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Diagnostic imaging

Ontario produces PACS study, aims at province-wide network

Ontario has completed an initial PACS/DI study, part of the groundwork for a province-wide PACS that would see sharing of images by hospitals and independent clinics.

Roger Girard, chief e-Health strategist for the Ontario government, sketched out the findings of the report (conducted by IBM Canada) at an ITAC Ontario conference in Toronto, in mid-June. He noted the document will soon be circulated to attract further comment from healthcare providers and developers of technology.

Girard said the wide-ranging study involved over 500 persons, including radiologists, technologists, nurses, administrators and others.

Ontario is aiming towards a province-wide PACS as part of an effort to transform healthcare delivery. “PACS enables radiologists and technicians to be more productive,” commented Girard. “There’s an estimated 25 to 35 percent productivity gain, with radiologists able to see more patients in the same amount of time. They can provide a diagnosis more quickly, and patients don’t need to travel over long distances.”

The sooner a patient is diagnosed, the faster treatment plans can begin. Electronic picture archiving and communications enable quicker diagnoses, and often better ones, as they provide tools that allow radiologists to analyze images in a way that film-based reading don’t allow.

Some findings of the study, which was conducted over the past seven months:

• There are approximately 16.6 million diagnostic imaging exams performed  annually in Ontario. About 10 million are conducted at the province’s 190  hospitals and 6.6 million at 700 private-sector clinics.

• 68 percent of hospitals have a PACS.

• 10 companies provide 75 percent of the current PACS solutions.

Some ‘choke points’ or danger zones the province must be wary of when building its interoperable PACS network came to light in the survey:

• Clinical standards must be promoted across the province. “So the radiologist in Toronto trusts the image sent by the technologist in Thunder Bay, and simply doesn’t order another exam,” said Girard.

• Funding. “It’s not going to be cheap,” he noted, adding that there is no money at present to build an interoperable PACS network. “Funding will be addressed later,” he said, when recommendations are made to the government.

• Agreements must be reached among hospitals and private clinics. In particular, private clinics are businesses which exist in a competitive climate and are not accustomed to sharing information with rivals.

• Unique patient identifiers. In order to maintain accurate records, a province-wide system of patient ID must be developed.

• High bandwidth networks. “The volume of data will require high-capacity networks,” said Girard. Many parts of the province do not have wide bandwidth networks.

• Redundancy. Most sites don’t have back-up systems, and face downtime with current systems. In a province wide network, this can’t be tolerated – one partner’s system can’t be down when another needs to send or receive urgent information.

• Interoperability of differing PACS across the province. Here is where standards such as Integrating the Healthcare Enterprise (IHE) will be critical.

• Organization are currently at differing stages of computerization – many are still using film for readings. If one site is still using film, commented Girard, all of the others will be forced to maintain the ability to view films.

• Hospital funding for PACS must be moved to the enterprise level from its current departmental level.

Girard said a revised strategy will likely be ready by the fall of 2005. While the productivity and quality benefits of PACS are known and accepted, Girard stressed that costing the project will be a challenging matter. “We’ve now got to determine the cost of the strategy for Ontario, as well as the cost savings.”