A Made-in-the-North Solution!

1. "Removing Geography from the Quality of Care Equation" A Made-in-the-North Solution! Digital Imaging in North Eastern Ontario

2. Removing Geography from the Quality of Care Equation: Diagnostic Imaging in North Eastern Ontario

3. NORrad PACS(Picture Archiving and Communications System) The Impact of the Digital Radiology Project

4. 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

5. Overview of the NORrad Network 13 Region • 12 separately governed hospitals • 17 Sites  Timmins to James Bay  Over 100,000 people  Over140,000 Procedures/Year  Over300,000 square miles  Resource-based economy: mining + forestry • Population older than provincial average • 2 Radiologists

6. Challenges in North Eastern Ontario  Distance • Weather  Access  Health Care and Physician Shortages  Availability of Diagnostic Resources  Sparse Population • Poor Health Status

7. 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

8. Health Care Benefits Hospitals  Enhanced support for small hospital physicians  Increased relevance of local and district hospitals  Elimination of lost films, decreased x-ray film storage and operating costs  Transfer of diagnostic images to referral or teaching hospitals to eliminate unnecessary patient travel  Avoids duplication of exams and reduces radiation exposure

9. Health Care Benefits Physicians/DI Techs  Leverages shortage of physician  Reduces medical risk and professional isolation  Provides a virtual consulting relationship between radiologists + referring doctors irrespective of distance  Facilitates retention of existing physicians  Increased hospitals’ attractiveness to new physicians  Provides high tech employment for northerners  Improved working environment  Physician access to images/reports in their offices  Supports northern medical school innovation mandate

10. Health Care BenefitsPatients • 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

11. 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

12. NORrad PACS Vision • To improve patient care by providing 24 / 7 / 365 radiologist access to all member hospitals • 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. • Top 5 challenges and barriers • Provincial: Vision, Leadership, Funding, • District: • MPI Solution • Integration between multiple HIS/RIS systems. • Governance structure • Politics

13. Timmins Network • 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. • 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 • Direct link to the North Eastern Ontario Regional Cancer Centre • was established for the benefit of patients referred to Sudbury for cancer care. • Web 1000 • VPN remote access to Web1000 permits consultation with specialists outside the NORrad group (e.g Toronto Sick Kids Hospital) • Orthopaedic Template software • allows orthopaedic physicians to make pre-operative measurements for hip and knee prostheses digitally.

15. Sudbury Network • 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. • Linking of Sudbury and Timmins databases completed. • Now able to transmit/retrieve images between a total of 24 hospitals in Northern Ontario • 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

17. Sault Ste Marie Network • The SAH (Sault Area Hospital) PACS implementation will include Group Health, Richard’s Landing, and Thessalon • PACS implementation to commence pending approval of funding requests. • The technical configuration will be similar to Sudbury and Timmins • Connectivity will be established using SSH allowing seamless transmission of images with Sudbury and Timmins allowing access to DI Images from all 24 hospitals

19. North Bay Network • Has chosen Philips/Stentor PACS, installation in 2006

21. NORrad Phase 2 The NORrad PACS model has been recognized by Canada Health Infoway as a key asset to constructing an EHR • 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 • 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

22. NORrad Phase 2 • Projects underway • Sonultra OB Reports • Cardiac Intergration • Holter, Stress, ECG and Pyramis Intergrated Cardiology System

25. 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

27. 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

29. 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

30. Patient Match Score Manual Interaction No Match

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

35. THANK YOU !!