Card Tech Minutes 2015.11.09-11

November 9th, Monday, Conf Room 114

• Tech Framework Maintenance: Discussion of the CP for the RCS-C profile was reviewed in a group setting. The four changes were minor and could be found in the CP folder. These will be submitted to the larger Google group of IHE members with voting rights. The ballot will be open for 30 calendar days, mid-November through mid-December. The ballot will also be sent to the Planning Committee for their information and comment, but not for voting, as this technical framework is owned by the Technical Committee.

November 10th, Tuesday, Conf Room 112

• EP White Paper Review: Discussion of the Buxton Report and the review of a PPT that highlighted the benefits of a standardized workflow.The goal is to have this completed by Feb 15, 2016, for PC co-chair David Slotwiner MD to present at the HRS annual meeting. The HPS for ICD/Ablation should be published by May 4, 2016.
• Cycle Planning: Refinement of the cycle project times lines for RCS-C and RCS-EP. These will be updated and posted here.
• Cardiovascular Consult: Arsenal IT presents details around the Cardiology Consult profile. This may be developed with the assistance of the PCC Domain. The discussion included the development of uses cases in acute and sub-acute settings. The first was a simple case with limited IT. The second was more clinically complex with extensive IT support. An emphasis on XDS/DSUB/XDW infrastructure brings flexibility to exchanging clinical information. There will be continuing conversations through the week with the Tech Committee and the Planning Committee on Thursday. Tomorrow will include a draft of Volume One: Uses Cases, Actors, etc. Members of the PCC Domain were invited to participate. Questions: Are all of the use cases covered? Are there possible deviations that could lead the workflow down other unintended pathways? What are some other decision points around patient transfers that could impact the workflow and profile complexity?
• RCS-C v5.0 Updates: Review of the changes and steps to improve harmonization with RCS-EP. Patient Demographics included with discussion of the vocabulary constraints with regards to patient race value sets and conditional binding. History & Risk Factor will update to the Task Force 2015 AUC Criteria. Encounter Entry and Discharge Section and Pre-procedure Activity Organizeranticipates alignment with RCS-EP and will consider further after evaluating the v5.0 datasets. A related discussion of the SNOMED terminology as well as the process of compositional grammar and creating new codes. It may be recommended for the ACC to develop codes that meet specific internal needs then submit them to SNOMED for consideration.
• Strucural Heart, Pt 3: Review of terminology of with comparisons to TVT Registry with an extensive conversations around the data entry form and narrative reports. The decision was made to regroup the reports into three groups. There was also a detailed review of the profile documentation to resolve questions. Questions: Is the scope to try and create a basic template that can be used?

November 11th, Wednesday, Conf Room 112

• Update from IHE-Japan: Japan Circulation Society Standards (JCS) discussion of SS-MIX2 Standardized Medical Information Exchange developed in 2004 to assist in moving clinical data between EHR vendors. This is important for the new nation-wide clinical registries. There is interest in standardizing cardiac cath reports, ultrasonic cardiography reports, and ECG reports. These are using established IHE profiles for these IHE-J profiles. Yes, these are building on IHE technical Frameworks, with the goal of harmonizing across domains. They are also in contact with LOINC to have new codes developed for mapping to procedures. It was asked if there are SNOMED codes which could meet those gaps. As it turns out there are licensing fees for SNOMED which make this difficult. The use of CDA templates has been used when possible. There may be some benefits to updating the CIRC profile with the assistance of IHE-J. There may be some new opportunities to work with IHE-J for updating. IVI profile in CATH profile option can follow "Final Text Process". And about the HL7 version in CARD has been confirmed that v2.3.1 is default and v2.5.1 is option in the Technical Framework.

• Cardiovascular Consult: Arsenal IT presented on Volume 1, now renamed to Cross Enterprise Cardiovascular Team Workflow Definition profile. More details were offered around the integration with XDW. Review of the clinical workflow was extensive and it was highlighted that there needs to be a notification process from the final treatments provided by the distant clinician back to the referring physician. The Use Case discussion continued with the limited use case scenario for the chronic CAD. Highlights were made of the physicians initiation of the process that was then performed by ancillary staff. The second use case describes a more complex, emergent patient care scenario. There was discussion around the definition of the word urgent. The workflow described did not seem to be infused with the time constraints. There was also discussion to exclude the scenarios of life-threatening emergency cases as out of scope for this profile. During the conversation about the actors of the profile the Heart Team Performer was renamed the Heart Team Manager to better describe the responsibilities. Some of the items, such as creating the final report, are out of scope for this role. An XDW chart would be helpful in the clarification of who performs which tasks, at what times.

• Structural Heart. Pt 4: Further discussion about Value Sets and the mapping of clinical terms. It was suggested that Charles Thomas contact staff at the NCDR to discuss possible solutions that may have been developed for similar situations. He will also review the list of codes to find items that could be removed.

• 2016 Cycle Planning: Preliminary plans were made for the two face-to-face meetings of the Technical Committee: April 5-7, in Chicago, IL immediately following ACC.16. The second meeting is planned for the week of July 11th, location TBD.