Inside the April 2005 print
edition of Canadian Healthcare Technology:
Feature Report: Electronic Medical Records
Capital Health solution
integrates DI and cardiology
Capital Health has chosen technology from Agfa HealthCare to build a
solution that integrates RIS, PACS and cardiology images, along with
speech-recognition-based dictation and transcription, throughout its
Secure e-mail connects the circle of care
Secure e-mail, through the auspices of Smart Systems for Health
Agency, is expected to help automate the flow of paper among
healthcare professionals at the University Health Network, the
Toronto Community Care Access Centre and Saint Elizabeth Health
READ THE STORY
News of the world at HIMSS
Kodak announced its expansion out of the radiology department and
into clinical systems across the board at the latest HIMSS
conference. News on this and other developments.
Oacis for Montreal hospitals
After a year-long evaluation, Montreal’s McGill health system and
the CHUM both selected Dinmar’s Oacis as the core of their
electronic health record systems. The project will provide new
levels of connectivity within each organization.
READ THE STORY
The federal government is providing $8 million to the western
provinces for the development of interoperable systems for chronic
disease management. The systems will be targeted at diabetes,
hypertension and renal failure.
A Capital EHR
Edmonton-based Capital Health discusses how it developed netCARE,
its region-wide electronic health record. The browser component will
be used province-wide as a viewer for provincial and regional
systems. Some lessons learned are reviewed.
PLUS news stories, analysis, and features and more.
Capital Health solution integrates DI and
By Neil Zeidenberg
EDMONTON – Capital Health has chosen technology from
Agfa HealthCare to build a solution that integrates RIS, PACS and
cardiology images, along with speech-recognition-based dictation and
transcription, throughout its 13-hospital alliance.
For Agfa, it’s the company’s largest integrated PACS/cardio
implementation in North America.
The $20 million project is also unique in that Agfa and Capital Health
are sharing both risk and rewards.
“We’re essentially helping to guarantee the clinical, operational,
financial and technical success of the system,” said Michael Green, vice
president, Healthcare, Agfa Canada.
Essentially, Agfa will work with Capital Health to create diagnostic
imaging and cardiology departments that are completely electronic and
require very little in the way of film. Capital Health’s facilities
together perform over 750,000 exams annually, and the shift to filmless
radiography is expected to take 18 months.
Agfa will train the physicians and technologists, spearhead the change
management and ensure Capital Health gets the utilization it desires
from the system.
However, should a specified degree of film reduction throughout the 13
hospitals not be achieved, Agfa will subsidize the difference.
The Agfa solution, called IMPAX, will fully integrate cardiology and
radiology images and information – a rarity in the healthcare market
since many current implementations don’t allow the two to communicate
well. They’re usually provided by two different vendors, with different
architectures and incompatibilities.
“With an integrated system, the entire workflow for both radiology and
cardiology will be streamlined and improved,” said Donna Strating, CIO
at Capital Health. “It will help us to schedule and order exams, manage,
store and display both cardiology and radiology images and speed up the
report turnaround time by using the TalkStation speech recognition
Due to its sheer geographical size, Capital Health doesn’t have
specialized radiologists at every site. That’s why it’s critical to have
physicians able to read exams for patients at other sites, too. By
electronically integrating the sites, and providing access to diagnostic
images over computer networks, IMPAX is expected to help maximize the
expertise of Capital Health’s various radiologists. They’ll be able to
call up exams from repositories, no matter which site they may be
They’ll also be able to make better use of netCARE, Capital Health’s
electronic health record. The radiologists’ text reports, including RIS,
will link to the images, so physicians can look at written reports, lab
tests and diagnostic images at once. “That will lead to improved quality
of care, patient safety and physician satisfaction. And physicians won’t
get frustrated over lost films,” Strating commented.
Notably, wait-list management abilities are built into the system. The
latest version of Agfa’s integrated RIS/PACS system allows facilities to
offer patients convenient and timely access to the first available exam
at any site in the region through implementation of a ‘single look’
regional diagnostic imaging scheduling program. It’s expected to result
in more effective use of available imaging resources.
“When a doctor calls in and wants a study done for a patient, clinicians
will query the system to find out which sites have availability,” said
Strating. Based on that data, that site can be offered as an alternative
if someone’s in a hurry and can’t wait to be X-rayed at the site closest
Capital Health in Edmonton is Canada’s largest academic health region,
providing complete health services to 1 million residents in the cities
of Edmonton, Fort Saskatchewan, Leduc, Spruce Grove and St. Albert, and
the counties of Leduc, Parkland, Strathcona and Sturgeon (and
communities within their geographical areas), as well as the Town of
Devon and communities in the eastern part of Yellowhead County.
Capital Health serves a total of 1.6 million people across central and
northern Alberta, providing specialized services such as trauma and burn
treatment, organ transplants and high-risk obstetrics.
Toronto healthcare facilities become the first to launch secure
By Catherine Krever
TORONTO – In February, the University Health Network,
the Toronto Community Care Access Centre, and Saint Elizabeth Health
Care became the first large-scale Ontario healthcare organizations to
connect electronically to each other with secure email – helping them
improve patient care through quicker communication of patient
Until now, exchanging patient information between the three
organizations involved slow and laborious methods – faxing and
couriering paper documents, phoning, leaving voicemail messages,
transcribing hand-written notes, and sorting and filing documents.
Using secure e-mail to transmit, store and locate documents is speeding
the process, and making it faster and easier to find what’s needed, when
Staff at the organizations regularly exchange information to provide
services to patients discharged from the UHN, but who still need
follow-up care. When the UHN is ready to discharge a Toronto patient,
staff contact the CCAC to develop a patient care plan. The CCAC in turn
identifies and contracts the appropriate services from a healthcare
provider, for instance, Saint Elizabeth for home care.
Secure email will allow for rapid availability of patient information,
and will also help healthcare professionals share information more
securely – enabling them to spend more time with patients.
Kay McGarvey, clinical resource nurse with Saint Elizabeth, says:
“Secure email provides a springboard for a more integrated, efficient
and team-oriented model of healthcare. When front-line health
professionals have the information they need at their fingertips, in the
client’s home or other healthcare settings, it ultimately means more
timely treatment and better healthcare for everyone.”
While email is a reality of everyday life for most sectors, it has been
a long time coming to healthcare professionals. That’s because regular,
or unsecure, email is insufficient for exchanging patient information.
There can be no service downtime, messages cannot be intercepted or
hacked during transmission or in storage, and messages absolutely must
arrive to the right person. As well, getting the technical
infrastructure in place, so that the systems at individual organizations
become compatible, is challenging.
Another issue: individuals at healthcare organizations must change their
business processes to accommodate and take advantage of communicating
over secure email.
But secure email for all healthcare professionals in Ontario is now
developing into a reality. The technology is set to become and important
way to improve patient care.
Secure email allows healthcare professionals to share patient data
knowing that data sent over the Internet is fully protected. It also
gives providers the confidence of knowing that the person to whom they
send a message is actually the person listed – and nobody else.
UHN, Toronto CCAC and Saint Elizabeth are working with Smart Systems for
Health Agency (SSHA), whose secure email and related services is
connecting the 12,000 staff members. SSHA is also creating a searchable
directory to allow them to easily find and contact their colleagues at
The technologies being used are Microsoft Identity Integration Server (MIIS),
Active Directory Application Mode (AD/AM) and Transport Layer Security
(TLS). This solution provides the three organizations with access to a
centralized directory hosted by SSHA either through their existing email
or through a web-based application.
The directory provides a centralized listing of resources with email
accounts within each organization. Emails travel with TLS enabled over
SSHA’s managed private network. This system will significantly speed up
the way patient information has traditionally been exchanged – such as
walking to the fax machine, faxing, waiting for a confirmation, and
physically filing the document.
Greg Lewis, project manager at the UHN, has studied how information is
shared between the Toronto CCAC and the 14 hospitals and care facilities
it supports. Lewis found that every month, the Toronto CCAC’s Admitting
and Health Records department manages 150,000 messages. This includes
everything from client administration forms, to service order requests
received from hospitals or sent to a provider, service confirmations or
rejections, and client administration forms.
“The amount of paperwork is staggering,” he notes.
“A communication administration form package, for instance, can consist
of physiotherapist and speech therapy reports, nursing order and in-home
services requisitions, supply requisitions and orders, and equipment
orders. These papers are faxed by CCAC coordinators to the CCAC
Admitting and Health Records department.
“Once received, a team assistant inputs portions of the form package
into billing and service ordering systems. The assistant then re-faxes
the documents to the appropriate service provider such as a home care
agency, which confirms acceptance by faxing back a confirmation form.
The CCAC team assistant then transcribes the confirmation into the
service ordering system.”
“Maintaining appropriate turnaround times and quality standards have
been a challenge,” says Lewis. “There is a chance of error every time
data is entered and re-entered, or handwriting interpreted, and faxes
can get lost or become detached. They don’t always get through.”
Daniela Sabatini, manager, admitting and health records, Toronto CCAC,
agrees. “We are looking forward to dealing with less paper so we can
receive patient information faster and order patient care services
earlier,” she says.
“We want to reduce the time a patient sits in hospital waiting to be
discharged in order to go home,” says Sabatini. “No hospital will
discharge a patient – no matter how ready that patient is – until all
paperwork is complete and correctly filed. Secure email will help us
eliminate steps in our workflow. We will be able to improve our response
and delivery times. This means we will be able to care for more
patients. We will also be able to prevent more patients from going back
into hospital once they have been discharged, through providing
increased in-home health services.”
Matthew Anderson, vice president and chief information officer, UHN, and
chief information officer, Toronto and North York CCACs, says: “When you
have hospital patients who are ready to return to the community, you
need to first have all the supports in place before they can be
“Because of our cumbersome paper environment, patients can be stuck in
hospital for an extra day or two. This delay has a huge impact on wait
If patients could get out faster, we would free up beds faster – and
this would have a trickle-down effect of reducing wait times. This is
what we are looking forward to with secure email and a centralized
on-line directory – to start making the process better for our
For the Toronto CCAC and Saint Elizabeth, greater efficiency is around
the corner. With secure email, they are changing the way they work to
take full advantage of the technology and improved results.
More information about Smart Systems for Health Agency is available at:
Catherine Krever is a communications advisor at Smart Systems for
HIMSS 2005: News about EMRs, patient safety and mobile solutions
By Jerry Zeidenberg
DALLAS – You can easily tell that more Canucks are
trekking to HIMSS each year – all you have to do is monitor the
dimensions of the room used for the Canadian reception.
The annual party, hosted by HIMSS Ontario and CHITTA, gets bigger each
year – this time round, in Dallas, nearly 600 showed up at an Adolphus
Hotel ballroom. It was a bigger crowd than ever before, and luckily, the
organizers had booked a spacious venue.
Overall, the Healthcare Information Management Systems Society (HIMSS)
show never disappoints – it’s always a treasure-trove of information
about hospital and medical office IT.
The latest convention drew over 20,000 attendees – that’s a testament to
the value people get out of participating. They find out about the
latest in I.T. systems, as many of the companies demonstrate their
latest solutions and discuss work-in-progress. They also use the event
to make major announcements.
Some of the latest market info gleaned by this reporter:
• In an ambitious move, Kodak announced plans to expand its suite of
solutions beyond the radiology department to include the electronic
health record across the enterprise and healthcare continuum. Kodak’s
new CareStream solutions are scheduled for general availability in the
second half of 2005.
According to company officials, Kodak acquired much of the technology
from an Australian developer and has been refining the systems.
Currently, the company has two pilot sites. At HIMSS, Kodak’s Health
Group showed for the first time its scalable suite of CareStream
solutions that includes:
• CareStream Clinical Solutions. Comprises electronic medical record (EMR),
computerized physician order entry (CPOE), enterprise-wide scheduling,
care guides, nursing, decision support and closed-loop medication
• CareStream Foundation Solutions. Manages images and information,
provides secure communications and interfaces to departmental and other
information management systems.
• CareStream Pharmacy Solutions.
• Misys made a major announcement in the area of hospital-to-physician
office connectivity. Physicians working across the Sherbrooke, Que.,
region now have secure web access to information systems at the Centre
Hospitalier Universitaire de Sherbrooke (CHUS), a 710-bed hospital
organization that employs Misys Healthcare’s CPR as its electronic
patient record system.
That means referring physicians can quickly find out the results of
tests and determine the status of their patients in real-time, instead
of waiting days or weeks for information to be phoned, faxed or mailed.
“Physicians can obtain lab results immediately, they can see radiology
reports and access the whole patient chart,” said Guy Bujold, Canadian
manager for Misys Healthcare. He noted that Sherbrooke is the first
Misys site to go live with web access to the hospital CPR, and that the
company invested in systems in Sherbrooke to create the prototype for
its new web upgrade.
In the first version, the system is ‘view only’, with physicians being
able to obtain data but not update it. Subsequent versions will enable
doctors to add and modify patient orders, interact with clinical alerts
and email, enter clinical documentation, and utilize reminders and
• Over the past few years, Philips has been aggressively expanding its
presence in the healthcare marketplace, largely by snapping up
diagnostic imaging companies. Extending its reach throughout hospitals
and clinics, at HIMSS it unveiled its new “Xtenity” portfolio of
enterprise and departmental information technology (IT) solutions, a
product suite that was developed through an alliance with Epic Systems
Corp. of Madison, Wisc.
Epic is consistently rated as a top EMR system in the United States. In
one recent large-scale contract, it was selected by Kaiser Permanente as
the solution that will form the core of the IT systems used in Kaiser’s
hospitals and clinics.
“Epic will continue to market its EMR solutions to the larger hospitals
in the United States, while Philips will target the mid-sized and
smaller centers in the U.S. Over the coming year Philips will roll-out
its Xtenity solution worldwide,” said Jeff Vachon director, information
technology, for Philips Medical Systems Canada.
Vachon noted that Philips recently won a major contract from Quinte
Health Care, based in Belleville, Ont., for a digital imaging solution
that integrates PACS, CR, DR and its latest 64 Slice CT across a
• Patient safety and medication management are top priorities for most
hospitals and clinics these days, with much discussion of the best way
of reducing medical errors. Several of the major medication management
vendors were at HIMSS with new or enhanced solutions.
Thomson Micromedex, based in Greenwood Village, Colo., announced
‘InfoButton Access’, a tool that enables ‘one-click’ access to trusted
clinical reference information from any electronic medical record or
It’s said to improve clinical decision-making by providing quick access
to Micromedex’s drug, disease and patient education information,
including online animations for the benefit of patients.
According to the company, the system is designed to integrate with a
hospital or clinic’s EMR. So when a doctor clicks on the InfoButton, the
EMR will respond with pertinent information about drugs, interactions,
While the application is in its initial stages, and currently provides
general information about medications, diseases and treatment
guidelines, Micromedex says that future releases will become more
‘patient-centric’ and ‘provider-centric’, and will customize the
responses to particular patients.
In this scenario, patient data from the EMR is coded into a secure
message to the Micromedex InfoButton application. Infobutton conducts a
search within the Micromedex clinical content database, and returns a
response matching the query parameters to the EMR.
Upcoming releases of the system, the company said, will include the
• Patient-specific parameters, such as age, gender, allergies, test
results, and co-morbidities, which will enable more patient-specific
treatment or medication recommendations to be returned;
• User-specific parameters, such as clinical role, speciality, or
user-defined responses to be tailored according to user demographics.
The use of these parameters could help reduce “noise” and just provide
information relevant to the individual practitioner;
• Context-specific parameters, such as clinical setting or
organizational affiliation, which will enable responses to be tailored
to an outpatient or emergency care setting. Similarly, the results would
also be customized for a particular formulary.
• For its part, Wolters Kluwer Health, Clinical Tools Division, based in
St. Louis, Mo., announced several developments in the medication
management area. They included the launch of a Medication Order
Management Database (MOMD) to support computerized prescriber order
entry (CPOE) and e-prescribing applications.
According to the company, MOMD provides clinically relevant medication
orders (otherwise known as ‘sigs’ or ‘dosing instructions’) to ensure
that patients are prescribed the most appropriate dose based on a given
drug and set of clinical parameters. MOMD is aimed at reducing the
medical errors that occur in hospitals, clinics and pharmacies.
As a flat-file database, MOMD can be integrated with vendor or
self-programmed systems. Incremental and full database updates are
available weekly and monthly via CD-ROM or telecom. For additional
information visit www.medi-span.com
On a related note, at the end of 2004, Wolters Kluwer Health entered
into an agreement with Cerner Corp. to enhance point-of-care decision
support in Integrated Delivery Networks (IDNs) and hospitals. Drug and
medical data from WKHealth’s SKOLAR MD and Clin-eguide Order Sets will
be integrated into the Cerner Millennium clinical knowledge system,
called Executable Knowledge. This will enhance the medical, pharmacy and
nursing information clinicians can access using Executable Knowledge to
help improve patient outcomes and reduce medical errors.
• Mobile computing was another hot topic at HIMSS. On this front, there
was an interesting announcement involving the Blackberry, the
Canadian-made telephone/internet email and browser device.
Beiks LLC, a leader in reference and language titles for mobile devices,
and Lippincott, Williams and Wilkins (LWW), a top publisher in the
healthcare industry, have teamed to provide anytime/anywhere access to
medical reference information to users of the BlackBerry platform.
The library of medical reference works available to BlackBerry users has
begun with Stedman’s Concise Medical Dictionary for the Health
Professions, which gives access to the core language of medicine and
allied health, including terminology, definitions, tabular material, and
valuable appendix sections.
Coming soon to Beiks’ s collection will be LWW’s Physician’s Drug
Handbook, providing information on more than 900 generic and 2,000 trade
“As the number of healthcare providers using BlackBerry as a business
tool grows, the need for clinical applications and medical reference
material – both off-line and on-line – increases significantly,” said
Seema Esteves, president of Circul Technology, a Canadian-based
high-tech training company that focuses on helping organizations use
BlackBerry to their full potential.
Based on Beiks’s mobile industry standard BDicty Dictionary Reader, the
LWW medical reference for BlackBerry is specially optimized for one-hand
operation, minimal memory requirements and optimal access speed. It can
be installed on the device’s main memory and once installed does not
require or utilize a network connection.
Large Montreal hospitals select Dinmar’s Oacis for EHR systems
MONTREAL – After a year-long evaluation of electronic
health record systems, two large hospital systems in Montréal have opted
for Oacis, an EHR system that’s owned and developed by Dinmar Ltd. of
The Montréal-based McGill University Health Centre (MUHC) and the Centre
hospitalier de l’Université de Montréal (CHUM) have both signed
agreements to implement Dinmar’s Oacis enterprise-wide. The system is
expected to provide numerous clinical and administrative benefits for
the organizations. High on the list is the ability for doctors and
nurses to access patient records from any site within their respective
Each of the large Montréal hospital organizations plans to invest
approximately $60 million in information systems – both hardware and
software – over the next several years as part of an EHR modernization
strategy, noted Jean Huot, who is chief information officer for both the
MUHC and the CHUM.
By way of background, the bilingual MUHC currently comprises five
teaching hospitals while the francophone CHUM consists of three large
hospitals. Both organizations soon plan to break ground on new
‘super-hospitals’, which will consolidate services at three main sites.
While they’re not expected to be fully open until 2010, they’re
investing now in IT so that clinicians become familiar with the systems,
and will be up to speed with them when the new facilities open.
Each super-hospital is expected to cost on the order of $1.1 billion. At
the end of the construction of the new sites, Huot estimates there will
be an additional investment of $50 million by each in technological
infrastructure, such as VoIP equipment.
While there is close cooperation between the two organizations, which
share a CIO, each of the two establishments will have its own
applications and database systems completely independent of the other
organization. That’s due to Quebec’s current privacy laws, which don’t
permit sharing of patient data among different organizations.
Huot said the government is already working on recasting these laws, and
he foresees in the near future the ability for clinicians to access
records, with patient consent, across the two organizations.
It only makes sense, Huot explained, as there’s a need to establish
clinical complementarity between the clinical centres of excellence at
Meanwhile, when fully implemented enterprise-wide, the Oacis system will
help manage more than 2,800 beds, 80,000 inpatient stays, and over 1.6
million outpatient visits annually.
Huot said the CHUM and MUHC decided upon Oacis after a rigorous
evaluation process that involved the input of some 600 employees and
clinicians, including doctors, nurses and therapists. Nine different
bidders and their solutions were assessed.
He believes the inclusiveness of the evaluation process has fostered
buy-in from the clinicians, and that early acceptance of the system by
the users will help in its successful implementation.
He said there is a lot of enthusiasm about the capabilities of the Oacis
“The level of functionality achieved by the product, its
user-friendliness and its bilingual capabilities were big winners with
our selection committees,” said Huot. “Our technology teams were
attracted to its ability to quickly connect separate systems across all
sites, thus preserving our current I.T. investments.”
He added that, “From an executive viewpoint, Oacis fully supports our
strategy to consolidate clinical information systems across diverse
healthcare delivery landscapes, and to contribute to improving care
Mark Groper, president and CEO of Dinmar, pointed out that the
interoperability capabilities built into Oacis were among the most
important features for the Montreal hospitals. Groper noted that OACIS
is, in fact, an acronym for Open Architecture Clinical Information
The system was designed with a clinical data repository and built-in
integration engine at its core, thereby easing interoperability with
Moreover, an enterprise master patient index application identifies
patients across all organizations and automatically eliminates duplicate
records as they flow through the network. According to Oacis, an
underlying database management system from Sybase meshes with the
technologies and clinical applications to ensure that caregivers have
access to a complete and accurate patient record throughout broad and
“The selection of Oacis at the CHUM and the MUHC continues to re-enforce
the strong market need for open systems, which empower healthcare sites
with robust, yet easy-to-use EHR functionality,” said Groper. “Although
the competition is always very challenging, we knew early on that the
Oacis solution was perfectly suited for the complex needs of the MUHC
and the CHUM. ”
Thanks to an intuitive user interface, Oacis Order Management has won
accolades from physicians, who say it is the most comprehensive solution
for computerized physician order entry (CPOE) available today, according
to a Dinmar release.
Also, the built-in drug prescription capabilities quickly respond with
appropriate alerts to patient-specific information located within the