Card Tech Minutes 2013.10.13-10.17.01

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Attendees

  • Abdul Malik Shakir - ACC (NCDR Profile)
  • Alan Katz - ACC (Strategy)
  • Antje Schroeder - Siemens
  • Charles Thomas - University of Washington (Strategy)
  • Chris Melo - Philips
  • Elias Mazur - ACC
  • Elizabeth Perpetua - University of Washington (Strategy)
  • Ganesan Muthiah - ACC (NCDR Profile)
  • Harry Solomon - GE
  • Jason Kreuter - ACC (Strategy)
  • Jimmy Tcheng - ACC (Strategy)
  • Kim Kayler - ACC (Promotion)
  • Mead Walker - ACC (NCDR Profile)
  • Nakano Shinichi - IHE-J (NCDR profile)
  • Nandini Kuntipuram - ACC (NCDR profile)
  • Nick Gawrit - heartbase
  • Paul Dow - ACC
  • Paul Seifert - Agfa (TF Maintenance)
  • Salima Shakir - ACC (NCDR Profile)
  • Sharleen Fairbanks - ACC (Promotion)
  • Tom Dolan - Philips
  • Traci Connolly - ACC (NCDR Profile)

Meeting Notes

EP Report Content

  • very active sub committee involving three physicians and two nurses
  • It was decided to use MDC codes (MDC_IDC IEEE 11073) for Result Obeservations (as used in the IDCO profile)
    • Snomed is more focused on procedures and lacking codes for device measurements.
    • Potentially need to apply for new MDC codes
  • Switched to using new NYUMC templates rather than the previously used "Hungo-Reports"
  • Use case section has been updates based on physician feedback
  • Template development started with defining a complete xml sample for an implant/explant report as a basis
  • Review of the single lead ICD Implant Report example, which is about 95% ready.
  • Started review of code sets

Registry Submission Content - NCDR Cath/PCI Registry

Promotion

  • Review of survey results
    • only 8% of 149 participants had heard about IHE
    • 86% think that interoperability is very important and that ACC should support IHE
    • some of the interoperability concerns are focused around cross-enterprise document sharing.
    • with regards to MU2 requirements and what they mean to cardiologist we should work with the ACC advocacy group (Lisa Goldstein):
      • Show how stage 1/2 and trends for stage 3 impact interoperability
      • make clear what IHE has to offer in order to address these requirements
    • Some more ideas on what we can do:
      • make use of Success stories like the Dutch Cardiology XDS example
      • Illustrate how HIEs are using IHE for cross enterprise exchange
      • Map survey feedback for interoperability issues to IHE profiles for the ACC taskforce by Nov.2 (Tom), where ACC is putting togehter a 5year plan for IHE - TOM
  • Discussion with ACC Marketing Team (Kim Kayler, Sharleen Fairbanks)
    • Promote IHE to ACC audience
      • ACC Management
      • ACC Staff
      • ACC membership
    • Use ACC publishing media to get news out (e.g. CardioSource World News
    • Start with staff, then management and then members
    • ultimate goal is to educate clinicans to assertain their IT needs to their IT staff
    • ACC on behalf of their members should communicate the message that interoperability is a big need to Product Management of vendors, so that systems are ready for Health Information Exchange
    • Some of the basic messages
      • IHE ties into quality which is key mission of the college by making practice more efficient and enabling data collection for NCDR part of regular clinical practice
      • MU – all state HIE’s are run using work done by IHE-ITI. Emerging MU guidelines will be about clinical information exchange and image transfer - IHE has been establishing the standards underlying the MU and the role of IHE in supporting connecting practices to HIE’s for referrals and care transition documents will be key.
      • In cardiology we have focused on better working of cardiology department – the challenge is that there are not MU spend here, there isa value prop for members so that systems work better together within cardiology which efficiencies should underlie accreditation issues
    • Action Item for Paul Dow to provide logos and IHE visuals to ACC marketing team

Technical Framework Maintenance

  • There are currently no new CPs that need work

Updates from other SDOs, IHE Domains, ...

  • DICOM
    • WG 1 Cardiology has been quiet - there are open work items on additional SR templates for EP and IVOCT
    • WG 27 Web Technology - working on restful web services for imaging.DICOM needs to “brand” the web services ( DICOM Web). Looking for ways to ty into FHIR
    • WG8 and WG 20
      • DICOM will develop a method for creating CDA radiology reports - will allow professional sub-societies to write clinical templates for those reports e.g. knee musco-skeletal MR – primarily standard text in a narrative structure, may highlight a few discrete structured measurements to use of that report which would be mapped to CDA and
      • Obstetrics and breast imaging are more interested in structured data for registry and data collection use.
      • Work is Proceeding, but slowly
  • HL7
    • Structured documents - late binding of vocabulary to structured CDA templates to enable medication and clinical vocabularies to specific regions
    • FHIR – next gen HL7 – simplified resource modelling compared to HL7 V3 , can be represented by web-services
      • Use case is lightweight and ad-hoc access to healthcare information - flexible, mobile-device , more dynamic workflow with unpredictable, on-demand access
      • Production-oriented workflow in hospitals could still be in v 2
      • HIT is considering FHIR going forward
    • C-CDA 2.0 was balloted for DSTU ( 53% approval) with over 1000 comments to be procesed before publication
    • Multiple new templates addedd ( because of no late binding)
      • Pain points on binding are not obvious – most folks are at too high a level
      • Lack of tool support ( which isoutside HL7) is the biggest reason
      • The issues in tool support for template versioning
      • The PCC CCDA harmonization effort will see some o the pain this year - so that may be a way we can get attention to this
      • Art-décor is a non lantana, international realm tool set that exists
  • IHE
    • IHE Certification
      • IHE international issued an overview of conformance assessment
        • IHE Schema owner
        • Connectathon testing
        • Product iIHE ntegration statement ( attestation)
        • Product accredation testing ( ISO….)
        • Certification ( ISO….)
      • HIE states have asked for certification of technology
        • E.g. illinois HIE re facing issues onboarding new members and would like some of that integration work pushed back down the chain
      • Still no tie-in to real benefits, market needs - or to other certification bodies – HL7, MU-certification
    • IHE-RAD
      • Tomosynthesis
      • Mobile health for imaging – rest-based access to images
    • PCC
      • Patient visit view summary - patient-oriented summary document

Strategic Discussion with Planning Committee

  • Review of University of Washington Proposal for TAVR structured Reporting
    • Workflow for creating evidence docs for TAVR
    • Should cover Registry Reporting into the joint NCDR/STS registry, which currently has about 200 members
    • Currently 200-300 different data elements need to be collected for registry submission, about 100 of them are the same as in CRC. Therefore CRC could be used as a starting point that would have to be expanded in the procedure section as well as in the pre-procedure section.
      • Starting point could be a paper, that publised the TAVR vocabulary (REFERENCE!)
    • Market forces driving TAVR
      • reasonable high prevalence of the disease – current meds are ineffective, surgical treatments are high-risk,
      • TAVR is attractive and effective for high-risk patients. – CMS coverage demands registry submission as a renumeration pre-condition. Innermax registry funding is been defunded.
    • CMS is not interested in data collection
    • Some statistics
      • TAVR – world - multiple 10’s of thousands – 2 orders of mag. Less than angio ( 3 milion/year) ,,, there is 20 angio patients versus 1 aortic stenosis - 83/1,000,000 cases in Germany .
      • About 200 members of TAVR registry vs. 2500 for PCI – 8000 cases done per 18 months. – Duke does 5-10/week – needs 2 cardiologits plus 3.5 FTE’s on mgt. – expensive procedure vs. angio ( $500) ….room to grow.
    • Current plan:
      • Charles Thomas and colleagues start mapping the TAVR vocabulary (using CRC and the Mapping Sheets as a starting point). This will be used as input for a proposal for next year's cycle. Nick and Chris to provide latest mapping spread sheets.
      • First call to introduce CRC and some initial planning on Dec.11, 2013 at 10am EST.
  • Jason is working with EHR vendor community to provide information for registries (PINNACLE)
    • EPIC is on board with this effort
    • Most of EHRvendors are currently working on MU
  • Dr. Katz is working on an outline for a paper to promote IHE to the ACC
  • Any promotion effort should target the business level (c-level), therefore the American Hospital Association, CHIME and HIMSS are a good audience.
  • Four year plan should cover
    • Marketing
    • Make sure our current profiles are contemporary and meet current needs
    • Clean up existing profile proposals
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