Echo Workflow

Neal Grotenhuis
Philips Medical Systems
IHE Cardiology Planning Committee
 Source: 16th Annual HIMSS Leadership Survey
sponsored by Superior Consultant Company/ACS Healthcare Solutions.

June 28-29, 2005 2 IHE Workshop

 Business Issues

IT Barriers

1. Lack of adequate financial support for IT

2. Vendors’ inability to satisfactorily deliver products and
services
3. Lack of staffing resources
4. Difficulty proving ROI
5. Lack of clinical leadership

16th Annual HIMSS Leadership Survey

sponsored by Superior Consultant Company/
ACS Healthcare Solutions.

June 28-29, 2005 3 IHE Workshop

 Introduction

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 4 IHE Workshop
 IHE is driving interoperability in
Echo

June 28-29, 2005 5 IHE Workshop

 IHE 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 6 IHE Workshop

 Goals For IHE cardiology

• 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

June 28-29, 2005 7 IHE Workshop

 Echo Profile Scope:
Imaging Workflow

• 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
June 28-29, 2005 8 IHE Workshop
 Use 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 9 IHE Workshop
 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 10 IHE Workshop

 Echo Actors & Transactions
ADT
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]
DSS/ Order Filler Order Placer

Modality PS in Progress [CARD1]

-  Procedure Scheduled [RAD-4]
Modality PS Completed [RAD-7]  Patient Update [RAD-12]
 Procedure Updated [RAD-13]
 Instance Availability Notification [RAD-49]

Evidence Image
Modality PS in Progress [CARD1] Creator Display
Modality PS Completed [RAD-7]

Query Images [RAD-14]

Storage  Modality Image/Evidence Retrieve Images/Evidence [CARD4]
Performed Commitment Stored [CARD2]
[CARD3] Query Evidence [RAD-44]
Procedure
Step Mgr
Image Image
Manager Archive
 Modality PS in Progress [CARD1]
 Modality PS Completed [RAD-7]

Storage Modality Image/Evidence

Commitment  Stored [CARD2]
[CARD3]
 Modality PS in Progress [CARD1]
Modality PS Completed [RAD-7]
Acquisition
Modality
Query Modality Worklist [RAD-5]
June 28-29, 2005 11 IHE Workshop
 Actors

• 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 12 IHE Workshop

 Transactions

• 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.

“I’m sending images”

“I received them”
“Will you commit to store these?”
Local
storage “Yes, you can delete your copy now”

June 28-29, 2005 13 IHE Workshop

 Transactions

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

June 28-29, 2005 14 IHE Workshop

 Benefits

• Support for lossy JPEG images

RLE? Sorry.
Uncompressed? Yes, but…
JPEG?

• Handling of intermittently connected

devices

June 28-29, 2005 15 IHE Workshop

 Transactions

Modality Images/Evidence Stored –

cont’d Views
– Stress Echo Option Apical two chamber
• Stage Number & View Number Apical four chamber
• Stage Code Sequence & View Code Apical long axis
Sequence Parasternal long axis
Parasternal short axis
Parasternal short axis at the aortic valve level
Coding Code Value Code Meaning (0008,0104) Parasternal short axis at the level of the mitral chords
Scheme (0008,0100) Parasternal short axis at the Mitral Valve level
Designator
(0008,0102) Parasternal short axis at the Papillary Muscle level
Right Ventricular Inflow Tract View
SRT P5-01201 Image acquisition at baseline
Right Ventricular Outflow Tract View
SRT P5-01202 Pre-stress image acquisition
Subcostal long axis
SRT P5-01203 Mid-stress image acquisition
Subcostal short axis
SRT P5-01204 Peak-stress image acquisition
Suprasternal long axis
SRT P5-01205 Image acquisition during recovery Suprasternal short axis
June 28-29, 2005 16 IHE Workshop
 Benefit: Stress Echo
Viewing Consistency

June 28-29, 2005 17 IHE Workshop

 Results

•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 18 IHE Workshop

 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 19 IHE Workshop

 Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
In the Enterprise
and Across Care Settings

WWW.IHE.NET
June 28-29, 2005 20 IHE Workshop