Solutions for self-care, community care shown at eHealth

By Jerry Zeidenberg

VANCOUVER – Vendors at the eHealth 2008 conference and trade show, held here in May, were prominently displaying computerized solutions for self-care and community care.

That was an appropriate development, considering the conference planners were consciously hoping to widen the scope of the event – which has traditionally focused on institutions such as acute care hospitals and nursing homes – and had even proclaimed the theme as, ‘Extending the Reach’.

As you walked through the doors of the show floor, you were likely to run smack into the Telus booth. There, the telecom giant was demonstrating an extensive community care solution that’s now offered across Canada through an alliance with New Zealand-based Healthphone. The application provides home care nurses with instant, wireless access to the records of their patients – on PDAs such as BlackBerries, as well as on tablet and notebook PCs.

It’s currently being rolled out by home-care agency Closing the Gap in the Toronto area, and at the time of writing, Healthphone was in discussions for a rollout of the system with a large health region.

“It gives you paper-free communication and access to the electronic health record,” commented Jan Carter, a senior consultant with Telus. It also allows the visiting nurse to make notes once at the point-of-care, instead of re-keying them when back at the office, she added.

Such wireless solutions can make a dramatic difference in the working day of a visiting nurse – both in the ability to access information quickly and to give the appropriate care to patients, without delays.

For example, instead of driving to a central office to pick up eight or more paper files each day, a nurse can log-on to the system from her home to securely view her workload and the related patient records.

While at the patient’s home, she can continually monitor the record – obtaining new results in real-time, as other caregivers make additions to the chart. For instance, a test result may be sent by the lab while the visit is in progress, providing the nurse with up-to-the-minute information.

Referrals can be sent in this paperless way, too. “You could send a referral on to a nutritionist and include all of the relevant notes,” said Carter.

Wound care is an important part of the solution – the Healthphone system contains the award-winning WebMed wound care system that was developed by British Columbia physician Jonathan Burns. Indeed, Healthphone is now the global distributor of the WebMed, wireless wound-management system.

On a related note, Telus and Healthphone are now bringing out a new set of solutions in Canada that will focus on health-related behaviour management problems. The first one focuses on smoking cessation, and will initially be used to help smokers at Telus kick the habit. The program – called STOMP – goes live in June; it will then be offered to other organizations and health regions with an interest in getting their smokers to butt out.

The system uses wireless alerts on cell phones, BlackBerries and computers to deliver reminders, alerts and advice. “It’s usually a matter of keeping in close communication with people trying to quit smoking, giving them encouragement when they need it, and continually reinforcing the behaviour they’re aiming for,” commented Matt Hector-Taylor, president and founder of Healthphone, based in Auckland, New Zealand.

Hector-Taylor noted the platform was originally devised at the University of Auckland, and has been tested in New Zealand with positive results. He said the system has been licensed and further developed by Healthphone, and could be used for a wide variety of conditions and issues.

The biggest presence on the show floor was that of Bell Canada. Among other solutions, the company was showing an advanced new system for home and community care that it’s offering in conjunction with IgeaCare Systems Inc., of Richmond Hill, Ont..

The Bell/IgeaCare solution is designed for both the visiting nurse and for self-care by patients and their families.

It runs on a variety of hardware, such as BlackBerry PDAs, tablet and notebook PCs, and various medical devices can be used with it – such as blood pressure cuffs. There’s no need to plug-in these devices, as they use Bluetooth, the short-range wireless technology, to connect with the computerized device.

The application can be used to monitor vital signs, manage nutrition, set up exercise plans, monitor weight and set medication reminders. It also supports video visits.

Results can be transmitted automatically and wirelessly to the patient’s caregiver – such as a homecare centre or doctor’s office. The caregiver can be alerted if certain variables are too low or too high – for example, when a patient’s blood pressure is consistently too low.

Low blood pressure could mean that a patient’s heart medication is incorrect, leaving him or her in danger of falling and suffering broken bones. By catching this kind of issue early, the patient and care-giver work in tandem to prevent serious problems from occurring.

Interestingly, Bell has launched a program in which it will underwrite the costs of healthcare groups that wish to test the system, to a maximum of six selected projects. As a bundle, Bell is offering 20 BlackBerries, data connectivity free of charge for three months, the Healthanywhere software application (www.healthanywhere.com) from IgeaCare, professional services for project design and implementation, and support to enable health monitoring.

However, it is requiring that participants themselves invest $5,000 in the program. “We’re looking for serious participants, and that’s more likely to happen if you’ve made a commitment, no matter how small it is,” commented John Anders, senior director, business development, for Bell Canada.

On another front, Agfa HealthCare announced new inroads in community care. The company has been scoring success among hospitals with a portal solution that connects disparate electronic record systems. It has now implemented portals at all hospitals in Ontario’s LHIN 5 and 6.

Now, it’s widening the reach of portals into the nursing home sector. Recently, the Yee Hong geriatric centre, in Toronto, started using an Agfa portal solution to access electronic patient records at the Scarborough General and Scarborough Grace hospitals. This will enable its administrators to quickly obtain the charts of patients who are coming for care – and doctors and nurses will be able to see lab test results, medication records and assessments.

“It’s being set up so that the nursing home staff can only see the records of patients who are going back and forth between the hospital and the long-term care centre,” noted Dieter Pagani, director of enterprise systems for Agfa Canada. “Privacy is a very important issue.”

Pagani noted that regional portals are an excellent way of tying nursing homes and acute care hospitals together, since most of them operate on different types of electronic health record systems.

Often enough, nursing homes are not yet as far along as acute care hospitals in the use of the electronic health record. In an interesting twist, Agfa – which is itself known for providing large-scale systems to acute-care hospitals – soon plans to pursue the long-term care sector, and will market its Orbis EHR to nursing homes. “Orbis is very strong on nurse charting and notes,” commented Pagani. “It make sense for them to use it.”

Also on the community healthcare front, Anyware Group, of Saint John, N.B., is about to start piloting a chronic disease management solution – targeted at diabetics – at two sites, the Atlantic Health Sciences Corp. in Saint John and Huron-Perth Healthcare Alliance, based in Stratford, Ont.

Anyware Group is the creator of the ROAM platform, (Role Oriented Access Management) which is now implemented in 60 hospitals throughout North America. ROAM allows users to access records in hospitals and clinics, anywhere, anytime, using a secure, hosted portal system and a common interface.

The chronic disease management systems will extend use of the system to patients and members of their families, enabling them to access certain records (those permitted by physicians and other caregivers).

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RIS development group in PEI has become a global success story

By Jerry Zeidenberg

SUMMERSIDE, PEI – It always surprises people when they find out that a team of software engineers in Canada’s smallest province is winning large-scale contracts around the world for their advanced healthcare systems.

The Carestream Health group, in Summerside, PEI, has emerged as a leading developer of Radiology Information Systems (RIS). Earlier this year, it was recognized for its success, winning an award for ‘fastest market penetration’ from high-tech market researcher Frost & Sullivan (www.frost.com).

Recently, the group snagged as customers all of the health trusts in Scotland, and it’s now supplying the RIS for the leading-edge Cedars-Sinai Medical Center, in Los Angeles, Calif. – one of the top acute-care hospitals in the United States.

Overall, it now has a base of 600 organizations that are using its RIS worldwide, including 20 sites in North America. The crew in PEI provides ongoing service and support, and conducts leading-edge R&D from the island, working hand-in-glove with the company’s PACS team in Israel and archive developers in France and Rochester, N.Y.

For its part, Carestream Health is based in Rochester, where it was spun-off from Kodak. In May 2007, Carestream was purchased by Toronto-based Onex Corp., which is headed by high-profile Canadian entrepreneur Gerry Schwartz.

As worldwide director of RIS research & development David Perry points out, geography is no longer a barrier. Using high-powered telecommunications networks, along with remote control software and simulations, much of the support work can be done from a distance.

What’s critical, of course, is the brainpower needed to create the cutting-edge applications. Carestream seems to have attracted that talent, growing from an original core of seven people in the year 2000 to over 55 today.

Many of them, notes Perry, are Maritimers who have worked far from home and are eager to return, often for quality of life reasons.

“We’ve got people who’ve worked in Silicon Valley, as well as in Ontario and in Western Canada, and they’re coming back with new ideas and skills,” comments Perry.

The Carestream Health centre, moreover, has developed its own home-grown expertise. And it uses a software development methodology known as the ‘agile’ system, which allows it to respond quickly to the ongoing needs of current customers, even as it develops new versions of its RIS software.

Recently, the company won its first RIS customer in Canada – an independent imaging clinic in Pierrefonds, Quebec, on the island of Montreal.

Perry points out that the RIS marketplace – until recently regarded as a mature sector with slow growth – is currently booming, thanks to two important factors.

First, new intelligence is now being built into RIS. That’s causing customers in hospitals and health corporations to upgrade, so they can take advantage of these new features. “There’s a big replacement effort going on in hospitals right now,” comments Perry, explaining that the new generation of RIS have interfaces to scores of hospital systems, such as PACS, laboratory information systems and scheduling systems.

He notes that in many hospitals, radiologists have to physically get up and log into different computers to access PACS, let alone lab or other components of the hospital information system.

Having the ability to tap into various hospital systems, from a single workstation, is a big time-saver, and can have a dramatic impact on the productivity of radiologists. “Some hospitals have told us that this feature alone is worth the investment in a new RIS,” said Perry.

Carestream Health is currently working on Version 11 of its RIS, which will be ready for market in the fall of 2009. It’s being built on the Oracle database using Microsoft’s .Net framework. Perry explains that .Net is allowing the team to answer the market’s demands for web-based applications, while still including features that aren’t typically found in web-based systems, such as voice-recognition and biometric security.

A second driver of the growing RIS market can be found in independent imaging clinics. These clinics operate outside the walls of hospitals, but typically conduct a huge number of diagnostic exams – about 50 percent of the total number of medical images in Canada.

Until recently, they haven’t bothered with PACS or RIS, which have been too expensive for them.

However, the prices of imaging systems and PACS have dropped in recent years. Moreover, Carestream Health intends to grab a portion of that market with its Version 11 RIS, which will be available as a hosted application, also known as an ASP.

For example, the turnkey cost for a centre doing up to 15,000 exams per year will be approximately $80,000 – software and hardware included.

There will be no need for investment in storage or networking infrastructure, as Carestream Health will be able to handle that from a data centre. This should eliminate most maintenance headaches for clinics.

“A lot of clinics simply haven’t had the infrastructure or the support to handle PACS and RIS,” commented Sean Booth, manager of RIS research and development for Carestream Health.

“It’s often the doctor’s nephew taking care of the computers at these centres,” he quipped, adding that in these scenarios, there’s no way the radiologists wanted to start supporting advanced hardware and software applications.

A hosted environment, however, removes both the barriers of cost and support. “They’ll have no big capital expense up-front,” said Booth.

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Performance measurement tools improve service in community care

By Dianne Daniel

Whether providing a ‘dashboard’ for managers or an integrated website for members of a local health integration network (LHIN), Ontario community care access centres (CCACs) are ramping up efforts to optimize performance, and it’s all about getting key information to decision makers at the right time.

“One of the things we’ve been trying to really drive is a culture of accountability and using information to guide decision-making,” says Perry Doody, senior director, performance management and accountability, at the Central CCAC in Newmarket, Ont.

For the past year, the Central CCAC has been working with ABS System Consultants, of Toronto to implement performance measurement technology, including Metrics3D, a business intelligence tool developed by ABS specifically for non-technical users. The goal is two-fold: on one hand the CCAC is working to improve its interaction and integration with service providers, including members of its LHIN; on the other hand, it is building an internal scorecard to track its own service delivery targets.

To facilitate the sharing of information between the seven hospitals in its LHIN, for example, the Central CCAC has established a web-based business intelligence solution that provides key information about alternative level of care (ALC) patients, who are waiting to transfer from a hospital bed in an acute care facility to either a long-term care (LTC) home, rehabilitation program or continuing care at home. The CCAC uploads information about long-term care waiting lists, while each hospital enters its own data regarding ALC-designated patients.

“We wanted to create something that would be readily available and would provide a basis for having a more informative discussion,” says Doody. A common misconception, he adds, is that the reason for the high number of ALC patients is primarily due to lengthy long-term care wait lists. However, as soon as the web-based tool started to collect data, it became clear that there was more to the issue, he says.

“Waiting to go into a home accounted for about 40 percent of the ALC problem,” says Doody, noting that the other 60 percent was related to rehabilitation facilities and continuing care. “Was this a self-interested type of initiative? In a way, but what we’re hoping for is that the system can benefit from it.”

The ALC website took two months to implement. In addition to helping the LHIN to pinpoint the real pressure points in the system, it also prevents information from slipping through the cracks.

“The daily updated information allows them to expedite the process by making sure the nursing homes are aware that there is a patient waiting ... and that the CCAC is aware that the hospital has an ALC patient waiting to go, whether to a nursing home, mental health or rehabilitation facility, or back home with support services,” says Steve Grosfield, director, healthcare practice, ABS System Consultants.

Another initiative at the Central CCAC is the rollout of Metrics3D to its internal management team. The Central CCAC uses Metrics3D to measure 18 performance indicators related to what Doody refers to as the four ‘c’s’: culture, case management, collaboration and customer service. Through a simple point-and-click interface, users can manipulate customized reporting templates and results are displayed in highly visual three-dimensional graphics.

For example, one indicator tracks the time from when the CCAC receives a referral to when a client is visited at home. “We just published our scorecard for the last year and we actually decreased our time by 80 percent,” says Doody. “What’s really compelling is we just didn’t track it from an organizational perspective; we tracked it by type of service – how long does it take to get a nursing visit, how long does it take to get a therapy visit – and we’ve seen it decline month after month.”

Another indicator tracks how long it takes to place a client in a long-term care home from a hospital setting. “We chose that one because some of the contributors are beyond our control, but we do believe it’s an indicator of system integration – how well we are working with the hospitals and long-term care facilities,” he notes.

While reporting on data isn’t new, what is “revolutionary,” says Grosfield, is that Ontario’s CCACs are able to integrate disparate sources of information in a dynamic reporting environment, something he considers a real feat given that the 42 regional centres recently amalgamated into 14.

“When they tried to amalgamate the information retrained in the legacy systems of their former branch CCACs, they were finding real apple-to-orange issues and they just couldn’t synthesize the data to turn it into useful information,” he says.

Jamie Stevens, quality manager at the Champlain CCAC in Ottawa, knows firsthand just how complex that process can be. Created by the amalgamation of four community care organizations in January 2007, Champlain is currently in the process of “refreshing” its performance monitoring application and expects to re-launch it later this year.

“It’s been a bit of an issue to really bring the data together,” says Stevens, explaining that each CCAC had a different database for its client system.

Like Doody at the Central CCAC, Stevens uses the Metrics3D tool to make it easier for managers to track a pre-determined set of statistical and financial indicators, using its drill-down reporting capability to better understand the information presented. He is currently looking at integrating quality measures into the tool so that the CCAC can begin to track relationships between data sets as well.

For example, a quality measure may be the resident assessment instrument (RAI) used to monitor patient outcomes in home care and long-term care environments. Another may be a client satisfaction survey. “Now I can start to see whether there’s a relationship between the quality indicators and perhaps some of our efficiency measures, such as the number of dollars we’re spending per client per month,” says Stevens. “If that starts to go down and our quality remains the same, then we know we’re being more efficient with our dollars while maintaining care.”

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