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Inside the April 2013 print edition of Canadian Healthcare Technology:

Feature Report: Wireless and Mobile Solutions

Massive acceptance of BYOD at MUHC
The Bring Your Own Device (BYOD) phenom has certainly taken hold at Montreal’s McGill University Health Centre. In fact, when it comes to mobile devices for caregivers, it may be the only option.


‘Big data’ for big problems
Many of the speakers at the recent HIMSS conference, in New Orleans, addressed the need to use analytics to solve healthcare’s woes. But you’ve got to have access to clean data, and lots of it.


Infection-fighting phones
Cornwall Community Hospital has acquired a new generation of washable phones in a bid to improve communications and access to data, but at the same time reducing the infections that handheld devices can carry.


Physicians, nurses and patients all make heavy use of mobile devices and apps
You might think medical mobility has gone over the top, judging from the 2nd annual Mobile Healthcare Summit, organized by the Strategy Institute and held in a Toronto airport hotel recently.


Certified consumer health
With surging consumer interest in online healthcare solutions, Infoway has turned its attention to certifying systems that connect consumers with their own health data. It’s a way of bringing standards, and confidence, to the marketplace.

Information governance
Healthcare organizations are producing scads of computerized data. It’s high-time they devised strategies for dealing with issues of quality and risk; what’s more, high-level executives, including CEOs, should be involved.

PLUS news stories, analysis, and features and more.


Massive acceptance of BYOD at MUHC

By Jerry Zeidenberg

The Bring Your Own Device (BYOD) phenom has certainly taken hold at Montreal’s McGill University Health Centre. In fact, when it comes to mobile devices for caregivers, it may be the only option.

“There’s no dedicated budget at the new hospital for mobile devices, so we’ll likely go to BYOD,” commented Dr. Jeffrey Barkun, professor of surgery at McGill University and chief clinical officer for technology transition at MUHC.

Dr. Barkun was a speaker at the Toronto-based Mobile Healthcare Summit, which was organized by the Strategy Institute and held in late January. He explained that MUHC is in the midst of building a new, billion-dollar facility, but money is so tight, there’s nothing in the budget to equip clinicians with wireless devices.

“BYOD is really a necessity,” commented Dr. Barkun.

In recognition the world is going wireless – clinicians included – MUHC launched its own BYOD pilot in 2009. And they decided to target the smartphone as the device of choice, rather than tablet computers.

In large measure, that’s because a majority of the nurses on the targeted ward were found to already own smartphones, along with a good number of the residents. Research predicted that 80 percent of physicians were likely to own a smartphone by 2012, and among them the iPhone was most popular.

A team of two persons was created to produce web apps that would enable clinicians to connect with patient records housed in the organization’s Oacis information system.

Dr. Barkun explained that the approach wasn’t aimed at providing full access to the HIS. “We didn’t want to reproduce the HIS on a small device,” he said. Instead, the team created apps and screens that are optimized for smartphones, giving clinicians quick access to key pieces of information about patients.

Less than four years later, there has been extraordinary acceptance of the BYOD solution and the VSign software devised at MUHC. Today, noted Dr. Barkun, there are nearly 1,000 users of the system – including 750 residents and staff physicians, 62 nurses and some 50 pharmacists.

The hospital IS group has been developing a Specialized System platform to document clinical notes, and the incremental cost of developing and testing VSign was about $278,000 over a period of two-and-a-half years. On a cost-effectiveness basis, “This was a home run,” asserted Dr. Barkun. “We’ve had a higher return on this than almost any other software developed for clinicians.”

Indeed, on a day-to-day basis, clinicians can obtain the information they need right at the patient bedside.

And although the desktop workstations are still regarded as the main computers for data entry, the residents by far prefer using their own smartphones to look-up what they need about their patients.

And on one occasion, when the wired network went down temporarily at one of the hospital sites, clinicians were still able to obtain patient data by using their smartphones.

Six categories of patient information are instantly available, including vital signs and lab results. Clinicians can see which medications a patient is on, and views are organized according to the needs of physicians and nurses.

Upcoming applications include views of patients by ward or area of service. As well, the next phase of the software will show which doctors and nurses are caring for patients – something that is extremely useful for team members when seeking information or a helping hand. The communication system used is SMS text, and clinicians are able to keep in touch with each other wherever they may be – even while on coffee breaks.

In future, the hospital plans to expand the results that are available so that radiology and microbiology are included. It also hopes to add clinical note-taking. And it intends to continue ramping-up so that VSign is an enterprise-wide solution.

Dr. Barkun said there were originally some qualms raised about infection control with the devices. As one solution, containers of wipes were placed throughout the hospitals and clinicians were urged to keep their devices clean.

The stratagem worked. “Nurses tell us their phones are cleaner than anything else on the wards,” commented Dr. Barkun.

An ancillary benefit has been that with the handiness of the wipes, staff and clinicians are cleaning other pieces of equipment, as well.

Privacy was also a concern, but no data actually resides on the smartphones, it only appears on screen and can’t be saved. There’s a 40-minute inactivity logout, and to get into the system, users must identify two images in the correct order.

And while a desktop computer on the ward can be read by anyone walking by, it’s been found to be virtually impossible to read a patient record on a smartphone by peeking over someone’s shoulder.

Indeed, those who first voiced concerns about infection control and security are now supporters of the smartphone solution.

Not everything has been ideal, however, about the introduction of BYOD. Cellular signals, for example, are not uniformly prevalent throughout the hospitals. “We have 3G, but it’s good in some areas and not so good in others,” said Dr. Barkun.

As well, budget constraints have meant that only two staff members were allocated to app development and support.

Nevertheless, those talented individuals produced the software, called VSign, and it has been quickly adopted by clinicians – a testament to the usability of the system. And the dynamic duo has also been open to answering the texts of users, and even providing support on weekends.

Dr. Barkun says the hospital still has no official BYOD policy, but it’s in development and will soon be formalized.

He contrasted the approach taken at McGill University Health Centre, which focused on smartphones, with that of the Ottawa Hospital, another user of the Oacis information system. For its part, the Ottawa Hospital has acquired over 3,000 iPads as the device of choice for clinicians.

“What they have done with iPads is terrific, but we couldn’t even afford to buy one iPad,” said Dr. Barkun.

While other organizations may opt for iPads, the focus on smartphones has worked out well at McGill, where there has been massive acceptance of the BYOD strategy. “We didn’t do any promotion for this,” said Dr. Barkun. “It grew on its own.”


Health analytics takes centre stage at New Orleans HIMSS conference

By Jerry Zeidenberg

NEW ORLEANS – When a huge ballroom is filled to capacity, and attendees are willing to stand at the back to hear what’s going on, it’s a sure sign the lecture topic has hit a chord. That was the case at the recent HIMSS conference, when executives from Denver Health, in Colorado, reported on their use of ‘Big Data’ to achieve among the lowest mortality rates in the United States.

The centre is Colorado’s largest ‘safety net’ health provider – it has nearly a million visits annually and 46 percent of the patients are unable to pay for their care. Nevertheless, the centre has avoided deficits for the past 20 years.

“I.T. is the way we handle this,” said Greg Veltri, CIO for Denver Health, a 477-bed organization that invests more than $30 million a year in information technology.

Using analytics, Denver Health has been able to predict onslaughts of disease outbreaks, enabling it to prepare in advance. It has also been able to determine which treatments have the best outcomes. “You can find out which physician treatments have the best outcomes at the lowest costs,” said Veltri.

Veltri and his colleague, Mical DeBrow, principal consultant with Siemens Medical, held forth on the lessons they’ve learned from the centre’s business intelligence implementation. “It doesn’t help you to know what happened 30 days ago,” asserted DeBrow. He said managers need real-time or near real-time information, and that means they’ve got to link the myriad databases throughout the organization.

That in itself is a huge task, due to interoperability challenges. Another daunting task is creating a common language of medical terms. “A data dictionary that’s used across the enterprise is critical,” said DeBrow. Producing one isn’t so easy. Veltri noted that even the term ‘live birth’ had multiple meanings in his organization. “There were 19 different categories of live births,” he said, explaining that the I.T. team wasn’t able to resolve this on its own. “You need to get your physicians involved.”

Equipped with data mining tools, “you can actually predict patterns of behaviour,” said Veltri. Added DeBrow: “You need to be able to predict to be able to plan.”

He lamented that most U.S. healthcare providers have yet to use data mining or analytical software, and are far behind other industries in this area. “Walmart knows more about your patients than you do,” quipped DeBrow.

Keynote speaker Warner Thomas, CEO of the eight-hospital Ochsner Health chain, hammered on the same theme in his HIMSS address – healthcare providers must make greater use of ‘Big Data’ to solve their problems. “Why don’t we do more of this in healthcare,” he repeatedly asked, pointing to how airlines and successful companies like Walmart and Amazon use data to run their businesses.

For its part, New Orleans-based Ochsner is investing heavily in information technologies to help produce better outcomes at lower costs. It’s midway through an I.T. conversion with Epic as its partner. Already, the hospital has achieved Level 6 on the HIMSS EMRAM rankings – by contrast, there are only three or four such hospitals in all of Canada.

Thomas noted that healthcare must also learn from other industries about re-engineering to reduce its costs. He pointed extensively to the airline industries as a model, noting that in 1995 U.S. airlines carried 460 million passengers and employed 546,000 people. By 2010, they carried 700 million passengers but had reduced their employee count to 536,000.

“How did they do it?” asked Thomas, answering his own question by pointing out that airlines now have consumers doing much more work. “They’ve moved work to us, and we like it,” commented Thomas. He observed that passengers now make their own bookings and check themselves in at airports.

“It means they need fewer staff on the desk at check-in,” said Thomas. His hospital is now incorporating some of these techniques – such as self-booking of appointments and self-check-in.

In Canada, Centre Hospitalier Universitaire de Sherbrooke (CHUS) is now investigating the use of self check-in with an easy-to-use kiosk from Quadramed. The system also allows patients to make appointments from home, instead of going to the hospital and waiting in lines.

Normand Bilodeau, assistant director of IT at CHUS, pointed out that if there is a wait for a test or service at the hospital, the kiosk can arrange to text the patient on his or her phone, alerting them that the hospital unit is ready for them.

The kiosk can provide consent forms for various procedures, and can also check provincial health cards or take payments from people who don’t have coverage.

An innovator in Canada when it comes to the use of analytics is the province of New Brunswick. Department of Health chief information officer Cheryl Hansen observed that a partnership with Orion Health has enabled providers to pull health data from a wide variety of sources. That’s helping clinicians get the medical data they need for on-the-spot care, but it’s also aiding policy makers.

Hansen asked her team at the department to build dashboard using Google Analytics – a free and easily understandable tool – to analyze the data in the system. That immediately transformed the way they look at information.

“It gives us a real-time look at what’s happening, instead of waiting for reports that are months old,” said Hansen. In one instance, they used a Google Analytics-powered application to examine lab utilization trends.

“We’ve got the infrastructure in place [through Orion] for this,” commented Hansen. “We also have heavy-duty analytics tools, like Cognos and SSRS, but you can actually do a great deal with simple visual tools like Google.

“Once you have the underlying infrastructure, we’ve shown that you can do things without a lot of extra investment,” noted Hansen. However, she did caution that it takes guidance and training to shift employees into using new analytical tools. “It’s a culture change,” she observed.



Cornwall hospital takes technological leap with Sony mobile phones

CORNWALL, ONT. – Cornwall Community Hospital has recently acquired new mobile devices to assist with communications within its complex healthcare environment. As many healthcare workers will attest, it is difficult to find devices that meet the stringent infection control standards of today’s environment, especially when it comes to mobile devices.

The hospital seized an opportunity to exploit new applications developed for the hospital workforce, which required modern communication tools such as email alerts to various clinical and support staff. It was evident at the beginning of the planning process that a smartphone-type of device was required; a tablet or laptop proved to be too large to be convenient for staff, not to mention, these devices lacked the ability to meet infection control guidelines.

Nancy-Ann Bush, manager of Infection Prevention and Control, commented: “From an infection prevention and control perspective, the use of electronic devices in the hospital environment is a challenge. Most of these devices cannot be disinfected with hospital grade disinfectants, and they tend to sustain damage to internal systems from excessive fluid.

“This ‘smartphone’ with its waterproof feature will allow cleaning and rinsing with soap and water,” added Bush. “As always, hand hygiene is the most important factor in the prevention of transmission of microorganisms and all devices should be approached with clean hands.”

It was then determined that in order to leverage the hospital’s sophisticated 300 megabit switched Wi-Fi network, a small portable device with email and Session Initiation Protocol (SIP) clients would be ideal. The SIP client would essentially allow the hospital to add the devices as extensions to the hospital’s phone system, allowing them to make calls free of charge.

Mario Alibrando, director of Information Technology, said: “We are pleased to have found the perfect device that meets our current needs.” The Sony Xperia GO is an unlocked phone sold by Sony Canada. It includes features such as an IP67 rating, meaning it is completely protected against ingress of dust and is water resistant in up to 1 meter of water, immersed for 30 minutes.

The phone comes equipped with the Android 4.0 operating system, and a Sony integrated software package that includes a built-in SIP client. It is sold completely unlocked, meaning that a SIM card or monthly plan through a service provider is not required to operate the device.

The hospital has since implemented the technology that will be utilized for clinical and support staff, including the hospital’s medication reconciliation program.

When particular conditions are met within the HIS Electronic Bed Management software, automated emails will be sent to clinical and support staff. For example, when an isolation cleaning for a patient room is required and entered in the Bed Management system, an automatic email will be sent to mobile support staff via their Sony Xperia GO phones.

This allows for an expeditious turnaround of the patient room that can be measured by the timestamp within the email. The Sony Xperia GO can then be washed under a tap to remove any residual infectious material that may adhere to it.

Jeanette Despatie, chief executive officer (CEO), is excited about this advancement of technology in the hospital. “As a recognized Eastern Counties leader in the provision of exceptional health services, CCH is proud to be the first hospital in Ontario to institute these phones in the workplace.”

She added, “We are always striving to make new improvements in our community hospital while keeping in mind that patient safety is at the forefront of all that we do. The fact that these devices are impervious to water damage and can be cleaned between uses will lessen the chance of spreading infection.”

Perhaps it was designed for the clumsy individual who may drop it in water or expose it to an unusual amount of dust, but it complements the healthcare environment very well. Having these modern devices at their fingertips is sure to simplify some of the complexities in staff members’ everyday tasks.



Physicians, nurses and patients all make heavy use of mobile devices and apps

By Andy Shaw

You might think medical mobility has gone over the top, judging from the 2nd annual Mobile Healthcare Summit, organized by the Strategy Institute and held in a Toronto airport hotel recently.

“Well, I think we are certainly at the tipping point. We know of about 50,000 different apps that have been produced for eHealth already and I think there is enormous promise in that,” said John Mattison, Mobile Healthcare’s moderator in an exclusive interview, just after wrapping the speaker-rich, two-day conference.

Dr. Mattison should know. He is the assistant medical director and chief medical information officer at San Diego’s mammoth Kaiser Permanente health management organization, one of the elite organizations to have achieved the HIMSS Level 7 designation. Currently, Dr. Mattison’s keenest research and development interest is in providing direct-to-provider and direct-to-patient advanced clinical decision support via mobile applications.

“We have developed all these mobile applications, but to date, solid evidence of which one works for whom and why – is what we have been lacking,” said Dr. Mattison. “But what’s really exciting for me is that this year’s conference has shown that’s really beginning to change. And nowhere do I sense it more than from what we are seeing being developed in Canada.”

There was no lack of conference speakers, both Canadian and American, who wanted to present solid evidence of how the mobile applications they had chosen to implement were either improving patient care or boosting provider productivity, or more often, doing both.

The conference’s first presenter, for instance, Mark Farrow, VP and CIO at Hamilton Health Sciences Corporation (HHSC), in Hamilton, Ontario, was the first of the conference’s 16 scheduled presentations to use “BYOD”, an acronym related to making care givers more productive. Farrow presented a case study of how his six-hospital corporation had successfully taken a low-cost BYOD, or Bring-Your-Own-Device approach, to connecting up HHSC’s 1,000 plus physicians using their own already-paid-for iPads, iPhones, BlackBerrys, Androids, and other mobile devices.

On Farrow’s heels came two more case study presentations. One from Dr. Jeffrey Barkun, a professor of surgery and chief clinical officer for technology transition at McGill University Health Centre, in Montreal. Dr. Barkun showed how the combination of a mobile solution using bring-your-own smartphones, and the in-house development of easy-to-use apps, has resulted in quick acceptance by nurses, residents and physicians. That, in turn, has led to more efficient access to information at the point-of-care.

Next, Californian Benjamin Kanter MD, chief medical information officer (CMIO) at Palomar Pomerado Health (PPH) in San Diego, related how a mobile device-agnostic approach to the hospital’s Medical Information Anytime Anywhere project to enhance the workflow around PPH’s established EHR, had improved both physician practices and patient care. Interestingly, Dr. Kanter’s team has partnered with a private sector firm on software development, and the company will be commercializing the system in the near future.

Dennis Giokas, chief technology officer (CTO) for Canada Health Infoway, formally opened the conference with a keynote address on “Enhancing the Patient Experience Using Mobile Solutions.” He gave context to the whole conference by citing the “nexus” of four powerful forces that have converged to give modern computing a new digital, development-shaping environment: information, mobile devices, social media, and cloud computing.

This nexus, he said, is “breaking medicine out of its cocoon”, with a tip of the hat to author Dr. Eric Topol and his book along these lines, The Creative Destruction of Medicine. And Giokas had some surprising Canadian numbers to back that view up.

“When we look at mobile computing in healthcare today, we know that: 67 percent of Canadian family physicians now own smartphones; and 82 percent have used them for drug references; and 50 percent for clinical decision support. We also know that 30 percent of physicians now own an iPad with the majority of them, some 62 percent, using it for professional purposes,” Giokas pointed out.

On the learning, social, and collaborative media fronts, Giokas reported that from their mobile devices: 52 percent of physicians have visited the website of Medscape (for news and continuing medical education credits); 44 percent of doctors belong to SERMO (largest physician exclusive online community); and the top downloaded apps by Canadian docs are Epocrates (drug interaction news and references), Lexi-Comp (pharmacology, dental, dosing, adverse reactions), MedCalc (clinical, bioscience calculator), Medscape (medical news, journals), and Skyscape (multiple resources for doctors, nurses, and medical students). And all function comfortably on iPads, iPhones, Androids, and BlackBerrys, among other mobile devices.

“Doctors are using mobile apps like these and online physician communities with the goal to confer, refer, and learn from the experts,” said Giokas.

So clearly our doctors are no longer technology Luddites. Nor are hospital accountants and other healthcare bean counters as skeptical as they once were about mobile technology’s promise to save gobs of money.

“We do know, of course, that in the past systems that were put in and expected to save a lot of money, have actually cost money, but a Deloitte study still suggests there will be some very significant savings in the not-too-distant future,” said Giokas. Just take what Deloitte predicts remote patient monitoring alone can save the U.S. healthcare system: $195 billion over 25 years – if remote patient monitoring is put in place effectively.

A similar “if” applies, Giokas pointed out, to remote patient monitoring benefits to patients: a 25 percent drop in care costs for the elderly; a reduction of 30 percent in maternal and pre-natal mortality rates; double the number of rural patients who can be reached by a doctor, and costs related to medical data collection could fall 24 percent.

But those dramatic percentage shifts pale, Giokas later pointed out in his presentation, compared to the public’s and patients’ interest.

“The records show that the number of people world wide who downloaded a health app went up from 124 million in 2011 to 247 million in 2012,” said Giokas. “That means the downloads nearly doubled in just one year!”

Numerous real-world case studies of mobile health successes were also on the conference agenda, including what the Innovation Acceleration Program at Boston Children’s Hospital is achieving, presented by Naomi Fried, Chief Innovation Officer.

Joe Cafazzo, the engineering lead at Centre for Global eHealth Innovation in Toronto, told of what the Centre has figured out both physicians and patients can do best with mobile apps.

Three presenters unveiled to the conference how mobile devices have boosted productivity and care for mental health patients at the London Health Sciences Centre in London, Ontario. And near the end of the second day, Ida Sim, PhD, a professor of medicine at the University of California in San Francisco, revealed how she researched and then founded Open mHealth. It’s an open-architecture initiative that conference moderator John Mattison believes will push device development beyond its current tipping point and make mobile healthcare truly pervasive.

“There’s no doubt that, until recently, we have been living in the wild, wild west of mobile care, with a lot of snake oil and false promises,” concluded Dr. Mattison. “But now we are beginning to see a number of very good apps rising above the others and really demonstrating their clinical, social, and financial value.”