Card Tech Minutes 2018.07.09-11

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Chris Melo, Co-Chair, Philips Healthcare
Nick Gawrit, Co-Chair, heartbase
Rebecca Baker, ACC
Antje Schroeder, Siemens Healthineers
Bruce Bray, Univ of Utah
Nakano Shinichi, Canon, IHE Japan
Takeshi Ozeki, Canon, IHE Japan
Charles Thomas, University of Washington[WebEx]
Jim McRae, University of Washington[WebEx]
Christina Demur, GE Healthcare[WebEx]
Andrea Price, Indiana University [WebEx]
Sophia Chaidez, HCA [WebEx]

Day 1 Minutes

Introductions / Agenda review
CPN Extensions - Charles Thomas
Review of public comment feedback on CPN Extensions profile

Got comments from Siemens, Epic, Philips, ACC, and heartbase. ACC comments included on values in the Indications value set. Will address the corrections to the existing value set. Will not add new values but that work will be part of the separate focus on the specific clinical reports. Action: Bruce, Rebecca, Charles to review the issues raised and how to solve.

Update on related cardiology standardization activities - Bruce Bray
HSPC - Health Services Platform Consortium - is focused on implementation of standards.
CIIC - Clinical Information Interoperability Council - is focused on implementation of standards. FDA, CMS are involved.
HL7 Clinical Interoperability Council (CIC) - includes a project on registry data elements.

These are focused on US realm initially. But there is interest in expanding to international. There will be a meeting of HSPC and CIIC at the end of July. ACC Informatics task force is discussing how to link to these efforts.

DICOM WG1 - Antje and Bruce are leading this. Exploring what to focus on - finding ourselves. How do echo templates support guidelines coming out or recently have come out. One topic is support for echo reporting. This is not covered by CPN curently.

Have interacted with European Society of Cardiology - for eCardiology to standardize reporting and workflows. Suggested to raise this with the Planning Committee.

CPN Companion Guide - current status - Rebecca
Rebecca reviewed the current status of the documents. Discussion about what should be in the technical document. There is need for a document/template for use in the RFI process.
Nick suggested only publishing the executive and clinical documents. These would be used to help in the RFI process. Not for vendors to implement the profile.
Andrea suggests putting links into the clinical document to the CPN profile. Example of how to model a lesion. Driven by the content of the clinical document. When review the clinical document, find out where information is needed. When all the clinical document is reviewed, the supportive material is complete.
Began review of clinical document. Rebecca will post the updated document to the ftp site.
Homework for all - review clinical and see where additional explanation is needed in the clinical portion of this document.
CPN Extension - triage feedback - Charles
Collated public comments - only 51 comments.
Addressed comments from Siemens and Philips.
Homework:Charles to review the remaining comments. Will propose resolutions for discusson on Tuesday.

Day 2 Minutes

CPN Companion Guide - review of clinical document - Rebecca
Question - how will we publish this? We will need to check with Mary on ways to do this. We will plan to publish for public comment as a PDF document generated from MS Word. Chris to check with Mary for best way to do this.
Nick to create example of representing lesions and using lesion information from previous CPN documents.
This document will be reviewed by the non-technical audience. Andrea has contacts to review. Also will have David Slotwiner Jerry Serwer as Planning Committee reps to review. This document should be published by the Planning Committee.
Charge capture - procedure and equipment information can be included in CPN but is not explicitly described as how to use the information for charge capture. Andrea will draft a short summary of how to use CPN for this use case to support charge capturing.
Inventory management - the Procedure Description section with a device organizer is used to list the devices used. These devices can be associated with the specific procedures where they are used.
Suggestion to have a single writing style for the entire document. Will be reviewed when content is complete to make consistent.

CPN Extensions - Charles Thomas
Review/discussion of public comment feedback on CPN Extensions profile
Review of comments from heartbase.
Question about requiring support for all procedure types for Structural Heart Intervention option. Nick will follow-up with David/Jerry for clarification.
Support for pacemakers as a procedure type? There is a code for pacemaker implantation as a procedure activity procedure, but not one for pacemaker explant. Does CPN support data needed for pacemaker procedures? Will add pacemaker codes to EP procedure activity procedure value set. Will also add open issue explaining further detailed analysis is required to determine if pacemaker procedures are fully supported.
Review of comments from Epic.
Need further clarification on comments from Epic. Will look to schedule next weekly t-con to discuss these comments.
playingDevice - is classCode=MMAT acceptable by CDA? Gazelle indicates this is not valid. This is in ProcedureDeviceOrganizer template. Chris will look into this.

IVI analysis discussion - Nakano Shinichi
Since December 2017 discussion, they went to 2 university hospitals in Japan. The clinical staff knows what procedure knows what they need to do for the patient. The systems don't use MPPS. They also don't use MWL - patient info is entered manually. Vendors support MPPS but charge for this capability. But these sites don't use the CATH workflow.
For connected use case, angio can get the MWL from the DSS/OF. But in disconnected mode, can't get the MWL so need to have patient info entered in on the modality.
Cardiologist ust push "completed" button on the DSS/OF. They understand when the study is completed.
Dose information needs to be sent from the MOD to the DSS/OF. This should not be done using MPPS but should be sent using dose SR. DICOM also retired the use of MPPS for this information.
Initially had requested to make MPPS optional for IVUS/IVOCT. Now asking for making MPPS optional for all modalities in CATH workflow. The rationale is that there is a cardiologist placing the order, interacting with the DSS/OF and using the angio modality.
How does interaction with IM/IA achieved?
We should discuss the questions to ask to flush this topic out. Antje had drafted some initial questions. Nakano gave feedback on the questions. These questions were not discussed. This should be the next step.
IHE purpose of MPPS is for status communication. Other data can be include for inventory info, etc as optional behavior.
Next steps: review the questions to ask for feedback. Determine who to ask these questions of. Main vendors in Japan include GE, Siemens, Philips. Nakana will reach out to Japan for feedback. Will leverage ACC for feedback on US use models.
IHE-Japan update - Takeshi Ozeki
Update on SEAMAT project. See presentation in ftp folder for TC meeting. SS-MIX2 is used for hospital-hospital and hospital-clinic communication.
Using DICOM, DICOM SR, HL7 CDA for report content, LOINC for content. Not using SNOMED due to licensing cost. ECG, mesurements, etc as DICOM. CDA from report servers to SS-MIX2 extended storage and for storage. Have CDA documents for studies stored in folder structure in extended storage. Will reformat the report content into format appropriate for destination/consumer. JCS has CDA Implementation Guides that is similar to IHE Card CDA templates. J-PCI registry uses AHA coronary tree model as doctors have been using it and are used to it.
Looking at time line for work to get the SEAMAT specification prepared for ISO TC 215 Technical Report. Main target is for research purposes (big data analytics) although also supports care coordination and registry needs. Will look to have further discussion on this topic in future meetings.
CPN Companion Guide - review of clinical document - Rebecca
Continued review of document.
Question of how to represent the location, facility and actual lab room where the procedure is/was done. The location is part of the CDA header - encompassingEncounter location. This can get down to the level of service delivery location. Is this sufficient? May need further analysis and create an example. Possibly add to technical FAQ.

Day 3 Minutes

CPN Companion Guide
Rebecca will work to have complete draft of executive and clinical documents by Monday (July 16). Will review the draft on weekly t-con - July 18.
Suggestion to possibly only publish the Executive Overview initially. Rebecca to send out the Executive Overview today for review. Deadline is July 20 for feedback. Voting meeting to publish for Public Comment will be July 25. Plan is to send to Mary on July 31.
CPN Extensions - Charles Thomas
Charles to have completed document with all changes by COB July 13.
Review comments from Epic on t-con Wednesday July 18th.
Voting meeting on t-con Wednesday July 25th.
Send to Mary on July 31st.
Planning for 2018-2019 development cycle
Technical Committee meetings
Call for proposals - opens 10-AUG close - 30-SEP
Planning Committee - F2F October for 2 days
Tech Committee F2F kick-off - Dec 11-13
ACC Annual Conference - possibly host IHE Card Connectathon - 16-MAR - 18-MAR
F2F Prep for Public Comment - week of 25-MAR (Possibly hosted by IHE-J)
Send to Mary for Public Comment - 15-APR
F2F Public Comment - April 29 - May 27
Prep for TI - Jun 10-14
Send to Mary - 30-JUN
Planning for 2019 IHE Cardiology domain Connectathon at ACC Annual Conference
Only for testing of CPN. Considering hosted by ACC at their annual conference (March 16-18).
This would require test cases for pre-connectathon and connectathon to be created. There is need for the TPM and testing monitors. Need to test the creator and need to test the consumer.
Paul is working on obtaining funding. Expected to have feedback on this by end of August.