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. NORrad Partners • Timmins • Hearst • Kapuskasing • Smooth Rock Falls • Cochrane • Iroquois Falls • Matheson • Kirkland Lake • Moose Factory • Englehart

5. Overview of the NORrad Region  9 separately governed hospitals  Timmins to James Bay  Over 100,000 people  Over130,000 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

13. Timmins Network • 10 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 partnership 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 • 5 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 15 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 19 hospitals possible

19. North Bay Network • Currently undergoing RFP process

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 – End of April 2005 • 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

24. Data Centre Design • Combination of Storage Appliances – IBM DS8100 and DS4500 – 5 years projected storage on spinning disk. • 14 TB (FC) on the DS8100, expansion to 115 TB • Images requiring quicker access times will reside on the DS8100. • Expansion could be used for other LHIN 13/14 applications that require robust storage capacity • DS 4500 – 135TB useable space using SATA Drives. • Images not requiring faster access times reside on cheaper SATA drives. • IBM Tivoli Storage Manager connecting the above architectures allowing data to be moved between storage media. • IBM 3584 Tape Library for Backup purposes – GEN 3 Drives, 1167 slot capacity • Potential to use site as a true Business Continuance Site. Other factors that have to be considered are network bandwidth, MPI, etc. • Total Cost of this solution - $ 3,001,068.00

26. THANK YOU !!