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Inside the  March 2010 print edition of Canadian Healthcare Technology:


Feature report: Wireless and mobile solutions


Patients test shareable records using smartphones
Dr. Wendy Graham, lead physician with North Bay’s Blue Sky Family Health Team, is directing a three-month pilot project to test MiHealth, a mobile personal health record that runs on popular smartphones.

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Treating strokes effectively
New X-ray equipment with ultra-high resolution is giving interventional radiologists a better view of blood vessels in the brain as they deploy tiny instruments. It’s all leading to much improved outcomes for patients.

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Safeguarding privacy
Frank Work, privacy commissioner for Alberta, asserts that the best way of ensuring the privacy of personal health records is to open up those records to the individuals who own them. They’ll holler if they discover a breach.

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RFID is making waves
Canadian healthcare centres are deploying radio-frequency ID systems that allow them to better locate equipment and people. A new generation of ‘active’ systems is attracting interest; but innovations are also occurring using the cheaper, passive tags, too.

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PACS for nuclear medicine
Nuclear medicine is especially useful for diagnosing heart, bone and cancer-related illnesses. This unique form of imaging also requires a special type of PACS. Find out why in our report.


PLUS news stories, analysis, and features and more.

 

Patients test shareable records using smartphones

By Rosie Lombardi

NORTH BAY, ONT. – Dr. Wendy Graham, lead physician with North Bay’s Blue Sky Family Health Team, is directing a three-month pilot project to test MiHealth, a mobile personal health record that runs on popular smartphones.

The ultra-secure records can be quickly updated and shared with multiple healthcare providers, giving patients and the care-givers they visit instant access to key health information. Because it’s constantly updated, the patient’s consolidated health record is kept current and relevant.

MiHealth addresses a major disadvantage in the applications of most Personal Health Record companies, such as Microsoft HealthVault and Google Health, which is that patients must enter their data themselves. “When you look at your medical data, you want it endorsed by your healthcare provider,” said Dr. Graham. “When a patient and I enter the data together on MiHealth, we can both look, agree, share and lock it down with secure messaging.”

The impetus for MiHealth’s start-up began at a Washington conference last year, when Dr. Graham attended the “Wounded Warrior” presentation by Diversinet Corp., a Toronto-based security provider, about a recent project.

In 2009, the U.S. army ran a pilot with 100 participants to determine if soldiers who require constant medical care after suffering traumatic brain injuries have improved outcomes if they’re in frequent contact with their case managers. The patients were supplied with cell phones secured with Diversinet’s AllOne Mobile technology to ensure their communications were private.

Results were promising, and the army announced plans to expand the project to accommodate 10,000 returning soldiers in 2010. Diversinet approached Dr. Graham to run its first Canadian pilot, redesigning the application for bi-lateral communications in a general family practice setting. She worked with the company to develop the MiHealth product, Canadianizing the look-and-feel of personal health records for our healthcare system.

How it works: For the three-month pilot, Dr. Graham told her North Bay patients at the Blue Sky Family Health Team about the opportunity to access and update their health records using cell phones. She planned to accept the first 150 who enrolled. As it turned out, patients were eager to test it: “In the first three days it was offered, 72 people signed up,” she said.

MiHealth’s software will run on over 200 different `mobile devices, and patients can securely store their healthcare data on a USB key or home PC. A record has several components.

One is a summary of the person’s healthcare information – what would look like a cumulative patient profile (CPP) in most electronic medical records (EMR) or paper records showing the family history, main diagnoses, allergies, medications and therapies.

Another component records upcoming and past appointments, and tracks the current physicians the person is seeing for various conditions. There’s also space for radiology and other lab reports that could be downloaded to devices in the future.

Finally, there are fields to capture extra information that’s often overlooked. “There can actually be more details than in a typical CPP, as there’s space for the patient’s demographic information, third-party insurance providers and even their passport number,” said Dr. Graham.

The information can be shared with any healthcare provider the patient chooses.

People with chronic-care conditions aren’t necessarily the primary category of patient interested in MiHealth. “We did a pre-survey of our participants, and were surprised to learn that 57 percent had been to an emergency room in the past year, and 33 percent had been twice,” said Dr. Graham. “People instantly see MiHealth as insurance for crisis medical situations when they may not be conscious or coherent enough to provide accurate information.”

In addition, 69 percent said they wanted to be referred to Web sites for self-care information by their providers, 95 percent said they wanted to share medical information with other healthcare providers of their choice – and a universal 100 percent said they didn’t want to go back to the doctor’s office for test results. “That’s a significant finding that needs to be addressed.”

Security: MiHealth is secured with Diversinet’s military-grade security, which was a major reassuring factor for participants, said Dr. Graham. In addition, the team has gone to extreme lengths to implement “privacy by design” concepts that were developed by Ontario’s Privacy Commissioner, said Jon Benjamin, an independent healthcare IT consultant involved in the project.. “Every aspect of design has been cleared by every regulatory authority available, and Mihealth has gone through an exhaustive privacy impact assessment led by a former provincial privacy officer.”

Practice management improvements: The coming wave of personal health records needs to be acknowledged and incorporated into the healthcare system, said Dr. Graham. “Whether we like it or not, people are joining different health groups of doctors. Although we’re striving to have patients on the same EMR, the reality is that patient information is often in two or three different EMRs.”

A shareable central record such as MiHealth would not only allow patients to shift to the provider of their choice, but it would also help patients push consistent information into different EMRs.

Streamlining practice management for physicians is another plus. Appointment scheduling and call-backs about test results, for example, are now laborious manual processes, requiring much back-and-forth with patients, frequent calls and reminders. Mondays are typically the heaviest day for this, said Graham. “I’m an average doctor, and I get 188 calls on Mondays.”

This workload could be smoothed over the week using MiHealth to push information about scheduling options and test results to patients, “Physicians could focus on the patients with the greatest need, instead of spending time on scheduling or visits just to relay test results. And it’s quicker and less expensive to organize appointments for hundreds of patients than manual methods.”

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System provides radiologists with brain images of startling clarity

By Paul Brent

TORONTO – As one of the top neuroradiologists in the world, Dr. Karel Terbrugge speaks bluntly about the risks involved in interventional radiology for the brain. “We cannot make a mistake because if we do, the patient is basically dead. That is the negative thing about what we are doing – if we have a complication, it is usually pretty bad.”

As such, top-notch imaging tools for interventional neuroradiologists are of the utmost importance. Thanks to progress on the technological front, and the growing expertise of interventional neuroradiologists, great medical strides have been taken in the last two decades.

The hardware (catheter, wires and “little plastic tubes” in Dr. Terbrugge’s words) have gotten finer and more easy to manipulate, while imaging technology has allowed radiologists to see what they are doing more precisely – a crucial requirement given the delicate and tiny pathways of the brain.

Using these devices, neuroradiologists are able to close off aneurysms and bleeding vessels which produce debilitating strokes in patients. They’re also able to remove clots within the brain – which can also cause strokes.

“We used to do one stroke every month or two – now we’re doing one stroke every day or two,” said Dr. Terbrugge, who is a professor of radiology and surgery and head of the Division of Neuroradiology, University of Toronto and Toronto Western Hospital.

Ontario’s stroke strategy, which has established stroke centres across the province to which patients are shuttled to in the first crucial hours, has also greatly increased the demands on neuroradiologists.

Because neuroradiologists are completely reliant on remote images to carry out procedures, they are quick to adopt the latest generation of technology. In Dr. Terbrugge’s case, the next step in imaging technology at Toronto Western Hospital is Toshiba’s Infinix VF-i/BP interventional angiography biplane system, which utilizes a new flat-panel detector to present high-quality fluoroscopic and fluorographic images.

The flat-panel images produced by Toshiba’s biplane system “are much superior to anything that we have ever had in the past, so this allows us to do things more safely and treat patients more safely,” said Dr. Terbrugge. Instead of the “fuzzy” images of older generation systems, with the flat-panel images “everything is sharp and the pictures are just unbelievably beautiful. The blood vessels are just like anatomical textbooks.”

Toronto Western was the first facility in the world to use Toshiba’s next-generation biplane system, said Behram Engineer, general manager of Toshiba Canada’s Medical Systems Group. The stepped-up resolution and magnification have been a boon to the interventional radiologists.

“They are using wires that are smaller than your hair, so to see these things [with the naked eye] is almost impossible,” he said. Besides better imaging and a lower radiation dose, Toshiba’s continuous imaging Infinix system is smaller and easier for medical professionals to work around, compared with older analog systems. “Angio units near the head used to be the size of a bucket. Ours is now the size of a picture frame and you can get much closer to the patient’s head,” said Mr. Engineer.

In a one-to-two hour procedure, neuroradiologists like Dr. Terbrugge have a long route to take to the brain. A frontal projection helps guide a catheter and specialized tools through the abdomen and chest up to the neck, where a side-view image proves crucial in navigating the delicate and narrow vessels of the brain. “We can simultaneously see the catheter, the plastic tube and the wire moving through the vessel,” he said. “We create a roadmap and we inject the vessel, we superimpose the movement of the device, go to the target and do whatever we need to do, take our pictures and hopefully fix the problem.”

Neuroradiological treatment of stroke is “probably the most sexy” procedure his team is doing, Dr. Terbrugge says, because of the headlines it has generated in recent years. But it also provides the most bang for the medical buck. Quick treatment of strokes (along with positive long-term lifestyle changes) can get patients back as functioning members of society. Rather than lengthy hospital stays, rehab and lingering symptoms, patients are today going back to work within days of suffering a stroke. “This is a major difference,” said Dr. Terbrugge.

Some of the credit for the revolution in stroke treatment can go to the so-called ‘clot busting’ wonder drug tissue plasminogen activator (tPA), although it can’t be used on all patients and it doesn’t guarantee all effects of a stroke will be minimized. Intravenous injection of tPA reopens vessels about one-third of the time, said Dr. Terbrugge. “If you do what we do with the catheters and imaging equipment…we can now open up the vessels in as many as 80 percent of patients.”

Dr. Terbrugge’s hospital and other facilities are now doing what he terms “bridging” therapy. Stroke patients are given a one-half dose of the anti-stroke drug through an IV with the remainder injected directly into the vessel-blocking clot. “The only negative thing is that not everybody has a Toshiba biplane unit which means that people have to go to regional stroke centers like ours,” he said.

“But if it you do it that way, the number of patients doing well nearly triples,” concluded Dr. Terbrugge.

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Personal access to healthcare records helps guard to information

Franklin J. Work, a Calgary lawyer with a degree in Environmental Design, began his work with Alberta’s Office of the Information and Privacy Commissioner in 1996 and in 2002 was made Commissioner. In that role, he oversees compliance with the province’s umbrella privacy legislation as well as with the Alberta Health Information Act. In his long tenure in privacy, Commissioner Work has had a front row seat at the dramatic developments and changes Alberta has brought to its healthcare system, including the Netcare portal for clinicians, a provincial EHR for all residents, and the scrapping of its health regions.

Contributing editor Andy Shaw caught up with the Commissioner in December following his presentation at Insight Information’s eHealth Forum in Toronto.


CHT: Commissioner Work, Alberta was the “first-out-of-the-gate”, as you put it in your presentation, with a province-wide, interoperable health record. What’s been the advantage of that so far?

Work: Well, it enabled us to make all the mistakes first. And I mean that seriously – because the money spent on those mistakes will not be wasted if all the other health jurisdictions in the country pay attention to what we did or didn’t do.

I do not know but I have the impression that the various jurisdictions in Canada do not share this kind of information enough. They should, it’s not like it’s personal information. I don’t know if there is a way to institutionalize this information transfer. I hate to see the experience lost.

CHT: So among the things you did do right, what basically did you rely on to support your privacy efforts for Alberta’s healthcare?

Work: When I was preparing my presentation for this conference, I was going to say we had four pillars of privacy supporting us. But when I looked at them later, I thought that was wishful thinking and maybe they were really more like tent-poles of privacy. Or really more like toothpicks of privacy – so much has happened to undermine them.

For instance, way back when I started out in this field, the big pillar was “Consent”. Meaning, in an ideal world, that you would have people’s consent to collect, to use, or to disclose their personal information. But that notion of consent over time has been abrogated.

With the Alberta Health Information Act, for instance, what they simply said in effect was that there will be no consent. But they said there will be rules; there will be principles; and there will be a Commissioner. In Ontario, they were a bit kinder with their legislation, where it talks about “deemed consent”. But it still basically works out to no consent being needed to collect your health information.

CHT: What’s bad about that?

Work: You lose a big privacy control feature. When you ask people for their consent – you know, as in: Can we have this information about you? or Can we do this with it? – then people tend to police how their information is used.

I believe that we are past the point where, in a fully functioning electronic record environment, we can realistically seek patient consent for every information transaction. There would be millions a day and this would overwhelm the system and the users. Therefore, we have gone along with the notion that, within the “arena” or the “circle of care,” consent is either presumed or not needed. This does mean you have to really monitor the perimeter of the arena and deal with misuse immediately. People have to be able to trust that the information they gave up is being taken care of. In Alberta, the users of health info are called “custodians”. In other places, trustees, but it’s the same concept.

I think the technological development which will really help in this regard will be the “patient portal.”

I am not a “technology has all the answers” kind of person, but a patient portal could allow people not only to see their own information and therefore be more involved in their own wellness, as well as allowing them to see if their information is correct and what uses are being made of it. People will monitor these things and let the monitors – i.e. regulators – know if something is amiss.

CHT: And what would that individual policing do for you and your office as Privacy Commissioner.

Work: It supports a second pillar of privacy – access. If people can see their records, they often know if something wrong was done with them.

For instance, most of the investigations we’ve launched into wrong doings with Alberta Netcare have been initiated by patients who said, after looking at their healthcare log: Why is this person looking at my records? I don’t think they are involved with my treatment. And if they don’t get a satisfactory answer they come to us.

CHT: And what has happened then?

Work: In the one case we’ve prosecuted so far, a healthcare worker was looking frequently at the health record of her boyfriend’s ex-wife, who was going through cancer treatments. The healthcare worker was tracking the ex-wife’s progress. And we wouldn’t likely have found that if the ex-wife hadn’t asked us what was going on.

As a result, we had charges laid against the healthcare worker. She entered a guilty plea and was given a $10,000 fine.

And though it isn’t my favourite way of ensuring privacy, the conviction was very significant for the electronic health record. First of all, it showed that the Attorney General’s department could successfully prosecute a case based on our evidence. Also, the high level of the fine showed that the court system considered the infraction serious. You need both a stick like that and a carrot to ensure privacy.

CHT: So what carrots does your Office offer hold out to encourage people not to snoop?

Work: The carrot is training, sense of ethics, professional responsibility. You do the right thing because it is the right thing to do.

CHT: What about your other pillars of privacy? Seems obvious you would need some sort of audit process – if you are going to successfully track who is looking at what and why.

Work: You know I hope we’re not having the debate any more about whether an audit process is needed for the electronic health record. I do remember back in the late 1990s, when Netcare was just getting going, we had a lot of meetings with people who argued an audit process wasn’t really needed and we’d be better off putting the money saved into more clinical systems.

But the audit is fundamental because it records the three important events that change health records. And those events are: the collection of the information, the use of the information, and the disclosure of the information to other people.

There is no doubt that the audits are expensive. I am not sure they are practical on an annual basis. But, if you have the audit logs, there are ways of sampling them or random audits which can identify misuses.

CHT: Has the consolidation of Alberta’s healthcare regions weakened that audit pillar at all?

Work: In the past, as my health record information, say, got passed from Edmonton to Calgary it crossed regions and so it was deemed a disclosure and was logged. But now that we are down to no regions and just one healthcare entity for the whole province, there are people that say we don’t need a log of disclosure anymore. We’re just one big happy family and we’re all just Alberta Health Services users. But without disclosures you lose a very important element of privacy and security. So you have to watch out for that, particularly as regions amalgamate.

So we need to be able to monitor disclosure generally, even if the disclosures are within an organization. This can be done. There are some advantages to centralization: possibly better training, consistent standards, development of privacy expertise that a small organization might not be able to afford, more sophisticated technology like firewalls, intrusion detection and prevention and so on.

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RFID systems lower costs and speed patient throughput

By Andy Shaw

RFID in healthcare is going into ‘active’ mode. The passive radio frequency identification (RFID) of the past is still with us. Indeed, the cheap, passive RFID tags carrying radio-wave sensitive microchips require no battery. And whether they’re stuck on wheelchairs or hospital staff, they will continue to do 80 percent of the RFID work – telling us what is where. But the technologies of RFID, like most others, have evolved.

Now, hospitals in the United States, Europe, and beginning here in Canada, are demonstrating that investments in so-called ‘active’ RFID tags – which work without asking – are paying huge dividends. These new, albeit much more expensive, battery-driven RFID tags and their behind-the-scenes software can tell you where things and people are with far greater accuracy – and they do it in real time.

This has taken RFID out of the stock room and into mission-critical operations like a hospital’s Emergency Department or Operating Room, or an entire nursing home. This, among other significant benefits, tends to greatly streamline an institution’s workflow, improve patient care, and results in reduced inventory.

Indeed, in this new active mode, RFID has morphed into what’s dubbed “real time locating systems” or RTLS for short. It’s an acronym and concept you’re going to be hearing a lot more about if major proponents and providers like Cisco Systems have their way.

“In healthcare, low-cost passive RFID tags have not gone away. They will become pervasive in things like drug distribution,” says Brantz Myers, the director of healthcare development for Cisco Systems Canada. “But for us now, the thing is the active RFID tag based on wi-fi technology. It’s only about the size of a package of matches. And it has a long-life lithium battery in it that will run for at least a couple of years.”

Myers says the active tags can be modified to suit the workflow they’re placed in and can be tracked by the network. He cites a personal example.

“A few years ago I was in for some day surgery but I had anesthetic, so the hospital rules said I could only be discharged if I went out in a wheelchair. It took 20 minutes to find me a wheelchair,” recalls Myers. “But now that hospital could put a small tag under the seat of every wheelchair. A search for it will bring up a map on the computer screen showing not only where it is but where the nearest porter is who can fetch it.”

Such a RTLS not only aids the discharge workflow, but can also save costs.

“When you know where all your wheelchairs are, you need fewer of them,” says Myers. “Infusion pumps are another classic example. There are all sorts of them in a hospital for different kinds of patients. You can add a tag, and the new pumps are coming with an RFID tag built in, so you can find the right pump for the right patient, right away, no matter where it is.”

To make that work reliably, however, requires a secure, medical grade wireless network as infrastructure, the kind Cisco supplies. Something not all Canadian hospitals thought worth the investment, until now that is.

“We’ve seen a posture change in the Canadian market just in the last year,” says Myers. “A few years back, we were hearing acute-care hospitals in particular tell us about their concerns over privacy and security that a wireless network raises. But now we’re hearing that their number one desire is to have a wireless network. It’s moved from a not sure, or nice to have – to let’s make wireless our primary network.”

First extensive evidence of such networks benefits have come in first from the United States and Europe.

AeroScout, based in Redwood City, California has over 300 installations on both continents and is one of the market leaders in Wi-Fi “asset visibility” solutions.

AeroScout studies cite two measurable results on both sides of the ledger. In one instance, on the expense side, reduced “equipment search” labour costs before and after surgeries in five ORs resulted in over $608,000 savings annually.

A Pennsylvania company, CenTrak, has taken such wireless pinpointing of hospital assets to a new level of accuracy and productivity with its InTouchCare tags and other RTLS products.

“In the past, RTLS systems have only given an estimation of the location of a tagged object. They rely, like sea-going navigation, on triangulation that gets you within a couple of feet of where it actually is,” explains CenTrak’s CEO, Ari Naim. “So when we entered the healthcare market, we went to hospitals and asked them: What kind of accuracy do you really need? We were stunned by their answer when they said: We need four-inch accuracy!”

At that point, Naim and his development team thought of forsaking healthcare in favour of less demanding verticals who might only need to know where all their golf carts are roughly.

“But we went back to the hospital and asked why do you need such accuracy. Does being four inches out really make that much of a difference?”

Naim said the question was answered indelibly in his mind when a hospital executive first placed one of CenTrak’s tags on one side of a wall – then led Naim out the door to the hallway and put the tag on the other side of – the four-inch wall.

“That’s when the light bulb went on,” says Naim with a laugh. “What they really want to know is: Is that wheelchair or is that patient in the room or in the hallway? So in that instance, four inches can account for a lot of wasted time.”

Naim points out that traditional RTLS give locations of tagged objects as map co-ordinates.

“If you stop a nurse and give her map co-ordinates as the location for something you want, she’ll look at you like you’re from Mars,” says Naim. “But if you talk to her about rooms, and closets, and hallways, and nursing stations as locations, she and everyone else will understand the language.”

As a result, Naim and CenTrak eschewed standard radio frequency technology, considered ultrasound, but settled on infrared light, which sits on the light spectrum between the end of visible light and the beginning of microwaves.

“Actually, we even dismissed infrared at first, remembering what can happen, or doesn’t happen, when you block the direct line of site from your channel changer to your TV, for instance. But we found that if you turn things around and put the infrared emitter on the ceiling and have it fill the room with infrared light. So you can take our tags and stick them under 10 blankets and they’ll still catch the infrared light.”

The benefits of the ceiling emitter are two-fold, Naim, explains further. The location of anything in the room can be shown with 100 percent accuracy, because the infrared light like visible light illuminates everything when turned on. But the infrared won’t pass through the four-inch wall into the hallway. Only the emitter in the hallway will see what’s on its side of the wall. Hence, the “four-inch accuracy” CenTrak can claim for its products.

But today’s RTLS sophistication doesn’t end there. “These infrared emitters, or monitors, as we now call them each have a unique ID, which they also communicate to the tag on any piece of equipment or person in the room, which also have unique IDs. “And all that information gets communicated back to the network,” explains Naim. “That communication with the network is happening every three seconds, all the time. So you’ll know within moments whenever a patient or a physician or anyone else walks into a room anywhere in your network coverage. And you’ll also know who it is.”

The other good news, adds Naim, is that old asset-locating software you might have already shelved could be born again.

“A lot of such software was developed over the last decade, but none of it worked very well because it was all made on the assumption that you could get accurate locations of tagged objects. But you couldn’t, so it didn’t.”

Naim says a leading applier of such RTLS innovation is Momentum Healthcare Inc., based in Winnipeg. Momentum is now targeting acute care users, as well, but it honed its expertise in long-term care.

“We’re working with CenTrak and offering to Canadian long-term care and nursing homes a number of their applications that use our software. But our primary focus right at the moment is replacement of dated nurse-call systems,” says Momentum’s sales manager Chris Olson. “With CenTrak, we are offering a wireless nurse-call to replace a lot of the 20-year-old systems that are out there. It has all the stations, the pull-cords, and the dome lights you would expect to see, but we also layer in the software apps for tracking and location of all the residents. So it is not just nurse-call but really a complete solution.”

Complete in the sense that the new CenTrak-Momentum RTLS can even control light levels as well as door and cupboard locks.

The first benefit of all this is that the general environment becomes quieter.

“There are no alarms or buzzers or paging to be heard anymore. Our alerts go right to staff’s cell or mobile communication device. So it really feels more like a home for the residents,” says Olson. “Also knowing where all your people and your equipment is saves staff a tremendous amount of time. So instead of searching for a lift, say, our clients tell us their staff members are spending more time with patients, actually providing care.”

For acute care institutions, Momentum and CenTrak are focusing on the bottlenecks of patient flow – where finding what you need fast in the Emergency Department, for example, reduces wait times.

Bottlenecks also stall patient and work flow significantly in ORs – where both people and equipment come at a high value.

Passive radio frequency identification (RFID) solutions are also evolving, and some of the most ingenious innovations in this area have been made by Logi-D, a Canadian company. “Like other companies, we have been interested in tracking high-value medical supplies since we started introducing RFID to healthcare in 2006,” says Richard Philippe, the president of the pioneering Logi-D, which is headquartered in Laval, Quebec, near Montreal. “But the first application we actually developed was aimed at low-value items. About 80 percent of the items in a hospital’s supply chain are low value. So that makes it a problem for RFID. For it to work in the traditional way, every item has to be tagged.”

Consequently, as much as RFID might be desirable for managing the great volumes of stuff a hospital handles, it is often not affordable. “So what we did was to develop a unique patent-pending RFID system based on the Toyota KanBan approach. It does not require that all items be tagged in order to collect data or manage inventory,” says Philippe.

Moreover, in 2007, Philippe and Logi-D engaged the competition and also went after the 20 percent high value market – but again with a unique, patent-pending approach.

“Other companies have taken a ‘smart shell’ approach which involves reading in real-time, individually tagged items requiring sufficient smart shelves or cabinets to store all items to be traced,” says Philippe.

He points to the cath labs where some very expensive, single-use catheters must be replaced regularly.

“In the traditional setting found in most hospitals, the nurses are the ones who drive this by doing the paperwork that notifies the manufacturers that an item needs to be replenished,” says Philippe.

“So we stood back and asked: How can we take clinical people out of this loop in a cost effective way and let them get back to providing care?”

Philippe says he and his staff concluded that the nurses’ administrative responsibilities should end when they throw out the package. “So we developed a smart garbage can – which we refer to properly as an ‘intelligent receptacle’.

“At all our installations in OR and cath lab procedure rooms, there are intelligent receptacles,” explains Philippe.

When a replacement product such as an implant arrives, its package is tagged with a passive RFID transponder by the hospital. When the package is thrown in the receptacle, the ‘smart’ garbage can equipped with RFID reading technology reads the transponder on the package and creates a data record that is pushed through the hospital network (wired or wirelessly) to a materials management application – the system knows that an item has been used and will need to be replenished.

The data on the implant package can also be pushed to clinical records for tracing purposes.

Intelligent receptacles were first installed at the Southlake Regional Health Centre in Newmarket, Ontario, but can now be found scanning junked packaging elsewhere across the country, including the Alberta Mazankowski Heart Institute in Edmonton, the L’Hôpital Laval, institut universitaire de cardiologie et de pneumologie de l’Université Laval in Quebec City and Hopital Sacré Coeur in Montreal.

It’s a clever solution that’s making nurses – and hospitals in general – more efficient. The intelligence of the computerized system, assisted by RFID, takes care of product replenishment. And as a result, nurses are able to spend more time with their patients – something all healthcare organizations hope to accomplish.


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