retrieve ecg for display profile retrieve ecg for display profile john donnelly ihe-cardiology...
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Retrieve ECG for DisplayProfile
Retrieve ECG for DisplayProfile
John Donnelly
IHE-Cardiology Planning Committee
June 28-29, 2005 Interoperability Strategy Workshop2
ECG NeedsECG Needs
• ECGs Accessible Everywhere!• Need broad distribution of ECGs using ubiquitous
technology (Web).– Allow medical applications to easily retrieve and display
ECGs in a platform/vendor neutral way.
• High-quality ECG documents. Avoid artifacts on zoomed ECGs and arbitrary display geometries.– Vector images required (not rasterized)
• Facilitate apps for serial comparison (side-by-side synchronized display).
June 28-29, 2005 Interoperability Strategy Workshop3
ECG Profile ECG Profile Abstract / ScopeAbstract / Scope
• Provide ECGs and related documents to enterprise• Reuse IHE-ITI RID
– Retrieve list of documents; retrieve single document
– ECGs served in ready-to-display format (PDF, SVG)
• Limited extension for ECG-specific needs– Add requirements on display format and quality
– Include XML-based ECG report list
June 28-29, 2005 Interoperability Strategy Workshop4
Out of ScopeOut of Scope
• ECG acquisition and reading workflow.• ECG raw data interchange.• Export of reports to external repository.• Central management and configuration of ECG
devices.
June 28-29, 2005 Interoperability Strategy Workshop5
ECG ProfileECG ProfileValue PropositionValue Proposition
• Use ubiquitous HTTP Get mechanism as defined in IHE-ITI RID– Standardized URLs
• Use PDF for easy integration with existing display applications
• PDF vector graphics supports scalable waveforms• XML list of ECGs for serial comparison apps
June 28-29, 2005 Interoperability Strategy Workshop6
Example ECG in PDF FormatExample ECG in PDF Format
June 28-29, 2005 Interoperability Strategy Workshop7
Example ECG in SVG FormatExample ECG in SVG Format
June 28-29, 2005 Interoperability Strategy Workshop8
ECG ProfileECG ProfileTransaction DiagramTransaction Diagram
Display InformationSource
Retrieve Specific Info for Display [ITI-11]Retrieve ECG List [CARD-5]
Retrieve ECG Document for Display [CARD-6]
June 28-29, 2005 Interoperability Strategy Workshop9
ECG Profile ECG Profile ActorsActors
• DisplayDisplay – A system that can request and display preformatted (“presentation-ready”) data using Web technologies.
• Information SourceInformation Source – A system that responds to requests for patient-related ECG data by encoding it in a presentation-ready format using Web technologies.
• Same actors as RID Profile
June 28-29, 2005 Interoperability Strategy Workshop10
ECG ProfileECG ProfileStandards UsedStandards Used
• HTTPHTTP – Query/response• XHTMLXHTML – Response list format• XMLXML – Alternate response list format (processable)• PDFPDF – ECG content format• SVG SVG – Alternate ECG content format
– A W3C Standard (XML meets graphics)
– Allows scripting for embedded client side controls
June 28-29, 2005 Interoperability Strategy Workshop11
ECG ProfileECG ProfileTransactionsTransactions
• Retrieve Specific Info for Display [ITI-11]– Uses HTTP Get query parameters “SUMMARY” or “SUMMARY-
CARDIOLOGY”– Response list of documents (including ECGs) in ready-to-display
format (XHTML)
• Retrieve ECG List [CARD-5]– Uses HTTP Get query parameter “SUMMARY-CARDIOLOGY-
ECG”– Response list of ECGs in processable format (HL7 RIM-derived XML)
• Retrieve ECG Document for Display [CARD-6]– Response ECG served in PDF– SVG allowed if Display actor asks for it and Information Source
supports it
June 28-29, 2005 Interoperability Strategy Workshop12
ECG XML List ECG XML List based on HL7 V3 R-MIMbased on HL7 V3 R-MIM
IHEDocumentListclassCode*: <= ACTmoodCode*: <= EVNcode*: CD CWE [1..1] <= ActCodeactivityTime: TS [0..1]
DocumentInformationclassCode*: <= ACTmoodCode*: <= EVNid*: II [1..1]code: CD CWE [0..1] <= ActCodetitle: ST [0..1]text: ED [0..1]statusCode: CS CNE [0..1]effectiveTime: TS [0..1]
0..* documentInformationtypeCode*: <= COMP
component
PatientclassCode*: <= PSNdeterminerCode*: <= INSTANCEname: PN [0..1]administrativeGenderCode: CE CWE [0..1] <= AdministrativeGenderbirthTime: TS [0..1]
0..1 patientPatient
0..1 providerOrganization
PatientRoleclassCode*: <= PATid*: II [1..1]
1..1 patient *
typeCode*: <= RCTrecordTarget
IHEDocumentList(AABB_RM444448)
This contains information about a set of documentsreturned from an IHE “Request List of ECGs” request.
DeviceclassCode*: <= DEVdeterminerCode*: <= INSTANCEid: II [0..1]code: CE CWE [0..1] <= EntityCodemanufacturerModelName: SC CWE [0..1] <= ManufacturerModelNamesoftwareName: SC CWE [0..1] <= SoftwareName
0..1 assignedDevice
AssignedAuthorclassCode*: <= ASSIGNEDid: II [0..1]
0..1 assignedAuthor
typeCode*: <= AUTnoteText: ED [0..1]
author
OrganizationclassCode*: <= ORGdeterminerCode*: <= INSTANCEid: II [0..1]name: ON [0..1]
June 28-29, 2005 Interoperability Strategy Workshop13
ECG XML List SchemaECG XML List Schema
June 28-29, 2005 Interoperability Strategy Workshop14
ECG PDF Content RequirementsECG PDF Content Requirements
• Waveform as vector graphics– Gives high quality line drawings at any screen resolution and zoom
factor– Rasterized (e.g. scanned, bitmapped) ECG “images” not allowed
• Minimum context– Patient Name and ID– Date/time of recording– Confirmation status of interpretation
• Waveform technical content– Standard calibration “pulse” 1 mv x 200 ms– Nominal 1 mm grid– Lead labels– Frequency response
June 28-29, 2005 Interoperability Strategy Workshop15
Use Case D1: Simple DisplayUse Case D1: Simple Display
• Display actor requests list of ECG documents for a specific patient ID.– RID profile SUMMARY-CARDIOLOGY request returns
list as HTML.
– ECG profile SUMMARY-CARDIOLOGY-ECG request returns list as XML with stylesheet.
• Display actor requests a specific ECG document using a unique document ID.– The ID of the requested document may not have been
obtained from the previously retrieved list.
June 28-29, 2005 Interoperability Strategy Workshop16
Example List as HTMLExample List as HTML
June 28-29, 2005 Interoperability Strategy Workshop17
Use Case D2: Advanced DisplayUse Case D2: Advanced Display
• Display actor requests list of ECG documents for a specific patient ID using ECG profile request type.– List of ECGs returned as structured XML.
• Display actor parses structured document list to select related ECGs for serial comparison, for example.
• Display actor requests the specific ECG documents using the unique document IDs obtained in structured list above.
• Display actor displays the ECGs in a meaningful way.
June 28-29, 2005 Interoperability Strategy Workshop18
ECG XML List ExampleECG XML List Example
June 28-29, 2005 Interoperability Strategy Workshop19
ECG List XML Example Formatted ECG List XML Example Formatted with Stylesheetwith Stylesheet
June 28-29, 2005 Interoperability Strategy Workshop20
ECG List XML ExampleECG List XML ExampleSimple Serial Comparison App.Simple Serial Comparison App.
June 28-29, 2005 Interoperability Strategy Workshop21
Serial Comparison ExampleSerial Comparison Example
23-April-2004 13:45:02
23-April-2004 13:47:45
June 28-29, 2005 Interoperability Strategy Workshop22
More information….More information….
• IHE Web site: www.ihe.netwww.ihe.net• Technical Frameworks, Supplements
• Cardiology Technical Framework • IT Infrastructure Technical Framework • ECG XML List Schema and examples
• Non-Technical Brochures :• Calls for Participation• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Products Integration Statements
June 28-29, 2005 Interoperability Strategy Workshop23
W W W . I H E . N E TW W W . I H E . N E T
Providers and VendorsWorking Together to Deliver
Interoperable Health Information SystemsIn the Enterprise
and Across Care Settings