Inside the June/July 1999 print edition
Canadian Healthcare Technology:
Feature Report: Directory of healthcare I.T. suppliers
The James Paton Memorial Hospital in Gander has scored a technological
coup by installing the first Picture Archiving and Communication System (PACS) in
Newfoundland. PACS technology makes use of computers and electronic networks to store and
transmit diagnostic images.
Mount Sinai Hospital, in Toronto, is studying the effectiveness of
3Coms Palm computer devices in a Critical Care Unit. Its said to be the first
study of its kind to systematically evaluate the benefits of palm computers as medical
Open source software
Minoru Development Corp. is using available-to-everybody source code to
develop new applications for a community health network in Hamilton, Ont. Modules include
a clinical management system, a Web-based physician-pharmacist consultation system, and a
geriatric patient index.
Xerox in healthcare
Xerox Corp., which built its empire on hardware such as photocopiers,
has announced a major expansion into software and networked solutions. It is targeting the
health sector in the United States, and will soon roll-out a healthcare effort in Canada.
The Royal Ottawa Hospital has announced that in September, it will
become the site for a year-long program to train telehealth technicians. The development
appears to confirm that demand for distance medicine solutions is growing, as
urban hospitals seek to extend their expertise to rural patients and medical centres.
Highly portable computing devices (Palm and Windows CE, for the most
part) have been on the scene for several years, but they havent really made it into
the business or healthcare mainstream. That may soon change, as useful software
applications begin to emerge.
PLUS news stories, analysis, and features and more.
Newfoundland hospital improves care by combining PACS with teleradiology
By Jerry Zeidenberg
GANDER, Nfld. The James Paton Memorial Hospital in Gander has
scored a technological coup by installing the first Picture Archiving and Communication
System (PACS) in Newfoundland. PACS technology makes use of computers and electronic
networks to store and transmit diagnostic images.
At the same time, the centre has also launched an ambitious
teleradiology network that will connect three rural hospitals to the medical centre,
dramatically speeding up access to medical specialists for doctors and patients in the
In May, the 92-bed James Paton hospital announced the installation of a
$1 million Agfa IMPAX system, along with a computed radiography (CR) system for capturing
routine X-rays in digital form instead of using photographic film.
The reduced need for film, chemicals and storage space for records will
result in annual savings of $150,000.
As well, the PACS and teleradiology system are expected to greatly
improve medical care for the public by enabling radiologists and other specialists to
analyze diagnostic images more quickly. The rural hospitals will be able to send X-ray
images and ultrasound files to Gander for quick, expert opinions.
Were leading the way for the province, commented Dr.
Clayton Hann, chief of radiology at the James Paton Memorial Hospital.
Dr. Hann explained that two of three outlying hospitals
Brookfield Bonnews Health Care Centre in Brookfield, and Notre Dame Memorial Health Care
Centre in Twillingate are 90 minutes away by car. When doctors at these smaller
hospitals need an expert opinion about an X-ray, they typically send the films by courier
to Gander. However, because of the time needed to physically transport the films and get
them into the hands of radiologists, they can wait hours for a reply.
The process is even longer from Fogo Island, which relies on ferry
transport to Gander. In the spring, depending on ice conditions, the ferry can be
out of service, noted Dr. Hann. It can be days before we get the films.
In contrast, by scanning the X-ray films and sending the images over
the telephone wires, specialists in Gander can be accessed in minutes. In the case
of a broken bone, if there are questions about how to treat it, one of the rural hospitals
can beam images to one of our orthopedic surgeons, said Dr. Hann. In a few
minutes, the orthopedic specialist could be giving advice to the remote doctor.
In addition to X-rays, all three remote sites have recently acquired
new ultrasound machines, and will be able to send images directly through the
teleradiology network for analysis by specialists in Gander.
Dr. Hann said that in the future, if funding is available, the
teleradiology system could be extended to other rural hospitals across the region. This
could save patients car trips of four or five hours, when they need to consult a
specialist in Gander. Instead, their diagnostic images could be sent via the teleradiology
network, and the Gander-based specialist could quickly call back with an opinion.
Inside the James Paton Memorial Hospital, the PACS will be connected to
workstations in the radiology department and also to the ER, OR, coronary intensive care
units, and to orthopedic clinics. Physicians will be able to electronically retrieve
digital X-ray images, along with pictures produced by ultrasound, nuclear medicine, and
digital fluoroscopy. Later this year, the hospital intends to acquire a spiral CT machine,
Dr. Hann said that mammography will continue to use film, because the
digital technology for this specialty which requires greater resolution than
routine X-rays hasnt yet been perfected in a commercial format.
The James Paton Memorial Hospital serves a population of 53,000 in
primary care and 120,000 for specialty areas such as orthopedics and ophthalmology.
David Lewis, CEO of the Central East Health Care Institution Board,
said the teleradiology application is the next logical step in regionalization.
The first step is to eliminate duplication. Now we have to
enhance services to patients in rural Newfoundland, he said. This system gives
the rural hospital access to specialists, and adds to the comfort level of rural GPs
because they can have a radiologist look at an image and get back with an accurate
diagnosis. Consequently, patients get better healthcare.
Mount Sinai Hospital evaluates Palm Pilots in critical care
TORONTO Mount Sinai Hospital and 3Com Canada Inc. have entered
into an agreement to study the effectiveness of Palm computer devices in a Critical Care
Unit. This is said to be the first study of its kind to systematically evaluate the
benefits of palm computers as a medical tool.
Handheld computing technology offers enormous potential for
facilitating medical care management, but this has not been formally studied, says
Dr. Stephen Lapinsky, principle investigator for the research project. We propose to
evaluate Palm computer devices in the Critical Care Unit and develop a formal research
study to assess the benefits of this technology in the critical care setting.
As part of the agreement, 3Com is providing Mount Sinai Hospital with
17 Palm IIIx and technical support for the duration of the study.
Palm computing devices offer new and exciting ways to gather and
exchange information quickly and accurately within a hospital environment. We are excited
to work in partnership with Mount Sinai Hospital to extend the reach of Palm technology
and to help improve efficiencies within a Critical Care setting, said Michael
Moskowitz, National Sales and Marketing Manager, 3Com Canada, Palm Computing Division.
Critical Care is a good area for technology research projects because
it is the highest cost area of the hospital, said Dr. Tom Stewart, director, critical care
unit, Mount Sinai Hospital and assistant professor of medicine and anesthesia at the
University of Toronto. He added that CCUs face increasing demands due to an aging
We envision that these type of devices, along with some minor
advances, will enable our team to be more efficient at patient care, teaching and research
in an era of limited resources, explained Lapinsky.
The research group will work with 3Com to identify the needed advances
and the necessary information to be exchanged between the Critical Care team members. The
Palm computer project will consist of two phases:
A six-month period during which time members of the Critical
Care Unit will provide feedback on their experiences with the technology and suggest ways
that the information exchange and storage can be improved.
A formal evaluation period that will assess various roles for
the technology related to improving patient care and efficiency. The criteria for
assessing the Palm computers include simplicity of use; perceived benefits over current
practices; measurable benefits; novel use of the technology; and enhancement of patient
care, teaching and/or research.
The Critical Care program at Mount Sinai Hospital is said to be a
popular Critical Care training program at the University of Toronto, attracting a large
number of residents and fellows of high calibre. The program has an established and
growing research reputation, under the direction of Dr. Tom Stewart.
Open source software used to create low-cost clinical applications
By Andy Shaw
The basic idea behind open source is very simple. When
programmers on the Internet can read, distribute, and modify the source for a piece of
software, it evolves. People improve it, people adapt it, people fix bugs. And this can
happen at a speed that, if one is used to the slow pace of conventional software
development, seems astonishing.
The Open Source Page
There cant be a much more public, open source of
information than a street sign. Its there for all the world to see who pass it by.
And true to its nature, Minoru Development Corp. (www.minoru-development.com) took its
name from a Vancouver street sign.
But its Hamilton, Ont., where this unusual firm
specializing in the development of open source information systems for
healthcare is making its mark. Working with HappIN, the non-profit Hamilton Area Public
and Private Information Network, Minoru is using available-to-everybody source code to
develop a number of new applications for HappINs community health network.
The HappIN network already provides its member hospitals
and community care givers with e-mail, Web access and online discussion forums. But Minoru
is leading the development of new modules for the network including a clinical management
system, a Web-based physician-pharmacist consultation system, and a geriatric patient
Now in various stages of development and clinical trials,
these projects hold the promise of revolutionizing the deployment, integration, and
especially the cost of community health information systems everywhere.
In our last project the total software cost was
$200, says Joseph Dal Molin, a principal and co-founder of Minoru. Thats
because we are using open source tools like Linux as a base and its free to
As many will know, Linux is a Unix-type operating system
for computers that was created by Linus Torvalds with the assistance of developers around
the world who contributed their innovations via the Internet. Long a favourite with
computer hobbyists, Torvalds has now taken Linux into the corporate world. There, even the
likes of the mighty Microsoft Corp. are beginning to give it nervous attention as
competition both for their operating systems and applications. (And with good reason. Use
of Linux is rapidly growing. For example, the Apache web servers used by the majority of
Internet service providers around the world run on Linux code.)
Weve really taken application development and
turned it on its ear for the healthcare market, says Dal Molin, who earned his
health information stripes running the former Digital Equipment Corp.s health
systems business in Canada. If there was one thing I observed in working in the
healthcare environment, it was that the propagation of information systems was not really
as fast as it could have been.
That was partly because, Dal Molin concluded, the
healthcare environment is not a competitive one. Its an altruistic industry.
But the irony is there is so much development working going on in various places, and yet
so little of it is being shared. Thats why open source code makes such good sense
for healthcare. If anything is developed on an open-source model, it can be shared via the
Internet with everyone else.
Dal Molin points out that open source development is not
entirely new to healthcare. For example, he says, theres been a complete suite of
open source, hospital information systems available publicly for a number of years. It was
developed for U.S. veteran hospitals. But what is new is that Dal Molin and Brian Bray,
Minorus president, have developed a business model for their company and for their
clients that encourages sharing and rapid development of inexpensive systems.
With proprietary software you make money on your
investment by selling and reselling the original product, says Dal Molin. You
try to extract as much as you can from your investment. But in open source development we
make our money by continuing to improve the product. We keep looking for projects that
will fund additional development of the base code. So you are adding value as you go.
Its very dynamic.
Dal Molin says on the current Hamilton-based projects,
more than 200 on-line software developers are voluntarily contributing to the development
of their code. Their payoff, of course, is that they get to use what they helped develop
I think the concept is marvelous, says Dr.
David Chan, a member of HappINs widely representative Board of Directors. Chan is a
family practice physician and medical director at Stonechurch Health Centre. He also
teaches at McMaster University. The great thing about it is that open source
software is constantly evolving. And we need that in healthcare. The questions we asked of
our patients five or 10 years ago are not the same as we ask now. Nor will they be same in
another five or 10 years. So, youre never all kept at the same level, nor stuck with
the same proprietary vendor.
Dr. Chan is currently asking questions of the clinical
management committee he supervises for HappIN. With Minorus help, it is designing a
minimum data set for the geriatric information-sharing project. So if a senior
patient is referred to one of our day hospitals, the staff there can find out what
happened when the patient had a stroke at St. Peters Hospital.
Chan is also keen on the project now in clinical trial stage that links six family doctors
with three pharmacies. Potentially it will enable pharmacies to play a more
important role. They can do a more enhanced medication profile and send it with a
keystroke over HappINs secure dial-in network to the physician and then discuss it
between them. The doctor will now have better information because the pharmacists will be
aware of not only of the patients prescribed medication, but also whatever vitamins
or herbal remedies the patient is taking. So pharmacists can become more like
As consultants to HappIN and its application projects,
Minoru and Bray bring sterling development credentials. President Bray is a former
Microsoft project manager who is largely credited the development of the Microsoft Mail
Later, as a healthcare systems architect he designed an
electronic medical record system now used by hospitals worldwide. Dal Molin, while at
Digital, helped develop the McMaster University Medical Centres clinical repository.
That reputation helped land Minorus second major
contract since starting up the company last fall. Minoru will do the front-end consulting
in the Hamilton area for the Ontario governments primary-care network projects.
In the past, proprietary vendors could always point to the
absence of support provided by open source developers. But with Minoru active in the field
and a legion of online programmers constantly making the applications more robust and
sharing the results, support is much less a concern.
So a hospital does not have to rip out applications it has
invested in to joint the open source movement.
The corporate world is also getting the open source
message. Apple recently opened the server version of its QuickTime streaming technology to
all takers. And even Microsoft is making rumblings of making much of its code public.
Royal Ottawa Hospital to run program for telehealth technicians
By Jerry Zeidenberg
OTTAWA The Royal Ottawa Hospital has announced that in
September, it will become the site for a year-long program to train telehealth
technicians. The development appears to confirm that demand for distance
medicine solutions is growing, as urban hospitals seek to assist physicians and
patients in surrounding areas via computerized networks.
Whats often missing from the equation is a pool of well-trained
technicians who are able to install and maintain telehealth systems and computer networks
To alleviate the shortage, the ROH has entered an agreement with
Novatech Computer Careers of Kingston, Ont., a privately run school that has been
accredited to deliver the telehealth technology courses by the Ontario government.
For its part, Novatech has taught computer education for six years and
launched its first telehealth training-program a year ago. Its said to be the only
program producing telehealth technicians in Canada, and the courses cover a wide variety
The students have six hours of lectures and labs every day, five
days a week, commented Rick Lawless, president and founder of Novatech. They
obtain Microsoft and Novell certification, and gain expertise in personal computers,
telecommunications, telephony, cable technologies and computer security.
He noted that students also learn about medical technologies.
They have training in medical software and hardware, said Lawless.
Its a hands-on program. By the end of it, theyre able to take a bucket
of parts and put a PC together, or a remote stethoscope.
Admittedly, its an intensive curriculum, and Novatech will be
screening applicants to make sure theyre committed. One of the most important
things a student can do is to show up every day, said Lawless, adding that a great
deal of motivation and drive is also required to complete the assignments. Students
dont need a background in computer technology, but they must be eager to learn.
Theres a serious financial commitment at stake, too. Tuition is
$13,500 for the program. But Lawless says that similar community college programs offering
Microsoft and Novell certification cost as much as $19,000.
Moreover, Lawless asserts that its a worthwhile investment, since
95 percent of graduates from the school have found jobs. Companies hiring the students
include Nortel Networks, Newbridge and Corel.
Over the last two years, the school has graduated about 200 students,
and currently employs 25 instructors.
At the Royal Ottawa Hospital, the organizers are expecting about 30
full-time students to enroll. Theyll be split into two classes.
Lawless expects that some of the students will be recently laid-off
healthcare workers who are re-training themselves for jobs in high demand computer
technicians, with special expertise in telehealth. Other applicants might simply wish to
change the direction of their careers.
According to Lawless, the small class size typically eight to 10
students is a big boost to learning. He observes that university computer classes
often contain as many as 150 students. Students there are lucky to talk to their
professors once a year, said Lawless, himself a graduate of the University of
Guelphs public administration program, and in computer science from Pennsylvania
By contrast, he said that Novatechs students spend much more time
with their instructors, who have all had actual field experience with companies such as
Compaq Computer Corp., Rogers Cablesystems, and others.
For more information about Novatech Computer Careers, including the
scope of the curriculum, readers can visit its web site at www.novatech.on.ca or call the
school at 613-384-7959.