This is an example of the data that would be used for a Cath-PCI Submission. The full map is a logical model as that allows conformance to the FHIR Standard the way a custom Resource would not. Each element has the short name of the data, a full description and the paths to fetch and place the information, by data standard type, for each. A section (such as Demographics) is a BackboneElement (holds no values). All subordinate elements are strings. Each mapping includes the following:

• identity = standard used for the mapping (e.g., FHIR)
• language = mime type that matches identity
• map = FHIRPath expression of the path to the data
• comment = Output mapping only Profile for inclusion in the Submission Bundle if not the Core resource

Environment Variables used: %patient (Patient resource for the subject of the procedure) %period (Encounter period i.e. Encounter.period) %procedure (Cath PCI Procedure resource) %procedure.period (CathPCI Procedure period i.e., Procedure.performedPeriod)

Adminstrative Data

Code used for reason of submission

ACC Assigned Facilty ID

Software Vendor ID

Vendor Software Version

Status of the Submission, always final

Submission Type, always Episode of Care Record

Time Frame of Data Submission quarter start (e.g., Q2 start date Apr 1)

Registry Identifier

Submission Type

Date and Time of the Submission

Organization Submitting the Record

The Patient who is the subject of this record

Episode information

Indicate the unique key associated with each patient episode record as assigned by the EMR/EHR or your software application.

Health Insurance Provider

Medicare Claim Number

patient requested for their information not to be used for any research or studies for the associated episode of care.

Admitting Provider

Attending Provider

ACC study the patient is currently enrolled

History and Risk Factors

Family History of Premature Coronary Artery Disease

Prior MI Incidence

Prior PCI Incidence

Prior CABG Incidence

Current Cerebrovascual Disease

Current Diabetes Mellitus

Patient on Dialysis

Frailty Scale

Current Chronic Lung Disease

Peripheral Arterial Disease Instance

Hypertension Instance

Dyslipidemia Instance

This is for encoding all smoking status, including quantity

Patient Height

Patient Weight

Cardiac Status

Indicate if a cardiac arrest event occurred outside of any healthcare facility.

Indicate if the out-of-hospital cardiac arrest was witnessed by another person.

Indicate if the out-of-hospital cardiac arrest occurred after arrival of Emergency Medical Services (EMS).

Indicate if the out-of-hospital cardiac arrest occurred after arrival of Emergency Medical Services (EMS).

Indicate if the patient had cardiac arrest at the transferring healthcare facility prior to arrival at the current facility.

CathPCI Procedure Information

Blood Pressure (Systolic)

Results of this query will fill the %Procedure and %procedure.period environment variables

Diagnostic Coronary Angiography

Diagnostic Catheterization Operator

Instance of Left Heart Diagnostic Catheterization

Diagnositic Left Heart Cath LVEF%

Concomitant Procedures Performed

Cumulative Air Kerma

Indicate the total fluoroscopy time recorded to the nearest 0.1-minute.

Indicate the total fluoroscopy dose to the nearest integer. The value recorded should include the total dose for the lab visit.

Indicate if the procedure involved a crossover to a different access site.

Indicate if a venous access was obtained for the purpose of the diagnostic or PCI procedure.

Indicate if a cardiac arrest event occurred at this facility PRIOR to the cath lab visit.

Pre-procedure Information

Indicate if the patient has been diagnosed with heart failure, diagnosis date and the Heart Failure type.

Indicate the patient's latest dyspnea or functional class, coded as the New York Heart Association (NYHA) classification.

Pre-procedure Diagnostic Tests

Indicate the results of the electrocardiac assessment.

Indicate if the patient received a NEW antiarrhythmic therapy PRIOR to evaluation within the cath lab.

Indicate the findings of the electrocardiac assessment.

Last value between 30 days prior to 1st procedure (or previous procedure) and current procedure

Indicate the best estimate of the most recent left ventricular ejection fraction within 6 months of procedure.

Cardiac CTA

Agatston Calcium Score

Indicate if the patient had a prior diagnostic coronary angiography procedure without a subsequent intervention.

Indicate the results of the prior diagnostic coronary angiography.

Heart Rate

Indicate Stress Test Performed and results

Indicate the risk or extent of ischemia for the non-invasive stress test.

Indicate the assigned identification number associated with the medications the patient was prescribed or received.

Responses to the Seattle Angina Questionnaire

Responses to the Rose Dyspnea Scale Questionnaire

Method and Device used for procedure closures

Arterial Access Closure Method

Arterial Access Closure Devices

Preprocedure Lab Results

Indicate the hemoglobin (Hgb) value in g/dL.

Indicate the creatinine (Cr) level in mg/dL.

Indicate the Troponin I result in ng/mL.

Indicate the Troponin I result in ng/mL.

Indicate the cholesterol level mg/dL.

Indicate the cholesterol level mg/dL.

Results of Postprocedure Labs

Indicate the hemoglobin (Hgb) value in g/dL.

Indicate the creatinine (Cr) level in mg/dL.

Indicate the Troponin I result in ng/mL.

Indicate the Troponin I result in ng/mL.

Information Regarding the Cath Lab Procedure

Indicate the patient symptoms or condition prompting the cath lab visit.

Indicate the chest pain symptom assessment as diagnosed by the physician or described by the patient.

Cardiovascular instability includes, but is not limited to, persistent ischemic symptoms (such as chest pain or ST elevation), cardiogenic shock, ventricular arrhythmias, symptoms of acute heart failure, or hemodynamic instability (not cardiogenic shock).

Indicate if the patient required any type of ventricular support (i.e. IV vasopressors or mechanical).

Indicate if the patient required pharmacologic vasopressor support.

Indicate when the mechanical ventricular support device was placed.

Indicate the type of surgery for which the diagnostic coronary angiography is being performed.

Indicate the functional capacity of the patient as documented by the physician in the medical record.

Indicate the surgical risk category as documented by the physician in the medical record.

Instance and Type of Organ Donor

Indicate the severity and cardiac valve(s) with stenosis as diagnosed by the physician.

Valvular Disease Stenosis

Coronary Anatomy

Native Vessel

Native Lesion Segment Number

Indicate the best estimate of the most severe percent stenosis in the segment of the native coronary vessel identified.

Indicate if an invasive diagnostic measurement was obtained of the native vessel segment.

Indicate the instantaneous wave-free ratio (iFR ratio) of the native vessel segment.

Graft Vessel

Graft Lesion Segment Number

Indicate the best estimate of the most severe percent stenosis in the segment of the graft coronary vessel identified.

Indicate the vessel that was used for the coronary artery bypass graft.

Indicate if an invasive diagnostic measurement was obtained of the graft vessel intra-procedure.

Indicate the instantaneous wave-free ratio (iFR ratio) of the graft vessel segment.

information regarding the PCI Procedure

Indicate the status of the PCI. The status is determined at the time the operator decides to perform a PCI.

Indicate when hypothermia was initiated.

Indicate if a cardiac surgical consult was obtained prior to engaging in PCI.

Indicate the cardiovascular surgery recommendation and/or patient/family decision.

Indicate if the PCI procedure was performed in the presence of multi-vessel disease.

Indicate the type of multi-vessel PCI procedure that was performed during this lab visit.

Indicate the reason the percutaneous coronary intervention PCI is being performed.

Acute Coronary Syndrome Symptom

Indicate the Syntax Score for the PCI procedure.

Indicate if a STEMI or STEMI equivalent was noted on either the first ECG or a subsequent ECG.

Indicate the Subsequent ECG date and time.

Indicate if the subsequent ECG was obtained in the Emergency Department at this facility.

Indicate if the patient was transferred from another facility to have a primary PCI for STEMI at this facility.

Code the date and time of arrival to the original, transferring facility as documented in the medical record.

Indicate the date and time the first device was activated regardless of type of device used.

Use the earliest time from the following:

1. Time of the first balloon inflation.
2. Time of the first stent deployment.
3. Time of the first treatment of lesion (AngjoJet or other thrombectomy/aspiration device, laser, rotational atherectomy).
4. If the lesion cannot be crossed with a guidewire or device (and thus none of the above apply), use the time of guidewire introduction. This is a process measure about the timeliness of treatment. It is NOT a clinical outcomes measure based on TIMI flow or clinical reperfusion. It does not matter whether the baseline angiogram showed TIMI 3 flow or if the final post-PCI angiogram showed TIMI 0 flow. What is being measured is the time of the first mechanical treatment of the culprit lesion, not the time when TIMI 3 flow was (or was not) restored.

Indicate the patient-centered reason for delay in performing the percutaneous coronary intervention (PCI), if needed.

The operator who is performing the PCI procedure

Indicate the location of percutaneous entry for the procedure.

Indicate if the patient required mechanical ventricular support.

Indicate the mechanical ventricular support device used.

Medications administred intra-procedure

Information on the Lesions treated and Devices Used

The lesion counter is used to distinguish between multiple lesions on which a PCI is attempted or performed.

When specifying intracoronary devices, list all treated lesions in which the device was utilized. The software-assigned lesion counter should start at one and be incremented by one for each lesion. The lesion counter is reset back to one for each new PCI lab visit. At least one lesion must be specified for each PCI procedure.

Indicate the segment that the current lesion spans.

Indicate if the stenosis is considered to be responsible for the acute coronary syndrome.

Indicate the percent diameter stenosis immediately prior to the treatment of this lesion.

Indicate if the segment with 100% pre-procedure stenosis was presumed to be 100% occluded for at least 3 months previous to this procedure AND not related to a clinical event prompting (or leading to) this procedure.

Indicate the pre-intervention TIMI flow.

If a lesion spans multiple segments with different TIMI flow, code the lowest TIMI flow within the entire lesion.

Indicate the date the lesion has been treated in a prior episode of care.

Indicate if the previously treated and stented lesion is being treated for in-stent restenosis.

Indicate if the previously treated and stented lesion is being treated because of the presence of a thrombus in the stent.

Indicate the type of stent used in the previously treated lesion.

If a patient has multiple stents in the lesion code 'bioabsorbable' over either of the other two options when it is present.
If a DES and BMS are present in the lesion, code 'DES'.

Indicated if the lesion is in a coronary artery bypass graft.

Indicate in which type of bypass graft the lesion is located.

Indicate the location of the most severe stenosis, if the lesion is in the graft.

Indicate if treatment of the native artery lesion required navigating through a graft (to reach the lesion).

Indicate the complexity of the lesion

Indicate the length of the treated lesion in millimeters.

If the lesion length is not available it is acceptable to code the length of the device used to treat the lesion.

If multiple devices are used sequentially, total the individual device lengths.

Information obtained after the baseline angiogram can be used to help determine lesion length (e.g. for total occlusions where the distal vessel can not be visualized).

Indicate if there was severe calcification of the lesion.

Indicate if a guidewire successfully crossed the lesion.

Indicate if a device was deployed during the procedure.

Indicate the post-intervention percent stenosis for the treated lesion.

Indicate the post-intervention TIMI flow.

Devices used during the PCI procedure

Indicate the devices utilized during the current procedure.

Events occuring Intra and post-procedure

Indicate the event that occurred between the procedure and the next procedure or discharge.

Indicate the post-intervention TIMI flow.

Indicate the number of transfusion(s) of packed red blood cells.

Discharge Information

Indicate other interventions (percutaneous or surgical) that occurred during this hospitalization.

Indicate the status of the coronary artery bypass graft (CABG) surgery.

Indicate the reason coronary artery bypass graft (CABG) surgery is being performed.

Provider that discharged the patient

Indicate if the patient was transferred for the purpose of performing a coronary artery bypass graft.

Indicate if the patient has a CABG planned after discharge.

Indicate if there was written documentation of a referral for the patient (by the physician, nurse, or other personnel) to an outpatient cardiac rehabilitation program, or a documented medical or patient-centered reason why such a referral was not made.

Indicate if the patient expired during the procedure.

Make sure to only capture 'Death during the procedure' in the procedure appropriate registry. For example, if the patient had a CathPCI procedure and a TVT procedure in the same episode of care (hospitalization) but different cath lab visits and the death occurred during the TVT procedure. Code 'Yes' only in the TVT Registry and not the CathPCI Registry. If the CathPCI procedure and TVT procedure occurred during the same cath lab visit then code 'Yes' in both registries.

Indicate if the medication reconciliation was completed as recommended by the Joint Commission's National Patient Safety Goals.

Indicate the specific medication classes that were reconciled.

This is an example of the data that would be used for a Cath-PCI Submission. The full map is a logical model as that allows conformance to the FHIR Standard the way a custom Resource would not. Each element has the short name of the data, a full description and the paths to fetch and place the information, by data standard type, for each. A section (such as Demographics) is a BackboneElement (holds no values). All subordinate elements are strings. Each mapping includes the following:

• identity = standard used for the mapping (e.g., FHIR)
• language = mime type that matches identity
• map = FHIRPath expression of the path to the data
• comment = Output mapping only Profile for inclusion in the Submission Bundle if not the Core resource

Environment Variables used: %patient (Patient resource for the subject of the procedure) %period (Encounter period i.e. Encounter.period) %procedure (Cath PCI Procedure resource) %procedure.period (CathPCI Procedure period i.e., Procedure.performedPeriod)

Adminstrative Data

Code used for reason of submission

ACC Assigned Facilty ID

Software Vendor ID

Vendor Software Version

Status of the Submission, always final

Submission Type, always Episode of Care Record

Time Frame of Data Submission quarter start (e.g., Q2 start date Apr 1)

Registry Identifier

Submission Type

Date and Time of the Submission

Organization Submitting the Record

The Patient who is the subject of this record

Episode information

Indicate the unique key associated with each patient episode record as assigned by the EMR/EHR or your software application.

Health Insurance Provider

Medicare Claim Number

patient requested for their information not to be used for any research or studies for the associated episode of care.

Admitting Provider

Attending Provider

ACC study the patient is currently enrolled

History and Risk Factors

Family History of Premature Coronary Artery Disease

Prior MI Incidence

Prior PCI Incidence

Prior CABG Incidence

Current Cerebrovascual Disease

Current Diabetes Mellitus

Patient on Dialysis

Frailty Scale

Current Chronic Lung Disease

Peripheral Arterial Disease Instance

Hypertension Instance

Dyslipidemia Instance

This is for encoding all smoking status, including quantity

Patient Height

Patient Weight

Cardiac Status

Indicate if a cardiac arrest event occurred outside of any healthcare facility.

Indicate if the out-of-hospital cardiac arrest was witnessed by another person.

Indicate if the out-of-hospital cardiac arrest occurred after arrival of Emergency Medical Services (EMS).

Indicate if the out-of-hospital cardiac arrest occurred after arrival of Emergency Medical Services (EMS).

Indicate if the patient had cardiac arrest at the transferring healthcare facility prior to arrival at the current facility.

CathPCI Procedure Information

Blood Pressure (Systolic)

Results of this query will fill the %Procedure and %procedure.period environment variables

Diagnostic Coronary Angiography

Diagnostic Catheterization Operator

Instance of Left Heart Diagnostic Catheterization

Diagnositic Left Heart Cath LVEF%

Concomitant Procedures Performed

Cumulative Air Kerma

Indicate the total fluoroscopy time recorded to the nearest 0.1-minute.

Indicate the total fluoroscopy dose to the nearest integer. The value recorded should include the total dose for the lab visit.

Indicate if the procedure involved a crossover to a different access site.

Indicate if a venous access was obtained for the purpose of the diagnostic or PCI procedure.

Indicate if a cardiac arrest event occurred at this facility PRIOR to the cath lab visit.

Pre-procedure Information

Indicate if the patient has been diagnosed with heart failure, diagnosis date and the Heart Failure type.

Indicate the patient's latest dyspnea or functional class, coded as the New York Heart Association (NYHA) classification.

Pre-procedure Diagnostic Tests

Indicate the results of the electrocardiac assessment.

Indicate if the patient received a NEW antiarrhythmic therapy PRIOR to evaluation within the cath lab.

Indicate the findings of the electrocardiac assessment.

Last value between 30 days prior to 1st procedure (or previous procedure) and current procedure

Indicate the best estimate of the most recent left ventricular ejection fraction within 6 months of procedure.

Cardiac CTA

Agatston Calcium Score

Indicate if the patient had a prior diagnostic coronary angiography procedure without a subsequent intervention.

Indicate the results of the prior diagnostic coronary angiography.

Heart Rate

Indicate Stress Test Performed and results

Indicate the risk or extent of ischemia for the non-invasive stress test.

Indicate the assigned identification number associated with the medications the patient was prescribed or received.

Responses to the Seattle Angina Questionnaire

Responses to the Rose Dyspnea Scale Questionnaire

Method and Device used for procedure closures

Arterial Access Closure Method

Arterial Access Closure Devices

Preprocedure Lab Results

Indicate the hemoglobin (Hgb) value in g/dL.

Indicate the creatinine (Cr) level in mg/dL.

Indicate the Troponin I result in ng/mL.

Indicate the Troponin I result in ng/mL.

Indicate the cholesterol level mg/dL.

Indicate the cholesterol level mg/dL.

Results of Postprocedure Labs

Indicate the hemoglobin (Hgb) value in g/dL.

Indicate the creatinine (Cr) level in mg/dL.

Indicate the Troponin I result in ng/mL.

Indicate the Troponin I result in ng/mL.

Information Regarding the Cath Lab Procedure

Indicate the patient symptoms or condition prompting the cath lab visit.

Indicate the chest pain symptom assessment as diagnosed by the physician or described by the patient.

Cardiovascular instability includes, but is not limited to, persistent ischemic symptoms (such as chest pain or ST elevation), cardiogenic shock, ventricular arrhythmias, symptoms of acute heart failure, or hemodynamic instability (not cardiogenic shock).

Indicate if the patient required any type of ventricular support (i.e. IV vasopressors or mechanical).

Indicate if the patient required pharmacologic vasopressor support.

Indicate when the mechanical ventricular support device was placed.

Indicate the type of surgery for which the diagnostic coronary angiography is being performed.

Indicate the functional capacity of the patient as documented by the physician in the medical record.

Indicate the surgical risk category as documented by the physician in the medical record.

Instance and Type of Organ Donor

Indicate the severity and cardiac valve(s) with stenosis as diagnosed by the physician.

Valvular Disease Stenosis

Coronary Anatomy

Native Vessel

Native Lesion Segment Number

Indicate the best estimate of the most severe percent stenosis in the segment of the native coronary vessel identified.

Indicate if an invasive diagnostic measurement was obtained of the native vessel segment.

Indicate the instantaneous wave-free ratio (iFR ratio) of the native vessel segment.

Graft Vessel

Graft Lesion Segment Number

Indicate the best estimate of the most severe percent stenosis in the segment of the graft coronary vessel identified.

Indicate the vessel that was used for the coronary artery bypass graft.

Indicate if an invasive diagnostic measurement was obtained of the graft vessel intra-procedure.

Indicate the instantaneous wave-free ratio (iFR ratio) of the graft vessel segment.

information regarding the PCI Procedure

Indicate the status of the PCI. The status is determined at the time the operator decides to perform a PCI.

Indicate when hypothermia was initiated.

Indicate if a cardiac surgical consult was obtained prior to engaging in PCI.

Indicate the cardiovascular surgery recommendation and/or patient/family decision.

Indicate if the PCI procedure was performed in the presence of multi-vessel disease.

Indicate the type of multi-vessel PCI procedure that was performed during this lab visit.

Indicate the reason the percutaneous coronary intervention PCI is being performed.

Acute Coronary Syndrome Symptom

Indicate the Syntax Score for the PCI procedure.

Indicate if a STEMI or STEMI equivalent was noted on either the first ECG or a subsequent ECG.

Indicate the Subsequent ECG date and time.

Indicate if the subsequent ECG was obtained in the Emergency Department at this facility.