Seeing the future

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By Erin Lynch

The IWK Health Centre is the pediatric and women’s tertiary care facility for the Maritime Provinces. This requires a tremendous amount of health information sharing with stakeholders, neighbouring provinces, as well as with healthcare collaborators involved in care provision.

Historically, a request for sharing of imaging health information would require data to be burned to a CD/DVD and couriered to an outside facility, with unknown delay in care delivery. Now, the requests can be processed and transmitted 24 hours a day, 365 days a year to referring facilities, or uploaded into the local system.

The key player in this facilitation is the Picture Archiving and Communication System team in Diagnostic Imaging at the IWK. They oversee the imaging informatics aspect of health records for Radiology, Ophthalmology, Dentistry, Ambulatory Gynecology, Laparoscopic Gynecology, Fetal Assessment Clinic and Cardiology. These images are stored in a centralized provincial database with built-in redundancy and catastrophic failure mechanisms in place.

Enterprise solutions exist, but they are expensive and not currently available to Nova Scotia. In the meantime, the conventional PACS system is being used to manage and store non-conventional images.

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Facilitated by the in-house development of an image request database, a notification is generated and the images can then be sent electronically. Building on existing Secure File Transfer Protocol service of the Nova Scotia Health Authority, the IWK PACS applications specialists have facilitated timely, reliable imaging health information-sharing across Canada, the United States, Europe and as far away as Australia.

The Nova Scotia PACS system is directly linked, meaning images aren’t required to be packaged, but can directly transmit to Prince Edward Island, New Brunswick, and Newfoundland. This direct Atlantic interconnectivity across provinces is very unique around the world, and something the IWK uses every single day.

Being a fairly small hospital has allowed the innovative and adaptable two-person PACS department to build relationships and trust with outside facilities, troubleshoot and adapt to the evolving requirements in the changing networked healthcare delivery environment.

This has also been the case in using existing infrastructure to support diagnostic image archival in the eHealth record, beyond the traditional confines of Radiology. As enterprise imaging becomes more readily available for integration, these connections move away from being a novel idea, to the expectation for complete patient records, access and care. While locally enterprise imaging is still a ways into the future, the application specialists at the IWK have established a system to accommodate the growing imaging informatics needs of the healthcare team in the provision of truly collaborative care.

The IWK has incorporated women’s laparoscopic gynecology operating room media, Dentistry (both radiographic and oral photos), Ophthalmology, Fetal Assessment Clinic and Ambulatory Gynecology imaging into PACS. Having these five departments fully integrated in the PACS environment allows the IWK to round out the imaging aspect of health records, beyond traditional radiology (xray, CT, MRI etc) and allows the care team to access and share a variety of images related to the patient care that they didn’t have access to as recently as even three years ago.

On the horizon, Gastro Intestinal endoscopy is moving towards storing their images on PACS, as well as external images for Orthopaedics.

These imaging health information processes have streamlined not only the turn-around time for sharing and collaborating, but also significantly reduced the timeline of imaging critical healthcare decisions for Oncology, Orthopaedics, Genetics, Surgery, Emergency Medicine and more.

Erin Lynch is the Communications Specialist at IWK Health Centre.