Transcript Slide 1

A Province-wide,
Open Telepathology System
A Province-wide, Open,
Telepathology System
Michael McNeely MD
Medical Informatics Consultant
[email protected]
Joanne Philley ART, MBA
Telepathology Project Manager
[email protected]
Provincial Laboratory Coordinating Office
920 - 700 West Pender St. Vancouver, BC V6C 1G8
http://www.plco.ca/
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A Province-wide,
Open Telepathology System
Introduction
• British Columbia: Canada’s most westerly
province has embarked on an interoperative
province-wide telepathology solution.
• A fundamental question – should it be a Single
vendor solution or an open system?
• The time is ripe for Telepathology considering
geographic, personnel, financial, infrastructure,
and political reasons.
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A Province-wide,
Open Telepathology System
Geography
BC
366,000 sq. miles
4 million people
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A Province-wide,
Open Telepathology System
Personnel
• Relative shortage of Pathologists and expert Technologists
in remote locations
Financial Incentive
• Canada Health Infoway  iEHR for 50% of Canadians by 2010
• http://www.infoway-inforoute.ca/
Platform
• HealthNet BC: BC’s response to Infoway
http://healthnet.hnet.bc.ca/
Political Will
• Formation of the PLCO: Provincial Laboratory Coordinating Office
• DBCO: Diagnostic & Blood Coordinating Office (Imaging, Pathology,
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and Blood Bank services
A Province-wide,
Open Telepathology System
Multiple
Jurisdictions
(Health Authorities)
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A Province-wide,
Open Telepathology System
Interoperative: a “must have” 
The case for an Open vs. Closed system
Advantages
• HA have different service demands best solved locally
• Technology change over time will bring new products
and “open” approach avoids becoming locked in.
• Corporate changes over time cannot ensure a
continuing product line
• Solve the Open system and develop a system that will
work across the country (and the world)
Disadvantages
• Need for interoperative standards
• More complex set-up
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• Potential loss of bulk purchase cost concessions
A Province-wide,
Open Telepathology System
Goals
• Develop a User “Community of Cooperation”
• Obtain funding (CHI)
• Obtain eHealth Recognition
• Establish Interoperative Standards
• Design and Carry Out Pilot Projects
• Initiate Clinical Service (within Regions)
• Interoperative Telepathology (Cross Region)
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A Province-wide,
Open Telepathology System
Interoperative Standards
• Privacy
• Quality
• Business Rules
• Licensing
• Storage
• Architecture
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A Province-wide,
Open Telepathology System
Interoperative Standards: Privacy
• Generic review of privacy considerations based on the OECD rules
(Organization for Economic Co-operation and Development -- 1980)
• Personal Information Protection and Electronic Documents Act ------ (PIPEDA) [Bill C-6 1999].
• Generic Review using a block diagram
• Privacy Impact Assessments
from each HA – reviewed by
the provincial eHealth Privacy
Director and Infoway
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A Province-wide,
Open Telepathology System
Interoperative Standards: Quality
• No available specific Quality Guidelines
• Development of an inspection Check List based
on College of American Pathologists and provincial
Diagnostic Accreditation Program guidelines.
• Circulated for comment
• Will be reviewed in pilot phase
• To post on the API website ?
• Hope is for official incorporation into
accreditation requirements.
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A Province-wide,
Open Telepathology System
Interoperative Standards:
Business Rules
• Multi-jurisdictional cross-over requires business
rules
• For example:
• How to request referral
• Who keeps the image?
• What is a referral and what is a helpful look?
• Etc.
• Now an open file that will be formalized as the
system grows
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A Province-wide,
Open Telepathology System
Interoperative Standards: Licensing
• Not a PLCO project.!!!
• Currently no clarity re licensing for Telepathology
• Lack of understanding by provincial medical
licensing authorities (i.e. College of Physicians and Surgeons)
• Teleconsultation is recognized for other medical
disciplines in the province
• A concern to Radiologists who can be our strongest
allies.
• Pushing for:
• 2nd Opinion/Expert: Same as now. Should be local
Pathologist referral.
• Primary interpretation: Pathologist must be licensed in BC
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(or license must be recognized by Provincial College).
A Province-wide,
Open Telepathology System
Interoperative Standards: Storage
• Plan is to use vendor and internal storage
solutions due to control (of data and database
management), economies of scale, meeting
internal technical needs/policies, and privacy
issues
• To combine with other medical images in HA
PACS?
• DICOM / LDIP
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A Province-wide,
Open Telepathology System
Interoperative Standards:Architecture
• Not yet finalized
• Federated system likely
• Storage in each Health Authority
• Text report included in Provincial EHR (PLIS) with
linkage to the image.
also
• A central image index with pointers to the locally held
images
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A Province-wide,
Open Telepathology System
Pilot Projects
• Conduct “proof of concept” evaluation
to assess the different modalities of TP
and their appropriateness for specific
applications.
• To further identify, develop and refine standards that
support the development of an integrated provincial
system and lay the foundation for an integrated national
and international system, and
• To develop parameters and an implementation plan for
the expansion of successfully piloted proof of concept
evaluations in support of an integrated provincial
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network.
A Province-wide,
Open Telepathology System
Pilot Projects:
Northern Health Authority
Static telepathology for education and
distant consultation
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A Province-wide,
Open Telepathology System
Pilot Projects:
Interior Health Authority
An evaluation of image quality with
existing whole-slide systems, for
conducting rounds and education
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A Province-wide,
Open Telepathology System
Pilot Projects:
Vancouver Island Health
Authority (VIHA)
Streaming telepathology for rounds,
education, and consultation.
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A Province-wide,
Open Telepathology System
Pilot Projects:
Fraser Health Authority
Dynamic whole-slide telepathology for
frozen sections
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A Province-wide,
Open Telepathology System
Pilot Projects:
Provincial, Coastal and UBC
collaborative
An expansion of ePath/CME program for education.
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A Province-wide,
Open Telepathology System
Goal Status
Done
• Develop a User “Community of Cooperation
• Obtain funding (CHI)
Done • Obtain eHealth Recognition
Being verified
• Establish Interoperative Standards
Underway • Design and Carry Out Pilot Projects
Underway • Initiate Clinical Service (within Regions)
To come • Interoperative Telepathology (Cross Region)
Done
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A Province-wide,
Open Telepathology System
Conclusion
Our province is well on the way to developing an
interoperative and open system supported by
appropriate technical and operational standards
that should serve as the foundation for an
integrated cross-Canadian system that may well
provide an international model.
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A Province-wide,
Open Telepathology System
Acknowledgements
British Columbia
FHA: Minnie Downey, Janet Tunnicliffe, Dr. Scott Cornell, David Izzard, Kwok Lau, Judy
Newman
VIHA: Margarita Loyola, Diana Nagy, Lisa Moore, Dr. Brain Berry, Pam Ganske
VCHA: Dr. Robert Coupland, Dr. Monika Hudoba, Jordon Pope, Ricki Kruger
PHSA - Dr. Diponker Banerjee, Alex Stuart
IHA: Marty Woods, Dr. Kirk Ready, Ted Legate, Bill Stinson
NHA: Cormac Hikish (consultant) , Dr. Justin Lo, Paula Young, Ken Wining
UBC: Dr. Rick Hegele
PLCO: Joanne Philley, Wil Taylor, Dr. M. McNeely ( consultant), Barb Suen, Dr. David Pi
Project SMEs: Dr. U. Balis, Dr. M. Beceich
Quebec
Dr. Bernard Tetu, Giles Pineau, Francios Boilard, Sebastian - Pierre Leroux
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