Inside the February 2010 print
edition of Canadian Healthcare Technology:
report: Developments in medical imaging
Manitoba begins $22.5 million EHR project
As the next step in its plan to create a
province-wide Electronic Health Record, Manitoba has launched a
$22.5 million project that will consolidate in a centralized
repository the various types of patient information that have
already been computerized across the province – including lab
results, medication histories and immunization data.
Canadian health system needs better linkages, chief of the CMA
Speaking in Toronto late last year at the
Economic Club of Canada, Dr. Anne Doig noted that patients in this
country suffer because so many healthcare providers are disconnected
from one another and can’t share information.
READ THE STORY
Pathology is on the verge of great changes, with
automation hitting it the way that computerization changed medical
imaging departments. New slide scanners and other systems are on the
READ THE STORY
Hôpital CSSS de Trois-Rivières goes with lean solution for the
When healthcare facilities can’t keep up with demand
for their services, the traditional solution has been to add
resources – namely, doctors, nurses, support staff and equipment.
Lately, however, a new approach has appeared.
READ THE STORY
Quality control in DI
News of suspected errors made in reading exams in
diagnostic imaging departments has raised the issue of quality
control in radiology. Dr. David Koff of Hamilton Health Sciences
suggests a possible solution – one that is computerized.
I’ll take Finland?
Finland, another northern country with a cold
climate, has reached almost 100% usage of electronic health records
by hospitals and physicians. How did they do it, and what can Canada
learn from the Finnish experience?
A Montreal-based company is pioneering a novel way of
improving the flow of supplies in hospitals. It’s combining a
Japanese, two-bin approach with radio-frequency identification (RFID)
technology to achieve superb results – supply bins are never empty.
PLUS news stories, analysis, and features and more.
Manitoba begins $22.5 million EHR project
By Jerry Zeidenberg
WINNIPEG – As the next step in its plan to create a province-wide
Electronic Health Record, Manitoba has launched a $22.5 million project
that will consolidate in a centralized repository the various types of
patient information that have already been computerized across the
province – including lab results, medication histories and immunization
data. The plan is to move quickly on this project, with the pieces
connected in a working EHR by the end of 2010.
One of the problems that care-givers face in most parts of Canada – and
around the world – is that computerized patient data in one hospital
can’t be accessed by physicians located at another facility. According
to a spokesman in Winnipeg, the EHR in a centralized repository will
allow authorized physicians and care-givers across the province to
quickly obtain the information they need to make complete and accurate
In a second stage, the system will be connected to an existing
repository of radiological images and reports, giving healthcare
professionals access to another key source of patient information. This
phase of the project is expected to be working by 2011 or 2012.
Manitoba is going full steam ahead with its provincial EHR at a time
when the wheels have slowed or even stopped in other provinces, due to
widely publicized problems with eHealth initiatives. In particular,
Ontario was burned by a scathing report from the provincial
auditor-general, who concluded last fall that a $1 billion investment by
the province in eHealth had produced little of value.
But Manitoba eHealth’s chief information officer, Roger Girard, says
that what’s come under fire in Ontario and other parts of the world is
not eHealth itself, but how some jurisdictions have tried to implement
“There’s little disagreement among the public about the need for eHealth,”
said Girard. “The criticism is about the means which some have used on
the journey to eHealth, but it’s not with eHealth itself. The EHR is
widely considered to be a foundational element in improving healthcare.”
He added that, “The public agrees that it’s time to get on with it.”
For its part, Manitoba has been working on an eHealth strategy for
several years, involving an investment of $150 million.
The existing drug, lab and immunization databases, which have emerged as
part of the eHealth strategy, will be consolidated in two data centres.
The data centres have already been developed, also as part of the
provincial eHealth plan.
In December, the province announced that IBM Canada had been tasked with
leading the $22.5 million integration and EHR development project. IBM
will be working with a number of partners, including dbMotion, which is
supplying the health information exchange software.
“The dbMotion technology integrates information from different sources
and represents it [in the EHR],” commented Giovanni Vatieri, partner in
IBM Global Business Services. “It will be the core technology in the
He said dbMotion has had success in health exchange projects around the
world, including Pittsburgh, New York, Israel and sites in Europe.
Vatieri noted there are other partners in the project, including
Microsoft, Momentum Healthware, and xwave.
Data will be made available to healthcare professionals in real-time
using common browser-based interfaces, creating a portal-like solution
for the end-users.
Girard said the system will rely on the intelligence of a sophisticated
client registry that has been developed with the help of Infoway. The
client registry is able to identify patient information in different
repositories, and working with the solutions from IBM and dbMotion, will
consolidate it all in the EHR.
The client registry, explained Girard, uses various systems to ensure
that patient information is associated with the right person.
The province has had some recent successes in creating repositories and
electronic solutions, including the DI repository – which is currently
used by radiologists and specialists – and a Computerized Physician
Order Entry project at one of the large teaching hospitals in Winnipeg.
Realistically, Girard notes that the creation of consolidated EHR won’t
be an easy task, and some errors will probably be made along the way.
“That’s only normal, but we can’t turn back every time we hit a bump on
the road,” he said. “We have to learn from the mistakes and move on.”
In upcoming phases, the EHR project will seek to integrate data from
other sectors, including long-term care, home care and physician
Of course, a province-wide system of electronic health records also
needs an extensive, high-speed network. Girard said that Manitoba
currently benefits from the Provincial Data Network, which delivers
high-capacity bandwidth to most parts of the province.
He asserted that Manitoba is currently running the largest telehealth
service in the world on a per capita basis, and that telehealth relies
day-to-day on the telecommunications system.
He noted that high-bandwidth service is lacking in some parts of the
province, but the network continues to evolve, just as the EHR
application will be further developed. “This is a journey that will take
place over the next 10 years,” said Girard.
Physician incentives, better designs needed for EMRs:
A conversation with Saskatchewan family physician, Dr. Anne Doig,
president of the Canadian Medical Association. Recently, Dr. Doig was in
Toronto to speak to the Economic Club of Canada, where CHT contributing
editor Andy Shaw caught up with her.
CHT: Dr. Doig, you spoke today of a CMA plan that is ‘an
unprecedented effort by Canada’s physicians to reach out to patients and
put their interests back at the heart of healthcare.’ Why do we need
such a plan?
Dr. Doig: Speaking as a physician, I get frustrated and fed-up
every day with a healthcare system that can’t seem to put the patient
first, which is the reality of what I must do every day. Our so-called
healthcare system is a misnomer. Really what we provide patients with is
a series of episodic interventions which do not provide systematic,
continuous care. Patients too are frustrated by this and particularly by
overly long wait times. So the CMA is calling for a transformative
change in our healthcare so that patients get good care in a timely
CHT: So how do you make that happen?
Dr. Doig: Well, you make the whole system do the same things we
try to provide patients with in our clinics and offices every day as
physicians. I call them the four C’s. You provide comprehensiveness,
continuity, co-ordination, and a community of care.
CHT: Aren’t those just the things that the EHR, the electronic
health record, is supposed to facilitate across the country?
Dr. Doig: The problem is we’re not there yet. We can’t feed
information into that system unless all our doctors have computers and
electronic medical records in their offices.
CHT: Then why do Canadian physicians rank right near the bottom
in their uptake of office computer systems and EMRs?
Dr. Doig: Doctors are healthily skeptical, so they need to see
first hand how computers and electronic records make their work better,
not easier, but better. They need to be shown that when you have an EMR
in your office you make fewer mistakes. And that you can have better
information at your finger tips more quickly, so that patients get
improved and faster care. They also need to see how these systems
connect to other resources such as labs, pharmacies, hospitals and
specialists, so that both you and the patient can better manage the
CHT: Wouldn’t it be quicker for our governments to simply require
physicians to have computers and EMRs?
Dr. Doig: I don’t think you could require that until there is a
capacity in the system to interconnect. Also, the kind of information
technology systems we’re talking about are very expensive. So we also
need a different financial model that gives doctors incentive to adopt
them. Therefore governments have to make a policy decision, as you
pointed out they did in Britain, to provide all doctors with electronic
office systems. And that’s also where patients and the public come in.
We all need to start demanding that our politicians act and decide what
our healthcare system pays for and what we expect from it.
CHT: Is there anything to be learned from what other politicians
in other lands have decided to do about their country’s healthcare?
Dr. Doig: My predecessor as CMA president, Dr.
Robert Ouellet, toured five countries overseas last year, including
France, to see what could be learned. And the first thing we learned is
that they all do things differently. There is no one cookie-cutter
solution that can be immediately transferred and plunked down Canada and
made to work exactly as it works in other countries. But there are
specific lessons to be learned from abroad, such as government-mandated
coverage by a private insurer. In Denmark and Israel, for example, six
insurance companies are available to patients. There is a mix of
employer, government, and private payment and the result is that nobody
waits very long. When I was in Israel and told a cab driver that our
national guidelines include getting our longest wait times down to six
months, he was appalled because his maximum wait time for a knee
replacement, say, would be two weeks.
CHT: In terms of the electronic records that
would track such an operation, is there something our EMR vendors aren’t
doing to increase uptake by Canadian doctors?
Dr. Doig: What they need to do is involve the end-user more in
the design of the system, and not just some clever person in IT who has
a wonderful idea. We need those latter types because they make the
systems work, but I can tell you about the RFP for a province-wide,
front-line EMR we’ve just come through in Saskatchewan. We had 30 plus
vendors respond to the RFP, but for a good number of them the immediate
reaction of the doctors involved in our selection said: “There’s no way
that one will work! It just isn’t my business process.” So it would be
good for vendors to go to a bunch of doctors who are techies and let
them play before they build the final version of the system. Let the
pros help them decide how to make it work properly.
CHT: In terms of other forms or electronic record keeping, do you
think that personal health records or PHRs that patients maintain
themselves are worthwhile?
Dr. Doig: It would be a very good thing if people could own and
control at least some of their healthcare data elements. If you could
have a smart card with a microchip on it, for instance, that you could
carry around with some of your vital data. The problem no one has really
decided yet what that data set would include and not include. Most of
the data available has a very short shelf life. If a person has had a
head injury for example, it is important at the time to know when they
are in the ICU what his or her blood gases were, or what their
electrolytes were doing. But once the patient has recovered and left the
ICU, all that information is just historical. It is of no further or
very limited use.
Breakthrough imaging solutions on horizon for
By Jerry Zeidenberg
Pathology appears to be on the verge of the kind of computerization that
hit the radiological world some 20 years ago with the advent of Picture
Archiving and Communication Systems (PACS).
Instead of archiving banks of glass slides, pathology is making the
transition to digital images. However, one of the roadblocks has been
the slowness of acquiring the high-resolution images needed of digital
slides. One could literally set up the scanner, go for a coffee and be
back before a single image was completed.
But in recent months, both GE Healthcare and Philips have announced
breakthroughs in acquiring high-res slide images in rapid fashion.
“There are digital slide scanners on the market, but they’re slow,”
commented John Wellbank, senior director of sales, North America, for
Philips Healthcare’s digital pathology unit. “They typically take two to
four minutes at 20x [magnification of the slide] and from two-and-a-half
to eight minutes at 40x, for each slide.”
By contrast, Wellbank said that Philips has a new scanner under
development that scans a slide each minute at 40x magnification – a
remarkable breakthrough in speed and resolution.
“Philips has a lot of technology in imaging,” said Wellbank.
“Headquarters in Eindhoven is a world centre in optics and imaging.”
He said the technology is now out of the labs and into clinical trials
with four university partners. If all goes according to plan, a
commercial product should be available in the middle of 2010 – at least
in the United States, pending FDA approval.
Wellbank noted that it’s not only the high-powered scanner that’s being
offered, but a workstation for image processing, along with transfer and
workflow software that’s designed to improve the productivity of
Meanwhile, GE Healthcare is also making waves in digital pathology
through Omnyx, its joint venture company with the University of
Pittsburgh Medical Centre. Last November, Omnyx won a Growth Strategy
Leadership Award from technology market research firm Frost & Sullivan.
The award recognizes Omnyx for making strides in digital pathology
systems by creating and refining solutions in conjunction with
pathologists at UPMC – a real-world test lab.
Tony Melanson, vice president of strategy and marketing for Omnyx,
commented that, “We are developing a complete system that includes
scanners, imaging software and workflow software. We are approaching
digital pathology by looking at the challenge through the eyes of
pathologists, histotechnicians and the information technology managers.”
He added that, “We recognized immediately that the transition to digital
would only be successful if the products were developed based on a
complete understanding of the user in the context of their clinical
The products from Omnyx – which await FDA approval in the United States
– address the major technical challenges that have historically existed
in digital pathology: scanning speed, image quality, image viewing
performance and image storage.
On the scanning side, in 2009 the company was awarded a U.S. patent for
its new digital slide scanning technology. The patent covers a system
that uses two image sensors in a digital microscope, with a primary
sensor for acquiring images at a fast rate and an auxiliary sensor that
acquires focus data at a faster rate.
“Traditional digital pathology systems use only one sensor to perform
both tasks. This new concept uses two sensors which allows the whole
process to be faster while still taking a huge amount of focus points,
thereby creating high-quality images at a faster rate,” said Michael
Montalto, PhD, vice president of instrument development for Omnyx.
“Although the concept seems reasonably simple, it requires sophisticated
timing algorithms between the two sensors and light source, all while in
“It took us several years in the concept feasibility phase just to prove
we could acquire a high-quality image at a fast speed,” said Robert
Filkins, PhD., co-inventor and digital pathology program leader at GE’s
Global Research Center. “The technology allows for image acquisition to
be 2 to 4 times faster than existing technologies.”
On another front, by working with GE engineers in Israel, Omnyx has
developed a streaming technology optimized for pathology images that
will allow pathologists to navigate digital pathology images with near
zero-latency over standard hospital networks, and even from home.
Image storage has been an obstacle and Omnyx is designing their storage
system to scale to the needs of large scale clinical operations like
UPMC. Omnyx is also working closely with the GE Enterprise Archive team
to interoperate with that product for long term medical image archiving.
Hôpital CSSS de Trois-Rivières goes with lean
solution for the ER
When healthcare facilities can’t keep up with demand for their services,
the traditional solution has been to add resources – namely, doctors,
nurses, support staff and equipment. Lately, however, a new approach has
Many healthcare centres are now borrowing ‘lean methodologies’ from the
manufacturing sector. They’re learning to do more with existing
Using this lean approach, emergency room doctors at a hospital in
Trois-Rivières, Que., are now able to see 40 percent more patients each
day – without increasing their own working hours.
Moreover, “they didn’t need to add staff or increase the budget,”
commented Camil Villeneuve, vice president, Lean Solutions at Fujitsu
Canada, the consulting company that helped the hospital analyze
bottlenecks and produce solutions. “Instead, they found more efficient
ways of working.”
The hospital, the Centre de santé et de services sociaux de
Trois-Rivières (CSSSTR), first investigated lean solutions because
management was troubled by long wait times, quality and the average stay
for patients in its emergency room.
It wanted to remain attentive to its most important customers – the
patients – who were making over 30,000 visits each year to the ER.
The management group at CSSSTR worked with Fujitsu Canada Lean Solutions
consultants to help reorganize their work and optimize processes in the
ER. After only four months, the project was a success – patients on beds
stay on average only 4.2 hours in the ER instead of 17.4 hours
previously; and average ambulatory patient wait times have been cut from
4.9 hours to only 2.7 hours.
“We were able to redesign the ER layout in a way that not only optimized
patient flow, but balanced the workload for all staff”, said Dr. Valérie
Garneau, chief of the emergency room. Prior to embracing lean healthcare
concepts, patient satisfaction was waning and there was great stress on
doctors and medical staff.
How did they do it?
Using a variety of lean analytical techniques, including statistical
analysis and simulations, some of the biggest bottlenecks were spotted.
In these cases, smarter ways of working were determined.
For example, it was found that patients took a long time to go through
triage and registration before seeing a doctor – a process that was
frustrating to both patients and care-givers. It also meant that the
waiting room was backing up.
As Villeneuve notes, delays resulted because patients first reported to
a triage area, where they explained their problems to a nurse and
returned to the waiting area. They would then see a nurse for admission,
who repeated many of the same questions.
As a solution, “We combined triage and admission in one step,” commented
Villeneuve. “Patients see the triage nurse and admissions clerk at the
same time. This means they have to tell their story just once instead of
The ‘work cell’ concept, where staff members with complimentary jobs
work in teams, has been extended to the doctors and nurses. Originally,
patients in the ER might be seen quickly by a doctor, but would then
have to wait for certain tasks to be completed by a nurse. Similarly, if
they were first seen by a nurse, they would then wait for the doctor.
Now, doctors and nurses work in tandem and see patients at the same
time. Diagnosis, paperwork and orders are all done without delay,
greatly speeding up the rate of patient turnover in the ER.
Non-clinical tasks – such as procurement – have benefited from lean
solutions, too. It was found that nurses were spending a good deal of
time counting and ordering ER supplies.
As solutions, the level of inventory was halved, and automated
replenishment systems were installed.
“The more stock you have, the more time you spend counting it,” observed
Villeneuve. By reducing the inventory, and automating replenishment,
less time was needed for managing procurement. “Nurses could spend more
of their time with patients,” said Villeneuve.
Now that patients are seen and discharged much more quickly, the ER
waiting rooms are less crowded and patients rarely have to wait
anymore.“We have more time to care for patients who need it most,” Dr.
“The work of emergency room staff is much easier and productive – all
this was accomplished without adding additional resources of people or
technology,” she said.
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