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
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
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
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
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
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)
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.
Gynaecology MCN Pilot
• 300 patient referrals / year
• BOC with 5 DGHs across
west of Scotland
• Oncologists, gynaecologists,
pathologists, surgeons,
radiology, nursing,
radiography, clinical trials
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
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
MCN VC Meetings
Video Conference Activity
50
Audit Staff
40
Technical
30
Clinical Trials Staff
Nursing
20
Medical
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No. of Staff
60
Calendar Month
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
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
 E-mail communication of summary data
 Conference management tools to anonymise patient
identity during VC meetings; all network communication over
NHSNet / HealthNet Community (secure network)
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 e-mailed to clinical staff after MCN
session for patient follow-up

Data captured consistent with MCN (SIGN) guidelines
for future audit purposes

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)
 Radiology images (CT, MRI)
 Key Radiotherapy treatment data (VARiS)
 Key Chemotherapy treatment data (ChemoCare)

MCN
dependent
CIIMS end of Phase 3
NORTH GLASGOW
TRUST
Glasgow North
HOMER PAS
CROSSHOUSE
HOSPITAL
Excelicare
Client PC
TELEPATH
COMPAS PAS
REVIVE LABS / RAD
CT SCANNER STORE
Crosshouse Firewall
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VARIS RT
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Exceliport
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Excelicare
Client PC
SCI PAS, LABS, RAD
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Excelicare
Data Store
Server
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Inverclyde Firewall
FORTH VALLEY
TRUST
Com
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Excelicare
Client PC
SCI PAS, LABS, RAD
North Glasgow Firewall
Falkirk
Forth Valley Firewall
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mm
Excelicare
Client PC
Excelicare
Client PC
LANARKSHIRE
TRUST
Excelicare
Client PC
Glasgow Royal
Excelicare
Client PC
Beatson Oncology
Centre
Hairmyres
Excelicare
Client PC
Stobhill
SCI PAS, LABS, RAD
PACS STORE
Wishaw
Lanarkshire Firewall
Courtesy of AxSys Technology Ltd
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
Technical Challenges
Data Quality
 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

Clinical Challenges
Standardisation
 Variation in Pathology testing regimes

Differences in radiology acquisition & reporting
 Coding & nomenclature
Cultural change
 Acceptance of new technology
 Process changes
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?
Questions?