Resting ECG Workflow

Summary

Resting Electrocardiograms (ECGs) are a widely prescribed diagnostic test in Cardiology. Current workflows are based on proprietary communication protocols, which hamper interoperability and clinical workflows.

The profile describes workflows associated with digital electrocardiography. Similar to the Cath and Echo Workflow integration profiles, this profile deals with patient identifiers, orders, scheduling, status reporting, and data storage. It also addresses the issues of acquisition modality devices that are intermittently connected to the network, such as portable electrocardiograph machines, as well as ECG-specific data requirements. The Resting ECG Profile will handle the cases of unordered and urgent ECG tests and ECGs acquired in both hospital and office settings. It also handles ECGs acquired for the purposes of clinical trials and research.

Benefits

An “Integrated ECG Manager” actor makes it easier for traditional ECG management products to adopt this profile

Details

The Resting ECG Workflow (REWF) Integration Profile:

Establishes the continuity and integrity of basic departmental ECG data by profiling specific usage of HL7 messaging across multiple systems including: Patient registration (ADT), Order Placing (CPOE) and Order Scheduling (CVIS) systems.
Bridges the gap between HL7-based systems (like CVIS) and DICOM-based systems (like ECG carts and PACS) within the cardiology department by specifying the semantic mappings between messages.
Maintains the consistency of patient demographic and ordering information across multiple systems by making that information available to ECG carts via the DICOM Modality Worklist (MWL) Service.
Allows storage and management of ECG evidence documents and final report creation and storage
Ensures that acquired ECGs are not inadvertently lost by specifying that the DICOM Storage Commitment Service is used to transfer the custodianship of images from the modality to the PACS.
Ensures that the status of acquisition workflow steps are known throughout the department by specifying the use of the DICOM Modality Performed Procedure Step (MPPS) Service to convey that status from the modality to the CVIS and the PACS.
Allows multi-vendor interoperability between major subsystems:
- Registration and ordering (HIS, CVIS)
- ECG archive (PACS, ECG Management)
- Acquisition devices (Electrocardiographs)
- ECG analysis and reporting workstations (ECG or PACS Workstations)
- ECG report consumers (EMR)
Uses HL7 transactions for HIS and EMR
Uses DICOM transactions for acquisition devices and workstations
- ECG waveforms stored as DICOM General ECG Waveform objects
- ECG measurements and interpretations stored as DICOM Structured Reports

Systems Affected

Systems involved in this profile are:

Enterprise-wide information systems that manage patient registration and services ordering (i.e., admit-discharge-transfer (ADT)/registration system and hospital information system)
Cardiology information systems that manage department scheduling and report creation
Picture Archiving and Communication Systems that manage storage of images, waveforms and evidence documents.
Review workstation that allow for querying, retrieving and displaying images, waveforms (ecg) and evidence documents
ECG carts for the acquisition of waveform data and evidence documents.
In order to allow legacy systems easier transition, the Cardiology Information System and PACS can be grouped into an integrated ECG Manager.

Actors & Transactions: