the laval university (québec) virtual slide telepathology project; a structured patient-oriented...
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The Laval University (Québec) virtual slide telepathology project;
A structured patient-oriented network involving 21 sites
Bernard Têtu MD, Medical director
Christine Houde MD, Jean BoulangerCo-chairs, telehealth steering committee,
Laval UniversityQuébec, Canada
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Canada: 34, 108, 752
Québec: 7, 907, 375
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Integrated University Health Networks
1,729,000 408,760 Km2
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Density of population and Distribution of pathologists on the territory
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History of the project
• August 2004: • Quebec MOH mandates the Integrated University Health Networks to develop telehealth in the province.
• Laval University prioritizes telepathology• Fall 2004:
• Creation of telehealth steering committee• Spring 2005:
• Survey on needs and services in the territory
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Telepathology – clinical context
• Part-time pathologists available:• Schedule of operations depends on the presence of a pathologist
• Difficulty recruiting surgeons
Surgeon’s perspective
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Telepathology – clinical context
• No pathology department but oncologic surgery:
• Two-step surgeries (sentinel lymph node)• Patient transferred if frozen section expected
• Resection margins not available• Difficulty recruiting surgeons
Surgeon’s perspective
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Telepathology – clinical context
• Insecurity, especially in early practice• Impossibility to rapidly obtain a second opinion• IHC performed in university hospitals: delays
to get slides back• Limited continued medical education
Pathologist’s perspective
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Telepathology – clinical context
• Difficulty in being absent without disturbing the organization of the surgical unit
• Average age of pathologists increasing and entries in residency stable: worsening of the shortage is expected
• Resources merely adequate, even in university hospitals
Pathologist’s perspective
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Telepathology – clinical context
Creaghan Commission, New Brunswick:
Recommendation #12: The Department of Health study and plan for the potential of providing pathology services for regional hospital laboratories through new technology in the field of pathology digital imaging and computer transmission…
Reports of Commissions of Inquiry in Canada
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Telepathology – clinical context
Cameron Commission, Newfoundland:
Recommendation #24: The Department of Health and Community Services should also ensure that adequate resources are available to fund technical resources such as telemedicine technology, particularly for pathologists who work alone, as well as new technology in the field of pathology digital imaging and computer transmission.
Reports of Commissions of Inquiry in Canada
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History of the project
• January 2006:• Project charter accepted by the MOH and Canada Health Infoway; phase 0
• Summer 2006:• Extensive consultation of medical teams and professionals to better identify needs and services required
• January 2007:• MOH authorizes the continuation of the project toward further steps
• 6,136,662$ covered equally by MOH and CHI
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History of the project
• Summer 2008:• Request for proposals
• October 2008:• Call for tender (slide scanner, gross station/videoconferencing and viewer)
• April 2009:• Compliancy testing of technologies (pathologists, technologists, experts in information and change management)
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History of the project
• Summer 2009:• Final choice of solutions
• Fall 2009:• Contracts, agreements on physician’s fees
• January 2010:• Deployment and validation
• January 2011:• Expected completion of the deployment
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Aims of the project
• Implement an innovative solution to provide uniform pathology services in the whole Laval University Health Network territory
Main objective
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Aims of the project
• Provide frozen sections anywhere, anytime• Provide second opinion from a colleague or a
panel of experts• Allow fast return of IHC performed in university
hospitals
Specific objectives
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Aims of the project
• 21 sites (3 additional possible sites)• 6 hospitals devoid of pathology laboratory• 15 sites with pathology laboratory
• 7 with 1 pathologist• 7 with 2 or more pathologists• 1 with no pathologist
Deployment
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Slide scanner: nanoZoomer RS & HT
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Gross station (PathStand) and videoconferencing (Sony HD)
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Viewer and image sharing solution: mScope, Aurora
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Internet
Serveur WebSlide
Station devisualisation 2Bus
Schéma simplifié du réseau proposé
RTSS
NanoZoomer HT
Réseau de l'hôpital (grand volume)
Visioconférence
Serveur WebSlide
Station devisualisation 2Bus
NanoZoomer RS
Réseau de l'hôpital (petit volume)
Visioconférence
Accès à distancede l'extérieur du RTSS PathStand
PathStand
Simplified schema of network
A
B
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Région 01 Bas-Saint-Laurent
3,25 PATHOLOGISTES
Région 02 Saguenay-Lac-St-Jean
7 pathologistes
Région 03 Québec
30 pathologistes
Région 09 Côte-Nord
2 pathologistes
Région 11 Gaspésie-îles-de-la-
Madeleine
1 pathologiste
Région 12 Chaudière-Appalaches
5 pathologistes
CSSS de Matane
O pathologiste
CSSS de la Matapédia
0 pathologiste
CSSS de Kamouraska
0 pathologiste
CSSS Témiscouata
0 pathologiste
CSSS Maria-Chapdeleine
0 pathologiste
CSSS CharlevoixHôpital de la
Malbaie 0 pathologiste
CH de Charlevoix 0 pathologiste
CSSS des Îles0 pahologiste
CSSS du Rocher-Percé
0 pathologiste
CSSS de la Haute-Gaspésie0 pathologiste
CSSS de Beauce1 pathologiste
CSSS de la région de Thetford
0 pathologiste(itinérance)
Hôpital Laval3 pathologistes
CHAUQ12pathologistes
CHUQ15 pathologistes
CSSS Lac St-Jean Est
1 pathologiste
CSSS Domaine du Roy
1 pathologiste
CSSS Baie-des-Chaleurs
0 pathologiste
CSSS de Montmagny
1 pathologiste
Centre local
CentreUniversitaire
Région
CSSS de Rivière-du-Loup
1,25 pathologistes
CSSS de Rimouski-Neigette
2 pathologistes
CSSS de Chicoutimi
5 pathologistes
CSSS de Sept-îles
1 pathologiste
CSSS de Manicouagan1pathologiste
CSSS de la Côte-de-Gaspé1 pathologiste
(+itinérance)
CHAU - Hôtel-Dieu-de-Lévis
3 pathologistes
Centre régional
Health Authorities in Eastern Quebec
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CSSS Cléophas-Claveau
CSSS de Jonquière
Région 02 Saguenay-
Lac-St-Jean
CSSS Domaine du
Roy
CSSS Maria-Chapdeleine
CSSS Lac St-Jean Est
CSSS de Chicoutimi
CSSS de Témiscouata
CSSS de la Matapédia
CSSS de Kamouraska
CSSS de Matane CSSS du
Rocher Percé
CSSS de la Mitis
CSSS les Basques
CSSS des Etchemins
CSSS du Grand Littoral
Centre Hospitalier
Robert-Giffard
CSSS de Charlevoix
Hôpital Laval
CHAUQHôpital de
l’Enfant-Jésus
CHAUQHôpital du Saint-
Sacrement
CHUQ HôpitalSaint-François
d’assise
Région 01 Bas-Saint-
Laurent
CSSS de Rivière-du-Loup
CSSS de Rimouski-Neigette
Région 03 Québec
CSSS de la Minganie
CSSS de la Haute-Côte-
Nord
CSSS de la Basse-Côte-
Nord
CSSS de Port-Cartier
CLSC Naskapi CSSS de l’Hématite
Région 09 Côte-Nord
Région 11 Gaspésie-îles-de-la-Madeleine
CSSS de la Côte-de-Gaspé
CSSS des Îles
CSSS Baie-des-Chaleurs
Région 12 Chaudière-Appalaches
CSSS de Sept-îles
CSSS de Manicoua-
gan
CHA - Hôtel-Dieu-
de-Lévis
CSSS de Beauce
CSSS de la région de Thetford
CHUQCHUL
CHUQLaboratoire
central
Centre Régional
CSSSCentreUniversitaire
Région
CSSS de Montmagny
CSSS de la Haute-Gaspésie
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Expected volume of activities
• Over 2000 frozen sections and second opinions • Over 4000 immunohistochemistries returned
by telepathology
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Governance of the project
Electronic medical record, MOH
Telehealth executive committee
Project manager
Management committee
Medical director
Committee of experts
6 health authorities
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Committee of experts
• 18 members from university and community hospitals
• Mandate:• Propose organizational models• Develop clinical protocols• Evaluate and select solutions• Advise executive and management committees
• Advise on the deployment of the project (cohesion, respect of project charter)
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Conclusions: strengths of the project
• For patients:• Improved medical cares• Decreased transfers to regional hospitals• Faster diagnoses and treatment
• For pathologists:• Easier access to second opinion • Decreased professional isolation
• For organizations:• Easier recruitment of surgeons and pathologists
• Less movement of pathologists = efficiency• Easily transportable technology
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Future direction
• Grant application:• « Partnerships for health system improvement »
• Canadian Institutes of Health Research• Objectives:
• General: evaluation of telepathology to improve the quality of cares
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Future direction
• Specific objectives: • Patients:
• Transfers prevented• two step surgeries prevented
• Pathologists• Consultations performed• TAT for cases with IHC• Overall satisfaction
• Organisations : • Stability of the frozen section coverage• Time saved to start treatment• Retention of pathologists and surgeons
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