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Inside the February 2007 print edition of Canadian Healthcare Technology:


Feature Report: Developments in diagnostic imaging


Sick Kids creates fast-access system for documents

The Hospital for Sick Children has devised a method of digitizing all paper documents generated by care-givers within 48 hours, giving doctors and nurses fast access to information.

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New medical imaging technologies abound at RSNA

Chicago is often referred to as America’s Second City, but when it comes to diagnostic imaging, this town is top of the heap and A-number one. (Sorry, New York.)

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eHealth Collaboratory

The eHealth Collaboratory is now open for business. With management and staff now in place, the organization is ready to help healthcare providers and vendors test the interoperability of their solutions, and determine if they meet national standards.

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Physician productivity

Vancouver Coastal Health has launched PC Central, a web portal that consolidates the support resources that physicians need. Designed specifically for the region’s GPs, PC Central offers decision support tools, referral information and forms, and more.

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Appropriate DI

Dr. Robert Miller, president of the Canadian Association of Radiologists, asserts that the volume of diagnostic imaging exams ordered by physicians could be reduced by 10 percent. It will require more appropriate requisitioning of tests.


UHN acquires top-tier CTs

Toronto’s University Health Network has purchased three of Toshiba’s newest CT scanners, machines capable of imaging the heart or brain in a single rotation.


PLUS news stories, analysis, and features and more.

 

Document imaging system consolidates paper charts and e-records

By Jerry Zeidenberg

TORONTO – The Hospital for Sick Children has found a way of making almost all patient information quickly available on computers – including documents that are created originally on paper – thereby allowing several doctors, nurses and other clinicians to view charts at the same time, wherever they are in the facility and whenever they require information.

The system has made it much easier for care-givers to access the information they need, leading to faster communication among healthcare professionals, patients and their families. It also allows clinical decisions to be made more quickly, with more data to draw upon.

“The children we’re treating are usually seen by more than one care-giver during a visit. They can be seen by a cardiologist, a neurologist, a nurse, physiotherapist and a dietician,” commented Dr. John Edmonds, clinical director of medical informatics. “That complexity makes it difficult to handle cases with a paper chart. Each clinic will be waiting for the chart, and if the records are on paper, moving them around becomes very difficult.”

Since 2004, however, the hospital has been scanning all paper records that are produced by non-computerized departments, along with paper documents that enter the hospital from other medical centres to become part of a patient’s chart.

Using a solution from Microdea Inc., of Richmond Hill, Ont., a centralized office in the hospital scans all documents (as TIFFs) within 48 hours, and automatically routes them into the appropriate folders in Electronic Patient Charts.

The documents are bar-coded so the indexing is done fast and accurately – for example, documents are directed into tabs or folders for lab, medications, diagnostic images, surgeries, etc., as specified by the barcode. Some 15,000 to 17,000 documents are scanned each day.

The solution, called the Electronic Patient Chart (EPC), runs on Microsoft SQL Server and now includes all paper records generated since the year 2000. Using EPC, any number of authorized doctors, nurses and clinicians can access a patient’s records in seconds.

If a care-giver or researcher needs older charts, they can still be pulled from paper archives.

The hospital also runs an extensive Electronic Health Record system using technology from Eclipsys. In addition, it operates some 40 other electronic systems for departments such as lab, radiology and the operating rooms. Patient information, in each case, is entered directly into computerized records, resulting in accurate, paperless charts.

However, as Dr. Edmonds points out, some parts of the organization still haven’t adopted these solutions and continue to generate paper records. Moreover, patients often enter the hospital with paper documents from outside labs, hospitals and clinics – meaning that paper is still a big part of the health record.

As a result, the hospital is running its Electronic Patient Chart in parallel with its other electronic solutions. The data collected by these systems is, in many cases, fed into the EPC using interfaces, creating a consolidated patient chart.

The EPC has produced multiple benefits. First and foremost, care-givers can access the documents they need, simultaneously and as soon as they need them.

This has proved especially useful in the emergency department. Patients who arrive there have, in many cases, been treated at the Hospital for Sick Children for a pre-existing condition and have charts at the facility. “The emergency physicians no longer make phone calls for patient records, or wait for them to be delivered,” said Dr. Edmonds. “They can access the charts right away.”

He noted that EPC has also made a big difference for coders. “They can do their coding on the EPC, using digitized documents, instead of shuffling through piles of paper.”

And physicians and residents on rounds are thrilled with the system, because they can quickly call up a variety of documents when checking on patients.

Debi Senger, director of health records, observed that patients and their families have also benefited, as they often call in to check for details about their medications or other information. Nurses, in the past, used to scramble to find paper charts, and patients would have to wait. Now, nurses can quickly call up patient records on a nearby workstation and answer questions immediately. “You don’t have to tell them, ‘I’ll call you back’,” said Senger.

What’s more, the system has put an end to the phenomenon known as ‘shadow charts’, where nurses keep copies of important documents on the ward, so they’ll be quickly accessible when needed. During a visit to the Hospital for Sick Children, one of the ward nurses told us that shadow charts are no longer necessary, since everything is instantly available on the EPC.

Senger said the EPC system has become so popular among care-givers at the hospital that the project leaders had to increase staffing in the scanning centre. “It was originally set up as a Monday to Friday operation,” said Senger. “But we soon had to add staff on weekends, because the ER wanted records to be available immediately.”

The EPC also offers far greater security than paper records, noted Ana Andreasian, technology director for Sick Kids. Once paper charts are delivered to a department, she observed, there’s no way of telling who has looked at them.

By contrast, there is an audit trail with the Electronic Patient Chart – the system identifies the user, the reason for accessing the record (for example, clinical or research), and the time of usage.

One of the latest security features added to the EPC is a ‘lock-box’ function. This allows patients, if they choose to do so, to specify that certain parts of their records be inaccessible.

Andreasian said the EPC also saves space and reduces costs. It currently requires a good deal of in-house and off-site storage-space to maintain paper records – indeed, 1,200 linear feet are needed each year. Additional costs are rung up when records are pulled and transported.

She said paper records are to be destroyed shortly after they are scanned. That’s not happening right now, but will start soon, once the hospital implements a second data centre for large-scale back-up and redundancy.

Dollar figures on how much the EPC cost weren’t available, but Dr. Edmonds said the Hospital for Sick Children annually invests 5 percent to 6 percent of its operating budget in I.T., much more than the national average. (Canadian Healthcare Technology’s 2005-2006 I.T. survey found the average I.T. investment for hospitals was 2.5 percent of the operating budget.)

Dr. Edmonds said the solution has been attracting attention from other hospitals, and Sick Kids has hosted several site visits from organizations looking for ways to improve their document management. “We’ve had a lot of interest in this system,” he said.

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New medical imaging technologies abound at RSNA

By Jerry Zeidenberg

Chicago is often referred to as America’s Second City, but when it comes to diagnostic imaging, this town is top of the heap and A-number one. (Sorry, New York.)

That’s because Chicago’s cavernous McCormick Place is the site of the week-long RSNA conference, held each year after the American Thanksgiving weekend.

Billed as the world’s largest medical conference, the Radiological Society of North America’s annual educational meeting and trade show attracts more than 60,000 delegates – including a large contingent of radiologists, DI managers and hospital executives from Canada.

Some of the technological highlights of RSNA 2006 included:

MRI: Philips produced an MR that can be upgraded from 1.5T to 3T, when a hospital or clinic is ready, without changing the magnet. As Philips Medical Systems’ vice president of marketing John Desch explained, “Normally, a limitation of MR is that a customer will install a 1.5T magnet, but in three years, they may want to upgrade to 3T. Using our solution, you start with a 1.5T, and later you can put in new coils and you’ve got a 3T MR. It can save customers $1 million.”

Traditionally, installing a new magnet has not only been costly, but it was also disruptive and often required the use of cranes and forklifts. However, the new technology eliminates the need to bring in a new magnet, resulting in minimal downtime during the transition from 1.5T to 3T, the company said.

For its part, Siemens announced an MR scanner with a moving table that slides the patient through the magnet – much like a patient passes through a helical CT machine. The technique, according to Siemens, results in faster scans, higher resolution and the potential for new types of studies. “This will do to the MR market what spiral CT did for computed tomography,” ventured a Siemens spokesperson, stationed at the company’s pavilion.

Meanwhile, GE Healthcare announced that it has now shipped 10,000 MR magnets worldwide. Of those, 300 are 3T systems, and the company expected to ship 55 more 3Ts by the end of 2006. In terms of emerging applications, by far the greatest growth is being experienced in MR for breast imaging. “For MR breast imaging, the number of procedures grew by 51 percent [in 2005],” commented Vicki Hanson, an MR marketing manager based in Waukesha, Wisc. She added that interventional MR procedures increased by 48 percent in that period, and cardiac MR exams grew by 36 percent.

Image-Guided Therapy: GE Healthcare demonstrated a system that combines MR guidance with ultrasound ablation. It is currently being used as an effective surgical technique for the removal of uterine fibroids – essentially reducing a three-month recovery process to a few days. “It dramatically lowers the length of stay for the hospital, and transforms a procedure that previously required a 12-week recovery period into day surgery,” said Peter Robertson, general manager of GE Healthcare of Mississauga, Ont. “If she wants to, a woman can go back to work in two days.” Robertson pointed out that the procedure has important economic repercussions for patients and their families, healthcare facilities and governments – not only are patients discharged from hospital beds earlier, they’re also back to being productive members of society much more quickly.

Significantly, the technology is showing great promise for oncology, and is being further developed for ablation of prostate, breast, liver, bone and brain tumours. Robertson explained that ultrasound waves, when used at high frequencies, can heat and denature cancerous tissue at the focal point while leaving surrounding structures intact. Exact positioning, and checking the results, is completed with the simultaneous use of MR imaging.

Enterprise IT Solutions: Agfa HealthCare continued to demonstrate its transformation from what was traditionally viewed as a radiology-centric PACS provider to a full-scale healthcare informatics player. This was highlighted with their display of an Enterprise Scheduling offering (iPlan), which can reside on top of any existing application to extend functionality, Impax MPI, and the upcoming launch of their Orbis platform in North America, scheduled for mid-late 2008. The Orbis platform, widely used in Europe, will deliver HIS/CIS/LIS/ pharmacy/and enterprise management applications and related services – effectively extending Agfa HealthCare’s reach from radiology to the entire healthcare continuum. Additionally, Agfa HealthCare is also ramping up their professional services offerings with the launch of a Canadian healthcare consulting arm.

At the same time, Agfa showed a technology that’s capable of pulling together electronic medical records from remote repositories – creating a virtual electronic record, on an as-needed basis. This ‘federated’ model implements EMPI technology and single sign-on – meaning users need only log-on once to access a variety of systems. Agfa is offering the solution through a partnership with Medseek; it’s now being used by several Canadian hospitals.

Teleradiology: Kodak demonstrated, as a work-in-progress, its CareStream PACS system using ‘workflow grid computing’. The technology connects imaging centers and hospitals region-wide, nationally or internationally – producing a synchronized worklist that can be tackled by any of the radiologists who are available. That could solve many problems in countries such as Canada, which face shortages of radiologists in many regions – especially rural districts. What’s more, the system uses dynamic streaming technology, which means that in areas with low-bandwidth, radiologists can start viewing the first images in a study while the others are being transmitted. “You can set up a pool of radiologists to do readings from a global worklist,” commented Ulf Andersson, worldwide general manager of PACS and 3D applications. “Radiologists with extra time or capacity can read the exams and create reports. Naturally, you can also create a compensation structure for them.”

It should be noted that in January 2007, Kodak announced a plan to sell its healthcare division to Toronto-based Onex Corp., for US$2.35 billion. In a webcast, Onex managing director Robert Le Blanc and Kodak Health Group president Kevin Hobert both noted the division will be renamed in the future, but will continue with its current strategy and product offerings. Le Blanc said there will be increased investments in research and development.

Digital Mammography: Several companies have devised CR solutions for mammography, but in Canada, only Christie Group with its Fuji technology have so far been approved by Health Canada. Christie announced that it has now installed CR mammo at St. Martha’s Hospital, in Antigonish, N.S., and Credit Valley Imaging Associates clinic, in Mississauga, Ont. For its part, Konica Minolta demonstrated its CR mammo system, which it claims has the highest resolution. Konica Minolta’s Regius PureView Mammography System, with 25 micron resolution compared with 50 microns for many other CR mammo systems, is currently being used in pilot studies at the University of Chicago Hospitals.

Digital Radiography (DR): Canada’s Imaging Dynamics Corp. released a new DR system and unveiled a DR mammography prototype. The Calgary-based outfit, which bills itself as the fastest-growing company in the medical imaging world, took the wraps off a fixed-table DR system with a single detector. Called the XM series, it’s designed as a more affordable fixed table option to the company’s X2200, which uses a dual-detector system. IDC also provided a ‘first-look’ at a prototype digital mammo system that uses an optically coupled detector to create high-resolution images at a relatively low price.

For its part, Kodak showcased a flexible DR system, the DirectView DR 9500, which boasts a ceiling-mounted U-arm containing both a tube and detector. The system can be easily moved around a patient, instead of requiring the technologist to move the patient into position. As such, it’s said to be an excellent solution for general radiography, enabling a wide variety of exams to be taken quickly, with high resolution and fast throughput.

Computed Radiography: Agfa showed off a Computed Radiography suite that offers resolution just below that of DR, at approximately half the cost of conventional DR. Alternatively, the system takes traditional CR-quality images using 50 percent of the X-ray dose of standard CR. “That’s especially important in pediatric imaging, where you want to make sure you’ve got the lowest dose,” said Mike Labelle, Agfa’s CR/DR product manager. According to the company, Agfa is now entering the modality market, in the sense that it’s installing whole rooms rather than pieces of equipment. The new CR solution is appealing to cash-strapped hospitals that would rather open two CR rooms at the cost of one DR room – with near DR quality. Rooms can be outfitted with both DR and CR technology – the CR can act as a backup in case of DR failure, and also provides a portable option for taking images of patients at the bedside.

Computed Tomography: Toshiba was the talk of the CT town with its foray into 256-slice CT imaging. At the RSNA, Toshiba announced it will install its first U.S. beta site 256-slice CT scanner at the Johns Hopkins University School of Medicine and its Heart Institute, in February 2007.

The system will be at Hopkins for a limited period of time to acquire data for further product development. The 256-slice scanner is designed to image the brain or heart in a single rotation.

During the RSNA, Toshiba announced a large implementation of DI systems at Toronto’s University Health Network, including three high-end Aquilion CT scanners. (See our coverage in this issue.) Two of the machines will be installed at the UHN’s Peter Munk Cardiac Centre; a third Aquilion will be applied to stroke and neural imaging at the Toronto Western Hospital, also part of the UHN.

Just as cardiac imaging is pumping up the MR marketplace, so too is it a hot application in CT. GE Healthcare is claiming a breakthrough in this area with its Snapshot Pulse technology for CT cardiac imaging, a system that reduces the X-ray dose by 70 percent or more while maintaining image quality. Brian Duchinsky, GE’s global CT manager, explained that the system uses ECG to synchronize the X-rays with the resting stage of the heartbeat – thereby acquiring the clearest images while using far less radiation. “One clinician attained an 83 percent reduction in dose,” said Duchinsky.

For its part, Siemens demonstrated its ‘Webspace’ applications for CT, which enable physicians to view and manipulate 3D reconstructions of large CT datasets on any kind of computer, at any location – home, office or operating room. The systems solve a problem facing physicians today – while CT exams now generate hundreds or thousands of images, which are most useful in 3D form, it usually takes a high-powered workstation to handle the volumetric data.

However, the new Siemens solution, like just a few others on the market, does all of the processing on a central server. As a result, radiologists, surgeons and other physicians can access the 3D images on virtually any computer – they no longer require access to a high-powered workstation. Industry observers say this leading-edge, thin-client solution will catch on, as it makes it possible for physicians to work with 3D studies wherever they may be. A radiologist on-call at home can review the most sophisticated CT exams on his home computer; a radiologist waiting for a workstation in the DI department can use a regular desktop PC to continue his readings; or a surgeon in the operating room can review 3D reconstructions of a trauma patient who has just had a CT exam and is being wheeled to the OR.

PACS/RIS: Many of the PACS vendors were touting integration, and showed how a variety of modalities could be viewed on a single workstation. Laurie Rogers, general manager of IT for GE Healthcare Canada, stressed this as an important development for radiologists, as many rads are currently forced to hike to different workstations to view CT, MR, ultrasound or other types of images. New workstations from GE Healthcare allow a single log-in to gain access to a variety of modalities, 3D reconstructions, RIS and voice recognition-based dictation.

GE Healthcare highlighted its adoption of IHE profiles into its PACS solutions. Rogers noted the company currently provides eight of the most important IHE profiles as part of its Centricity solution, including scheduled workflow (SW), patient reconciliation (PR), and consistent presentation of images (CPI, so images will look the same on different workstations.) Also available are key image notes (KIN), PICS and XDS.

Kodak demonstrated advanced 3D capabilities, including vessel tracking and measurement, automated bone removal for clearer images of organs, and in an upcoming release, image fusion and volume matching – enabling accurate comparisons of images generated by different modalities. “Our 3D systems are something of a well-kept secret,” commented Mike Jackman, Kodak’s general manager, healthcare information solutions.

Another little-known facet of Kodak’s imaging business: its worldwide development team for RIS is based in Canada – in Prince Edward Island. “We’ve had a great team of software developers there for about six years,” said Jackman.

Philips emphasized a big push on the integration front, with the close coupling of its various solutions into the iSite system.

“We’re using iSite as our delivery platform,” said Matt Long, vice president of healthcare informatics for Philips, noting iSite’s strengths as a fast, web-based solution with wide-ranging functions.

Long commented that Philips is focusing on clinical solutions that are ‘close to the patient’. “We do better with active patient data at the clinical layer,” said Long. “We’re concentrating on DI and monitoring solutions, essentially the capture, review and diagnosis of clinical information.”

In Canada, Philips recently won the bidding to supply a province-wide PACS and RIS solution to Saskatchewan; at press time, contract details were still being worked out.

On another front, Agfa highlighted a central archiving solution -– capable of housing not only diagnostic images, but all healthcare data for a region. “The Impax Data Centre solution emerged from our work in the United Kingdom, where Agfa is involved in two of the five regional PACS projects,” said Jason Knox, marketing manager for Agfa Canada. The company recently won major contracts to build data centres for the Quebec City and Sherbrooke regions of Quebec and the Toronto East Network in Ontario.

While most large hospitals have now implemented PACS, or have made a purchasing decision, many smaller hospitals in Canada still haven’t acquired the technology. Neither have independent imaging centres. McKesson is addressing this segment of the DI sector with a PACS solution that uses a portion of the company’s Horizon PACS. It includes multiple patient ID, cross-location communication and reporting, and workflow tools.

“A piece of PACS technology is needed with the right pricing,” said George Kovacs, senior product marketing manager. “Rural hospitals also need minimal disruption – they can’t afford to be down. We’ve designed a disruption-free cycle for them.”

Productivity: In an interview with Canadian Healthcare Technology, Philips’ vice president of healthcare marketing, John Desch, noted the company is working hard to deliver productivity solutions to radiology departments – and to caregivers in general.

Chief among these productivity solutions is the automation of many procedures – reducing the amount of work needed to conduct an exam, and making things faster and easier for patients and caregivers.

As an example, Desch pointed to the company’s ‘SmartExam’ solution for magnetic resonance imaging. “It’s a set of built-in protocols, and with one button you can do a whole procedure,” said Desch. “It minimizes the time for both the patient and the MR operator.”

Ultrasound: On the topic of simplifying exams in this way, Philips also demonstrated ‘onboard protocol optimization’ for ultrasound. Pat Venters, an ultrasound specialist with Philips, explained that during hospital ultrasound exams, operators typically take numerous views, which requires a great deal of keyboarding. Using a new workflow enhancer, “any number of views can be included in a protocol, and a button can bring up a list of different protocols,” said Venters. In this way, much of the exam can be automated.

She noted that a recent test of the solution at Duke University, researchers found a 30 percent time-savings on exams. “They saved 400 keystrokes on a carotid exam,” said Venters. “The solution makes ultrasound exams faster, and it also provides consistency in a hospital.”

Portable ultrasound developer SonoSite, Inc., announced wireless capabilities for its systems, and pointed to a successful implementation at the University Health Network, in Toronto, where a single sonographer can provide ER exams at three different sites, shuttling from one to another by car, and beaming the images to the PACS wirelessly.

Once in the PACS, the exams can be read and interpreted by radiologists and other physicians throughout the hospital system. Sonosite also announced upgrades to its MicroMaxx hand-carried ultrasound system, including a high-frequency transducer that’s said to be ideal for pediatric and neonatal studies, line placement and nerve visualization.

Zonare Inc., which last year released a breakthrough technology that conducts ultrasound exams up to 10 times faster than conventional systems, announced several software additions to its systems at the RSNA.

The new advances include Compound Harmonics, Virtual Apex Array, Auto-Dop Trace and IQ Scan. The software upgrades are available for ZONARE’s z.one ultrasound system, which it calls the world’s first Convertible Ultrasound system. The cart-based system can be easily converted to a premium, portable sonography unit.

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eHealth Collaboratory ready to work with care providers, IT vendors

TORONTO – “The eHealth Collaboratory is open for business,” says Kees Schuller, executive director of the new organization. “We have a great team, a solid architecture, and we’ve proven our initial concept.”

The eHealth Collaboratory was created to provide conformance testing services for pan-Canadian standards based applications and implementations, as well as offering procurement assistance to jurisdictions making decisions around electronic health record (eHR) applications.

Launched in May 2006, the eHealth Collaboratory received initial funding from Canada Health Infoway, and is incubated at the University Health Network’s Centre for Global eHealth Innovation, in Toronto.

Schuller joined the Collaboratory team as executive lead in June, 2006. Among several of his high-profile roles in the IT business sector in the past, Schuller was the founding general manager of Sapient Canada, a provider of business and technology consulting services.

At the eHealth Collaboratory, he has led efforts to study what is happening in the field of IT conformance testing both nationally and internationally, and has directed team-building and the development of work processes.

“Once the whole team was in place, things moved quickly,” said Schuller.

The team now includes Brian Leung as the technical lead, Joanne Hohenadel as operations lead, Anjum Chagpar as the usability lead and Allie Grassie as the stakeholder engagement manager, as well as additional technical and operational staff.

The initial service offerings of the Collaboratory are focused on recently released Infoway “stable for use” HL7 Version 3 based standards – Client Registry, Provider Registry, and the pharmacy specification CeRX.

What the Collaboratory quickly found is that conformance testing involves far more than HL7 message specification validation.

Each Canadian jurisdiction is implementing the specifications somewhat differently, based on their business requirements and workflows. For example, some messages are optional, and some that are mandatory contravene current legislation in certain jurisdictions. For these reasons the Collaboratory is developing its architecture to be flexible.

What the Collaboratory is building is a plug-and-play stubbed version of the pan-Canadian interoperable Electronic Health Record, one standard at a time.

“Currently, we are gearing up to test the CeRX standard,” said Schuller. “That requires the automated testing tool, known as the ‘harness’, to be able to test drug information, hospital information, and point of service or pharmacy systems.

“Each of these is created as a ‘stub’ or ‘simulation’ within our harness architecture,” he continued. “When we need to test a system, we can remove the stub, and place in the real system. We then run the test data and catalogue of a particular jurisdiction.”

The same methodology is used for the Client and Provider Registry, and will be used for further standards, as released. While the Collaboratory considers interoperability and functionality to be the core of their operations, it can offer far more, including usability testing, in partnership with the usability team here at the Centre for Global eHealth Innovation.

The premiere facilities and access to clinical staff ensure that it will have the most robust usability assessments available.

Additional services in the area of procurement will be key for hospitals, Local Health Integration Networks and jurisdictions looking to invest in a manner that is in line with the overall eHealth vision.

“As more vendors are tested, our procurement service offering will grow,” said Schuller. “Initially, we can offer testing to short-listed prospects, but eventually, a buyer can come into the Collaboratory website and review those vendors who have passed conformance testing, or other testing.”

Allie Grassie, previously the Secretariat for HL7 Canada, has been meeting with vendors from across Canada and beyond. “We know that vendors are looking for ways to assure clients that their products will interoperate seamlessly with other applications and implementations, in order to generate further sales,” she said. “They also want to reduce the cost and time of development. We can help them to do that.”

The Collaboratory is working diligently to ensure that its processes are fair and unbiased, a key success factor for engaging the vendor community, said Grassie. It is also reaching out to the jurisdictions, promoting the value proposition of a faster, more effective, interoperable eHR implementation, with better clinician uptake, and removing the fear and uncertainty surrounding purchasing decisions.

The eHealth Collaboratory is currently engaged in initial conversations with a number of jurisdictions, as well as partnership talks with other conformance groups and technology providers.

Further information for vendors, jurisdictions and interested parties can be found at www.ehealthcollaboratory.ca.

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PC Central web portal designed for Vancouver’s family physicians

By Jerry Zeidenberg

VANCOUVER – Too often, family doctors are slowed down by the search for the right reference book or web site. They’re hindered by the hunt for the proper referral form, or the paperwork needed for reporting information to their provincial ministry of health.

Now, Vancouver Coastal Health is aiming to eliminate these frustrating searches – and the delays that go along with them – by creating a web portal called PC Central that aggregates many resources on one site. The regional health authority hopes to speed-up patient care and workflow by making commonly used resources available to general practitioners in a few keystrokes.

The pilot site was launched last fall with 19 family doctors participating; the plan called for an expansion to 100 GPs by January, and to 500 by the end of 2007. The project has been funded by a $250,000 contribution from Vancouver Coastal Health’s Primary Care IT Strategy, with additional investments planned for the future.

“So far, two things on PC Central have been especially helpful to me,” said Dr. Patricia Mirwaldt, director of Student Health Services at the University of British Columbia and physician leader of the PC Central project. “First, the clinical reference tools have been really useful,” said Dr. Mirwaldt. “Also, the access to referral forms right on the web site has saved a lot of time and trouble.”

She noted that a number of high-quality clinical databases have been integrated into the site, enabling family doctors to quickly find answers to their questions – including queries about obscure diseases or conditions and how to treat them. As an example, she cites the case of a student whose lab test results indicated a bacterial strain that Dr. Mirwaldt was not familiar with.

Instead of spending a lot of time searching for references, or sending the student to a specialist, she used a clinical database on PC Central and discovered that the mysterious bacteria could be treated with antibiotics. “Within two minutes I was phoning the patient and arranging appropriate follow-up and medication,” said Dr. Mirwaldt. “In the past, this process would have taken me days, while I called TB Control and Infectious Disease to find out what to do. As a result of PC Central, my day was calmer and I was more confident.”

Dr. Mirwaldt explained that PC Central currently consolidates a number of ‘public access’ databases, including the College of Physicians and Surgeons Library. There have been discussions to add commercially available resources, like UpToDate Online, as part of the future development of the site.

Quick access to referral forms on PC Central has also made the working day easier for physicians. The portal has been designed specifically for Vancouver Coastal Health’s family doctors, and provides links for local hospital departments, labs, X-ray centres and independent clinics, along with specialized facilities to which GPs would most commonly refer their patients

It also contains access to the referral forms needed for each, and alerts doctors about other information they should know about – such as paperwork that must accompany the patient, how the patient should prepare for the appointment, how the physician should fill out the requisition, and the hours of the clinic.

“I recently needed to get one of my patients into an eating disorder program,” said Dr. Mirwaldt. “I was able to find a local clinic and went directly into its web site, right from PC Central. I found out what they needed, the referral forms, and how to get in touch with them.” She noted that many different types of local or regional facilities are listed on the site, such as detox centres for addictions – and more are to be added, as PC Central is undergoing continuous development.

There are additional resources on the site that assist doctors with workflow, including quick access to provincial and national guidelines for treating various conditions. For example, the provincial guidelines answer questions about treating asthma and diabetes, or the fitness of seniors to drive. As the provincial website is constantly updated, physicians obtain the latest information each time they click the links.

National guidelines are also available, such as whether CT or MR is better for diagnosing a specific condition. In this case, the guidelines are supplied by the Canadian Association of Radiologists.

As well, the forms for reporting adverse drug reactions are right at hand. “We know that adverse drug reactions are underreported,” said Dr. Mirwaldt. “This makes it much easier for primary care physicians – using this tool, the data goes right to Health Canada.”

The site automates reporting the incidence of certain diseases to provincial authorities. “In British Columbia, for example, clymidia must be reported,” said Dr. Mirwaldt. “We can do it easily through PC Central.”

The portal is also helpful for patient education, with patient handouts that can be printed and given out to reinforce the issues discussed during the clinical encounter. Moreover, the handouts often direct the patients to web sites that are considered sources of ‘trusted information’ for further education. “Patients often get their information from web sites that are badly written and offer poor quality information,” said Dr. Mirwaldt, citing clinical depression as one example of a condition with web sites of questionable quality. “We’re pointing them to trusted sources, with high quality information. They’re not provided by drug companies, or by people who have had a bad experience [and have an axe to grind].” Finally, the site has a news section that keeps GPs updated about local developments, such as the opening of new clinics or facilities.

PC Central is led by a committee consisting of eight physicians, including Dr. Mirwaldt, along with two staff members.

One of the physician members came on board as a ‘technological Luddite’, and was initially skeptical of the value of the web-based solution. “He has brought up some very helpful ideas,” said Dr. Mirwaldt, who added that the doctor is now a full-fledged supporter of PC Central. “He’s a believer,” she said

According to Vancouver Coastal Health, more than a dozen physicians and medical office assistants spent over a year identifying useful content and links to be featured on PC Central. It now has more than 750 content items available, with additional resources planned for the future. In a press release issued by Vancouver Coastal Health, Vancouver physician Rainer Borkenhagen said: “PC Central is like a medically oriented, locally resourced, primary-care Google. It provides valuable information about programs in the community and in hospitals. It also makes it easier for me to download the appropriate forms for these programs.”

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