Benefits and Examples
Value for Ontarians
The existence of the HDIRS repository — as well as the other diagnostic imaging repositories (DIRs) — creates value for a variety of stakeholders.
DIRs securely share DI studies, may reduce DI wait times and costs, and help to maintain a flexible, sustainable healthcare system.
HDIRS continuously evaluates opportunities to advance healthcare, create knowledge among health service providers, accelerate care, and ensure healthier Ontarians – where the real value lies.
Benefits to Clinicians and Patients
- Provides faster, more reliable access to images.
- Enables authorized HSP access to images from anywhere, at any time.
- Results in fewer unnecessary repeat procedures and less exposure to radiation.
- Reduces patient wait times.
- Promotes collaboration among clinicians (can view images simultaneously from different locations).
- Facilitates more accurate and timely diagnosis and faster treatment.
- Standardizes workflow processes and clinical practices.
- Reduces patient travel time.
- Streamlines handling of emergency cases.
- Enhances continuity and comprehensiveness of patient care.
Improving Patient Care: A Case Study
A story told by Dr. Calvin Law, Sunnybrook Health Sciences Centre
Dr. Law tells of the story of a patient who travelled for several hours from a small Ontario town to her appointment at one of Toronto’s cancer treatment centres.
Upon arriving, the already stressed out and scared patient realized that she had forgotten the diagnostic pancreatic x-rays she was asked to bring with her. In even more of a panic, she explained the situation to Dr. Law. Being resourceful, he checked whether they were in the digital imaging repository, which they were. What used to be a 200km, 6-hour mistake, became an instantaneous sigh of relief for both the patient and doctor alike. This patient’s experience was transformed because of HDIRS technology. HDIRS was a true partner in this patient’s journey.
Because of HDIRS, she can have her surgery in Toronto, and be treated post-surgery closer to home. She’ll travel less, stress less, and likely live a better quality of life as a result. HDIRS powers better patient care.
Benefits to Hospitals and Independent Health Facilities
- Provides for greater data security and disaster recovery capability.
- Increases health service provider productivity.
- Frees up IT resources (human and equipment) by moving storage off-site.
- Improves recruitment and retention.
- Offers an environmentally friend way of sharing DI studies.
- Yields capital and operational cost savings via economies of scale.
- Ensures security and privacy issues are addressed collaboratively.
- Provides a foundation for other advanced, regional, digital technologies.
Sharing Data and, More Importantly, Sharing Knowledge: DIR Observations from a Clinical User
A story inspired through a conversation with Karen Pearson, Director of Imaging Services at Kingston General
Accessing information at regional health centres used to be a real challenge. Getting/sending exams, reports, images, etc. was not simple or fast because we had to rely on the mail and couriers. The delays caused a dreadful time lag and unnecessary expense. Old films couldn’t be duplicated. In the early days of digital imaging, we accessed images on CD ROM, which was better than film, but still required a physical transfer of materials.
We now live in an age where we expect to receive things instantly, especially digital files. HDIRS enables that to happen, real time. What a relief on so many levels.
The unintended benefit that we recognized, however, has become the biggest game changer of all. We now share information more easily than ever before…but, more importantly, we share knowledge. When we collaborate across digital files, we’re actually transferring and deepening knowledge. This accelerates learning, diagnosis, and care plans like never before. Add a researcher and we could have volumes of data to help solve the bigger, more complex problems affecting populations at large.
The potential of HDIRS can enable every healthcare centre, no matter the size or depth of resources, to share knowledge. The collective wisdom that emerges from collaboration from all corners of the Province has the power to change the world.
Radiologists Find a Friend in HDIRS
A story inspired by Dr. Mathew Downey, Radiologist, Quinte Health Care
There’s an old adage that a radiologist’s two best friends are another radiologist [for consultation] and old films [for comparison]. We can now consider adding a third friend to that list―HDIRS.
Temporal resolution―or being able to view a patient’s past imaging studies to identify physiological change and the natural and treatment history of disease―is critical to radiologic diagnosis.
When a new examination is obtained, the PACS-DIR interface now automatically retrieves all prior imaging studies available from other HDIRS hospital and independent health facility (IHF) partners. Previous images, radiology reports, and requisitions often containing critical clinical context can be viewed in our own PACS environment. Prior to this interoperability, radiologists often would be completely unaware of relevant prior imaging from other institutions. If they were aware of prior imaging, then time-consuming manual search and retrieval would be required.
Consider the everyday scenario where a radiologist detects a lung nodule that has been previously documented at another institution, is stable, and could be readily dismissed as benign and requiring no further investigation, surveillance, or treatment. If this is unknown to the radiologist, however, then (s)he might raise the diagnostic possibility of a lung cancer, precipitating unnecessary follow-up imaging, radiation exposure, invasive diagnostic procedures, wasted healthcare expenditure and, most significantly, unwarranted patient anxiety and loss of productivity. The critical previous image might even be an unrelated exam (e.g., lung apex included on a shoulder radiograph), emphasizing the importance of having access to the complete prior imaging record.
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 today without DIR access to patient imaging from outside of my own institution than I could using a computer or smartphone without access to the internet.
We’ve come a long way with bright future prospects that challenge the imagination.
Benefits to Ontario’s Healthcare System
- Contributes to and aligns with Ontario’s Patients First and Digital Health Strategy
- Reduces the number of diagnostic imaging retakes – lowers costs.
- Enhances risk management.
- Supports improvements in patient care.
- Helps the province maintain a flexible, scalable, sustainable healthcare system.
- Supports the developing, specialized, regional treatment centre model for cancer, cardiology, etc.
- Helps patients get treatment closer to home or at their preferred locations.
- Facilitates remote diagnosis, treatment, and care.
Shaping the Future of Healthcare: A Case Study
A story inspired by Dr. Alex Hartman from True North Imaging
True North Imaging is an independent health facility with 25 sites that use HDIRS technology.
Dr. Hartman tells a story of a patient in the early stages of pregnancy. She was having an issue with the pregnancy and visited a hospital 10 days before arriving at True North Imaging. Thanks to HDIRS, Dr. Hartman could see the hospital’s diagnostic test results and give the patient the reassurance that she needed that all was normal. Without HDIRS, the patient may have needed an additional ultrasound, resulting in more inconvenience and time away from work, additional anxiety, and costs for the system to bear. All unnecessary because the information was accessible and readily available. In this case, “there couldn’t have been a better outcome because of HDIRS.”
In another case, a patient came in for an ultrasound that showed a large unidentifiable mass. The senior citizen did not remember having another test related to this issue. As the lab prepared to write its report to recommend additional tests, including an MRI and other expensive tests, the HDIRS workflow process, in fact, showed that the same mass existed 5 years prior and there had been no change. Thanks to HDIRS, this patient also avoided needless tests and inconveniences, and the health system saved costs.
HDIRS is, without a doubt, helping to shape the future of healthcare.
Journal of Digital Imaging: Measuring the Benefits of a Regional Imaging Environment
From a DIR, it is fairly easy to report on the overall number of foreign exams transferred from the DIR to individual sites. While this metric provides some insight into migrating patients and demonstrates increases in the number of exams shared, it does not provide insight into the use and value of these foreign exams to clinical users and their patients.
A recent Journal of Digital Imaging article by HDIRS describes means to quantify DIR benefits. Regional study results indicated that:
- Accessing a patient’s longitudinal diagnostic imaging record has become a regular, expected part of the clinical workflow and, as such, the repository must be providing some value.
- The number of CD/DVD PACS imports has significantly reduced, which represents cost and time savings.
- At one hospital corporation, availability of outside imaging through a DIR has reduced the rate of repeat imaging by 15–17%.
Reducing Repeat Imaging in Hepatico-Pancreatico-Biliary (HPB) Cancer Care Through a Shared Diagnostic Imaging Repository
A 2016/2017 study sponsored by Canada Health Infoway and conducted by researchers at the University of Toronto in collaboration with the Institute of Clinical Evaluative Sciences assessed the proportion of repeat, cross-sectional imaging associated with lack of access to a DIR and evaluated the impact of the lack of DIR-based imaging on delays in management and outcomes.
Julie Hallet, Natalie Coburn, Amanda Alberga, Longdi Fu, Sukirtha Tharmalingam, Laurent Milot, and Calvin Law examined HPB cancer patients moving through the Ontario healthcare system from 2003 to 2014. The study divided patients into HDIRS and non-HDIRS groups based on where initial imaging (CT or MRI within 6 months of surgical consultation) was conducted.
The authors reviewed data related to repeat imaging before surgery for the same and different modalities (e.g., repeat CT scan vs. CT scan and MRI), wait time for surgery from initial imaging and surgical consultation, 90-day post-operative morbidity, and overall survival rate.
Of 839 patients, 474 (56.5%) were from HDIRS institutions:
- HDIRS patients were subjected to less repeat imaging overall (57.6% vs. 76.2%).
- The median wait time to surgery from initial imaging (64 vs. 79 days) and surgical consultation (39 vs. 45 days) was shorter for HDIRS patients.
- Post-operative length of stay, morbidity, mortality, re-admission, and emergency department visits did not differ between groups.
Adjusted analysis (adjustments were made based on demographic, social, and clinical factors) confirmed that patients can reduce their odds of potentially redundant imaging by 42% if their healthcare providers are connected to HDIRS.
The study showed a 19% absolute reduction in repeat cross-sectional imaging following initial surgical consultation. For every 5 patients whose healthcare provider uses a repository such as HDIRS, 1 patient can avoid repeat imaging.
Deterministic vs. Probabilistic: Best Practices for Patient Matching Based on a Comparison of Two Implementations
HDIRS-East and HDIRS-West use different methods for patient matching. HDIRS-East uses a deterministic match based on one specific value, while HDIRS-West uses a probabilistic scorecard that weighs a variety of patient demographics to assess whether the patients are a match. In this study, the HDIRS team assessed how a patient identity domain that uses a deterministic approach compares to the accepted “standard” and shares interesting insights on both approaches.
Dr. Medhat El-Mallah
Regional Radiation Clinical Lead for the Central East Regional Cancer Program and Section Chief of Radiation Oncology for the RS McLaughlin Durham Regional Cancer Centre at Lakeridge Health
We cover radiation clinics in five peripheral sites. We now totally rely on HDIRS to review studies done at these locations, whether requested by us or not. Actually, we even use HDIRS for looking at our local images, as it facilitates comparison with external studies (e.g., CTs or PET scan) done elsewhere.
It is not infrequent that our lung cancer patients get admitted with COPD exacerbation at one of these hospitals and end up getting CT imaging during admission. In preparing our follow-up clinics, our clerks routinely check whether previously ordered “routine” studies were done before the patient’s appointment. If clerks become aware that patients had imaging for whatever other reason, they communicate with us to check whether those patients still need to proceed with their “routine” imaging. We not infrequently cancel the latter when appropriate.