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

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Oct 06, 2022 120 likes •299 views

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,

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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

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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

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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

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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

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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

My Perspective

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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

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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

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POCUS (Clinic, ED, ICU, etc)
Patient and provider focus
Mobile/telehealth
Global telehealth

Point Of Care Imaging

www.gehealthcare.com/vscan/ Utah Telehealth Network

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CV Workflows: Atrial Fibrillation

CMRI: Gd DE Scarring
Left atrial morphology
LV function
AF ablation mapping
LA appendage thrombus
LA appendage closure

Holmes, Circ CV interventions 2016 Gan, doi.org/10.3892/etm.2016.3745 Higuchi heart.bmj.com/content/100/7/590 Bunch jtd.amegroups.com/article/view/3812

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Valve Regurgitation Guidelines

www.onlinejacc.org/content/70/2/252

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Multispecialty:
CT & Vascular Surgery
Cardiology/Anesthesia/

Radiology

Preop: Valve Clinic multidisciplinary

clinical assessment

Clinical, Echo/TEE/CT
Cath hemodynamics/

angiography

Intraop: hemodynamics,

fluoroscopy, TEE, rhythm monitoring, pacing

Postop: monitoring, Echo

Aortic Stenosis: TAVR

citoday.com/pdfs/cit0317_F3_Jilaihaw

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~350 Data Elements Clinical, Echo, Cath, Outcomes

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Imaging Workflow and EHRs

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

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Imaging Workflow and EHRs

RIS/ Modalities / PACS

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

EHR / PHR

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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