Canadian health care is almost filmless

Canada will be filmless by the end of 2010, according to Dave Wilson, vice-president of Agfa HealthCare Canada, a member of the Agfa-Gevaert Group. “If you look at the Canadian marketplace for PACS and radiology, we are pretty much on the leading edge for saturation from a hospital perspective,” he said.

PACS (Picture Archiving and Communication Systems) replaces medical images on film with digital computer generated images that are stored on a computer. Benefits include allowing medical staff to manipulate images, access images remotely, share files immediately with other hospitals and reduce loss or misplacement.

Adoption of PACS remains largely within hospital systems, which implement the systems in areas such as radiology, ultrasound and mammography. “As far as radiology is concerned, I think we are leading the curve. Across Canada, the bulk of the projects are finished or almost finished,” said Wilson.

Wilson attributes part of the success to promotion and funding from Canada Health Infoway. “You really have to give a lot of credit to the Infoway funding and what they’ve done because it has stimulated hospitals to buy PACS and get that implemented,” he said.

With the foundation for radiology almost in place, the ability to populate that data into the electronic health system is the next step, Wilson noted. “Canada Health Infoway is driving electronic health records as are a lot of the provincial governments, so I think it’s just a matter of time,” he said.

Radiology is one of the more challenging areas of eHealth because the size of the digital images are so large, Wilson noted. A typical chest X-ray could be 10MB, while a mammography image could be 60MB, he said. “When you are able to overcome that challenge of sending data over networks that are so large, the rest becomes pretty simple from a performance perspective,” he said.

Traditionally in the business of the radiology department, Agfa HealthCare has about 60 per cent of the market share in Canada, noted Wilson. Nova Scotia, New Brunswick and PEI are 100 per cent Agfa PACS using the IMPAX product line. Alberta and Manitoba follow second at nearly 100 per cent. In Ontario, BC and Quebec, Agfa represents roughly 30 to 40 per cent of the market.

The most recent deployment of Agfa’s integrated PACS solution, which consists of IMPAX 6 PACS and DI-r (Diagnostic Imaging Repositories that act as a central archive for long-term storage), took place in Eastern Quebec.

The company rolled out its solution to 51 sites in within 18 months, after being selected as the preferred vendor for the Quebec Government’s request for proposal to implement a PACS solution across the RUIS of Université Laval region in late 2006.

Centre Hospitalier Universitaire de Québec (CHUQ) completed their implementation in the winter of 2008. Based in Quebec City, the CHUQ network includes three hospitals, five clinics and serves approximately two million people.

Key factors in the decision to go with Agfa’s technology was its compatibility with solutions from other providers and its experience in other countries, said Dr. Paul Langis, assistant radiological department director at Hôpital Saint-François d’Assise, one of the three hospitals within the CHUQ system.

“Agfa seemed to offer the best solution since its technology suited our needs and responded to the different evaluation criterions. For the radiologists, the version tested was easy to use, user friendly and was answering our performance need,” said Langis in an e-mail interview.

Deployment was fast and progressive, according to Langis. “We were well prepared and the Agfa support team was onsite to help our PACS managers and the IT team. The implementation was successful and the healthcare professionals were fully able to use the system after only six weeks,” he said.

The main benefit, according to Langis, is the ability to access current and prior exams within seconds for comparison or follow-ups. “We have made a major gain in productivity at this level. In addition, clinicians didn’t have to move around from department to department in order to view images and wait for an employee of the film archive department to find the film they are looking for,” he said.

Langis also found the solution intuitive, which “makes it easy for radiologists to use the systems and understand the basis.”

Other strengths include the ability to deploy the system across the web, store data from vendors, PACS and hospitals that are not using Agfa, and Agfa’s failover model, Wilson pointed out.

“The software is designed to be largely deployed over the Internet, so when you get the large central core installed, you can then roll it out to the different clinicians. Then it’s just a matter of getting timing on the training and getting the administrator prepared to put in users names and passwords so it can get secure access to the system,” said Wilson.

What’s significant about the failover model, according to Langis, is that each diagnosis console and PACS servers have a UPS. “We are always able to work even if there is a power shortage,” he said.

Agfa’s system was designed for a U.K.-based project that performs 10 million exams each year, Wilson pointed out. “If you have five minutes of downtime, you are 20,000 studies behind. So you can’t afford to have five minutes downtime,” he said.

The architecture works well in Canada and hospitals can rely on it to always be running, Wilson said. The data centre technology is robust and reliable and has no single point of failure, he pointed out. “It’s automatically routed to the other site so they never know they are down,” he said.

The CHUQ project ties the region together and allows the referring physicians and specialists to see the longitudinal view – a patient’s entire medical imaging record – from one location, said Wilson. “It makes it more efficient for everyone involved in a patient’s healthcare,” he said.

The next step for CHUQ, according to Langis, is sharing X-ray exams with other healthcare establishments from RUIS Laval (Côte Nord, Gaspésie, Bas-St-Laurent, Capitale Nationale and Chaudière-Appalache). “These establishments now store their exams at the diagnosis imaging deposit at Hôpital St-François d’Assise with mirror images at Enfant-Jésus, which results in 2.2 million exams per year,” he said.

Two developments going into field trials at the end of September are Agfa’s “next best thing” in Canada, said Wilson.

The first is the ability to support XDS, which will enable cross-document sharing. Agfa is currently working with the Province of Alberta on the delivery of XDS, which will enable sharing between vendors and across the province, he said.

The second development, a next step for Agfa’s DI-r, is a zero footprint viewer that will provide remote viewing capabilities. Agfa is creating a viewer that will allow you to display medical images on any type of PC, said Wilson.

The viewer is going to be “critical for the next step of the electronic health record and the patient health record and Canada Health Infoway’s blueprint,” said Wilson. “It’s higher performance, there’s no installation of any software. Think of it as an Internet browser that allows you to look at medical images,” he said.

Over the past year, Agfa has expanded into chronic care registries and data sharing across departments such as labs and nursing. “Agfa HealthCare has become an enterprise healthcare solution provider across the board,” said Wilson.

Radiology has been a good launching point for Agfa to expand in other areas, according to Wilson. “Because we’ve been able to deal with large images and large complex provincial projects, when we move into areas like chronic disease registries – diabetes, cardiac, cancer – the expertise is already in house on how to deliver a large project,” he said.

“The outcome is different, but the methodology and the process to get there are the same more or less. It’s been a great learning experience for Agfa and it’s allowed us to expand our business beyond the radiology side of things,” said Wilson.

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