DIAGNOSTIC IMAGING
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
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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LANDSCAPE –DI-rs
‹#›
LHINs
Erie St. Clair
South West
Waterloo Wellington
Hamilton Niagara
Haldimand Brant
5. Central West
6. Mississauga Halton
7. Toronto Central
8. Central
9. Central East
10. South East
11. Champlain
12. North Simcoe
Muskoka
13. North-East
14. North-West
NEODIN DI-r
LHINs 11,13,14
67 hospital sites
(Independent Health Facility)
1.
2.
3.
4.
INFOWAY PHASE
1
2
2
14
2
GTA West DI-r
LHINs 5,6,part of 7, 12
35 hospital sites
12
SWODIN DI-r
LHINs 1,2,3,4
72 hospital sites
2
1
6
2
11
10
8
5
2
2
9
3
2
1
1
13 1
2
HDIRS DI-r
LHINs part of 7, 8,9,10
38 hospital sites
7
4
DI-r
Geographic coverage
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
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DI COMMON SERVICE VISION
To enable and
support the sharing
and viewing of
images and
reports across Ontario
to all hospital- and
community-based
providers anytime,
anywhere, using the
tools best suited to
their
work practice
Reports
and
images
Hospital/Imaging
Clinics
NEODIN Diagnostic
Imaging Repository
(DI-r)
67 hospital sites
78 IHFs
Reports
and
images
GTA West DIagnostic
Imaging Repository
(DI-r)
35 hospital sites
133 IHFs
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
Hospital/Imaging
Clinics
Hospital/Imaging
Clinics
Reports
and
images
HDIRS Diagnostic
Imaging Repository
(DI-r)
38 hospital sites
264 IHFs
SWODIN Diagnostic
Imaging Repository
(DI-r)
72 hospitals sites
143 IHFs
Hospital/Imaging Clinics
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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
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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)
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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
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