Development of Telemedicine-Based Managed Clinical Networks for Gynaecological Cancer in

the West of Scotland

GD Currie, P Campbell, GF Brunton

Beatson Oncology Centre

North Glasgow University Hospitals NHS Trust

Background

Beatson Oncology Centre Largest cancer centre in Scotland providing tertiary cancer care services to 2.7 m population across west of Scotland

radiotherapy & chemotherapy services site specific cancer teams clinical trials unit radiobiology research unit

Issues in Cancer Care

Poor outcomes in cancer care

Specialists moving between clinics

Shortage of oncologists

Tumour site specialisation

Communication between primary, secondary care

Requirement for multidisciplinary decision making process

Managed Clinical Networks

“Linked groups of health professionals and organisations from primary, secondary and tertiary care working in a coordinated manner unconstrained by existing professional and Health Board boundaries to ensure the equitable provision of high quality clinically effective services throughout Scotland” MEL(1999)10

- prospective audit

- plan for service redesign and improve the patient journey

- deliver requirements of Clinical Standard Board for Scotland with evidence based (SIGN) guidelines

MCN Core Principles

- Robust data collection system

- Demonstrate improvements as a result of an effective network

- Facilitate educational and research activities

- Strategic planning to influence redesign of service

- Effective communication links

- Discussion time to develop evidence based guidelines

How Could Technology Help?

Gynaecology Managed Clinical Network chosen to pilot the application of modern information

technology and networked information systems to support the oncology MCN’s in the West of

Scotland

Pilot funded by Scottish Executive’s Scottish Telemedicine Action Forum(Aug 2000 – Aug 2003)

Project Aims and Objectives

Establish ‘virtual’ clinical meeting rooms using video conferencing.

Provide a secure clinical information system to describe the patient journey - electronic episode record of care. Provide a core repository for essential clinical information and medical images, making available all relevant information for MCN decision making process Assist with establishment of robust data sets & facilitate audit processes Provide means of informing primary, secondary and tertiary care teams of ongoing cancer care.

Gynaecology MCN Pilot

• 300 patient referrals / year

• BOC with 5 DGHs across west of Scotland

• Oncologists, gynaecologists, pathologists, surgeons, radiology, nursing, radiography, clinical trials

Project Phasing

2. Clinical Information & Image Management System (CIIMS) Implementation

1. Videoconferencing Implementation

• Record MCN decisions using existing Access database - limited visibility to VC participants

• Share pathology, radiology images across VC system

• Establish a virtual MCN meeting room

Videoconferencing System

Sony VC units installed at five MCN sites

Accord Multi Conferencing Bridge 6 x ISDN-6 (384 kbps) + 6 x IP

Communication using BT ISDN-6 lines

Mixed ISDN / IP Network Full IP within Glasgow sites

Nov 01 – Feb 02

Sep 2002

MCN VC Meetings

Video Conference Activity

0

10

20

30

40

50

60

Calendar Month

No

. of

Sta

ff

Audit Staff

Technical

Clinical Trials Staff

Nursing

Medical

CIIMS Requirement Specification

MCN Episode of Care Record

Data collection tool and audit system

Patient Care Summary

Electronic record of the decision on future care management for each patient as decided by MCN participants (diagnosis, surgery, treatment).

Support the management & organisation of the conference and record who attended.

Provide a central repository of collated data and images to help the MCN determine the optimum care pathway.

MCN ExceliCare System

Wide area networked system with central SQL database

Electronic interfaces built to deliver automatic update of demographics, key labs data, radiological images, pathology images

Reporting and audit tools

E-mail communication of summary data

Conference management tools to anonymise patient identity during VC meetings; all network communication over NHSNet / HealthNet Community (secure network)

CIIMS Implementation

Small number of pilot systems (15-20 clients installed across WoS initially)

CIIMS screens dynamically pushed to all participants during VC sessions using NetOp software across NHSNet

Manual data entry (registration, conference lists, special forms)

Summary reports e-mailed to clinical staff after MCN session for patient follow-up Data captured consistent with MCN (SIGN) guidelines for future audit purposes

Data forms agreed and security permissions applied

CIIMS Electronic Interfaces

Interfaces developed with ‘automated’ transfer of data & images into ExceliCare Demographics (iSoft, COMPAS, SCI) Key Laboratory data (Telepath, Revive, SCI) Pathology images (microscopy, e-scope) Radiology images (CT, MRI) Key Radiotherapy treatment data (VARiS) Key Chemotherapy treatment data (ChemoCare)

MCN dependent

CIIMS end of Phase 3

ExcelicareData Store

Server

ExcelicareClient PC

North Glasgow Firewall

ExcelicareClient PC

NORTH GLASGOWTRUST

Beatson OncologyCentre

Stobhill

ExcelicareClient PC

Glasgow Royal

Glasgow NorthHOMER PAS

ExceliportSlaveServer

TELEPATH

ExceliportMasterServer

CHEMOCAREVARIS RT

Crosshouse Firewall

ExcelicareClient PC

CROSSHOUSEHOSPITAL

LANARKSHIRETRUST

Inverclyde Firewall

ExcelicareClient PC

INVERCLYDEHOSPITAL

Forth Valley Firewall

ExcelicareClient PC

Lanarkshire Firewall

ExcelicareClient PC

FORTH VALLEYTRUST

Falkirk

ExcelicareClient PC

Hairmyres

Wishaw

COMPAS PASREVIVE LABS / RAD

CT SCANNER STORE

SCI PAS, LABS, RAD

SCI PAS, LABS, RAD

SCI PAS, LABS, RADPACS STORE

Courtesy of AxSys Technology Ltd

ExceliCare MCN – How does it work

Pre Conference Secretarial / admin staff prepare case record

During Conference

Patient registered to MCN, supporting data ‘pulled’

Application locked in a Conference Mode Record reviewed & updated during discussion

Patient entered onto Conference List

Summary available for distribution

Selected images chosen by specialists for meeting

Technical Challenges

Image capture Imaging units visible on LAN / WANs?

Data Quality

Data matching via interfaces requires high accuracy

Identifying the correct patient (CHI)

Requirements for adequate bandwidth DICOM connectivity / compliance

Bespoke interfaces due to limitations of connecting systems

Clinical Challenges

Standardisation

Cultural change

Coding & nomenclature

Differences in radiology acquisition & reporting

Variation in Pathology testing regimes

Acceptance of new technology Process changes

Benefits in Patient Care

Earlier case discussion with specialist input

Educational opportunities for MDT teams

Reduced professional isolation

Higher quality data set leading to improved audit

Rollout to other MCNs with steps towards a Scottish cancer EPR?

Questions?