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Medical Imaging Strategic Plan 2014 – 2025

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Medical Imaging Strategic Plan 2014 – 2025 Medical Imaging Strategic Plan 2014 – 2025 Prepared by: June 3rd, 2014 Medical Imaging Strategic Plan 2014 Strategic Planning Framework MANDATE To provide a strategic plan for Medical Imaging to 2025, to aid in equipment planning, service provision planning, and to prepare Northern Health for the challenges of tomorrow. GUIDING PRINCIPLES Medical Imaging Services in Northern Health: Will be innovative in meeting the challenges of service delivery in the North. Will be inclusive in the planning stage to inform and support decision making. Will be aligned with the over-all services offered by the facility and with HSDA planning of services. Will be accessible and provided appropriately based on facility service levels. Will demonstrate value to the public health system through strategies to reduce capital and operational costs on medical imaging equipment. Will make decisions on equipment placement and operation that demonstrate acceptable return on investment. Will seek to maximize equipment utilization through adopting benchmarked throughput targets. Will uphold and practice quality in daily activities, and regards quality as foundational to service provision planning. Will provide services that are accredited by the Diagnostic Accreditation Program of BC. DISCLAIMER This report was prepared by INSITE Consultancy Inc. for Northern Health Authority. All reasonable care has been taken by Northern Health and INSITE Consultancy Inc. to achieve accuracy of this document, but accuracy cannot be guaranteed. By proceeding to the information beyond this notice, each reader waives and releases Northern Health and INSITE Consultancy Inc. to the full extent permitted by law from any and all claims related to the usage of material or information made available. In no event shall Northern Health or INSITE Consultancy Inc. be liable for any incidental or consequential damages resulting from the use of this material. Copyright © Northern Health 2014. All rights reserved. www.insiteconsultancy.com 14564 18A Avenue. Surrey. V4A 8A4 (604) 484-2160 Prepared by INSITE Consultancy Inc. 2014 Page 1 Medical Imaging Strategic Plan 2014 Executive Summary The Medical Imaging Strategic Plan 2014 – 2025 is a critical review of current and future state for Medical Imaging (MI) services across Northern Health (NH) over the next 10 years. It is the result of a comprehensive consultation process and detailed analytical study of the current and future demand for services. The most important challenges and priorities for the future are summarized in the Key Findings and Strategic Priorities, with additional information provided in the following sections and throughout the Strategic Plan. KEY FINDINGS WORKLOAD: NH provided over 293,000 exams across more than two dozen facilities in 2012/13. Population is expected to grow 15% by 2020 (driven by LNG projects), but workload projections estimate a 25% to 28% increase in exam volume for the same period, as growth compounds with an aging population. ACCESS: Rural communities with sparse populations have difficult access to MI services, yet insufficient demand to support the permanent implementation of local services. Alternative service delivery models should be explored, especially for: MRI, CT, Bone Densitometry, Digital Mammography and Ultrasound. EQUIPMENT: MI services has $47m of equipment assets deployed, yet the replacement process is not centrally coordinated and not consistently evaluated through a business case process. This leads to an automated process of assumed equipment requirements and investment, which in some cases results in expensive assets being significantly underutilized (Bone Densitometry and CT scanners). INFORMATION TECHNOLOGY: A provincial initiative now underway presents opportunities for NH to participate in provincial sharing of medical images and reports. With a surprising number of cases that are either imports or exports from NH, patients will benefit from continuity of care. SERVICE PRESSURE POINTS: MRI: This is clearly the most pressing need in the Northeast and Northwest regions. The detailed analysis performed through this work confirmed the findings of the MRI business case (May 2013) and further recommends that specific MRI service locations be constantly reviewed as demand rises. Ultrasound: This is consistently reported by stakeholders as the second most significant gap in service for the most rural communities. Trained staff shortages are the greatest constraint to address this gap. Breast Health: Digital Mammography and the Provincial Breast Health strategy present a financial challenge to NH. It is expensive and the proposed deployment model by SMPBC will lead to 3 static units and 1 mobile unit, which are projected to be underutilized. However, breast screening participation rates are known to be related to access, and low participation is linked to late detection of breast cancer. The development of breast health centers of excellent is an opportunity for NH and is supported by strong evidence to be highly effective. Improvements in service are mainly due to process re-design and lead to a very large reduction in the time to diagnosis of suspicious breast cases. STRATEGIC PRIORITIES Implement cross-education of staff on multiple modalities to address human resource shortage and critical mass issues, particularly in smaller and more remote communities. Expand and create new rotating and mobile services to improve access in small communities with insufficient demand to safely support a full service locally. Develop a patient centric model to allow users more control and flexibility on the choice of location to receive service, based on available capacity and wait times. Achieve high equipment utilization through improved capital planning and operating models. Prepared by INSITE Consultancy Inc. 2014 Page i Medical Imaging Strategic Plan 2014 CONTEXT Northern Health (NH) provides health services to more than 300,000 people over an area of 600,000 square kilometers. Services include acute care, mental health and addictions, public health, and home and community care. Within these services, Medical Imaging (MI) is an important support service to other core clinical specialties. MI comprises eight different modalities: Radiology and Fluoroscopy, Interventional Radiology, Ultrasound, Bone Density, Nuclear Medicine, Mammography, Computerized Tomography and Magnetic Resonance Imaging. Similar to the rest of BC, and Canada in general, the population of NH is growing and aging. The compounded effect of these two factors is additional demand for services. In addition, the recently announced Liquefied Natural Gas (LNG) Strategy is expected to attract a large workforce to areas of NH, further increasing demand into the future. Given the extent and complexity of MI service delivery, and considering the anticipated growth and aging of NH’s population, it became imperative to look into the future, estimate future demand, and develop service models that efficiently meet the needs of the population. The MI Strategic Plan 2014 – 2025 looks at the next 10 years and makes projections for the future demand and recommendations for capacity replacement. The evolving nature of the population and service delivery means that multiple factors will continue to change and therefore this strategic planning exercise should be revised on a periodic basis to evaluate current progress and incorporate new planning considerations. METHODOLOGY This plan involved a comprehensive consultation process and analytical study. The engagement and planning process comprised several face-to-face meetings with NH staff, consultation with experts in the field, and a planning workshop with over 30 participants from different regions and areas of work in NH. The analytical study was based on record-level data from the Cerner Hospital Information System and official population projections from BC Stats (adjusted for LNG workforce increase). Utilization rates for each service were calculated at the population level for each Local Health Areas (LHA) in NH, using age and gender groups to better capture the aging effect in the population. Referral patterns depicting the sites where residents of each LHA go to receive services were determined. Access to services was also estimated using driving distance to the closest service location from each LHA. Detailed demand projections were estimated using current utilization rates over the future population, and referral patterns used to distribute demand over the different sites. Two projection scenarios were developed: 1) Baseline, consisting only of current utilization rates and future population, and 2) Adjusted, involving additional service-specific assumptions developed during the consultation process. To assist the planning process, two decision support tools were developed: the “Access Tool”, and the “Capital Equipment Planning Tool”. These are Excel-based applications with automated calculation routines, reports and charts. They allow the user to alter the present state parameters as equipment or services are developed or removed, and create scenarios to support decision-making. PRESENT STATE AND WORKLOAD PROJECTIONS Utilization of MI services across NH varies significantly. The Northern Interior region generally shows high utilization rates across all services, while the Northeast has the lowest. This is in part due to the more limited access to services in the Northeast, resulting in some people accessing services outside NH. Of special attention is MRI services.
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