The International Association for the Study of Lung Cancer Early Lung Imaging Confederation.

PURPOSE: To improve outcomes for lung cancer through low-dose computed tomography (LDCT) early lung cancer detection. The International Association for the Study of Lung Cancer is developing the Early Lung Imaging Confederation (ELIC) to serve as an open-source, international, universally accessible environment to analyze large collections of quality-controlled LDCT images and associated biomedical data for research and routine screening care. METHODS: ELIC is an international confederation that allows access to efficiently analyze large numbers of high-quality computed tomography (CT) images with associated de-identified clinical information without moving primary imaging/clinical or imaging data from its local or regional site of origin. Rather, ELIC uses a cloud-based infrastructure to distribute analysis tools to the local site of the stored imaging and clinical data, thereby allowing for research and quality studies to proceed in a vendor-neutral, collaborative environment. ELIC's hub-and-spoke architecture will be deployed to permit analysis of CT images and associated data in a secure environment, without any requirement to reveal the data itself (ie, privacy protecting). Identifiable data remain under local control, so the resulting environment complies with national regulations and mitigates against privacy or data disclosure risk. RESULTS: The goal of pilot experiments is to connect image collections of LDCT scans that can be accurately analyzed in a fashion to support a global network using methodologies that can be readily scaled to accrued databases of sufficient size to develop and validate robust quantitative imaging tools. CONCLUSION: This initiative can rapidly accelerate improvements to the multidisciplinary management of early, curable lung cancer and other major thoracic diseases (eg, coronary artery disease and chronic obstructive pulmonary disease) visualized on a screening LDCT scan. The addition of a facile, quantitative CT scanner image quality conformance process is a unique step toward improving the reliability of clinical decision support with CT screening worldwide.

Development of a draft pan-Canadian primary health care electronic medical record content standard.

In collaboration with a broad range of stakeholders, the Canadian Institute for Health Information (CIHI) led the development of the draft pan-Canadian primary health care (PHC) electronic medical record (EMR) content standard to be used in EMR applications across the country to support PHC data capture and information use and improved health system management. To achieve this goal, CIHI initiated the following activities: stakeholder engagement, information requirements gathering and adoption and implementation promotion of the common content standard for wide-spread use. The resulting pan-Canadian standardized data set will allow consistent data capture that will improve understanding and ability to report on PHC utilization and access, chronic disease prevention and management, health promotion, medication usage, patient safety, quality of care including patient safety and outcomes. The standard will improve patient care information by providing the structured comparable information needed to care for patients over time and across the continuum of care. Standards support clinical practice reminders and alerts, improvements in operating efficiencies, onscreen feedback reports to PHC providers and the ability to look at clinical trends over time. This standard will improve the flow of information by providing standardized information to providers at points on the continuum of care leading to better coordination of care and a reduction of repeat tests. Lastly, a common content standard will improve the health system use of data; by enabling aggregation and analysis of comparable standardized health information, clinicians, jurisdictions, and regions can benefit from using this data for more effective planning and policy decisions. The jurisdictions and clinicians, supported by CIHI and Canada Health Infoway will continue to work together with other key stakeholders, such as vendors to support the adoption and implementation of this standard into future jurisdictional EMR vendor specifications.

Solving the information overload problem: a letter from Canada.

Doctors are inundated with medical information, some inadequately evidence-based, much of it captured in clinical practice guidelines (CPGs). The Ontario Guidelines Advisory Committee (GAC) selects topic areas, searches for all CPGs on the topic, and reviews them using the AGREE Instrument. Based in large part on the AGREE score, the GAC summarises one guideline in each topic area and mounts it on its website, with links to other information (eg, clinical algorithms) where possible. Two topic areas have been selected for implementation--the reduction of unnecessary preoperative testing and the rational management of acute low back pain. Implementation strategies include performance feedback, training of opinion leaders, development of algorithms and reminders, and communication through journals and continuing medical education activities.