A Provincewide,

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A Province-wide, Open Telepathology System
A Province-wide, Open, Telepathology System
Michael McNeely MD Medical Informatics
Consultant mmcneely_at_islandnet.com
Joanne Philley ART, MBA Telepathology Project
Manager Jphilley_at_plco.ca
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 Canadas 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 BCs 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

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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
• Potential loss of bulk purchase cost concessions

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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 (or license must be recognized by
  Provincial College).

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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 StandardsArchitecture

• 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 network.

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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

• 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
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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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