helping communities move toward a collaborative care model
DESCRIPTION
This is a Centricity Live 2013 conference session presentation, featuring GE Healthcare's experience with regional Image exchanges.TRANSCRIPT
Helping Communities Move Toward a Collaborative Care Model
GE Healthcare’s Experience with Regional Image Exchanges
David Roeder
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Agenda
• Moving towards Collaborative Care
• GE Healthcare’s experience with Image Exchanges (IX)
• Southwest Ontario: A successful Image Exchange
• What does success look like?
• Interoperability
• Implementation partner
• Commitment to standards
• What’s next?
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The Move To Collaborative Care
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Healthcare costs are rising
• Ageing population and chronic diseases increase demand
• Waste-redundant procedures due to fragmentation
• Healthcare cost in excess of 10% of GDP (U.S. 17.6%)1
Shortage of skilled specialists
• Healthcare in rural areas
• Unbalanced Public-Private staffing
• Diagnosis turnaround time
Incomplete data may create quality issues
• Duplicate imaging
• Unnecessary patient transfers
1- Source: OECD Health Data, 2012 - http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html
Today, an unsustainable healthcare model across the globe
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From
Episodic, single-patient care Continuous population management
Provider-centric Patient-centric
Fee-for-service Payment for value
Silos Systems
To
Focus on improving quality of care at lower cost
Resulting in a paradigm shift…
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Evidence-based care
Patient engagement
Population health
Care coordination workflows
Outcome driven
Quality measurement
& improvement
Patient
Silos of data; Hospital-centric; Closed systems • Payer • Hospital • Ambulatory • Patient
Work flow & analytics focus; Support of distributed care; Open & interoperable
Shift means new healthcare delivery ecosystems are required.
…that is driving an evolution toward collaborative care
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Benefits Key Initiatives
Access to relevant priors in other PACS
Cross community clinical access
Enable ED & remote expertise reading
Distribute reporting
Helps improve competitiveness
Helps improve report
turn around time
Helps improve workload sharing
Helps reduce patient transfers
Helps inform clinical
decision making
Helps reduce duplicate exams
Reduce vendor complexities
Consolidate access to patient data
Investments shift from
Hospitals to Communities &
Regions
Technology shift to Data sharing & Workflow sharing
(Regional infrastructures)
Impact
Imaging is helping lead the transformation
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GE Healthcare and Collaborative Care
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GE Healthcare is partnering with regional healthcare organizations to demonstrate the positive impact of community-based image exchanges.
Image Exchange leverages: • Standards-based technology
• Extensible and scalable platform
• Strength and history in imaging IT
• Expertise integrating heterogeneous HIT environments
Radiologists
Clinicians
GPs
IX
Performance tools Analytics – Patient flow
Vendor neutral archive
Store and exchange data
Information sharing
Access patient data, anywhere1
Collaborative workflows
Distributed reporting
1- Where there is an internet connection available.
Community-based Image Exchanges
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Objective • Central repository of images and reports
• Immediate access to prior images and reports from the whole region
• Primary viewing platform outside imaging
• Improved imaging workflow
Solution • Common repository across 17 hospitals
• IHE standards
• Web access to images and reports
• ASP model since 2006
• Sweden’s second largest region
• 1.5 million residents
• 17 hospitals
• Heterogeneous RIS/PACS systems
Västra Götaland Region (VGR, Sweden)
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Ile de France (France)
Objective (regions sans film)
• Leapfrog Paris region to HIT
• Sharing imaging results
• Help improve care quality through collaboration
• No more film or CD
Solution • Standards based information repository
• Data center
• 24 x 7 high availability service
• SAAS model – pay per use
• 12 million patients, 500+ radiologists
• 30 hospitals growing to 90
• Multi-vendor RIS-PACS systems (PACS: Carestream, Telemis, GE; RIS: EDL, Waid, local)
• Standards compliance (DICOM, IHE, HL7)
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Southwestern Ontario VNA & workflow sharing
Ile De France Cloud archive + information sharing
Singapore VNA + information sharing
VGR, Sweden VNA + information sharing+ collaborative workflows
HA, Hong Kong VNA + information sharing
North Eastern Ontario VNA & workflow sharing
Waldviertel, Austria Collaborative workflows
GE Healthcare is helping deploy a collaborative care model across the globe
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Southwestern Ontario:
Collaborative care in Canada
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Two of four Image
Exchange projects storing all hospital diagnostic images in Canada’s largest province (15 million people).
Northwest Territories
Yukon
British Columbia
Alberta
Manitoba
Ontario
Quebec
New Brunswick Nova
Scotia
PEI
Nunavut
Southwest Ontario (SWO)
North & East Ontario (NEO)
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One of four Image Exchange projects
Northwest Territories
Yukon
British Columbia
Alberta
Manitoba
Ontario
Quebec
New Brunswick Nova
Scotia
PEI
Nunavut
Southwest Ontario (SWO)
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To improve patient care through image/report sharing by care
providers across a region between Windsor/Detroit and Niagara Falls • Help enhance care provider productivity
• Centralize patient records
• Help reduce patient transfers
• Help reduce duplicate exams
• Help optimize storage infrastructure cost savings
SWO Project Goals
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A cancer patient is referred by a clinician at Windsor Regional Hospital (WRH) to an oncologist at London Health Sciences (LHSC). The oncologist needs:
Consult of a Referred Patient
• Patient CT from Windsor hospital for radiation and treatment planning
• To gather priors across all hospitals for future MDT meetings and clinical decisions
Clinical scenarios for collaboration
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A stroke case in a small hospital in Goderich requires immediate consultation and a transfer decision. This requires:
Trauma transfer from community hospital
• Images need to be shared with a remote specialist for transfer decision
• The intake specialist (ortho, surgeon, etc.) at the remote trauma center needs access to priors to create a treatment plan
Clinical scenarios for collaboration
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SWO Image Exchange
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7 PACS vendors
5 RIS vendors
• 62 hospital locations
• 19 hubs with separate RIS/PACS
• 3.2 million exams/year; 120TB/year
• 1600+ system users
• H/W redundant, disaster recovery
• High availability, dual data centers
SWO Architecture
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• Helps optimize turn-around on treatment decisions
• Helps make more informed decisions More robust patient jacket,
no matter where imaging was performed.
• Helps breakdown CD workflow challenges Incompatible viewers, import errors, delays
• Helps enhance test efficiencies Images available, anywhere, anytime1
• Helps enhance patient care experience Fewer transfers, smooth care workflow
1- Where there is an internet connection available.
Clinical benefits achieved
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• Centralized storage management Helps enhance management cost efficiencies/TB versus local archives
• Reliability and disaster recovery Helps enhance cost avoidance at local sites for reliable dual data centers
• Exam duplication reduction Eliminate 3% exams annually (90,000)*
• Reduce CD transfers and admin overhead Cost is the management, not media
• Patient transfer efficiencies Savings estimated at annual $10 Million for ENITS‡
*Savings estimate per 2008 True North Assoc. Infoway study. ‡ Emergency Neuro Imaging Transfer System for trauma consult use cases.
Economic benefits
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Success factor 1: Interoperable
solutions
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Application neutral (DICOM,HL7,IHE) • Rapid & predictable implementation
• Store information in native format
IT platform neutrality (Virtualize, ZFP) • Leverage the continuous improvement in
infrastructure technology to lower cost
• Preserve your existing investment
Format neutrality (DICOM, IHE-XDS) • Access information in multiple formats
• Access information anywhere, anytime1
Objects
NAS CAS
SAN
CentricityTM Clinical Archive
DICOM, PDF, ECG, EEG,
endoscopy, photos,…
PACS/RIS LAB
Departmental systems
Enterprise systems
Others
HIS EMR
IT Platform Neutral
Application Neutral
DICOM, HL7, IHE-XDS, WADO
Format Neutral
1- Where there is an internet connection available.
Multi-level neutrality is important
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Exam storage in a sharable format • GSPS, KIN
• DICOM part-10 storage
Maintaining data quality • Synchronize PACS and Vendor Neutral Archive
(exam updates, merges, rejects)
• Avoid exam modifications in proprietary ways
Desktop integration • Context launch of Viewer from radiologist PACS or
physician EMR, helps enhance adoption
• Zero-footprint viewers
VNA
RIS
PACS
Interoperability across system silos
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Predictability • Measurable and reproducible results pre-tested at
IHESM Connectathons1
Specialization
• More vendors can play in the solution
Flexibility • To connect multi-vendor systems
Cost control
• Rapid, predictable implementations
Interoperability enables collaboration and helps lowers costs
Key profiles
PIX/PDQ XDS XDS-I DSUB ATNA BPPC
1- IHE is a registered Service Mark of IHE International®.
Standards adoption is important
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Success Factor 2: Experienced partner for
Implementation
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Clear Agreement and Documentation • Site and Workflow Assessments
• PACS Vendor Survey
• Clear Statement of Work
Proven multi-year project methodology • Resource scheduling for optimizing delivery
• Change control management
Project Kickoff
2008 (1Q)
1st Hub Live
(10 sites)
2008 (4Q)
+5 hubs Live (31 sites)
2009
+7 hubs Live (14 sites)
2010
+5 hubs Live (6 sites)
2011
Last Hub Live (1 site)
2012
Implementation rigor from GE and SWO
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Implementation rigor from GE and SWO
Project Kickoff
2008 (1Q)
1st Hub Live
(10 sites)
2008 (4Q)
+5 hubs Live (31 sites)
2009
+7 hubs Live (14 sites)
2010
+5 hubs Live (6 sites)
2011
Last Hub Live (1 site)
2012
HL7 interface specification • Define an HL7 spec for inbound ADT, order and reports
• Enforce this mapping from customer HIS, RIS
• Be prepared for mapping costs and resist noncompliance
Technical gap solutions • GE has developed workaround scripts and conversions for proprietary vendor
techniques and gaps in standards
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Implementation rigor from GE and SWO
Project Kickoff
2008 (1Q)
1st Hub Live
(10 sites)
2008 (4Q)
+5 hubs Live (31 sites)
2009
+7 hubs Live (14 sites)
2010
+5 hubs Live (6 sites)
2011
Last Hub Live (1 site)
2012
Rolling test method for new hub additions • Unit , end-to-end and simulation load testing
• Code freeze two weeks before go-live
• Seamless transition to support teams
Partner approach for adoption • Customer site champions to promote adoption
• Governance group (GE and SWO)
• Clear R & R and op. mechs
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Success Factor 3: Commitment to
standards development
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• Not-for-profit agency accountable to 14 federal/provincial governments
• $2.6 billion in federal funding for eligible projects and on-going operations
eHealth Leadership
• National planning to support eHealth implementations
• EHR Architectural Blueprint
• Pan-Canadian Standards
Strategic Investor
• Co-invest with jurisdiction and private sector partners
• Project planning, manage risk, ensure deliverable quality and benefits realization
GE is active in Infoway Standards Group 10- Diagnostic Imaging Aligned with IHE International to enhance global standards
Canada Health Infoway
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Data Quality • How to handle DICOM exam changes
• Drafted Image Object Change Management (IOCM) IHE profile
Radiology Report Handling, Formatting • Defining CDA R2 format with a standard header
• Addendum management
DI Terminology Reference Set • Defining common terms for body parts and image procedures
• Extensions to SNOMED CT standard; site
Infoway Working Group 10 Diagnostic Imaging Standards
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Infoway Working Group 10 Diagnostic Imaging Standards
Non-DICOM extensions • Define use cases and query fields
• Propose updates to the XDS-I Profile at IHE
Foreign Exam Management • Propose an IHE Pre-fetch Management Profile
• Handling of multiple study identifiers for a single study
• Clinical Consult for an unknown patient
XDS Implementation Guide • Informs and aggregates content from other groups
• Produces Knowledge Artifacts to guide project deployments
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What’s next?
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HIS
EMR
Patient
Demographic Sources
LDAP
User
Management
Sources of Patient Clinical Data
Message sources
(HL7)
Non- DICOM sources
DICOM Sources
e.g., RIS/ PACS CVIT
Scanners, digital
cameras
Other consumers
EMR/Dept
Consumers of patient
information
RIS
ATNA
Audit Logs
EMPI IHE-XDS
Registry
Add-ons
Device Integration
Clinical Gateway
ZFP
clinician viewer
Information Repository
Non-
DICOM DICOM
1-Centricity Clinical Archive solution includes the following product components: Centricity
Enterprise Archive, Centricity Enterprise Web - Patient Information View module, Centricity Enterprise Web, Caradigm eHIE, Centricity Clinical Gateway, NextGate MatchMetrix EMPI,
PACSGEAR PacsSCANTM
Centricity Clinical Archive a robust, standards-based solution
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Centricity Clinical Archive solution
Departmental Archive
DICOM Archive
Enterprise DICOM Archive
Multi-PACS, cardiology
Enterprise Multi-specialty
Archive
Connecting to ‘ologies, enterprise
registry
Multi-institution Patient Information
Management
Multi-PID, patient consent, gateway
to image exchange
Level 2 (DICOM) Imaging consolidation across enterprise
Level 3 (+XDS) Enterprise-wide clinical data consolidation
Level 4 (+XDS) Cross-enterprise patient repository & sharing
Level 1 (DICOM) Independence of PACS application
GE offers a multi-level adoption model
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• Collaborative care models demonstrate key benefits
• Data aggregation and sharing is key
• Image Exchanges can help drive collaboration
• Deploying Image Exchanges requires • Interoperable solutions through standards
• An experienced partner to help drive the transition
In summary
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