Teleradiology: At Work Night and Day

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The nexus between digital imaging systems, telematic services, advanced telecommunications and information technology infrastructure has yielded unbelievably creative solutions to a wide array of healthcare challenges. Support for remote healthcare facilities, night-time coverage for overworked radiology departments and facilitation of diagnostic consultation between referring physicians and subspecialty radiologists in far flung settings describe a few of the activities enabled by teleradiology. Here are the tales of three groups for which teleradiology has spelled success.

Narrowing space and time

Since radiological activities serve as a core element of effective healthcare, the Timmins and District Hospital in Timmins, Ontario, Canada has championed a $10 million regional health teleradiology network. The NORrad (Northern Radiology) network began implementation in 2002 to facilitate patient care throughout Northeastern Ontario. This integrated health care system relies on PACS from AGFA Healthcare configured as a "hub with spokes" design over a Northern Telephone telecommunications network infrastructure. NORrad is designed to serve 100,000 patients throughout a 150,000 square mile area.

Some of the positive outcomes include reductions in expensive ambulance transfers between institutions, an enhanced level of local patient care in smaller facilities, improved physician efficiency and easier access to diagnostic studies and information for those clinicians in remote sites.

Mike Gasparotto, PACS System Administrator for NORrad, explains that the first phase of the project is essentially complete. Functional aspects include sending images from all modalities including MRI, CT, ultrasound, computed radiography and nuclear medicine scans as well as secure patient information across the network to central hubs. This has been implemented to enable images and reports to be sent between referring physicians, radiologists and emergency staff.

The final aspect of this integrated healthcare network is the deployment of a Master Patient Identifier (MPI) solution. This functionality, currently being tested and nearing completion early this month, was accomplished in partnership with NORrad, AGFA and Initiate Systems. It is designed to cross-reference patient demographic information supplied by the HIS/RIS to determine matches. The result is a system that is able to discern that John Smith (in city A) and Jonathan Smith (in city B) are the same person by analyzing their demographical information.

Referral patterns in NE Ontario are such that patients often travel to different hospitals for certain imaging procedures. "With the MPI solution, we are able to have the Agfa IMPAX system automatically retrieve a patient's relevant prior studies regardless of what hospital the procedure was done at," explains Gasparotto.

The first phase of the project includes 10 sites. All images can be stored locally for six months to a year, depending on the workload in that specific facility. On a daily basis, all studies are transmitted to Timmins District Hospital to be read and stored on the primary archive, where it is stored for as long as it is required.

Phase II of the project (which is still ongoing), is the addition of a second hub at Sudbury which currently has four remote sites that are filmless and transmitting to that hub. The two hubs are linked currently with a 50 MB "pipe."

The current network is comprised of 15 hospitals (two hub sites of Timmins and Sudbury) on the network. The next two months will see the addition of six more hospitals to the network. The next six months will see the addition of another seven hospitals including Sault Ste. Marie as a third hub site. In total, 28 hospitals in NE Ontario will be PACS equipped and part of the NORrad network in the next six months.

Gasparotto describes an essential partnership with AGFA which provides service 24/7 to the entire network. Most troubleshooting can be done via remote connection, but AGFA service representatives are also onsite in both Timmins and Sudbury.

Aside from many technical hurdles, one of the more challenging aspects of establishing this network was the drafting and signing of an inter-hospital agreement. Given that each of these facilities operates autonomously, this was a major accomplishment. This agreement created a governance structure which is the foundation of NORrad's success and was by far worth the effort.

The vision and leadership of both Claude Vezina,