Upgraded PACS in NWT allows clinicians to share images more easily

Providing diagnostic imaging services for a population of 45,000 across a region as vast as the Northwest Territories can be a real challenge, but a new picture archiving and communication system (PACS) acquired by the Department of Health and Social Services (DHSS) for the delivery of radiology services is making a huge difference.

In February, DHSS retired its AGFA IMPAX system and went live with an AGFA HealthCare Enterprise Imaging (EI) platform that offers speedier transmission of images from remote communities across the territory to Yellowknife’s Stanton Territorial Hospital and a private reading service in Alberta.

The new system also provides improved clinical tools, increased storage capacity, better auditing features and the ability to share images for clinical consultations, said John Bowser, DHSS’s manager of project management services.

Additionally, the EI platform features a fully functional auxiliary system that can serve as a backup. It provides business continuity and disaster recovery to ensure 24×7 access in virtually any situation.

“Clinical access and continuity of care are paramount across the territory’s geography when emergency situations arise and speed-to-care can significantly impact outcomes,” said Lisa Shoniker, AGFA HealthCare’s regional vice president, sales, who worked with the DHSS on the transition to the new Enterprise Imaging platform.

“A decision was made to conduct a public procurement process and acquire a new solution when we learned that our PACS storage was due for replacement and that Agfa was due to end support for its IMPAX system,” said Bowser.

The NWT Health and Social Services Authorities have an extensive fleet of X-ray, ultrasound, CT, mammogram, fluoroscopy and bone mineral density imaging devices in 18 community health centres, four hospitals and primary care clinics across the region’s 1,346,000 square kilometres, an area larger than France, Germany and Poland combined.

However, the Northwest Territories has no resident radiologists and relies on locums and a private reading service in Alberta.

Bandwidth challenges in the past required a hub and spoke architecture with some storage in remote communities, but the new centrally located EI platform in the Territories’ capital, Yellowknife, allows for much faster transmission and sharing of images.

“Previously, only clinicians at Stanton had access to imaging performed anywhere else in the Territories,” said Dr. Marius Diaconescu, a Montreal-based radiologist who does locums in Yellowknife.

“Now, clinicians in remote communities have access to imaging performed anywhere else in the Northwest Territories. This can help a lot by providing clinicians with an imaging history of patients.”

For example, Diaconescu cited a call he received from a doctor in a remote community about a pediatric patient with a suspected fracture.

“In such a circumstance, they would have sent the patient with the child’s family to Stanton to be evaluated by an orthopedic surgeon, but because of the new system, they also had access to imaging that was done a few weeks earlier on the patient somewhere else in the Northwest Territories that documented the same finding.

“That’s what prompted the doctor to call me for a second opinion. I could tell that what we were looking at was actually a growth plate, an area of active, new bone growth made up of cartilage that eventually hardens into bone. They’re found in all children, but can sometimes be misdiagnosed as fractures even by experienced radiologists.”

Being able to identify a growth plate allowed Dr. Diaconescu and the doctor in the remote community to provide a faster, more accurate diagnosis that avoided flying the child and his family to Yellowknife, a huge expense for the Health Authority and a potentially stressful experience for the family.

The improved access to imaging for interactive consultations by specialists outside the Northwest Territories, or for rounds or tumour boards is also important to confirm diagnoses and treatment.
“These enhanced capabilities improve the patient care experience and can help avoid unnecessary long-distance travel,” said Shoniker.

AGFA HealthCare’s Enterprise Imaging assists in allowing patients to return to their rural communities sooner because sharing of medical images, reports and related patient data is readily available for patient follow up or further consultation.”

Dr. Diaconescu began providing locum services to the Northwest Territories in November 2023 when the IMPAX system was still in place, so he is intimately familiar with the improvements made possible by AGFA HealthCare’s EI platform.

“It’s definitely more intuitive to use and more customizable,” he said. “For example, I’m able to highlight multiple studies in my list and once I finish reporting one study, the system immediately jumps to the next one, so it makes my workflow much faster. I’ve used many different PACS systems in my career and Enterprise Imaging is one of my favourites. It was very easy to learn, but I also have to give credit to the Authority’s talented PACS administrator, Stephen Kruger, who was there to answer all my questions.”

The opportunity to provide locum services in Yellowknife acquainted Dr. Diaconescu with the challenges affecting the delivery of healthcare in the Northwest Territories.

“It was a great experience. The team I worked with – the radiology team, the Emergency team, the clinicians and specialists – were amazing. Everybody does their best to work with the limited resources they have and to help their patients as much as possible. It was eye-opening to see the geographic challenges and resource limitations they contend with, but it was a fantastic experience and that’s what keeps me coming back.”

As for next steps, DHSS hopes to also integrate the Enterprise Imaging platform with a proposed territory-wide electronic health record solution that will allow clinicians in the field to access images directly from their EHR.