Card Tech Minutes 2011.12.12-13

Attendees

This content profile was supposed to be build upon Key Data Elements for Cath procedures defined in an ACC Paper, which is currently in progress. That work is still in the early stages and not yet directly usable, instead we will collaborate in parallel with the lead editor ( Dr. Tcheng) so we canuse that material as it becomes available. It was decided to build the report on the NCDR CATH/PCI date elements.
The Cath Report Content Profile will be based on the structure define in the CIRC (Cardiac Imaging Report Content) Profile
During further discussions we investigated how the NCDR data elements fit into the CIRC structure and identified gaps in the CIRC implementation guide, where we need to add new templates/specialize existing templates
Decided not to use ACC coding, since ACC changes codes on a regular basis, we will use e.g. RxNorm for device-lists, instead to provide multi-year continuity.
We will also follow the XDW effort. It’s currently in early stages, but could be used to describe workflow with XDS-CDA’s

Scope of this profile is the definition of reporting templates for ablations and implant procedures (ICD and pacemakers). The data should be prepared in a way that they could be used for a submission to the NCDR ICD registry (use of RFD - retrieve form for data capture by ITI).
It was decided not to cover the complete episode of care but to address only data captured after the patient enters the EP Lab
The EP Report Content Profile will be based on the structure define in the CIRC (Cardiac Imaging Report Content) Profile
During further discussions we reviewed the EP Key Data elements defined by ACC and HRS and mapped them to the CIRC template and identified gaps in CIRC where new templates need to be added.

Technical Framework updates based on the new templates proposed by the Domain Coordination Committee has been postponed, since templates are not finalized yet. However, we will use the new templates for our new 2011/12 CATH/EP profiles.
A CP was proposed to remove the Nuclear Imaging Option from the stress profile, because
- it has not been adopted,
- it depends on the Cardiac Option to the Radiology NM Image profile which has not been tested at all
- it therefore prevents the STRESS profile from being moved to final text. There is a big reluctance in the committee to do this, since the American Society of Nuclear Cardiology is one of the sponsors. Therefore the CP was put on hold
In order to address the work item to add a pre-procedure documents option to the CATH profile, a CP to Radiology was submitted and accepted to add document references to the order messages in the underlying Rad transactions and to MWL, so that these documents can be accessed in the CATH lab (Card re-uses Rad transactions, therefore Radiology needs to address this CP)

Currently there is a noticeable interoperability problem for display systems to display structured reports. This is a general problem, however most prominently occurs in Ultrasound
Some reasons are the large variation in SRs due to post-coordination, the use of private extension, the lack of proper test sets and validations tools.
However root causes have never been systematically collected and analyzed. Therefore it was suggested to convene a workshop to discuss these issues:
Identify root causes,
Prioritize them
Define a plan how to address them
DICOM WG 12 is a major stakeholder in this effort, however the scope extends beyond ultrasound (DICOM WG 8, IHE Rad and Card, Display and PACS vendors), therefore IHE suggested to convene this workshop.
Plan is to have a planning meeting with co-chairs of relevant committees and hold a workshop with goals mentioned above in May/June timeframe.

DICOM WG 8 started supplement 155 to handle CDA templates in DICOM. The goal is to define a Meta Template Schema, which could be used to encode the RSNA reporting templates into CDA.
- Terminology for describing disease etc. presentation on visual images
- Uses relax-ng for style and low-entry barrier
- Not linked to (CIRC-like) CDA nor DICOM SR templates, nor ACC key image data measures
- Harry Solomon and Chuck Kahn (medical college Wisconsin) are leading this effort.
The CDA consolidation project was balloted in summer and should be published as a DSTU in January
- Sidebar- only HL7 members can use HL7 (2003 change from HL7, they started enforcing this in last 6 months). There may be discussions for a national US license as part of MU.
Unified Procedure Step has been released into the DICOM standard. The push model defined in UPS may be used ( CP?) in Cath workflow to inform all participating modalities, rather than the current work around.
IHE Japan has an IHE Supplement for intravascular OCT (IV-OCT). A meeting at ACC should be convened to discuss this supplement and to see how this can be synchronizeded with the IHE Card TC work.
- Dan Roman has Meeting planned for Sun March 25th 6-8 PM – room TBD
MU stage 2
- Interoperability for PCC is – expected – to be based on the exchange of CDA docs in accordance with CDA consolidation guide (funded by the federal gov.)
- Our IHE-CARD CIRC is a proper subset of PCC and so should be aligned with MU

GE withdrew their CIRC content consumers from the North American Connectathon Testing and the HIMSS show case. Therefore the scope of the relevant use cases at the HIMSS show case was modified to just display the human readable content and not the structured data, so that generic content consumers could be used.

Calendar overview
- 12 weekly meetings between Jan and March - alternating between Cath and EP profile
- Need to identify open issues for clinician feedback BEFORE we go into public comment prep
- 4 days public comment PREP
- 3.5 days public comment PROCESSING
Timeline
- Starting Jan. 4, 2012, weekly t-cons (Wednesday, 10 am EST – no meeting on Jan. 11, 2012 due to Connectathon). Main topic of first meeting is Cath Report Content
- March 26-29 in Oak Brook: Face to face to prepare supplements for public comment. Try to arrange for meeting with Planning Committee members, who will be attending the ACC Show
- April 17: Submit Supplements to Mary Jungers for publication for public comment
- April 23 – May 19: Public Comment
- May 21-24 in Washington, DC: Face to face to resolve public comments
- End of June: publication for trial implementation