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

  • Mead presented a presentation introducing their work:
    • Goals:
      • Precise representation of data requirements
      • build library of templates
      • standards based
    • One report contains only information for one patient (1 to many encounters), included are relevant data from the period prior to encounter, details on the encounter itself and discharge information. Procedures are grouped by session and include medications, results and complitcations
    • How to batch multiple reports into a submission still needs to be decided (workflow profile)
      • Zip file (like in REM)?
    • Profile should address different flavours of submission and define business rules accordingly as profile constraints.
      • this includes blinding of PHI, or how to deal with PCI only procedures for example.
      • How are business rules for conditional content documented? How does this affect structure of templates?
    • Structure of document:
      • Header
      • Encounter
        • Medical History
        • Procedure Sessions
          • Clinical Evaluation
          • Pre-procedure Medication
          • Procedure indications
          • Administered Medications
          • Procedure Results
          • Complications
        • Discharge Observation
        • Discharge Medication
    • Design Decisions for Clinical History
      • Medical History contains items associated with encounter
      • Clinical Evaluation contains items associated with current cath lab visit
      • Nesting only to preserve meaning
      • Distinction between pre- and post-procedure Labs. First one in clincal evaluation, latter in procedure results
      • For medications a yes/no indicatior is needed ==> in order to ensure consistent data, children should be set to no, if parent is set to no (this should be part of the business rules. Tools do no address these, therefore this information needs to be documented in the implementation guide separate from the template generated by the tool).
    • Design Decisions for medications
      • Ther are pre-procedure meds, meds adminstered during procedure and dishcarge meds.
      • Use substance administration and consumeable material to capture medications
      • How to distinguish between a medicine itself and a medication class. The second category is treated as an observation
      • How to record administered, blinded, contraindicated? As a single Medication Administration Observation?
    • Design Decisions for Procedure
      • Procedure Activity Procedure Template repeats within a procedure session
      • Uses internal cross references to link devices and lesions with procedures and results
    • Questions
      • How to associate observation types and value sets?
      • When is it helpful to identify parent templates?
        • When putting parent templates it means additional validation effort against parent templates
      • When should new templates be created as opposed to elaborating structure within existing ones?
  • Review of profile draft
    • Title: Registry Submission Content: ACC NCDR Cath/PCI Registry
    • Use cases should cover scenario for grouping multiple encounters for one patient into one report
    • Uses tabular form as generated out of Trifolia
      • We should take into acount that the existing tools do not offer enough flexibility to model all our needs)
      • Stress testing options should be kept as observations (==> should be modeled as a prior procedure)
      • Pre Procedure Labs as observations in clincial evaluation section
      • Complication - Bleeding event has been modeled in CRC (keep same structure as an observation)
      • How to put a reference to current medication list to profile, URN? One observation for each valid value/medication!

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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