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					     GTA West DI-r

Regional Diagnostic Imaging
Presentation Overview
• Concept of the DI-r

• GTA West Project History

• GTA West Project Description

• GTA West Project Procurement Strategy

• Current Status of the GTA West

• Next steps

• Questions and Open Discussion
Concept of the DI-r – Visual Representation

Reference: eHealth MOH 2006
Concept of the DI-r - Challenges
• Funding for Modalities, PACS, Archives and Infrastructure

• Hospitals and IHFs have different models (both need access to images
  at point of care)

• Unique Patient Identification - EMPI

• High capacity, high availability networks not sufficient across the

• Many existing film-less sites lack sufficient resources for full
  redundancy to provide seamless business continuity

• Strong provincial leadership needed, clinical quality guidelines and
  standards, local and regional governance, collaboration and sharing
  required, balanced with independence

Reference: eHealth MOH 2006
Concept of the DI-r - Challenges
• Interoperability of various RIS/PACS solutions

• Organizations at different stages of film-less
  maturity, aggravating persistence of Transportable
  Media (Films, CDs)

• PACS investments often perceived as
  departmental instead of enterprise

• Balancing economies of scale with DI solution
  performance needs (response)
Concept of the DI-r - Rationale
• Supports biggest considerations: Clinical needs,
  Funding, Governance, Flexibility and Performance

• Supports patient referral, provider service patterns,
  existing and new collaboration

• Sharing and Clustering where viable, respects
  hospital and IHF differences

• Incorporates existing PACS/RIS investments,
  solutions and initiatives underway
Concept of the DI-r - Rationale
• Uses existing data centers

• Accommodates geography and network

• Provide options in the future for
  consolidating functions
Concept of the DI-r - Rationale
• Supports patient referral and provider
  service patterns

• Limits local infrastructure burdens,
  optimizes resources
Concept of the DI-r - Rationale
• Levers Extensive investments which have
  been made in departmental and enterprise
  RIS/PACS – no tear downs

• Supports established and new collaborative
  frameworks (e.g. In Urban/Suburban/Rural
  and North geo clinical profiles, where
  resource shortage is acute, region/group
  collaboration and sharing is extensive)
GTA West Project History
• The GTA West Diagnostic Imaging (DI) Repository
  Project is a joint initiative commissioned by a voluntary
  consortium of 22 hospital corporations that span the central
  and southern regions of Ontario. The project launched in
  mid 2007 to undertake a Phase 0/1 Planning Project
  sponsored by Canada Health Infoway (Infoway).

• GTA West represents the last DI-r in Ontario (second last
  in Canada) and is being sponsored by the Ministry of
  Health, Canada Health Infoway and the participating Local
  health Integration Networks.
GTA West Project History
• GTA West started off with a group of
  hospitals that are located in the western side
  of Greater Toronto Area (population ~2.5

• The group expanded beyond the GTA
  borders to include hospitals and regions that
  had not yet joined a DI-r
GTA West Project Description - Region
•   LHIN 5

•    Headwaters Health Care Centre
•    William Osler Health Centre

•   LHIN 6

•    The Credit Valley Hospital
•    Halton Healthcare Services
•    Trillium Health Centre

•   LHIN 7

•    Baycrest
•    Bridgepoint Health
•    Centre for Addiction and Mental Health
•    The Hospital for Sick Children
•    Mount Sinai Hospital
•    The Salvation Army Toronto Grace Health Centre
•    St. Joseph's Health Centre
•    The New Women's College Hospital
•    Toronto Rehab Institute
•    University Health Network
•    West Park Healthcare Center

•   LHIN 8

•    Humber River Regional Hospital

•   LHIN 12
     Royal Victoria Hospital
     Orillia Soldiers Memorial Hospital
                                                      ~ 3 Million DI exams
•    North Simcoe Hospital Alliance
•    Muskoka Algonquin Healthcare
•    Collingwood General & Marine Hospital
GTA West Project Description
• UHN is acting on behalf of the participating hospitals as
  their representative with respect to the execution and
  administration of the agreements with Canada Health
  Infoway and the eHealth office of the Ontario Ministry of
  Health and Long term Care

• Canada Health Infoway will fund 75% of the eligible costs

• The Ministry of Health has agreed to fund the remainder of
  the costs

• There are no operational costs to hospitals for the first 2
  years…MOH funded.
GTA West Project Description – Project Team
GTA West Project Description - Committees
Clinical Oversight Committee:
    –   The GTA West Clinical Oversight Committee will be responsible for providing clinical
        oversight for the planning, development, implementation and operation of a shared digital
        diagnostic imaging repository (DI-r).
    –   Review, approve and deliver the clinical components of the Current State and Future State
        Architecture and Clinical Requirements documents;
    –   Review project deliverables as may be requested by the PMO resources from time to time

Technical Advisory Committee:
    –   Provides technical oversight for the planning, development, implementation and operation of a
        shared digital diagnostic imaging repository (DI-r).

    –   Review and recommend the Future State Technical Architecture and Technical Requirements

    –   Provide advice to the PMO resources as to the content of the above documents

    –   Review project deliverables as may be requested by the PMO resources from time to time
 GTA West Project Description - Deliverables
                                                                   Conceptual     Detailed
 #     Phase 0/1 Deliverables                                       Phase 0       Phase 1
 1.0   Project Management
 1.1          SOW/Charter
 1.2          Legal Agreement/TPA/Reimbursement Schedule
 2.0   Options Evaluation/Future State
 2.2          Description                                         Checkpoint    Completion
 2.3          Gap Analysis                                        Checkpoint    Completion
 2.4          DI-r - Vendor Information Gathering Process (RFI)   Checkpoint    Completion
 2.5          Vendor Workshops/Discussions                        Checkpoint    Completion
 2.6          Refresh                                             Checkpoint    Completion
 2.7          Test Strategy                                       Checkpoint    Completion
 3.0   Business Case and Financial Analysis                       Checkpoint    Completion
 4.0   Conceptual Privacy and Security Architecture (CPSA)        Checkpoint    Completion
 5.0   Conceptual Privacy Impact Assessment (CPIA)                Checkpoint    Completion
 6.0   Conceptual Threat Risk Assessment (TRA)                    Checkpoint    Completion
 7.0   Change Management                                          Checkpoint    Completion
 8.0   Risk Management                                            Checkpoint    Completion
 9.0   Integrated Project Plan                                    Checkpoint    Completion
10.0   Communications Plan                                        Checkpoint    Completion
11.0   Governance                                                 Checkpoint    Completion
12.0   Preparation of Phase 2 Documents                                         Completion
GTA West Project Description – End Goals

• To deliver a DI-r capable of accepting
  PACS data as well as RIS data in native
  format from multiple institutions and
  present it through a 3rd party viewer and
  within the GTA West partners RIS or PACS

• To deliver a DI-r that will facilitate the
  integration of the other DI-r systems in
GTA West Project Procurement Strategy
GTA West Project Procurement Strategy
• Decided to procure a service and not a
  solution to ensure that an existing public
  entity would be able to govern the system
  with minimal to moderate effort

• Built a comprehensive RFP administered by
  a RFP administrator and controlled by
  fairness consultants
GTA West Project Procurement Strategy
• Sections of RFP
  –   **Clinical – Use cases
  –   Technical
  –   **Governance
  –   Privacy and Security
  –   Total Cost
  –   Company profile
Current Status of the GTA West
• 95% Completed Phase 0/1
  – Site surveys
  – RFP architecture
  – RFP evaluation
  – Selection of vendor
  – Governance group
  – Contract signing
Next Steps
• Complete Phase 2 funding exercise for CHI
  and eHealth Agency
• Redo business case
• Sign on partners
• Build Project team
• Initiate project in Sept 2009
  – First go-live site late 2010

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