Transcript CDI Project - Welcome to Diagnostic Accreditation Program

BC Connecting DI Project:
DAP Conference
April 25th2008
1
Overview
 What is Connecting DI?
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–
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What Problem?
How can Technology be part of the Solution?
How CDI will work
 Quality
–
–
Opportunities
Challenges
 Safety
 Getting There….Road Map to CDI
–
–
–
Viewer
Archive
Full CDI Solution
 Questions
2
What is Connecting DI?
3
Connecting DI Vision Statement
Through the Longitudinal Electronic Health Record, provide
seamless access to Diagnostic Images and Reports to
authorised users anywhere in BC regardless of where in BC
the examination took place.
4
Diagnostic
Imaging……What
Problem?
5
 Each year, approximately 2 million DI exams are not seamlessly
accessible to health care professionals when they need them to
deliver quality care
 Many health authority PACS are not integrated
 Over 1 million exams conducted in the private clinics have yet to
be integrated into the Provincial infrastructure
 Approx 500,000 patients annually receive care in health authorities
other than their local area of residence
 If 10% of these are repeated due to “access challenges” …50,000
avoidable repeats
 The average MSP fee per DI exam is $44…. do the math
 $2.2m per year and rising…
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 There are about 1900 Radiologists in Canada – this number has
been static since 2000
 There is an increasing shortage of Radiologists as demand for their
services continues to grow
 BC has a large number of small rural communities
 Nationally 46% of facilities are less than 50 beds
– 83% of facilities are less then 250 beds
The average age of Radiologists is 53
The average annual volume is 18,000 exams/radiologist[1]
(CAR recommendation is max 15,000 exams/radiologist)
 Radiologists are located predominantly in metropolitan centres and
regional hospitals
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...How can technology be a part of the
solution?
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 All PACS and RIS sources of diagnostic imaging results will be
integrated to a provincial DI solution
 The DI archive will be a shared resource to all PACS sources
 All relevant prior DI results available…..support efficient workflow
and improved diagnosis
 Complete provincial view of the DI record to all authorised users
 Specialists to have better access to DI information…saves time
and facilitates tele-medicine and radiology workload balancing
 Connection of PACS-ready private imaging clinics to the provincial
DI solution
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…..How will CDI Work?
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NETWORK CAPACITY IMPROVEMENTS
PRIVACY & SECURITY
INTEROPERABILITY STANDARDS
COMMON INFOSTRUCTURE
EHR to Point of Service
CHANGE MANAGEMENT AND COMMUNICATIONS
REGISTRIES
Laboratory
Solution
Diagnostic
Imaging
Drug Solution
OTHER EHEALTH
PROJECTS
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FUTURE STATE ARCHITECTURE
Provincial DI
Reports
JURISDICTIONAL INFOSTRUCTURE
Registries Data
& Services
Client/EMPI
Registry
Provincial DI
Ancillary Data &
Services
EHR Data & Services
Shared
Health
Record (DI)
PHS
Reporting
Outbreak
Management
Images
Drug
Information
DI IMAGE
Archive
Data
Warehouse
Laboratory
Health
Information
Provider
Registry
Location
Registry
Business
Rules
Registry
EHR
Index
Message
Structures
Normalisation
Rules
Longitudinal Record Services
Security
Management Data
Local DI Reports
Privacy
Data
Configuration
Local
DI Images
Common Services
HIAL
Communication Bus
EHR Viewer
Provincial
DI Viewer
Source/
Adaptor
Consumer
DI Adaptor (DTML)
Source/
Adaptor
Consumer
Adaptor
Source/
Adaptor
Consumer
RIS
PACS
PACS
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Quality….
..Opportunities
Included in Current CDI Plans

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

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



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Seamless Access to relevant priors by Radiologist
Seamless Access to all imaging by specialists
Workload balancing improves health system performance
All relevant prior images and reports will be available to support efficient workflow and
improved diagnosis
Improved sharing of relevant clinical information
Reduction in repeat exams saving time, money and radiation dose
Improved productivity – leverage PACS across organisational boundaries
Reduction in operating costs
Sustainability (HR and demand challenges)
Improved workflow – image sharing integrated into workflow when possible
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Quality….
..Opportunities
Future …. after the infrastructure is in place
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

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Decision support tools
Integrated reporting technologies
Tele-radiology
Integrated electronic ordering of all exams – completes the electronic round trip
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Quality…
..Challenges

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Change in practice
Change in governance
Change in patient access to information
Implementation cost
Re-distribution of costs
Privacy and security
Interoperability standards
Quality Assurance in a digital environment
Network and file transfer speeds
Service continuity planning
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Safety….
 Mainly a function of reduction in unnecessary DI exams
 Repeats are frequently done due to the exam being
performed elsewhere
 Each year, approximately 2 million DI exams are not
seamlessly accessible to health care professionals when
they need them to deliver quality care.
 Over 1 million exams conducted in the private clinics have
yet to be integrated into the Provincial infrastructure.
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Clinical motivations
For DI Data Sharing in the Lower Mainland alone
To what extent do patients seek care across organisational boundaries?
?
145,165
Vancouver Coastal
Fraser Health
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Clinical motivations
For DI Data Sharing in the Lower Mainland alone
C500,000
All Health Authorities
All Imaging Clinics
To what extent do patients seek care across all organisational boundaries?
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Getting There….Road Map to CDI
– Viewer
– Archive
– Full CDI Solution
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Deployment Phases
Phase
Benefit
VCH/FH
PHSA
IHA/VIHA/NH - optional
Provincial DI
Viewer
Provincial DI
Archive
(integrated with DI
Viewer)
2008
2009
CDI Solution
Integrated to
iEHR
2010+
Sharing of images and reports for transfer patients
Access by physicians in HA’s
Strong business case
Addresses clinical Need
Sharing of images and reports for all patients
Access by physicians outside of HA’s
Supports radiology workflow
Supports report notification to physicians
Integrated patient health record
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The Viewer Phase
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Provincial DI Viewer
JURISDICTIONAL INFOSTRUCTURE
Registries
Data &
Services
Ancillary Data &
Services
EHR Data & Services
Data
Warehouse
Longitudinal Record Services
HIAL
Common Services
Communication Bus
Provincial
DI Viewer
FH
VCH
IH
PACS
RIS
PACS
RIS
PACS
NH
VIHA
RIS
RIS
PACS
PACS
RIS
PACS
PHSA
RIS
22
22
Provincial DI Viewer
Fraser Health
Vancouver Coastal
Health
(multiple)
RIS
Agfa PACS
GE PACS
Miditech RIS
RIS HL7
Messages
(ADT/ORM/ORU)
RIS HL7
Messages
(ADT/ORM/ORU)
EMC Centera Archive
Archive
FH LAN
PNG Network
FH Firewall
Local Images
Viewed on
local PACS GE Centricity
Viewer
PACS Viewer
VCH LAN
VCH Firewall
Image Transfer Grid
Node
Image Transfer Grid
Node
Local Images
Viewed on
local PACS
Viewer
Agfa PACS Viewer
Image Transfer Grid
Node
VCH LAN
iSite
Enterprise
Application
Server
iSite Enterprise Viewer
Current State
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PHSA
Provincial DI Viewer
iSite
Enterprise
Application
Server
Fraser Health
RIS HL7
Messages
(ADT/ORM/ORU)
Vancouver Coastal
Health
RIS HL7
Messages
(ADT/ORM/ORU)
Agfa PACS
GE PACS
Miditech RIS
RIS HL7
Messages
(ADT/ORM/ORU)
RIS HL7
Messages
(ADT/ORM/ORU)
EMC Centera Archive
DICOM
Links to iSite
DICOM
Links to iSite
FH LAN
PNG Network
FH Firewall
Local Images
Viewed on
local PACS GE Centricity
Viewer PACS Viewer
Archive
VCH LAN
VCH Firewall
iSITE
PROC Server
(cache)
iSITE
PROC Server
(cache)
Foreign results
Viewed on iSite
Viewer
(multiple)
RIS
iSite
Enterprise
Viewer
Agfa PACS
Viewer
iSite
Foreign results
Viewed on iSite Enterprise
Viewer
Viewer
Reports
and Images
Reports
and Images
VCH LAN
iSyntax
Streaming
iSite Enterprise Viewer
PHSA
Future State
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The Provincial DI Archive
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Provincial DI Archive
JURISDICTIONAL INFOSTRUCTURE
Registries
Data &
Services
Ancillary Data &
Services
Provincial
EMPI
EHR Data & Services
Data
Warehouse
Longitudinal Record Services
HIAL
Common Services
Communication Bus
Provincial
DI Viewer
Provincial
DI Archive
FH
VCH
IH
PACS
RIS
PACS
RIS
PACS
NH
VIHA
RIS
RIS
PACS
PACS
RIS
PACS
RIS
PHSA
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26
The Full CDI Solution
27
Full CDI Solution
JURISDICTIONAL INFOSTRUCTURE
Registries Data
& Services
Client/
EMPI
Registry
Ancillary Data &
Services
Outbreak
Management
EHR Data & Services
PHS
Reporting
Secure
Health
Record
EHR
Index
Message
Structures
Drug
Information
Data
Warehouse
Provincial
DI Archive
Health
Information
Laboratory
Provider
Registry
Location
Registry
Business
Rules
Normalisation
Rules
Longitudinal Record Services
Security
Management Data
Privacy
Data
Configuration
Common Services
Communication Bus
HIAL
DTML
DI Adaptor
Adaptor
Adaptor
Adaptor
EHR Viewer
Adaptor
Provincial
DI Viewer
RIS
PACS
PACS
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Provincial DI Viewer
Stage 1 of Phase 1:
Implement VCH and FHA
Project Stage
Months
Mandate
Project Mgt
Infoway / MoH
activities
Inc
Procurement
validation
Philips Contract
Clarification
Communications
From initial concept > approvals > engagement > media > inter-project>
CM Training > CM Teams > Workflow / Training / Expectation
Management / Issue Resolution
Change Mgt
VCH/FHA
PIA’s
Privacy
Governance
Operations and
Support
Implementation and
test
Revised
Steering
Committee
Operational
Agreements
SLA’s and
Service Desk
HL7 Feed / FH PACS DICOM link /VCH
DICOM link
End to End
testing
GO
LIVE
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Provincial DI Archive
Archive Deployment
2008
2009
Source to Viewer Stream
Archive to Viewer Stream
Procurement Stream (Archive and
Remaining CDI Solution)
Data Center Hosting Stream
Policy / MoU Business Stream / SLA’s
Install
Archive
Test
Deploy
Adoption at all 6 HA’s
eHealth IM/IT Alignment Continues Throughout Process of Interim Solution Deployment
s
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Questions?
31