Project: Health Infostructure Atlantic: TELE-i4

2005
Canada health infostructure partnerships program (CHIPP)

Synopsis

The Health Infostructure Atlantic (HIA) is a $24 million health infostructure project jointly funded by CHIPP in cooperation with four Atlantic provinces. The HIA project portfolio consists of three broad initiatives:

• Tele-i4 - a Picture Archiving and Communications System (PACS) and teleradiology initiative;
• New or enhanced applications to support Case Management in the community health sector; and
• " Development of a Common Client Registry at the provincial level in Prince Edward Island.

This synopsis covers Tele-i4 - a Picture Archiving and Communications System (PACS) and teleradiology initiative implemented in New Brunswick (NB), Nova Scotia (NS), Prince Edward Island (PEI), Newfoundland and Labrador (NL). Tele-i4 stands for the interprovincial integration of images and information and refers to the capture and transmission of digital images and information across broad band networks within provinces and across provincial boundaries to support clinical care

Outcomes

In the opinion of stakeholders, early experience with Tele-i4 technology suggests that these diagnostic tools will play a significant role in improving the delivery of quality health care to residents of Atlantic Canada. Examples of improved diagnostic accuracy, faster treatment decisions, and reduced patient inconvenience from transfers out of the community or from overnight admissions for observation were all cited as indicators of the potential current and long term benefits of this technology investment.

PACS can reduce the occurrence of missing images. In the opinion of stakeholders, significantly fewer films are misplaced or 'lost' in a PACS environment comparedto conventional film. Thus, Tele-i4 technology appears to save time when retrieving and delivering images.

Radiologists in certain areas of the Atlantic region are now able to arrange improvements to their on-call schedules as a result of this technology (How? Not clear to me.). HIA anticipates that the health care system's ability to recruit and retain physician specialists, including radiologists, in rural communities, will be positively affected by this technology. In fact, this is already happening. PEI was able to recruit two new radiologists as a result of this technology.

The availability of provincial archives provides a very rich source of data for medical training, continuing education and research. Mining these data will result in improvements in the health delivery system and also support tracking specific diagnoses and patient outcomes over time thereby improving both the clinical system and the management and organization of health care.

Research Implications

Easy access to the historical data residing in a provincial archive will support improved research on specific diseases compared to the past. Further, the availability of radiological images in an archive will also support improved training of radiologists over time.

Lessons Learned

The tele-i4 project reported many lessons learned, including the necessity of examining existing radiology department workflow, planning for downtime, establishing an electronic data security and disaster recovery plan, and the need to conduct random security audits. In addition, the project learned the following:

• Where possible, sites should be provided with sufficient technology to become relatively filmless - this includes improvements in local/provincial storage capacity to enable electronic filing of images from all digital modalities where appropriate;
• Image quality from PACS workstations must be regularly monitored and continuing education and training provided for radiology and IT staff and for PACS administrators; and
• Equipment ergonomics and the potential impact on surrounding work environments in terms of noise and heat should be addressed when establishing locations for equipment. Integrating PACS and radiology information systems into a single workstation and providing touch screen or voice recognition software facilitates workstation operation.

The Future

Tele-i4 has been rolled out in selected sites across the four provinces and staff have been hired who are responsible for the maintenance and support of the application and its users. The implementation of Tele-i4 across Atlantic Canada has increased the demand for this technology to the extent that some jurisdictions contributed additional funds to enhance the planned deployment.

Further, at least one jurisdiction reviewed and updated the provincial plan for deployment of this technology and planned for its integration with other applications including the use of the provincial network. Other provinces reevaluated and increased their existing bandwidth requirements to ensure that it could meet the needs of Tele-i4.

Appendix A: Document or Products Generated

The products generated are listed in the HIA project overview synopsis.

For more information, please contact:

New Brunswick: David Cowperthwaite at: david.cowperthwaite@gnb.ca

Newfoundland Labrador: Paul Caines: PCaines@gov.nl.ca

Nova Scotia: Mary McKeen: mckeenme@gov.ns.ca

Prince Edward Island: Faye Campbell: fecampbell@ihis.org

Health Inforstructure Atlantic (Secretariat): Sharon Scott: scottshr@gov.ns.ca