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Inside the June/July 2004 print edition of Canadian Healthcare Technology:


Feature Report: Directory of Healthcare I.T. Suppliers


Toronto set to launch ‘assistive technology’ R&D facility

Toronto researchers are about to start construction on the world’s largest facility for the development of “assistive technologies” – advanced devices to help persons with disabilities.

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Do-it-yourself broadband

Since a lack of high-speed connectivity was holding up its plans for a regional PACS and EHR, the Niagara Health System organized public and private sector partners to create the infrastructure.

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New solutions for dictation

California-based Vianeta recently won contracts in Alberta to supply healthcare organizations with region-wide dictation, transcription and document solutions that make use of the Internet.

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IHE to form Canadian wing

Healthcare professionals and vendors are joining forces to create a Canadian offshoot of Integrating the Healthcare Enterprise, a movement to produce readily accepted IT standards. The IHE is battling the problem of information silos among healthcare providers.

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EHR at Capital Health

The Edmonton region’s Capital Health Authority has launched an ambitious electronic health record system that connects hospitals and other organizations throughout the region. In partnership with private sector companies, it’s now working on a patient portal.


PLUS news stories, analysis, and features and more.

 

Toronto set to launch ‘assistive technology’ R&D facility

By Jerry Zeidenberg

Toronto researchers are about to start construction on the world’s largest facility for the development of “assistive technologies” – advanced devices to help persons with disabilities. The centre, called iADAPT, will be constructed at the Toronto Rehabilitation Hospital in the city’s downtown core, as part of an expansion of the hospital. iADAPT recently received $18.5 million in funding from the Canadian Foundation for Innovation, and project leaders believe they’ll soon qualify for another $16 million from other agencies, bringing the total to nearly $35 million.

“We’re building an international centre for the creation of assistive technologies,” said Dr. Geoff Fernie, vice president of research at the Toronto Rehabilitation Centre. “There’s nothing in the world like this right now.”

He asserted that not nearly enough attention has been paid to the development of technologies for people with disabilities, dementia, or for the infirm and elderly. iADAPT is expected to help rectify the problem.

When completed in four years, it will involve 200 researchers, including 100 graduate students. iADAPT is also seeking to develop partnerships with the private sector for the commercialization of technologies.

At the Medical Devices Canada (www.medec.org) annual meeting in May, Dr. Fernie outlined the plans for the facility, which will include three large laboratories.

One of the labs will be built 60 feet below ground, where it will include a mobile, circular platform and simulator that will allow researchers to test various technologies in an environment that approximates the real world – complete with simulated motion, rain, darkness, bright sunshine, snow and wind. A crane will be used to drop equipment from above onto the circular platform, which measures six-metres in diameter.

“It will exceed the standards for aircraft industry simulators,” said Dr. Fernie. “It will even let us enjoy winter all year round,” he quipped.

Another lab will be constructed 12 floors up in the new wing of the hospital. It will include a small house, open at the top, allowing observation. Researchers plan to focus on the development of smart homes, in which artificial intelligence will be used to assist the occupants.

Dr. Fernie said the aim will be to produce ‘context aware’ systems that can determine the right time and circumstances to offer assistance. For example, motion sensors would sound an alarm if a person was immobile on the kitchen floor for 10 minutes, but not if the occupant was lying on the bed.

By the same token, the household computers would be able to remind the person to wash his hands in the bathroom, or to wear a coat when going out. It can also offer reminders about taking medications, and automatically shut off the stove if the homeowner has forgotten.

Dr. Fernie stressed the aim is to perform all of this in an intelligent way. For example, the system must be able to understand the routine of the householder, and know that it can remind him about medications later if the person is going out for a regular, 15 minute walk on a Monday afternoon. But if it’s Tuesday, and he’s going to the Legion Hall and won’t be back for six hours, it’s important to remind him to take his pills before he leaves. Researchers will even develop ‘intelligent toilets’, which can determine “how much pooping or peeing,” a person is doing – a useful measure of the health of the elderly or the disabled when living on their own.

“We might not be able to monitor blood sugar,” said Dr. Fernie, explaining that a blood sample is difficult to obtain remotely. But intelligent water closets could provide the answer. “In this way, we can monitor urine sugar.”

He pointed out that the dramatic surge in computing power helps make this possible. Computer processing capabilities have been doubling every 18 months, and by all indications, the trend will continue for some time.

If this state of affairs does continue, by 2017, a laptop computer will process as many operations per second as there are synapses in the human brain, said Dr. Fernie. “And by 2040, you’ll carry around the equivalent of a million human brains in your laptop.”

He stressed that partnerships with the private sector will be extremely important to the iADAPT centre. “Assistive technology hasn’t moved forward quickly enough,” he said. “It hasn’t had enough innovative design or marketing.”

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Niagara System innovates to produce a regional broadband network

By Jerry Zeidenberg

NIAGARA FALLS, ONT. – What can a group of hospitals do if there’s no high-speed infrastructure in their region? Well, they can always gather up some partners and create it themselves – which is exactly what the Niagara Health System did. The effort paid off handsomely – this fall, a new fibre-optic-based network, running at 1 gigabit/second throughout the region, will go live, supplying the hospitals with all of the bandwidth they need.

The project began in 2001, shortly after eight of the ten hospitals serving the Niagara peninsula of Ontario amalgamated into a single corporation. To create a common electronic medical record system, including an upcoming Picture Archiving and Communication System (PACS) for diagnostic images, a high-speed data network was needed. Without the broadband network, communication would grind to a halt.

“The high-speed infrastructure simply wasn’t available,” said Bala Kathiresan, chief information officer for the Niagara Health System. “The telcos could not adequately address our requirements and the cost was relatively even for lower bandwidth.”

Kathiresan and his colleagues at Niagara Health joined forces with other public sector entities, including the region’s public school board, the separate school board, local library, Niagara College, and the regional municipality – all of which had branches spread across the southern Ontario ‘fruit belt and wine region’ and would benefit from high-speed connections.

Together, they developed an RFP for their business case, and a group of six local hydro companies and a network design company banded together to produce the best solution. Under their proposed solution, new cabling would be widely dispersed throughout the region, involving an investment of approximately $10 million in high-speed infrastructure.

For their part, the Niagara Health System sites and their public sector partners will pay relatively low monthly fees for the new broadband service. “Our cost will be less than the cost of a T1 connection at today’s rate per site” said Kathiresan, referring to a commonly used 1.55 meg/sec connection that was once considered high-speed.

He noted that the new communications system, known as the Niagara Regional Broadband Network, is a win-win for all of the parties – the hydro companies have developed a new line of business and a fresh stream of revenues. At the same time, the public sector partners have produced a low cost solution to their computer networking needs. And the region has produced a new economic development tool that can help draw companies and skilled workers to the Niagara area.

“We’ve developed infrastructure that previously didn’t exist,” said Kathiresan.

He asserted that the network will be crucial to the future development of the information and communications technology at hospitals.

To improve the speed and accuracy of service, and to cut costs by reducing the duplication of tests, electronic patient records and images must be shared throughout the region as patients and healthcare professionals visit various medical centres.

As a stopgap measure, the hospitals currently have microwave technology that delivers 100 megabits/sec between the major facilities and 10 meg/sec to the smaller ones. However, the signals can be severely degraded by physical phenomena, like heavy storms.

By contrast, fibre optic networks are much more reliable, whatever the weather.

Dale Maw, regional director of information technology for Niagara Health, said the Niagara Health System is in the midst of a $17 million Information Systems implementation. The plan includes the creation of an electronic patient record and the reduction of current paper in a patient’s chart by 85 percent over the next three years.

The eight sites, which previously used a variety of hospital information systems, including paper charts, are now all upgrading or switching to a recent version of Meditech, one of the leading electronic healthcare information systems vendors.

To obtain the full benefit of the computerized clinical and business systems, the eight hospitals need to readily exchange information. The broadband network was the missing piece of the puzzle – Niagara Health System found its solution in the new fibre-optic network, produced in conjunction with its hydro partners and system integrators.

“It’s a very cost-effective way of doing it, and a good demonstration of a public/private partnership,” said Kathiresan. “Hydro companies have the basic networks to make it happen. And today, high-speed Internet is as essential as electricity.”

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Dictation upgrade helps Alberta Cancer Board span health regions

By Joaquim P. Menezes

It’s tough for physicians to record, access and share health information when their dictation system conks out frequently – often for hours at a time.

The Alberta Cancer Board (ACB) learned that the hard way, which is why it will soon embark on a complete system overhaul.

In the next few months, the Board will replace its aging dictation systems with a spanking new clinical documentation infrastructure.

Based on technology from Milpitas, Calif.-based Vianeta Communications, the new Web-based system will unify and automate every aspect of Health Information Management at the ACB – from dictation, transcription and speech recognition to chart completion and distribution.

The Vianeta system is likely to boost physician efficiency at ACB facilities by as much as 25 percent, enhance transcription speed, accuracy and flexibility, and reduce IT costs.

“It will also be intuitive and much easier to use,” predicted Shivan Boodoo, project manager, Information Systems at the ACB. He said the approximately 100 physicians attached to the Board frequently move around between major facilities, associate offices and remote clinics. “Now they won’t need to carry a Dictaphone or dial into anything.”

Boodoo has no regrets about replacing the Board’s existing dictation infrastructure, which has triggered more disk drive failures and crashes than he cares to remember. (After a crash, it would typically take several attempts and a great deal of time – and teeth gnashing – to get the system up and running again).

And system failures were not the only challenge. Replacement parts for the aging Dictaphone and Lanier systems were hard to come by and, when obtained, very costly to maintain. “Dictation quality was bad,” said Boodoo. “Transcriptionists couldn’t understand recordings, and the system was generally quite erratic.”

In a couple of months, though, all these problems will be no more than an unpleasant memory.

With the much anticipated launch of the new Vianeta-based system, the ACB is gearing up for dramatic improvements in availability….not to mention data quality, access and usability.

All this is not just wishful thinking. Three Alberta Health Regions that standardized on Vianeta early last year are already reaping these very rewards.

For hundreds of physicians at the David Thompson, Palliser and Chinook Health Regions, the new Vianeta system is just what the doctor ordered (no pun intended!)

“Cost and availability were the main drivers behind these three deployments,” according to Ralph Aceves, vice-president of field operations at Vianeta. He said aged legacy dictation equipment at the three regions was difficult to maintain. “Every upgrade was painful and expensive as the regions’ proprietary hardware could not integrate with other systems. Limited storage capacity made it impractical to archive dictations for more than five days. Some physicians dictated into microcassettes, causing workflow problems, and creating a separate management load for supervisors.”

Aceves said three components in the Vianeta arsenal have helped resolve these challenges conclusively: adaptable digital dictation and speech recognition products, a workflow management server (WMS), and a multi-channel distribution capability.

All these elements, he said, work seamlessly together, providing hospital administrators, physicians and other stakeholders with complete and easy access to patient information. “The dictation products integrate well with the WMS hardware, so hospitals can configure workflow efficiently, while multi-channel distribution offers a choice of delivery modes: online, print or fax.”

Once workflow rules are set up in the WMS the entire process is automated. “Report delivery is a snap,” said Aceves. “No longer are reports physically carried

to multiple clinics, departments or hospital floors. Once transcribed, they are transmitted electronically to physicians for editing and signing, and signed reports become part of an electronic medical record. All that happens without any human intervention.”

With the success of the David Thomson, Palliser and Chinook projects, excitement at the ACB – about its own forthcoming deployment – is running high.

“Automation and standardization,” is the new magic mantra at the Board. Automation is seen as the highroad to better transcription and distribution processes. A single standardized dictation system across four regions is expected to significantly improve the efficiency of the physicians working at the Board’s numerous facilities.

“Our doctors often move from one region to another,” said Boodoo. “Now when that happens, they won’t need to learn an entirely new set of commands and controls, as all regional systems will have the same specifications.”

According to Aceves, another efficiency booster is the system’s Web interface that enables the physician to access transcribed reports from any location, edit them online, sign them electronically and distribute them to appropriate stakeholders – all without loading any software on his local PC. “Internet access and a standard Web browser is all that’s needed.”

Aceves said the system enables proxy signatures to be set up in a few seconds.

“Doctors going on vacation, for instance, could assign someone else to sign on their behalf for a specified time period. The substitute then automatically starts getting that doctor’s reports. When the specified time elapses, the proxy expires.”

Even niftier capabilities are expected when the ACB transitions to IP telephony this year – a process that’s already under way.

“When the migration is completed,” said Boodoo, “doctors will be able to log on to a Cisco 7970 IP phone, punch in a patient ID, and within moments pull up relevant patient information on the phone’s display.”

He said the technology for patient capture and workflow processing will be provided by Vianeta. The Vianeta system supports both analog and digital technology, so the dictation system can be integrated into the network without an analog gateway.

According to Aceves, the VoIP implementation will also enhance security. “Everything will be secured through an IP backbone, there’s no danger of any leaks from the PBX side of things.”

Vianeta’s success in Alberta has prompted the company to enter into discussions with other Canadian provinces. Aceves said his company was in competitive negotiations for projects in other health regions, but could not provide details at this point.

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IHE ‘steamroller’ rallies support in Canada, paving way for standards

By Jerry Zeidenberg

TORONTO – Moves are afoot to create the Canadian wing of Integrating the Healthcare Enterprise (IHE), a U.S. group that’s quickly gaining ground in the United States and around the world.

By specifying the way computers should talk to each other when carrying out different functions – everything from sending basic patient information to radiology, lab or other test results, the IHE consortium is paving the way for dramatically better communications between computerized systems.

The IHE organization first emerged from the radiology world in 1998 via the Radiology Society of North America (RSNA), and soon embraced IT in general through an alliance with the Healthcare Information Management and Systems Society (HIMSS). They’re now reaching out to cardiology and laboratory informatics associations and vendors.

“IHE is a breakthrough in healthcare,” said Dr. David Koff, a radiologist at Sunnybrook and Women’s Health Sciences Centre in Toronto. “Hospitals and clinics have had a lot of trouble moving computerized images and information around – this gives them a way of doing it.”

Dr. Koff made his remarks as a spokesperson for the Canadian Association of Radiologists at a recent Toronto meeting to promote the IHE in Canada.

The videocast event drew over 180 participants in Toronto, Halifax, Montreal, Ottawa, Calgary, Edmonton and Vancouver. It was jointly organized by the Ontario Hospital Association (OHA), HIMSS Ontario and the Information Technology Association of Canada’s Ontario branch (ITAC Ontario), in conjunction with the Canadian Association of Radiologists and trade association CHITTA – a remarkable display of camaraderie and cooperation.

Extensive information about the IHE is available at www.himss.org/ihe and www.rsna.org/ihe

Canadian healthcare professionals and vendors wishing to become involved were asked to contact Caren Adno, a vice president at ITAC. She can be reached through the web at www.itacontario.com

Healthcare professionals in Canada and the United States have long complained that information is trapped in ‘silos’ and is inaccessible because the computer systems are incompatible.

Even communication standards such as HL7 and DICOM haven’t helped, because vendors have incorporated these standards in different ways. There are dozens of ways to write a function in accordance with HL7 and DICOM, resulting in a computerized Tower of Babel where one system still doesn’t understand the next.

As one observer quipped, standards like HL7 and DICOM are akin to providing a visitor to the Czech Republic with a set of words in Czech, but they don’t actually tell him how to say, “I need to find a washroom.”

IHE, however, is creating specific phrases, or profiles, so that systems can pass messages and transactions.

Hospitals shouldn’t delude themselves into thinking that a single-vendor solution will solve the compatibility problem. “We’ve got 167 servers in our organization, and no single vendor can supply all of the applications,” said Dr. Nogah Haramati, chief of radiology and surgery at Albert Einstein College of Medicine, based in the Bronx, N.Y. Dr. Haramati, a member of IHE, outlined the nature and benefits of the movement at the Toronto conference.

He stressed that IHE is user driven, meaning healthcare professionals play a lead role in defining the communication and compatibility problems they’d like to see resolved by vendors.

Backing the IHE framework – a set of hundreds of communication specifications, or profiles, with many more in the works – makes sense for users, said Dr. Haramati. It ultimately means that executives and senior managers are supporting the integration of computer systems, which in turn leads to faster access to information, improved workflow and better patient care.

According to Dr. Haramati, Canadian hospitals would be wise to “draw a line in the sand from this point on,” and insist in contracts that vendors comply with IHE profiles for all of the functions they require in their IT systems.

He noted that even if the IHE doesn’t currently have a profile for a particular function, it should be included in the contract – so that the vendor must incorporate it later at no cost to the user.

“Put it in your contracts now, so that when it’s available later, you’re protected,” said Dr. Haramati. “Do not buy anything unless the vendor guarantees that when an IHE profile is developed, it will be added. In this way, the functionality won’t cost you a fortune later on.”

He urged hospital and healthcare managers to start planning for IHE now, because they will inevitably be doing it at some point – and the earlier they start, the more they will benefit.

“The IHE makes so much sense,” he said. “It’s a steamroller that’s unstoppable.”

He said the best course of action is to “create an IHE steering committee in your hospital or organization.

“My recommendation is to become familiar with the IHE and the profiles that are being developed. Check out the profiles on the web every once in a while.”

He also advised Canadian groups to form an ‘IHE Canada’, so that Canadianized profiles can be developed for functions that need it. “Get involved in the process and look at it from a Canadian perspective,” said Dr. Haramati. “Create extensions that support your needs, or else you’ll get the plain vanilla IHE that you’ll have to deal with later.”

Kevin O’Donnell, a Canadian who is manager of systems solutions with Toshiba Medical Systems in the United States., and also serves as co-chair of the IHE radiology planning committee, said the IHE is “trying to get integration happening faster than it currently is.

“You don’t want to keep inputting data five times, for five different systems, because you’ll get errors,” he said.

O’Donnell noted that it’s clinicians who set the agenda for IHE, defining their system integration needs. Vendors then go about developing standards-based solution profiles. These profiles make up the IHE Technical Framework.

Various societies, such as HIMSS, the RSNA, and the American College of Cardiologists, then supervise the documentation, testing, demonstration and promotion of the profiles.

He said that vendors have enthusiastically embraced the IHE, because it makes life easier for them, too. “It’s better to solve a problem at the beginning through the IHE than later, at a customer site, where it may take you six months to sort out and fix,” said O’Donnell.

He observed that a major event for the IHE is the annual ‘Connectathon’, in which vendors congregate and link their systems in a mass demonstration of compliance with IHE specs.

“Our last one had 35 different vendors with 70 to 75 different products,” said O’Donnell.

IHE has been catching on in Europe and Asia, too, which also face the problem of computer-system incompatibility in healthcare. “The problem everywhere is that people are turning to IT as a solution, but IT is broken,” said Dr. David Channin, chief of imaging informatics at the Department of Radiology, Northwestern University, in Chicago. “Computer systems don’t talk to one another, and getting them to talk has been hard to do and expensive.”

This has occurred despite the rise of standards such as HL7 and DICOM, because these solutions are too general. “There are no standards for the use of standards,” quipped Dr. Channin. For its part, IHE has stepped in to create highly specific methods of performing the transactions and messaging that are required when using healthcare data, regardless of the department or type of institution.

Said Dr. Channin: “The next killer apps will be in the areas of communication and integration.”

 

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