The Laval University (Québec) virtual slide telepathology project;
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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 Boulanger Co-chairs, telehealth steering committee, Laval University Québec, Canada.

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Bernard Têtu MD, Medical director Christine Houde MD, Jean Boulanger

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Bernard t tu md medical director christine houde md jean boulanger

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 Boulanger

Co-chairs, telehealth steering committee,

Laval University

Québec, Canada


Bernard t tu md medical director christine houde md jean boulanger

Canada: 34, 108, 752

Québec: 7, 907, 375


Bernard t tu md medical director christine houde md jean boulanger

1,729,000

408,760 Km2

Integrated University Health Networks


Bernard t tu md medical director christine houde md jean boulanger

Density of population and Distribution of pathologists on the territory

2

7

1

3

30

5


History of the project

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


Telepathology clinical context

Telepathology – clinical context

Surgeon’s perspective

  • Part-time pathologists available:

    • Schedule of operations depends on the presence of a pathologist

    • Difficulty recruiting surgeons


Telepathology clinical context1

Telepathology – clinical context

Surgeon’s perspective

  • 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


Telepathology clinical context2

Telepathology – clinical context

Pathologist’s perspective

  • 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


Telepathology clinical context3

Telepathology – clinical context

Pathologist’s perspective

  • 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


Telepathology clinical context4

Telepathology – clinical context

Reports of Commissions of Inquiry in Canada

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…


Telepathology clinical context5

Telepathology – clinical context

Reports of Commissions of Inquiry in Canada

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.


History of the project1

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


History of the project2

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)


History of the project3

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


Aims of the project

Aims of the project

Main objective

  • Implement an innovative solution to provide uniform pathology services in the whole Laval University Health Network territory


Aims of the project1

Aims of the project

Specific objectives

  • 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


Aims of the project2

Aims of the project

Deployment

  • 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


Slide scanner nanozoomer rs ht

Slide scanner: nanoZoomer RS & HT


Gross station pathstand and videoconferencing sony hd

Gross station (PathStand) and videoconferencing (Sony HD)


Viewer and image sharing solution mscope aurora

Viewer and image sharing solution: mScope, Aurora


Bernard t tu md medical director christine houde md jean boulanger

Simplified schema of network

A

B


Health authorities in eastern quebec

Health Authorities in Eastern Quebec


Expected volume of activities

Expected volume of activities

  • Over 2000 frozen sections and second opinions

  • Over 4000 immunohistochemistries returned by telepathology


Governance of the project

Governance of the project

Electronic medical record, MOH

Telehealth executive committee

Project manager

Medical director

Committee of experts

Management committee

6 health authorities


Committee of experts

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)


Conclusions strengths of the project

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


Future direction

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


Future direction1

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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