eHealth Ontario close to making project announcements
TORONTO – Critics of eHealth Ontario continue to carp that the agency is running late in producing meaningful systems for care-givers and the general public. Most recently, provincial opposition MPPs asked questions about several long-awaited projects: the lab results system, the diabetes registry, the medication management system and a Toronto-area network of electronic records.
However, many of these systems are now about to get started, or will soon do so. In a May interview, eHealth Ontario CEO Greg Reed noted that proposals for the provincial Medication Management System were in the final stages of review and that a winner would be announced by mid-year.
He said three proposals were under evaluation for Connecting GTA, the $72 million Toronto-region electronic health records system, and a winner would be announced shortly. And finally, the long-delayed Ontario Lab Information System has started to provide information in the Ottawa area, with rollouts to other regions underway, including implementation in the Grey-Bruce region, a rural area with 12 hospitals, and the Greater Toronto Area, with its 24 hospitals, over the next year.
In terms of delays, Reed explained the medication management system and Connecting GTA are large projects. And given the scandal-ridden history of eHealth Ontario, every step had to be taken to fairly evaluate proposals before handing out a contract.
“We had to follow the rules to the letter,” said Reed. “So the procurement cycles were long and complicated.”
But in addition to these systems, which Reed refers to as the “heavy lifting projects,” eHealth Ontario has been busy supporting the expansion of successful regional systems across the province.
In particular, it has backed the rise of ClinicalConnect in Hamilton, the Southwest Physician Office Interface to Regional EMR (SPIRE) System, a northern system linked to Sudbury, as well as solutions in Ottawa and Barrie.
This has involved a shift in strategy that has been in play since Reed came on board as CEO in 2010. Instead of focusing solely on ‘megaprojects’, eHealth Ontario managers decided it would be much more realistic to support regional projects that had been shown to work, and to help them grow.
“Just about the dumbest thing to do would be to rip out these systems,” said Reed. “The people who created these solutions are proud of them. And they work.”
“So we decided to tell them to keep doing what you’re doing, and we’ve continued to fund them.
“We’ll solve the regional interoperability problem later as part of our overall implementation plan for the province.”
Reed said that most healthcare delivery is local, in any case. “A person with a problem in Windsor will go to a hospital in Windsor. And if it can’t be dealt with there, he or she will be taken to London. But they’re unlikely to go to Thunder Bay, so it’s not a high priority to make their records electronically available across the board. Eventually we’ll do it, but not right away.”
Reed said that getting primary care physicians up to speed on EMRs has also been a priority, because so much care starts with general practitioners. What’s more, after hospital care, patients go back to their GP’s care.
Currently, about 7,900 primary care physicians in the province have electronic medical record systems. The goal is to reach 10,500 – that’s nearly all of the primary care providers.
“We now have more doctors using EMRs than in all the other provinces combined,” said Reed. “We’ve gone from being worst to first.”
When doctors are on electronic systems, they will be able to supply information to other providers. They also receive lab, drug and hospital information about their patients much more quickly.
But Reed noted that it is important to have live feeds to the doctors’ EMRs – at the moment, some 1,800 physicians already receive lab results from local and hospital labs, and hospital reports. OLIS lab results are being made available to the province’s doctors through a rolling implementation over the next 18 months.
In terms of medications, prescriptions for seniors are viewable throughout the province – amounting to 46 percent of the medications that are prescribed in the province, when individuals are visiting any hospital ER.
The Medication Management System – the winning vendor is to be announced shortly – will make all prescriptions given to patients viewable online. What’s more, there will be a built-in drug-checking system, so that doctors will know which medications they can safely give to patients who are already on other drugs, and which meds to avoid.
Another important system that’s been supported by eHealth Ontario is the Hospital Report Manager, which sends many hospital reports – including patient discharge summaries – directly into the EMRs of referring physicians.
Among other things, this is helping to reduce the numbers of hospital readmissions, as GPs are quickly getting the information they need to create care plans for their patients. “Physicians have told us that they can reduce readmissions if they see their patients within a week of discharge, so they can create an accurate care plan,” said Reed. But to do that, they also need accurate information about what happened to patients while in hospital.
“With paper records, it can take three to four weeks for doctors to receive discharge summaries,” said Reed. “Now, it can be done electronically as soon as they are transcribed.”
It’s this type of solution, commented Reed, which has doctors saying an EMR is worth it.
Not only does eHealth Ontario want to supply doctors with information, it also wants physicians making their patient information available to others. This two-way flow has encountered a few snags, however, including a regulatory one. It will require physicians to give permission to others to use their private records, something that is being discussed by the Ontario Medical Association.
“Right now, there’s no return path for information,” said Reed. “It’s all going one way.”
Something that’s also in the works is a Personal Health Records strategy – a system that gives patients access to their own medical history and records. Currently, eHealth Ontario has three test beds under way, with more about to appear, to determine the design of such as system.
What has been learned so far is that many patients don’t want or need an all-encompassing medical record. “Most people don’t want access to all of their raw medical data,” said Reed. What we’ve learned is that they want e-mail access to their doctors and the ability to book appointments online. They also want access to the records of family members – for example, for an elderly parent who they’re caring for.
“There is a small patient population that wants to track actual results, but for most, the bar is far lower.”
Reed noted that when a PHR solution is produced, it will likely be available on smartphones and mobile computers, as that’s the way most people now want to access information. He said this method is already being deployed at the Ottawa Hospital, where iPads are used by an increasing number of clinicians. What’s more, privacy and security can be maintained on these systems.
“The information never stays on the iPad. Once you’ve finished accessing the record, it’s gone.”
All in all, eHealth Ontario is moving ahead steadily. The agency is spending about $400 million a year. That may sound like a lot, but as Reed points out, it’s less than 1 percent of the province’s healthcare budget. “That compares with 4 to 5 percent in banks and other industries that have made the transition to make electronic records available at the consumer point of care,” said Reed.
Still, he expects that eHealth Ontario is en route to getting its job done, creating a province-wide system of electronic health records. “By 2015, we’ll have the records of 13 million people online. We’re on schedule to do this.”
Canadian imaging leaders join forces to raise awareness of the issues
OTTAWA – Canada’s top medical imaging associations banded together on Parliament Hill in May to kick-off an annual Medical Imaging Team Day. The goal is raise awareness of imaging issues among politicians, healthcare providers and the general public.
At the same time, the aim is to improve the delivery of care to patients, making imaging as safe and effective as possible.
While diagnostic and interventional imaging have become fast-growing areas of medicine, most of the public are unaware of the differences between modalities such as CT, MRI and ultrasound, let alone image-guided therapies. If they’re to become true partners in their own healthcare, as many are urging, patients will have know more about the various diagnostic procedures available to them.
And even though the general physician population relies on imaging to make decisions about patient treatment, many GPs and family doctors need further education about the potential hazards of X-ray, nuclear medicine and radiation therapies.
Additionally, politicians need to be made aware of the urgent need to keep Canada’s stock of equipment up to date, so that patients receive the best care possible.
A key goal in launching Medical Imaging Team Day was to raise awareness of the need for appropriate doses. “We’ve been trying to educate more people about our campaigns, especially in the pediatric area, to ‘Image Gently, Image Wisely,’” said Amanda Bolderston, president of the Canadian Association of Medical Radiation Technologists (CAMRT).
Studies have found that patients can be given large doses of X-ray radiation, due to differing protocols at various hospitals or even among radiologists and technologists. As well, referring physicians sometimes order tests that are unnecessary.
It has been suggested that up to 20 percent of the imaging tests ordered by physicians are not needed. Dr. Jamie Fraser, president of the Canadian Association of Radiologists, concurred, saying there must be greater cooperation among radiologists, specialists and general practitioners.
The Canadian Association of Radiologists has been working hard to create guidelines instructing physicians about when to image and what kinds of exams to order. They have also collaborated to test software that helps determine the appropriate exams to use.
Dr. Fraser noted that further steps must be taken to integrate technological solutions in the workflow of physicians, to make it easier to choose the appropriate tests, and to avoid unnecessary exams.
Not only does excess radiation pose a risk of harm to patients, superfluous tests also burden the healthcare system with extra costs and delays. To promote further education and to implement useful technologies for decision support, the group plans discussions with the Canadian Medical Association. “An interface with the CMA makes a lot of sense,” said Dr. Fraser. “It’s a logical way to progress.”
An additional stumbling block can be found in the area of communications – test results aren’t readily available to many clinicians, and as a result, they tend to order new exams. “Results are not transmitted or reviewed between organizations,” said Kim Boles, past-president of the Canadian Society of Diagnostic Medical Sonographers. “That’s where more consultation is required, and that’s what will lower X-ray doses. It’s true of chemotherapy and radiation therapies, as well.”
Better communication and review systems must be devised to overcome this hurdle, he said.
Ensuring that Canada has the imaging technologies and equipment needed to provide top-notch care to patients is another important issue. Unfortunately, many hospitals and clinics are burdened with machines that are old and nearly obsolete, and simply don’t have the budgets to replace them.
Dr. Peter McGhee, President, Canadian Organization of Medical Physicists, noted that in Canada, acquisitions of imaging equipment are usually done through capital purchases which require hundreds of thousands of dollars, and often millions of dollars. It’s hard to come up with these funds, which means that equipment is often operated for 10 to 12 years or longer, until it just won’t work any more.
By contrast, added Dr. McGhee, in the United States, acquisitions are often through leases, which have the double benefit of lowering cash-flow outlays and also contain an automatic replacement to new and improved technologies after just a few years.
Perhaps the method of acquiring medical imaging equipment should be changed in Canada, possible by tax incentives for hospitals and clinics.
Dr. Fraser noted that the Canadian Association of Radiologists and CAMRT are jointly working on a study of the current state and capabilities of medical imaging equipment in Canada. “We’re investigating the state of technology, and we’re using as much evidence as possible to judge whether it’s appropriate or not.”
He observed that in Canada, “we’re always a bit resource-poor,” which has led to antiquated equipment and technologies in some institutions, and a dearth of leading-edge machinery.
An example of this is Positron-Emission Tomography (PET), a form of scanning which is considered the gold-standard for oncology imaging in the United States and Europe. By contrast, Canadian provincial governments have largely avoided funding PET due to the heavy costs associated with it, and in the past, the lack of definitive evidence about its usefulness.
“We believe that proof is now there,” said Dr. Fraser. However, the need for various technologies must be established through scientific surveys and studies, and then conveyed to the general public, hospital decision-makers, and ultimately, governments. It’s the governments, after all, who control the purse-strings.
Not to be forgotten in all of this is the development in radiology from diagnostics to incorporating therapies – an area where Interventional Radiologists have emerged. That’s why the Canadian Interventional Radiology Association is involved, with its president, Dr. John Kachura, on the committee.
CAMRT executive director Chuck Shields observed that the group will continue to consult with various groups over the course of the year to raise awareness and improve the delivery of care to patients. A follow-up meeting was scheduled for Toronto in June, and meetings with provincial governments and various medical associations are in the works.
Agency awarded $4 million to commercialize medical imaging ideas
By Jerry Zeidenberg
Researchers in Toronto and London, Ont., who are said to be on are the verge of making groundbreaking advances in cancer imaging and therapies, have been awarded $4 million over four years to speed up the commercialization of their innovations.
In April, the Ontario Institute for Cancer Research (OICR) announced it would provide the funding to the Centre for Imaging Technology and Commercialization (CimTec), a relatively new organization that’s based at Western University in London and the Sunnybrook Research Institute in Toronto.
The key team leaders at CimTec are Dr. Aaron Fenster, who works in London, and Dr. Martin Yaffe, who is based at Sunnybrook. Dr. Fenster is leading the charge in medical imaging of cancer, while Dr. Yaffe is pioneering new methods in digital pathology to accelerate and improve the diagnosis of cancer.
Already, the new CimTec organization has filed for one patent and has two more in the works.
Nevertheless, getting new ideas to the bedside so that cancer care is improved requires a wholly different set of skills and capabilities.
At the announcement of the $4 million in funding, project leaders at the two sites were connected using live videoconferencing. In his remarks, Dr. Fenster noted that universities have spun-off dozens of companies with brilliant ideas, but “many are struggling and may close.”
He explained that these firms often lack the business knowledge that’s needed to commercialize their innovations. “They’re often missing components such as business savvy and business advice,” said Dr. Fenster. “That’s why CimTec was created, to enable more small and mid-sized companies to become successful.”
He said part of the money from OICR will be used to hire staff members with the expertise needed to take new cancer imaging ideas from lab bench to the patient bedside.
Examples of leading-edge work include image-guided laser ablation of prostate cancer, which can destroy cancer cells while preserving surrounding tissues. Compared with radical prostatectomies, which remove the entire organ, this method greatly improves the quality of life for the patient after surgery.
Similar types of minimally invasive, image-guided ablation are being pioneered for liver and breast cancers.
A look at the board members at CimTec shows their entrepreneurial way of thinking. They’ve got GE Healthcare Canada president Peter Robertson as a member. Also on the board is John Soloninka, president and CEO of HTx, the healthcare technology commercialization agency that’s based in Toronto.
At the event, Mr. Soloninka said it will be important to build links internationally. Dr. Fenster said he would soon travel on behalf of CimTec to India, to meet with potential investors to help with commercialization. He mentioned that he had already been to China to recruit “bright minds to Canada, and also funding”.
As well as Western University and Sunnybrook, CimTec is currently working with researchers at the University Health Network in Toronto, as well as scientists in Halifax and Waterloo, Ont.
In addition to the medical imaging and therapies that CimTec is developing, Dr. Yaffe pointed to work that his team is doing in digital pathology. “Pathology is still done today the way it was 50 to 100 years ago,” he commented, with pathologists gazing at slides under a microscope.
“We’re developing algorithms that will make pathology digital,” he noted, so that pathologists will be assisted by computer-aided diagnosis. This can dramatically reduce the time needed to make diagnoses and improve the quality of analysis, he believes.
“Pathology is a medical imaging problem, but the field hasn’t taken advantage of that in the past,” he said.
Dr. Yaffe believes that CimTec has pulled together a team that will make a breakthrough in digital pathology. Members include an expert who was recently recruited from Boston, and an innovative company in the Waterloo-area that has made incredible strides in this area. “Within the next year, we expect to see some of the pieces commercialized,” he said.
Dr. Yaffe also noted that Ontario has great potential as a seedbed for innovative ideas in medical imaging, but commercialization has been a stumbling block. “Ontario has a strong record in imaging research. We publish our work in leading journals, but that’s often as far as it goes.
“What’s more gratifying is shepherding innovation from idea to the bedside, but we often come up short on commercialization.” He explained that spin-off companies often lack the experience in market research, prototyping, attracting investors and making the sales that are needed to succeed.
But that’s where CimTec is designed to step in. “CimTec will facilitate the commercialization,” said Dr. Yaffe. “It will identify the hurdles and help new companies pass over the valley of death.”
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