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1 GE Healthcare Centricity * Clinical Archive Centricity Clinical Archive solution 1 is a multi-ology, multi-site vendor-neutral solution that transforms rigid departmental silos into fluid information sharing systems. Centricity Clinical Archive offers healthcare enterprises the foundation to help simplify operations and broaden access to care, while helping lower the shared cost. To navigate through this document, follow the instructions below: Turn The Page Click on the back or forward arrow icon to move between pages. > Home Home Button Click on this button from any page to return to the Table of Contents. 1 Centricity Clinical Archive 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 ṬM

2 Operational Excellence Centricity Clinical Archive solution The system provides a single point of access to a single patient jacket where clinicians can see all the exams that patient has had across Southwestern Ontario. Dave Veeneman, PACS/DI-r Manager London Health Sciences

3 Page 1 Creating the model for medical image management in Canada Southwestern Ontario relies on Centricity Enterprise Archive to connect 62 hospitals with disparate PACS & RIS systems, resulting in increased productivity and enhanced quality of care. Business Situation Southwestern Ontario (SWODIN) is funded by several participating hospitals: ehealth Ontario, an agency of the province s Ministry of Health and Long-Term Care charged with establishing electronic health records for the province s 15 million residents; and Canada Health Infoway, a not-for-profit corporation funded by the Government of Canada with a mandate to create a Pan Canadian electronic health record. Client Profile London Health Sciences Centre, London, Ontario Details 62 hospitals across the region 19 hubs with seven vendors PACS and five vendors RIS 3.2 million exams/year 1,600+ system users Technologies Centricity Clinical Archive solution deployed as multi-site DICOM VNA with Centricity Enterprise Archive Centricity Enterprise Web Benefits Increased radiologist and clinicians productivity Improved radiologist services to remote areas Reduced duplicate exams Reduced storage infrastructure costs Improved collaboration between care providers The system started as a pilot project in 2004 with eight locations, including London Health Sciences Centre, St. Joseph s Health Care, London, and six community hospitals. At the outset, there was no point of reference for creating a regional system for sharing diagnostic images. Most individual hospitals were already acquiring and storing images digitally through individual PACS, and several had joined to create local information hubs to cost-share technology and resources. SWODIN took the concept of local hubs to a regional level. The project engaged clinicians, group practices, and leadership across Southwestern Ontario to achieve consensus and to maximize the positive impact on patient care. The resulting technology and infrastructure network links individual systems that use many different vendor platforms through a unified, web-based interface. Ultimately, SWODIN will serve as one of the models for interconnected network covering the entire province and eventually all of Canada. Currently, our large-scale vendor-neutral archive takes a number of modality exams general radiology, fluoroscopy, CT, MR, mammography, nuclear medicine, angiography, and ultrasounds. Scott Charlton Technical Lead for SWODIN and Solutions Architect at London Health Services Centre which hosts the network s IT resources

4 Page 2 Solution Overview Since 2008, 62 hospitals in the Southwestern Ontario region of Canada have shared a single archive and network for diagnostic images. This Image Exchange, also known as SWODIN, is built on the highly scalable and vendor-neutral platform of Centricity Enterprise Archive to help realize substantial cost savings through reductions in duplicate exams, unnecessary patient transfers, and improved radiologist and technologist productivity. SWODIN connects radiologists, referring physicians and specialists at hospitals across the region, allowing them more rapid access to patient images, through Centricity Enterprise Web, no matter which hospital produced them, and regardless of the PACS and RIS technology that hospital uses. Scott Charlton, Technical lead for SWODIN and solutions architect at London Health services center noted that currently, our large scale vendor neutral archive takes a number of modality exams general radiology, fluoroscopy, CT, MR, mammography, nuclear medicine, angiography and ultrasounds. There is opportunity to enhance the system with cardiology, pathology, endoscopy, dermatology, ophthalmology basically all the ologies. That s the concept of the vendor-neutral archive. We can scale out across hospitals using standards, and we can also scale up within the functions of a hospital. Scott Charlton Technical Lead for SWODIN We store 3.2 million exams per year, which equates to 120 terabytes per year. At present we use only a small portion of our capability. There is opportunity to enhance the system with cardiology, pathology, endoscopy, dermatology, ophthalmology basically all the ologies. That s the concept of the vendor-neutral archive. We can scale out across hospitals using standards, and we can also scale up within the functions of a hospital. Powerful Benefits SWODIN has realized multiple benefits, among them: Clinicians have access to imaging records of the patient across 62 hospitals through Centricity Enterprise Web, supporting more informed and timely clinical decisions that help patients receive the most appropriate treatment in a timely manner. Any clinician in the region can access a patient s prior exams acquired at any hospital within the network, helping to avoid duplicative or otherwise unnecessary studies. There is much less need for patients to carry CDs of images from one hospital to another; hospitals that performed the studies are spared the expense of generating the CDs, and the hospitals receiving the studies no longer have to import the CD information to make it part of the patient s records. Clinicians at smaller hospitals can consult on images remotely with specialists at major medical centers, enabling decisions on whether patients need to be transported for emergency treatment, improving the patient experience.

5 Page 3 We take DICOM studies from all the different PACS that are connected to us, Charlton says. We store the images within our storage network. The database is continuously updated as new exams are completed. A user who logs on will query in a patient and be able to access the database and see an exam that just came in. The web servers will then retrieve that exam from storage directly. Vendor neutrality At the heart of SWODIN s system is Centricity Enterprise Archive. Using efficient, industry-standard components, it provides a flexible, standards-based imaging repository for secure, highly scalable, and reliable long-term storage. A key consideration in SWODIN s development was to allow hospitals to continue using their existing PACS and RIS technologies and related work flows. In the process seven different PACS vendors were connected, which are GE, McKesson, Philips, Carestream, SECTRA, RamSoft and AGFA, and five different RIS vendors, which are Cerner, Meditech, McKesson, Novarad and MediSolution. Centricity Clinical Archive serves as middleware, enabling images from any vendor s technology to be stored and viewed seamlessly from any point on the network. Images are quickly available. There is no caching of images on the web server and the data is streamed directly from the repository. The application allows all network users to examine images using the same Centricity Enterprise Web viewer application, enabling easy viewing and analysis, and supporting more informed care decisions. Infrastructure disaster recovery The system includes built-in redundancy so that in case of a power failure or hardware issue at the primary data center, a duplicate backup is activated and the network s function is not interrupted. We use a replicated data center model, Charlton says. Within the vendor-neutral repository, we replicate the DICOM transactions across both sites, so that each site has a complete database of all the exams, indexed under DICOM tags as well as their own separate storage networks. Standards compliance The system provides a single point of access to a single patient jacket where clinicians can see all the exams that patient has had across Southwestern Ontario. This is done via various standards. Right now, we use HL7 and DICOM. We have WADO available, as well as IHE PIX. In the future we ll be converting over into XDS/XDSi and others to enhance the number of systems we can talk to and how they can talk to us.

6 Page 4 Care scenarios Two examples help illustrate how SWODIN helps enable more timely care and sound clinical decisions. Oncologist In the first case, a patient is referred by a clinician at Windsor Regional Hospital to an oncologist at London Health Sciences Centre. The patient had a CT study at Windsor and is now with the oncologist, who needs to review the CT study to support radiation and treatment planning. Here, image exchange is beneficial because the oncologist is able to base decisions on a more complete picture of the patient s history, even though the imaging was performed elsewhere. Treatment begins faster, as the oncologist can access prior images directly. The London staff does not have to request a guest-imaging CD, nor does Windsor have to create and send it. Furthermore, there are no issues with a different image viewer on the guest CD. Trauma In the second case, a trauma patient is admitted to a small hospital in Goderich and undergoes diagnostic exams. Clinicians decide to transport the patient to London Health Sciences Centre, where the intake specialist needs to review the images to plan for treatment before the patient arrives. Here, image exchange is beneficial because the tests already performed at Goderich are quickly available and easily viewable, and do not have to be repeated at London. There is no need for Goderich to create and send a guest CD. Clinicians at London are well prepared for the patient s arrival and can start treatment quickly. The economic benefits most directly tied to a diagnostic imaging repository, beyond IT simplification and cost reductions, include increased clinician productivity that translates into two positive impacts for our patients: faster access to imaging services and more time for our clinicians to collaborate on complex cases. Glen Kearns IVP of Technology Services St. Josephs Health and London Health Sciences

7 Page 5 True North study demonstrates clear cost savings To help validate the economic benefits of electronic diagnostic imaging, repositories and vendor neutral archives like SWODIN, Canada Health Infoway in 2008 commissioned a study by consultants Videre and True North Consulting & Associates. Across Canada, the study found that PACS and diagnostic imaging networks, when fully implemented, would avoid 10,000 to 17,000 patient transfers per year at savings from $8 million to $14 million. Some 800,000 to 1.3 million duplicate exams would be avoided, at savings from $47 million to $71 million. Other pan-canadian benefits were projected to include a 30 percent improvement in report turnaround time, allowing care delivery ten to 24 hours sooner, positively affecting patient length of stay Added benefits with networks like SWODIN s include image storage cost savings. Centralized storage management costs are greatly reduced versus distributed local archives, says Hough. The cost per terabyte to manage the data is much lower when there is a large, centralized facility that benefits from economies of scale. While the study looked mainly at projected economic benefits to the Canadian healthcare system as a whole, it identified two benefits specific to imaging network repositories: reducing patient transfers and reducing duplicate imaging. Regarding duplicate exams, Hough says, Now, exams taken on any day are available ubiquitously everywhere as soon as they are archived. That means exams that were done yesterday do not have to be repeated today because the patient has changed locations. Radiologists suggest that one to six exams are unnecessarily duplicated each week. That, multiplied by the number of radiologists, turns out to be a very large number. The study found that SWODIN eliminated 60,000 to 90,000 exams annually (2 to 3 percent of total exams) at savings from $2.1 million to $4.5 million per year along with elimination of unnecessary radiation dosage to patients. Similarly, Hough observes, business continuity and disaster recovery are improved with a centralized system. Overall, the Videre/True North study found that, once fully implemented across Canada, a diagnostic imaging repository would generate $850 million to $1 billion a year in health system efficiencies through increased clinical productivity, reduced patient transfers, reduced duplicate exams, and film costs. In addition, patient care will be enhanced because physicians will have faster access to all patient imaging in support of more informed and timely treatment decisions. As imaging centralization expands beyond radiology, clinicians will have access to an increasingly comprehensive view of patients condition, heightening the impact on care quality. Clearly, SWODIN has helped provide a strong business case for image exchange with vendor-neutral archives as a way to support high-quality healthcare and achieve cost efficiencies. Now, exams taken on any day are available ubiquitously everywhere as soon as they are archived. Thomas Hough President and Founder True North

8 Page 6 GE Healthcare s Diagnostic Imaging System First in Canada to Achieve Infoway Certification Centricity Enterprise Archive, the imaging repository of the Centricity Clinical Archive solution, has helped Southwestern Ontario Diagnostic Imaging Network, Canada connect the imaging departments of the network s 62 hospitals and seven different RIS/PACS systems to a single, central repository, helping provide web-based information access to over 1,600 clinicians across the region. GE Healthcare has the first IT system in its class to achieve Infoway certification, meeting stringent national DI-r certification requirements. Infoway Certification Services provides a national process to certify trusted, standardsbased health information solutions. I congratulate GE Healthcare Canada for having their Centricity Enterprise Archive v4.0 DI-r Class Diagnostic Imaging System application become the first in its class to successfully complete the Infoway certification process, says Richard Alvarez, President and CEO, Canada Health Infoway. Digital diagnostic imaging has already played a role in generating cost savings and efficiencies of more than $800 million annually across Canada, and we believe that as the interoperability and use of solutions matures, further gains are possible. The Infoway certification is a result of Centricity Enterprise Archive s demonstrated performance and scalability in large implementations with vendor-neutral support of multiple applications.

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