Sharing digital images is already increasing productivity and can eliminate up to 17,000 patient transfers a year, according to a study Canada Health Infoway commissioned last year. (Purestock)The northeastern corner of Ontario — a vast area extending from just northeast of Wawa to Hudson Bay — has 51 hospitals and one permanent radiologist.

That's why Northern Radiology (NORrad) was created seven years ago to allow nine of those hospitals to share digital diagnostic images such as X-rays and ultrasounds. Before NORrad, emergency-room physicians in remote communities with only limited diagnostic capabilities often had to ship patients out to larger centres.

Now 17 hospitals are tied in to NORrad, allowing a radiologist in Timmins and visiting specialists — known as locums — to read medical images remotely, which has greatly reduced the number of patients being transferred, says Guy Guindon, manager of NORrad's medical imaging and cardiopulmonary department.

Especially in remote communities, that's one big reason Canadian hospitals need to share medical images — something many still can't do.

Picture archiving and communications systems (PACS) replace film with digital images, which must happen before hospitals can share them electronically.

The shift to PACS is nearly complete, says Mark Nenadovic, group director of programs for Canada Health Infoway, the federally funded non-profit organization promoting electronic health records across the country. But most are still limited to a single hospital or multi-site health-care organization.

Projects like NORrad have started breaking down those barriers across Canada.

Easier access to images

Another reason to share images is that patients don't always visit the same hospital. If a Sydney, N.S., resident goes to Halifax to see a specialist, that specialist can look at any medical images taken of that patient in Sydney, says Sandra Cascadden, chief information and health transformation officer for the Nova Scotia Department of Health.

Images taken anywhere in the province are available because Nova Scotia is one of three provinces — the other two are neighbouring Prince Edward Island and Newfoundland — that have fully adopted diagnostic image sharing.

Alberta is well along with a similar system. More than 90 per cent of that province's diagnostic images are digital, and all hospitals can share images within their health districts, according to Dan Sheplawy, executive director of Alberta Health and Wellness's information systems delivery branch.

By the end of 2010, image-sharing will be possible between Alberta's health districts.

British Columbia has image sharing in its Fraser and Interior health authorities and is working to extend it through the province.

The other provinces and territories are in various stages of implementation, Nenadovic says. Ontario and Quebec, the largest provinces with the most hospitals, each have some regional image-sharing projects but will not have provincewide sharing for at least a year.

Compatibility can be problem

A Nova Scotia survey found that 50 per cent of physicians in the province said that sharing diagnostic images has improved their efficiency. (iStock)The big provinces' problem is that they have more large hospitals, which are more likely to have different PACS systems.

Nova Scotia had an easier time implementing its province-wide system because only one health region — the Capital Health region that takes in Halifax and surrounding area — already had a PACS system, Cascadden says. So the province rolled out the same technology to other regions and didn't have to deal with incompatible systems.

Contrast that with Credit Valley Hospital, Halton Healthcare Services and William Osler Health Centre, just west of Toronto. They wanted to share images and other medical records, but they had incompatible hospital information systems.

So they set up a web portal that sits on top of all three systems and pulls the records together in one place so physicians in any of the hospitals can see them. Additional software compares information across systems to determine when separate records in different institutions refer to the same person.

Before, a physician with access privileges at multiple hospitals could have obtained the images by logging on to separate systems, while those without would have had to request the data from the other hospitals, says Dave Wilson, vice-president of Agfa HealthCare Canada, which built the web portal.

Depending on how important the physician thought the images were, he or she might or might not have taken time to obtain them.

Less time wasted

Now "they can see how that patient was treated literally yesterday or even earlier in the morning," says Dan Germain, vice-president and chief financial officer for Credit Valley Hospital. "It makes for better quality and less wasted time for the physician."

A study that Canada Health Infoway commissioned last year found that sharing digital images is already increasing productivity and can eliminate up to 17,000 patient transfers a year, boost technologists' productivity by 25 to 30 per cent and save up to $1 billion a year once fully implemented across the country.

Sharing diagnostic images is just one part of the larger dream of universal electronic health records, which would ultimately mean all of your health information would be available to any health-care worker treating you, in any location across the country.

Provincewide systems are the first step, and the eventual goal is a nationally integrated system. That will take several more years yet, Nenadovic admits. Along with the technical challenges are issues such as the need to harmonize privacy legislation across provinces, he notes.

But one possible obstacle that doesn't plague image-sharing initiatives is resistance from physicians — certainly not in Nova Scotia.

Cascadden says the province's medical community was solidly behind the effort to make diagnostic images shareable right from the beginning, because the benefits were so obvious. In a provincial survey, 99 per cent of radiologists and 50 per cent of physicians said the technology has made them more efficient.

"They know this is the right thing to do," Cascadden says, "and they want to move it forward."