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 2

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2 2

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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

109

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76

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 information8

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