Inside the June/July 2006 print
edition of Canadian Healthcare Technology:
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.
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.
READ THE STORY
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.
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.
READ THE STORY
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.
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
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
“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
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
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.
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
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
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
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
“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.”
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
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,
• “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
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
Information about the service is available at www.e-therapeutics.ca It’s
a subscription-based service; individuals can subscribe for $389 per
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
“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.”
Sunnybrook implements suite for financial modelling, cost control
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
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
“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
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
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.