This is a Centricity Live 2013 conference session presentation, featuring GE Healthcare's experience with regional Image exchanges.

1. #centricitylive
Helping Communities Move Toward
a Collaborative Care Model
GE Healthcare’s Experience with Regional Image Exchanges
David Roeder
Coming up – Centricity Live 2014

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©2013 General Electric Company – All rights reserved.
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3. Agenda
• Moving towards Collaborative Care
• GE Healthcare’s experience with Image Exchanges (IX)
• Southwest Ontario: A successful Image Exchange
• What does success look like?
• Interoperability
• Implementation partner
• Commitment to standards
• What’s next?
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4. The Move To
Collaborative Care
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5. Today, an unsustainable healthcare model
across the globe
Healthcare costs are rising
• Ageing population and chronic diseases increase demand
• Waste-redundant procedures due to fragmentation
• Healthcare cost in excess of 10% of GDP (U.S. 17.6%)1
Shortage of skilled specialists
• Healthcare in rural areas
• Unbalanced Public-Private staffing
• Diagnosis turnaround time
Incomplete data may create quality issues
• Duplicate imaging
• Unnecessary patient transfers
1- Source: OECD Health Data, 2012 - http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html
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6. Resulting in a paradigm shift…
From
To
Episodic, single-patient care
Continuous population management
Provider-centric
Patient-centric
Fee-for-service
Payment for value
Silos
Systems
Focus on improving quality of care at lower cost
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7. …that is driving an evolution toward
collaborative care
Shift means new healthcare
delivery ecosystems are required.
Silos of data;
Hospital-centric;
Closed systems
•
•
•
•
Payer
Hospital
Ambulatory
Patient
Quality
measurement
&
improvement
Outcome
driven
Evidencebased care
Patient
Care
coordination
workflows
Patient
engagement
Population
health
Work flow & analytics focus; Support of
distributed care; Open & interoperable
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8. Imaging is helping lead the transformation
Key Initiatives
Impact
Investments shift from
Hospitals
to Communities &
Regions
Consolidate access to
patient data
Reduce vendor
complexities
Cross community clinical
access
Access to relevant priors
in other PACS
Technology shift
to Data sharing &
Workflow sharing
(Regional
infrastructures)
Distribute reporting
Enable ED & remote
expertise reading
Benefits
Helps improve
workload sharing
Helps improve report
turn around time
Helps inform clinical
decision making
Helps reduce
patient transfers
Helps reduce
duplicate exams
Helps improve
competitiveness
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9. GE Healthcare and
Collaborative Care
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10. Community-based Image Exchanges
GE Healthcare is partnering with regional healthcare
organizations to demonstrate the positive impact of
community-based image exchanges.
IX
Image Exchange leverages:
• Standards-based technology
• Extensible and scalable platform
• Strength and history in imaging IT
• Expertise integrating heterogeneous HIT
environments
GPs
Radiologists
Clinicians
Performance tools
Analytics – Patient flow
Collaborative workflows
Distributed reporting
Information sharing
Access patient data, anywhere1
Vendor neutral archive
Store and exchange data
1- Where there is an internet connection available.
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11. Västra Götaland Region
(VGR, Sweden)
Objective
• Central repository of images and reports
• Immediate access to prior images and reports
from the whole region
• Primary viewing platform outside imaging
• Improved imaging workflow
Solution
• Common repository across 17 hospitals
• IHE standards
• Sweden’s second largest region
• 1.5 million residents
• 17 hospitals
• Heterogeneous RIS/PACS systems
• Web access to images and reports
• ASP model since 2006
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12. Ile de France
(France)
Objective (regions sans film)
• Leapfrog Paris region to HIT
• Sharing imaging results
• Help improve care quality through collaboration
• No more film or CD
Solution
• Standards based information repository
• Data center
• 24 x 7 high availability service
• SAAS model – pay per use
• 12 million patients, 500+
radiologists
• 30 hospitals growing to 90
• Multi-vendor RIS-PACS systems
(PACS: Carestream, Telemis, GE;
RIS: EDL, Waid, local)
• Standards compliance (DICOM,
IHE, HL7)
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13. GE Healthcare is helping deploy a
collaborative care model across the globe
Southwestern Ontario
VNA & workflow sharing
VGR, Sweden
VNA + information sharing+
collaborative workflows
North Eastern Ontario
VNA & workflow sharing
HA , Hong Kong
VNA + information sharing
Ile De France
Cloud archive + information
sharing
Waldviertel, Austria
Collaborative workflows
Singapore
VNA + information sharing
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14. Southwestern
Ontario:
Collaborative care
in Canada
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15. Southwest Ontario (SWO)
North & East Ontario (NEO)
Two of four Image
Exchange projects
storing all hospital
diagnostic images in
Canada’s largest
province (15 million
people).
Nunavut
Yukon
Northwest
Territories
British
Columbia
Alberta
Manitoba
Quebec
Ontario
New PEI
Brunswick
Nova
Scotia
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16. Southwest Ontario (SWO)
One of four Image
Exchange projects
Nunavut
Yukon
Northwest
Territories
British
Columbia
Alberta
Manitoba
Quebec
Ontario
New PEI
Brunswick
Nova
Scotia
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17. SWO Project Goals
To improve patient care through image/report sharing by care
providers across a region between Windsor/Detroit and Niagara
Falls
• Help enhance care provider productivity
• Centralize patient records
• Help reduce patient transfers
• Help reduce duplicate exams
• Help optimize storage infrastructure
cost savings
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18. Clinical scenarios for collaboration
Consult of a Referred Patient
A cancer patient is referred by a clinician at Windsor Regional
Hospital (WRH) to an oncologist at London Health Sciences
(LHSC). The oncologist needs:
• Patient CT from Windsor hospital for radiation and
treatment planning
• To gather priors across all hospitals for future MDT
meetings and clinical decisions
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19. Clinical scenarios for collaboration
Trauma transfer from community hospital
A stroke case in a small hospital in Goderich requires
immediate consultation and a transfer decision.
This requires:
• Images need to be shared with a remote specialist for
transfer decision
• The intake specialist (ortho, surgeon, etc.) at the
remote trauma center needs access to priors to create
a treatment plan
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20. SWO Image Exchange
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21. SWO Architecture
• 62 hospital locations
7 PACS vendors
• 19 hubs with separate RIS/PACS
• 3.2 million exams/year; 120TB/year
• 1600+ system users
• H/W redundant, disaster recovery
5 RIS vendors
• High availability, dual data centers
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22. Clinical benefits achieved
• Helps optimize turn-around on treatment decisions
• Helps make more informed decisions
More robust patient jacket,
no matter where imaging was performed.
• Helps breakdown CD workflow challenges
Incompatible viewers, import errors, delays
• Helps enhance test efficiencies
Images available, anywhere, anytime1
• Helps enhance patient care experience
Fewer transfers, smooth care workflow
1- Where there is an internet connection available.
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23. Economic benefits
• Centralized storage management
Helps enhance management cost efficiencies/TB versus local archives
• Reliability and disaster recovery
Helps enhance cost avoidance at local sites for reliable dual data centers
• Exam duplication reduction
Eliminate 3% exams annually (90,000)*
• Reduce CD transfers and admin overhead
Cost is the management, not media
• Patient transfer efficiencies
Savings estimated at annual $10 Million for ENITS‡
*Savings estimate per 2008 True North Assoc. Infoway study.
‡
Emergency Neuro Imaging Transfer System for trauma consult use cases.
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24. Success factor 1:
Interoperable
solutions
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25. Multi-level neutrality is important
Application neutral (DICOM,HL7,IHE)
• Rapid & predictable implementation
• Store information in native format
Enterprise systems
Departmental systems
PACS/RIS
Others
LAB
DICOM, PDF, ECG, EEG,
endoscopy, photos,…
HIS
EMR
IT platform neutrality (Virtualize, ZFP)
• Leverage the continuous improvement in
infrastructure technology to lower cost
• Preserve your existing investment
DICOM, HL7, IHE-XDS, WADO
Application Neutral Format Neutral
CentricityTM Clinical Archive
Format neutrality (DICOM, IHE-XDS)
• Access information in multiple formats
• Access information anywhere, anytime1
IT Platform Neutral
Objects
SAN
NAS
CAS
1- Where there is an internet connection available.
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26. Interoperability across system silos
Exam storage in a sharable format
• GSPS, KIN
• DICOM part-10 storage
Maintaining data quality
• Synchronize PACS and Vendor Neutral Archive
(exam updates, merges, rejects)
• Avoid exam modifications in proprietary ways
Desktop integration
• Context launch of Viewer from radiologist PACS or
physician EMR, helps enhance adoption
• Zero-footprint viewers
PACS
RIS
VNA
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27. Standards adoption is important
Predictability
• Measurable and reproducible results pre-tested at
IHESM Connectathons1
Specialization
• More vendors can play in the solution
Flexibility
• To connect multi-vendor systems
Cost control
Key profiles
PIX/PDQ
XDS
XDS-I
DSUB
ATNA
BPPC
• Rapid, predictable implementations
Interoperability enables collaboration and helps lowers costs
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28. Success Factor 2:
Experienced
partner for
Implementation
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29. Implementation rigor from GE and SWO
2008 (1Q)
2008 (4Q)
2009
2010
Project Kickoff
1st Hub Live
(10 sites)
+5 hubs Live
(31 sites)
+7 hubs Live
(14 sites)
2011
2012
+5 hubs Live Last Hub Live
(6 sites)
(1 site)
Clear Agreement and Documentation
• Site and Workflow Assessments
• PACS Vendor Survey
• Clear Statement of Work
Proven multi-year project methodology
• Resource scheduling for optimizing delivery
• Change control management
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30. Implementation rigor from GE and SWO
2008 (1Q)
2008 (4Q)
2009
2010
Project Kickoff
1st Hub Live
(10 sites)
+5 hubs Live
(31 sites)
+7 hubs Live
(14 sites)
2011
2012
+5 hubs Live Last Hub Live
(6 sites)
(1 site)
HL7 interface specification
• Define an HL7 spec for inbound ADT, order and reports
• Enforce this mapping from customer HIS, RIS
• Be prepared for mapping costs and resist noncompliance
Technical gap solutions
• GE has developed workaround scripts and conversions for proprietary vendor
techniques and gaps in standards
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31. Implementation rigor from GE and SWO
2008 (1Q)
2008 (4Q)
2009
2010
Project Kickoff
1st Hub Live
(10 sites)
+5 hubs Live
(31 sites)
+7 hubs Live
(14 sites)
2011
2012
+5 hubs Live Last Hub Live
(6 sites)
(1 site)
Rolling test method for new hub additions
• Unit, end-to-end and simulation load testing
• Code freeze two weeks before go-live
• Seamless transition to support teams
Partner approach for adoption
• Customer site champions to promote adoption
• Governance group (GE and SWO)
• Clear R & R and op. mechs
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32. Success Factor 3:
Commitment to
standards
development
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33. Canada Health Infoway
• Not-for-profit agency accountable to 14 federal/provincial
governments
• $2.6 billion in federal funding for eligible projects and on-going
operations
eHealth Leadership
Strategic Investor
• National planning to support
eHealth implementations
• Co-invest with jurisdiction and
private sector partners
• EHR Architectural Blueprint
• Project planning, manage risk,
ensure deliverable quality and
benefits realization
• Pan-Canadian Standards
GE is active in Infoway Standards Group 10- Diagnostic Imaging
Aligned with IHE International to enhance global standards
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34. Infoway Working Group 10
Diagnostic Imaging Standards
Data Quality
• How to handle DICOM exam changes
• Drafted Image Object Change Management (IOCM) IHE profile
Radiology Report Handling, Formatting
• Defining CDA R2 format with a standard header
• Addendum management
DI Terminology Reference Set
• Defining common terms for body parts and image procedures
• Extensions to SNOMED CT standard; site
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35. Infoway Working Group 10
Diagnostic Imaging Standards
Non-DICOM extensions
• Define use cases and query fields
• Propose updates to the XDS-I Profile at IHE
Foreign Exam Management
• Propose an IHE Pre-fetch Management Profile
• Handling of multiple study identifiers for a single study
• Clinical Consult for an unknown patient
XDS Implementation Guide
• Informs and aggregates content from other groups
• Produces Knowledge Artifacts to guide project deployments
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36. What’s next?
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37. Centricity Clinical Archive a robust,
standards-based solution
Patient
Demographic
Sources
EMPI
IHE-XDS
Registry
RIS
Information Repository
HIS
EMR
Consumers
of patient
information
ZFP
clinician
viewer
NonDICOM
Other
consumers
DICOM
EMR/Dept
Add-ons
User
Management
LDAP
Device
Integration
Clinical
Gateway
Audit Logs
Scanners,
digital
cameras
Message
sources
(HL7)
NonDICOM
sources
DICOM
Sources
e.g., RIS/
PACS CVIT
ATNA
Sources of Patient Clinical Data
1-Centricity Clinical Archive solution includes the following product components: Centricity
Enterprise Archive, Centricity Enterprise Web - Patient Information View module, Centricity
Enterprise Web, Caradigm eHIE, Centricity Clinical Gateway, NextGate MatchMetrix EMPI,
PACSGEAR PacsSCAN TM
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38. GE offers a multi-level adoption model
Centricity Clinical Archive solution
Enterprise
DICOM Archive
Departmental
Archive
Multi-PACS,
cardiology
Enterprise
Multi-specialty
Archive
Multi-institution
Patient Information
Management
Multi-PID, patient consent,
gateway
to image exchange
Connecting
to ‘ologies,
enterprise
registry
DICOM Archive
Level 1 (DICOM)
Level 2 (DICOM)
Level 3 (+XDS)
Level 4 (+XDS)
Independence of PACS
application
Imaging consolidation
across enterprise
Enterprise-wide clinical
data consolidation
Cross-enterprise patient
repository & sharing
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39. In summary
• Collaborative care models demonstrate key benefits
• Data aggregation and sharing is key
• Image Exchanges can help drive collaboration
• Deploying Image Exchanges requires
• Interoperable solutions through standards
• An experienced partner to help drive the transition
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40. Thank You For Attending!
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