1. GD Currie, P Campbell, GF Brunton Beatson Oncology Centre
Development of Telemedicine-Based Managed Clinical Networks for Gynaecological Cancer in the West of Scotland
GD Currie, P Campbell, GF Brunton
Beatson Oncology Centre
North Glasgow University Hospitals NHS Trust

2. Background Beatson Oncology Centre
Largest cancer centre in Scotland providing tertiary cancer care services to 2.7 m population across west of Scotland
radiotherapy & chemotherapy services
site specific cancer teams
clinical trials unit
radiobiology research unit

3. Issues in Cancer Care Poor outcomes in cancer care
Shortage of oncologists
Specialists moving between clinics
Requirement for multidisciplinary decision making process
Communication between primary, secondary care
Tumour site specialisation

4. Managed Clinical Networks
“Linked groups of health professionals and organisations from primary, secondary and tertiary care working in a coordinated manner unconstrained by existing professional and Health Board boundaries to ensure the equitable provision of high quality clinically effective services throughout Scotland” MEL(1999)10
- prospective audit
- deliver requirements of Clinical Standard Board for Scotland with evidence based (SIGN) guidelines
- plan for service redesign and improve the patient journey

5. MCN Core Principles - Robust data collection system
- Discussion time to develop evidence based guidelines
- Effective communication links
- Strategic planning to influence redesign of service
- Facilitate educational and research activities
- Demonstrate improvements as a result of an effective network

6. How Could Technology Help?
Gynaecology Managed Clinical Network chosen to pilot the application of modern information technology and networked information systems to support the oncology MCN’s in the West of Scotland
Pilot funded by Scottish Executive’s Scottish Telemedicine Action Forum
(Aug 2000 – Aug 2003)

7. Project Aims and Objectives
Establish ‘virtual’ clinical meeting rooms using video conferencing.
Provide a secure clinical information system to describe the patient journey - electronic episode record of care.
Provide a core repository for essential clinical information and medical images, making available all relevant information for MCN decision making process
Assist with establishment of robust data sets & facilitate audit processes
Provide means of informing primary, secondary and tertiary care teams of ongoing cancer care.

8. Gynaecology MCN Pilot 300 patient referrals / year
BOC with 5 DGHs across west of Scotland
Oncologists, gynaecologists, pathologists, surgeons, radiology, nursing, radiography, clinical trials

9. Project Phasing 1. Videoconferencing Implementation
Establish a virtual MCN meeting room
Share pathology, radiology images across VC system
Record MCN decisions using existing Access database - limited visibility to VC participants
2. Clinical Information & Image Management System (CIIMS) Implementation

10. Videoconferencing System
Nov 01 – Feb 02
Sony VC units installed at five MCN sites
Communication using BT ISDN-6 lines
Sep 2002
Accord Multi Conferencing Bridge
6 x ISDN-6 (384 kbps) + 6 x IP
Mixed ISDN / IP Network
Full IP within Glasgow sites

11. MCN VC Meetings

13. CIIMS Requirement Specification
MCN Episode of Care Record
Electronic record of the decision on future care management for each patient as decided by MCN participants (diagnosis, surgery, treatment).
Support the management & organisation of the conference and record who attended.
Provide a central repository of collated data and images to help the MCN determine the optimum care pathway.
Patient Care Summary
Data collection tool and audit system

14. MCN ExceliCare System
Wide area networked system with central SQL database
Electronic interfaces built to deliver automatic update of demographics, key labs data, radiological images, pathology images
Reporting and audit tools
communication of summary data
Conference management tools to anonymise patient identity during VC meetings; all network communication over NHSNet / HealthNet Community (secure network)

15. CIIMS Implementation
Small number of pilot systems (15-20 clients installed across WoS initially)
Data forms agreed and security permissions applied
Manual data entry (registration, conference lists, special forms)
CIIMS screens dynamically pushed to all participants during VC sessions using NetOp software across NHSNet
Summary reports ed to clinical staff after MCN session for patient follow-up
Data captured consistent with MCN (SIGN) guidelines for future audit purposes

16. CIIMS Electronic Interfaces
Interfaces developed with ‘automated’ transfer of data & images into ExceliCare
Demographics (iSoft, COMPAS, SCI)
Key Laboratory data (Telepath, Revive, SCI)
Pathology images (microscopy, e-mscope)
MCN
dependent
Radiology images (CT, MRI)
Key Radiotherapy treatment data (VARiS)
Key Chemotherapy treatment data (ChemoCare)

17. Courtesy of AxSys Technology Ltd
CIIMS end of Phase 3
Courtesy of AxSys Technology Ltd

18. ExceliCare MCN – How does it work
Pre Conference
Secretarial / admin staff prepare case record
Patient registered to MCN, supporting data ‘pulled’
Patient entered onto Conference List
Selected images chosen by specialists for meeting
During Conference
Application locked in a Conference Mode
Record reviewed & updated during discussion
Summary available for distribution

23. Technical Challenges Data Quality Image capture
Identifying the correct patient (CHI)
Data matching via interfaces requires high accuracy
Bespoke interfaces due to limitations of connecting systems
Image capture
Imaging units visible on LAN / WANs?
Requirements for adequate bandwidth
DICOM connectivity / compliance

24. Clinical Challenges Standardisation
Variation in Pathology testing regimes
Differences in radiology acquisition & reporting
Coding & nomenclature
Cultural change
Acceptance of new technology
Process changes

25. Benefits in Patient Care
Earlier case discussion with specialist input
Educational opportunities for MDT teams
Reduced professional isolation
Higher quality data set leading to improved audit
Rollout to other MCNs with steps towards a Scottish cancer EPR?

26. Questions?