Inside the March 2009 print
edition of Canadian Healthcare Technology:
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.
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.
READ THE STORY
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.
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.
READ THE STORY ONLINE
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
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
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
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
“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
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
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
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
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
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
So Procura and Medshare are now racing to the marketing and sales front
“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
“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
“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
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
Sick Kids’ radiologists opt for voice-recognition
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
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.
Intelligent software in medical lab supports staff,
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,
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
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
“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.