SIIM 2018 Cardiovascular Informatics: Imaging and Workflows - PowerPoint PPT Presentation

SIIM 2018 Cardiovascular Informatics: Imaging and Workflows Session Co-chairs: Bruce Bray and David Piraino Presenters: Bruce Bray, MD, FACC, University of Utah Brian Choi, MD, MBA, FACC, George Washington University Neil Greenberg, PhD, Cleveland Clinic

Co-chairs / Presenters: Bruce Bray, MD, FACC Professor, Biomedical Informatics and Cardiovascular Medicine University of Utah School of Medicine Neil Greenberg, PhD Biomedical Engineer Heart and Vascular Institute Cleveland Clinic

Objectives This session will provide a brief introduction to current informatics topics in the cardiovascular (CV) domain with an emphasis on: • CV perspective on imaging workflows • Structured reporting • Clinical decision support • Advanced imaging modalities from a cardiology perspective • Note: CV imaging Roundtable Discussion on Saturday, 9:45am

Presentation Outline Overview of CV imaging workflows • Point of Care and Mobile CV imaging • Integrating feature extraction • Imaging guidance for interventional procedures. • Atrial fibrillation • AS, AVR/TAVR • Structured Reporting • Clinical decision making and advanced CV imaging in CAD

My Perspective • Cardiologist • Patient focus vs Modality/Procedure focus • Consulting/teaching • Non-invasive Imaging • Outreach / telemedicine • CV “Phenotyper” • Clinical Informaticist • Value Driven Outcomes: Value = (Quality+Service)/Cost • “Feature Extraction” from multiple sources (including images) • Clinical outcome measurement/automation • Information Integration (EHR, EDW, PACS/RIS) • Informatics Standards: HL7/DICOM/IHE/LOINC/SNOMED • Structured reporting • Clinical and translational research • Socio-Technical Systems / Cognitive Support • Clinical Decision Support • Consumer Health Informatics /Health Literacy

CV Imaging Themes • MultiModality • ECG/EP, CXR, TTE/TEE/ICE, Doppler, Strain, CCT/CCTA, MR/MRA, Fluoro/Angio, Nuc/SPECT/PET, 3D, Fusion, Path/Biopsy • Motion • Cine loop, Physiology (hemodynamics) • Stress, temporal trends • Interventional procedure guidance/monitoring • Measurement • Quantify anatomy/physiology • “Feature Extraction” from multiple sources • Integrated into clinical guidelines/decision making • Multidisciplinary • Cardio/CT/Vasc surg/CV Rad/Int Rad/Anesthesia/Crit Care/ED

Example Clinical CV Workflows: • Point of Care and Mobile CV imaging • Atrial Fibrillation • Valve Disease - Aortic Stenosis: TAVR • Clinical Trials/QI data management (Structured Reporting) • Ischemic Heart Disease Imaging Decision Support

Utah Telehealth Network Point Of Care Imaging • POCUS (Clinic, ED, ICU, etc) • Patient and provider focus • Mobile/telehealth • Global telehealth www.gehealthcare.com/vscan/

CV Workflows: Atrial Fibrillation • CMRI: Gd DE Scarring • Left atrial morphology • LV function • AF ablation mapping • LA appendage thrombus Higuchi heart.bmj.com/content/100/7/590 • LA appendage closure Holmes, Circ CV interventions 2016 Bunch jtd.amegroups.com/article/view/3812 Gan, doi.org/10.3892/etm.2016.3745

Valve Regurgitation Guidelines www.onlinejacc.org/content/70/2/252

Aortic Stenosis: TAVR • Multispecialty: • CT & Vascular Surgery • Cardiology/Anesthesia/ Radiology • Preop: Valve Clinic multidisciplinary clinical assessment • Clinical, Echo/TEE/CT • Cath hemodynamics/ angiography citoday.com/pdfs/cit0317_F3_Jilaihaw • Intraop: hemodynamics, fluoroscopy, TEE, rhythm monitoring, pacing • Postop: monitoring, Echo

~350 Data Elements Clinical, Echo, Cath, Outcomes

Imaging Workflow and EHRs • Clinic Visit • Clinical Decisions • Differential Dx • Clinical Decision Support • Imaging Order • Patient Communication • Scheduling • Outcome Measurement • Acquisition • Clinic Follow-up • Interpretation • Reporting • Communication

Imaging Workflow and EHRs • Clinic Visit • Clinical Decisions • Differential Dx • Clinical Decision Support • Imaging Order • Patient Communication • Scheduling • Outcome Measurement • Acquisition • Clinic Follow-up • Interpretation EHR / PHR • Reporting • Communication RIS/ Modalities / PACS

CV Imaging Themes Summary • Multidisciplinary, Multimodality, Motion, Measured, Mobile • Anatomy + Physiology = precision phenotype/assessment • Workflow integration (EHR and PACs) • Structured Reporting for workflow/QI/Decision Support /PopHealth/Research • Learning Health System