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Inside the June/July 2006 print edition of Canadian Healthcare Technology:


Feature Report: Directory of Healthcare IT suppliers


RSHIP sets course for advanced clinical systems

Alberta’s Regional Shared Health Information Program, made up of seven provincial health authorities, has an aggressive plan for implementing core and advanced IT systems.

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Alberta’s electronic surgical record is a world first

Better surgery equals better outcomes for patients, especially for patients with cancer. Now, a new tool will help Alberta surgeons to improve the quality of cancer surgery – and thus patient outcomes.

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Medication management

The Canadian Pharmacists Association has launched a web-based medication management tool, called e-Therapeutics, that offers quick decision-support to caregivers at the point of care.

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Performance analysis

A decision support system at Sunnybrook Health Sciences Centre, in Toronto, is enabling the hospital to closely monitor the costs of a wide range of procedures. That will allow the centre to better analyze financial and clinical performance.

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Ambulance integration

Toronto’s Emergency Medical Services is implementing a new electronic Patient Distribution System across the city’s hospitals, in a bid to reduce delays when offloading patients to emergency rooms.


Interview: Salois-Swallow

An interview with Diane Salois-Swallow, CIO of two fast-growing hospitals in the Toronto region. Ms. Salois-Swallow provides readers with insights on how to successfully implement complex IT systems. She provides examples of how her organizations involved IT users to help ensure success.


PLUS news stories, analysis, and features and more.

 

RSHIP completes core systems, soon to begin advanced applications

By Jerry Zeidenberg

RED DEER, ALTA. – Now that it has completed a large-scale, $90 million implementation of core clinical and financial systems across seven regions, Alberta’s RSHIP partners (composed of seven rural regions) are ready to embark on the next phase of their ambitious IT program.

Phase two will consist of a $47 million leading-edge installation of advanced clinical systems (ACS), which are essentially patient-safety applications – including physician order entry, bedside medication verification, as well as error-checking systems not only for acute-care hospitals, but also for nursing homes, home care, public health and mental health organizations.

“It’s only because we’ve got the core systems in place that we can add and use the advanced applications in an intelligent way,” commented Pat Ryan, executive director of RSHIP. “We believe that up to 40 percent of medical errors can be eliminated by using these systems.

“But you first need the core applications to provide information about vital signs, medical profiles, allergies and other important data,” he said.

According to Ryan, many of the North American hospitals and health regions that have installed patient safety applications haven’t derived the expected value from them, as they’re not linked to foundation systems.

“They can do order entry, but they can’t check orders against previous medications or allergies,” said Ryan, as just one example.

For its part, RSHIP’s installation of patient safety systems is slated to start in the Spring of 2007 and will involve an investment of $15 million to $20 million annually over a three-year period.

From now until the actual ACS installation begins, the partners will work on ‘readiness’ – the education and training that’s necessary to make physicians and nurses aware of the applications and their benefits.

“We have to demonstrate to the doctors why these solutions are important,” said Ryan. “When we capture their interest, we can rally them to the cause. The deployment of ACS will be led by physician and clinician champions from within the RSHIP regions.”

All told, RSHIP has quietly emerged as a national leader in the application of healthcare IT. It’s demonstrating how organizations can band together to extend the benefits of computerized solutions across a wide range of stakeholders.

“I think other provinces will want to take a look at what we’re accomplishing,” said Ryan.

RSHIP is also demonstrating how to modernize the healthcare system at lower cost, through a shared services model. As a group, the partners struck up a deal for their core systems and advanced applications from Boston-based Meditech, a major supplier in both the U.S. and Canada.

By using the shared services model, RSHIP has been able to obtain additional software and hardware at affordable prices, including sophisticated data centres for storing and safeguarding information.

“On their own, the regions couldn’t have achieved this level of functionality at this price,” said Ryan.

Ryan, well-known in the sporting world as a two-time world curling champion, was previously chief information officer for Interior Health, in British Columbia. He joined RSHIP in September 2005.

The chance to help lead the transformation of a huge geographical area in Alberta was exciting. “I do believe that by cooperating and using a shared services model, the health system can reduce the duplication of services that leads to the waste of taxpayers’ dollars,” said Ryan. “The seven CEOs at RSHIP believe in this model, and were already working together. They believe that together, they can go further, faster.”

In addition to the core and advanced systems, RSHIP has embarked on a large-scale implementation of PACS. The Picture Archiving and Communication System, from Agfa, will be used in every hospital imaging department, as well as all of the region’s independent imaging centres.

The PACS, part of a province-wide project, involves the investment of an additional $64 million in RSHIP centres over a two-year period.

The plan calls for a go-live at RSHIP’s largest district, the David Thompson Health Region, as well as at East Central Health Region, by March 2007. The remaining five regions will be hooked-up over the next two years.

All images – along with electronic health record data – will be fed into a central repository in Red Deer, with a mirrored site for backup and emergency purposes in a secondary site.

Ryan noted that RSHIP’s clinical information will also be connected to the province-wide NetCare system, which will enable doctors and health professionals across the province to access patient records on an as-needed basis.

The leading-edge NetCare system, led by Alberta Health & Wellness is expected to provide Alberta physicians with fast access to more accurate information – letting them make better clinical decisions and cutting back on the duplication of tests.

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Alberta’s electronic surgical record is first of its kind worldwide

By Lynne Smith

CALGARY – Better surgery equals better outcomes for patients, especially for patients with cancer. Now, a new tool will help Alberta surgeons to improve the quality of cancer surgery – and thus patient outcomes. Web Surgical Medical Records (WebSMR) is an electronic data collection program that allows immediate analysis of completed surgeries.

“Our initial phase has been more than successful,” says Dr. Walley Temple, chief of surgical oncology at the Alberta Cancer Board’s Tom Baker Cancer Centre in Calgary. “This approach has really moved surgery from an art to a science. Suddenly, you can analyze what works and what doesn’t work.”

WebSMR is the first of its kind in the world for surgery. It replaces the traditional narrative OR report – dictated orally by the surgeon – with a web-based questionnaire that takes about the same amount of time to complete. But it’s better.

“This synoptic method of reporting operations is as effective as dictating, but produces 50 percent more information, on average, than narrative reporting,” Dr. Temple says. “We can now give out that information in one day, and it’s more accurate and reliable.”

Surgeons complete a questionnaire that includes a precise description of the procedure, data on demographics, diagnostic evaluation, staging, and functional measures, and can be used for any type of tumor. Because the data collection tool is on-line, physicians can complete the report in the operating room or their offices – in fact, virtually anywhere.

A preliminary study conducted in 2004 comparing WebSMR data with those from narrative reports confirmed the advantages of the system. In July, 2005, the first surgeries – for liver and rectal cancer – ‘went live’ on WebSMR in Calgary. Reaching that stage, however, required an enormous amount of work by Alberta surgeons and a group known as Cancer Surgery Alberta (CSA).

The project was initiated in 1998, when the Alberta health regions asked the Alberta Cancer Board (ACB) for clear guidelines and outcome indicators for cancer surgery.

Because surgery is a regional responsibility controlled by no single body, Dr. Gavin Stuart, then vice-president of the ACB and Director of the Tom Baker Cancer Centre and his project team at the ACB, in collaboration with the health regions, struck a provincial working group largely consisting of surgeons. Dr. Temple assumed the leadership of CSA reporting to Dr. Anthony Fields, vice president, medical affairs and community oncology at ACB.

The group’s first attempt at standardization, using a customized commercial package, wasn’t satisfactory – it not only took too long to get data for analysis, but too long for physicians to complete. Surgeons wanted a system that took five minutes, as dictation had. And if this system was to replace narrative reports, they wanted to be able to run it using nothing more than mouse clicks. The group decided to develop a template from scratch.

Working around their surgery schedules, Alberta surgeons in eight sites met mornings and evenings to identify what comprises a proper cancer operation and determine the minimum data sets for each type of cancer.

Dr. Temple says the project team received “absolute commitment” from surgeons throughout the project and credits them for their willingness to subject themselves to critiques.

Once the template was finalized, the project team met with the surgical community in an education and consensus workshop. After they demonstrated and explained the tool, the team asked if it would be useful. If the surgeons had said no, the working group was prepared to scrap the project, says Evangeline Tamano, program leader of CSA. Happily, “They said ‘Go for it.’” The ACB then funded the project infrastructure.

Implementation is being done in phases. It began with the smallest tumor-surgery group, the liver group, so any bugs could be worked out on a smaller scale; rectal cancer surgeries followed. WebSMR was implemented first in three of the nine Alberta health regions (Chinook, Palliser and Calgary) for rectal and liver cancer surgeries. Breast cancer surgeries are now documented on WebSMR in those regions, as well as the Cross Cancer Institute in Edmonton. Currently 50 rectal cancer surgeries have been documented on WebSMR and 80 for breast cancer.

The next phase will see those surgeries being recorded in the remaining regions, plus reports on surgery for melanoma, sarcoma, and ovarian, colon and thyroid cancer for all regions. That will be done concurrently, says Ms. Tamano, although the timing of each will depend on the integration of technology systems.

Technology created some difficulties – Alberta’s health organizations currently use three different EMR systems. Administrative infrastructure, such as privacy regulations and policies, also created challenges.

“You wouldn’t think changing from narrative format to digital would make a difference, but the system is built in such a way that it did,” Dr. Temple says. “By the end of the project, what I came to appreciate is how complex our system is.”

Still, it’s been more than worth the effort. While in the past, guidelines tended to get shelved because there was no seamless way to systematically incorporate them into the surgical documentation process, “These synoptic reports, through the templates we designed, automatically build in guidelines,” Dr. Temple says.

“The other amazing thing that has come out of this is that, because surgeons know so much about the patients, they can add so many new things to the information that formerly wasn’t part of surgical record, but might be factors in patient outcomes.”

For example, the analysis of surgical practices, such as why patients with rectal cancer are having anal preserving process rather than a colostomy, can be made more accurately with the expanded data.

In the short term, Dr. Temple is looking at WebSMR being used across Alberta within 1-1/2 years. Beyond that, he says, “Our vision is that this unique approach is going to be a nation-wide standard.”

The potential of this tool isn’t limited to oncology. “This is kind of the mother pilot for all surgery. It digitizes our work so we can analyze it through dynamic, real-time feedback.” It’s not even limited to surgery. Eventually, Dr. Temple would like to see the integration of other specialties – medical and radiation oncology – on the system, “So we can understand more of the biology of cancer, and integrate the three…We still don’t fully understand the process on function and morbidity. And as we get better at controlling disease, we have to make sure we also get more effective at decreasing morbidity.”

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e-Therapeutics offers drug management tools to doctors, pharmacists

By Jerry Zeidenberg

TORONTO – Assisted by $8.8 million in development funds from Health Canada, the Canadian Pharmacists Association has launched a web-based medication management tool that’s designed to offer quick decision-support at the point of care.

The CPhA calls it “a second opinion from Canadian experts on what works, when – that you can consult anytime, anywhere.”

Dubbed e-Therapeutics, the system enables physicians, nurses, pharmacists and other practitioners to check the use of various drugs, obtain warnings about possible interactions with other medications and herbal remedies, and view ‘best treatment’ options for a wide variety of medical conditions.

All of this is presented in a Canadian context, with Canadian drug names, and advisories and alerts from Health Canada.

Care-givers can use the system through the e-Therapeutics web portal or on handheld computers, like the Palm or Pocket PC.

“It’s important to note that the information is unbiased, that it’s not coming from a drug company,” said Janet Cooper, senior director of professional affairs at the Canadian Pharmacists Association. As such, said Cooper, healthcare professionals can have confidence in the service as a trusted source of information.

Cooper spoke at a launch event for e-Therapeutics, held in Toronto.

She said e-Therapeutics is the result of a three-year project that involved nearly two dozen developers, along with some 200 pharmacists, nurse practitioners and physicians. “We received feedback from them in pilots, and built their recommendations into the system,” said Cooper.

The system was developed with the assistance of IBM Canada and the College of Family Physicians of Canada. Major resources – which have been incorporated into the solution – include the CPHA’s publications, such as:

• “The Compendium of Pharmaceuticals and Specialties” (CPS). According to the association, this is the definitive Canadian source of drug information. It contains nearly 3,000 current product monographs, including 108 drug or drug-class monographs prepared by CPhA, quick reference drug information and clinical tools, directories of sources of drug and healthcare information, a list of discontinued products and a comprehensive crossed-reference index of generic and brand names.

• “Therapeutic Choices”, which offers comparative and evaluative information on treatment options on 118 common medical conditions. Data are organized in a clear and concise format, including decision trees, tables and a comprehensive index.

• Lexi-Comp’s Lexi-Interact, providing comprehensive drug-to-drug, drug-to-herb and herb-to-herb interaction information.

“When it comes to appropriate therapies, the system shows when various classes of drugs are appropriate, and whether drugs are needed at all,” said Cooper. “It’s evidence-based, and it shows the sources of the evidence.”

Moreover, she said e-Therapeutics also notes the costs of various drug therapies. “Doctors often don’t know the costs for many medications, or if a generic is available.

Some generics can be 10 times or 20 times less expensive,” she said, adding that cost is an important issue for patients and the healthcare system, in general.

Dr. John Maxted, associate director of the College of Family Physicians of Canada, said “there have been changes in the way physicians practice medicine in recent years,” with doctors constantly looking up information. “They need to access information as quickly as possible, while seeing patients.” For that reason, he believes e-Therapeutics will become a valuable addition to the tools used by primary care physicians.

“Instead of browsing through heavy textbooks, we can go online,” said Dr. Maxted.

Information about the service is available at www.e-therapeutics.ca It’s a subscription-based service; individuals can subscribe for $389 per year.

Because it uses industry standards, the system is designed to integrate with various electronic medical record systems. However, actual integration with leading EMRs hasn’t yet been accomplished.

In the future, e-Therapeutics might be used to double-check current and proposed therapies for a patient’s medical condition while a physician is studying the chart.

Wayne Lepine, director of pharmaceutical policy for Health Canada, said the e-Therapeutics project is expected to lead to healthcare renewal, to improvements in patient safety through the use of technology.

Canadians now use approximately $25 billion worth of medications annually, and it is a problem to ensure they are used appropriately. Various Canadian and U.S. studies have pointed out the high levels of medication error that currently exist.

“The Health Council of Canada has recommended that we look for solutions to increase the accuracy of prescribing,” said Lepine. For its part, the Canadian government has also been developing a national pharmaceutical strategy. “This could provide one conduit,” said Lepine.

Neil Stuart, practice leader for IBM, also highlighted the patient safety challenge.

“There’s a gap between what we know [about medications] and what we do in practice,” said Stuart. “The e-Therapeutics application gets knowledge to the point-of-care, and helps close that gap.”

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Sunnybrook implements suite for financial modelling, cost control

By Andy  Shaw

TORONTO – Sunnybrook Health Sciences Centre, never faint-hearted about technology, took another decisive step in April when the hospital announced its decision to buy and implement the Alliance Suite of decision support tools from Atlanta-based Avega Health Systems.

As announced, the Alliance Suite “integrates financial, clinical, and administrative information to support decision-making across the healthcare enterprise.”

According to Sam Marafioti, Avega is all that and then some.

“For us, the selection of the Avega Suite was very much about case costing,” says Marafioti, Sunnybrook’s vice president of corporate strategy and its chief information officer. “Like any other business, management needs to know what the services of all of our program units cost, from two points of view. First, what the unit costs are for every patient discharged. And second, how our unit costing compares with other healthcare organizations.

“We pride ourselves in being a top performing organization,” he adds. “So, to maintain that position, management has to know accurately what our unit costs are.”

Marafioti says that while many software products can track and analyze costs well, none do it better in healthcare than Avega.

“Using Avega we can tell, for each patient discharged, what the nursing costs were for that patient, what the lab costs were, what the radiology costs were, and what any other costs from any other unit were,” says Marafioti.

And the ability to do that really ties the organization together from the front line to the CEO. What Avega does in real-time really well is to provide information on the desktops of the CEO, of the patient care managers, of the service providers. And therefore, it lets everybody involved know if something is going off our budget targets. The CEO and department managers alike can look at the Avega application and see, using a colour-code schema, what’s happening. “Green means everything is OK,” says Marafioti. “Red means it’s not. Amber means you’re just on the edge.”

This intimate access to performance data also strengthens management’s relationship with Sunnybrook’s board of directors.

“They have a governance responsibility, so what we are planning to do as we implement Avega is to provide the Board with monthly summaries of key performance indicators,” says Marafioti. “That helps them meet their commitment to the taxpayer that the hospital is providing its services at the highest efficiency levels possible. Avega will help them understand costs, how they are attributed, and how they can correct the course if the hospital is not heading in the direction it should be.”

Marafioti says Avega will also help the Board and management make better plans for the future. “With the data you can get out of the application you can do what we call budget modelling. Once you know what your costs are, you can ask yourself questions like: If we did another 100 cancer care cases, what will that mean to us?

“You can then go to the Avega system and determine what that would cost the hospital; into what units would we need to put more money; or even better yet, how can we handle these additional cases without putting more money into the system. Good case costing data allows you to create such models. And with them you can avoid surprises or unexpected costs you didn’t plan for.”

The Alliance Suite purchased by Sunnybrook Health Sciences consists of three major components: Alliance for Decision Support, Alliance for Financial Management, and myAlliance Enterprise Portal.

The Alliance for Decision Support in turn consists of three sub-components: Contract Modeling & Revenue Cycle Management, Cost Management, and Clinical Management. Similarly, the financial management component consists of four sub-components: Budgeting, Productivity, Long-Range Planning, and Performance Reporting. The portal component provides enterprise-wide, desk-top access to the reports generated by the other components.

Founded 23 years ago in El Segundo, California and bought out by Atlanta-based MedAssets Inc. in January of this year, Avega remains as a separate subsidiary. It first developed its decision-support products in 1995. Today, its Alliance for Decision Support is in use at over 400 hospitals in the United States, but is making only its second appearance in Canada at Sunnybrook. West Park Healthcare Centre, a rehabilitation, complex, and long-term care hospital in Toronto, is also an Avega user.

“This is the way of the future, as we move into an age where accountability is becoming paramount,” says Marafioti. “It will not surprise me at all to see Avega become a big player here in Canada, especially among teaching hospitals. With teaching hospitals, you have academic and research costs you carry in addition to all of the normal hospital costs. So it is particularly difficult to get on top of those as cost components. Avega’s system allows you to do that.”

Marafioti says Sunnybrook Health Sciences Centre made the purchase despite Avega’s Oracle database underpinnings. “We’ve been purposely shifting away from Oracle and towards Microsoft for our databases, because Microsoft is so much cheaper. But the functionality of Avega is just so superior that the Oracle database was not a deterrent.”

Also, Marafioti says that the cost of the Avega suite was “... not in the millions. By comparison with other enterprise-wide systems you might buy for a hospital, this decision support system is not expensive.”

American experience suggests Sunnybrook Health Sciences Centre could re-coup its investment in Avega soon. Catawba Valley Medical Center, a 258-bed, not-for-profit medical centre in North Carolina, for example, used Avega to analyze high drug costs connected with its pneumonia patients. Resultant changes to prescription procedures boosted Catawaba’s bottom line by $40,000.

Similarly, the Eisenhower Medical Center, in Southern California, used the Crystal Reports ad-hoc reporting tools provided with the Alliance for Decision Support to identify which supplies chargeable to patients were running highest over the course of a year. The reports empowered Eisenhower Medical management to make cost-cutting supply chain decisions. The Children’s Hospital of Pittsburgh (CHOP) used its Avega decision support tool to discover that payments for babies born elsewhere but switched to CHOP for care were lower than stipulated. CHOP then petitioned state health authorities and collected over $1.5 million in retrospective underpayments.

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