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REACTS MAKES TELE-ULTRASOUND EASY AND EFFICIENTCIUSSS DE L’EST-DE-L’ÎLE-DE-MONTRÉAL
Using Reacts, independent technologists at CSSS
de la Pointe-de-l’île can contact radiologists at
Hôpital Maisonneuve-Rosemont in real time to
review and discuss ultrasound exams.
www.reacts.com
Better communication.
Better efficiency.
Better care.
Wait times for an appointment for an abdominal or pelvic ultrasound
considerably exceeded standards for many years in East Montreal.
The main hospitals, including Hôpital Maisonneuve-Rosemont (HMR),
were unable to meet demand for this service within the service times
recommended by the Ministère de la Santé et des Services sociaux
(MSSS).
In December 2014, the MSSS proposed a solution: adding positions
for independent technologists at Hôpital Maisonneuve-Rosemont,
CSSS de la Pointe-de-l’île (PDI), Hôpital Santa Cabrini, and CSSS
du Cœur-de-l’Île. Adding these technologists would increase the
availability of abdominal and pelvic ultrasounds in this area, thus
improving user satisfaction. This project, in line with the Centre de
répartition des demandes de service (CRDS) ultrasound project,
reduced the wait time for an ultrasound appointment from three
years to only a few days.1
What is an autonomous ultrasound practice?
Following requests by the Ordre des technologues en imagerie
médicale, en radio-oncologie et en électrophysiologie médicale
du Québec (OTIMROEPMQ) and the Association des radiologues
du Québec (ARQ), the MSSS introduced a certification process
for an autonomous practice based on recognition of experience.
. . .
CIUSSS DE L’EST-DE-
L’ÎLE-DE-MONTRÉAL2
• Population served: 527 085
• Points of service: 43
• Medical and specialized clinics: 71
• Beds (short-term, long-term,
mental health): 6 354
• Staff: 14 125
• Independent ultrasound
technicians: 6 (variable)
To be autonomous, a technologist must obtain/maintain an
autonomous practice certification subject to conditions that include
experience (determined minimum number of exams per year), external
validation (letter from employer), and a minimum number of hours
of ongoing professional training every year. In his or her day-to-day
practice, the technologist works relatively independently,
and a radiologist verifies the exam when necessary.
Lack of resources and technological constraints
The arrival of autonomous technologists substantially improved
the efficiency of the ultrasound service. But what were autonomous
technologists to do when they needed the opinion of a radiologist
during an exam at institutions without an on-site radiologist, like the
CSSS PDI? In this case, outside radiologists (those at Hôpital Maison-
neuve-Rosemont) needed to review the ultrasound exams.
. . .
• Wait time for an ultrasound
appointment reduced from 3 years to a few days*
• The MSSS introduced a certification
process in 2014; by 2018, there
were approx. 350 certified independent technologists.
• The Reacts platform is certified by the MSSS and endorsed by
the Canadian Medical Association.
*For the frontline clientele of East Montreal
Island, referred by the CRDS and scheduled
based on proximity.
. . .
To work around this constraint, the service thought of having a
compact disc containing the ultrasound exam images delivered to
the medical imaging department at the hospital. This turned out to
be problematic because it meant the images were analyzed well after
the exam was finished and the patient had left the CSSS. If the
radiologist found that more images were required, a second exam
had to be scheduled with the patient to obtain these.
A solution for retransmitting the images through an orchestrating
intermediary was developed by the Montreal Technocentre. This image
routing system was effective for real-time analyses, but ultrasound
videos could not be saved, and there remained the challenge of
connecting two different PACS systems.
To optimize the process, the Réseau universitaire integré de santé
(RUIS) of Université de Montréal subsequently proposed the use of
a videoconferencing system to connect the ultrasound system at the
CSSS PDI to the Radiology Department at Hôpital Maisonneuve-
Rosemont. This allowed the technologist to contact and share a live
ultrasound exam with the hospital’s radiologist in real time.
. . .The clinical need
An efficient way for ultrasound
technologists and radiologists to
consult with each other remotely and
to share high-quality ultrasound
images in both real time and
asynchronously.
The technological needA collaborative solution that is easy
to use, safe, affordable and that can
reliably transmit live ultrasound
images of adequate quality.
. . .
This live transmission of ultrasound exams by videoconferencing,
together with image acquisition protocols specific to each clinical
indication, meant that the autonomous technologists were able
to practise independently and from a wider range of locations.
When necessary, they could contact the assigned radiologist
by videoconferencing in order to review the ultrasound images
in real time.
Adoption of the Reacts platform
This operational model was initially useful and entailed certain benefits.
Nonetheless, a number of impediments arose in short order, making it
hard to deploy, adopt and use remote assistance by videoconferencing
for ultrasound exams. The main challenges concerned the following
points: the high cost of videoconferencing stations and technical
support, mobility issues (i.e., the radiologist had to review the exam
at a fixed station) and most critically, the suboptimal quality of
the images transmitted live by the videoconferencing station was
suboptimal, making it hard for radiologists to interpret them remotely.
Given these limitations, the various stakeholders involved eventually
agreed to retire the tele-ultrasound videoconferencing system; instead,
patients were sent to Hôpital Maisonneuve-Rosemont when additional
images were necessary.
. . .
The solution Use of a secure, flexible,
interactive, collaborative
communication platform
that allows the transmission
of high-quality video streams.
The technological component
The Reacts platform was selected
for its ability to transmit multiple
high-quality video streams
simultaneously and securely, in
addition to offering an interactive set
of collaboration tools, using existing
equipment (computers, standard
Internet connection, web cams, etc.).
. . .
After searching for a technological upgrade solution to relaunch
the tele-ultrasound program, the team at CIUSSS de l’Est-de-l’Île-
de-Montréal heard about the Reacts platform and its ability to
simultaneously and securely transmit multiple video streams, in
addition to affordably providing a series of interactive collaboration
tools that are accessible from existing equipment (computers,
standard Internet connection, web cams, etc.). Because Reacts is
certified by the Ministère de la Santé et des Services sociaux and
supported by the Canadian Medical Association, the platform met
the project’s security requirements.
The Reacts solution allowed a significant reduction of costs and led
to a wider-scale rollout of the tele-ultrasound service that was quick
and easy. The Reacts solution also facilitated optimizing mobility by
allowing radiologists to conduct Reacts tele-ultrasound sessions from
their personal computer, tablet or mobile device. After a few trial
sessions, the team at CIUSSS de l’Est-de-l’Île-de-Montréal decided
to proceed with the implementation of the Reacts solution for their
tele-ultrasound needs.
. . .The benefits
– Allows for rollout of a wide-scale,
high-quality tele-ultrasound service
easily, quickly and affordably with
greater satisfaction among
technologists and radiologists.
– Saving patients a trip for a second
exam and reassuring them by
ensuring that an expert can give his
or her opinion live to optimize the
quality of the ultrasound exam.
“Reacts allows us to provide a high-quality tele-ultrasound service
that is simple and easy to deploy. In addition to being affordable, it
has helped us improve clinician satisfaction and provide better
service.”
-- Janie DeschênesDivision Head, Radiology
HSCO IUSMM et CommunautéCIUSSS de l’Est-de-l’Île-de-Montréal
Hôpital Santa Cabrini
Reintroducing tele-ultrasounds at CSSS PDI yielded direct benefits
for patients, as they no longer had to return for a second exam, and
reassured them because an expert was able to give a live opinion,
thereby optimizing the quality of the exam.
With its many benefits and advantages, use of the Reacts platform for tele-ultrasound will make it possible to roll out this virtual assistance modality in other areas of the province, which will improve the service offering and reduce wait times for an ultrasound appointment.
New program for medical ultrasound technologists
A new college-level program for medical ultrasound technologists will
be offered in Rimouski in the fall of 2018. The program will prepare
students to become ultrasound technologists without first having to
take the radiology technologist program. The introduction of this new
program reflects the recognition by the Ministère de la Santé et des
Services sociaux's recognition there is a growing need for more
ultrasound technologists in order to improve service across the
province. In this context, remote assistance and collaboration between
independent technologists and radiologists through tele-ultrasound
has come into its own and should grow significantly in the near future.
Sources :1) Janie Deschênes, Head of the Radiology Department, Hôpital Santa Cabrini, “La télémédecine au service de l’échographie”, MedActuel, August 2016.
2) Le Centre intégré universitaire de Santé et de Services sociaux de l’Est-de-L’île-de-Montréal, http://ciusss-estmtl.gouv.qc.ca/a-propos/portrait/ .
Reacts (Remote Education, Augmented Communication, Training
and Supervision), is a secure, integrated collaborative platform
created by Quebec-based Innovative Imaging Technologies Inc. (IIT).
It was designed to suit the multiple collaborative needs of healthcare
professionals and patients, and incorporates unique and unparalleled
interactive features, such as augmented reality for remote virtual
guidance, supervision and training.
Reacts is presently being used in over 80 countries, across
various medical disciplines in both clinical and educational
settings, for applications ranging from secure messaging, remote
wound care, tele-ultrasound, and teleconsultations, to interactive
tele-surgical assistance and remote procedural supervision. Strategic
partnerships include medical device manufacturers and healthcare
innovation focused organizations. For more information,
visit: www.reacts.com .
About Reacts
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