Inside the February 2006 print
edition of Canadian Healthcare Technology:
Feature Report: Developments in diagnostic
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.
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
READ THE STORY
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.
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.
READ THE STORY
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
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
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
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
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
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
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,
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,
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
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
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
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.
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
“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
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
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
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
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 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
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
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
“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.”
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
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
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
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
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
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
Cancer Care Ontario wins CIPA award for pathology
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
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
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.