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Any fact facing us is not as important as our attitude toward it, for that determines our success or failure. Norman Vincent Peale

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May 2009 Newsletter 18

Southwestern Ontario Digital Imaging Network Newsletter

“Any fact facing us is not as important as our

attitude toward it, for that determines our success or

failure.”

Norman Vincent Peale

What's in this issue

• South West Summary • CKHA Goes Live

• Frequently Asked Questions • Grey Bruce Update

• ENITS Update • RSS Update

• Wordsearch Puzzle

• Terminology and Acronym Guide

South West Summary

Phase 2.2 Update - A Note From the PM

Below is a map of the entire area that will be accessing and sending images to the DI-r, including all of LHIN's 1, 2, 3 and 4. We are very excited about the clinical value that a shared repository will have for such a large region. Every day we are getting closer to our goal of "Access to any image, at any time, from any place."

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Hub Implementation Date Grey Bruce Information Network (12

sites)

December 11, 2008

TVHPP & Huron Perth Region (17 sites)

February 12, 2009

Chatham Kent Health Alliance April 20, 2009

St. Joseph’s Hamilton June 9, 2009 Listowel and Wingham July 2009

Bluewater October 2009

Windsor Essex Regional December 2009 / January 2010

Chatham Kent Healthcare Alliance had a very successful go live. Order information, images and reports began flowing into the DI-r as planned on April 20, 2009. The previous table lists the implementation dates for the sites that are contributing to the regional DI-r. Congratulations to all those involved in the implementation on a job well done!

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LHIN 3 – 4

The LHIN 3 – 4 team has been working hard on their first hub to integrate to the DI-r. The first site that will integrate will be St. Joseph’s Hamilton in June. The agreement with LHIN 3 – 4 specifies that the project schedule in SWO cannot be compromised by the integration of their sites but we will plan to interject some of their sites in between ours where possible. They have also begun working with the Niagara Health System as their second hub.

SWODIN Next Steps

We have begun some early planning activities with Listowel and Wingham as the next site to integrate. They have just completed a project to convert to the Cerner system in London and they have a Philips PACS. We will kickoff with the Hub Project Team toward the end of May. We are targeting go live for the end of July.

We are also in the early planning stages with Bluewater Health in Sarnia. Bluewater has a Meditech HIS/RIS and Agfa PACS.

Babette MacRae, SWODIN Project Manager

CKHA GOES LIVE!

Chatham-Kent Health Alliance (CKHA) is very pleased to have completed their

integration with the SWO DI-r on April 20, 2009. From the MOHLTC perspective, CKHA is three hospitals – Public General Society of Chatham, St. Joseph’s Hospital, and Sydenham District Hospital. CKHA cares for its patients as a single entity using a

singular Master Patient Index (MPI), one ‘best-of-breed’ HIS and a GE Centricity PACS. CKHA serves the medical/imaging needs of residents in the Chatham-Kent, Lambton and Essex region. Image review and interpretation is provided by Radiologists located in Chatham, Windsor, and London. As a community level hospital, CKHA relies on the larger centres for urgent and tertiary care. This real-time connection with the SWO DI-r will now benefit our patients by allowing rapid access to up-to-date Diagnostic Imaging information for clinicians in the participating LHINs.

The implementation team was comprised mostly of staff from Consolidated Health Information Services (CHIS) with significant support from CKHA personnel. CHIS, an incorporated not-for-profit organization, provides IT services to member hospitals and is the project management office for the Erie St. Clair LHIN. The CHIS motto could

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easily be extended to reference the SWO DI-r initiative: “The right information at the right time, in the right place.”

In November of 2008, CKHA began PACS image archiving to the DI-r in London. During the third weekend in April 2009, image interpretation reports were added to Oneview for the most recent 28 months. Following the SWO DI-r lead of using standards-based solutions, CHIS achieved this load of historic reports by using HL7 messaging instead of a custom developed solution. CHIS partnered with one of their RIS vendors, McKesson, to send HL7 order and result messages based on specific date ranges. End to end, CKHA and SWO PACS loaded reports for 208,622 exams in 16 hours.

The SWO DI-r continues to pave the way for future implementations. Because CKHA and Windsor Regional Hospital (WRH) share a RIS and a multi-facility HIS, multiple solutions developed by the SWO DI-r and CHIS for the CKHA implementation can be re-used when it is time for the WRH implementation. These include the historic load

strategy, HL7 translations, and ‘community-level’ patient identifiers.

Back row: Matt Chambers, Craig Reed, Jackie Smith, Connie Campbell Front row: Durk Elliott, Wendy Van Torre, Alis Gillett

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Frequently Asked Questions

How does information get to DI-r?

Each Hospital sends Radiology order and results information to the DI-r as well as the associated images from the local PACS. When the order is received from the regional Hospital Information System, the Patient Matching Solution does a search for any

related exams for that patient. If exams exist, the current exam information is attached to the patient otherwise a new patient is created in the DI-r. The images are forwarded by the hospitals PACS system and the DI-r matches the images to the exam.

Access Methods

The sites that are now connected to the DI-r are able to access the longitudinal record either by logging directly into the DI-r application (OneView) or by launching the OneView application via an application interface within their local PACS application. Users in the Carestream PACS in the Grey Bruce, the Centricity PACS in Thames Valley/Huron Perth regions and the Centricity PACS in the Chatham region are able to press a button within their PACS application, passing their user credentials and the patient information through to OneView. The list of exams is presented to the user and

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can be sorted by related exams. The report information for the current exam is

displayed along with the list of exams. If a related exam is selected the report for that exam is also displayed on the same screen for comparison purposes. Images can also be displayed by clicking on the image icon. The images are retrieved from the DI-r and displayed in the DI-r image viewer. Standard image manipulation tools are available to enhance the view of the image.

Training and Support Model

Each of the Clinical Areas is assessed to determine their current and future need for access to the longitudinal record. It is important that once given access, there are people available within these areas to provide training and support. Our

approach for this strategy is to have Brenda Rankin of the PMO work with the identified SuperUsers to ensure that the clinical

staff is provided with the training, training materials, and support required to

successfully use OneView in their clinical workflow. The training requires minimal effort and most users have been able to self-teach based on the training materials provided.

“A positive attitude may

not solve all your

problems, but it will annoy enough people to make it worth the effort.”

Herm Albright

Grey Bruce Update

GBIN’s Carestream local PACS system was successfully upgraded in April, with the new version continuing to be integrated with the SWO DI-r. While the upgrade was

occurring, the system was down for several hours. However, access to GBIN images remained available throughout the scheduled downtime via the DI-r: many users had been trained ahead of time and several used the DI-r during this period.

GBIN has been archiving images on a go-forward basis since December, and these images are available in the DI-r within minutes of being completed. Now the historical image migration has also been started and is well underway. Within a few months all GBIN digital images will be stored in the DI-r.

With multiple radiology, PACS, order management, registration and interface systems, plus different workstation and network configurations, integration on this scale is very complex. Skills, teamwork, resourcefulness and dedication on the part of all the participants have contributed to making it a success.

Diana Lewis, Grey-Bruce Hub Project Manager

The link ed image cann

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ENITS Update

SWO PACS infrastructure is helping to improve urgent neurosurgical care in Ontario

Every second counts when treating patients with traumatic head injuries. Ontario has only approximately 70 neurosurgeons, practicing in 13 hospital sites, to provide urgent telephone consultations to physicians caring for patients that are presently at any of the other 150+ hospitals across the province. CritiCall links these referring physicians (usually ER physician) with available neurosurgeons to discuss the patient’s condition and determine the best course of treatment.

The current situation is sub-optimal. Neurosurgeons have to make critical decisions based on information that can be highly variable in content and quality. Although neurosurgeons are well trained to make critical decisions based on clinical assumptions, they are often required to err on the side of caution and transfer the patient to a

neurosurgical centre for further assessment and potentially treatment. It is estimated that up to half of all transfers turn out to be unnecessary. These avoidable transfers present health risks to the patient, add to the inconvenience and frustration to all

involved, and costs a lot of public money. The Emergency Neurosurgery Image Transfer System (ENITS) has the potential to completely transform this care pathway.

ENITS is not to be confused with the Southwestern Ontario Digital Imaging Repository that is a long term storage and access system for all Digital Images across the region. ENITS has a very specific goal which is to enable referring hospitals to ‘push’ head CT images to a provincial repository which can then be accessed by neurosurgeons across the province using temporary passwords issued by CritiCall. With the help of ENITS neurosurgeons will be able to make better informed decisions about the need for neurosurgical interventions mandating immediate transfer. Many transfers may be avoided, allowing patients to be cared for closer to their loved ones.

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After assessing several options, the MOHLTC eHealth Program decided to use the PACS infrastructure in Southwestern Ontario as the corner stone on which to build ENITS. The ENITS repository is considered an interim solution as the provincial DI-r, which is in development, will enable this functionality in years to come. Implementation of ENITS began in September 2008 and is expected to be completed across the province at the end of August 2009. As of March 30 2009, 33 CT scanners in 27 hospitals locations in LHINS 1-4 have been connected to ENITS. The implementation of the system has been funded by the MOHLTC eHealth Program and has been informed by members of the Ontario Neurosurgical Action Team, chaired by Dr. J. Rutka. The implementation team has been connecting with DI and IT departments within hospitals to provide more in-depth information and to facilitate the necessary connections and changes. Information and training sessions are also being scheduled with ICU/ER/DI staff as well as

neurosurgeons.

RSS Update

A word from Regional Shared Services

In the September 2008 edition of the newsletter, I wrote about my trials and tribulations in building a new home. At the time, the parallels were very evident with SWO project preparations. Seven months later, I can tell you that we’re successfully moved into our new home. As with any new

construction, there were little bumps along the way, such as:

1. Dishwasher ran with no water in the line (the installer forgot to turn the intake tap under the sink back on)

2. Washer running on “cold” cycle came out hot (plumber interchanged the blue(cold) and red (hot) taps on faucets)

3. Toilets wouldn’t flush properly (plumber forgot to remove the temporary plug used to pressure-test the lines)

Needless to say, while our hub rollouts have gone extremely well, they’ve all had their respective little “plumbing bugs”, most of which have since been addressed.

On the operational side of the “house”, there are three foundational accomplishments of note:

1. The SWO project and RSS operations teams worked extremely hard to bring three hubs on stream (Grey-Bruce, Thames Valley, and Chatham-Kent), with more to come each and every month.

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(through Mohawk Shared Services) is almost complete

3. Our 09/10 budget got approved by the Digital Imaging Steering Committee, which means that we will have the capability to ramp up new roles to the RSS operations team

Speaking of new roles, I am pleased to announce that Carolyn (Carrie) Milligan has accepted an offer to join RSS on May 25th on a temporary basis. Reporting to me, she will have the following responsibilities:

1. Establish the performance modeling and reporting required by the various RSS stakeholders.

2. Establish and maintain the RSS service contracts (services purchased by the hospitals).

3. Identify venues and vehicles for showcasing RSS accomplishments and performance.

While one could argue that the DI-R is the greatest thing since indoor plumbing, the work is not yet complete, but well underway!

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Wordsearch Puzzle

Across

7 Three hospitals make up this Hub. (4) 8 Name of PACS made by Kodak. (10)

11 Group of hospitals that will go live together during the DI-r project (3) 12 Approximately how many neurosurgeons does Ontario have? (7) 13 How many hospitals in Ontario have Neurosurgeons? (8)

14 The colour in the name of a hub that is already implemented in the DI-r (4) 15 Type of User who will help provide training. (5)

16 What does the "I" stand for in DI-r? (7) 18 What was missing in the dishwasher? (5) 19 The "H" in LHIN (6)

23 Stephane Ouellett is the Director of what? (3) 24 The "U" in EUID (6)

26 What sends radiology order information in a hospital? (3) 27 Who issues neurosurgeons their passwords? (9)

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Down

1 "Access to any image, at any time, from any ____." (5) 2 Device where images are acquired. (8)

3 What type of organization is CHIS "Not for_____" (6) 4 What city is Bluewater Health in? (6)

5 Emergency Neurosurgery Image _________ System. (8) 6 CKHA serves residents in this town. (7)

9 A type of archive. (10)

10 What is one thing that has contributed to the success at Grey Bruce? (6) 11 ENITS deals with images for what body part? (4)

17 What you click on to display images. (4) 18 Short form for Windsor Regional Hospital (3) 20 Analogy used by RSS Director (5)

21 Short form for Master Patient Index (3)

22 Name of the application that is used to view the Longitudinal record. (7)

23 The list of exams presented to the user can be sorted by what type of exams? (7) 25 How many hubs are operational? (5)

27 Type of images being sent to the ENITS repository. (2) 28 The "L" in MOHLTC (4)

30 Month that the project will "kick-off" Listowel / Wingham. (3)

Terminology and Acronym Guide

CHI – Canada Health Infoway

DI-r - Diagnostic Imaging Repository

GBIN - Grey Bruce Information Network

HIS/RIS - Hospital Information System / Radiology Information System

HUB –Group of hospitals that will go live together during the DI-r project

LHIN –Local Health Information Network

MOHLTC – Ministry of Health and Long Term Care

ENITS - Emergency Neurosurgery Image Transfer System

RSS- Regional Shared Service

SSHA - Smart Systems for Health Agency

SWO – Southwestern Ontario

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Your feedback is important to us

Our goal is to keep you Informed as the digital imaging project unfolds. If you have any questions or comments please let us know. In future issues we’ll respond to your

questions; if a more immediate answer is required we’ll ensure your questions are answered as quickly as possible. We welcome suggestions for topics to cover in future issues. If you have examples of the positive impact the networked PACS system is having on patient care, we'd love to to publish the story.

Contact us

Please send questions, comments or suggestions to brenda@clientoutlook.com. If you would like other names added to the e-mail list, or a name removed, please let us know.

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