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

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

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Helping communities move toward a collaborative care model Presentation Transcript

  • 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
  • 2. General Electric reserves the right to make changes in specifications and features, or discontinue the product or service described at any time, without notice or obligation. This does not constitute a representation or warranty or documentation regarding the product or service featured. Illustrations are provided for informational purposes, and your configuration may differ. This information does not constitute legal, financial, coding, or regulatory advice in connection with your use of the product or service. Please consult your professional advisors for any such advice. Operation of GE Healthcare products should neither circumvent nor take precedence over required patient care, including human intervention of healthcare providers. GE Healthcare products and services do not code medical procedures. Accurate coding is the responsibility of the provider or billing professional. GE, the GE Monogram, Centricity and Imagination at Work are trademarks of General Electric Company. ©2013 General Electric Company – All rights reserved. 2 Centricity LIVE Speaker Training 11/4/2013
  • 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? 3 Centricity LIVE Speaker Training 11/4/2013
  • 4. The Move To Collaborative Care 4 Centricity LIVE Speaker Training 11/4/2013
  • 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 5 Centricity LIVE Speaker Training 11/4/2013
  • 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 6 Centricity LIVE Speaker Training 11/4/2013
  • 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 7 Centricity LIVE Speaker Training 11/4/2013
  • 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 8 Centricity LIVE Speaker Training 11/4/2013
  • 9. GE Healthcare and Collaborative Care 9 Centricity LIVE Speaker Training 11/4/2013
  • 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. 10 Centricity LIVE Speaker Training 11/4/2013
  • 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 11 Centricity LIVE Speaker Training 11/4/2013
  • 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) 12 Centricity LIVE Speaker Training 11/4/2013
  • 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 13 Centricity LIVE Speaker Training 11/4/2013
  • 14. Southwestern Ontario: Collaborative care in Canada 14 Centricity LIVE Speaker Training 11/4/2013
  • 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 15 Centricity LIVE Speaker Training 11/4/2013
  • 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 16 Centricity LIVE Speaker Training 11/4/2013
  • 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 17 Centricity LIVE Speaker Training 11/4/2013
  • 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 18 Centricity LIVE Speaker Training 11/4/2013
  • 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 19 Centricity LIVE Speaker Training 11/4/2013
  • 20. SWO Image Exchange 20 Centricity LIVE Speaker Training 11/4/2013
  • 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 21 Centricity LIVE Speaker Training 11/4/2013
  • 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. 22 Centricity LIVE Speaker Training 11/4/2013
  • 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. 23 Centricity LIVE Speaker Training 11/4/2013
  • 24. Success factor 1: Interoperable solutions 24 Centricity LIVE Speaker Training 11/4/2013
  • 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. 25 Centricity LIVE Speaker Training 11/4/2013
  • 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 26 Centricity LIVE Speaker Training 11/4/2013
  • 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 1- IHE is a registered Service Mark of IHE International®.27 Centricity LIVE Speaker Training 11/4/2013
  • 28. Success Factor 2: Experienced partner for Implementation 28 Centricity LIVE Speaker Training 11/4/2013
  • 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 29 Centricity LIVE Speaker Training 11/4/2013
  • 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 30 Centricity LIVE Speaker Training 11/4/2013
  • 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 31 Centricity LIVE Speaker Training 11/4/2013
  • 32. Success Factor 3: Commitment to standards development 32 Centricity LIVE Speaker Training 11/4/2013
  • 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 33 33 Centricity LIVE Speaker Training 11/4/2013
  • 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 34 Centricity LIVE Speaker Training 11/4/2013
  • 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 35 Centricity LIVE Speaker Training 11/4/2013
  • 36. What’s next? 36 Centricity LIVE Speaker Training 11/4/2013
  • 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 37 Centricity LIVE Speaker Training 11/4/2013
  • 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 38 Centricity LIVE Speaker Training 11/4/2013
  • 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 39 Centricity LIVE Speaker Training 11/4/2013
  • 40. Thank You For Attending! Please take a moment to fill out a survey. #centricitylive See what’s coming - Centricity Live 2014