Framework for a web-based breast imaging learning module built on the open-source CAISIS platform and integrated with the new Breast Imaging EMR and existing breast imaging information technology infrastructure at Capital District Health Authority

Abstract

This report describes the work performed during an 18-week summer internship in the Department of Diagnostic Radiology at Capital District Health Authority (CDHA) by Master of Health Informatics (MHI) candidate Mete Erdogan as part of the requirements for the MHI program at Dalhousie University in Halifax, Nova Scotia). The internship project involved designing and developing a framework for building a web-based breast imaging learning module that is integrated with the existing breast imaging IT infrastructure at CDHA and the new Breast Imaging EMR (BIEMR). BIEMR was built upon the open-source CAISIS data management system and is currently in the final stages of user acceptance testing. Nova Scotia is the only province in Canada that has an organized breast screening program with full capture of all breast imaging taking place within the province in a single database. The Nova Scotia Breast Screening Program (NSBSP) was created as a provincial program in 1991 by the NS Department of Health & Wellness and given a mandate that includes monitoring the delivery of certain clinical services. Recently, the program completed a three-year process to upgrade the mammographic imaging equipment at every fixed site (screening and diagnostic) across the province from the traditional film-based mammography to Full-Field Digital Mammography (digital mammography or FFDM). The NSBSP is now in the process of updating their information technology (IT) infrastructure to better manage their needs following this transition to FFDM technology. Working together, a group of radiologists, academic researchers, radiation technologists and breast screening program managers from Nova Scotia and Newfoundland have collaborated to develop a the BIEMR system, built upon the open-source CAISIS clinical and research database platform. The goal of this internship project was to conceptualize a web-based breast imaging learning module that would provide radiologists, radiology residents, and radiation technologists with access to previous imaging cases for self-review and self-teaching purposes. Traditionally, radiology education and depended on teaching file repositories based on paper and film, making them prone to physical deterioration and limiting the ways in which the files could be created,stored, used and shared. Advances in digital imaging technologies such as the picture archive and communication system (PACS) environment and full-field digital mammography (FFDM) have opened the door to a new era of teaching in radiology. The development of a BIEMR Learning Module (BIEMR-LM) will provide an online educational resource and tool for radiologists, radiology residents, and mammography technologists to improve their ability to accurately read or acquire digital breast images and allow for radiologists and technologists to access and review any previous imaging cases stored in the CAISIS database as part of a work-up review system. The framework presented here proposes a number of open-source software solutions for the development of an online teaching file system for radiology. Going forward, it is recommended that the new BIEMR-LM be developed fully within the CAISIS platform using open-source tools.