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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 13-hospital alliance.

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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 Care.

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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.

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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.

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Managing disease

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 cardiology

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 system.”

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 working at.

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 to them.

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.

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Toronto healthcare facilities become the first to launch secure e-mail

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 information.

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 it’s needed.

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 each organization.

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 discharged.

“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 times.

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 patients.”

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: www.ssha.on.ca

Catherine Krever is a communications advisor at Smart Systems for Health Agency.

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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 management.

• 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 workflow tools.

• 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 regional network.

• 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 clinical application.

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, diseases, etc.

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 following abilities:

• 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 name drugs.

“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.

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Large Montreal hospitals select Dinmar’s Oacis for EHR systems

By Jerry Zeidenberg

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 Ottawa.

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 institutions.

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 different hospitals.

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 system.

“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 quality.”

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 System.

The system was designed with a clinical data repository and built-in integration engine at its core, thereby easing interoperability with other solutions.

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 complex organizations.

“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 record.

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