NORrad Northern Radiology PACS Picture Archive Communication System A Made-in-the-North Solution!...

NORradNORradNorthern RadiologyNorthern Radiology

PACSPACSPicture Archive Communication SystemPicture Archive Communication System

A Made-in-the-North Solution!

Digital Imaging in North Eastern

Ontario

"Removing Geography from the Quality of Care Equation""Removing Geography from the Quality of Care Equation"



Removing Geography from Removing Geography from the Quality of Care the Quality of Care

Equation:Equation:

Diagnostic Imaging in North Eastern Ontario



NORrad PACSNORrad PACS((PPicture icture AArchiving and rchiving and CCommunications ommunications SSystem)ystem)

The Impact of the Digital Radiology Project

NORrad Partners

•Timmins

•Hearst

•Kapuskasing

•Smooth Rock Falls

•Cochrane

•Iroquois Falls

•Matheson

•Kirkland Lake

•Moose Factory

•Englehart



Overview of the NORrad Region

9 separately governed hospitalsTimmins to James BayOver 100,000 peopleOver130,000 Procedures/YearOver300,000 square milesResource-based economy: mining + forestry Population older than provincial average 2 Radiologists



Challenges in North Eastern Ontario

Distance WeatherAccessHealth Care and Physician ShortagesAvailability of Diagnostic ResourcesSparse Population Poor Health Status



Why a Made-in-the-North Solution?

Patient care improvements locally and regionally Practical solutions to meet real needs Enhancing the integration of care among hospitals Leveraging technology to overcome natural obstacles Leveraging technology to create medical/fiscal efficiencies Fiscally viable service Making better use of limited human resources



Health Care Benefits Hospitals

Enhanced support for small hospital physiciansIncreased relevance of local and district hospitalsElimination of lost films, decreased x-ray film storage

and operating costsTransfer of diagnostic images to referral or teaching

hospitals to eliminate unnecessary patient travelAvoids duplication of exams and reduces radiation

exposure



Health Care Benefits Physicians/DI Techs

Leverages shortage of physicianReduces medical risk and professional isolationProvides a virtual consulting relationship between

radiologists + referring doctors irrespective of distanceFacilitates retention of existing physiciansIncreased hospitals’ attractiveness to new physiciansProvides high tech employment for northernersImproved working environmentPhysician access to images/reports in their officesSupports northern medical school innovation mandate



Health Care Benefits Patients

• Better patient care provided locally in distant communities• Improved access to local patient care• Better outcomes• Shorter lengths-of-stay & fewer admissions• Fewer emergency evacuations• Reduced travel to district & regional hospitals



Clinical Example of PACS:• Moose Factory patient with bowel obstruction• Patient x-rayed at Moose Factory hospital• Local surgeon calls Timmins radiologist for diagnosis• Diagnosis made• Clinical consultation between radiologist and surgeon• Decision made to treat locally• Successful operative outcome• Enhanced local physician support• Unnecessary $5K emergency evacuation avoided• Better care provided locally



1) NORrad PACS Vision

To improve patient care by providing 24 / 7 / 365 radiologist access to all member hospitals

2) DI/PACS Current State

10 Hospitals in Network 13 – 100% filmless and fully integrated into the Timmins District Hospital Database 5 Hospitals in Network 11 are fully integrated into the Sudbury District Hospital Database Working with SSM and Network 9 to fully integrate a PACS Solution fully compatible with Network 13 & 11 Working on Integration between all 15 PACS “Live” sites to integrate an MPI Solution. System will be LIVE by

end of April 2005.

3) Top 5 challenges and barriers

Provincial: Vision, Leadership, Funding,

District: MPI Solution Integration between multiple HIS/RIS systems. Governance structure Politics



1. 10 hospitals network 13 - Filmless and fully integrated into the Timmins District Hospital Database

• All DI images from each site are sent via WAN to TDH where they are reported and permanently stored.• Each site has between 6 months and 1 year (or more) of local online storage depending on the workload

at the site.• Each site has the ability to access images from any of the other NORrad sites as required.

2. EMPI AGFA (Enterprise Master Patient Identifier) solution • AGFA partnership with Initiate Systems to create an EMPI which will allow the automatic retrieval of

relevant prior studies regardless of their origin within NORrad. • complete and seamless integration between all sites

3. Direct link to the North Eastern Ontario Regional Cancer Centre• was established for the benefit of patients referred to Sudbury for cancer care.

4. Web 1000• VPN remote access to Web1000 permits consultation with specialists outside the NORrad group (e.g

Toronto Sick Kids Hospital)

5. Orthopaedic Template software • allows orthopaedic physicians to make pre-operative measurements for hip and knee prostheses digitally.

Timmins Network



1. 5 Hospitals in Network 11 are now fully integrated into the Sudbury District Hospital Database

• All DI images from each site are sent via WAN to Sudbury Regional Hospital (Laurentian Site) where they are reported and permanently stored.

• Each site has between 6 months and 1 year (or more) of local online storage depending on the workload at the site.

• Each site has the ability to access images from any of the other NORrad sites as required.

2. Linking of Sudbury and Timmins databases completed.• Now able to transmit/retrieve images between a total of 15 hospitals in Northern Ontario

3. St. Joseph’s and Memorial Sites• Currently moving forward with implementing PACS at these two sites

• Emergency, Ortho, ACU, ICU, Cardiac will be film less

• Tentative completion date of 1st quarter 2006

Sudbury Network



1. The SAH (Sault Area Hospital) PACS implementation will include Group Health, Richard’s Landing, and Thessalon

2. PACS implementation to commence pending approval of funding requests.

a. The technical configuration will be similar to Sudbury and Timminsb. Connectivity will be established using SSH allowing seamless transmission of images with Sudbury and

Timmins allowing access to DI Images from all 19 hospitals possible

Sault Ste Marie Network



1. Currently undergoing RFP process

North Bay Network



The NORrad PACS model has been recognized by Canada Health Infoway as a key asset to constructing an EHR

1. EMPI – Enterprise Master Patient Identifier (Initiate Systems)• LIVE Date – End of April 2005• Will allow access to a patient’s relevant prior DI images regardless of the originating institution

2. North Network has chosen AGFA PACS to facilitate the delivery of clinical care in Ontario.

• 100 member hospitals• 1500 health professionals (GP’s, Physiotherapists, Nutritionists, and Speech Pathologists)• 700 specialists across 70 medical specialties• 1000+ clinical consultations/ month • 3000 people participating in 150 educational sessions/month

NORrad Phase 2



• Projects underway– Sonultra OB Reports

– Cardiac Intergration

• Holter, Stress, ECG and Pyramis Intergrated Cardiology System

NORrad Phase 2



– Combination of Storage Appliances – IBM DS8100 and DS4500 – 5 years projected storage on spinning disk.

– 14 TB (FC) on the DS8100, expansion to 115 TB– Images requiring quicker access times will reside on the DS8100.– Expansion could be used for other LHIN 13/14 applications that

require robust storage capacity – DS 4500 – 135TB useable space using SATA Drives.– Images not requiring faster access times reside on cheaper SATA

drives. – IBM Tivoli Storage Manager connecting the above architectures

allowing data to be moved between storage media.– IBM 3584 Tape Library for Backup purposes – GEN 3 Drives, 1167

slot capacity– Potential to use site as a true Business Continuance Site. Other

factors that have to be considered are network bandwidth, MPI, etc.

– Total Cost of this solution - $ 3,001,068.00

Data Centre Design



THANK YOU !!

NORrad Northern Radiology PACS Picture Archive Communication System A Made-in-the-North Solution!...

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