(2011), "Canada - Telepathology poised for rapid growth", International Journal of Health Care Quality Assurance, Vol. 24 No. 2. https://doi.org/10.1108/ijhcqa.2011.06224bab.002Download as .RIS
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Canada - Telepathology poised for rapid growth
Article Type: News and views From: International Journal of Health Care Quality Assurance, Volume 24, Issue 2
Keywords: Telepathology pilot, Primary diagnosis systems, Healthcare improvement
“Faster, better and cheaper,” is the promise of a telepathology pilot network currently operating between Toronto’s University Health Network and a number of rural and northern Ontario hospitals.
The first such system of its kind in the province, the network links physicians in remote locations to UHN’s roster of 45 pathology specialists in real-time via the internet, instantly transmitting digital images of tissue samples.
The goal of the network is to give physicians access to the resources of big-city hospitals, regardless of the size of their facilities.
“It is more than just about the technology,” said Dr Sylvia Asa, medical director of the Laboratory Medicine Program and pathologist-in-chief at UHN, who stressed that patients are the immediate beneficiaries of the new network. “Faster, better, cheaper is what I like to say. We are getting samples faster, we are producing better results and it is actually cheaper for the people of Ontario.”
The project has been strongly supported by Canada Health Infoway, the provincial government’s OntarioBuys program and eHealth Ontario.
Telepathology promises to improve the current system, which often relies on a general pathologist who serves one or several remote hospitals and must often send off tissue samples from challenging cases to city laboratories.
With turnaround times of at least 48 hours, that makes intra-operative consultations all but impossible – meaning more patient visits and delays for critical treatment.
That is no longer the case with telepathology, where consultations can be done in minutes. The telepathology program started modestly enough about five years ago as a way to better shift resources between the three facilities that comprise UHN (the Princess Margaret, Toronto General and Toronto Western hospitals). To date, almost 2,000 digital slides have passed through the system with about 10 percent coming from the northern hospitals, a percentage Dr Asa expects to grow.
“As with any other technology, you start it for the most critical things,” she said. “We have been supporting intra-operative consultations where they need the answer immediately. But now that we are comfortable with the technology and we have it working well, we are hoping to do everything this way in the long term.”
Currently, the UHN-linked hospitals still send glass slides – those deemed not critical or urgent – south for specialist evaluation. “I’m dreaming of the day, which hopefully will not be too far down the road, when we won’t need to send slides all around the province,” said Dr Asa. “That is a risk for everybody, it’s expensive and it slows everything down.”
The network now links the UHN to a dozen northern and rural hospitals. Three of them, in Timmins, Sault Ste. Marie and Kapuskasing, are linked 24 hours per day.
The UHN’s interest in telepathology dates back to 2002 when staff pathologist Dr Andrew Evans began to investigate a digital system. He has served as the telepathology coordinator since the program’s inception in 2004, first utilizing remote-controlled microscopes.
In 2006, the UHN implemented digital slide-based telepathology to link its Toronto Western wing to the Toronto General, where the bulk of its pathologists are based. Dr Evans stated recently that while various forms of telepathology have been used internationally since the late 1980s, the UHN program is the first in the world to use cutting-edge virtual slide telepathology for primary diagnosis in patient care.
In Quebec, a telepathology network based in Laval aims to link more than 21 sites in eastern province, which would vie with the UHN project for the largest of its kind in the country.
In the early days of the initiative, the UHN implemented the telepathology network without fanfare, in part to see whether physicians in the participating hospitals would even notice that their team of UHN consulting pathologists had adjusted the regular visiting rotation and were now only consulting virtually.
Dr Asa recalls an instance at the Timmins and District Hospital earlier this year in which a surgeon in one of the operating rooms had an intra-operative consultation over the telephone with a pathologist. The Timmins doctor concluded the call with a promise to “walk by your office” to speak with the pathologist about another case, having no idea that he was in fact sitting in downtown Toronto.
“Honestly, the biggest compliment for us is when they say they haven’t noticed a big difference between when we are there or not,” she said.
The Timmins hospital was the first facility to sign on with the telepathology network. It is one of the strongest backers for expanding its use and capabilities in the future. “We’re very strongly supportive of the initiative,” said Roger Walker, chief executive of the Timmins and District Hospital.
The hospital currently sends about ten to 12 slides digitally every month, however it is anticipating a massive ramp-up in capability and utilization of the system once more robust equipment is installed and configured. “We are looking at upward of 200 to 300 (images) a day when we move into this new rollout of the technology that is being developed and we are essentially piloting with UHN for evaluation purposes,” said Walker. “So it will be dramatically different in terms of volumes.”
The benefit for rural hospitals is the access to a team of specialist pathologists such as those at UHN. “A hospital of this size would have one, maybe two (general) pathologists,” said Walker. Much of the evaluation work those local pathologists do is cancer-related and referred to specialists in larger hospitals. For a facility like Timmins, that can mean delays of ten days to two weeks, he said. “That’s a long time for somebody to sit and wait.”
The main factor which has delayed the use of virtual pathology is not the size of digital slides (which are quite large), or the space they take up on UHN servers, but rather the technological limitations of the digital scanners.
“The limiting factor is the time it takes to scan the slides,” said Aline Letourneau, regional general manager of lab services at Timmins. “Today’s digital scanners offer low throughput and require a technician to run slides through one at a time. But advances in scanning technology will be able to handle as many as 100 slides at a time and scan high-quality images far more quickly.”
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