Benefits & Examples

• 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.

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.

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.

• 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.

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.

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.

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.