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

Network 13 NORrad Partners

•Timmins

•Hearst

•Kapuskasing

•Smooth Rock Falls

•Cochrane

•Iroquois Falls

•Matheson

•Kirkland Lake

•Moose Factory

•Englehart

•Hornepayne

•Wawa

•Chapleau

•Moosonee

•Fort Albany

•Attawapiskat

•Kashechewan

Network 11 NORrad Partners

•Sudbury

•Espanola

•Blind River

•Little Current

•Mindemoya

•New Liskeard

•Sturgeon Falls



Overview of the NORrad Network 13 Region

12 separately governed hospitals 17 SitesTimmins to James BayOver 100,000 peopleOver140,000 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 hospitals2) DI/PACS Current State

17 Hospitals in Network 13 – 100% filmless and fully integrated into the Timmins District Hospital Database

7 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

Have completed the MPI Integration between all 24 PACS “Live” sites.3) Top 5 challenges and barriers

Provincial:Vision, Leadership, Funding,

District:MPI SolutionIntegration between multiple HIS/RIS systems.Governance structurePolitics



1. 17 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 has partnered 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. 7 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 24 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 24 hospitals

Sault Ste Marie Network



1. Has chosen Philips/Stentor PACS, installation in 2006

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 – March 2006• 24 Sites connected to the Initiate MPI Solution• 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

PNOPP Partners

Phase 1

10 Hospitals

Phase 2

19 Hospitals

3 First Nation Nursing Station

Phase 3

41 Hospitals

1 Private Clinic

10 First Nation Nursing Station



Timmins

Thunder Bay Sudbury

North Bay

Sault Ste Marie

Kenora

ParrySound

AGFAOP PACS DBMSREPLICATIONPHILIPS

OP PACS DBMSREPLICATION SIEMENS

OP PACS DBMSREPLICATION

DIEMPII

LHIN 14 Data Centre LHIN 13 Data Centre

PrimaryMirror

Mirror

MirrorDICOM

HL7

Op PACS DBMS Redundancyfor Business Continuity

Archives

SudburyPrimary

Thunder BayMirror

Agfa -planned

AGFA

AGFA

Phillips -planned

Phillips

SpokeCache

SpokeCache

SpokeCache

PNOPP Conceptual Architecture - Scenario 1

Thunder Bay Sudbury

AGFA

Siemens

PrimaryDICOM

HL7DICOMStage

DICOMStage

Teleradiology

Replication ofDatabase

Structure (Oracle)

TeleradiologyDI Viewer - DI Image Viewer - DI Text Reports

Integration Layer

Data Centre Redundancy

DataRedundancy

DBMS Redundancy

PACS ApplicationRedundancy

?

11Spokes

6Spokes

8Spokes

16Spokes

4Spokes

SpokeCache

SpokeCache



DI/MPI Goals

• To create a “Virtual Hospital”

• Allows the Radiologists to have all previous and current exams from all sites with a single click of the mouse, irrespective of the Patient ID at the different sites



DI/MPI Score• Health Card Number• Date of Birth• Name (Last Name / First Name / Middle Name)• Sex• Address• Phone Number• Etc…

Each piece of information is given a weight and then an associated score



Patient Match

Manual Interaction

No Match

Sco

re



MPI Example:•Same patient had exams performed in Timmins, Sudbury and Iroquois Falls

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THANK YOU !!

a made-in-the-north solution!

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