Ontario produces PACS study, aims at
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
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
Some findings of the study, which was conducted over the past seven
• 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
• 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
• 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.”