Overview & History of HDIRS
For many years, X-rays and other diagnostic images were film-based. Now, health service providers use, store, and share images electronically.
Radiologists started creating and using digital diagnostic images (DI) regularly in the 1990s. Soon after diagnostic images became digitized, hospital imaging departments and independent health facilities (IHFs) started using centralized Picture Archiving and Communications Systems (PACS) to collect, store, distribute, and access digital DI information from anywhere within the organization. By implementing PACS, hospitals and IHFs have reduced the delay time between an X-ray being taken, health service providers receiving reports, and patients being treated.
Traditionally, hospitals and IHFs have managed their own information technology (IT). While DI digitization within an organization represented progress, it still left the issue of how to make DI exams appropriately available to other organizations as a patient moved through the province or healthcare system.
In the early 2000s, Ontario hospitals and IHFs began to discuss how to create more regional access to patient data. They thought of creating a central, accessible repository. Because DI was largely digitized, it represented an early opportunity to form part of the overall electronic health record (EHR). To encourage the creation of EHRs, Canada Health Infoway invested in DI projects across the country, including in Ontario, where the provincial government (through a new agency called eHealth Ontario – now Ontario Health) provided investment as well.
DI exams can contain a large amount of data — as much as a full-length movie on a DVD. DIRs must be able to receive thousands of these exam files every day, store them, retrieve them, and send them quickly and securely to those who need them. They needed very powerful computers with very large storage capacities for this level of processing. In 2006, a single system could not handle DI data for the entire province. Consequently, decision makers created four regional DIRs, including HDIRS.
Formed with the founding goal of creating a shared DIR for health service providers (HSPs) east of Yonge Street in Toronto, HDIRS now operates two repositories that enable storage and retrieval of hundreds of thousands of DI exams every month by dozens of hospitals and IHFs all across the Greater Toronto Area (and beyond). By working together, HDIRS partners are receiving operational and clinical benefits that could not have been realized independently, and Ontarians are benefitting from a more collaborative healthcare system.
Today, all acute care hospitals in Ontario and many IHFs are integrated with and contributing to one of the DIRs, creating four large “pools” of DI information. Each of the four DIRs allows sharing to some degree within their region. However, sending and viewing exams across regions remains somewhat of an issue, and HDIRS is collaborating with Ontario Health and the other provincial DIRs (e.g., through the Diagnostic Imaging Common Services (DICS) project) to enable authorized health service providers all across Ontario to access DI exams.
In addition to enabling province-wide sharing, DIR technology has created a foundation useful for sharing other patient image types and supporting system-wide improvements. HDIRS strives to create continuous value by evaluating other services that may help members, such as peer review, decision support, radiation dose monitoring, support for cardiology and pathology image types, and PACS as a service. Leveraging secure IT services to promote collaboration and knowledge creation among HSPs in this way captures the essence of HDIRS’ strategy and mandate.
Today, hospitals and independent health facilities from 7 (of 14) of Ontario’s Local Health Integration Networks (LHINs) submit and share patient DI exams with the two repositories that HDIRS operates.
The Southwestern Ontario Diagnostic Imaging Network (SWODIN) and the North Eastern Ontario Diagnostic Imaging Network (NEODIN) repositories serve the other LHINs.
For a list of HDIRS’ member and client sites, visit the Contributing Sites page.
Dr. Daniel Rappaport, MD, FRCPC
Staff Radiologist, William Osler Health System
Adjunct Associate Professor, University of Toronto
At William Osler, we view DI exams in conjunction with DIRs on a daily basis, if not hourly. Over 90% of the time, we use it for comparison purposes. We find the DIRs particularly useful for looking at disease progression or stability. Accessing images within a DIR allows us to change reports from “follow-up to ensure stability” to “this is stable” – as such, DIRs reduce appointments and patient anxiety. Contributing to and using the DIRs is paramount to a patient’s continuity of care and an advantage that should be capitalized in a socialized medical system.
Focused entirely on providing value to hospital members and independent health facility clients contributing to the repositories, HDIRS’ small, dedicated team is organized into four main pillars.
HDIRS’ clinical program team manages data quality, DIR benefits, training, site engagement, and stakeholder relations.
HDIRS’ operations team oversees the technology, support, privacy, security, policies, and reporting for the HDIRS-East and HDIRS-West repositories.
Project Management Office (PMO)
HDIRS’ PMO executes projects involving vendors, individual members, and the membership as a whole.
Architecture, Security, and Privacy
This team oversees privacy and security as well as the DIR architecture in the context of external standards and the larger health system.
Funded by Ontario Health (formerly eHealth Ontario) and accountable to all Ontarians, HDIRS is committed to transparency in its business administration.
HDIRS discloses its financials to promote integrity, trust, and a deeper understanding of its role in the healthcare system.
Ontario Health (Formerly eHealth Ontario)
Ontario Health is the provincial agency responsible for ensuring Ontarians receive high-quality health care services where and when they need them. The Ontario Health team includes eHealth Ontario, which is responsible for delivering a comprehensive, patient-focused, secure and private electronic health record system that makes it easier to access and share the information needed – when and where it’s needed – to improve patient care.
Canada Health Infoway
Canada Health Infoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption, and effective use of digital health solutions. Infoway, funded by the federal government, strategically invests in hundreds of digital health projects. In the past, HDIRS was one of of those projects.
Dr. Matt Downey, CD, MD, FRCPC
Radiologist, Quinte Health Care & Chair, HDIRS Clinical Advisory Committee
For one of a generation who has witnessed the digital technology revolution scaled to medical imaging only within the past 15 years, I can no more imagine practising radiology in 2018 without HDIRS access to patient imaging from outside of my own institution than I could using a computer or smartphone without access to the internet. Early HDIRS experience confirmed that the complete patient medical imaging record is frequently fractionated among multiple hospitals and independent health facilities (IHF).
There is an adage that “a radiologist’s two best friends are another radiologist [for consultation] and old films [for comparison].” As such, radiologists and patients have found a friend in HDIRS.