Utility and perceived value of a provincial digital diagnostic imaging repository: a multi-methods study.

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 and community-based clinicians throughout the province. OBJECTIVE (1) To explore real-world utilization and perceived clinical value of the DICS following the provision of system-wide access, and (2) identify strategies to optimize the technology platform functionality and encourage adoption. METHODS This multi-methods study included semi-structured interviews with physicians and administrative stakeholders, and descriptive analysis of current DICS usage data. RESULTS Forty-one participants were interviewed including 34 physicians and seven administrative stakeholders. Four key themes emerged: (i) utilization of the DICS depended on awareness of the technology and preferred channels of accessing images, which varied widely; (ii) clinical responsibilities and available institutional resources were drivers of utilization (or lack thereof); (iii) centralized image repositories were perceived to offer value at the patient, provider and health system levels; and (iv) enabling factors to realize value included aspects of technology infrastructure (i.e., 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 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 of patient and provider experience, population health and health system costs. CLINICALTRIAL