Accurate and automatic demographic and order reconciliation
– Verify all images are securely archived
– Improved workflow
June 28-29, 2005 IHE Workshop11
Pt. Registration [RAD-1]Patient Update [RAD-12]
Pt. Registration [RAD-1] Patient Update [RAD-12]
Placer Order Management [RAD-2]Filler Order Management [RAD-3]
ADT
Query Images [RAD-14]Retrieve Images/Evidence [CARD4]
ImageDisplay
Modality Image/Evidence Stored [CARD2]
Storage Commitment
[CARD3]
Procedure Scheduled [RAD-4]
Procedure Updated [RAD-13]
Query Modality Worklist [RAD-5]
PerformedProcedureStep Mgr
Modality PS in Progress [CARD1]-Modality PS Completed [RAD-7]
Modality PS in Progress [CARD1] Modality PS Completed [RAD-7]
Modality PS Completed [RAD-7]
Order Placer
AcquisitionModality
ImageManager
ImageArchive
DSS/ Order Filler
Patient Update [RAD-12]
Modality Image/Evidence Stored [CARD2]
Storage Commitment
[CARD3]
EvidenceCreator Modality PS in Progress [CARD1]
Modality PS Completed [RAD-7]
Query Evidence [RAD-44]
Instance Availability Notification [RAD-49]
Echo Actors & TransactionsEcho Actors & Transactions
Modality PS in Progress [CARD1]
June 28-29, 2005 IHE Workshop12
ActorsActors
• Echo profile uses existing actors that use cardiology specific transactions– Department System Scheduler/Order Filler (DSS/OF)– Order Placer– Performed Procedure Step Manager – Image Archive– Image Manager– Acquisition Modality– Image Display– Evidence Creator
June 28-29, 2005 IHE Workshop13
TransactionsTransactions
• Storage Commitment – A requestor (Acquisition Modality) requests that the Image Manager confirm ownership for the specified DICOM objects (images, waveforms, evidence documents, or any combination thereof) that the requestor stored in the Image Archive, thus allowing the sender to delete those objects now owned by the Image Manager. – This option requires the Image Manager to send the N-Event Report
message to the mobile modality at the time that reconnects to the Image Manager.
Localstorage
“I’m sending images”
“Will you commit to store these?”
“Yes, you can delete your copy now”
“I received them”
June 28-29, 2005 IHE Workshop14
Modality Procedure Step In Progress: Informs the PPS Manager of the start of a new Procedure Step, PPS Manager informs the Department System Scheduler/Order Filler and Image Manager.
Retrieve Images: An Image Display requests and retrieves a particular set of images from the Image Archive. Echo option requires ability to retrieve Echo Evidence.
Modality Images/Evidence Stored
• An Acquisition Modality sends acquired or generated images, waveforms, or other evidence documents to the Image Archive.
• Echocardiography Options• Image Archives & Image Displays must support:
– JPEG Baseline
– YBR_FULL_422
– Certain defined SOP classes
• Echo Evidence
TransactionsTransactions
June 28-29, 2005 IHE Workshop15
• Support for lossy JPEG images
• Handling of intermittently connected devices
BenefitsBenefits
RLE? Sorry.
Uncompressed? Yes, but…
JPEG?
June 28-29, 2005 IHE Workshop16
ViewsApical two chamber
Apical four chamber
Apical long axis
Parasternal long axis
Parasternal short axis
Parasternal short axis at the aortic valve level
Parasternal short axis at the level of the mitral chords
Parasternal short axis at the Mitral Valve level
Parasternal short axis at the Papillary Muscle level
Right Ventricular Inflow Tract View
Right Ventricular Outflow Tract View
Subcostal long axis
Subcostal short axis
Suprasternal long axis
Suprasternal short axis
TransactionsTransactions
Modality Images/Evidence Stored – cont’d– Stress Echo Option
• Stage Number & View Number
• Stage Code Sequence & View Code Sequence
CodingScheme
Designator(0008,0102)
Code Value(0008,0100)
Code Meaning (0008,0104)
SRT P5-01201 Image acquisition at baseline
SRT P5-01202 Pre-stress image acquisition
SRT P5-01203 Mid-stress image acquisition
SRT P5-01204 Peak-stress image acquisition
SRT P5-01205 Image acquisition during recovery
June 28-29, 2005 IHE Workshop17
Benefit: Stress EchoViewing ConsistencyBenefit: Stress EchoViewing Consistency
June 28-29, 2005 IHE Workshop18
ResultsResults
•Improved patient safety/reduce medical errors•Improved interoperability & workflow•Customers can choose best-in-class equipment based on clinical features, not based on whether it connects
Vendor X
June 28-29, 2005 IHE Workshop19
More information….More information….
• IHE Web sites: www.ihe.net• Technical Frameworks, Supplements
• Cardiology Technical Framework • IT Infrastructure Technical Framework • Displayable Reports Supplement
• Non-Technical Brochures :• Calls for Participation• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Products Integration Statements
June 28-29, 2005 IHE Workshop20
W W W . I H E . N E TW W W . I H E . N E T
Providers and VendorsWorking Together to Deliver
Interoperable Health Information SystemsIn the Enterprise
and Across Care Settings