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BC Connecting DI Project: DAP Conference

BC Connecting DI Project: DAP Conference. April 25th2008. Overview. What is Connecting DI? 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.

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BC Connecting DI Project: DAP Conference

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  1. BC Connecting DI Project: DAP Conference April 25th2008

  2. Overview • What is Connecting DI? • 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

  3. What is Connecting DI?

  4. Connecting DI Vision Statement Through the Longitudinal Electronic Health Record, provide seamless access to Diagnostic Images and Reports to authorised usersanywhere in BC regardless of where in BC the examination took place.

  5. Diagnostic Imaging……What Problem?

  6. 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…

  7. 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

  8. ...How can technology be a part of the solution?

  9. 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

  10. …..How will CDI Work?

  11. PACS PACS RIS Longitudinal Record Services Common Services Provincial DI Reports Provincial DI Images Communication Bus FUTURE STATE ARCHITECTURE JURISDICTIONAL INFOSTRUCTURE Registries Data & Services DataWarehouse Ancillary Data & Services EHR Data & Services Laboratory HealthInformation DI IMAGE Archive SharedHealthRecord (DI) DrugInformation Client/EMPIRegistry PHSReporting OutbreakManagement ProviderRegistry LocationRegistry Registry NormalisationRules BusinessRules EHRIndex MessageStructures Local DI Images Local DI Images Local DI Reports PrivacyData SecurityManagement Data Configuration HIAL DI Adaptor (DTML) EHR Viewer Source/ Consumer Adaptor Source/ Consumer Adaptor Adaptor Source/ Consumer Adaptor Provincial DI Viewer

  12. Quality…...Opportunities Included in Current CDI Plans • 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

  13. Quality…...Opportunities Future …. after the infrastructure is in place • Decision support tools • Integrated reporting technologies • Tele-radiology • Integrated electronic ordering of all exams – completes the electronic round trip

  14. Quality…..Challenges • 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

  15. 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.

  16. Clinical motivationsFor DI Data Sharing in the Lower Mainland alone To what extent do patients seek care across organisational boundaries? ? 145,165 Fraser Health Vancouver Coastal

  17. Clinical motivationsFor 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?

  18. Getting There….Road Map to CDI • Viewer • Archive • Full CDI Solution

  19. Deployment Phases VCH/FH PHSA IHA/VIHA/NH - optional 20

  20. The Viewer Phase

  21. Provincial DI Viewer JURISDICTIONAL INFOSTRUCTURE Longitudinal Record Services Registries Data & Services Data Warehouse Ancillary Data & Services EHR Data & Services Common Services Communication Bus HIAL PACS PACS RIS PACS RIS PACS PACS RIS RIS RIS PACS RIS Provincial DI Viewer PHSA VIHA IH NH FH VCH 22

  22. Provincial DI Viewer Current State

  23. Provincial DI Viewer Future State

  24. The Provincial DI Archive

  25. Provincial DI Archive JURISDICTIONAL INFOSTRUCTURE Longitudinal Record Services Registries Data & Services Data Warehouse Ancillary Data & Services EHR Data & Services Common Services Communication Bus HIAL PACS PACS PACS PACS PACS RIS RIS PACS RIS RIS RIS RIS Provincial EMPI Provincial DI Viewer Provincial DI Archive PHSA VIHA IH NH FH VCH 26 26

  26. The Full CDI Solution

  27. Full CDI Solution PACS PACS RIS Longitudinal Record Services Common Services Communication Bus JURISDICTIONAL INFOSTRUCTURE Registries Data & Services DataWarehouse Ancillary Data & Services EHR Data & Services Laboratory HealthInformation Provincial DI Archive Secure Health Record DrugInformation Client/ EMPIRegistry PHSReporting OutbreakManagement ProviderRegistry LocationRegistry NormalisationRules BusinessRules EHRIndex MessageStructures PrivacyData SecurityManagement Data Configuration HIAL DTML DI Adaptor Adaptor EHR Viewer Adaptor Adaptor Adaptor Provincial DI Viewer 28

  28. Provincial DI Viewer Stage 1 of Phase 1:Implement VCH and FHA

  29. Provincial DI Archive Archive Deployment

  30. Questions?

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