REACTS MAKES TELE-ULTRASOUND EASY AND EFFICIENTCIUSSS DE L’EST-DE-L’ÎLE-DE-MONTRÉAL

Using Reacts, independent technologists at CSSS

de la Pointe-de-l’île can contact radiologists at

Hôpital Maisonneuve-Rosemont in real time to

review and discuss ultrasound exams.

www.reacts.com

Better communication.

Better efficiency.

Better care.

Wait times for an appointment for an abdominal or pelvic ultrasound

considerably exceeded standards for many years in East Montreal.

The main hospitals, including Hôpital Maisonneuve-Rosemont (HMR),

were unable to meet demand for this service within the service times

recommended by the Ministère de la Santé et des Services sociaux

(MSSS).

In December 2014, the MSSS proposed a solution: adding positions

for independent technologists at Hôpital Maisonneuve-Rosemont,

CSSS de la Pointe-de-l’île (PDI), Hôpital Santa Cabrini, and CSSS

du Cœur-de-l’Île. Adding these technologists would increase the

availability of abdominal and pelvic ultrasounds in this area, thus

improving user satisfaction. This project, in line with the Centre de

répartition des demandes de service (CRDS) ultrasound project,

reduced the wait time for an ultrasound appointment from three

years to only a few days.1

What is an autonomous ultrasound practice?

Following requests by the Ordre des technologues en imagerie

médicale, en radio-oncologie et en électrophysiologie médicale

du Québec (OTIMROEPMQ) and the Association des radiologues

du Québec (ARQ), the MSSS introduced a certification process

for an autonomous practice based on recognition of experience.

. . .

CIUSSS DE L’EST-DE-

L’ÎLE-DE-MONTRÉAL2

• Population served: 527 085

• Points of service: 43

• Medical and specialized clinics: 71

• Beds (short-term, long-term,

mental health): 6 354

• Staff: 14 125

• Independent ultrasound

technicians: 6 (variable)

To be autonomous, a technologist must obtain/maintain an

autonomous practice certification subject to conditions that include

experience (determined minimum number of exams per year), external

validation (letter from employer), and a minimum number of hours

of ongoing professional training every year. In his or her day-to-day

practice, the technologist works relatively independently,

and a radiologist verifies the exam when necessary.

Lack of resources and technological constraints

The arrival of autonomous technologists substantially improved

the efficiency of the ultrasound service. But what were autonomous

technologists to do when they needed the opinion of a radiologist

during an exam at institutions without an on-site radiologist, like the

CSSS PDI? In this case, outside radiologists (those at Hôpital Maison-

neuve-Rosemont) needed to review the ultrasound exams.

. . .

• Wait time for an ultrasound

appointment reduced from 3 years to a few days*

• The MSSS introduced a certification

process in 2014; by 2018, there

were approx. 350 certified independent technologists.

• The Reacts platform is certified by the MSSS and endorsed by

the Canadian Medical Association.

*For the frontline clientele of East Montreal

Island, referred by the CRDS and scheduled

based on proximity.

. . .

To work around this constraint, the service thought of having a

compact disc containing the ultrasound exam images delivered to

the medical imaging department at the hospital. This turned out to

be problematic because it meant the images were analyzed well after

the exam was finished and the patient had left the CSSS. If the

radiologist found that more images were required, a second exam

had to be scheduled with the patient to obtain these.

A solution for retransmitting the images through an orchestrating

intermediary was developed by the Montreal Technocentre. This image

routing system was effective for real-time analyses, but ultrasound

videos could not be saved, and there remained the challenge of

connecting two different PACS systems.

To optimize the process, the Réseau universitaire integré de santé

(RUIS) of Université de Montréal subsequently proposed the use of

a videoconferencing system to connect the ultrasound system at the

CSSS PDI to the Radiology Department at Hôpital Maisonneuve-

Rosemont. This allowed the technologist to contact and share a live

ultrasound exam with the hospital’s radiologist in real time.

. . .The clinical need

An efficient way for ultrasound

technologists and radiologists to

consult with each other remotely and

to share high-quality ultrasound

images in both real time and

asynchronously.

The technological needA collaborative solution that is easy

to use, safe, affordable and that can

reliably transmit live ultrasound

images of adequate quality.

. . .

This live transmission of ultrasound exams by videoconferencing,

together with image acquisition protocols specific to each clinical

indication, meant that the autonomous technologists were able

to practise independently and from a wider range of locations.

When necessary, they could contact the assigned radiologist

by videoconferencing in order to review the ultrasound images

in real time.

Adoption of the Reacts platform

This operational model was initially useful and entailed certain benefits.

Nonetheless, a number of impediments arose in short order, making it

hard to deploy, adopt and use remote assistance by videoconferencing

for ultrasound exams. The main challenges concerned the following

points: the high cost of videoconferencing stations and technical

support, mobility issues (i.e., the radiologist had to review the exam

at a fixed station) and most critically, the suboptimal quality of

the images transmitted live by the videoconferencing station was

suboptimal, making it hard for radiologists to interpret them remotely.

Given these limitations, the various stakeholders involved eventually

agreed to retire the tele-ultrasound videoconferencing system; instead,

patients were sent to Hôpital Maisonneuve-Rosemont when additional

images were necessary.

. . .

The solution Use of a secure, flexible,

interactive, collaborative

communication platform

that allows the transmission

of high-quality video streams.

The technological component

The Reacts platform was selected

for its ability to transmit multiple

high-quality video streams

simultaneously and securely, in

addition to offering an interactive set

of collaboration tools, using existing

equipment (computers, standard

Internet connection, web cams, etc.).

. . .

After searching for a technological upgrade solution to relaunch

the tele-ultrasound program, the team at CIUSSS de l’Est-de-l’Île-

de-Montréal heard about the Reacts platform and its ability to

simultaneously and securely transmit multiple video streams, in

addition to affordably providing a series of interactive collaboration

tools that are accessible from existing equipment (computers,

standard Internet connection, web cams, etc.). Because Reacts is

certified by the Ministère de la Santé et des Services sociaux and

supported by the Canadian Medical Association, the platform met

the project’s security requirements.

The Reacts solution allowed a significant reduction of costs and led

to a wider-scale rollout of the tele-ultrasound service that was quick

and easy. The Reacts solution also facilitated optimizing mobility by

allowing radiologists to conduct Reacts tele-ultrasound sessions from

their personal computer, tablet or mobile device. After a few trial

sessions, the team at CIUSSS de l’Est-de-l’Île-de-Montréal decided

to proceed with the implementation of the Reacts solution for their

tele-ultrasound needs.

. . .The benefits

– Allows for rollout of a wide-scale,

high-quality tele-ultrasound service

easily, quickly and affordably with

greater satisfaction among

technologists and radiologists.

– Saving patients a trip for a second

exam and reassuring them by

ensuring that an expert can give his

or her opinion live to optimize the

quality of the ultrasound exam.

“Reacts allows us to provide a high-quality tele-ultrasound service

that is simple and easy to deploy. In addition to being affordable, it

has helped us improve clinician satisfaction and provide better

service.”

-- Janie DeschênesDivision Head, Radiology

HSCO IUSMM et CommunautéCIUSSS de l’Est-de-l’Île-de-Montréal

Hôpital Santa Cabrini

Reintroducing tele-ultrasounds at CSSS PDI yielded direct benefits

for patients, as they no longer had to return for a second exam, and

reassured them because an expert was able to give a live opinion,

thereby optimizing the quality of the exam.

With its many benefits and advantages, use of the Reacts platform for tele-ultrasound will make it possible to roll out this virtual assistance modality in other areas of the province, which will improve the service offering and reduce wait times for an ultrasound appointment.

New program for medical ultrasound technologists

A new college-level program for medical ultrasound technologists will

be offered in Rimouski in the fall of 2018. The program will prepare

students to become ultrasound technologists without first having to

take the radiology technologist program. The introduction of this new

program reflects the recognition by the Ministère de la Santé et des

Services sociaux's recognition there is a growing need for more

ultrasound technologists in order to improve service across the

province. In this context, remote assistance and collaboration between

independent technologists and radiologists through tele-ultrasound

has come into its own and should grow significantly in the near future.

Sources :1) Janie Deschênes, Head of the Radiology Department, Hôpital Santa Cabrini, “La télémédecine au service de l’échographie”, MedActuel, August 2016.

2) Le Centre intégré universitaire de Santé et de Services sociaux de l’Est-de-L’île-de-Montréal, http://ciusss-estmtl.gouv.qc.ca/a-propos/portrait/ .

Reacts (Remote Education, Augmented Communication, Training

and Supervision), is a secure, integrated collaborative platform

created by Quebec-based Innovative Imaging Technologies Inc. (IIT).

It was designed to suit the multiple collaborative needs of healthcare

professionals and patients, and incorporates unique and unparalleled

interactive features, such as augmented reality for remote virtual

guidance, supervision and training.

Reacts is presently being used in over 80 countries, across

various medical disciplines in both clinical and educational

settings, for applications ranging from secure messaging, remote

wound care, tele-ultrasound, and teleconsultations, to interactive

tele-surgical assistance and remote procedural supervision. Strategic

partnerships include medical device manufacturers and healthcare

innovation focused organizations. For more information,

visit: www.reacts.com .

About Reacts

Discover hyperpresence!

www.reacts.com

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Better communication.

Better efficiency.

Better care.