Trend Tracker | IHE Cardiology: A Framework to Facilitate Cardiac Care

Tired of waiting? Try being a doctor for a change, rather than a patient. If you are a cardiologist waiting for an all-encompassing IT solution that is based on the real-world aspects of your practice and patient flows, well, pull up a chair, it's going to be a while longer.

But first recognize that the wait is not due to delays and foot-dragging on the part of bottom-line focused IT vendors. In fact, many well-known brand names in the field of cardiology imaging, networks and healthcare IT are investing real resources and addressing interoperability issues. In fact, they are directly building solutions to clinical cardiology problems that involve the coordination of data and transactions across multiple devices from different manufacturers. This is a task that can not be pulled off by any individual company working alone, thus giving rise to the opportunity to employ a unique framework developed seven years ago in the radiology market.

Many in this industry have already been introduced to IHE - Integrating the Healthcare Enterprise - as an effort to provide solutions that work across the spectrum of manufacturers and clinical care settings. While IHE started in radiology, it has now spread to many different areas of clinical specialties, including cardiology. At the most recent American College of Cardiology meeting in March in Orlando, IHE Cardiology made its debut with a demonstration of products and solutions - and these products are now available for purchase.

And, much like the over-used Titanic analogy, there is far more to IHE Cardiology (thanks to the Radiological Society of North America and Healthcare Information Management Systems Society), as it now has published the Year 2 Technical Framework and plans for the Connectathon (product testing for interoperability) and ACC 2006 Demonstration. IHE Cardiology efforts also extend to Japan and Europe, where the recently concluded European Society of Cardiology meeting in Stockholm included an IHE Cardiology Demonstration Area, bringing this approach to the front-line European based cardiologists.  

In quick summary form, Year 1 of IHE Cardiology delivered a series of building block Integration Profiles that gained impressive reviews for functionality:

• Cath Lab Workflow: Enabling the coordination of this multi-modality environment, synchronizing data and demographics in many real-world settings for unscheduled and emergency procedures.
• Echo Lab Workflow: Enabling the scheduling and management of exams in a mobile and emergency care setting, handling imaging systems that are intermittently connected to the network and also multi-stage stress exams.
• Retrieve ECG for Display: Allowing rapid access to ECG exams using web technology.

Year 2 of IHE Cardiology continues this effort, and is focused on several topics of high interest to cardiology practices, including workflow extensions to the previous Year 1 Integration Profiles. These extensions, scheduled for demonstration at the ACC 2006 meeting, include:

• Displayable reports: The ability to transfer and display any report (cardiac cath lab, echocardiography lab, nuclear medicine, ECG, electrophysiology lab) as a pdf file.
• Evidence Documents: The ability to utilize measurements and discrete data from cardiac cath lab and echo lab procedures.
• Cross Domain Document Sharing: The ability to share documents, e.g. between a cardiologist's office and the hospital care setting.

And yes, there is even more effort already underway for Year 3 of IHE Cardiology, following a five-year roadmap (see chart on previous page) that guides the overall direction of the group. A Portable Integrated Cardiac Record looks to be an interesting development as well.

The IHE Cardiology Roadmap represents a substantive document for everyone involved in cardiology, including practicing physicians, manufacturers, consultants and IT professionals. The direction is clearly set by cardiologists, and the work is carried out by vendors. Users are next, as they are now being invited to step up and begin specifying and buying IHE-enabled products. The more you know about IHE, the better prepared you are to use it to your advantage. Obviously, you don't need IHE to have a successful cardiology practice. Or maybe you'd rather still be using a slide rule and recalling how life was simpler in the good old days. Probably not, so please, let's use technology and developments when they prove themselves appropriate. The smart money is now being waged on adding IHE functionality to as many parts of the healthcare enterprise as soon as possible.

The workflow benefits appear to be substantial, the error rates will likely drop and patient care routines will be made far more efficient. It is time to abandon the white boards that form the backbone of scheduling systems in cardiology labs and practices. So, wait if you choose, but your competition won't.

There is substantial information available regarding both IHE and IHE Cardiology, which can be most easily found at www.ihe.net. You also can find the latest cardiology specific data via the ACC web site, under the Quality section.

Douglas F. Orr is principal of J&M Group. Send Trend Tracker questions and comments to dforr@aol.com.