1. 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

2. 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

3. LANDSCAPE –DI-rs LHINs 1. Erie St. Clair 2. South West 3. Waterloo Wellington 4. 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

4. 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 4

5. 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 5

6. DI COMMON SERVICE VISION 6 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

7. 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

8. 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 8

9. 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

10. 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 10

11. 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 11

12. 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 12

13. 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 13

14. 14 QUESTIONS