The Picture Archiving and Communication System (PACS) is a computerized system for the storage, retrieval and display of diagnostic images in a networked environment. PACS provides remote access to patient images and radiology report information, to authorized users, no matter where they are located in the province.

PACS works with diagnostic imaging devices (X-ray, CT scanner, MRI, and ultrasound) to capture images in a digital format. Images can be stored, archived and shared over a secure computer network. This eliminates the need for traditional film.

PACS joins the Pharmaceutical Information Program (PIP) as the first components of a provincial electronic health record. The Electronic Health Record is important because we need to do more than just collect patient medical information and store it in various file cabinets throughout the province. We need the ability to integrate key patient medical information and to have it readily available to authorized health care providers. We have to be able to manage the data and transmit it securely to the place where health care decisions are being made.

PACS will benefit patients and health care providers in these ways:

• improved secure access to diagnostic imaging services in rural areas;
• shorter wait times for patients in physicians' offices;
• authorized family physicians will be able to access diagnostic images online at any time and from any location, which will mean faster results and treatment for their patients;
• access to specialist consultations will improve due to secure electronic images stored in the PACS, allowing both the clinician and the referring radiologist to review the same images at the same time;
• a reduction in unnecessary patient transfers due to the ability to transfer the diagnostic image for assessment prior to transferring the patient;
• a reduction in unnecessary repeat diagnostic exams due to a previous study not being immediately available;
• repeat diagnostic imaging exams and some patient transfers will be prevented by being able to take and read images in one location and have them reviewed by a physician in another;
• decreased test-to-results waiting times - results will be available at the time that the image is stored in PACS;
• no need to physically transport films between locations, whether in the same facility or across the region or province;
• authorized medical staff will have secure access to PACS and the patients' complete digital imaging history, including reports giving a more complete patient history upon which to base patient care decisions.
  

Increased access - PACS will provide physicians across regions and across the province with electronic access to patient images, providing rural patients with access similar to that of urban dwellers. Additionally, the need for patients to travel for a health care consultation will be significantly reduced. Improved turnaround times for examination results will allow for faster diagnosis and medical decision-making, meaning faster treatment.

Retaining and attracting health professionals - Health care providers in training expect to work with the most recent medical technology on which they are training. State of the art systems will attract and keep more health care providers. The supply of radiology professionals is already a concern, especially in smaller cities and rural areas.

Improved job satisfaction for health care providers - PACS will create improved opportunities for continuous learning and development for radiologists, technologists and referring physicians. The systems will enhance planned recruitment for radiologists and technologists and contribute to better retention of current physicians and technologists.

Improved workplace safety for health care providers - PACS will eliminate the requirement for some harmful chemicals and radiation as facilities that currently develop film, go filmless.

Other workplace improvements for health care providers - PACS will improve workflow, offer enhanced efficiency and provide the most modern technology to support health care.

Integration with Electronic Health Record (EHR) initiatives - PACS will integrate with components of the EHR as they become available, ultimately providing access to a more complete electronic health record for all authorized health care providers. PACS will integrate with existing hospital information systems.

• Reduce dependence on conventional photographic film technology and hardcopy storage by 90 per cent by 2010.
• Improve operational efficiency of diagnostic imaging by 20 per cent by 2010.
• Achieve 80 per cent availability of online diagnostic images/reports by 2010.
• Integrate diagnostic imaging with current Electronic Health Record initiatives by 2010.
• Provide more effective clinical diagnostic imaging services throughout the province through appropriate use of 80 per cent digital technology by 2010.
  

Prior to PACS, all X-rays images were developed on film and printed. A radiologist would examine the film and prepare a paper report that would become part of the patient's file. The film would be mailed or couriered to the patient's physician and a paper record kept in various locations such as a hospital, doctor's office or clinic. In the past, doctors in these locations may not have known about the patient's current records and images. As a result, they may have had incomplete information or requested duplicate tests. Health care practitioners would have to phone, fax, or mail information to each other, which could be time consuming and result in delays in treatment. PACS will help to ensure that authorized health care providers have the information needed to make the best decisions about their health care.

• Traditional Film - regular x-ray machine
• Computed Radiography (CR) is a technology that uses charged phosphorous plates instead of traditional film for existing X-ray machines. The image is captured on the plate and run through a reader that takes the information from the plate and converts it into a digital image that is stored on the PACS. This technology allows facilities to go digital without replacing the X-ray machines.
• Digital Radiography (DR) is a replacement for a traditional X-ray machine. Images
  (X-rays) are captured directly during the exam and sent directly to the PACS. This technology is more expensive than CR technology; however, it is much more efficient. In Saskatchewan, DR facilities are located in Regina and Saskatoon.
  

PACS will eliminate the need for traditional film, film related supplies, processing and storage space. Filmless imaging enables the authorized health care providers to:

• acquire and convert to diagnostic images in a digital format and to store these images electronically on a server for future retrieval;
• view images on a computer monitor or workstation within the healthcare facility or remotely from home or office via a secure remote network connection; and
• securely transmit images within a hospital/clinic site or to other sites for access by limited authorized users.
  

The importance of PACS is its role in improving patient care and ensuring that technology is used to create better, safer, faster and more secure health care for the province.

In addition to patient care enhancements, workflow improvements and operational efficiencies will lead to better use of existing resources, resulting in increased capacity and throughput in the near future. Reduced costs from eliminating film processing alone will amount to over $3 million annually. In addition, sites such as the new Cypress Health Regional Hospital in Swift Current do not have large areas devoted to processing and storing traditional film and film related supplies.

By securely linking patient data across regions, and by exchanging patient images to take better advantage of limited specialist resources in other areas, the need for patients to travel or be transferred for a health care consultation is significantly reduced.

Patients will also benefit from improved turnaround times for examination results. This promotes faster diagnosis and medical decision-making, which in turn leads to accelerated treatment startup, potentially reducing the long-term cost of care.

This new system links to a new diagnostic imaging schedule that will improve the management of diagnostic wait times and ensure the most effective use of radiology equipment.

Referring clinicians will be able to securely review patient images stored in the PACS on computers anywhere in the province. Patients will eventually experience shorter wait times as the system becomes more efficient.

The total cost of implementing PACS provincially is estimated at $35 million. Canada Health Infoway is contributing $11.4 million for phases one and two. The provincial government and the health regions will monitor the implementations for these phases and base future investments on progress.

In Cypress Health Region the cost is $567,000; just over half a million dollars. $337,000 (for the provincial component) and $230,000 from the Cypress Health Region (workstations and legal costs).

It is estimated that the $3M annually in savings from reduced and eliminated costs associated with processing and handling traditional diagnostic imaging films will offset implementation costs.

Services typically performed in diagnostic imaging departments will be part of the PACS Project including: general X-ray; ultrasound; computed tomography (CTs); magnetic resonance imaging (MRIs); nuclear medicine; bone density; lithotripsy (non-invasive treatment of kidney stones and stones in the gallbladder or in the liver); angio/interventional (use of x-rays and contrast dyes to diagnose). In the future, diagnostic mammography will also be included in some locations, for example Regina's Pasqua Hospital.

Over the next few years more components of an Electronic Health Record for Saskatchewan will be introduced. PACS will ultimately integrate with other electronic systems containing patient information, as they are developed, (such as prescription drug information and lab results) to provide clinicians with the information they need to plan safe and effective care for their patients.

PACS was implemented in the three provincial hospitals located in Saskatoon in October 2007, and in Cypress Regional Hospital in March 2008.

The next phase, scheduled in 2008, will include the remaining five regional hospitals (Yorkton, Moose Jaw, North Battleford, Lloydminster and Prince Albert) and the provincial hospitals in Regina. These hospitals, together with private radiology clinics, account for the majority of medical imaging within the province.

Private radiology clinics are currently not included in implementation. Planning for the provincial PACS has, however, allowed for the future inclusion of private radiology clinics. Authorized radiologists will, however, have secure access via the web to films and reports stored in the provincial PACS that were captured from health region imaging equipment.

Yes. All diagnostic images will be stored within a secure central repository managed by the health region with the support of the Ministry of Health. Access is limited to authorized health care providers, and all necessary provincial privacy and security requirements will be followed in the management and use of personal health information.

The Ministry of Health has strictly controlled and limited access to PACS and all other components of the EHR.

To identify digital images, the following information is collected:

• Registration information such as name, address, phone number, date of birth, and health services number and medical records number.
• Information about the type of diagnostic imaging exam requested by the physician and your physician's name.
  

Your personal health information is confidential and the regional health authorities (RHAs) and the Ministry of Health take great care to protect personal health information. Information is kept in strict confidence and is used or disclosed as authorized or required by law. Privacy safeguards outlined in The Health Information Protection Act (HIPA) apply to the PACS.

Safeguards are in place to ensure only health professionals involved in your care access your personal health information in PACS:

• All health care providers are made aware of their responsibilities and agree to maintain the confidentiality of information and use it only on a need-to-know basis.
• All access to PACS data is tracked and recorded for audit purposes. You can request a printout of who has accessed your information in PACS.
• Patients are able to globally mask their PACS record.

Strict security safeguards are also in place. Policies, practices and computer systems are designed to protect your information from unauthorized use, error and loss. User access is restricted to only authorized health care professionals. High-quality network security is in place, and all electronic messages are encrypted. Each health region is the trustee of, and is responsible for, the images created within the region.

The Centralized Privacy Service is managed by a limited number of staff at the Ministry of Health whose role it is to provide a service to patients/clients to provide them with information about the privacy protections offered in the PACS system and to provide patients with the opportunity to mask or unmask their information if they so choose. Central Privacy Service staff are prevented from seeing any diagnostic imaging information.

Specifically, the PACS Centralized Privacy Service supports patients/clients in Saskatchewan by:

• Providing answers to common questions about the RIS/PACS Project;
• Developing and maintaining a website and other communications materials relating to the RIS/PACS Project (e.g., patient/client brochure);
• Providing global masking and unmasking of one's PACS record;
  Offering individuals, upon request, a report detailing who has accessed their record in the PACS application; and
• Referring the individual/ the individual's inquiry to the appropriate trustee (e.g., privacy complaints, access requests).
  

Strict security safeguards are in place. Policies, practices and computer systems are designed to protect your information from unauthorized use, error and loss. Each health region is the trustee of, and is responsible for, the images created within the region.

In the event that something inappropriate happens, the Ministry of Health, RHAs and the Saskatchewan Cancer Agency (SCA) have policies and procedures in place to manage breaches of privacy. A provincial privacy group made up of representatives of the Ministry of Health, RHAs, and the SCA has developed general guidelines for the management of privacy breaches. These guidelines indicate that all breaches are to be quickly contained and patient's whose information has been put in jeopardy are to be notified of the incident. Incidents are investigated and action to prevent or reduce the likelihood of a recurrence is subsequently put into place. Privacy Officers in each health region, the cancer agency and at the Ministry of Health are available to patients who have concerns about the privacy and confidentiality of their information.

If a facility loses computer hardware through theft, fire or another circumstance, there is no security risk to the information in PACS. The actual data is not stored on local computer equipment.

All patient diagnostic imaging information in PACS is stored in a secure central repository managed by the health region supported by the Ministry of Health, so that only authorized users can look at the information and/or print a copy of the information for their files.

The database is well protected by using best practice technical, administrative and physical safeguards, which ensures only authorized users who have a need to know may access the centrally stored system.

Policies and practices for users and administrators are also in place to ensure that personal health information is protected.

While there are many benefits to PACS, we recognize that some people may not be comfortable with the electronic sharing of their personal health information between authorized health care providers. Saskatchewan residents may choose a masking option (request that diagnostic imaging information be masked and made unavailable for view). Individuals who choose this option should call the Centralized Privacy Service at 1-800-667-1672 for more information. You can ask to have a masking form sent to you by mail or click on the Request to Mask Form below. Once you complete the form, sign it and return it to the Chief Access and Privacy Officer, Centralized Privacy Service at the Ministry of Health, your PACS records will be masked until you advise otherwise.

When authorized health care professionals log into the PACS application and select a masked record, they will be prevented from seeing any diagnostic imaging information, except in these circumstances:

• With consent: At any time, you may give your health care provider (such as your physician) consent to view your flagged information. This authorization can be time-limited (such as a specified number of days or months) or indefinite.
• In an emergency, when a person is unable to provide consent: This would allow a health care provider to access the history in an emergency, such as if a person is unconscious or unable to provide consent due to illness. The information could be life-saving in these circumstances.
• When an authorized radiologist requires access to report on a procedure.
• When an authorized technologist requires access in order to complete a procedure.
  

If you have concerns regarding your personal health information, or its use, talk to your healthcare provider. If you still have concerns, talk to the appropriate supervisor or manager responsible for radiology services within your RHA. If you wish to register a formal complaint regarding a privacy issue, you are encouraged to contact your RHA's Privacy Officer.

If the RHA is unable to resolve your complaint or concern to your satisfaction, you may contact the Saskatchewan Information and Privacy Commissioner. This provincial office oversees The Health Information Protection Act (HIPA) in Saskatchewan. The Saskatchewan Information and Privacy Commissioner can be contacted at:

Saskatchewan Information and Privacy Commissioner
503-1801 Hamilton Street
Regina, Saskatchewan,
S4P 4B4
Phone: (306) 787-8350, or toll free (within Saskatchewan) at 1-877-748-2298
Fax: (306) 798-1603
Email: webmaster@oipc.sk.ca

Yes. If, in your health care provider's professional opinion, a particular course of treatment cannot be recommended because all the patient history information cannot be accessed, your health care provider may refuse to provide or recommend treatment.

You can give your health care provider consent to view your diagnostic imaging information for a limited time. This would still ensure that your record remained masked and unavailable to other users.

Individuals may provide consent to an authorized health care professional to view their masked PACS information. In addition, if choosing to unmask your diagnostic images and reports for a longer period of time, please click the form Request to Unmask below or phone 1-800-667-1672 and ask that your diagnostic images and reports be unmasked to give access to authorized health care providers. You will receive a form to sign and return to the Chief Access and Privacy Officer, Centralized Privacy Service at the Ministry of Health. Once your request has been received and processed, your PACS records will be available for authorized health care providers to access as needed.

Yes. Individuals may request a report of who has accessed their PACS information. Please click on the form Request for Report on Diagnostic Imaging Record Access below or phone 1-800-667-1672 and request a form to sign from Saskatchewan Health. Once your request has been received and processed, a report will be sent to you by return mail, marked "PRIVATE & CONFIDENTIAL".