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Inside the February 2006 print edition of Canadian Healthcare Technology:


Feature Report: Developments in diagnostic imaging


Northern Health docs set the pace for EMR adoption

Low-cost access to a high-speed network is spurring doctors in British Columbia’s Northern Health Authority to log-on to the system and adopt electronic patient record systems at a torrid pace.

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New technologies unveiled at annual RSNA meeting

Diagnostic imaging professionals from around the globe flock to the annual Radiology Society of North America conference, eager to learn about new technologies, procedures and industry developments.

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Regional scheduling for docs

Sudbury-based Chyma has devised a web-based scheduling system that dramatically improves scheduling and tracking of physicians who work at multiple sites across a region. The solution is being used across Ontario.

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Reporting system for cancer

Cancer Care Ontario recently won gold at the CIPA awards for an application that speeds up the collection of critical information by a factor of four, and reduces costs dramatically. It also ensures that higher-quality stats are obtained. 

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Telepharmacy boosts safety

Hospitals in Northern Ontario are alleviating the shortage of pharmacists by making use of a tele-pharmacy solution. A pharmacist in the Ottawa area can review medication orders remotely by using a virtual private network. It’s technologically simple, but effective. 


Interview: Greg Feltmate

Reporter Andy Shaw converses with Greg Feltmate, CIO of Vancouver Coastal Health – one of Canada’s largest health regions, with 14 acute-care hospitals and other facilities.


PLUS news stories, analysis, and features and more.

 

Northern Health docs set the pace for EMR adoption

By Jerry Zeidenberg

Low-cost access to a high-speed network is spurring doctors in British Columbia’s Northern Health Authority to log-on to the system and adopt electronic patient record systems at a torrid pace. Over 90 percent of the region’s doctors were expected to be online by the end of 2005, and over 50 percent are using some form of electronic medical records.

That compares with most estimates of 10 percent EMR adoption by physicians in Canada and the United States.

It helps that local physician leaders have encouraged the trend, along with regional healthcare executives. Indeed, the Northern Health authority – one of six regional health authorities in British Columbia – recently took upon itself the task of building a network that would deliver ‘last mile’ high-speed connectivity to doctors’ offices throughout the region, an area bigger than France.

With just 445 doctors spread across Northern Health, getting broadband to the physicians’ offices was a dilemma – as it is in most rural areas. But Northern Health solved the problem using a made-in-Canada solution.

When dropping fibre to doctors’ offices is too expensive or troublesome, Northern Health is employing a microwave technology from Wi-Lan, Inc., of Calgary. The microwave system beams high-speed signals from base stations to physician offices and back again, often over long distances.

It’s a licensed wireless technology that operates in the 3.5 Gigahertz frequency. When hooked up to the doctors’ offices, it delivers real-world throughput of up to 12 megs/second, fast enough to support instant downloads of web-based information and easily able to support applications like videoconferencing.

The broadband network that’s now fanning out across Northern Health, a project dubbed Physician Connect, offers a whole host of benefits.

Not only do the doctors obtain high-speed internet services, but the network is basically a closed system, or intranet, that comes with three layers of security. Those security features take a load off the minds of many doctors who are worried about patient information floating around the internet.

It’s also simple to use.

“With respect to connectivity and authentication, we treat the doctors just like staff members,” says Joseph Mendez, chief information officer for Northern Health. “Like everyone else, they log-on with a user name and password, and they’re authenticated and gain single sign-on to the Northern Health network.”

Doctors can obtain access to Northern Health’s help desk and I.T. support services, in case they’ve got a snag with their network connectivity. It’s re-assuring to know that help is just a phone-call away.

A key feature of the system is that it’s relatively low-cost. Northern Health used a $1.2 million contribution from the federal government’s Primary Healthcare Transition Fund, funneled through the province, to foot the bill for the wireless infrastructure.

Mendez salutes the province, too, for its support of the Physician Connect project. It’s a one-time investment in equipment that will provide service to the region’s doctors for at least 10 years.

The on-going operating costs, to pay for the wireless spectrum rental, are cheap – about $25 per month per doctors’ office. If there are five doctors at a site, they simply split the $25 monthly fee – about $5 a month for each physician.

That compares with the typical $50 monthly bill that an office would otherwise pay for a DSL or cable line in a large city.

The broadband network has proven to be a springboard for the use of electronic solutions by docs in Northern Health.

For example, Northern Health’s physicians have become heavy users of the provincial online toolkit for chronic disease management. (More information about the system is available at www.healthservices.gov.bc.ca/cdm/cdminbc)

In brief, the toolkit is a web-based service that allows doctors to maintain electronic records for their patients presenting with chronic diseases, “in addition to paper-based records and memory,” comments Paula Young, project manager for Northern Health’s Physician Connect program.

She adds that the toolkit also keeps track of patient information for a variety of chronic medical conditions, tests, medications and recalls, as well as protocols for the best care.

Uptake of the toolkit by Northern Health physicians stands at 63 percent. That compares with just 17% when looking at the province as a whole! Access to a high-speed, secure network is given a good deal of the credit, as the docs can access records quickly and securely.

The CDM toolkit covers a limited number of diseases and conditions, but has been an excellent introduction to using technology in the medical practice. Seeking a more comprehensive solution, Northern Health’s docs have also embraced full-fledged EMRs to an astonishing degree. Again, access to a low-cost, high-speed communications network is cited for spurring the use of yet another electronic solution.

“Secure, reliable, fast internet access is a prerequisite to having an electronic health record,” says Terrace family practitioner Dr. Bill Redpath.

About 50% of the physicians currently using the high-speed network are also using full-bore electronic medical record (EMR) systems. That compares with industry estimates of just 10% for doctors across Canada and the United States.

Paula Young noted that most of Northern Health’s physicians use a solution from local supplier MedOffIS,which is based in Prince George, B.C. (See http://www.pgfamedres.bc.ca/mois/moisindex.htm)

A few other systems are also being used, almost all of them developed in Western Canada. They include Wolf Medical Systems Corp., of Surrey, B.C., Osler Systems Management Inc., of Sidney, B.C., Jonoke Software Development Inc., of Edmonton, Clinicare of Calgary and Montreal-based Purkinje of Montreal (which recently merged with Wellinx, of St. Louis, Mo.)

MedOffIS is developed and implemented by Prince George physician Dr. Bill Clifford, who says the emergence of the secure, broadband network has done wonders for the uptake of EMRs and usage of online resources.

“As a result,” says Dr. Clifford, “adoption of the technology has blossomed. Fifty percent of primary care practitioners in the Prince George area use an EMR, with no subsidy other than that provided by the NHA for the network infrastructure.”

Dr. Clifford and his colleague, Dr. Redpath, are no doubt correct in saying the high-speed network has stimulated the rapid uptake of electronic solutions. But other areas of Canada have had this infrastructure for years, yet their physicians have been slow to adopt computerized applications.

In addition to the high-powered infrastructure, you’ve got to credit the healthcare leadership in Northern Health – they include Dr. Clifford, Dr. Redpath, the staff at the Northern Health authority, and CEO Malcolm Maxwell and many others – with believing in the technology and convincing physicians across the region to use it.

As well as the provincial toolkit for Chronic Disease Management, high-speed networking allows for access to tools such as UpToDate Online. Decision-support systems of this sort give rural physicians, like those in Northern B.C., a quick second-opinion on many difficult medical issues. That kind of feedback might take hours or days to obtain by traditional means, such as phoning or even emailing colleagues.

UpToDate Online (www.uptodate.com) is a web-based service that answers clinical questions that arise in daily medical practices, including information pertaining to 15 different specialties such as pediatrics, cardiology, oncology and infectious diseases.

Young observed that decision support tools like UpToDate really only become feasible for a doctor when he or she has access to high-speed services.

By tapping into the hospital portal, the physicians can now obtain access to diagnostic images in Northern Health’s Picture Archiving and Communication System – its repository of X-rays, CTs and other scans. Those test images currently reside in PACS supplied by Agfa and McKesson.

What’s more, in 18 months, when Northern Health will convert its current electronic record systems over to leading-edge Cerner applications, the docs will begin to have access to lab reports, pharmacy records and general electronic medical records.

That information – such as lab test results and discharge summaries – currently takes days or weeks to arrive by fax or mail. Once the electronic connections are in place, it will be available in seconds.

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Technology developers, integrators provide enlightenment at RSNA

By Jerry Zeidenberg

CHICAGO – Major developers of radiology systems always save a few big announcements for the RSNA conference. It’s a good strategy, since they’re vying for the attention of 60,000 attendees, all of whom are being wooed by vendors claiming the latest and greatest.

The Radiological Society of North America’s annual convention was held at the end of November, with imaging and IT professionals streaming to the McCormick Centre like pilgrims on the haj to Mecca.

They were enlightened about breakthrough technologies and landmark contracts. But some of the more interesting announcements were on the organizational side – essentially, new and improved solutions for moving imaging and IT systems into hospitals and health regions.

Project Management. These solutions address the big picture. They recognize that diagnostic imaging isn’t just a matter of technology. Rather, getting DI up-and-running also involves people, communication and project management.

For its part, Philips announced that it has appointed a manager of ‘customer satisfaction’, with responsibilities for North America. Based in the Seattle area, the manager is coordinating teams in Canada and the United States to ensure that feedback from hospitals is dealt with in a timely manner. “We’ve created a high-level focus on customer satisfaction,” said Brent Shafer, president and CEO for Philips Medical Systems, North America.

Philips has been winning large projects in Canada of late, including a $70 million deal to supply Capital Health in Alberta with DI solutions, and a $20 million contract with Quinte Health in the Belleville area of Ontario for PACS and modalities. As big projects proceed, said Schafer, it’s important to make sure that any snags are dealt with quickly and effectively.

“There’s no shortage of data,” commented Carl DeCoste, VP of customer service for Philips Medical Systems in Canada. “It’s a matter of making it meaningful and responding quickly.”

John Cieslowski., vice president of sales and marketing for Philips Medical Systems Canada, added that the company is now “formalizing the customer satisfaction process. We’re making it key.”

Also addressing enterprise-wide issues, Siemens has recently launched a group that’s helping hospitals and health regions in North America devise whole strategies about re-tooling workflow through the use of new IT and diagnostic imaging solutions.

Headed by Tom Giannantonio, regional director of global solutions for Siemens Medical Solutions, the group is already working with several Canadian hospitals, including William Osler Health Centre, in Brampton, Ont. Giannantonio explained that Siemens is helping organization ‘re-think’ the hospital, so that patients and data move more efficiently around the facility, ultimately resulting in better patient care.

“We’re focused on workflow planning and improving the performance of organizations,” he said. “We’re embracing IT as an enabling technology, for better quality, safety, outcomes and speed.”

Andy Hind, vice president of Siemens Canada’s medical solutions division, noted that the time is ripe for this kind of re-engineering of the hospital world, as there’s currently an extraordinary amount of hospital expansion and re-development going on. New hospitals are being built – such as a major facility in Brampton – and old hospitals are demolishing wings and implementing new systems.

Contracts: On the implementation side, several major Canadian and international deals were publicized during the RSNA show.

Nova Scotia announced that it would purchase six MRI scanners from GE Canada, with several of them to be installed in rural locations. Not only is Nova Scotia increasing its capacity for MRI scanning, it’s also putting them closer to patients, so they don’t have to travel to Halifax for diagnostic imaging.

New units will be installed in Kentville, New Glasgow, Yarmouth, and Antigonish once renovations, human resource plans, and community funding are in place. The remaining two units will replace existing MRIs at the QEII Health Sciences Centre in Halifax.

The province set aside up to $12.5 million for this purchase, which was made possible through the 2004 First Ministers Meeting Accord funding for medical equipment. Each district health authority that’s receiving equipment will also contribute about $750,000 toward its MRI purchase and installation.

Also in late November, Agfa announced that its new IMPAX 6.0 PACS had been selected by Niagara Health for use in the eight-hospital network. It’s the first Canadian implementation of Agfa’s latest PACS technology.

In the case of Niagara Health, it will be used for the acquisition, storage, and distribution of more than 300,000 exams and reports generated annually.

The system is web-deployable and includes a Voice Recognition solution to automate the reporting process. As well, Niagara Health will utilize Agfa’s CR (Computed Radiography) technology to acquire and process digital X-ray images.

Interestingly, Kodak announced that it had won its biggest-ever PACS contract – a multi-million dollar deal to supply Scotland with a nation-wide PACS. Specifically, the solution will deploy Kodak’s CareStream PACS to 39 hospitals across the country and connect to a further 67 satellite centers with X-ray departments, overall managing an estimated 3.2 million exams annually.

PACS images will be archived centrally at two data centers, serving the 16 health boards across Scotland. Implementation will begin with the Southern General Hospital in Glasgow, which includes the Institute of Neurological Sciences and the Victoria Infirmary. A phased roll-out will follow over the next 2.5 years with full deployment anticipated in 2008.

Computed Tomography: There was lots of excitement about CT at the RSNA. Philips announced a new innovation called Halo – a system that eliminates the need for a separate control room. Instead, the system introduces a curved, motorized shield that moves into place when needed. As a result, the technologist can stay in the room with the patient – reducing the time and trouble needed to take exams, and saving a good deal of real estate.

The folks at GE Healthcare were also touting CT. In fact, the company had installed over 500 units of its 64-slice machine, the LightSpeed, from the time it started shipping in early 2005 until the RSNA. “The big driver has been non-invasive cardiac imaging,” commented Scott Schubert, global product manager for CT.

He noted the device enables physicians to conduct a heart exam in 5 seconds, giving radiologists and cardiologists the opportunity to quickly check on coronary artery disease and the health of valves.

A work-in-progress, said Schubert, is adaptive CT. In the future, the system will synchronize to the patient’s heart rate and anatomical changes. This means that in the case of patients with arrhythmia, the device can sense the problem and re-scan the same area. As a result, the physicians get the images they need. Moreover, a new dose control system means the dose is reduced by a factor of three. “The dose only occurs during the resting stage [of the cardiac exam], said Schubert.

On a related front, GE released a new BrightSpeed CT model, capable of acquiring 4, 8 or 16 slices in a gantry rotation. Schubert explained that not every centre needs a 64-slice machine. For them, the BrightSpeed is a much less expensive option (about US$400,000 to US$800,000 vs. US$1.5 million or more for the 64-slice LightSpeed.) What’s more, the BrightSpeed is smaller, which may also appeal to centres that have space constraints.

Siemens, for its part, unveiled a new CT technology – what it dubs the world’s first dual source computed tomography (CT) system. According to the company, the scanner uses two X-ray sources and two detectors at the same time, compared to all other CT systems that use only one source and detector.

On the technical side, with 0.33 seconds per rotation, electrocardiogram- (ECG) synchronized imaging can be performed with 83-millisecond temporal resolution, independent of the heart rate, resulting in motion-free cardiac images.

Siemens says that its SOMATOM Definition will image patients with high or irregular heart rates, or even arrhythmia, without beta-blocker medications that have been previously needed to slow a patient’s heart. The system also enables physicians to better identify and characterize plaque, an early indicator of heart disease.

The first U.S. installations are expected to take place in early 2006 and will include the Mayo Clinic, in Rochester, Minn., the Cleveland Clinic Foundation, and New York University Medical Center.

Many of the CT vendors at the show – including Siemens, GE and Philips – are devising technologies that allow physicians to simultaneously image hard and soft tissue, something that has been difficult to do in the past. For its part, Philips currently has a pilot project under way in Israel.

On the CT side, Canadian innovator Dr. Stergios Stergiopoulos demonstrated a system that he devised in conjunction with the National Research Council of Canada. The signal processing technology provides motion correction for existing CT scanners, enabling physicians to capture better studies of difficult-to-image patients. These include patients with arrythmias, fidgety children or the elderly with conditions like Parkinson’s or Alzheimer’s disease.

The technology is available through Dr. Stergiopoulos’s company, Canamet Inc. of Toronto (www.canamet.com) or his U.S. distributor, Block Imaging International Inc., at www.blockimaging.com

Dr. Stergiopoulos also demonstrated a device for acquiring accurate blood pressure readings of patients in harsh or noisy environments, such as air ambulances, sports arenas or military zones. (The system has been licensed by the U.S. Department of Defense.) The electronic Piesometer MK-1 incorporates a noise and vibration cancellation technology, meaning that patients can talk or move and an accurate reading can still be taken. Moreover, the computerized nature of the device allows readings to be captured and stored as an electronic record. The system also has potential use in ERs, ICUs and for home care.

CR: There was a quite a buzz about CR at the RSNA this year, particularly in the area of mammography, where high resolutions are required for accurate exam readings. In Canada and U.S., Computed Radiography hasn’t yet been certified for mammo exams. But it appears that the go-ahead is not too far away, and the vendors are revving-up for it.

For its part, Fuji Photo Film demonstrated a ‘cassetteless’ CR system with resolution equal to that of DR. The system produces up to 270 images per hour, with images available on a console in seven seconds. Systems will be available in upright and table versions.

Fuji showed another interesting CR system, one that uses cassettes and imaging plates. Called the Profect CS, it features high productivity and is actually three imagers in one – providing normal resolution capabilities for general X-ray, and high resolution for pediatric and mammography use. It uses different types of plates for the various kinds of exam and has the ability to automatically recognize each.

Medical centers could conceivably use this system, with its triple capabilities, as a workhorse for a wide range of applications – including mammography, once it achieves approval from regulators.

Agfa was also touting a new, faster CR-based technology with DR resolution, albeit one with plate handling. Indeed, a unit has already been installed at the Credit Valley Hospital, in Mississauga, Ont., and more are to be implemented in the coming months.

Lenny Reznik, director of image and information solutions for Agfa Healthcare, North America, explained that when using Agfa’s Needle Phosphor technology, “you can cut the dose in half, or keep the dose the same and obtain higher resolution.” Agfa also plans to offer a ‘cassetteless’ CR technology in the near future. For its part, Konica highlighted a new CR technology for mammography, one that attains very high resolution – 43.75 microns with 20 line pairs. Konica is also awaiting approval for the systems in Canada and the United States.

According to Konica, the system produces digital pictures with the same resolution as film screen images. It provides the benefits of digital radiography at about half the price of digital radiography (DR) for mammography.

Kodak, too, showed CR mammography systems that are currently in clinical trials in the United States and Canada.

PACS: Kodak demonstrated an entry-level image system that’s aimed at independent clinics or small radiology departments that are interested in better management of their images, but aren’t quite ready for a full-fledged PACS.

The software is said to be ideal for short-term storage of images. On the viewing side, it provides templates for a variety of layouts. A terrific feature is its ability to print images to virtually any printer, according to the team at Kodak. This is especially useful for departments or clinics that are printing a lot of images for referring physicians, surgeons and specialists.

Instead of pulling films, scrambling to find them or waiting for them to be returned, staff members are able to quickly call up exams and print them in a desired format.

“It’s ideal for simple image management, and for centers doing a lot of printing,” said Dan Bartlett of Kodak. “It’s also a stepping stone into PACS, or a useful quick solution for those who already have a PACS.”

The software is available in three flavours: a free ‘lite’ version; a mid-tier system with an HIS/RIS interface(10 licences per server cost US$5,000); a third version with a CD/DVD publishing component (available for less than US$15,000).

On the PACS side, Philips demonstrated tight integration of the iSite PACS it acquired from Stentor with the Epic clinical systems it offers. The comprehensive solution is known as Xtenity. “It’s got the same look and feel across the board,” said Sybo Dijkstra, marketing director for Philips Medical Systems.

For its part, McKesson announced an application that extends its PACS to include analog optical devices, such as endoscopes. Its first iteration of the solution is aimed at Ear, Nose and Throat specialists.

Called Horizon Optical Imaging, the solution enables clinicians to take an analog device – like an endoscope – and turn it into a DICOM-enabled digital modality. That means the endoscopic images can be stored, archived and viewed through McKesson’s Horizon PACS across an enterprise. They can also be displayed alongside radiology department images, permitting more thorough diagnoses.

While the application was officially launched at the RSNA convention, McKesson has already deployed 14 Optical Imaging Image Capture Stations and four Horizon Rad Station workstations at the otolaryngology clinic of the University of Wisconsin and Clinics in Madison, Wisc.

“Integrating visible light and radiology images using our PACS enables our organization to enhance patient satisfaction, improve the quality of care and reduce costs associated with follow-up visits,” said Dr. Gary Wendt, associate professor of radiology at the University of Wisconsin Medical Center.

“For example, by viewing endoscopic images alongside radiology images, the physician may be able to immediately determine that a tumour is not malignant. In such a case, the patient is saved needless worry between exam and follow-up care, and we also avoid a biopsy.”

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Web communication system eases scheduling for physicians

Scheduling physicians into the workflow of a busy hospital is a complicated task – especially when many of them are actually independent practitioners who split their time between a hospital, clinics and their own office practice.

But a home-grown, web-based application called Chyma is solving the problem for many institutions.

“Physicians are often not employees of the disparate institutions they work at, or at least not uniquely employed in any one location,” said Dr. Dennis Reich, founder and now medical director of Sudbury, Ont.-based Chyma Systems. “They are probably more aptly described as self-employed. Because of their broad skill sets and the shortage of resources, it is not uncommon for some physicians to work at three or more institutions and to be involved in at least one committee or association.”

The healthcare system relies on having physicians on hand and knowing where they are, yet this is most often being accomplished with archaic paper based systems.

It is important for physicians to be up-to-date with new policies, procedures and important events, yet these details are usually located in the physician lounge or paper inbox for intermittent pick up.

So just how do you get physicians to adopt a technology solution for communication? “The answer is to give them a system that works the way that they work,” said Dr. Reich. “Give them a benefit they can see immediately. Give them an application that puts them in control of their own information.”

Chyma has been solving this very problem, as it is a web-based communication platform with integrated scheduling. Chyma contains application modules such as secure messaging, shared contacts, shared calendaring, discussion forums, document management, and built-in On-call scheduling and administration.

“Chyma allows each institution to be managed independently yet the users are free to float and interact among them.” said Bernie Aho, product manager of the Chyma system. “The Chyma interface integrates multiple institutions all on the same screen.

“For instance when Dr. Smith, a Toronto physician, logs into Chyma he sees his ER shifts, walk-in clinic shifts and events from his local medical association, all on the same calendar.”

Each community automatically gets its own discussion forum and the user can view them all on the same screen. This user community relationship is carried throughout the many applications. In the document manager, each user gets a personal folder and sees documents for each community he or she belongs to.

According to the company, Chyma is used by over 5 percent of the physician population in Canada. Chyma’s clients include: the North Bay General Hospital, Toronto Scarborough Grace ER, Toronto Scarborough General ER, Sault Area Hospital (five hospitals), Brantford Urgent Care, Northwood Medical Clinics, OMA Section on Pediatrics (Intranet), OMA Section on Family Practice (Intranet), Healthscreen Clinics, Sudbury Family Health Group and the Scarborough FHG, to name a few.

Chyma is Macintosh compatible through Firefox and has full SSL security. The system is available to health associations, clinics, departments or hospitals, governmental organizations and other health related communities.

The cost of usage ranges from 50 cents per user per month to just under $5 per user per month (depending on size, type and location of an organization). There are some installations which require an activation fee.

The Scarborough emergency department adopted Chyma post SARS and has nearly 100 percent physician adoption.

According to Dr. Chris Jyu, “this tool has ensured that there is less confusion around scheduling and knowledge transfer. It helps us to know exactly when and where physicians work, both in everyday circumstances and especially in emergency cases.”

He continued that, “each physician is more likely to have the shifts they want and that they are more successful in trading shifts when they are unable to work.” This ensures a happier workforce with an improved lifestyle – a priceless commodity with today’s overextended workforce.

Ensuring simple, correct and exact to-the-minute contact and on-call information also brings time and cost savings to hospitals. Examples of other benefits include no longer having to chase down paper documents to find out who is on call, no longer having nurses receive an earful from the wrong physician called in the middle of the night and not needing the finance department to reissue cheques due to miscalculated on-call stipends.

For the users, having all work schedules, important information and communication on the same workspace (regardless of which institution, committee, and department location) ensures time management is markedly improved.

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Cancer Care Ontario wins CIPA award for pathology reporting solution

TORONTO – Cancer Care Ontario won a gold medal in the Canadian Information Productivity Awards (CIPA) competition last fall for an application that speeds up the reporting of critical information by nearly four times, and reduces the cost of collecting reports from as much as $4 apiece to less than $1.

The solution also greatly improves the comprehensiveness of pathology reports that are submitted by Ontario hospitals to the cancer organization, ensuring that better statistics are collected. Moreover, it ensures that hospitals in return receive improved data, which can be employed for planning patient treatment.

CIPA awarded the gold medal – in the Organizational Transformation Not For Profit category – to Cancer Care Ontario at a ceremony in Toronto.

The organization charged with overseeing the battle against cancer in the province is Cancer Care Ontario. It’s an agency of the Ministry of Health and Long-Term Care, and it’s responsible for planning the full range of cancer services provincially and at the local level, setting quality standards, implementing quality improvements and measuring and reporting to the public on the performance of cancer care.

It’s also the responsibility of Cancer Care Ontario to gather statistics about cancer cases for research and healthcare planning purposes. But until recently, weaknesses in the paper-based reporting system meant that only 75 to 80 percent of cases were fully documented, and reporting was often slow. The transcription of pathology reports involved significant labour and was susceptible to error.

For half a century, Cancer Care Ontario and its predecessor organizations have been collecting information from physicians about cancer cases. Everything had been done on paper for all that time.

Typically, a report was generated in a lab by a pathologist, who then dictated a report. An administrative staffer transcribed the dictation, and a copy of the report was sent to Cancer Care Ontario, often in a monthly batch of faxes.

There were no standards governing content or format. When reports were received, staff at Cancer Care Ontario had to wade through each one to pick out key statistical information.

It often took six months from the time a patient was diagnosed until the data was available for analysis at Cancer Care Ontario -– and sometimes the data never arrived at all.

How could this collection of widespread data, involving so many individuals accustomed to their own particular working routines, be brought up to the standards of the 21st century? Who could overturn five decades of paper-based practices?

“The biggest human challenge we faced,” said Victoria Welch, director of the Pathology Information Management System (PIMS) project, “was establishing this initiative as a priority in hospitals among the multitude of priorities that they have raining down on them.”

Cancer Care Ontario set out to implement PIMS as a reliable, automated, secure and timely pathology reporting solution to collect cancer-related pathology information across the province – in real time, not months.

When the project began in April 2003, Cancer Care Ontario’s project management, information technology and registry teams knew that change management would be their most difficult challenge.

To meet with success, any new system would have to disrupt pathologists’ routines as little as possible. So they chose a system that didn’t alter the way pathologists reported their data, but instead transformed the way the data were presented and organized when they reached their destination.

Today, many pathologists still dictate their reports. But when the reports are entered into a computer, they change. The information is organized into a standard format, with key information always presented in the same place on the document and in the same way.

The PIMS system is an implementation of a software product called E-Path, from a Toronto company called Artificial Intelligence in Medicine Inc.

The software performs a lexical analysis of the pathology report text against a domain-specific, standard nomenclature. The lexical analysis produces a set of codes for the disease morphology and topography concepts expressed in the pathology report. These disease codes are then used to classify the type and seriousness of the condition reported.

As a result of PIMS, pathology reports are submitted 3.9 times faster than with the manual process, and the average processing cost of a report has plunged to 81 cents from between $3.35 and $4.00.

The system has enabled Ontario to move forward with adopting quality-control standards for pathology reporting that would never before have been possible.

Achieving these results took almost two years, through March 2005, at a cost of $3.5 million. The system was implemented across 46 hospital laboratories by a core team of six people, with lots of help from clinicians and hospital staff.

“The key to success in delivering this project was the models we built for implementing it, which were based on change management, stakeholder management, customer engagement, and in-your-face support and help through personal visits,” Welch said.

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