DI Common Service and IHF, Progress Report
Building Bridges; Removing Silos
Working Towards an Integrated Health
Delivery System
Angela Lianos, Director, Diagnostic Imaging Program
September 20, 2013
DIAGNOSTIC IMAGING
BACKGROUND Pre-2012, lack of an effective way of sharing
diagnostic reports and/or images between physicians in acute care settings, family physicians, and independent health facilities (IHFs), resulting in a difficult patient experience
Unnecessary movement Unnecessary diagnostic imaging (DI) procedures
In 2012, eHealth Ontario embarked on a pilot initiative to incorporate nine IHF hubs representing 47 facilities into the existing regional DI-rs (integrated with all hospitals in Ontario) prior to moving forward with additional IHFs
The goal of the pilots was to address the lack of online sharing between these sectors in an accelerated fashion, resulting in a more seamless workflow for clinicians and a better experience for patients
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INFOWAY PHASE
(Independent Health Facility)
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DI-r
Geographic coverage
SWODIN DI -rLHINs 1,2,3,472 hospital sites
NEODIN DI -rLHINs 11,13,1467 hospital sites
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HDIRS DI -rLHINs part of 7, 8,9,1038 hospital sites
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GTA West DI -rLHINs 5,6,part of 7, 1235 hospital sites
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LANDSCAPE –DI-rs
LHINs
1. Erie St. Clair2. South West3. Waterloo Wellington4. Hamilton Niagara
Haldimand Brant5. Central West6. Mississauga Halton7. Toronto Central8. Central9. Central East10. South East11. Champlain12. North Simcoe
Muskoka13. North-East14. North-West
BENEFITS – INTEGRATION OF IHFs & HOSPITALS TO DI-rs Increased collaboration between acute and
community care sectors Removal of geographic barriers Increased access to information digitally from a
shared regional DI-r without delay, leading to a more seamless workflow
Reduced burden on the imaging centre (for example, to burn CDs, answer calls, search for previous exams) resulting in workflow efficiencies
Reduction in unnecessary duplicate exams and a subsequent reduction in unnecessary radiation exposure as previous results are available and viewable
Better patient experience as a result of not having to travel between different care providers to obtain information
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CURRENT STATE CHALLENGES/OPPORTUNITIES The four DI repositories are currently self-
contained Diagnostic imaging results can only be accessed within
the regional repository where the diagnostic exam originated
There is clinical demand for cross-regional sharing (interoperability)
Access to DI repositories is not enabled for community-based healthcare providers where over 80% of care occurs There is clinical demand for access to DI repositories from
referring physicians, general practitioners, specialists in community-based settings
~20,000 physicians do not have immediate online access to current and prior DI information to assist them in making timely treatment decisions
Independent health facilities (IHFs) cross regional boundaries IHF organizations often span DI-r boundaries
DI COMMON SERVICE VISION
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GTA West DIagnostic Imaging Repository
(DI-r)35 hospital sites
133 IHFs
NEODIN Diagnostic Imaging Repository
(DI-r)67 hospital sites
78 IHFs
HDIRS Diagnostic Imaging Repository
(DI-r)38 hospital sites
264 IHFsSWODIN Diagnostic Imaging Repository
(DI-r)72 hospitals sites
143 IHFs
Hospital/Imaging Clinics
Hospital/Imaging Clinics
Diagnostic Imaging Common Service(set of Interfaces that allows DI-rs to
exchange messages and allows Integration with portal-based viewers/
portlets and physician EMRS)
Reports and
images
Reports and
images
Reports and
images
Reports and
images
Hospital/Imaging Clinics
Hospital/Imaging Clinics
To enable and support the sharing and viewing of images and reports across Ontario to all hospital- and community-basedproviders anytime, anywhere, using the tools best suited to theirwork practice
DI COMMON SERVICE BENEFITS Immediate online access to information by all
authorized healthcare providers regardless of location, addressing clinical demand ~12,400 referring physicians/specialists currently do not
have this access thereby delaying treatment decisions ~11,700 general practitioners do not have this access
thereby delaying the appropriate follow-up
Elimination of geographic barriers through interoperability of DI-rs
Improved reporting capabilities leading to quicker diagnoses
Timely access to DI information leading to improved access to care
Reduction in unnecessary duplicate DI exams leading to a corresponding reduction to unnecessary radiation exposure and associated costs 7
RELEASE 1 Release 1 will enable storage and sharing of DI reports across DI-r
boundaries to portal communities which encompass all types of providers including community-based and hospital-based physicians
This release will deliver foundational change, spanning a number of eHealth Ontario common services and DI-rs, that will support incremental and iterative future DI CS releases
A number of eHealth Ontario common services will be leveraged: PCR, PR, UR IF (interim HIAL)
Cross-Enterprise Document Sharing (XDS) and an XDS registry will be implemented which will support search and discovery of DI information across the province of Ontario. All DI reports will be stored and retrievable
A new portal-based access channel will be introduced through a new DI portlet and enhancements to the existing Client Selector portlet; this portlet can be inserted into any compliant portal, including the regional portals (e.g. cGTA)
DI-rs will continue to be the authoritative source of DI information
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RELEASE 2
Release 2 will provide viewer-based access to DI results via a provincial DI viewer that can be launched as standalone or in context from portal-based applications and desktop applications
Supports discovery, retrieval, and viewing of DI images and reports
Supports a feature-rich set of tools for viewing and manipulating diagnostic images – a key function in making treatment decisions
XDS-i will be implemented which will support search and discovery for DI images across the province of Ontario. All DI images will be stored and retrievable.
Additional eHealth Ontario common services will be leveraged
Terminology MCTA (provincial audit repository) CMP (provincial consent registry) 9
RELEASE 3
Release 3 will enable the EMR access channel which will allow for DI reports to be viewable within EMRs and the ability to launch images via a viewer (part of Release 2) while maintaining context
This release will support the: ad-hoc discovery and retrieval of DI reports from DI Common
Service automatic propagation of reports and report updates to EMRs
(pub-sub) federated identity access management solution
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RELEASE 4* Release 4 will enable the PACS-based access channel
primarily to provide (or enhance) seamless PACS-based access to DI results, including:
Seamless reading of local exams from PACS with foreign prior exams from DI-rs
The ability to pre-fetch relevant prior exams from DI-rs to local PACS
Ad-hoc discovery and retrieval of patient exams of interest from DI-rs to local PACS
Foreign Exam Management (FEM) to support the ingestion of foreign exams by a local PACS
This release will primarily improve the workflow of radiologists and other heavy PACS-based users
*Prior to this an analysis will be conducted to assess costs, benefits, and technology
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HIGH-LEVEL TARGET TIMELINES
Release 1 Production implementation, Spring/Summer 2014
Release 2 Production implementation, Fall/Winter 2014
Release 3 Production implementation, Spring 2015
Release 4 Production implementation, Summer 2015
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CURRENT STATE
99% of hospitals that perform diagnostic imaging procedures are integrated with a regional diagnostic imaging repository (DI-r)
~1 million exams out of a total of over 3.4 million acquired in digitally-enabled independent health facilities (IHFs) are captured in a DI-r, in the first year of integration
Procurement of XDS registry for DI Common Service completed
Procurement of XDS repository for DI Common Service in progress
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QUESTIONS