Adam Everyman presents at the electrophysiology (EP) follow-up clinic for his appointment. Adam will present for follow-up 7-10 days after implant and every 3-6 months thereafter, depending on the therapy protocol.

Dr. Ed Electrode, an Electrophysiologist - also referred to as a following physician, and Nancy Nightingale, an R.N., work in the electrophysiology (EP) follow-up clinic.

Note: In the area of Electrophysiology, a "programmer" is a commonly used term to describe a specialized computer that is capable of communicating with an implanted device. Programmers are used to interrogate implanted devices and "program", or make changes to, implanted cardiac device settings.

Nancy places a wand over the implant area. The wand is connected to a programmer that interrogates the device and extracts the data (e.g., settings, status, events) from the device. Nancy reviews the device data and captures the "current state" device data from the programmer screen and/or prints out the settings and/or uses an information transfer mechanism (e.g., floppy disk, analog cable, etc.) to transmit device data, which is in a proprietary format, to a translator system.

If the device data has been sent to the translator system, the clinician may desire to transmit data to the electronic health record (EHR). In this case, a necessary subset (pre-determined by the clinic and the entity responsible for the translator system) of the data that represents the device's 'summary data' is converted from the proprietary format and transmitted using HL7 messaging to the EP office electronic health record system (EHR). This summary data is considered to be a 'snapshot' of the device at a moment in time.

Dr. Ed Electrode reviews the device data and identifies appropriate changes to device settings. Nancy Nightingale makes these changes via the programmer. Nancy then captures the "final state" device data. Nancy then uses the information transfer mechanism to transmit device data, which is in a proprietary format, to a translator system, which again converts the data into an HL7 message and communicates the 'summary data' to the clinic's EHR. This second message will utilize the same HL7 message format as the first.

Note: In this storyboard the "initial state" and "final state"' are really subjective titles for device data at a moment in time. Therefore, there is no need to make a distinction between these two "states" in the message model.

It is important to note that a clinician can initiate one or two HL7 transmissions to the clinic's EHR. This choice is based on a given clinic's workflow. In either case the interaction is the same.

These reports are sent as unsolicited observation events.

A device summary report contains the following items:

• Device Diagnostics - represented by the DeviceTherapy act in the message model

• Events Counters - represented by the PatientObservation act in the message model

• Device Observations (except electrocardiograms) - represented by the DeviceObservation act in the message model

• Programmed Therapy Settings - represented by the DeviceTherapySetting act in the message model

• Clinician Comments - represented by the PatientObservation act in the message model

Portions of the previous storyboard may also apply to Adam Everyman having his device followed remotely. Adam will present to a device located outside of the clinic (e.g., in Adams residence) which will capture the state of his implanted device and will transmit the information to a translator system. The translator system, converts the data into an HL7 message and communicates the 'summary data' to the clinic's EHR.