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De Swart ME, Zonderhuis BM, Hellingman T, Kuiper BI, Dickhoff C, Heineman DJ, Hendrickx JJ, Kouwenhoven MC, Van Moorselaar RJA, Schuur M, Tenhagen M, Van Der Velde S, De Witt Hamer PC, Zijlstra JM, Kazemier G. Incomplete patient information exchange and unnecessary repeat diagnostics during oncological referrals in the Netherlands: exploring the role of information exchange. Health Informatics J 2023; 29:14604582231153795. [PMID: 36708072 DOI: 10.1177/14604582231153795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Data management in transmural care is complex. Without digital innovations like Health Information Exchange (HIE), patient information is often dispersed and inaccessible across health information systems between hospitals. The extent of information loss and consequences remain unclear. We aimed to quantify patient information availability of referred oncological patients and to assess its impact on unnecessary repeat diagnostics by observing all oncological multidisciplinary team meetings (MDTs) in a tertiary hospital. During 84 multidisciplinary team meetings, 165 patients were included. Complete patient information was provided in 17.6% (29/165, CI = 12.3-24.4) of patients. Diagnostic imaging was shared completely in 52.5% (74/141, CI = 43.9-60.9), imaging reports in 77.5% (100/129, CI = 69.2-84.2), laboratory results in 55.2% (91/165, CI = 47.2-62.8), ancillary test reports in 58.0% (29/50, CI = 43.3-71.5), and pathology reports in 60.0% (57/95, CI = 49.4-69.8). A total of 266 tests were performed additionally, with the main motivation not previously performed followed by inconclusive or insufficient quality of previous tests. Diagnostics were repeated unnecessarily in 15.8% (26/165, CI = 10.7-22.4) of patients. In conclusion, patient information was provided incompletely in majority of referrals discussed in oncological multidisciplinary team meetings and led to unnecessary repeat diagnostics in a small number of patients. Additional research is needed to determine the benefit of Health Information Exchange to improve data transfer in oncological care.
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Affiliation(s)
- Merijn E De Swart
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Barbara M Zonderhuis
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Tessa Hellingman
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Babette I Kuiper
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Chris Dickhoff
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - David J Heineman
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Jan J Hendrickx
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Mathilde Cm Kouwenhoven
- Department of Neurology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - R Jeroen A Van Moorselaar
- Department of Urology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Maaike Schuur
- Department of Neurology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Mark Tenhagen
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Susanne Van Der Velde
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Philip C De Witt Hamer
- Department of Neurosurgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
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Image Exchange in Canada: Examples from the Province of Ontario. J Digit Imaging 2022; 35:743-753. [PMID: 35386033 PMCID: PMC8986313 DOI: 10.1007/s10278-022-00623-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 03/17/2022] [Indexed: 11/30/2022] Open
Abstract
An increased number of healthcare providers across the continuum of care share responsibility for providing treatment and care to the patient. Treatment is often provided at community-based facilities and not necessarily at the hospital that performed the imaging. As a result, there is an increased dependency on readily available access to a patient’s longitudinal imaging records. The ways in which diagnostic images and results are exchanged among providers within a patient’s circle of care have expanded. This article explores three varieties of image exchange. First, we examine image exchange patterns within a regional Diagnostic Imaging Repository and identify missed sharing opportunities. Secondly, we explore the use of a regional clinical viewer widely used in southwestern Ontario, called ClinicalConnect™, and examine the adoption of the viewer by providers. Finally, the paper provides a high-level look at how patients can leverage patient portals to view their imaging data to empower their healthcare experience.
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Wickerson L, Fujioka JK, Kishimoto V, Jamieson T, Fine B, Bhatia RS, Desveaux L. Utility and Perceived Value of a Provincial Digital Diagnostic Imaging Repository: Multimethod Study. JMIR Form Res 2020; 4:e17220. [PMID: 32459644 PMCID: PMC7418016 DOI: 10.2196/17220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background Timely and comprehensive diagnostic image sharing across institutional and regional boundaries can produce multiple benefits while supporting integrated models of care. In Ontario, Canada, the Diagnostic Imaging Common Service (DICS) was created as a centralized imaging repository to enable the sharing and viewing of diagnostic images and associated reports across hospital-based and community-based clinicians throughout the province. Objective The aims of this study were as follows: (1) to explore real-world utilization and perceived clinical value of the DICS following the provision of system-wide access and (2) to identify strategies to optimize the technology platform functionality and encourage adoption. Methods This multimethod study included semistructured interviews with physicians and administrative stakeholders and descriptive analysis of the
current DICS usage data. Results In this study, 41 participants were interviewed, that is, 34 physicians and 7 administrative stakeholders. The following 4 key themes emerged: (1) utilization of the DICS depended on the awareness of the technology and the preferred channels for accessing images, which varied widely, (2) clinical responsibilities and available institutional resources were the drivers of utilization (or lack thereof), (3) centralized image repositories were perceived to offer value at the patient, clinician, and health care system levels, and (4) the enabling factors to realize value included aspects of technology infrastructure (ie, available functionality) alongside policy supports. High-volume DICS usage was not evenly distributed throughout the province. Conclusions Suboptimal adoption of the DICS was driven by poor awareness and variations in the clinical workflow. Alignment with physician workflow, policy supports, and investment in key technological features and infrastructure would improve functionality and data comprehensiveness, thereby optimizing health system performance, patient and provider experience, population health, and health care costs.
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Affiliation(s)
- Lisa Wickerson
- University Health Network, Toronto, ON, Canada.,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Jamie K Fujioka
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Vanessa Kishimoto
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Trevor Jamieson
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ben Fine
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Nagels J, Wu S, Gorokhova V. Deterministic vs. Probabilistic: Best Practices for Patient Matching Based on a Comparison of Two Implementations. J Digit Imaging 2019; 32:919-924. [PMID: 31292769 DOI: 10.1007/s10278-019-00253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In order to successfully share patient data across multiple systems, a reliable method of linking patient records across disparate organizations is required. In Canada, within the province of Ontario, there are four centralized diagnostic imaging repositories (DIRs) that allow multiple hospitals and independent health facilities (IHF) to send diagnostic images and reports for the purpose of sharing patient data across the region (Nagels et al. J Digit Imaging 28: 188, 2015). In 2017, the opportunity to consolidate the two regional DIRs that share the south-central and southeast area of the province was reviewed. The two DIRs use two different methods for patient matching. One uses a deterministic match based on one specific value, while the other uses a probabilistic scorecard that weighs a variety of patient demographics to assess if the patients are a match. An analysis was conducted to measure how a patient identity domain that uses a deterministic approach would compare to the accepted "standard." The intention is to review the analysis as a means of identifying interesting insights in both approaches. For the purpose of this paper, the two DIRs will be referred to as DIR1 and DIR2.
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Affiliation(s)
- Jason Nagels
- HDIRS, 7100 Woodbine Ave, Suite #214, Markham, ON, L3R 5J2, Canada.
| | - Sida Wu
- HDIRS, 7100 Woodbine Ave, Suite #214, Markham, ON, L3R 5J2, Canada
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