A Province-wide, Open Telepathology System

1. A Province-wide, Open Telepathology System A Province-wide, Open, Telepathology System Michael McNeely MD Medical Informatics Consultant mmcneely@islandnet.com Joanne Philley ART, MBA Telepathology Project Manager Jphilley@plco.ca Provincial Laboratory Coordinating Office  920 - 700 West Pender St. Vancouver, BC V6C 1G8 http://www.plco.ca/

2. 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.

3. A Province-wide, Open Telepathology System Geography BC 366,000 sq. miles 4 million people

4. 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, and Blood Bank services

5. A Province-wide, Open Telepathology System Multiple Jurisdictions (Health Authorities)

6. 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 • Potential loss of bulk purchase cost concessions

7. 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)

8. A Province-wide, Open Telepathology System Interoperative Standards • Privacy • Quality • Business Rules • Licensing • Storage • Architecture

9. 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

10. 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.

11. 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

12. 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 (or license must be recognized by Provincial College).

13. 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

14. 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

15. 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 network.

16. A Province-wide, Open Telepathology System Pilot Projects: Northern Health Authority Static telepathology for education and distant consultation

17. 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

18. A Province-wide, Open Telepathology System Pilot Projects: Vancouver Island Health Authority (VIHA) Streaming telepathology for rounds, education, and consultation.

19. A Province-wide, Open Telepathology System Pilot Projects: Fraser Health Authority Dynamic whole-slide telepathology for frozen sections

20. A Province-wide, Open Telepathology System Pilot Projects: Provincial, Coastal and UBC collaborative An expansion of ePath/CME program for education.

21. A Province-wide, Open Telepathology System Goal Status • 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) Done Done Done Being verified Underway Underway To come

22. 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.

23. 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