IT Perspective:

• Privacy and Retention Polices – DI is subject to strict retention policies imposed through jurisdictional legislations. To ensure adherence to such policies, the systems responsible for the long-term archive of the information must eliminate data loss and corruption through investment in h/w redundancy, data replication, backup, and other necessary technologies.
• Aggregation – In consortiums covering large number of healthcare facilities with existing referral patterns among them, a patient may have DI information across multiple providers. Hence, to eliminate duplicated procedures and to potentially improve the diagnosis and quality of care, it is imperative to ensure that information is available and could be consolidated from all sources, to present a complete snapshot of the patient’s history.
• Performance – To be useful, the DI Information that originated at another facility must be delivered to the point of diagnosis within an acceptable and consistent time frame.
• Scalability – Continuous evolution of h/w, s/w, and healthcare applications will result in the introduction of new product versions and/or technologies that will require upgrade, migration, and other maintenance activities to be executed at the consortium’s facilities.
• Network Topology – The network infrastructure must ensure sufficient connectivity between all participating systems within the consortium to enable desired clinical workflows.
• Standardization – the DI sharing clinical workflows are dependent on the ability to share information among PACS, RIS, and EHR systems deployed throughout the consortium. Support for HL7 and DICOM standards, as well as adherence to IHE SWF, PIR, CPI, KIN, ARI, SINR, ATNA, XDS-I, and PIX integration profiles, are imperative for comprehensive sharing of information.

Clinical Perspective:

• Normalization of information – To enable the desired clinical workflows, there is a need to establish relationships between related information which was created by different systems at different facilities utilizing different nomenclatures (e.g., radiology procedure code) and identifiers (e.g. patient ID).
• Access to information – To satisfy privacy and security requirements for protecting patient information, the consortium must implement common data governance policies across all of its members. Such policies include: patient consent, access controls to PHI, data sharing rules among different facilities, etc.

Business Perspective:

• Required investment – An adequate IT infrastructure that meets SLAs, with respect to performance, data retention, disaster recovery, and business continuity, requires significant operational and capital investments.
• Buying power – A significant investment is required in order to meet the objectives of the consortium; hence, the ability to lower TCO is critical to success.
• Data governance – The significant complexity of regional health projects stems from the large number of participating stakeholders and relationships (politics), technological complexity, policies and governance complexity. The successful implementation is dependent on clear ownership of the project, and the professionalism of the delivery team.
• Influence and decision making power – Every consortium member needs to maintain its independence and control over their affairs.