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Inside the March 2006 print edition of Canadian Healthcare Technology:


Feature Report: Wireless and mobile solutions


PEI announces $13 million investment in provincial EMR

Prince Edward Island is building a $13 million system that will standardize and connect electronic medical records in all seven of the province’s acute-care hospitals and a mental health facility.

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Calgary clinic offers Western Canada’s first open MRI

MYK Imaging, a private-sector clinic in Calgary, has launched Western Canada’s first open MRI service. The scanner makes it much easier to image claustrophobic patients, children and people who are obese.

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BlackBerry helps ICU staff

Trillium Health’s ICU doctors, nurses and healthcare professionals have deployed wireless BlackBerry devices to improve communication among them. Physicians can be more easily reached, and can respond to events in a more systematic manner.

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IT at new Toronto hospitals

Bridgepoint Health and the Humber River Regional Hospital recently received the go-ahead from the provincial government to build new facilities. They’re planning different approaches to the acquisition of IT solutions. 

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Interview: Capital Health

Reporter Andy Shaw converses with Sheila Weatherill, CEO of Capital Health, in Edmonton, and the organization’s CIO, Donna Strating. The executives talk about their approach to technological change. 


Referral system for rehab

There’s a new way for facilities in Eastern Ontario to send rehab referrals to each other and for community physicians to access rehab specialists. They can now do it online, using the Rehabilitation Integrated Transition Tracking System.


PLUS news stories, analysis, and features and more.

 

PEI announces $13 million investment in provincial EMR

By Jerry Zeidenberg

CHARLOTTETOWN – Prince Edward Island is building a $13 million system that will standardize and connect electronic medical records in all seven of the province’s acute-care hospitals and a mental health facility.

The province will implement computerized solutions from Cerner Corp. for a host of applications, including admissions, discharge and transfer (ADT), lab, pharmacy, ordering and scheduling, and emergency rooms.

Through quick access to medical records in hospitals across the province, the systems are expected to reduce paperwork and the duplication of tests, and to improve patient safety.

Funding for the project is being split three ways: the participating hospitals are contributing about $2.6 million, and the province of PEI and Canada Health Infoway are each chipping in approximately $5 million.

Not only is it a large-scale IT project, but it’s scheduled to be completed in just 15 months – a very fast implementation for an effort of this size. “A key measurement of a project’s success or failure is whether it takes too long to put in place, and one of our requirements was a solid methodology for getting the system up and running quickly,” said Calvin Joudrie, director of the iEHR/CIS project for Prince Edward Island.

Indeed, one of the main reasons the province selected Cerner as a partner was the company’s implementation strategy, as well as the quality and features of the clinical systems and, naturally, competitive pricing.

The effort with Cerner involves ‘co-building’ of some 22 modules to create the system, using a team of 24 individuals from PEI who are dedicated to the project, along with over 60 others from the province who are acting in support functions, as well as personnel from Cerner.

For its part, Cerner is committed to reach various targets at certain dates, with financial rewards for hitting each of those milestones.

Not only will solutions be accessible within hospitals, but a high speed network is already in place that will enable medical professionals in one location to access electronic records that have originated at another site. Electronic health records will be housed in a central repository, with a backup system in case the central warehouse ever fails.

Phase one of the project will start with the island’s two largest hospitals, the Queen Elizabeth Hospital in Charlottetown and the Prince County Hospital, in Summerside. Work is expected to be completed at the two sites by March 2007.

Systems at the other five hospitals are slated for completion in May 2007, with work ending at the mental health facility at the end of June 2007.

While Cerner is supplying the bulk of the new clinical systems, Joudrie noted the province will maintain its current Radiological Information Systems (RIS) from IDX and its Agfa Picture Archiving and Communication System (PACS).

Using these systems, Prince Edward Island is part of Maritime PACS network that enables clinicians in PEI, New Brunswick and Nova Scotia – and to some degree, Newfoundland – to share all diagnostic images.

The imaging system has worked well for the partners. “The sharing of information from the PACS is spectacular,” said Joudrie. “Any hospital can access any image, from any other hospital.”

These radiology systems are to be integrated with Prince Edward Island’s new clinical systems. So will other solutions that are found to be the best choice for particular applications. To make this kind of integration possible, said Joudrie, an access layer is being designed into the iEHR/CIS project to ensure that alternative solutions will be able to interface with the system.

The new system will also support wireless solutions, as well as various PDA (handheld computers) and tablet PCs with handwriting-to-text conversion. “This is a great attraction for people with low to average keyboarding skills,” said Joudrie. “We’re giving them tools so that they can make the jump to computers as easily as possible.”

He noted that there are also change management personnel on the project team, in recognition of the ‘people issues’ that must be worked through when implementing technology and changing the way that staff members do their work.

In the future, the province intends to provide referring physicians with connections to the hospital systems. For now, it’s testing this type of connectivity by linking four community health centres with the hospital systems.

The physicians will have access to lab and radiology results, and will be able to schedule appointments, in some cases.

“This can save a lot of time,” said Joudrie. “Instead of the doctor’s secretary calling and getting busy signals, and calling back again, the physicians themselves will be able to book many appointments using quick, electronic systems.”

Joudrie explained that the province is starting the physician-to-hospital connectivity as a pilot project so that it can test the level of integration that’s needed. It’s not yet known whether a ‘portal’ into the hospital system is sufficient, or whether full integration with the physician office systems used by some doctors is required.

Integration is also planned with PEI’s Drug Information System, which is connecting retail pharmacies and doctors’ offices. By bringing this data into the hospitals, physicians there will have even more information about the patients they encounter. “They can get a really good picture of the meds people are on,” said Joudrie.

According to a release from the Prince Edward Island government, “Providing health care professionals with the ability to access medical records electronically means patients will no longer have to take their charts with them to the hospital. This will also eliminate the need to copy and transfer paper versions of medical records between health facilities, which, in turn, will reduce the risk of error and improve the safety and security of medical records. The EHR will also help prevent the occurrence of duplicate medical tests, reduce the risk of drug reactions in patients and eliminate the need for patients to repeatedly answer the same series of questions when receiving treatment.”

Speaking on behalf of the Canada Health Infoway, which aims to improve the delivery of healthcare in Canada through the use of electronic solutions, CEO and president Richard Alvarez said: “PEI will be one of the first jurisdictions in Canada to have a complete provincial electronic health record, which will enable improved quality of care.”

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Calgary clinic offers Western Canada’s first open MRI

By Jerry Zeidenberg

CALGARY – A private-sector clinic has launched Western Canada’s first ‘open’ MRI scanner, a machine that makes it much easier to image claustrophobic patients, children, and people who are obese. As with other for-profit clinics, MYK Imaging is charging for exams – in this case, $695 per study.

But unlike other private centers offering MRIs, MYK Imaging soon hopes to obtain funding for patients through the local health authority or possibly the provincial government.

“We strongly believe in universal access for everyone, and we don’t want to charge patients,” said Dr. Deepak Kaura, medical director of MYK Imaging and a radiologist who also works at the Alberta Children’s Hospital. “We’re in discussions about obtaining funding through the region or the government.”

Dr. Kaura believes his centre, which consists of three clinics and currently performs 125,000 exams each year, has an excellent chance of qualifying for the funding, since there are no other open MRIs in Western Canada. As such, his company is offering a valuable service to patients.

“It’s something that’s not available in the public system,” he observed.

He noted that there are some patients who simply won’t go into the noisy, closed-tunnel MRI systems that are typically found in hospital radiology departments. Moreover, many children won’t sit still in the standard systems, but do very well with their parents sitting next to them in an open MRI.

Some elderly patients fall into this category, as well.

And often enough, patients are too big or heavy to fit into the tunnel of a traditional MRI – a phenomenon that has led some major vendors to start producing extra-wide MRIs for patients of larger girth.

The open machine, however, can accommodate all of these patients. Dr. Kaura added that among U.S. patients who have experienced an MRI exam in both an open system and a tunnel-based machine, the vast majority prefer the open systems when given the choice.

“I feel guilty about charging,” said Dr. Kaura, “but we’re trying to give people another option.” He explained that without the availability of an open system, many Calgary-area patients wouldn’t get an MRI scan at all.

Offering the service, however, is costing MYK Imaging a fair chunk of cash. Indeed, the MRI and new Picture Archiving and Communication System (PACS) the three-site clinic has installed required an investment of approximately $3 million.

Dr. Kaura’s MYK Imaging has installed a state-of-the-art open MRI scanner from Hitachi. He explained that thanks to recent advances in open MRI technology, the system compares favourably with closed tunnel systems. “There’s been a revolution in the open MR marketplace,” he said, explaining that in the past, the open systems used to require 40 percent more time to conduct a patient exam.

For its part, Hitachi reduced that figure to 20 percent in the machine that’s currently installed at MYK Imaging. But an even newer breakthrough has resulted in coils that completely level the playing field, enabling the open MRI to perform exams in the same amount of time as the closed bore systems. MYK Imaging has this technology on order; its new equipment is expected at any time.

There have also been breakthroughs in terms of image quality. In the past, open MRIs – which have lower field strengths than tunnel-based systems – haven’t been able to differentiate between fat and fluid as well as the bigger machines. “The 1.5 Tesla machines have always been able to do this,” said Dr. Kaura, referring to the standard systems found in hospitals.

Now, however, the 0.3 Tesla open system used in his private clinic can make fine distinctions between fat and water – something that’s important for determining pathology. “Hitachi has improved the hardware dramatically,” said Dr. Kaura. “The field is much more uniform.”

On the image management side, MYK Imaging has implemented a web-enabled PACS from Fuji – rendering it the first multi-site clinic in Western Canada to use a PACS.

Coupled with an advanced RIS from Unicus Data Systems, of Calgary, the clinic’s image management system is improving workflow for its 10 radiologists as well as referring physicians. Using an automated dictation/transcription service, radiologists can read reports, send them online to a transcription service, and receive an alert for sign-off when they’re returned.

Reports can then be automatically routed to referring physicians via fax server and as an electronic report, although Dr. Kaura stressed that radiologists always call the referring doctors when there’s an abnormality or medical complication.

The local physicians can also connect to the MYK Imaging system to view images in the PACS; this feature is already experiencing significant uptake from referring physicians. “There are 20 to 30 doctors using it at any given time,” said Dr. Kaura.

He noted that four of the clinic’s 10 radiologists are pediatric specialists, and that MYK Imaging runs Western Canada’s first and only pediatric radiology centre that’s outside of a hospital – a service called Kids Imaging and Diagnostic Specialists (KIDS). “It’s the first in this part of the country, and possibly in all of Canada,” said Dr. Kaura.

And while MYK Imaging plans to run its open MRI eight hours a day, it intends to offer researchers access to the machine for the other 16 hours. “We’ll make it available to them at minimum cost,” said Dr. Kaura. He explained that many radiologists, including himself, are also academicians who want to conduct leading-edge research. However, “there’s a paucity of time for research studies,” a problem compounded by the province’s drive to reduce wait lists by increasing the clinical use of available hospital MRI scanners. There’s already interest brewing from university and hospital researchers, as well as from the National Research Council of Canada. More information about MYK Imaging and its open MRI service is available on the web: www.openmriofcanada.com.

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Wireless BlackBerry transforms communication at Trillium’s ICU

By Andy Shaw

Critical care physician and medical informatics consultant Dr. Chris O’Connor certainly makes you think. That’s an intended pun connected with Dr. O’Connor’s initiatives taken under the banner of the THINK project at Trillium Health Centre, in Mississauga, west of Toronto.

THINK – Transforming Healthcare into Integrated Networks of Knowledge – is a concerted effort by the hospital to enhance its care by freeing up the flow of information.

At a recent Insight Information Co. conference on the state of the wireless art in healthcare, Dr. O’Connor made attendees think about what wireless email can do to free that flow – and why that’s needed.

“I don’t think we’re much different from other hospitals, but I went around Trillium on various floors and looked at how, in 2005, we communicated as clinical teams,” Dr. O’Connor told the conference as he put up slides capturing what he saw. “And as you can see, here’s how we do a lot of it. When a patient develops a need, the nurse writes it down on pieces of paper like this. In our ICU, incidentally, the preferred medium of communication was a note on a paper towel. And then they wait until the doctor physically comes around and finds the note before any action is taken.”

Dr. O’Connor went on to say that he found it “absolutely remarkable” that this paper-based system, and all its potential inefficiencies, would be the norm in the age of the internet and electronic communications.

Nor did he think much more of the one electronic effort to improve communication that is also a norm in hospitals – paging.

“Physicians dislike getting paged because it’s very disruptive,” said Dr. O’Connor. “And it turns out nurses and other members of the healthcare team like it even less because doctors tend to ignore their pages. So they have to page doctors multiple times. Or they wait to page until a patient is very, very sick. Either way, it’s not good for anybody.”

Neither was his secondary research any more encouraging.

“Communication between patient and care-givers is at the heart of what we do, but there is virtually nothing written on communication in the medical literature,” said Dr. O’Connor. “Paging, for example, is something the medical community does all day long, yet I found only three articles on paging.”

But what set Dr. O’Connor on his mission to improve communication more than anything else, he said, was a potentially fatal clinical mistake he made himself.

“A patient feeding tube was put into the lung of an ICU patient instead of the stomach and I didn’t notice it on the X-ray I was reviewing,” he said. “It’s a simple task and I had read thousands of such X-rays. Missing the error was inexcusable. The patient received two feeds into the lung and could have died. Luckily, he didn’t.”

The incident triggered some serious self-examination.

“I asked myself, Why did that happen? And I remembered that while I was reading the X-ray, I was surrounded by a scrum of nurses, all tapping me on the shoulder and telling me things like: the patient’s family is at bed 62; the guy in bed 50’s blood pressure is a little high; and the person in bed 36 has not passed much urine in the past couple of hours.

“And that led me to the realization that e-mail would be perfectly suited to this. It’s very good for short, little communications. So, why don’t we incorporate it into the care process,” concluded Dr. O’Connor.

Thus began a pilot project that led to a six-month trial and subsequently a full-blown deployment in the Trillium ICU of a BlackBerry wireless handheld e-mail system. It has wiped out intrusive shoulder tapping, reduced paging dramatically, and been a hit with physicians and nurses alike.

“It’s the first such system in the world, so far as we know,” said Dr. O’Connor. “We began by just giving the BlackBerrys to the ICU’s four physicians. The nurses had to log into their desktops to send their messages to the doctors. But that actually worked. It was a stunning success right from the start. It significantly de-fragmented the care process and improved the response time to messages.”

Dr. O’Connor said that the first order he ever responded to on his BlackBerry is indelibly etched in his mind.

“The nurse sent me a message suggesting that a certain patient needed more anti-hypertension medicine. That seemed reasonable, so I touched the Reply button and typed ‘Yes, go ahead.’ then hit the Send button and it was done. Done in less time that it would usually take me to even find a phone to answer a page. It took my breath away.”

Contributions of equipment and support from BlackBerry-maker, Research in Motion (RIM), and six months of free air time from Rogers paved the way for a full blown trial. BlackBerrys were also then made available to every shift of the ICU’s 20 nurses, as well as selected dieticians, physiotherapists, and other staff. Without retreating to a desktop, they all could now “tap the shoulder” of the physician by thumbing a message on their BlackBerrys, no matter where they or the doctors were – and without being disruptive.

“We’ve been getting 40 to 50 such a messages a day, but they don’t interrupt. You can deal with them in those little cracks of free time that show up between caring for patients,” said Dr. O’Connor. “It’s an extremely cool thing.”

And more beneficial things than even anticipated.

“Just things that we didn’t expect, like the staff going off on a coffee break. If they’ve forgotten to hand something off, for example, they are now sending a message from the cafeteria. Most staff are very conscientious so they like to be able to stay in touch,” said Dr. O’Connor. “They can also stay in touch with their families by e-mail (the BlackBerrys are not used as cell phones), so it helps them come into work even if there are some difficulties at home.”

Having such a useful device in hand, however, has not contributed to any pilfering and consequent loss of privacy. The BlackBerrys are signed for, picked up, and returned at the beginning and end of each shift. In more than six months of pilot and trial testing at Trillium, no BlackBerry has gone missing. And if one ever were to, its contents can be removed remotely. In the meantime, the messaging between caregivers is all logged and kept on a Microsoft Outlook account for each BlackBerry. That information will eventually find its way, said Dr. O’Connor, to every Trillium patient’s permanent electronic record.

As to drawbacks to the system, O’Connor said he’s been hard pressed to find any, although he anticipated some.

“We’ve not had change-management or intensive training needs, for instance. That’s partly because it was not imposed upon us. It was our own ICU’s initiative. RF (radio frequency) interference has not been an issue even in the ICU. Costs for running the system over cell net as we have in the trial would be about $17,000, minimal against our $20 million dollar ICU budget.

“But even those costs can be reduced to near zero if you run it over a Wi-Fi local area network as we intend to. I thought keystroke error might be a big issue, because you can be typing important numbers in the messages, but the physician gets to see those numbers before replying, so there’s a built-in check and we’ve had no keystroke errors so far.

“The system does mean there is less face-to-face time (or face-to-shoulder time) with the physicians, to be sure, but reducing communication to a short message makes one think about what’s truly important. Nursing resistance was minimal even at the start. About 75 percent accepted it right away and within a couple of months all of them were on board. Everybody likes it.”

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Two state-of-the-art Toronto hospitals take differing approaches to IT

By Andy Shaw

Just before the turn of the New Year, the Ontario Ministry of Health gave the go-ahead to the planners of two state-of-the-art, 700-bed hospitals to better serve the mushrooming pop-
ulation of the Greater Toronto Area.

Though they will be new in many ways – including new bricks-and-mortar and the latest in medical technology – they both have historic roots.

Humber River Regional Hospital and Bridgepoint Health (formerly Riverdale Hospital) both serve regions adjacent to rivers – the Humber and the Don – that once bracketed what was then a much lesser Toronto area. It was on those rivers emptying into Lake Ontario that natives and explorers of old voyaged and gave meaning to the town’s “meeting place” name.

Today, the builders of both Toronto hospitals are promising new “models of care” that will reach beyond hospital walls and into their respective communities. But there, the similarities end.

Humber River in north-west Toronto will move to a new site that will be home to a regional hospital dedicated to acute care.

Bridgepoint Health is staying put in its vantage point by the east end of the Gerrard Street Bridge, which spans the Don Valley. It will modify and expand its existing campus and its roles as a provider of care for complex diseases and as a rehabilitator.

Different too will be their respective approaches to adopting technology – especially information technology. CIO Peter Wegener says Humber River will be taking what he feels is an exciting and challenging “clean slate” approach to adopting new IT. His counterpart, CIO Steve Banyai, says Bridgepoint will be going with what they’ve got, building on their recently developed and unique web portal platform as a foundation.

“Given how technologies are both developing rapidly and converging, we want to develop a flexible, interoperable IT infrastructure that will be plug-and-play. So that we’re not ever caught by a technology going obsolete on us,” says Wegener.

“To do that, we’re going to take what you might call a visionary approach to creating that infrastructure and rely very heavily on the experts in the industry to help us develop a view of what that infrastructure should look like.”

Across town, Banyai knows what the new Bridgepoint’s infrastructure looks like now.

“I’ve had the advantage of being the industry consultant who developed the strategic vision for the hospital’s infrastructure before I moved over and became CIO. So I got to implement my own plan,” explains Banyai.

That plan strategically positioned Bridgepoint neither as an early adopter nor a laggard when it comes to technology uptake.

“We purposely did not put ourselves on the bleeding edge,” says Banyai. “We took the view instead that technology should be an enabler of both our care and business process and not the other way around.”

In that view, he shares some process-come-first common ground with Humber River and Wegener.

“Before we make any decisions about technology, we’re developing models of the types of patient care we want to deliver,” says Wegener. “Then we will go look for the technologies that can help us deliver that care in the most efficient and safe way.”

Wegener adds that he and Humber River Regional will not go looking for those technologies from only the traditional “big boys” among medical technology suppliers.

“If they have a technology that provides a particular service better than any other, then we would certainly welcome any niche provider in the industry into our partnership.”

Wegener feels Humber River has the flexibility to choose the very best partners in the building of the new facility, thanks to the Alternative Financing and Procurement (AFP) that will pay for the project. AFP, a policy announced by the Ontario government in 2004, allows construction work to be financed and carried out by private sector builders, who assume the financial risks of finishing the project on time and on budget. The completed facilities, however, remain publicly owned and controlled.

When the new facilities at Bridgepoint Health are complete, their information technology will be underpinned by an old Bridgepoint partner – Novell and its open enterprise software. “When I first got here, I looked at what Novell had in place and said, ‘Hmmm, this isn’t up to what Microsoft, for example, is doing as an industry standard,’ so I did a full review. But I discovered that Novell really did have the modern products we needed to deliver on our strategic plan. As a result, we maintained our relationship.”

With his updated Novell software, Cisco Systems networking, and HP hardware all up to speed, Banyai went on to add to them a system integrating suite called Novell exteNd, which gives users the keys to Bridgepoint’s wide-stance portal.

“What exteNd does for us is give us enterprise-wide single sign-on and identity management,” says Banyai. “So that to put technology in front of our users all they need is only one user name and one password. With them, they can get to all their data and all their applications with a couple of keystrokes or clicks. It gives them fast, secure, seamless, and transparent access to everything they work with.”

With that ease of access in place, Banyai could then build a multi-faceted portal that embraces a range of specialized views.

“We’ve built an executive portal or view, for example, where senior management can see at a glance how things are performing in real time.

“If you are the chief financial officer you want to know what we’ve been spending money on; if you are the VP of operations you want to know what our occupancy rate is. We’ve also created a clinical view, an administrative view, and next on our list is a physician’s view and then a remote view.”

And all those views can all be seen from any kind of workstation or web-accessing device, current or future.

The future of the technology employed at both the new Bridgepoint and Humber River hospitals is not without its challenges, albeit different ones.

For Bridgepoint Health and Steve Banyai, the immediate challenge is to step away this time from its leading-edge avoidance and, beginning in September, integrate a beta version of MediTech’s new Human Resources module.

“We’ll be the first site in Canada to install and beta test it,” says Banyai.

With that module proven and in place, however, Banyai feels Bridgepoint’s portal-based infrastructure will be ready to take on a larger challenge. Bridgepoint Health intends to become, for complex disease sufferers and those in need of rehabilitation, the country’s first “smart” hospital to care for them.

For Humber River Regional Hospital and Peter Wegener, the hurdles yet to be overcome in their clean slate approach are both mental and logistical.

“There are so many good technologies out there now, I’m just worried about not getting to see them all,” says Wegener. “Before we decide, I want to see the best in not just what will help us build our electronic health record and other clinical services, but also what will give us the best view of things like our financial information, of what will automate our building maintenance best, of everything. That’s the real challenge of the visioning exercise we’ll be going through soon for the new hospital.”

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