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Inside the April 2003 print edition of Canadian Healthcare Technology:


Feature Report: Wireless systems in healthcare


British aim for a ‘national’ electronic health record

This month, England launches one of the largest IT projects in the world – a bid to wire-up the National Health Service and its myriad of hospitals and physician practices.

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Digital cardiac hospital emphasizes patient safety

Said to be one of the first ‘paperless’ cardiac medical facilities in the United States, the Indiana Heart Hospital opened its doors in February.

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Wireless radiology

The RDS Diagnostics radiology clinics have launched a trial of a wireless technology that enables physicians and clinicians to send and receive images and reports, anywhere, anytime.

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Regional web portal

The Chatham-Kent Health Alliance, consisting of three hospitals, is installing a web portal that enables physicians to obtain a wide range of patient information using a single sign-on. Doctors can check on patients, 24/7, from any location.

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Patient safety scores high

The latest HIMSS survey of US hospitals found that medical error has become the top issue for IT managers. The poll also found that US hospitals have moved ahead on the electronic patient record and plan major installations of wireless.


Tracking transplant patients

The UHN and Hospital for Sick Children, in Toronto, are using a comprehensive communications technology to keep in touch with transplant patients. The system ensures patients are updated about medications, tests, appointments, and other information.


PLUS news stories, analysis, and features and more.

 

British aim for a ‘national’ electronic health record

By Jerry Zeidenberg

This month, England launches one of the largest IT projects in the world – a bid to wire-up the National Health Service and its myriad of hospitals and physician practices. At the same time, the project aims to spur the use of computerized communications, including a standardized, ‘national’ electronic health record.

Prime Minister Tony Blair’s government has given the effort the green light, and this year will boost spending on information systems at the NHS by 40 percent to £1.4 billion, with increases to £1.7 billion in 2004 and £2.2 billion in 2005.

That’s £5.3 billion, nearly Cdn$13 billion over three years.

The NHS also hired, for the first time, a director of IT. Richard Granger, 37, was selected last year over 100 other contenders for the job and will be paid $600,000 annually – reportedly the highest salary in the British civil service.

It’s a measure of the importance of the project – and its difficulty. Critics have been sniping at Granger and the government for months. They point out that IT projects have a high rate of cost overruns, delays and outright failure in Britain and abroad (just look at Canada’s gun registry; the UK, for its part, has had similar computer project failures.)

They’ve also carped that British hospital physicians are loath to use computers – some refuse to change their old-fashioned ways, while others see computerization as a mechanism for government snooping to rate their performance.

Nevertheless, there’s much agreement, by the British public and high-level government officials, that a connected system of health records would do much to improve communication among physicians – leading to faster decision-making and service delivery, along with better outcomes.

That’s why the wheels are in motion to link healthcare providers in Britain’s 28 strategic health authorities with a high-bandwidth network called NHSnet, and to create standards for shareable health records.

As the NHS’s blueprint for the program puts it, “The core of our strategy is to take greater central control over the specification, procurement, resource management, performance management and delivery of the information and IT agenda. We will improve the leadership and direction given to IT, and combine it with national and local implementation that are based on ruthless standardization.”

The key document outlining much of this effort is “Delivering 21st Century IT Support for the NHS: National Strategic Programme.” It can be found on the Department of Health’s web site at www.doh.gov.uk/ipu

The ambitious strategy has four parts. The components are to be installed nationally in at least nascent form by 2005 and at a comprehensive level by 2008. In a nutshell, they consist of:

• the broadband network linking healthcare providers;
• electronic prescriptions;
• electronic bookings of appointments;
• a national, electronic health record.

While the effort is centrally directed by the National Health Service, the 28 health authorities will be allowed to purchase systems from vendors of their own choosing – provided the companies and consortiums offer up solutions that meet standards created by the NHS.

As might be expected, there’s a tremendous amount of activity under way on the part of vendors and health authorities alike, and a torrent of words is being produced on the subject of computerized health systems in Britain. Here’s a summary of the main components of the program.

• Networks. In January, a £45 million upgrade to the NHSnet for hospitals, GPs and NHS trusts was announced. The network is regarded as the foundation for the whole system, and will enable physicians and clinicians to converse with each other via computers. The upgrade will give every GP practice a 256Kbps connection to the main network, while trusts, primary care trusts and strategic health authorities will be upgraded to a 2Mbps fixed link connection. The project, lead by British Telecom and Cable and Wireless, is due to be completed by March 2004.

The current project is said to be an initial measure to connect providers and to give them adequate speeds for data communication. In parallel, the NHS has begun the procurement process for an entirely new network.

• Electronic bookings. The goal is to allow patients more power to book appointments with hospital specialists of their choice, at convenient times, and to quickly change appointments when needed. It’s all to be done while patients are at the GP’s office, instead of waiting for a phone call and being told where to go and whom to see.

• Electronic prescriptions. Partnerships have been created with the private sector to conduct three pilot trials, all of which were to be completed by the end of 2002. It’s anticipated that the trials will continue to grow and attract an increasing number of GPs and pharmacists. The main benefits are expected to be more accurate communication of information about medications, and automatic drug interaction checking, resulting in greater patient safety.

• Electronic health records. The first generation of a national, electronic patient record is expected to appear by the end of 2005. A full system is expected by 2008; the Department of Health sees it as a project that will evolve as it goes along, to account for changes in technology and the experiences of pilot projects and end-users. The goal is a record that will have information most useful to care providers, enabling treatment of individuals no matter where in England they seek it. As part of this, a master patient index is being built; it is to be based on the NHS Number, even though it is recognized that some members of the public don’t have an NHS Number.

The NHS Information Authority currently has four key demonstration sites taking part in its Electronic Health Record Development Implementation Program (ERDIP), along with 13 smaller focus group communities. The projects are all aimed at developing standards and practices for the British electronic patient record.

It appears the British are aiming to develop a ‘virtual’ patient record, the parts of which can be pulled when needed from a variety of databases, such as various physician offices, hospitals and other organizations visited by patients. But in recognition of the current limitations of technology, in the immediate future, information may have to be concentrated in regional databases.

There’s a good deal of concern about the chances of success for such a large-scale project. For this reason, the British are subjecting it to their new Gateway review, a program that checks and re-checks the progress of large-scale public projects at five points from conception to finish – and asks whether the efforts live up to their billings at each step.

For more information, search the Department of Health web site; for a higher level of detail, check the National Health Service Information Authority web site, at www.nhsia.nhs.uk

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Digital cardiac hospital emphasizes patient safety

By Jerry Zeidenberg

You realize just how computerized the new, Indiana Heart Hospital is when the CIO tells you there are 795 workstations in the 88-bed facility – nine computers for every bed.

“It’s a $60 million hospital, and we’ve put 25 percent of that into information technology,” said Neal Bowlen, chief information officer at the facility, which opened in February.

Bowlen was part of a panel discussing the Indianapolis-based cardiology hospital at the recent Healthcare Information Management Systems Society (HIMSS) meeting in San Diego.

He emphasized that there’s no paper and no diagnostic film generated at the medical centre. All of the imaging modalities are digital, and any scrap of paper that’s brought into the building is scanned into the system.

The thrust on computerization isn’t just a matter of trying to look up-to-date. Instead, it’s the hospital’s core strategy for improving patient safety and outcomes while simultaneously lowering costs.

Hospital execs are aiming to reduce medical errors by 80 percent or better through the use of physician order entry systems, drug checking databases, and other methods.

Most of the computer hardware and software, along with diagnostic equipment, was supplied by GE Medical, which is the main partner of the Indiana Heart Hospital. Greg Lucier, president of Milwaukee-based GE Medical Systems Information Technologies, doesn’t mince his words about the patient safety issue.
“We’re having a 9/11 each month in terms of patient deaths in the United States,” he said. His reference was to the estimated 44,000 to 98,000 annual deaths that stem from medical errors. Digital technologies “will reduce error by 85 percent or more,” asserted Lucier.

The computerized systems are designed to make orders for drugs and medical tests more clear – eliminating the confusion that sometimes surrounds handwritten notes. Various databases, moreover, check drug doses and interactions. They also ensure the right patient is receiving the correct medications.

Finally, the information flows more quickly, enabling decisions to be made faster.

For example, all medical devices are connected to the clinical information system. Doctors and clinicians – from anywhere in the hospital – can check on a patient’s status through physiological monitors, IV pumps, ventilators and other equipment. “We have a tight integration between medical devices and I.T.,” said Bowlen.

Point-of-care lab work is also part of the equation. It, too, speeds up the flow of information and allows doctors to make faster decisions.

Bowlen said 75 percent of lab tests are done right at the bedside. This includes enzyme tests for heart damage when myocardial infarction is suspected. Instead of shipping off the blood sample to the lab, it can be analyzed by a device at the point-of-care, with the result integrated into the patient’s electronic health record.
“The all-digital technology at the Indiana Heart Hospital means that physicians can have life-saving information about patients in a keystroke, rather than having to wait hours or even days for critical medical records and results,” said Dr. Michael Venturini, chief medical officer at the Indiana Heart Hospital. “The time savings are critical, especially when diagnosing and treating people with heart disease.”

Recognizing that much simpler computerized systems have given hospitals difficulties in the past, one might wonder: will all of this actually work when you throw the switch and start operating in this new fashion?

Bowlen explained the hospital didn’t leave this issue to chance. Instead, it built a 5,600-square-foot test facility that replicated all of the systems to be used in the actual hospital. Over the past 12 months, members of the Indiana Heart Hospital put the mock-up through dry runs to see how well the systems worked.

During that time, Bowlen and his team also analyzed the work processes of doctors and clinicians, to determine if they could be improved – and if some steps could be eliminated in the quest for greater efficiency.

As one example, the partners were able to start connecting data collected by paramedics to the Emergency Department information system. “We’re grabbing information right from the ambulance,” said Bowlen. “We can take out the need for triage in that way,” he said, explaining that treatment of the patient can then begin even sooner.

“We analyzed what every doctor, nurse and clinician does, and asked ourselves, where can we make an improvement?,” said Bowlen. “It was the most labour-intensive part of the whole process.” Additional information can be found at www.hearthospital.com

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New, wireless system can handle text, medical images – anywhere, anytime

RDS Diagnostics Ltd., a diagnostic imaging organization with clinics throughout Southern Ontario, is conducting trials of a new wireless solution that enables physicians and technologists to view images and text reports in a secure fashion, regardless of geographical location.

Radiologists and other physicians can access up-to-the-minute images and charts as they move around a hospital or clinic, improving patient care through faster access to information. For multi-site organizations like RDS, this solution is expected to significantly enhance productivity.

Medical professionals moving from one hospital or clinic to another can gain access to the information they need, and also perform real-time billing as work is performed. Groups of physicians can consult in real-time using the wireless system, wherever they might be.

In an emergency, a radiologist outside the medical centre could be paged; he or she could then open a mobile computer and review downloaded images, regardless of location.

RDS Diagnostics is a leading provider of community-based diagnostic imaging services. The RDS business model is based on developing upscale facilities using state-of-the-art imaging equipment to service thousands of referring physicians in Ontario. The organization has pioneered certain diagnostic imaging procedures in Canada and is said to be the foremost provider of sonohysterographic services in the country.

Wireless Interactive Medicine (WIM) Inc., of Toronto (www.wimcare.com) provided the solution, which connects with historical medical information in hospitals and clinics. The system compresses rich media and securely transmits using WiFi, 802.11b, or data networks on the Rogers, Fido, Telus or Bell infrastructure in Canada. The WIM solution has also been tailored to assist many different medical specialty groups, such as cardiology, oncology and OB/GYN, implementing specific medical protocols.

All types of medical information, including medical charts, lab and diagnostic imaging images and reports, can be securely compressed and transported, anywhere, anytime.

This facility is using the GE Voluson 730 digital 3D/4D ultrasound platform, which has the ability to acquire three-dimensional volumes and to display the images in a 3D format as well as “real-time” 3D, which is also known as 4D imaging.

With this technology, a single acquisition provides an entire volume dataset. It can be manipulated to reconstruct the information in any plane and any section to obtain images that cannot be acquired using conventional 2D ultrasound.

Clinics owned by RDS Diagnostics Ltd. are the first users of this 3D/4D ultrasound technology in the Greater Toronto Area. The large files generated by the technology can be compressed and effectively transported by WIM’s wireless solution.

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Chatham Kent to launch web portal for access to patient information

By John Shoesmith

The Chatham-Kent Health Alliance (CKHA), a three-hospital group in southwestern Ontario, is set to become one of the first healthcare organizations in Canada to roll out a secure Web portal that will give its physicians “anytime, anywhere” access to comprehensive patient information.

More importantly, says Dr. Ranjith Chandrasena, a psychiatrist and chair of the CKHA’s I.S. Physician Advisory Committee, because the portal is intuitive and easy to use, the system will have an immediate and positive impact on patient care. “That’s the biggest advantage, its user-friendliness,” he says, which he believes will prompt rapid adoption of the system.

The portal, officially called the McKesson Information Solution’s Horizon Physician Portal, will provide clinicians with access to patient information from disparate sources. With a single sign-on, physicians will be able to retrieve data from across the entire enterprise – everything from patient demographics to medications. It will hold information on any and all patient investigational studies, such as lab and radiology results, along with dictated reports of all clinicians assessments performed on a patient (such as nursing, respiratory, physiotherapy and social work).

And all at the click of a mouse, says Chandrasena. “Physicians will be able to access whatever information they want and that is relevant to them,” he says. Moreover, the portal can be customized, tailored to fit the specific needs of a user. “When I go in, I can get only what I want or require, and I’m happy. The same with a GP or anybody else that uses it.” For example, says Chandrasena, if a surgeon only wanted to see certain key assessments for a patient rather than all the disciplines, “that can be easily modified for him.”

While the CKHA is the first hospital in Canada to implement McKesson’s portal, it was successfully introduced in the United States about two years ago. “It took off like hot cakes,” says Ron Dunn, vice president, Canadian operations, at McKesson Information Solutions Canada. He says the CKHA was committed to being one of the first Canadian hospitals to investigate and then commit to the portal. The CKHA also had an advantage: “They have the organizational integration in place to enable a portal like this to provide significant value across facilities,” says Dunn.

Sharon Pfaff, director of IT at CKHA, agrees the Alliance had many of the necessary electronic pieces in place to make the portal work. “One of the key things is how electronic a hospital currently is,” she says. “You have to have information electronically available in the first place. If you don’t already have a lot of things online, there’s not much benefit to the portal.”

Pfaff views the portal as yet-another piece in the CKHA’s big IT picture. The goal is a near-paperless environment that makes extensive use of electronic patient records. “When you look at this type of investment, you have to look at it long range,” she says of the portal. “In order to fully achieve (a paperless organization), we have to take off little pieces here and there. Certainly, the portal technology is a piece of that.”

When electronic patient records take hold at the CKHA, “that’s when the real cost savings kick in,” says Pfaff, pointing to manpower savings and greater efficiencies. However, because of funding challenges, that environment is still a few years down the road.

Cost savings aside, Dr. Chandrasena says the initial advantages of the web portal are improved patient care. He plucks a recent medical story from the mainstream press to demonstrate its possible medical benefits: the plight of the Mexican teenager who in February received replacement organs of the wrong blood type. (She eventually received another set of organs, but died.) “I wonder if these people had some type of electronic system, whether they would have picked up this was a mismatched transfusion,” he says. “It’s not so far-fetched.”

There are other, more tangible benefits. He points to physicians being able to access the portal remotely. “Imagine that I receive a call at home from the hospital, inquiring about a patient,” he says. “If I had my laptop in front of me, I can access that patient’s information with the click of a mouse, and within a few seconds I can bring up all the relevant information, and give the nurse my suggestions with that information in front of me.” What’s more, with the portal having toll-free access, “I can do that literally anywhere in the world.”

 

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