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 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 project;

Québec: 7, 907, 375


Bernard t tu md medical director christine houde md jean boulanger

1,729,000 project;

408,760 Km2

Integrated University Health Networks



History of the project
History of the project the territory

  • 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 the territory

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 the territory

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 the territory

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 the territory

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 the territory

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 the territory

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 the territory

  • 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 the territory

  • 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 the territory

  • 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 the territory

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 the territory

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 the territory

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





Bernard t tu md medical director christine houde md jean boulanger

Simplified schema of network the territory

A

B



Expected volume of activities
Expected volume of activities the territory

  • Over 2000 frozen sections and second opinions

  • Over 4000 immunohistochemistries returned by telepathology


Governance of the project
Governance of the project the territory

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 the territory

  • 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 the territory

  • 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 the territory

  • 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 the territory

  • 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