PACS paves way for pan-Northern eHealth record

Health-care providers often think of the largest urban centres and hospitals as pioneers in the deployment of new technology, but in more cases than is generally realized, it's smaller communities in Canada's more sparsely-populated north that lead the way.

Such was the case with the deployment of the NORrad Picture Archiving and Communication System (PACS) now serving most hospitals in northeastern Ontario.

Distance, demographics, weather and the scarcity of radiologists in the region prompted Dr. Claude Vezina, a veteran radiologist at the Timmins and District Hospital, to begin the search for new technology as early as 1996.

Health-care providers who ordered X-rays or other diagnostic tests in Moose Factory, Cochrane or any number of other communities in northeastern Ontario used to courier film to Vezina, or immediately transfer their patients to Timmins by ambulance.
Sending film by courier took a day or two, delaying treatment and jeopardizing the patient's health, while transferring a patient to Timmins could cost thousands of dollars and wasn't always necessary.

It took several years of research and planning, but by July 2002, nine hospitals in northeastern Ontario went live with the most advanced diagnostic imaging archiving and communication system in the province.

The NORrad picture archiving and communication system has served as a model for the rest of the country.

"If I want to look at an X-ray of someone in Hearst, I just have to click on a button," said Vezina. "If I want to look at someone from Kapuskasing, Moose Factory or Kirkland Lake, they're all a click of a mouse away from us.

Call centre
"We're basically like a call centre. If you want us to look at an image, you just call us. We look at it, give you our opinion and you can manage the patient thereafter."

The Timmins and District Hospital offers radiology reports by Vezina, his colleague, Dr. Pat Garces, and weekend locums 24/7, 365 days a year.

Imaging devices in each participating hospital are equipped with computed radiography cassettes containing a reusable imaging plate that is scanned and digitized to allow for transmission over a high-speed network.

The system archives X-rays, ultrasounds, CT and MRI scans and images from digital mammography devices from all over the region, eliminating film and chemistry costs and all of the labour and physical space requirements associated with storage and filing, explained PACS administrator Mike Gasparotto.

Five years worth of images are available online, and older images are available offline to comply with mandated storage requirements.

PACS has revolutionized health care, said Vezina.

"Whether the patient is on the floor or in emergency, or whether I'm (at the hospital) or at home, I can review the image and three, ten people can look at it at the same time and discuss it if necessary. We've even developed a link with Sick Kids in Toronto. If I have a difficult case here, I can call someone at Sick Kids and they'll look at it and tell me what they think, so it's a whole networking that's possible."

In some cases, the system avoids unnecessary transfer of patients by air. In others, it speeds the direct transfer of patients to better-equipped services in Sudbury, for example, if specialized care is urgently required.

According to Vezina, NORrad's picture archiving and communication system is also saving lives.

Lifesaver
The first week the system was installed, a woman in Moose Factory, an island in James Bay, went to Weeneebayko General Hospital complaining of abdominal pain. "The surgeon asked me if I could do a test on her while she was still there. The images were sent to me, I looked at them and we concluded that she had to have surgery immediately. She did and it saved her life."

The NORrad PACS project and equivalent systems in Sudbury, Thunder Bay North Bay and Sault Ste. Marie are now evolving toward a pan-Northern system that will eventually see the creation of a central diagnostic imaging repository for all of Northern Ontario. Sudbury and its satellite locations (Espanola, Mindemoya, Little Current, Elliot Lake and Blind River) are already linked to Timmins, and Sault Ste. Marie will join the pan-Northern network later this year, said Guy Guindon, Timmins and District Hospital's manager of diagnostic imaging.

Timmins, Sudbury and Sault Ste. Marie have purchased their systems from Agfa Healthcare, while North Bay and Thunder Bay selected competing technology from Philips Medical Systems.

The completion of a pan-Northern system will have to await the creation of a central repository with software capable of supporting multiple types of PACS systems.
The repository, explained Guindon, will also be designed to accommodate a complete electronic health record, bringing together not only diagnostic images, but also laboratory results and pharmaceutical data.

Northern Ontario hospitals have designed a blueprint for the proposed pan-Northern system and have worked closely with the Ontario eHealth Office and the Canada Health Infoway to ensure compatibility with eventual provincial and national eHealth record systems.

"We're ready and it's mostly designed now," said Guindon. "We have an agreement between all of the hospitals that they're ready to move forward with it. We have the organization - it's called ONeHealth - the corporation that's going to lead this. Now, it's just a matter of getting the dollars to make it happen."

www.norrad.ca