New South Wales (NSW) Health in Australia has completed the first phase of an ambitious project to create a statewide health imaging exchange. Healthcare accounts for 27 percent of total government spending in Australia, and with an aging population with increased chronic conditions, there is potential for an enterprise image repository (EIR) to improve diagnosis and lead to better patient outcomes.

A pilot of 12 public hospitals in the Western Sydney and Nepean Blue Mountains Local Health Districts began in February. “They were chosen for a number of reasons,” says Joe Hughes, program manager, Health Support Services, NSW Health. “Being a pilot, we wanted to test the technology and learn as broadly as possible from the implementation process. From an IT point of view we chose two organizations—the Westmead Children’s Hospital has one single PACS/RIS [picture archiving and communication system/radiology information system] and a PAS system (the equivalent to a master patient index), and the other two local districts share the same PACS/RIS and PAS, and each of them have different products. We chose them for this reason because we want to be sending studies from different PACS/RIS systems into the EIR and we want to be sending data to the patient registry component of the solution from the separate PAS products.”

Hughes says there is much his team learned from the pilot, including the fact that it was truly on the leading edge and integration with the vendors took longer than expected. “There are a lot of organizations who want to put in a vendor neutral archive or have done it on a small scale, but there aren’t a lot of examples that I’m aware of in the world that have done it on a scale that we are now,” he said. “As a result of that the PACS/RIS vendors were inexperienced at doing this sort of thing. We didn’t anticipate the complexity involved in doing this.”

Phase two began last month and will continue to roll out over the next year across 15 local health districts covering an area larger than the state of Texas, serving a population of more than 7 million people. This exchange will eventually connect nearly 110 clinical facilities, each using their own PACS, RIS, electronic health records (EHR), clinical and business practices, and patient identifiers.

Technical Aspects
The Enterprise Vendor Neutral Architecture (VNA) framework is being provided by the Milwaukee, Wis.-based TeraMedica Inc., a provider of vendor neutral, enterprise-wide solutions for medical image management. The EIR is composed of three key components: an imaging repository; an enterprise patient registry that manages reconciliation of patient identities, which are reconciled at the state level; and an enterprise service bus, which provides the HL7 messaging services.

The EIR will be a consolidated patient-centric imaging folder, incorporating the DICOM image and the full imaging study and report, to provide improved care wherever the patient may be located. In all, the EIR will connect nine PACS systems, processing more than 3 million annual imaging procedures. This system also possesses the ability to natively manage and distribute beyond DICOM using global standards such as MPG, JPG, PDF and other critical clinical content such as treatment plans for cancer care or vital reports in non-standard formats. In conjunction with its universal viewer known as Univision, the remote physician gains access to a universal view of all content.

Users have three ways to access images in the EIR:

1. Radiologists see auto-downloaded studies from the EIR, which are saved in their local PACS.
2. Clinicians outside radiology see a link in their native EHRs, which launch a browser access to the EIR if there is a study outside their hospital.
3. Both radiologists and referring clinicians also have direct access to the EIR when a patient isn’t already registered in their local system, like for instance, if a physician is consulting on a patient transfer to a tertiary hospital.

In the future NSW Health wants to replace the current Univision viewer, which compresses the radiological image, with a full-DICOM viewer. The health system, with its partners, is currently exploring technology to keep the full image from flooding the network bandwidth. NSW Health is working on other health IT projects, as well, including a national HIE, an electronic medication management system, and a clinical information system for intensive care unities across New South Wales.

Even though all hospitals connecting to the Australian imaging archive are state-owned facilities, which allows for easier governance and deployment, Hughes still thinks the U.S. can learn from his country’s example. Many U.S. organizations, as in Australia, share patients, especially those with chronic and complex diseases, and thus need to share information. “I think having a vendor neutral archive, would be really valuable in those cases, and if they were interested in improving access to studies in that way [it would give a] better patient history,” he concludes.