Inside the April 2001 print edition of
Canadian Healthcare Technology:
Feature Report: Wireless technology and healthcare
Wireless can improve hospital efficiency and enhance patient safety,
but only after precautions are taken.
sends medical-device data to charts
Toronto East General Hospital has implemented one of the first systems
in Canada that automatically loads data from medical devices into electronic patient
READ THE STORY ONLINE
Ontario resurrects its Smart System for Health
The Ontario government has revived its Smart Systems for Health
project, which aims to electronically connect healthcare providers and patients throughout
READ THE STORY ONLINE
Parents monitor babies
Using a new system called Baby CareLink, parents at home are able to
keep an eye on their premature infants when the undersized babies are kept in hospital.
The telehealth technology makes use of the Internet.
READ THE STORY ONLINE
MediSolution in PACS arena
MediSolution Ltd. of Montreal, known for its patient record and
administrative software, has broadened its offerings with the purchase of MarkCare, a
developer of PACS software for diagnostic imaging.
Ready for Bluetooth?
I.T. market research company Gartner Group predicts that Bluetooth will
become a major form of wireless data transmission by the year 2005. Slow speeds currently
hinder the transfer of some data, but work is afoot to greatly improve the speeds of this
Display tech improvements
Prices are dropping for flat-panel displays using LCD technology. This
technology offers advantages the monitors take up less space, generate less heat
and electromagnetic interference. But until now, theyve been pricey. Meanwhile,
traditional CRTs have improved.
PLUS news stories, analysis, and features and more.
New wireless systems speed up access to clinical information and boost patient care
By Andy Shaw
Bullfrogs and Mount Royal (in the heart of Montreal) probably
arent the first things that spring to mind when someone mentions the phrase
wireless medical technology. But for Dr. Bernard Segal, theres a
Now the countrys leading expert on the effects of
electro-magnetic interference (EMI) on medical equipment, the McGill University professor
began work on a PhD in neurophysiology by studying balance and dizziness in bullfrogs.
Graduating to cats and then humans, he became expert in shielding his equilibrium
measuring instruments from ground waves and other electronic distortions. As he also held
a masters degree in biomedical engineering, it wasnt long before he was
getting calls seeking advice on similar interference problems from local Montreal
A city with a central mountain is a good place to put up an
aerial, and its also a good place to put a hospital, so that patients have a nice
view, says Dr. Segal. Both factors help explain why the cluster of medical
institutions around Mount Royal were among wireless medical technologys earliest
Since his student days, Dr. Segal has gone on to form the McGill
Biomedical Engineering Group on Electro-magnetic Compatibility. Members include, among
others, the heads of biomedical engineering in five Montreal teaching hospitals, several
engineering professors, a lawyer, and even, Dr. Segal admits, a physician. Recognized by
the Canadian Wireless Technology Association for its expertise, the group researches EMI,
educates, and sets guidelines for bringing wireless technology into the healthcare world
Because hospitals work in a mobile fashion, there is no question
that hospitals NEED wireless technology and you can write the word NEED in bold
flashing letters, says Dr. Segal. The business community recognized some time
ago that if it didnt adopt information technology it would go bankrupt. The medical
community needs to do the same thing, or our healthcare may well go bankrupt.
And no form of technology is better suited to the hurly-burly of
hospital life than cord-free devices. Its not just a matter of efficiency but
there are medical errors that can only be prevented by wireless technology, and I
dont think most people realize that.
Dr. Segal cites the prescription of drugs as an example.
Its a very long chain of events and those events take place
not just at the nursing stations, but by the patients bedside, in the halls, in the
pharmacy, and all over the place. If those events are not monitored every step of the way,
there is a very real chance for medical errors. And that applies to just about every other
system in the hospital.
Yet Dr. Segal is first to admit there are good reasons why wireless
solutions have not yet taken acute-care problems by storm.
First of all, the EMI risks of wireless are not theoretical, they
are real. People have been injured, and worse, as a result of the radio waves wireless
devices emit. There are also other reasons why technology generally hasnt reached
its full potential in the medical world yet, including security, reliability, and perhaps
most of all, user interface issues.
Thats not to mention the precarious state of healthcare and
hospital budgets, nor the tearing down of walls to replace old network infrastructures.
Nor the non-electronic interference such physical changes bring to patients lives.
Nonetheless, Dr. Segal remains a firm believer in the potential of
wireless systems to address acute care needs, provided they are implemented with special
care. As they have been in two notable instances recently, at Cancer Care Manitoba and at
the Mount Sinai Hospital in Toronto.
The government-sponsored Cancer Care Manitoba is responsible for cancer
detection, treatment, and research in the province. But like so many other institutions,
it was jammed for space, especially at its main facility in Winnipeg.
So much so that its IT staff were moved up to temporary
trailers on the rooftop. More than three years later, all Cancer Care staff are looking
forward to the relief a new building under construction next door will bring when it opens
next year. But this year they are already benefiting from a state-of-the-art, wireless
patient information system that has been retrofitted into the old building and will also
come with the new space. As they move about, users can now stay in touch with Cancer Care
databases via an AirConnect Wireless LAN from 3Com.
Meanwhile, at Mount Sinai Hospital in Toronto, average response times
to patient calls have dropped dramatically, thanks to wireless wizardry that links a nurse
call system from manufacturer Rauland Borg to micro-cellular phones from Lucent
Technologies. The four-year project was made possible by the donation of a single,
In both locations, the challenge was: how to implement new systems in
old surroundings without closing shop.
Our problem was also lack of space, so there was no room to put
in wires or a complicated infrastructure. And to have shut down for any amount of time to
install it would mean disruption to patient care, says Mark Kuchnicki, Cancer Care
Manitobas director of information services. So a wireless system was the
answer. We already had wireless installed in our old building, but the problem was, it did
not have enough coverage. Yet we didnt have the room to put up any more (repeating)
nodes than we had in place.
But Kuchnicki found the new nodes from 3Com had a lot more range than
the old ones. So now wireless coverage extends over an entire chemo-treatment floor using
just nine nodes instead of the 12 that had served only half the floor previously.
Not only was the old systems coverage inadequate, so was its
speed. Nursing staff looking for data, or entering data, were constantly having to
wait for long stretches while their screens refreshed, says Kuchnicki.
Now AirConnect delivers high speed networking to wireless laptops and
hard-wired desktops alike. Nurses can do charting and reporting instantly and
unobtrusively from the patients beside, sharing records and information with other
care-givers in real time, regardless of their location within the coverage area.
Kuchnicki says the performance of the new system is fives time that of
the old and is remarkably flexible. He cites the example of what happened last year during
A contractor cut through a water pipe by accident and water began
pouring over eight patients undergoing day-long chemo-therapy in a special treatment room
we have for them in the basement, re-calls Kuchnicki. So our staff just closed
up their laptops, rolled the patients up to our regular room, opened up their laptops and
were right back in business.
At the 480-bed Mount Sinai Hospital, the speed and range of its
wireless patient call system are equally impressive.
Before we put in the system, our studies showed that it took the
mean average to respond to a patient call of about seven minutes, says project
manager Dana Ormston. Now the average time is 1.14 minutes.
Ormston, a former nurse with 30 years experience, made herself into
medical informatics specialist by taking a masters degree in the subject at the
University of Toronto. There, she was taught by Dr. Lynn Nagle, now her colleague and
Mount Sinais CIO.
Ormston and Nagle agree that the anonymous donation and the system it
financed have been a godsend to patient and practitioner alike.
Our patients told us that long delays in getting responses to
their calls was causing a great deal of anxiety and discomfort, says Ormston,
and our nurses told us the existing intercom system had poor audio quality. Not only
that, it was being used as a paging system to find providers and equipment. So the general
noise level was just not acceptable.
But before accepting any system Ormston says thorough consultations
went on with close to 200 individuals representing patients, care givers, and staff in the
hospital, including building engineers. That resulted in a task force given three
responsibilities. The first was to manage the risk of replacing the old system. This it
accomplished by recommending the hiring of extra nurses, making more frequent rounds
during the two weeks patients went without a buzzer by their beds.
The task forces second responsibility was to figure out criteria
for the mechanics of a wireless telephony solution. Top of the list (Dr. Segal
would be pleased to know) was to ensure that whatever new gear was picked would not
interfere with cardiac monitors, infusion pumps, and other gear sensitive to EMI
emissions. Also, the communication devices the nurses and others would be carrying had to
be full function telephones, with a minimum of four hours of talk time in their batteries,
and have the ability to make conference calls and receive text. The phones also had to
integrate with Mount Sinais digital phone system and thus enable users inside the
hospital to make outside calls.
The third responsibility was to ensure user buy-in and provide
comprehensive training packages (see columnist Richard Irvings article in our
September 2000 issue) for the new communications and emergency response system. This was
done largely through lunch and learn training sessions conducted by the
Rauland Borg Responder IV systems local supplier AATEL Communications and by Lucent
supplier AVAYA Communications.
As a result, the sight of a nurse running to her station to pick up a
phone call at Mount Sinai is a thing of the past. Now, when a patient pushes a bedside
call bell it rings the Lucent wireless phone the nurse is toting. The nurse, regardless of
where he or she is in the hospital, can re-act immediately to the patients needs.
The nurse, in turn, can page a physician, or ring up service assistants to bring supplies
or perform tasks. Also, if nurses encounter patients in cardiac arrest, for example, a
push on a Code Blue button above the patients bed rings all the phones of the nurses
on the unit as well as all the Code Blue teams pagers simultaneously.
The system is revolutionizing how care providers communicate with
their patients and with each other, concludes Dr. Nagle.
With vendor help, Mount Sinai was able to complete the four-year
project using in-house staff to complete almost all of its aspects.
The one aspect we needed outside consulting help with was
enabling us to link our 300 or so Lucent Definity wireless phones to our existing PBX
telephone switch. That was our biggest technical challenge by far, she says.
Cancer Care Manitoba had its own technological challenges.
Getting 11 megabits (of data transmission a second) over our new
system is a huge improvement over the 1 megabit speed of the old one, says
CancerCares Kuchnicki, but there are just some tasks that are handled better by a
100 megabit desktop.
3Coms Rhys Davies agrees. Hes the companys director
of business development and health, and is keenly aware of both the technical potential
and psychological limitations of wireless.
Hospital people all want to move their information faster and
know that wireless can do that, but they are also all concerned about how it will affect
their other equipment, says Davies. So in the CancerCare Manitoba case for
example, we took it down to the level of serial number and date of manufacture to confirm
that each piece of equipment would not be interfered with.
Once that EMI concern is allayed, says Davies, the trick is for each
potential user to figure out which piece of their puzzle they want wireless to solve and
then pick the most suitable kind of wireless. Were looking at expanding the
system at Cancer Care Manitoba, for example, so that we can wirelessly connect up the
offices of about 30 physicians. Now Bluetooth (infrared) wireless is arriving on the scene
and it would be ideal. It is inexpensive and the offices are all within Bluetooths
30-metre range. Most of the work the physicians will do in those offices is reading,
documenting, and reviewing text materials. They are not trying to look at images. They do
that at the crash carts (using high-bandwidth radio frequency wireless) on the floor. So
Bluetooths small bandwidth would be quite adequate.
In the end, whatever approach potential users take to wireless, Dr.
Segal recommends, they should start with the wireless research findings and consequent
recommendations perhaps best articulated on the Web site of the American Medical
But clearly theres more missionary work to be done.
Im amazed to be told, as I was recently by a local
biomedical engineer, that his hospital wont pay the $60 for the handbook, says
Dr. Segal. And I still get calls asking if it is OK for a surgeon to use his cell
phone in the operating room.
Computerized patient records system pulls data from medical devices
TORONTO Toronto East General Hospital has installed bedside
computers in its Intensive Care Units that automatically collect information from medical
devices hooked up to patients. These devices include cardiac monitoring devices,
ventilators and dialysis machines.
The information is available at the bedside, but is also fed to a
central server, allowing the data be accessed by medical professionals throughout the
The technology, called INet, was supplied by Cerner Corp. As we
move towards an Electronic Health Record, this is a key step in electronic documentation
that is both progressive and new, said Pegi Rappaport, director, special projects,
at Toronto East General. The INet implementation was built on the foundation of other
modules already used at the hospital, such as Cerners central data repository and
the Powerchart viewing tool.
Close surveillance of ICU patients is especially important, and an
application that can alert doctors and nurses throughout the facility about their status
of patients is extremely useful. Patients in the ICU require constant monitoring and
care, said Rappaport. Complete and extensive charting of the patients
condition and treatment is an integral component of the care received.
How does INet work? The cardiac monitoring devices, ventilators and
dialysis machines all have an RS-232 port interface that automatically downloads
information into a local Microsoft Access database on the bedside computer. Information is
collected every minute and is held in an acquired data table on the hard drive of the
The information is reviewed by the nurse, usually every hour, to ensure
that the data represents the patients current clinical condition. Its also
charted to the central patient data repository on the hospitals main server.
The charted information is available throughout the hospital. With
automatic data capture, a large portion of the manual typing for documentation is
However, to complete the documentation of the patients clinical
condition, staff input other data such as I.V. medications using a combination of
drop-down boxes and manual input.
The system also allows for interdisciplinary charting. For example,
Respiratory Therapists document their respiratory assessments into the same system,
eliminating the practice of separate charting. As a result, charting is complete without
Every ICU nurse participated in an extensive four-hour training and
education program, which was an integral component to the implementation. Other healthcare
providers, such as respiratory therapists, pharmacists and physicians, were also trained
on how to use the system for their needs.
The technology also exists to make ICU patient information available to
physicians in their offices and at home. Toronto East General plans to implement this
capability as security policies are completed.
The only true manual documentation of ICU patient care that is left is
nursing interventions and medication administration. The Cerner system has the capability
of capturing this data electronically as well, and it will be addressed in future system
Overall, the INet system supplies the following benefits to the ICUs at
Toronto East General:
consistent documentation and charting, mainly with structured data
elimination of duplication in charting between RNs and RTs
The INet technology at the bedside is a key example of a clinical
information system that is directly related to patient-focused care, said Jim Shave,
regional vice president, Canada, Cerner Corp. Toronto East General Hospital was
visionary in identifying the potential of electronic documentation, and is now
well-prepared to move forward towards the complete electronic health record.
Toronto East General selected Compaq as the back-end server supplier.
Compaqs Alpha server technology supports large, mission-critical applications
such as the electronic health record project. This is another example of
Compaqs commitment to advancing the electronic patient record, said Anne
Lawrence, Canadian Health and Education manager. Compaq is proud to be part of a
leading-edge project that takes data directly from medical devices and makes it part of
the patient chart.
Ontario resurrects its Smart System for Health
By Jerry Zeidenberg
TORONTO The Ontario government has revived its Smart Systems for
Health project, which aims to electronically connect healthcare providers and patients
throughout the province.
Its widely believed that such a network could vastly improve the
delivery of healthcare services by speeding up the delivery of patient records, reports,
tests, images, and other information among care-givers.
Ambitious plans were in the works three years ago to produce a
province-wide system of the same name, but the project never got beyond the cabinet
Queens Park has now given the green light to the plan, but in a
different form. While the original Smart Systems for Health proposed the development of
many clinical projects including the creation of comprehensive electronic health
records and telehealth services the current effort focuses on infrastructure.
Its not about HIS (hospital information systems) or
clinical information systems, said Michael Connolly, chief information officer, I
& IT cluster, Ministry of Health. Its more about wires, lines, messaging
and data centres.
Still, there are some exceptions. The government-funded plan does call
for some clinical development in the form of an emergency health record. The voluntary
record would enable emergency physicians to obtain information about allergies and
medications, for example for patients who are brought to ER departments and are
unable to recount their own medical histories.
And ultimately, the secure network may spur the use of a wider range of
clinical systems, like electronic patient records, lab and pharmaceutical software. Once
the infrastructure is in place, medical facilities and independent practitioners may find
that it pays to invest in the clinical systems to obtain faster results and quicker access
Queens Park has already started to issue competitive tenders
or will do so in the next few months for the following Smart Systems for
Practitioner Registration and Security
Emergency health record
Health knowledge and education.
The announcement of the revived system was held at a Toronto hotel,
under the auspices of the Information Technology Association of Canadas Ontario
wing, which has been a longstanding partner in the efforts to produce the Smart System for
The meeting attracted an overflow crowd of computer, software and
telecommunications vendors, along with representatives from hospitals, long term care
centres and medical associations.
In his introductory remarks, Connolly quipped that he was
surprised that after all these years, people are still interested in Smart Systems
At the event, stakeholders such as the Ontario Medical Association, the
Ontario Pharmacists Association, the Ontario Hospital Association and the Ontario
Association of Community Care Access Centres declared their support for the healthcare
Ontarios new Health Minister, Tony Clement, gave one of his first
speeches in his new portfolio at the event, which was held at the end of February.
Clement noted that once a secure network is in place, and applications
such as electronic patient records are developed, enhanced delivery of healthcare services
As benefits, he cited fewer repeated patient histories, and fewer
repeated diagnostic tests, once physicians, labs and other professionals can
communicate with each other over networks.
Clement said the network will be built using a modular approach, with components phased in
over a period of time. He observed that technology has a habit of quickly changing,
sometimes making massive investments obsolete. Just when you think you have the
answer, something new comes along... we favour an incremental approach, so we can be
nimble if a new technology comes along. Then we can adapt.
More specifically, the components will consist of:
A security infrastructure to register and authenticate system
A virtual private network for health service providers that will be fully
compatible with Internet standards and capable of migrating to the environment when the
Internets performance, security and reliability meet the requirements of Smart
Systems for Health. This will occur only when Internet Protocol 6 (IPv.6) is fully
supported by Ontarios Internet backbone most likely in four to six years.
A secure e-mail service and on-line directory, to enable users to locate and
communicate with one another electronically.
Two information repositories, one containing personally identifiable health
information, the other designed to store an anonymous version of this information for use
by health researchers and planners. The first of these repositories will function as the
basis for an Emergency Health Record (EmHR) for people who agree to the creation of an
electronic record containing the critical health information most often required in an
emergency. The second repository, called Comprehensive Health Data for Research and
Planning, will be compiled from a variety of sources. This data will provide researchers
and planners with access to a comprehensive and detailed pool of current and historical
health service information. The anonymity of patients and health service providers will be
rigorously maintained, according to the Ministry of Health.
A portal providing access to health knowledge and education tools that will permit
health service providers to access knowledge tools and best practice
information to improve health services.
Uniform data and technology standards for the collection, storage and transmission
of information. These standards will ensure that all users of the system can send and
receive information without encountering compatibility problems.
Connolly noted that one of the first components to be let for tender is
the messaging system. He said its more than a simple e-mail system, however, and
will include instant messaging, interconnectivity and voice mail.
Moreover, it will include directory services a database of all
provincial practitioners. The RFP asks for the design of a registry and delivery of the
solution. We dont yet know the best way of registering providers, said
Connolly, asserting that its a complex task.
The messaging and registry component will first be tested in a pilot
project involving 7,550 users at 268 sites. These will include Ontarios Community
Care Access Centres, which coordinate long-term care throughout the province. Phase two of
this project will involve a rollout to 150,000 users.
Parents at home can use web-video to monitor babies at hospital
By Neil Zeidenberg
FRAMINGHAM, MASS. A new telehealth application was recently
launched at the Beth Israel Deaconess Medical Center in Boston that takes telemedicine in
a new direction.
To date, most home-telehealth applications have allowed medical
professionals at a hospital or healthcare facility to monitor patients in their homes.
By contrast, a new application called Baby CareLink enables parents to
stay at home and use telehealth technology to monitor their premature babies at the Beth
Israel Deaconess Medical Center. For perhaps the first time, the monitoring is going the
other way from home to hospital.
For most parents, their babys admission is among the most
challenging and distressing episodes in their lives, said Dr. Charles Safran,
co-developer of the system, and chief executive officer of Clinician Support Technology,
an application service provider.
The community created by Baby CareLink helps address the
emotional needs of families by better connecting them with families and staff who have
been through similar circumstances. Moreover, being able to see their baby enhances
the bonding between parent and child.
The patients are all high-risk infants of low birth weight, unable to
eat on their own or breathe without the help of a respirator.
Baby CareLink connects parents to the hospitals Neonatal
Intensive Care Unit (NICU) through use of a home PC, videoconferencing equipment and a
high-speed Internet connection. Parents learn how to utilize the secure Web site to
monitor their babies, as well as schedule televisits and access medical information about
their childs condition.
In many cases, the knowledge and skills gained by parents during the
hospital stay is lost or forgotten within the first few days following discharge. But Baby
CareLink provides parents with information they need.
Baby CareLink originally used PictureTel 200 video boards in homes and
PictureTel equipment at the hospital, but the developers have recently engineered IP-based
videoconferencing using consumer grade USB-ready cameras and streaming video software.
The applications also makes use of the InterSystems CACHÉ database, a
scalable e-database management system (e-DBMS) that links with the hospitals
information system. CACHÉ gives parents secure Web access to over 500 clinical topics
related to newborns, in both English and Spanish, as well as updated photos, a baby growth
chart and doctors notes.
The network improves a parents readiness to become the primary
caregivers at home. As a result, the average hospital stay has dropped by 10 percent
And among the smallest children, the average length of stay has dropped
from 93 days to 77 days. At a cost of US$3,000 per day, that translates into huge
financial savings for the health system.
When you give parents the tools to care for their children, they
become better partners in care. They are more comfortable, confident and competent in the
care of their children. This allows them to take their children home earlier.
Moreover, parent satisfaction has been dramatically improved. The
number of parents who reported problems with their childs care decreased by 75
percent after using Baby CareLink technology.
By increasing the communication between doctors, nurses and
patients, bridging the gap between home environment and acute-care setting, we allowed
care to be transferred to the home more easily and everybody had a better
experience, said Dr. Safran.
To date, about 500 babies have been monitored using Baby CareLink. The
technology is currently in use at eight U.S. hospitals; CST is in various stages of
negotiation with other hospitals around the country, trying to get the product in use.
Baby CareLink began as a research evaluation project that was funded by
the National Library of Medicine in 1997. The idea was to use Internet and
telecommunications technologies to support the educational and emotional needs of families
who had very low birth-weight infants (children of 1500 grams or smaller), who stay in the
hospital on average 2-3 months.
Roughly 350,000 children are born premature every year in United
States, or approximately 1,000 per 1 million. The rates for premature births have steadily
increased over the last decade.
About one-third of premature babies are born early due to poor prenatal
care, and another one-third are multiple births. One reason for the increase in multiple
births is fertility technology (drugs, invitro fertilization). As more women wait longer
to have children, there is more demand for fertility technology. For more information see www.babycarelink.com