Online Radiology Images
21 October 2005
North Sydney/Central Coast Area Health Service
This project was entered in the Baxter 2005 NSW Health Awards, Access category.
Entries from the Baxter 2005 NSW Health Awards - full list
Author
Darrin Gray, Gosford Hospital Central Coast Health Services, NSCCAHS
Abstract
Many patients presenting to our hospitals undergo imaging examinations to aid in the diagnosis of their condition, enabling appropriate treatments to be commenced. Sometimes the appearance of the disease on imaging is subtle, and the time critical nature of the treatments requires rapid specialist image interpretation. The ability to provide the images to the specialist onto a desktop PC at a remote location in a timely manner has the potential to greatly assist timely clinical decisions, and the potential to result in the transfer of patients between hospitals based upon additional imaging based clinical information. By providing PC based access to images, image-based co-consultation has been enabled between Gosford and Wyong Hospitals and into the radiologists’ homes after hours using Broadband technology. This has provided an 88% improvement in the timeliness of access for Radiologists. The further expansion into other sites such as RNSH has been proven in concept, and represents a further phase of the project now underway.
Aim
To achieve timely specialist review and interpretation of radiological imaging to assist in appropriate patient management irrespective of the origin of the imaging examination or the location of the specialist(s).
Background
The Gosford and Wyong Hospitals utilise higher acuity specialist services including neurosurgery and cardiac surgery at RNSH. Within the Central Coast region, specialist services are often spread across the campuses. After-hours Radiologist and Specialist review has required transport of the x-ray films, or the specialist prior to determining an appropriate treatment or transfer regimen. The ability to electronically review images from the Gosford and Wyong Hospitals, at either site, at remote sites eg RNSH and in the Specialist’s home would improve access to services and decrease treatment delays and assist in the more appropriate transfer of patients.Electronic capture, storage and review of radiology images requires digitalisation of the modalities. The redevelopment of Gosford and Wyong Hospitals, achieved this objective.
Methodology
The clinician groups and the radiologists were experiencing delays with the ability to receive and provide opinion on urgent imaging tests such as trauma CT after hours. There was no effective mechanism for receiving inter-agency input into patient management utilising imaging. Evaluation of the suitability of Teleradiology Systems to achieve improvements in image access and timely review was undertaken. Following inter-agency agreement a successful submission was made to the Telehealth Initiative Program for this project. Funding was provided to purchase an image Webserver, update network infrastructure and provide some remote viewing PCs to allow Radiologists to access the images after hours from their homes. The radiology images would be printed for immediate local use, and also forwarded to a temporary image repository (The Radiology Webserver). It was anticipated that the images would be available for approximately 6 months (30,000 examinations). In the past only CT images were available, and only for approximately 1 month. The Radiologist would be contacted by the treating physician. The Radiologist would access the images on the Webserver, and discuss the diagnosis with the treating physician within minutes of the contact being made. Similarly orthopaedic, neurosurgical and cardiology specialists could review images and provide timely clinical advice across the entire NSCCAHS network.
Planning and Implementation
An analysis was completed by the Medical Imaging Service and the IM&T Department to evaluate the scope of imaging modalities to be included in the project, and the impact upon the network. Only two main imaging units would not connect to the system. An evaluation utilising onsite trials was undertaken, resulting in the purchase of the Webserver, network infrastructure and PCs. Installation and further testing was undertaken to maximise the efficiency of the system. Training tools were developed and a training schedule established. This is ongoing. The introduction is being undertaken in a staged manner commencing with the critical and high utilisation areas. Further rollout will continue as required. The introduction of the availability to other hospitals such as RNSH, has presented some IT related problems, that have now been resolved. Implementation of this phase of the project continues. The operational protocols were already established for the types of cases and mechanism for interaction between the treating and diagnostic clinicians. These were continued, utilising the advantages of significantly shortened timeframes.Within the Gosford and Wyong Hospitals many additional uses and advantages of the system are being realised, although the initial uses of the system remain the project focus.
Outcomes and Evaluation
The pre-existing closed network of CT scan image distribution (10% of workload) provided limited viewing to six locations in Gosford Hospital. The Webserver system complements this by providing general PC access to ten concurrent users for all radiology images (100% of workload) at any time and location within the secure bounds of the NSCCAHS IT network, including secure remote access via Broadband. Furthermore the transfer of images to the radiologist connected via Broadband has decreased from approximately 45-minutes to approximately 5-minutes, greatly decreasing the time required to attain a specialist opinion. The final stages of implementation are underway. A number of beyond-scope advantages are being realised by the project, providing enhanced utility of this system which has been in place since January 2005. Some members of the Intensive Care Unit are utilising the system to undertake their daily radiology evaluation, eliminating the time and resource consuming collation of x-ray films. There have been some IT issues that have resulted in project delays. These have highlighted the need for strong inter-agency representation and advocacy within the project plan to ensure that multi-site issues are addressed in a timely manner. This approach has resulted in a greater collegiate relationship between imaging services at Northern Sydney and Central Coast.
Future Scope
The introduction of a full clinical information system incorporating a PACS and RIS (Picture Archive and Communication System, Radiology Information System), will strengthen the utility gained, and add many advanced features. The availability of the image-receiving infrastructure establishes the opportunity to receive images and provide remote image interpretation from any remote site, including rural centres, within or outside of the Area Heath Service. Apart from having the potential to improve access to Radiological and other specialist image interpretation, it also improves the communication between clinical groups, across different hospitals, and between the private and public health care sectors.
