Card Tech Minutes 2016.04.05-07

Day One, April 5, 2016

• Structural Heart, Section One

All of the issues that have come up in the process are documented in the Open Issues list, in reverse chronological order. If we are closing an item, there should be a note that should document the reasons for the change of status. Some of the items listed are external to the scope of these project.

Are there any changes from CRC that were made to optimize TAVR? We will create a list of options that must be supported within the profile, possibly with a matrix listing.

A question [Item 47] was created to document how a patient arrived at an institution. This can be useful for patients who are transferred from facility A to facility B for a procedure, e.g. a VA patient arrives at UW for a cath. Does UW own the data, for registry purposes? The prior release of CRC has dealt with this type of scenario. If a patient has complications, it would be the responsibility of the VA, and not be under the control of UW. It may be helpful to ask the ACC Informatics Task Force the clinical benefits and usefulness of this type of report or information. Follow-up and further discussion may offer insight to the workflow theory, but it would not have the direct impact on the profile at this time.

• Cath 5.0 Update, Section One

Overview of what has changed from RCS-C to Cath 5.0 release. The bulk of the changes are related to:

1. Harmonization with other registries.
2. Diag Cath AUC
3. Updates to the revascularization AUC
4. Added more physicians for PQRS
5. We are adding Follow-Up to registries request info at 30 days and 1 year, are similar. Some option long term quality of care questionnaires significant for PCI.

Note: there was no 4.5 due to significant changes to 4.4 to jump up to 5.0. There has been a significant delay in the development of the data dictionary. We are projecting end of July or August for finishing the profile. This may put our participation in Connectathon 2016 at risk. Approximately nine months after release, the clock would start around the vendors will be required to use 5.0 and version 4.4 will start around July 2017. If we want to participate in the 2016 CTA, sign up starts in October 2016. We may need some trial implementation by August 2016. This would also include finding the time slot from Mary for Public Comment.

Discussion of Creating a Cardiology Only Connectathon @ NCDR.17 in Washington DC.

Changes to Cath-PCI: Race comes from the HL7 Standards for Race, which is based on data from US Census data.

the field for smoking status. This also tries to harmonize with the ACTION registry. These are not downloadable.

The AUC field for diagnostic imaging is considerably expanded, as well as the Revascularization AUC. There will be a code system number for each of the indications.

Much more graft information ideally using the same list from invasive testing.

Discharge now includes Cause of Death includes an expanded list of indications

Expanded list of physicians, including admitting, attending and discharge.

Follow Up can be optional with recommendations. This is not optional for the Vendor Layer, just the provider entry.

• Structural Heart, Section Two

Further discussion of sample text formatting.

• Cath 5.0 Update, Section Two

Ganesan S presented a review of the changes to Cath 5.0, which uses parts of RCS-EP. He demonstrated changes to the Patient Demographics primarily with the ethnicity. Preprocedure History observations have been updated to include smoking, and other risk factors, medication history, and diagnostic tests. Discharge Section has other disposition status observations that are similar to ICD. There is a new section which captures Provider information at the Encounter Observation level.Follow Up includes observations, medications, and quality of life questionnaire. This is a normal template that has been used before.

Day Two, April 6, 2016

• Structural Heart, Section Three

Refinement of the profile options of Content Creators and Consumers in Table 12.2-1. This includes such concepts as supporting at least one of the View or Discrete Data options. RCS-EP (page 14 of the supplement was referenced for guidance.) The questions is what parts of the document are the most useful for an implementer, who may not have a cath background, which pieces an engineer needs to use to deliver a diagnostic cath report.

A discussion of the procedure type may The level of documentation may vary from the complexity of procedure, e.g. diagnostic cath vs biopsy. The issue may just revolve around the correct result ending up in the right table. Taking a shortcut may be problematic. Following the template will provide the greatest opportunity for success.

Complications: device embolization is something that clinicians at UW want to quantify. You may blend two SNOMED codes for anatomy to develop a solution for a complication that includes a device.

• Cycle Planning

Do we need clinicians to drive demand for IHE profiles? If so, how do we convince them of its usefulness? The Health Policy Statement will provide basic information for C-suite and clinical on interoperability. The lack of data regarding financial and workflow benefits is a challenge. There may need to be a variety of approaches to address these points.

• Strucural Heart, Section Four

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• Session Planning

The timeline for the next five months of calls and meetings was developed.

Day Three, April 7, 2016

• EP Whitepaper

The paper is behind schedule due to clinician involvement. There is data assessment occurring right now. What do they need, how do they collect it, how will they use the data. As the number of procedures considered increased, the amount of work required to collect this information also increased. The consensus is to try and find the 80/20 rule for data elements. To further refine using the 'Shall, Should, May' categories contained within a spreadsheet. We are waiting for physicians to complete the data element assessment. The goal is present some of this project at the HRS annual meeting which takes place in May 2016.The risk is to get to detailed.

• Strucural Heart, Section Five

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