Helping communities move toward a collaborative care model

Helping Communities Move Toward a Collaborative Care Model

GE Healthcare’s Experience with Regional Image Exchanges

David Roeder

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11/4/2013

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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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The Move To Collaborative Care


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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

Today, an unsustainable healthcare model across the globe


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From

Episodic, single-patient care Continuous population management

Provider-centric Patient-centric

Fee-for-service Payment for value

Silos Systems

To

Focus on improving quality of care at lower cost

Resulting in a paradigm shift…


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Evidence-based care

Patient engagement

Population health

Care coordination workflows

Outcome driven

Quality measurement

& improvement

Patient

Silos of data; Hospital-centric; Closed systems • Payer • Hospital • Ambulatory • Patient

Work flow & analytics focus; Support of distributed care; Open & interoperable

Shift means new healthcare delivery ecosystems are required.

…that is driving an evolution toward collaborative care


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Benefits Key Initiatives

Access to relevant priors in other PACS

Cross community clinical access

Enable ED & remote expertise reading

Distribute reporting

Helps improve competitiveness

Helps improve report

turn around time

Helps improve workload sharing

Helps reduce patient transfers

Helps inform clinical

decision making

Helps reduce duplicate exams

Reduce vendor complexities

Consolidate access to patient data

Investments shift from

Hospitals to Communities &

Regions

Technology shift to Data sharing & Workflow sharing

(Regional infrastructures)

Impact

Imaging is helping lead the transformation


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GE Healthcare and Collaborative Care


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GE Healthcare is partnering with regional healthcare organizations to demonstrate the positive impact of community-based image exchanges.

Image Exchange leverages: • Standards-based technology

• Extensible and scalable platform

• Strength and history in imaging IT

• Expertise integrating heterogeneous HIT environments

Radiologists

Clinicians

GPs

IX

Performance tools Analytics – Patient flow

Vendor neutral archive

Store and exchange data

Information sharing

Access patient data, anywhere1

Collaborative workflows

Distributed reporting

1- Where there is an internet connection available.

Community-based Image Exchanges


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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

• Web access to images and reports

• ASP model since 2006

• Sweden’s second largest region

• 1.5 million residents

• 17 hospitals

• Heterogeneous RIS/PACS systems

Västra Götaland Region (VGR, Sweden)


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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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Southwestern Ontario VNA & workflow sharing

Ile De France Cloud archive + information sharing

Singapore VNA + information sharing

VGR, Sweden VNA + information sharing+ collaborative workflows

HA, Hong Kong VNA + information sharing

North Eastern Ontario VNA & workflow sharing

Waldviertel, Austria Collaborative workflows

GE Healthcare is helping deploy a collaborative care model across the globe


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Southwestern Ontario:

Collaborative care in Canada


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Two of four Image

Exchange projects storing all hospital diagnostic images in Canada’s largest province (15 million people).

Northwest Territories

Yukon

British Columbia

Alberta

Manitoba

Ontario

Quebec

New Brunswick Nova

Scotia

PEI

Nunavut

Southwest Ontario (SWO)

North & East Ontario (NEO)


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One of four Image Exchange projects

Northwest Territories

Yukon

British Columbia

Alberta

Manitoba

Ontario

Quebec

New Brunswick Nova

Scotia

PEI

Nunavut

Southwest Ontario (SWO)


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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

SWO Project Goals


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A cancer patient is referred by a clinician at Windsor Regional Hospital (WRH) to an oncologist at London Health Sciences (LHSC). The oncologist needs:

Consult of a Referred Patient

• Patient CT from Windsor hospital for radiation and treatment planning

• To gather priors across all hospitals for future MDT meetings and clinical decisions

Clinical scenarios for collaboration


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A stroke case in a small hospital in Goderich requires immediate consultation and a transfer decision. This requires:

Trauma transfer from community hospital

• 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

Clinical scenarios for collaboration


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SWO Image Exchange


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7 PACS vendors

5 RIS vendors

• 62 hospital locations

• 19 hubs with separate RIS/PACS

• 3.2 million exams/year; 120TB/year

• 1600+ system users

• H/W redundant, disaster recovery

• High availability, dual data centers

SWO Architecture


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• 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


Clinical benefits achieved


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• 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.

Economic benefits


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Success factor 1: Interoperable

solutions


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Application neutral (DICOM,HL7,IHE) • Rapid & predictable implementation

• Store information in native format

IT platform neutrality (Virtualize, ZFP) • Leverage the continuous improvement in

infrastructure technology to lower cost

• Preserve your existing investment

Format neutrality (DICOM, IHE-XDS) • Access information in multiple formats

• Access information anywhere, anytime1

Objects

NAS CAS

SAN

CentricityTM Clinical Archive

DICOM, PDF, ECG, EEG,

endoscopy, photos,…

PACS/RIS LAB

Departmental systems

Enterprise systems

Others

HIS EMR

IT Platform Neutral

Application Neutral

DICOM, HL7, IHE-XDS, WADO

Format Neutral


Multi-level neutrality is important


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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

VNA

RIS

PACS

Interoperability across system silos


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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

• Rapid, predictable implementations

Interoperability enables collaboration and helps lowers costs

Key profiles

PIX/PDQ XDS XDS-I DSUB ATNA BPPC

1- IHE is a registered Service Mark of IHE International®.

Standards adoption is important


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Success Factor 2: Experienced partner for

Implementation


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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

Project Kickoff

2008 (1Q)

1st Hub Live

(10 sites)

2008 (4Q)

+5 hubs Live (31 sites)

2009


2010


2011

Last Hub Live (1 site)

2012

Implementation rigor from GE and SWO


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Project Kickoff

2008 (1Q)

1st Hub Live

(10 sites)

2008 (4Q)


2009


2010


2011


2012

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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Project Kickoff

2008 (1Q)

1st Hub Live

(10 sites)

2008 (4Q)


2009


2010


2011


2012

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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Success Factor 3: Commitment to

standards development


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33

• 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

• National planning to support eHealth implementations

• EHR Architectural Blueprint

• Pan-Canadian Standards

Strategic Investor

• Co-invest with jurisdiction and private sector partners

• Project planning, manage risk, ensure deliverable quality and benefits realization

GE is active in Infoway Standards Group 10- Diagnostic Imaging Aligned with IHE International to enhance global standards

Canada Health Infoway


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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

Infoway Working Group 10 Diagnostic Imaging Standards


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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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What’s next?


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HIS

EMR

Patient

Demographic Sources

LDAP

User

Management

Sources of Patient Clinical Data

Message sources

(HL7)

Non- DICOM sources

DICOM Sources

e.g., RIS/ PACS CVIT

Scanners, digital

cameras

Other consumers

EMR/Dept

Consumers of patient

information

RIS

ATNA

Audit Logs

EMPI IHE-XDS

Registry

Add-ons

Device Integration

Clinical Gateway

ZFP

clinician viewer

Information Repository

Non-

DICOM DICOM

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 PacsSCANTM

Centricity Clinical Archive a robust, standards-based solution


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Centricity Clinical Archive solution

Departmental Archive

DICOM Archive

Enterprise DICOM Archive

Multi-PACS, cardiology

Enterprise Multi-specialty

Archive

Connecting to ‘ologies, enterprise

registry

Multi-institution Patient Information

Management

Multi-PID, patient consent, gateway

to image exchange

Level 2 (DICOM) Imaging consolidation across enterprise

Level 3 (+XDS) Enterprise-wide clinical data consolidation

Level 4 (+XDS) Cross-enterprise patient repository & sharing

Level 1 (DICOM) Independence of PACS application

GE offers a multi-level adoption model


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• 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

In summary

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Helping communities move toward a collaborative care model

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