(back to 2007 CIPA Winners)
Nova Scotia Department of Health
Nova Scotia PACS Project
Going Digital for Better Health Outcomes
Challenge
In Nova Scotia, more than 1.2 million medical images of patients are taken every year. Use of hardcopy film to record these diagnostic images presented the provincial health system with many challenges.
Films were often lost, misplaced or signed out to another individual, department or hospital. The resulting need to re-conduct exams resulted in increased patient inconvenience, delays in diagnosis and treatment and increased cost to the system.
Films also required a considerable amount of manual handling and management by radiologists, x-ray technicians and administrative staff, as well as by referring physicians, throughout the imaging, reporting and diagnosis process. Sending films back and forth among clinics, hospitals and physicians' and specialists' offices was time-consuming, expensive and inconvenient. It took too long for a radiologist to get a film, report on it and get the report and film back to the originating location or referring physician.
Some other provinces have implemented digital-imaging solutions but Nova Scotia's problems were compounded by staff shortages, the complexities of building an integrated system across nine district health authorities and a lack of high-speed Internet services spanning the province.
Solution
With support from Canada Health Infoway, the Nova Scotia Department of Health replaced nearly all film-based medical imaging in the province with a digital Picture Archiving & Communications System (PACS) and streamlined associated clinical and administrative processes.
The project implemented a provincial imaging archive using two data centres and a Web server that delivers diagnostic images and reports to 41 healthcare sites across the Nova Scotia health network.
Key solution components for this multi-year, $28.5-million project included:
- Upgrading the provincial image archive, database, storage and Web solution to accommodate all diagnostic images within the province;
- Upgrading the existing province-wide Nova Scotia Health Network to enable secure access to all hospitals;
- Creating the secondary data centre to provide backup and recovery for the provincial archive and related storage;
- Establishing policies and guidelines to direct PACS operations following implementation, including privacy and system access, security hardening and antivirus protection.
Due to the breadth and complexity of the project, a "rolling wave" implementation plan was created and then continuously updated and improved after each phase of the implementation.
Serious staff shortages made it impossible to form a single, permanent team to support all implementations across the province, so separate support teams were created for each implementation. Diagnostic imaging staff were recruited from various sites around the province and temporarily reassigned to the PACS project team. This ensured that the needs of small, medium and large sites were supported and fostered a true provincial team approach.
Results
The Nova Scotia PACS Project was completed on schedule and within budget. Within the first 30 days of implementation, every district was producing more than 99.1 per cent of its images without film.
Nova Scotia is the largest provincial jurisdiction with a fully digital imaging environment. Thousands of patients have benefited from reduced report turnaround times, faster diagnoses and therapy starts and improved care delivery.
Patient throughput in diagnostic imaging departments has increased. During the first six months of PACS operation, the average report turnaround time measured at selected evaluation sites improved by 22 per cent for general radiology.
Fifty per cent of referring physicians indicate that PACS has improved their efficiency, while 90 per cent of radiologists report consultation efficiency increases ranging from 25 to 75 per cent.
Costs have been cut for supplies and consumables, equipment maintenance, and film storage, disposal and handling. Cost savings for Cape Breton Regional Hospital, for example, are expected to be more than $700,000 during the first year of PACS operation.
Innovative Use of Technology
Overcoming the challenges associated with a project of this size and scope required a number of technological innovations, including a unique architecture.
The single, central image archive concept that has been used in other provinces would not work well in Nova Scotia due to the lack of a high-speed network throughout the province for distributing the large 20-25MB diagnostic image files.
Instead, a two-level, distributed archiving model was adopted in which copies of diagnostic images are kept in local image databases in hospital locations around the province as well as in a central provincial archive.
This eliminates the dependency on broad-based, high-speed connectivity to satisfy access requirements of local radiologists and physicians, while ensuring that images for all patients province-wide are also available in a single, central repository if needed.
Many areas in Canada are without high-speed network capability, so this distributed model is being considered for general adoption throughout the country.
A 2007 CIPA Winner!
For exceptional application of information technology to transform processes and bring benefits to its stakeholders, the Nova Scotia Department of Health has been awarded a CIPA Gold Award of Excellence in the Organizational Transformation, Not-For-Profit category.
Technology partners
Agfa Inc. & Agfa Waterloo
Dell Inc.
EMC Corporation
Medical Information Technology (Meditech) Inc.
Microsoft Canada Co.
Oracle Corporation Canada Inc.
Sierra Systems Group Inc.
Stratus Technologies Bermuuda Ltd.
Sun Microsystems Inc.
(back to top)
