Utility and Perceived Value of a Provincial Digital Diagnostic Imaging Repository: Multimethod Study

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.

Understanding Engagement and the Potential Impact of an Electronic Drug Repository: Multi-Methods Study

“…Although many participants perceived the data elements to be valuable, they were unaware that the repository existed or had limited knowledge on how to obtain access. This problem is not unique to the DHDR [ 45 ] and highlights the need for active dissemination strategies, such as engaging local clinical champions and increasing awareness and education about the repository through professional organizations (eg, the Ontario Medical Association, the Registered Nurses Association of Ontario, or the Ontario College of Pharmacists), which may increase the uptake [ 46 - 48 ]. Cumbersome access pathways are not unique to the DHDR [ 45 ], suggesting that efforts to streamline onboarding, such as bundling it directly to licensure or credentialing processes rather than keeping it as an independent activity, would have positive downstream impacts beyond those realized through the DHDR.…”

“…This problem is not unique to the DHDR [ 45 ] and highlights the need for active dissemination strategies, such as engaging local clinical champions and increasing awareness and education about the repository through professional organizations (eg, the Ontario Medical Association, the Registered Nurses Association of Ontario, or the Ontario College of Pharmacists), which may increase the uptake [ 46 - 48 ]. Cumbersome access pathways are not unique to the DHDR [ 45 ], suggesting that efforts to streamline onboarding, such as bundling it directly to licensure or credentialing processes rather than keeping it as an independent activity, would have positive downstream impacts beyond those realized through the DHDR. Integration into existing point-of-care systems is one such evidence-based strategy that would overcome a key barrier to adoption that plagues a range of digital technologies in health care [ 39 , 45 , 49 , 50 ] and has been successfully operationalized for a centralized drug repository [ 20 ].…”

“…Cumbersome access pathways are not unique to the DHDR [ 45 ], suggesting that efforts to streamline onboarding, such as bundling it directly to licensure or credentialing processes rather than keeping it as an independent activity, would have positive downstream impacts beyond those realized through the DHDR. Integration into existing point-of-care systems is one such evidence-based strategy that would overcome a key barrier to adoption that plagues a range of digital technologies in health care [ 39 , 45 , 49 , 50 ] and has been successfully operationalized for a centralized drug repository [ 20 ].…”

Image Exchange in Canada: Examples from the Province of Ontario

“…Originally, four regional DIRs were established across the province of Ontario. A DIR can be thought of as a health information exchange, focused on image exchange across a specific region [ 2 ]. Every hospital in the province is connected to a DIR.…”

A Biobanking System for Diagnostic Images: Architecture Development, COVID-19–Related Use Cases, and Performance Evaluation

“…The application of common standards and the validation and benchmarking of ICT infrastructures used for the repository architecture is a major focus of the research activity in this field [ 22 ]. Indeed, availability of different (role-specific) image access methods and perceived performance (speed of upload) have been confirmed [ 23 ] to impact the perceived usefulness, and thus the actual adoption, of such systems.…”