Card Tech Minutes 2012.12.10-12

Attendees

• Abdul Malik Shamir - ACC (for Cath/PCI NCDR Registry Content discussions)
• Anthony Scinicariello - St. Jude (for EPRC discussions)
• Antje Schroeder - Siemens
• Bryan Jennings - Medical Micrographics (partially)
• Chris Melo - Philips
• David Slotwiner - HRS (for Board Report discussions)
• Harry Solomon - GE
• James Tcheng - ACC (for Promotion discussions)
• Kevin O'Donnell - Toshiba (for IVI Discussion)
• Mike Simanowith - ACC (for Cath/PCI NCDR Registry Content discussions)
• Nakano Shinichi - IHE-J/Toshiba
• Nandan Shanbag - ACC (for Cath/PCI NCDR Registry Content discussions)
• Nichole Kallas - ACC (for Cath/PCI NCDR Registry Content discussions)
• Nick Gawrit - heartbase
• Paul Dow - ACC
• Paul Seifert - Agfa
• Steve Graunke - Medical Micrographics (for EPRC discussions)
• Tom Dolan - Philips

Meeting Notes

Update from other domains

• Radiology is working on a profile to Invoke an Image Display service (IID). This is based on transaction Card-15. Some more flexibility with regards to querying for studies/patients as well as some option (e.g diagnostic vs 'low quality' viewing, de-identification, viewer type) will be added.
• Radiology is debating to retire the existing (HL7 2.3.1 based) Scheduled Workfow with SWF.b, which will be based on HL7 2.5.1. This has some implications on Echo/Cath/REWF. We will update those, when there is evidence of acceptance for SWF.b
• DICOM WG 8/20 will update the Implementation guide for the Diagnostic Imaging Report with experience from last four years. This is supposed to be out for public comment by the end of summer. Goal is that this document will be updated and maintained by DICOM and not HL7
• DICOM WG12 is re-working TID 5200 to use more pre-coordinated codes rather than rely on post-coordination
• PCC is working to harmonize there CDA implemation guides with cCDA. In this context they are looking into the use of tooling (MDHT vs Trifoloa).
• cCDA is working on defining baseline metrics for what needs to be in a specification for publication

Cath/PCI NCDR Registry Content

• Current ACC Cath/PCI NCDR Registry activities:
  • Working on a Data Model based on the Care and Cath Registry data elements. Takes the HL7 RIM into account. Idea is that data model covers all NCDR registry.
  • Goal of this data model is to have a generic transmission format that meets the needs of all registries, but also takes the specifics of the various registries into account.
  • Transisition to NCDR Cath 4.5 data set in early summer
• Cath/PCI Registry:
  • Focus on the inpatient scenario
  • Focus on an episode of care and not just the procedure. Data collection is specific to episode of care.
    • Section for NCDR report may be different than the ones from CRC
    • Observations need to be matched with timing
    • Lesions are seen as defects in order to be extensible to other registries => generic template for defect to be defined with specialisation for lesion
    • It needs to be decided what the first ordering structure is: time, clinical content, ...?
    • Data collected are specific for one procedure, if procedure is repeated within the episode of care, data needs to be provided for each procedure.
    • Follow up is not yet modeled by the NCDR. This may be a separate submission
    • One patient can have multiple episodes of care, each episode of care can have multiple procedures, each procedure can deal with multiple lesions with multiple devices, of which each can span multiple lesions.
  • NCDR deals with lots of yes/no questions, which we have not dealt with in CRC.
  • Question is how to deal with the business rules, which are needed in order to make it a valid submission set
    • Should be modeled as constraints. Some of them could even be defined at the document level
    • Two step approach, focus on content first and then model business rules in second step
• Plan
  • finalize concepts,sections and some vocabulary by End of Aug
  • 3 steps to address value sets:
    • define concepts
    • maps concepts to SnoMed, Loinc
    • submit request for new values
  • Tasks
    • Identify data sets
    • Review NCDR data sets and data model and map specifics for Cath/PCI to R-MIM
    • Identify templates
    • Value set mapping
    • Create profile including xml examples

Electrophysiology Report Content

• Further proceeding:
  • Nick and Chris will work out a detailed plan by the April meeting on the detailed schedule for this supplement:
    • By phone call on Jan. 23 the following docuemnt should be reviewed
      • ACC/HRS paper
      • additional documents provided by Dr. Slotwiner
      • DICOM Supplement 129
  • Review Sample reports to come up with overall structure (3 weeks)
  • Work on domain analysis prior to April meeting (10 weeks)
    • Deliverable: content definition, data dictionary
• Dr. Slotwinder agreed to be clinical contact and to participate at regular meetings (first one on Jan. 23)
• Further discussion points
  • Supported study types: EP Study, Device implant/explant/replacement, Lead implant, explant, replacement, Ablation, Cardioversion
  • EPRC will be a separate profile from CRC, still to be discussed whether one profile or one per supported study type.
  • IDCO focuses on device settings and configuration and not the procedure itself. However some of the device information may be re-used based on IEEE nomenclature

Promotion

• Possibilities to increase awareness on IHE
  • Survey to find out why there is a lack of adoption
    • ACC has a survey group which regularly sends out a survey to a group of 200 cardiologist. We could add 6-8 questions to one of this surveys.
      • Questions should include question about the influence on purchasing decisions.
    • It is important to find out whether we are targeting the right audience with this survey
    • Potentilly try to quesstion ACCA members
  • Provide a Handbook
    • Should address multiple user groups (Cardiologist, IT administrators)
  • Cómment on Meaningful use stage 3 proposal via the ACC and HRS comments. Check also with RSNA and IHE USA whether they are commenting.

• Worked on comments to MU3
  • Currently primary focus are EHR systems, however no recognition of workflow issues. Workflow that generates data needed in the EHR should be included in MU as well. IHE already addresses these issues.
  • Worked on comments on the following items
    • SGRP118 Access to imaging results (images and additional information). Suggested to extend access to ambulatory offices and therefore include IEO in certification. Furthermore image access should be based on IID (invoke image display) and ECGs by the Retrieve ECG for display profile.
    • QMWG25 eCQM
    • MU05: EHR as central distribution channel for Health Information. Complete workflow should be taken into account based on IHE profiles like CATH and Echo

Intravascular Imaging

• Discussion of open issues identified by IHE-J
  • Data volumes, this is not a technical issue rather than one of user experience. However transfer to the image manager/archive is more for long term record than for direct review, and therefore there should not be any real time requirements
  • The assumption is that frame level retrieval is not needed, however this should be made an open issue.
  • For modality worklist IVI just adde one more device to the group of supported devices, which requires different modality and procedure codes.
    • Furthermore it should be checked whether the RIS is supposed to keep the work items on the worklist even after MPPS in progress, so that additional devices could use this information
  • The intermittently connected Modality is already part of Cath Workflow
  • MPPS is not an issues, since users don't really make use of this information, nevertheless keep the functionality
  • HL7, JJ1017 and specific order details (view, acces point, side of access, ...) should not be made an issue for this supplement
  • No modification in Echo needed.
  • A new use case for ad hoc addition of another procedure/additional equipement is needed.
• Further plan
  • Antje to provide supplement document based on new template with existing Cath text to Nakano-San by Jan. 11
  • March 5: T-con to vote on publication
  • Public Comment during April
  • Trial Implementation publication Mid March
  • Dates to be confirmed with Mary

TF Maintenance

• HL7 2.5 discussion: Card will wait with switching over to HL7 2.5.1 until Radiology has made its decision on how to proceed with the two versions of scheduled Workflow
• CP13: Grouping information will be moved to generic section
• New CP needed to move all grouping information from generic section to profile specific grouping section (Paul Seifert)
• CP9: HL7 profiling conventions. CP is based on ITI CP121, since that one is not done, wait until they are done. Furthermore depends on further proceeding with regards to HL7 versions
• CP 1: References to PCC: Wait until they have addressed their transition to cCCD
• Chris to write a CP to make CRC based on cCDA 1.1
• Issues for CIRC that need to be addressed: recently assigned Loinc Codes, new IHE template, some content changes, alignment with CCDA
  • Some ongoing discussion about how to structure structured data with HL7 => Harry to report back after Jan. HL7 meeting.
  • Do we need to wait for tooling. Some updates to the MDHT are needed
  • LOINC codes will be dealt with in a CP.
  • For all other changes Harry will accumlate the changes and then we will move the supplement through another public comment period

Scheduling and Next meetings

• Next Face To Face will be April 29 - May 1, 2013, Location TBD (either Oak Brook or ACC)
• Jan 09 - Promotion
• Jan 23 - EPRC Discussion (with Dr. Slotwiner) and HL7 feedback
• Feb 06 - Cath/PCI NCDR Content
• Feb 13 - IVI and Promotion
• Feb 20 - EPRC
• Feb 27 - Cath/PCI NCDR Content
• Mar 05 (6pm EST) - IVI vote for publication
• Mar 13 - Promotion and EPRC
• Mar 20 - Promotion and EPRC
• Mar 27 - Cath/PCI NCDR Content
• Apr 24 - Public Comment Resolution IVI

• IVI publication for Public Comment Mid March to Mid April (pending Mary's availability)
• IVI publication for Trial Implementation Mid May (pending Mary's availability)
• CP Ballot during the month of May
• Publication of TF/Supplement Revisions in July (pending Mary's availability)

Action Items

• Paul to update webex for planned meeting
• Paul to determine location for next F2F
• Antje to provide Template for IVI by Jan 11
• Tom to circulate Board Report to Planning Committee and DCC
• Harry to ciruclate Feedback on MU from IHE Card
• Paul to ensure IHE Card MU feedback gets incorporated into ACC feedback and also to communicate this to HRS
• Antje to coordinate publication dates with Mary Jungers