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Inside the  March 2009 print edition of Canadian Healthcare Technology:


Telus purchases MyChart from Sunnybrook
Telus, a Canadian telecommunications giant, is acquiring the MyChart personal health record system from its developer, Sunnybrook Health Sciences Centre, for a purported cost of approximately $3 million.

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Mobile solutions give nurses access to more information at the point of care
Visiting nurses, equipped with mobile computers and smart phones, provide more effective care.

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Advanced dictation
The Hospital for Sick Children, in Toronto, took its time when acquiring an updated dictation and transcription system. It waited until the voice recognition technology was mature, and it’s pleased with the outcome.

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Smart lab software
Automated hardware can do wonders for throughput in a busy laboratory. So can intelligent software, by reducing the workload for skilled technologists. We look at the gains made in this area at BC Bio, in Vancouver.

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Pediatric hospital design
New children’s hospitals are being created with a mixture of art and science – appealing artwork and designs that have a calming effect on kids, and high-tech equipment that enables doctors to provide the latest diagnoses and therapies.


New generation of CTs
In the last year, a new wave of CT technology has emerged, producing scans with much greater clarity and resolution while dramatically reducing the X-ray dose for patients. We look at the experience of several end-user sites.


PLUS news stories, analysis, and features and more.

 

Telus purchases MyChart from Sunnybrook

By Andy Shaw

TORONTO – Telus, a Canadian telecommunications giant, is acquiring the MyChart personal health record system from its developer, Sunnybrook Health Sciences Centre, for a purported cost of approximately $3 million. It’s said to be the largest sum ever paid in Canada by a private company for software created by a public healthcare organization.

The acquisition, announced in January, is the first major move by Telus since it announced last fall that it would invest $100 million in healthcare I.T. over the next three years. At that time, it signalled the importance of healthcare to the company with the creation of a new brand, Telus Health Solutions.

MyChart was developed over the past three years by Sunnybrook and is now used there by over 1,000 physicians and patients. It’s an innovative, continuity-of-care electronic record system that can be used by patients, their families and their caregivers over the web to access, update and manage records.

On the Internet, they can do all that, no matter where they are in their acute-to-home-care regimen or where they might be in the world.

However, continuous in-house development of an electronic health record system would be difficult, even for a large organization like Sunnybrook – hence the alliance with Telus.

“I’ve always said that the kind of integration that MyChart helps bring about would need a public-private partnership to fully develop it. And now we have a model for it,” says Sam Marafioti, who guided the MyChart development team as Sunnybrook’s vice president and CIO. “Part of that model is the strategic development relationship we’ve struck with Telus. So we will continue to help Telus develop the MyChart product and be identified with it.”

Telus appears to be a natural partner for Sunnybrook and its MyChart system, since the two organizations have been doing business together for some time. Sunnybrook has been a long-time user of the Oacis electronic health record system, which was acquired by Telus when the telecom company purchased the system’s developers, Emergis and Dinmar. While MyChart is aimed at patients, Oacis is the high-powered Electronic Health Record system that’s used by clinicians and health professionals. Sunnybrook recently announced that it will be upgrading Oacis to a web-enabled version.

Also as part of their new strategic relationship, Telus has joined Sunnybrook in another development partnership with the Central Ontario LHIN, the most populous regional health authority in the province. Earlier, Sunnybrook had contributed MyChart to the LHIN and had begun guiding its LHIN-wide deployment. That should now be speeded by the brand awareness that Telus, the country’s third largest telecommunications carrier, now adds to the effort.

“In healthcare, especially when it comes to a personal health record, the patient has to have trust in it. Faith in the brand, in other words. And, first of all, we think there is a lot of faith in the Sunnybrook brand,” says Barry Rivelis, the vice-president of consumer health for Telus. “But when information is passing electronically from one to another, there has to be faith in the carrier of that information too. And that’s where the Telus brand comes in.”

One of the trust-building elements in Telus Health Solutions’ favour, adds Rivelis, is the growing number of clinicians the division now has on staff and who advise and help with the development of their products and services. And they liked the capabilities of MyChart.

Through MyChart’s web portal, patients can opt-in to set up their personal and family health records, manage a fair chunk of their own personal health information, then share that data with multiple care providers they choose.

On their own, they can see their test results, schedule appointments, find out what to do in an emergency, and link to educational information about their condition. As well, patients can also write a diary about their health, build a contact list of their care team, watch instructive videos, maintain their medication history, and request prescription refills.

And that may just be the beginning.

“We’ve been in discussions with Microsoft HealthVault officials, who have come to visit us right from the top echelons in Redmond,” Marafioti said during the interview for this story. “There are other IT giants out there, like Google, who are working on a comprehensive patient health record. But Microsoft thinks healthcare information is just too complex, and comes from too many sources, to be consolidated into a one-person health record.

“So what HealthVault does,” continued Marafioti, “is simply to allow you to deposit all your healthcare information from any source, including the likes of MyChart, in a virtual yet secure vault. In our case, the Telus/Sunnybrook MyChart could well become a ‘deposit’ in Microsoft’s HealthVault.”

So impressed were his Washington state visitors from Bill Gates’ former fiefdom, that Marafioti expects Microsoft to join the MyChart development partnership with Telus and the Central Ontario LHIN.

To ensure the success of that partnership, Marafioti says they will first focus on frequent flyers. Chronic disease sufferers who have a constant need for their medical records will be the first to be offered MyChart. And the first among those firsts will be diabetics.

“MyChart is not really needed by all patients,” Marafioti notes. “But anyone who uses the healthcare system frequently, and especially those who use it at more than one location in the continuum of acute to community and home care, will benefit greatly from having MyChart at their and their doctors’ disposal. For them, it can be a God-send.”

Marafioti also admits MyChart was not saluted quite that way, by clinicians at least, when first run up the masthead at Sunnybrook. But now it is.

“We can see very clearly here how our doctors at Sunnybrook have moved from being skeptics about IT, generally, to being enthusiastic adopters – especially when the cell phone is involved,” says Marafioti. “When they find out they can access patient records through their cell phones, we start getting calls from them.”

Marafioti adds, “They’ve gone from being skeptical to pushing us for new uses. I get calls regularly from physicians asking how they can apply MyChart to their department or discipline at the hospital.”

This physician-led demand might well escalate by several notches once MyChart starts spreading throughout the LHIN.

Barry Rivelis says Telus Healthcare will roll out in phases. “First, we intend to make MyChart a success in Central Ontario. Then we can set our sights on the rest of Ontario, and from there on to the rest of the country. If all that works well, we might also look at international sales.”

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Mobile solutions give nurses access to more information at the point of care

By Andy Shaw

You can talk, dictate, or consult over the new BlueAnt Z9i cell phone headset in perfect clarity. Its award-winning “voice isolation technology” cancels out almost all background noise – whether you’re buzzing in for a roof-top landing in the Rescue chopper or dictating to the transcription service over the clatter of the hospital cafeteria. You wear the tiny 10-gram BlueAnt headset (developed in Australia) on your ear while it connects wirelessly via the Bluetooth 2.0 protocol to the cell phone in your smock pocket. It is yet one more weapon at your disposal in the growing arsenal of wireless healthcare technology.

Indeed, some healthcare pundits think there’s enough weaponry out there to suggest an uprising is afoot.

“A healthcare revolution is on the horizon,” says C. Peter Waegemann. “The new capabilities of modern cell phones, smart phones, PDAs, and other mobile devices are creating extraordinary new possibilities for healthcare.”

And Mr. Waegemann should know. He is the executive director of an outfit called the Center for Cell Phone Applications in Healthcare, or C-PAHC for short. He took the helm of C-PAHC when it was launched in August last year by the Medical Records Institute, based in Boston.

“New cell phone innovations are poised to make a huge impact on the healthcare industry. The changes are happening very fast and on an international level,” continues Waegemann, “Soon, millions of patients will have some of their health information on their cell phones and will be able to send insurance, allergy, and medication information in advance to their healthcare providers. Hundreds of systems are already available and more are under development...(and with them) patients can easily collect and maintain their own health information and transfer it, securely and wirelessly, using their cell phones. This field is about to explode on the international healthcare scene.”

If not exploding quite yet on the Canadian scene, there are certainly vendors, users, and their co-conspirators across the country lighting fuses.

For example, Victoria -based Procura and Waterloo, Ontario-based MedShare are collaborating with intention to eventually arm as many as 6,000 or more mobile homecare providers with either of the companies’ joint weapons of choice, the BlackBerry cell phone or the MedShare eMotion wireless tablet.

To do so, both companies can call on considerable forces. Procura provides integrated software for point-of-care, clinical, and back office administration to over 350 client sites in North America and Australia. At these sites, Procura software manages over 50,000 employees. MedShare specializes in mobile, point-of-care technologies meant to streamline the workflow of home healthcare agencies. Over the airwaves and into their mobile devices, they provide homecare workers with clinical information, decision support, documentation, and reporting tools while in the clients home – or back at their own home offices.

On the patient end of the battle line, IgeaCare Systems Inc., of Richmond Hill, Ont., is assisting the Health Access homecare agency in Beaconsfield, Quebec through a so far highly successful series of home monitoring trials. They are conducting them also with the help of Bell Canada and McGill University, and have even equipped an 85-year-old patient with the BlackBerry, who wielded it with enthusiasm during a three-month fray against her high blood pressure.

One barrier facing vendors and users of wireless devices like the BlackBerry are perceptions about their security. It’s a barrier Procura and Medshare know only too well.

“I’ve had people walk by our booth at trade shows, look at our BlackBerry and say, ‘You know those things aren’t secure’,” reports Barry Billings, president of MedShare. “But then I ask them on what grounds do you say that? Do you know, for example, that the BlackBerry has been cleared by the U.S. Army for use in combat? And that the Taliban can’t hack the BlackBerry.”

Closer to the home front, a few notables have recently endorsed that impenetrable security. Newly-elected U.S. President Barack Obama can keep his beloved BlackBerry say his U.S. security officials, at least for personal calls. And Ontario Privacy Commissioner Ann Cavoukian is about to release a report not just condoning such wireless devices in healthcare, but even urging their uptake, with a proviso.

“The one caveat she makes for her wireless device support is, “... if properly implemented,” says Billings.

To underline proper implementation, Cavoukian wrote her report with the co-operation of RIM, the maker of the BlackBerry, and Medshare. She was evidently impressed by the end-to-end encryption achieved by the two firms.

So Procura and Medshare are now racing to the marketing and sales front lines.

“At this point in our integration with the Procura platform, we are building our HL7 layer. Our technology teams are working together on that and it is going very quickly. In fact, they are ahead of schedule. So that integration should be complete and available in the second quarter of this year,” says Billings. “The new (joint) platform will be highly scalable, robust, and of course secure. We’ve built encryption into both the BlackBerry and our wireless tablet that allow only consent-based access.

“What that means is that an agency may be servicing 4,000 people who are being visited at home. But the only records of patients that a visiting caregiver will ever see when their device is turned on are the 40 cases or so they’ll be visiting that day,” says Billings. “What’s more, if a next-door neighbour were one of those 4,000, the caregiver wouldn’t even know that the neighbour was being looked after by the agency – unless their case showed up on their daily list.”

Currently, Billings says 11 of MedShare’s homecare agency clients are readying themselves for the MedShare/Procura platform. But MedShare’s “development partner” agency, Therapy Partners, a therapist homecare agency in Guelph, Ontario, will be the first to have it fully deployed.

“In effect it will enable Therapy Partners to go fully electronic, both in the field and back at the office.”

Procura president Warren Brown notes that much of the home care sector is in need of computerized tools. “It was part of the founding vision of this company to bring electronically aided healthcare to the home,” says Brown. “But as things stand now, most homecare workers in Canada are still using paper and fax machines to document and report their work.”

Brown cites a 2005 North American study of how paperwork tangles up the homecare process.

“The researchers concluded that home healthcare workers spend almost a third of their time filling in, fiddling with, filing, and sometimes forgetting their paper notes and forms,” says Brown.

That’s a huge amount of inefficiency in a sector already hard pressed for time. Brown and Procura believe that giving the homecare workers the technology to handle their workflow electronically will bring administration time down dramatically – by at least a third.

The cell phone-equipped patient can also do battle against the homecare inefficiencies. That’s what Donna Byrne, in partnership with IgeaCare, Bell Canada and McGill University, are out to prove.

Byrne, a registered nurse by background, is president of Health Access Santé in Beaconsfield, Quebec, a West Island suburb of Montreal. Byrne oversees the company’s home and nursing care services and has been pioneering videoconferencing and other remote access technologies ever since the company’s founding in 1996. Her passion for innovation and better homecare soon emerges as she talks about the three-month study just concluded with her partners.

“Hypertension is the silent killer. You don’t feel its symptoms. So in our study we handed out the BlackBerry and wireless blood pressure cuffs that communicated with their BlackBerry to 50 people with hypertension. They either volunteered directly or were referred by visiting nurses or some by their doctor,” says Byrne. “We asked them to take their blood pressure two to three times a day. And they did that for a week and in some cases up to four weeks, if their medications changed as a result of the readings that came in from the BlackBerry.”

One sidelight of interest to Byrne was the reaction of the older patients to the new technology. “One of our 85-year-olds was so keen about it, she wanted to see her results on her own computer in order to print them out. So we helped her set that up. Of course, she could also see her results on the BlackBerry, too.”

As results came into the central Access Health station and were captured on IgeaCare’s remote care software, monitoring Health Access nurses could see colour-coded results for each patient. When yellow indicated readings were heading outside parameters, they called the patient or arranged for a home visit.

But how effective is all this?

“Our principal investigator for all our studies is Dr. Antonia Arnaert. She’s a professor of nursing at McGill and does the analysis of them, assessing their cost-effectiveness contribution to the healthcare system,” says Byrne. “And so far the results are very encouraging.”

So encouraging that on the day of the interview for this story, Byrne, professor Arnaert (a registered nurse with a PhD) and Health Access were kicking off yet another study project – this one to bring the BlackBerry and self-care to the homes of diabetes sufferers who will be winging back their glucose levels. Next to come will be a similar study of wound healing in the home.

Byrne says further analysis of the results will determine whether the remote monitoring of hypertensive, diabetic, or wound healing patients will be offered as a permanent service by Health Access. She’s optimistic at least one will.

“It’s the anecdotal results that come in that really encourage us. From what patients tell us, they enjoy using the technology to monitor themselves and participate in their own care,” says Byrne. “So once we write down all of our protocols, policies, and procedures that the studies suggest, we think it will be a viable service that people will want to use.”

It remains to be seen whether the powers-that-be in the larger healthcare environment will also value such systems.

“It can be frustrating, because from what we are seeing in these studies is that there is just so much benefit including fewer visits to the doctor or the hospital. Our hope is that those responsible for our hospitals and those in our health ministries will take notice of our studies and start taking wireless technology more seriously,” concludes Byrne.

To help those authorities hear the message more clearly, maybe the folks at BlueAnt down under would be good enough to send them each a Z9i headset.

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Sick Kids’ radiologists opt for voice-recognition reporting solution

By Dianne Daniel


Patience has paid off for the Diagnostic Imaging (DI) Department at Toronto-based Hospital for Sick Children (SickKids). After waiting several years for speech recognition technology to mature, the department went live with SpeechQ for Radiology in June, 2008, and is now reaping the benefits of front-end voice recognition, largely due to tremendous support from radiologists, says Ellen Charkot, director of DI, at SickKids.

“By the time we brought this system in and started implementation, the radiologists were very much in favour of moving forward,” says Charkot. She noted that as a multi-national teaching centre, the department has a number of trainees with varying levels of English language skills, and was therefore waiting for a speech engine capable of a very high recognition rate.

The DI department had opted to avoid going down the interim path of back-end digital dictation and was using a tape-based system prior to choosing SpeechQ, a product provided by Lanier Healthcare Canada, which is based in London, Ont. In back-end dictation, transcriptionists are presented with either recorded voice files to transcribe or speech recognized files to edit. With front-end dictation, speech recognized reports are presented to the radiologists for self-editing. Knowing the change would be dramatic, the implementation team, led by project manager Fatima Lima-Simao, worked hard to consider different scenarios and identify workflow challenges upfront.

“The planning process was critical, as well as follow-up to make sure people were comfortable,” says Lima-Simao. “We brought application specialists in a few times and made sure radiologists were comfortable and could pose questions to them.”

There are 28 radiologists, 16 fellows and six to eight residents working at SickKids at any given time. Out of the entire group, only one is continuing to send reports to a transcriptionist for editing, says Lima-Simao. “We’ve gone from five-and-a-half full-time transcriptionists to one editor,” she says, adding that 95 percent of radiologists have said they’re happy with the new system.

SpeechQ for Radiology uses the Philips SpeechMagic speech engine. A key benefit of the technology is that it never stops learning; if it recognizes a word incorrectly, the user can edit the text and the system automatically instructs the engine to adapt. “Our biggest success story is how well the system recognizes voice,” says Charkot.

“We have fellows and residents from different countries who still struggle, but the problem is with grammar, not the voice recognition.”

Since implementing the technology, the department has significantly reduced the time it takes to turnaround reports. The target is 24 hours, with an upper limit of 48 hours, but preliminary reports are available in a matter of hours.

Radiologists are using a PACS-based workflow, where they go to the PACS work list, call up an image to be reported, initiate the dictation and then edit the report before accepting it as final. Once a preliminary report is completed, it can be made available to areas like Emergency and the Intensive Care Unit by selecting a specific tool within SpeechQ.

“Prior to using voice recognition, we would write on paper and fax preliminary reports to areas that needed immediate results,” explains Charkot. “Now we don’t have to worry about paper flow where maybe one person might see it but not another, or it might be misplaced.”

Although the department prepared for a reduction in transcriptionists following the implementation of SpeechQ – moving to contract employees versus full-time, for example – Charkot says she was surprised at how quickly the radiologists adopted the self-editing process. Instead of the 2.5 transcriptionists she initially anticipated, she only requires one and that person’s role is very different than that of the classic transcriptionist, she says.

With SpeechQ, the department is beginning to develop standards for different exams, using custom templates. For example, segments of pre-defined, standardized text can be inserted into a report using speech commands, the mouse or keyboard.

Another feature, called Smart Fields, enables reports to be automatically populated with information like patient demographics.

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Intelligent software in medical lab supports staff, boosts throughput

By Paul Brent


VANCOUVER – Most labs in Canada face a challenging future – their workload is rapidly escalating, but they’ve got fewer trained staff to handle the procedures.

High-performance machinery is often touted as a solution. To be sure, automated hardware is capable of speeding more samples through, with less reliance on human intervention, and many labs are investing in new, automated analyzers.

But what’s equally important is intelligent software that can make decisions about the results generated by automated systems, thereby smoothing the flow of information through a lab.

BC Bio is a large medical laboratory that has refined its software strategy in this way, and in the process has achieved startling results. Three years ago, the Vancouver-based laboratory installed software from Roche Diagnostics (Canada) called Process Systems Manager (PSM). In a nutshell, this software serves as an intelligent layer between the instruments used in the lab and the database, also known as the laboratory information system (LIS).

BC Bio took the time and trouble to customize the PSM so that it enhances the working of the lab. “BC Bio has really pushed the limit of it, and they are really using it to its full capability,” said Don Cole, Roche Canada’s manager of information solutions. “They have found ways to really drive value to their business.”

Smart functions that BC Bio has built into the PSM middleware include quality control alerts, as well as auto-validation rules that can accept a given result or demand repeat or alternate testing – and it’s all done automatically.

What’s more, the system can add comments to a result, again freeing up lab techs from mundane, time-consuming work.

BC Bio, a private testing lab, can carry out 28 different types of tests on samples. Typically, the lab conducts about five different tests per patient, and it handles an average of 20,000 tests a day.

The highest volume of tests fall under the rubric of “general chemistry”, and they include evaluating levels of electrolytes (sodium and potassium) and cholesterol (HDL and LDL).

Thanks to the PSM software, says Brenda Jackson, BC Bio’s lab director, the organization is able to process the 20,000 tests in a 13-hour period each day – avoiding the need to turn into a 24/7 operation. It can do the work with four technologists on hand – a reduction from the six who were needed before the PSM software system was implemented.

“A lot of tests go through the PSM every year and we wouldn’t be able to handle that volume without the system,” said Jackson.

The BC Bio lab director adds that the PSM middleware gives technologists comfort in those times when they are not confident of a specific test – it’s like having a second opinion at the ready.

For example, if the system spots a questionable result, it will block the sample from being released until the issue is resolved. “They get that comfort factor, so they are sure that they are releasing good, quality, valid results,” said Jackson.

One of the secrets of BC Bio’s success is a willingness to tinker with the middleware to suit their needs. “We provide them with an application and [training] to the point that they can run with it,” Cole explained. “They can add on analyzers, they can change analyzers, all independent of a third party.” But BC Bio has pushed the PSM’s validation rules, says Cole, “far beyond what our other customers have.”

Ironically, while Roche’s middleware application is all about automation, it is the human element that has really allowed BC Bio to get the most out of it. The facility has a technician on staff who has fallen in love with the system and continually tries to optimize it for the lab’s demands.

Indeed, selecting one lab staffer willing and able to master the system, and to concentrate on ways of utilizing the middleware, is BC Bio’s main recommendation for the 60 other Canadian facilities currently using PSM.

“You have to find a staff member who is a technologist, because you can’t just use your IT department, said Brenda Jackson, BC Bio’s lab director. “You need a person who loves that kind of work and takes the time to learn.” The technologist, adds Jackson, must be a person who is willing “to understand why we make rules the way we do.”

Together, the technician, other lab staff and Roche Canada have devised a system that optimizes the flow of tests through BC Bio. And that involved a particular approach to programming intelligence into the middleware system, so that technologists can focus on higher value activities.

“We have a really high volume,” commented Jackson. “We are an outpatient lab so we have a lot of normal results for our population. What PSM does is lets the normals go – with high confidence because we have written the rules – so my staff can spend their time on the abnormal results. That is where I want my staff to be focused, on abnormal results.” Barring any quality control issues, lab technicians never see normal test results, which are released automatically.

When an abnormal result does crop up, the PSM triggers a sequence of events. “So if a triglyceride is, say, greater than 13, we block other tests, which means that we don’t let other tests go to auto validation,” commented Jackson. “Then we tell the technologist, ‘this sample needs clearing and to repeat it.’ The technologist gets the cue right from the PSM,” and the problematic test is checked. It can then go on to the next step in the testing process.

For Jackson, a major benefit of the PSM system has been able to support her facility’s already stretched resources. “We are all dealing with less staff because there are so few technologists,” commented Jackson. “We have less staff and less funding because we are a private lab, but in hospital labs, funding has also gone down.”

Jackson’s lab is also facing enormous time pressure from physicians awaiting tests. However, with the PSM application tied into its results delivery system, BC Bio can send a test result to a physician within 20 seconds of the lab accepting the result. “Physicians expect results quickly now,” she observed, noting that the PSM software helps BC Bio satisfy the demands of its customers – the doctors.

The busy Vancouver facility has been so successful at adopting the Roche software, the company sends its sales team on visits there to learn how they do it, and to keep abreast of their latest applications.

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