Inside the March 2007 print
edition of Canadian Healthcare Technology:
Feature Report: Wireless and mobile solutions
Calgary rolls out ‘e_record’ system to
The Calgary Health Region has launched an extensive electronic
health-record system that integrates more than 80 specialized
systems used in its three adult acute-care hospitals, thereby
creating a consolidated patient chart.
SSHA on the mend?
An operational review of Ontario’s Smart Systems for Health Agency
found that its products and service delivery are of poor quality,
according to the organization’s own customers. However, the acting
CEO says there is now a plan in place to achieve excellence.
READ THE STORY
Clinical connectivity advances at Hamilton
Hamilton Health Sciences has developed a web portal that provides
clinicians with access to a variety of systems at the multi-site
organization, wherever the caregiver happens to be – in the
hospital, out in the community, or even overseas.
Making DI more efficient
Canada’s radiologists must work more closely together with referring
physicians, advising them about the most appropriate exams for their
patients as a way of cutting back the volume of unnecessary tests.
READ THE STORY
A project in southwestern Ontario has connected the lab systems of
nine different hospitals, enabling 14 different sites to view the
same information. Users are able to drill down to see details of
Canadian ultrasound success
Vancouver ultrasound developer Ultrasonix exhibited at the recent
Medica trade show, which attracted 135,000 attendees from around the
world. Demand for its technology was so high, Ultrasonix sold all of
the devices it brought.
PLUS news stories, analysis, and features and more.
Calgary rolls out ‘e_record’ system to caregivers
By Jerry Zeidenberg
The Calgary Health Region has launched an extensive electronic
health-record system that integrates more than 80 specialized systems
used in its three adult acute-care hospitals, thereby creating a
consolidated patient chart.
Over the past three years, the region has invested $80 million in the
project, called the e_record. The system now connects the city’s three
adult acute care hospitals and private labs, and as it rolls out in
phases over the next four years, it will connect to all other regional
hospitals, doctors offices, independent X-ray clinics, pharmacies and
other care providers.
“What we’re building is an e-record that will cover the 1.2 million
people in the Calgary Health Region,” said CHR’s vice president of
advanced technology, Bill Trafford, in an interview with Canadian
The main thrust of the project is to improve patient safety and enhance
the quality of care delivered through the use of integrated, electronic
Using connected IT systems, caregivers will have access to the
information they require to make accurate decisions, right at the moment
they need the data. Trafford explained, for example, that if physicians
find themselves waiting for lab results, they often re-order the tests,
resulting in greater costs for the healthcare system and a delay in
treatment until the new results are received.
But by using the e_record system, which connects all labs in the region
with the three adult acute care hospitals, results are delivered much
faster. “We’ve already seen the duplication of lab tests drop
significantly in the last few weeks,” said Trafford.
Rapid access to data is enabling physicians to make decisions more
quickly, which in turn allows treatment of the patient to start sooner –
resulting in a better experience for the patient.
Quality of care is also being enhanced by the adoption of ‘best
practices’ by the various clinical units of the Calgary Health Region.
Moreover, the agreed upon practices have been incorporated into the
e_record system as decision supports for physicians.
“Physicians don’t want to be told what to do,” commented Trafford. “But
they do want to be warned if they’re straying from the accepted path.”
Calgary’s new system not only shows them the accepted path, but it
highlights the best path, as established by the most up-to-date
research. And it has created best practice guidelines and order sets for
an astounding 1,200 clinical areas.
“We’ve taken the region’s 10 leading lights in various clinical
disciplines, and they’ve worked out the best practices in these areas,”
commented Trafford. All in all, the project has drawn on the expertise
of some 700 physicians and care-givers in building the order sets and
Moreover, it’s an on-going process, since medical knowledge virtually
doubles each year. As a result, the committees of physicians and
care-givers will continuously review and update the system, making sure
the ‘best practices’ reflect the latest information.
The decision support tools also help the region’s doctors stay current
with the latest practices – when they check on the protocols for various
diagnoses and therapies, they can quickly see if a previously used test
or medication has changed.
And because nearly all information in the Calgary hospitals is now
electronic, physicians can analyze patient therapies and outcomes much
faster than before, when records were kept on paper. That’s creating an
in-house source of determining best practices.
Trafford gave the example of one physician who noticed that he and his
colleagues were obtaining widely varying results when prescribing the
same medication. By reviewing the computerized records kept by his
peers, the physician found that each of his colleagues was prescribing
different doses of the medication. After a few telephone calls, the
physicians agreed upon the dosage that would lead to the best results.
“That process of review and analysis, using the electronic systems, only
took a couple of hours,” said Trafford. “When records were kept on
paper, it would have taken days or weeks – so long, that most physicians
wouldn’t have bothered.”
On the patient safety side, Trafford noted that 50 percent of errors are
made in just two areas – misidentification of patients, and mistakes
Using a panoply of new patient safety systems, Calgary Health Region
aims to take great strides on this front. Trafford commented that
worldwide, there is an error rate of about 2 percent when medications
are prescribed, delivered or administered. “We want to be at 0.2 by
2010,” he said.
That’s just one of the ways in which Calgary is “building a landmark
capability in Canada,” commented Trafford. He believes the e_record
system, and associated practices in the hospital, will make the region a
healthcare leader that should be emulated by others.
For its part, decision-makers in Calgary have looked closely at several
other top-performing organizations, and have modeled their own systems
on their best practices.
Trafford said that three hospital groups were the key examples for
Calgary Health Region: InterMountain Healthcare of Salt Lake City, Utah;
the Hospital for Sick Children, in Toronto; and for cancer care, the
Memorial Sloan-Kettering Cancer Center, in New York.
He noted that in U.S. quality ratings, InterMountain has consistently
been a top performer for years, and the organization is known for its
highly advanced decision support systems. “We’ve spent a lot of time
working with them,” said Trafford, adding that Calgary has learned a
great deal from Sick Kids Hospital, as well. “We’re working in a way
that’s similar to them,” he observed. And in the area of oncology, where
Sloan-Kettering is widely admired for its quality of care, Trafford
noted that Calgary collaborated closely with the New York-based
organization when developing order sets.
Trafford also said credit for the e_record system should also be given
to Alberta deputy minister of health Paddy Meade, who was instrumental
in keeping the project on track.
In due course, the system will also provide secure access to patients,
so they can communicate with their caregivers, book appointments
electronically, and access their records, thereby enabling them to keep
tabs on their own results and progress. “We’re creating a very big
cultural shift,” commented Trafford. “We’re creating a partnership
between doctors, nurses, caregivers and patients.”
Ontario’s Smart Systems for Health critiqued, aims for turnaround
By Jerry Zeidenberg
TORONTO – On the topic of Ontario’s Smart Systems for
Health Agency (SSHA), there’s lots of bad news. But there are positive
developments, as well.
First, the bad news. An operational review of SSHA, conducted by
Deloitte Consulting and made public in January, found the organization
to be a poor performer in just about every area it looked at. To put it
bluntly, you could say the SSHA was misfiring on all six cylinders.
After spending $458 million of taxpayers’ money (counting the current
fiscal year), the SSHA has created products that its users – hospitals,
community care providers and doctors – consider to be of poor quality
and ineffective. They also feel the SSHA’s service delivery levels are
Moreover, the reviewers at Deloitte concluded that SSHA functioned with
inadequate strategic planning and project management, had serious
governance and accountability problems, and provided little measurement
The 100-page operational review can be accessed at
On the other hand, there’s some good news, too: the caustic operational
review may have jolted the SSHA – and its overseer, the Ministry of
Health – into making the changes needed to become an effective provider
of eHealth products and services.
“As a board of directors, and as management, we accept the review and
its findings,” said Mike Lauber, the acting CEO of Smart Systems for
Health Agency. “We’re taking the work of Deloitte and using it to
transform the organization. The review is now our roadmap – we’re going
to take its recommendations. We’re going to implement the industry’s
While SSHA was formally launched in 2002, Lauber didn’t come on board
until December 2005, when he was appointed its chairman. By the spring
of 2006, he urged the underperforming organization to commission an
independent, operational review, as a first step on the road to
improvement. “I suggested it, and nobody resisted,” said Lauber, a
chartered accountant by training, and a former partner in KPMG’s audit
and consulting practice. He also served as ombudsman for the banking
industry, investigating and resolving customer disputes.
A new board of directors was appointed last spring, and by the fall of
2006 the previous CEO had departed, and Lauber shifted from his role as
chairman to that of acting CEO. (In late February, William Albino was
appointed as the new CEO; Lauber returned to his role as chairman.)
Lauber acknowledged that in the past, it was difficult to obtain
information from the SSHA about its spending and overall performance,
but as part of its current transformation, a new era of transparency
will be initiated. The first step on that front was making the
operational review public – something that didn’t have to be done.
“Our goal is operate at the standard of a TSX (Toronto Stock Exchange)
listed company,” said Lauber, with regular and rigorous reporting, along
with high standards of corporate governance and accountability.
To help implement the operational turnaround, moreover, a change
management office has been formed. It will assist the various parts of
SSHA, which now employs 300 people, as it puts ‘best practices’ into
place. Over the next six months, SSHA is focusing on four major areas:
• Project management. SSHA is aiming to improve its time controls and
budget management. As well, it’s putting an integrated, enterprise-wide
approach to project management in place. “Project management has tended
to be silo-based at SSHA,” said Lauber. “We’re building a unified
approach, so that projects are coordinated and use the same methods.”
• Data centre improvements. While a great deal has been invested in two
data centres, they haven’t used best industry practices – for example,
advanced automation for problem detection and automated reporting to
clients. These and other practices are currently being installed, as
part of a project called Setting the Course on the Operational Road to
Excellence (SCORE). “In six to eight months, we’ll have reached a good
operational standard,” said Lauber.
• Financial controls and expertise. SSHA is bringing in a Chief
Financial Officer. It is also implementing much more sophisticated
financial systems and reporting procedures. “We want to be able to tell,
at any time, how much it’s costing us to run a particular application,
like OLIS (the upcoming Ontario Laboratory Information System) or an EHR,”
He commented that, “General Motors knows down to a tenth of a cent what
it costs to put a bumper on a car – we should know our costs, too.”
On a related note, when asked about rumours of runaway costs in the
past, and overly large payouts to consultants, Lauber asserted that
Deloitte found no signs of “inappropriate use of funds” – nor did
professional firms in three previous accounting audits. He added that
SSHA made heavy use of consultants in its early days to launch the
organization and implement infrastructure, and paid standard consulting
fees, but the agency has changed course and is now almost entirely
staffed by its own employees.
• Strengthening human resources. “We may well hire an executive level
human resources director, because HR is such a critical issue here,”
said Lauber. He explained that as an I.T. organization, SSHA is
competing for highly skilled programmers, engineers, analysts and
managers. “It’s a huge talent management issue. I.T. professionals are
mobile and in great demand. We’re competing with banks and industry for
Lauber said an environment must be developed at SSHA that encourages
people to stay and develop their careers. “You want to slow down the
Of course, SSHA will have to deal with other problems, as well. For
example, it faces criticism that it has built infrastructure that few
are using – secure e-mail is a case in point. The Deloitte review notes
that of 60,000 secure email boxes that have been installed since 2003,
only one-third are in active use.
Part of the problem is that not enough storage space has been allotted
to the mailboxes for applications like receiving and storing diagnostic
images, which take up a great deal of room.
However, Lauber asserted that the size of the email boxes is currently
being increased. In addition, he said a rollout to Ontario physicians is
currently under way, and that the usage numbers will soon increase.
Finally, he observed that many doctors simply aren’t using email to
consult with their peers; instead, they’re still relying on the
telephone. It’s only a matter of time, he said, before their work
practices change. “It’s much like ATMs or the fax machine,” said Lauber,
noting there was resistance to them at first, but then sudden acceptance
once a tipping point was reached.
And while the Deloitte review paints a largely negative picture of SSHA,
Lauber says he doesn’t totally agree with its assessment, stating the
organization has strengths as well as weaknesses.
“There has been a lot accomplished,” said Lauber. “We’ve built data
centres, a reliable network, we host applications and secure email is
now rolling out.
“The major applications will only appear in the next two to three
years,” he continued, citing provincial lab, drug and imaging solutions
as the prime examples. “But they wouldn’t be possible if we didn’t do
the planning or build the infrastructure.”
Clinical connectivity advances at Hamilton Health
HAMILTON, ONT. – Dr. Justin deBeer, an orthopedic
surgeon at Hamilton Health Sciences, was halfway around the world in
Taipei, Taiwan but wanted to be able to keep tabs on his inpatients back
in Canada. What in the past would have been a next to impossible
proposition was actually done quickly and easily thanks to
ClinicalConnect – a web-based portal for physicians that brings together
data from three of the hospital’s most commonly used clinical software
systems in an electronic health record format.
Hamilton Health Sciences worked with Medseek to design and implement the
ClinicalConnect portal, but also engaged physicians from a variety of
disciplines to offer input and drive the creation of the final product.
Since Meditech is the most widely used information system at Hamilton
Health Sciences, it was the first to be merged into the ClinicalConnect
environment. ClinicalConnect offers a user-friendly view of the Meditech
information, which ranges from admission information to lab results, and
allows physicians to view the information simply by signing on to
The next step involved adding views of patient records, stored in a
system called Sovera. Currently the charts are scanned and merely
displayed through ClinicalConnect, however, the portal does allow
physicians to view the information and also indicates the number of
chart deficiencies that need to be resolved. By the end of this year,
physicians will be able to access Sovera directly through
ClinicalConnect, which will enable them to interact with patient
information in real time and directly resolve any chart deficiencies.
In the future, physicians will have the option to e-edit and e-sign
Meditech-based charts in the portal, and the updates will be passed back
to the Meditech system. When this feature is available in the portal, it
will also be available via PDAs.
Adding PACS to the system proved to be a tremendous enhancement, since
it enables physicians to view X-rays from the same system that houses
other clinical information about their patients. And by signing on to
one system, physicians can access and interact with all of this
information. They can also customize their views and pick and choose
which information they want to see and when.
“Our ClinicalConnect portal gives physicians and other clinicians
secure, real-time access to electronic patient records. Whether they are
at the hospital or elsewhere, our physicians can quickly access all
clinical reports, lab results, PACS images, pharmacy medication lists
and much more,” said Dale Anderson, information and communications
technology manager of projects and e-Health solutions at Hamilton Health
Already, more than 900 physicians, nurses and other clinicians at the
hospital and within the surrounding communities are using the system.
Many physicians, particularly those in family practice, have noticed
improved communication as a result of ClinicalConnect, since the
information is updated in real time and they have access to detail about
tests, medications, and other particulars that may affect their
patients, even after they have been discharged from the hospital.
As Hamilton Health Sciences expands the wireless network within its four
sites, ClinicalConnect will become even more valuable. Already, some
physicians have been piloting wireless applications of the system on
PDAs in certain areas of the hospital. They’ve got access to all
available patient information when they are seeing the patient. Patients
are also able to ask questions about particular tests and procedures
when they are with their doctor and do not have to wait for results to
be retrieved from another computer or system.
For Dr. deBeer, remote access to patient information through
ClinicalConnect enabled him to use Internet access on the computer in
his Taipei hotel room to call up the patient’s information, including
X-ray images and blood work, to check up on his hospital patients.
Noting that physicians are always pressed for time and routinely
required to travel as part of their practice or for educational
purposes, Dr. deBeer is confident ClinicalConnect is adding value for
physicians and their patients.
“Now regardless of where we are in the world, we don’t ever have to
leave patients behind,” he said.
Radiologists and referring physicians need to work more closely
Normand Laberge is chief executive officer of the
Montreal-based Canadian Association of Radiologists. CHT writer and
contributing editor Andy Shaw interviewed Mr. Laberge in Chicago, at the
recent Radiological Society of North America (RSNA) annual conference.
Shaw: Normand, clearly the tremendous advances in imaging
technology over the past few years are influencing the practice of
radiology. With higher resolution, more imaging modalities, and most
recently, much more government funding for new imaging equipment – what
has all this meant to Canadian radiologists?
Laberge: Canadian radiologists lobbied hard to ensure our
hospitals remained up-to-date in imaging technology and can be proud of
that accomplishment. They also stepped up to the plate when the system
asked them to focus on productivity. We’ve come to a stage in the
evolution of our healthcare system, however, where radiologists need now
to put the emphasis on quality in order to ensure that they remain
respected as professionals. If radiologists don’t emphasize the
professional quality and value-added aspects of the work they do,
there’s a danger they could put themselves out of business.
Shaw: That’s surprising to hear, can you explain a bit more about
being professional? What’s the problem?
Laberge: Imaging equipment is available to all physicians on an
unprecedented level. At the same time, we’re not producing enough
radiologists to meet the growing demand for medical imaging. Studies
clearly show that not all imaging tests ordered are the most
appropriate. As professionals, it is our duty to develop ways to ensure
our healthcare system avoids inappropriate tests and the costs
Shaw: How so?
Laberge: Canadian radiologists need to move beyond the simple
interpretation of images. The imaging process is a six-step job. As
professionals, radiologists must be involved in the entire process, from
the time the examination is considered for a patient, until the time the
final report is discussed with his physician. If there’s a certain
amount of resistance to the idea of greater involvement, it’s because
radiologists traditionally don’t like to be gatekeepers. But they’re the
experts here. They’re best placed to advise patients and their doctors
on which tests are the most appropriate. So it is their duty to be
Shaw: Can you describe those steps briefly?
Laberge: The very first step involves judging the appropriateness
of a test ordered by a physician, given what he or she is looking for.
The second step involves scheduling. Some patients can wait, others
can’t. Helping to manage the demand and the constant trade-off that must
be made between access to and quality of care is part of the
professional responsibility of radiologists. But even then, they’re not
ready to view images yet. The third stage involves the relevant
protocols. Are you going to use a contrast agent? What kind of views
will you do? Radiologists must become directly involved in determining
the use of protocols based on evidence and in the development of
standardized best practices.
Shaw: So now, as the radiologist, am I finally ready to do the
Laberge: Yes, and it is only at this fourth stage that the exam
is performed. But radiologists are also responsible for quality control.
You maintain the equipment, you pay attention to the workflow in the
department, and you supervise the technologists. Most importantly, you
make sure you are using the right level of radiation for each individual
case. This is critical and another professional responsibility of being
Next, at stage five, comes the interpretation of images and production
of a report. But this should not be the last step; there is a sixth one,
which is communication. You need to be available to discuss your
findings and the appropriate follow up with referring physicians and not
leave it to them to simply read a report. Consultation between
physicians and radiologists is fundamental in ensuring quality care to
Being a true radiologist means direct involvement at each of these six
Shaw: And if I don’t do them?
Laberge: Let me give you an example: In such a case, the
cardiologist who wants a CT or an ultrasound done will be much more
likely to just go ahead, have the imaging tests done and interpret the
results on his own. Because radiologists are not providing the kind of
full value-added, the six-step service I’ve just described, a real
danger exists that their role will eventually be seen as non-essential
and the healthcare system and its patients would be much the poorer for
it. We need to go back to emphasizing professionalism in our industry
not only for its continued existence, but to ensure that Canadians from
coast-to-coast benefit from the value it adds to their quality of care.
Shaw: Speaking of cost-cutting, what’s been the impact of
outsourcing? Teleradiology now makes it quite possible, for instance,
for images to be interpreted in India relatively inexpensively overnight
and sent back to the hospital with a report by the next morning. So
we’ve seen the rise of companies who do that, like Nighthawk.
Laberge: There is nothing wrong, per se, with outsourcing an
interpretation by teleradiology. For obvious job protection reasons it
is preferable to have this done within Canada, but as we’ve seen, the
interpretation of imaging is just one step of the medical act. Now who
takes care of the other steps? You still need a radiologist, even if you
are going to sub-contract a portion of the work, otherwise it would be
misleading to say that the entire medical act has been covered.
Shaw: If successful, and radiology starts to be done the right
and responsible way in today’s circumstances, where do you think it can
Laberge: Already, in some institutions, the first place trauma
patients go is not to Emergency but to Radiology. Imaging is rapidly
becoming a cornerstone of healthcare. You can’t treat if the diagnosis
is not done and this is our turf. We have evolved from what was just
radiology, to diagnostic imaging, and now on to what’s more
appropriately called with the addition of Interventional Radiology
“medical imaging”. In other words, as radiologists we are involved
before, during, and after. And that is a hell of a responsibility. That
is why we’re making professionalism an issue.