Project: NORrad

Canada Health Infostructure Partnerships Program

Project Synopsis

NORrad is a $10 million project to re-engineer the delivery of diagnostic imaging services in the most northern communities in Eastern Ontario by implementing digital radiology technology and high-speed networks to move diagnostic images and interpretations between community and regional hospitals. Employing proven information and communications technology as an enabling factor, the NORrad vision will support physicians and other health care professionals in providing new and improved health care services for residents of the area.

The project is unique in its complexity - bringing together representatives of nine independent health care organizations in and around the Cochrane District and James Bay health districts. This collaboration, known as the Northeastern Health Services Alliance, came together for the first time under a common set of goals and objectives for improving health care services and delivery for the 100,000 people living across an area of 150,000 square miles.

The NORrad Project is both a Picture Archiving and Communication System (PACS) and a teleradiology initiative that includes the following elements:

• Ability to convert to or acquire diagnostic images in a digital format and to store these images electronically on a server for future retrieval;
• Ability to view images on a computer monitor within the health care facility or remotely from a physician's home or office via the Internet; and
• Ability to transmit images within a hospital/clinic site or to other NORrad hospital sites for eventual access by multiple authorized users.

Outcomes

Implementation of the NORrad Project is a potential catalyst for shepherding in a new era of actively adopting information and communications technologies to improve health outcomes. The production, storage and transmission of electronic x-ray images will open new possibilities for more efficient and effective patient care. Outcomes of note are:

• The ability to manipulate the PACS image has virtually eliminated the need for retakes due to poor image quality, thereby reducing the need for repeated patient exposure to radiation; and
• Patients no longer have to make special trips into the hospital to pick up conventional x-rays when their clinician has access to the PACS server.

Policy Implications

There were no policy implications that could not be / were not addressed at the project level.

Research Implication

None noted.

Lessons Learned

The NORrad Project reported multiple lessons learned under four categories (Training, Documentation and Reporting, Technical Support, and Release of Images to another site) some of which have been summarized into the following four concepts:

• As this one must understand workflow, and preplan for equipment placement in order to realize productivity and operational efficiencies;
• Support the successful deployment and adoption of the technology by planning activities such as site visits to other PACS sites, managing expectations of referring physician's access to radiologists, and providing web-based access to images by radiologists while outside the hospital radiology department;
• Plan for PACS downtime, i.e., develop and institute contingency procedures to manage scheduled and unscheduled PACS outages. Enact a data security plan including disaster recovery procedures; and
• Adopt a project management methodology to manage and guide complex information technology projects such as PACS.

The Future

NORrad is a fully functioning program in all of the nine hospitals in and adjoining the Cochrane District and the project has operated virtually problem free for more than 1.5 years. The conversion from x-ray film to digital imaging has occurred in all areas planned for.

NORrad personnel have been active in providing support, advice and information to other northern hospitals, and to radiologists.

In July 2003, NORrad lead a consortium of other northern Ontario hospitals in developing a submission seeking Ministry of Health support to approve Medical Equipment Funding 2 (MEF2) over the next three years to allow the expansion of the NORrad PACS program beyond the Timmins and Cochrane key feature of the expansion would be the creation of a regional Master Patient Index for the purpose of developing an Electronic Health Record (EHR).

Appendix A: Documents or Products Generated

Document /Product Name

Release of diagnostic films and reports

PACS printing policy

Release of Information to Physicians/Institutions Outside NORrad

Release of Information to lawyers/Insurance Companies/Coroner

Release of Information to Patients

Duplication of films

Records Retention and Destruction

Securing Images for Legal Cases

CD Disposal

Verbal Reports

Emergency Reports

Reports and Returned Reports

Delinquent Reports

PACS Access Password Policy

Request for PACS Access Form

Daily Back-ups

Monthly Reports on Servers

Transmission of Examinations

Request for Previous Examinations

Scanned Requisitions

Request for PACS Exam Fix

Downtime

PACS After Hours Service

Patient Confidentiality

Privacy Program

Disaster Recovery Plan

Computed Radiology (CR) Workflow Analysis

Ultrasound Workflow Analysis

Nuclear Medicine Workflow Analysis

Computed Tomography Workflow Analysis

Magnetic Resonance Imaging Workflow Analysis

For more information, Please contact:

Guy Guindon at gguindon@tadh.com or at (705) 360-6078