Diagnostic Imaging: The Canadian Picture

Presented at the Medical Imaging Informatics and Teleradiology Conference

May 24, 2013

Presenter: Jeff Green, Program Director

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Overview

Canada Health Infoway

Diagnostic Imaging program

Progress across Canada

Addressing the challenges

Moving forward

About Infoway

Canada Health Infoway

• Created in 2001

• $2.1 billion in federal funding

• Independent, not-for-profit corporation

• Accountable to 14 federal/provincial/territorial governments

Mission: Fostering and accelerating the development and adoption of

electronic health information systems with compatible standards and communications technologies on a pan-Canadian basis with

tangible benefits to Canadians. Infoway will build on existing initiatives and pursue collaborative relationships

in pursuit of its mission.

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Infoway business strategies

• Collaborate with health ministries and other partners

• Co-invest with public sector partners (75:25 formula)

• Leveraged investment

• Engage clinicians

• Form strategic alliances with the private sector

• Manage risk and ensure quality solutions

• Measure benefits

• Strategic investor

• Privacy safeguards

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A global movement is underway

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Investment approach

12 targeted investment programs totalling more than $2.1 billion

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One patient, one record

Results and images Patient information Medical alerts

Medication history

Interactions

Immunization Problem list

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Points of care Homecare

Emergency Services

Pharmacy

Laboratory

Diagnostic Hospital Emergency

Specialist Clinic

Community Care Centre

Clinic

Focus on standards and interoperability

• Common architecture accepted and in use by jurisdictions

• Updated architecture includes privacy and security requirements

• Infoway Standards Collaborative

• Extensive standards development and implementation underway

• Architecture and standards are freely available

Point Of

Service

Applications

Ancillary

Data and

Services

EHR Data

& Services

Registries

Data &

Services

Health

Information

Data

Warehouse

Point Of

Service

Applications

EHR Viewer

EHR

Locator

HIAL

Longitudinal Record Services

EHR Solution

EHR Infostructure

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Infoway’s Diagnostic Imaging Program

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DI program vision

Filmless DI operations across Canada

Seamless sharing of DI data via the EHR

Conformance to standards as a means to achieve cost-effective interoperability

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Program objectives

— Implement digital storage of diagnostic images (MR, CT, X-ray, ultrasound, fluoroscopy, nuclear medicine) that permit clinicians to access and view images regardless of where they are located or where the test was conducted

— Adoption of pan-Canadian standards such as XDS-I and related IHE integration profiles to provide a solution for sharing (publishing, discovery and retrieval) of imaging documents across affiliated healthcare organizations

— Provide access to digital images in 100% of Canada’s acute care hospitals by 2016

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What is a Diagnostic imaging repository (DI-r)?

Centralized infrastructure serving as: — Storage repository for DI information — Shared operational PACS for green field sites (not filmless)

Purpose: — Reliably maintain and deliver DI information to clinicians via the EHR — Facilitate seamless sharing of DI information within the EHR

Requirements:

— Maintain a lifetime of ‘relevant’ DI data, including reports, images, key image notes, image processing results, overlay information, presentation states and other evidence documents

— Support 1.5 to 3 million exams per year (varies by jurisdiction)

— Provide high performance delivery of DI information over a network

— Provide reliable/uninterrupted access to DI information

— Maintain quality and integrity of data

— Comply with the EHRS Blueprint Architecture

— Conform to pan-Canadian Standards to achieve interoperability

Progress Across Canada

Diagnostic Imaging Information Progress

1. PACS and 16 provincial/regional repositories for images and reports

2. Canada now has PACS in ~94% of its hospitals

3. Repositories now hold nearly 100% of all public images and reports

4. Over 51,000 clinician and support staff users across Canada

5. Generating benefits of between $850M and $1B per year.

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Benefits Evaluation Benefits evaluations have indicated $850M to $1B per year in savings* via:

reduced patient transfers

improved turnaround times

improved productivity & capacity creation

reduced film costs

reduced duplicate tests

*Source: Canada Health Infoway Diagnostic Imaging Benefits Evaluation Report https://www.infoway-inforoute.ca/lang-en/about-infoway/approach/demonstrating-benefits-of-investments

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Improving access to care and boosting productivity

25-30%: improvement in Radiologists’ productivity

$169-203M: value for the Canadian health system on an annual basis

500: equivalent number of additional specialists across Canada due to efficiency and capacity gains

30 to 90: minutes per week saved by referring physicians due to improved efficiency of clinical decision-making

39%: radiologists reporting for new remote sites

30-40%: improvement in turnaround times (clinical decisions and subsequent treatment of patients now occurs 10-24 hours sooner)

10,000-17,000: number of patient transfers eliminated each year

Source: Infoway Benefits Evaluation Diagnostic Imaging (https://www.infoway-inforoute.ca/about-infoway/approach/investment-programs/diagnostic-imaging-systems/benefits)

Addressing the challenges

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PACS implementation in all facilities

Challenge: deliver PACS functionality to smaller facilities

80% of Canadian facilities have fewer than 250 beds

Stand-alone PACS installation not financially feasible for small facilities or clinics

Approach: shared services model provide PACS functionality to smaller centres

financially viable business model

centralize and share skilled technical resources

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Addressing PACS costs

Challenge: reduce cost of PACS installation as well as utilization costs such as storage, distribution, workstation

Approach: disparate buyers came together to negotiate preferred pricing

Joint procurement initiatives enabled individual jurisdictions and health regions to obtain better solution pricing for both hardware and software

File compression

Challenge: data storage costs and transmission efficiency

Approach: Infoway invested in a study on Irreversible Compression of DI

Findings:

Irreversible compression does not impact diagnostic quality

Potential savings: storage; retrieval time for remote access

Radiologist: average daily productivity increase by 5 per cent

In 2011, irreversible compression was approved as a standard by the Canadian Association of Radiologists (CAR) http://www.car.ca/uploads/standards%20guidelines/201106_EN_Standard_Lossy_Compression.pdf

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Moving forward

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Next Steps for Infoway’s Diagnostic Imaging Program:

Complete investments in Diagnostic Imaging Program over the next 12–24 months

Continue to facilitate pan-Canadian DI Jurisdiction Implementers Group

Promote standards to achieve DI integration into EHR – interoperability profiles, Foreign Exam Management, Cross-Document Sharing (XDS), terminology

Integrate DI systems with points of service solutions including hospital information systems and EMRs in physician offices to provide seamless data flows in support of patient care activities

The journey is far from complete

Leverage the existing DI infrastructure to:

Integrate private clinic volumes Expand to other diagnostic modalities (e.g. cardiology,

mammography) Expand to other clinical services (e.g. pathology)

Integrate DI systems with points of service solutions:

Improve communication among service providers (e.g. through the use of key image notes and presentation profiles)

DI text data into iEHR viewer for access to all authorized providers

Emerging technologies will impact medical imaging:

Mobile computing Cloud computing Big data (analytics)

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More information

Canada Health Infoway

https://www.infoway-inforoute.ca

DI Jurisdictional Implementers Group

http://forums.infoway-inforoute.ca/JDI

Standards Collaborative Working Group (SCWG) 10: Diagnostic Imaging

standards@infoway-inforoute.ca

Thank you