Inside the June/July 2001 print edition
Canadian Healthcare Technology:
Feature Report: Directory of Healthcare I.T. suppliers
hospital pioneers use of tele-surgery
Dr. Brian Taylor, chief of general surgery at the London Health
Sciences Centre, and Dr. Winston Hewitt, together completed an appendectomy on a patient
while located at different campuses of the hospital. They made use of robotics, minimally
invasive surgical gear, and video equipment. The telemedical systems could be of great
value in assisting surgeons in remote locations.
CAR calls for probe of $1 billion radiology program
The Canadian Association of Radiologists is urging Ottawa to create a
task force that would assess how the federal governments $1 billion radiology fund
was spent by the provinces.
The Hospital for Sick Children has officially opened its Centre for
Image-Guided Therapy, a $30 million facility thats said to be the worlds most
advanced when it comes to pediatric keyhole surgery and interventional radiology.
Ottawas EMR project
Canadas Health Infoway Inc., funded by $500 million, will act
more like a venture capitalist or a mergers-and-acquisitions company than a traditional
government agency, says William Pascal, director general, Office of Health and the
Palm encounters a crisis, opening up market opportunity to other players. Palm will
survive, but in the process will become a different, less ambitious company.
Saskatchewans Sanitec Canada touts itself as the countrys
sole provider of microwave technology for handling medical waste. Its said to be an
effective method of treating potentially harmful waste.
PLUS news stories, analysis, and features and more.
London Health Sciences Centre tests new telesurgical technologies
By Andy Shaw
Surgeons at the London Health Sciences Centre (LHSC) in south-western
Ontario have scored yet another world first by using a telementoring video system during
actual surgical procedures. Off-site physicians used the Socrates system on loan
from Computer Motion Inc. of Santa Barbara, Calif to assist surgeons in an
operating room 10 kilometres away conduct eight surgeries, including a plural biopsy, two
cardiac bypass procedures, a cardiac valve procedure, and an appendectomy.
During the appendectomy, surgical resident Winston Hewitt remotely
assisted Dr. Brian Taylor, the LHSCs chief of general surgery.
It was just like I was standing beside him, said Dr.
Taylor. To effect that sensation, the Socrates system provides both doctors with two-way
audio communication and gives remote advisors like Dr. Hewitt direct control of an
overhead camera so that both physicians can see exactly the same views of the
patients insides. It also comes with a telestrater, enabling the remote physician to
illustrate procedures or to point out anomalies on the video image the surgeon sees, much
in the way television sports broadcasters can superimpose explanations of football plays
for viewers at home. The system also has the potential to allow remote positioning of
There are two benefits I can see, said Dr. Taylor.
The first is probably the savings that can come from not having to bring people all
the way in here for complex surgery, if we can assist with doing it in their home towns
remotely. But I think the best thing about the system is that it is a superb teaching
I could be in an operating room, for example, talking to the
surgeon about what he is doing, while a remote classroom of medical students could be
watching and therefore be in on the operation.
Dr. Taylor is less enthusiastic about prospects for the next level in
surgical robotics, actually making the cuts and doing the surgery from afar.
What happens if the people with the patient cant do the
procedure and something goes wrong with the system? It just smacks too much of
danger, said Dr. Taylor.
Even the telementoring system is not yet quite as risk free as some
would like. In the London operations, at least one physician reported a bit of a
time delay before the remote doctors comments got through to the surgeon.
Nonetheless, LHSC management is confident of robotics future in
Canadian medicine and are betting a good chunk of their bottom dollars on it.
I think we have a very innovative spirit in Canada when it comes
to medical technology and particularly here in London, said LHSCs chief
executive officer, Tony Dagnone. We really like to push the envelope here when it
comes to finding better and less painful ways to treat the patient. Just over three years
ago at LHSC, we took a serious look at how we could mitigate the shortages of talented
people that we would be facing in medicine and decided that robotics, with its ability to
widen the reach of medical expertise, was a big part of the solution.
One embodiment of that vision is the National Centre for Advanced
Surgery and Robotics at LHSC under the direction of Dr. Douglas Boyd, one of the first
surgeons in the world to conduct a robot-assisted heart bypass on a closed chest. The
promise of similar minimally invasive techniques is to transform long hospital stays to
one-day or even outpatient procedures.
Dagnone said he hoped that his facility, in co-operation with
Londons St. Josephs Hospital, will break ground this fall on a much expanded
laboratory and test bed for robotic and computer assisted surgical techniques.
We want to create a facility where our medical industry partners
and ourselves can both do testing and validating of new procedures in a non-threatening
environment, said Dagnone. It would also be a centre for medical students and
medical staff to come and upgrade their skills. It will also be a place where surgeons,
somewhat like airline pilots, can come and have their skills in advanced techniques
Inspiration for the centre, and possible private sector partners in the
venture Dagnone hints, may come from Canadas efforts in space.
We marvel at what the Canadarm has done and I think its
technologies can be readily adapted to the medical field, said Dagnone. Why
not take advantage of the hundreds of millions of dollars weve invested in space
research, and why not apply that knowledge to the good of society?
For answers, we suggest you watch the latest news.
CAR seeks probe of governments $1 billion program for imaging
By Jerry Zeidenberg
MONTREAL The Canadian Association of Radiologists is urging
Ottawa to create a task force that would assess how the federal governments $1
billion radiology fund was spent by the provinces.
Prime Minister Jean Chretien announced the high-profile fund last
September, shortly before calling the federal election. Some $500 million was handed out
to provincial governments in the fall ostensibly to upgrade the nations stock
of aging and malfunctioning diagnostic imaging equipment. Another $500 million was given
out in April.
Recently, however, reports have surfaced in the national media stating
that much of the money wasnt used to purchase new high-tech equipment, but was
diverted to pay for beds, standard medical equipment, long-term care and other services.
Normand Laberge, president and CEO of the Canadian Association of
Radiologists, asserted the $1 billion was to be used to fight the crisis in radiology
to reduce the waiting lists for MRIs and other exams, and to modernize
Canadas imaging equipment so that doctors can make the best diagnoses possible.
Meanwhile, it has been discovered that no reporting mechanisms were put
in place by the federal government to track how the $1 billion was spent. Nobody knows how
many new MRIs or X-ray machines were acquired with the money.
According to Laberge, the task force would include the CAR, the
Canadian Medical Association, Health Canada and possibly some members of the diagnostic
In addition to assessing how the $1 billion radiology fund was actually
spent, Laberge said the task force would have three other functions:
To establish an expert panel that would produce diagnostic
imaging standards. These standards would serve as guidelines to be met by provinces and
hospitals across the country. The panel would determine, for example, which modalities are
needed to diagnose the most prevalent and serious diseases, how many of these machines
should be in operation in relation to the population, and the number of exams that should
be provided, based on the population.
The expert panel would also set standards regarding the life
cycle for diagnostic imaging equipment. The CAR, along with other organizations, has
conducted surveys that found much of Canadas radiological equipment is old and
outmoded. Some of it breaks down during exams, creating risks for patients.
Just as in aviation, you have rules that after so many flights
you must replace the tires on an airplane, you should have regulations governing
replacement cycles for diagnostic imaging equipment, said Laberge. This would
apply to whole machines and their parts. The panel would also assess how various
jurisdictions are meeting the guidelines and would issue report cards to this effect.
The panel would do the follow-up, said Laberge, to determine how well
the guidelines are being implemented.
The task force would also establish a five-year plan for
radiology in Canada, to deal with additional investments in equipment and human resources.
Laberge said the federal governments $1 billion fund was a valuable concept, but
that further spending is needed to upgrade the countrys stock of radiological
equipment. For example, he noted that while PET scanning has become important for
detection of cancer and other diseases in the United States and Europe, there is little
access to PET scanning in Canada. If planning isnt implemented soon for this
modality, private clinics will probably be established here, offering the technology on a
Laberge said the CAR has been meeting with senior officials at Health
Canada and has received positive signs that a task force may soon be established. For its
part, the CAR would like to see the organization set up by October. If it takes longer
than that, said Laberge, the delay would indicate a lack of seriousness on the part of the
Governments e-health records company to act like venture capital firm
TORONTO Canadas Health Infoway Inc. will act more like a
venture capitalist or a mergers-and-acquisitions company than a traditional government
agency, says William Pascal, director general, Office of Health and the Information
Highway, based in Ottawa.
The corporations job is not to manage a project, said
Pascal. Its to bring people together with competencies, and set out some
Speaking at the recent e-Health 2001 conference that was sponsored by
COACH and CIHI, Pascal provided the latest news about Canadas Health Infoway. The
company was established to dish out $500 million for the creation of electronic health
records across Canada. Prime Minister Jean Chretien announced the funding last fall, just
before he called the October election.
Pascal observed that investing in electronic health records and
telehealth isnt a short-term undertaking nor will the $500 million be enough
to do the job.
Its more like a ten-year journey that will likely cost $3
billion to $4 billion, said Pascal. But $500 million from the corporation is a
One of the main thrusts of the company is to ensure the emergence of
standards and interoperability. That way, systems created in one part of the country will
be able to converse with those used in another part of Canada.
The corporation intends to plow money into projects that show good
potential, so they have enough funding to prove the worth of a good concept. There
are people doing creative stuff in this country, but they dont have enough
funding, said Pascal. We can help them by investing, and then blow the
(technology) out across the country.
Pascal said this probably cant be done in every jurisdiction. But
if standards are engineered in the pilot projects, then the technology could be made
portable and adopted anywhere.
He said that Canadas Health Infoway wants to collaborate with
both the public and private sectors. He asserted that many healthcare providers do a
lousy job of reaching out to the vendors.
Vendors can tell us, in some instances, that were being far
too conservative in our solutions, observed Pascal.
Not only does the corporation want to build ties among providers and
vendors, its seeking to create linkages with other programs. These include the
primary care investment fund, an $800 million program, the $80 million Canada Health
Infostructure Partnerships Program (CHIPP) investments, and the National Broadband Task
force, which seeks to have broadband installed in every Canadian community by 2004.
Palm encounters a crisis, opening up market opportunity to other players
By Issie Rabinovitch, PhD
In December of last year, I attended PalmSource 2000 in Santa Clara,
California. Although organized by Palm, Inc., the conference is designed for everyone
involved in the Palm Economy. That includes Palm licensees (and competitors)
such as Handspring, Sony, and IBM, dozens of large software companies developing on the
Palm platform, and some of the over 100,000 independent developers.
The mood at PalmSource was extremely upbeat, but almost overnight that
conferences optimism has been wiped out by the slowing economy and other factors. No
one has been affected more than Palm itself.
Throughout much of last year, Palm was unable to keep up with the
surging demand for its handheld computers. Early in 2001, Palm signed long-term deals with
component suppliers to ensure that such a situation would not be repeated in 2001. The
market for handhelds crumbled before the ink had dried. January was a good month, but by
the end of February Palm was struggling with growing inventory levels.
By May, things had deteriorated to the point where Palm was
reconsidering its business model. It had already cancelled plans to build a new
headquarters, in order to preserve cash. It was forced to back out of a deal to acquire
Extended Systems, a developer of enterprise software for the handheld platform. Palm will
survive, but in the process will become a different, less ambitious company.
Palms new generation of handhelds, the monochrome m500 and the
16-bit colour m505, were announced in March and current models stopped selling. When the
m500s began to ship in limited quantities in May, Palm was sitting on several hundred
million dollars of unsold inventory.
The m500s represent a significant step forward. They are virtually
identical, with the exception of colour. Both resemble the popular Vx in size, have 8
megabytes of memory, an upgrade slot supporting the SD standard, and run on the newest
version of the Palm OS, v4.0.
Theres a speedier processor, a USB cradle for faster HotSync
operations, silent alarms (vibration and/or flashing lights), better security, and more.
The bundled CD has some very valuable new software, allowing users to view photographs,
view and edit documents and spreadsheets, and read books.
In addition to memory modules, a new generation of scanners, cameras,
GPS and Bluetooth modules, modems, telephones, and MP3 players will connect to the SD
The number 2 producer of Palm-compatible handhelds isnt Sony, as
might be expected, but Handspring. In May, Handspring announced the opening of its new
Canadian headquarters in Toronto. Handspring licenses the Palm OS from Palm, and ships a
line of handhelds called Visors. Handsprings market share in the United States is
around 25 percent and growing. Visors have been selling well in Canada since last year.
Now that Handspring has a marketing presence in Canada, the situation can only improve.
Handspring has also been affected by the market downturn, but it seems to have managed
better than Palm.
All Visors have a proprietary upgrade slot, called Springboard. Third
party support has been excellent. The choice of modules available today includes memory,
telephones, dictionaries and specialized reference materials, 56K and wireless modems,
digital still cameras, MP3 players, GPS navigational devices, digital voice recorders, and
game and entertainment packs.
Before years end, I expect Handspring to be on a more equal
footing with Palm, and to be more influential in determining the direction of the
platform. The handheld space consists of more than just the licensees of Palm, Inc. The
number two platform is the Pocket PC, which consists of a scaled-down version of Microsoft
Windows running on handhelds from Casio, Compaq, and Hewlett-Packard. Compaqs iPAQ
has emerged as the sales leader, and rightfully so. It has a brilliant colour screen,
multiple upgrade options, and better compatibility with Windows than anything on the Palm
It is slightly larger than the m505, more powerful, but harder to use.
If the next version of the Pocket PC operating system, due in late 2001 or early 2002,
delivers the anticipated improvements, Microsoft and its hardware partners could well be
in a position to pass Palm.
On the other hand, this may never happen. Palm and its partners still
enjoy a huge lead. If Palm is able to quickly solve its financial and inventory problems,
and many exciting SD cards reach the market without delay, Palm has a chance of
maintaining its position. Although it wasnt able to acquire Extended Systems, it
needs to work with them and others to enhance its ability to offer corporate and
enterprise solutions. It cant afford any more stumbles in this area, since it has a
natural disadvantage relative to the likes of Microsoft, HP, and Compaq.
Handhelds continue to grow in importance, despite the gloomy aspects of
some of the preceding discussion. I feel safe in predicting that, by the end of the year,
handhelds will have edged ever closer to the centre of gravity of the computing world.
Issie Rabinovitch, PhD, is a Toronto-based computer consultant,
writer and speaker.