The PACS/DI-r Pre-Fetch Project

London Health Sciences Centre (LHSC) and London X-ray Associates (LXA) are separate organizations that have a common goal of serving the needs of patient care in the London and area community from the perspective of Diagnostic Imaging (x-ray, ultrasounds, etc.). It is an interesting partnership, as organizations represent both private and public sectors. 

Due to challenges within the DI Department at LHSC, including room closures for renovations, increase in exam volumes/patient referrals, and ongoing overall hospital budget cuts, the volume of Ortho patients requiring x-rays were significantly increasing and patients were frustrated with the long wait times.  At times, patients were required to return the next day to have an x-ray taken! The project team documented challenges such as:

  • Orthopedic staff were utilizing the DI-r to view images, and utilizing the PACS system to obtain current images for the same patient (i.e. frustration and time wasted obtaining information from multiple sources)
  • Gaps recognized in the IT interface between the outside facility and LHSC
  • Patients were required to have x-rays repeated again during LHSC surgical consult. (Potential unnecessary radiation exposure)
  • Significant pressure placed on LHSC Radiology (approximately 2,000 new referrals per year)
  • Patient experience diminished due to the delays and significant wait times
  • Efficiencies of Orthopedic Clinic is reduced as Physicians were required to wait for patients to return from x-ray, thus causing further delay

LHSC and LXA teams met and agreed to pilot a project that would see to these patients obtaining timely x-rays.  After a process mapping by the Clinical Informatics team, a change in the workflow process was then implemented by the use of a new electronic referral and scheduling system.  These new systems allowed for the patient to obtain their X-ray at LXA, and then return to LHSC for a follow-up visit.

Although this sounded like the perfect solution to resolve these issues, more challenges came from “behind-the-scenes” IT systems functionalities. Diagnostic images are currently being created from 2 separate Picture Archiving and Communication Systems (PACS). LHSC is the host to the Southwestern Ontario Diagnostic imaging repository (  All hospitals and several clinics within LHINS 1-4 (including LXA) store a copy of their images for sharing.

The PACS/DI-r and Interface teams under the ITS portfolio at LHSC, had to figure out a solution that would assist the LHSC Orthopedic team in obtaining these images immediately into their existing PACS system , and therefore providing timely surgical planning and follow up for the patient……The deliverables for these images included in the scope were:

  • Pre and Post-surgical pelvic and hip general radiology
  • Pre and Post-surgical knee general radiology
  • Long length imaging systems
  • Specialized markers

By having the images arrive in advance of the follow up visit, gives the Clinical team immediate access to make informed, quality decisions.

In the Fall of 2016, saw the implementation of the new solution that combined existing software enhancements that addressed increased functionalities; better workflow by a seamless process; faster care; collaborative partnerships between public and private sectors, and increased patient satisfaction at no additional capital costs.  It was a proud moment to see individuals from various organizations, departments and teams come together to create a solution.  Using input from patients also allowed this work to become even more successful!

Since the implementation of this pilot project, other initiatives of a similar nature are being reviewed to understand if these diagnostic images available in the DI-r can be pre-fetched for other Clinicians into their local PACS to aid decision making and treatment in Emergency Room, Trauma and Cancer Care scenarios. Many other clinical uses will benefit in the future from this new “DI pre-fetching configuration”.

Testimonial from Orthopedic Patient:  “Going to LXA was definitely worth the experience and I would highly recommend it to others.  I went to my appointment that was pre-scheduled for me, at a clinic that was in Byron and close by to my home; I didn’t have to pay for parking as it was free; I hardly waited in the clinic (about 10 minutes) to have my x-rays taken and then I was finished and able to go home.  The most significant difference with going to LHSC is how long I would have to wait.  The parking costs are high and I have to navigate my way around the large hospital, which is not easy for me to do.”