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Inside the March 2013 print edition of Canadian Healthcare Technology:

UHN opens operating room of the future, today
A giant operating room – four times the size of most ORs and containing a dazzling panoply of imaging hardware and software – is opening this month at Toronto’s University Health Network.


Canadian teams are innovators in development of surgical robots
The frontier of surgical robotics is a busy one in Canada, as several medical research centres are adapting the U.S.-made da Vinci robotic system or building their own surgical robots in collaboration with private sector partners.


High-tech ecosphere
Southlake Regional Health Centre, in Newmarket, Ont., is helping to spur the rise of innovative healthcare technologies by allying with ventureLAB, a regional economic development agency.


Northern Ontario’s approach
Gaston Roy, chief information officer at Health Sciences North, in Sudbury, comments on the shared approach taken by hospitals in the region. It has reduced costs while bringing advanced systems to facilities that normally wouldn’t benefit from expensive solutions.


Laboratory automation
The lab at Saint-Eustache Hospital, in Quebec, has long been a leader in lab automation. It is now taking new steps in the post-analytical phase, and has implemented a paperless solution that makes it easier to locate and manage samples.

Bioabsorbable stents
UHN is the first hospital in Ontario to use bioabsorbable stents in cardiac surgery. The scaffolds, which open and support previously blocked blood vessels, are said to be a better solution than permanent stents.

PLUS news stories, analysis, and features and more.


UHN opens operating room of the future, today

By Jerry Zeidenberg

TORONTO – A giant operating room – four times the size of most ORs and containing a dazzling panoply of imaging hardware and software – is opening this month at the University Health Network. Called the GTx-OR (short for guided therapeutics operating room), the multi-million dollar facility houses a Siemens dual-energy CT Flash scanner and an Artis Zeego robotic fluoroscopy machine – the first site in the world to have them in a single operating room.

The top-of-the-line equipment will enable physicians to quickly and accurately image patients while they’re on the operating table, helping surgeons to provide the best possible outcomes through the use of image-guided procedures.

A team led by Dr. Jonathan Irish, chief of surgical oncology at University Health Network, has been planning the GTx-OR for several years. The project was spawned by the Techna Institute, a research and development centre at UHN that’s designed to produce and refine technologies to improve patient care.

Dr. Irish is also clinical lead for the guided therapeutics core of the Techna Institute. The surgical innovations devised at Techna are to be tested and further developed in the GTx-OR after extensive pre-clinical experimentation.

Dr. Irish and his colleagues are excited to finally start using the R&D operating room – not only have they incorporated new technologies, but they have also pioneered novel ways of working together in teams made up of surgeons, physicists, scientists, engineers, imaging specialists and nurses.

“There are no templates or training centres for an operating room like this,” said Dr. Irish. “We have figured it out as we went along, how people and equipment would all work together, and how the team members should be trained.”

He noted that an operation in the room is a complex affair that will probably involve two surgical teams, with 15 persons in the operating room itself and another three in a glass-walled control room, which also houses the banks of computers powering the hardware and software being used.

The first to be treated are likely to be cancer patients, as the project was led by oncology physicians and cancer funding provided most of the support. But other groups in the hospital are itching to use the facility, including cardiac surgeons, imaging specialists and transplant specialists.

“If people are eager and enthusiastic to join us, that’s a great thing,” said Dr. Irish. “But cancer money has built it, and that will be our main focus. Still, we won’t be excluding others.”

Techna and the GTx-OR are also working with industry partners in the development of new techniques and technologies. In particular, Siemens sees the site as a testing ground for ideas and technologies that can be commercialized and used to benefit patients around the world.

Dr. Irish stresses the GTx-OR is a research and development site, which is refining new ideas that have been developed at the Techna Institute, one of the hospital’s five R&D centres.

Patients in the GTx-OR will be the immediate beneficiaries, but the goal is to move the techniques out into other operating rooms in the hospital and into healthcare systems across Canada and worldwide.

Dr. Irish says that when using image-guided systems in the past, surgeons have been able to produce better margins when operating on cancer patients. They’ve been able to excise more of the tumours they’re targeting while leaving healthy tissue intact.

He’s expecting even better results with patients at the GTx OR, as the high-level imaging hardware and software should give surgeons an even better view of what they’re cutting. The centre will be monitoring outcomes by tracking patients over a long period of time. This will ensure, in a scientific manner, what the best practices are by using hard evidence.

“In cancer patients, we’ll be evaluating survival rates, how the patient functions after surgery, and the quality of reconstructions,” said Dr. Irish.

One of the major areas of usage at the GTx-OR will involve reconstruction surgeries in patients with head and neck cancers. The UHN does the highest number of these surgeries in Canada and is a global centre of expertise in this procedure, which includes replacing the jaw and tongue of patients with bone and tissue taken from other parts of the body. Dr. Irish explained that improved outcomes may be attained using the GTx-OR.

For example, the real-time imaging will allow surgeons to check “how the reattached blood vessels run through the tissue,” said Dr. Irish, explaining the team will be able to ensure that blood is flowing well through veins and arteries before ending the operation.

While “none of the technology replaces a good surgeon, anesthesiologist, and nurse,” says Dr. Irish, the technology does give surgeons enhanced abilities in the operating room. At the centre of the GTx-OR is the innovative pairing of the Siemens Artis Zeego and the company’s high-end Flash CT, which uses a dual-energy technique to produce high-quality, three-dimensional images.

“The dual-energy CT gives you exquisite image definition and incredible resolution,” said Dr. Robert Weersink, a medical physicist at UHN who is also a leader of the GTx-OR project. Dr. Weersink has been heavily involved with testing the new equipment and configuring the operating room, and in the development of new software.

As useful as it is, CT imaging in the operating room still has a downside, explained Dr. Irish. Namely, it’s difficult for a surgical team to work on a patient while he or she is being imaged in the CT scanner as there’s little space to maneuver – the patient is, after all, placed inside the O-ring of the scanner.

That’s where the Zeego comes in. The patient can be moved to the Artis Zeego, which also provides high-quality 3D images – not as fine as the CT, but still extremely useful for helping surgeons as they conduct open and minimally invasive surgeries. The highly robotic Zeego can be moved away from the patient while surgeons work, then back into exactly the same position as before, enabling the doctors to image again and resume their work.

Dr. Irish said a procedure may start by imaging the patient in the CT scanner to obtain highly detailed images; once the team is ready to begin, the patient can then be moved to the Zeego for real-time scanning during the operation.

The Zeego has a large C-arm, tipped with an X-ray generator on one end and a digital collector panel on the other; they spin around the patient to create 3D images that surgeons can use for navigation during an operation.

Afterwards, the patient can be returned to the CT scanner for a final, ultra-high resolution check. That’s where blood perfusion studies can be done, to test the quality of blood vessel reattachments, for example.

To further assist surgeons, the Techna team has produced GPS-like solutions that track the position of instruments inside the body and register them against the real-time fluoroscopic images produced by the Zeego.

Today, surgeons often employ minimally invasive techniques made possible with endoscopes and instruments on the ends of flexible catheters that are inserted into the patient’s body.

The tracking system not only shows the surgeon the location of instruments, it also highlights different structures in the body – showing the tissue that requires excision and that which should be left intact.

In addition to the GPS-like tracking of instruments, scientists at the Techna Institute have created other incredibly useful solutions, such as a system that alerts a surgeon when he or she is cutting too close to tissue that should be avoided, like a carotid artery or major nerve.

Visual images of these structures are mapped out on the large monitor the surgeon is looking at for guidance. But the system also produces visual, auditory and tactile alerts to let the surgeon know that he’s cutting too close to something that should be left alone.

“You can even have a buzzer go off in the instrument, if you wanted,” said Dr. Irish. “It’s a bit like that game of Operation that we played when we were kids,” he quipped.

Dr. Weersink noted this software has been used in operations already at Toronto Western Hospital, which specializes in neurosurgery. “The software creates ‘no-fly zones’ for the surgeons,” he said.

Drs. Irish and Weersink are fond of aviation metaphors, as the aircraft industry has emphasized patient safety and requires extensive testing of new airplanes before they’re allowed to fly. It also constantly monitors flight techniques and incorporates best practices into the everyday operations of airlines, all for the greater protection of passengers.

Techna and GTx, too, are all about extensively testing ideas – in the lab and then on cadavers, animals and humans. And they, too, are aimed at improving safety.

Another example of a superb software solution devised by Techna involves image overlays that advise the surgeon of where to start cutting during an operation. An image of where a cancer patient has previously received the highest dose of radiation therapy can be overlaid on top of a real-time image of the patient’s anatomy. The surgeon can then avoid making an incision in that spot.

“We know that tissue has the most complications, after surgery, in areas that have previously received a high radiation dose,” said Dr. Irish. “This solution shows us which region to avoid, and where to cut.” The radiation treatment overlay software was developed in conjunction with Dr. David Jaffray, a senior scientist with the Ontario Cancer Institute and director of the Techna Institute.

Dr. Irish noted that Techna currently has three people specializing in software solutions, but expects this area to surge in the next few years. “Software is a fundamental part of our platform,” he said.

What’s more, GTx has the space to add and experiment with new hardware. Indeed, that’s why the operating room is so large. “We know that new technologies are going to appear,” said Dr. Irish. We’ve got plenty of room for the next big technologies.”

Of course, it’s all being applied to advancing the art and science of surgery. And that means better outcomes for cancer patients, and likely others including cardiac, vascular and transplant patients.

“Techna is a platform for discovery,” said Dr. Irish. “We’re at the interface of industry and academia, surgery and physics. We can take ideas that start in the lab at MaRS [a research centre that’s located around the corner from UHN], test them and then bring them here, for the benefit of patients.”


Canadian teams are innovators in development of surgical robots

By Sheldon Gordon

The frontier of surgical robotics is a busy one in Canada, as several medical research centres are adapting the U.S.-made da Vinci robotic system or building their own surgical robots in collaboration with private sector partners. The goal is to help surgeons perform minimally invasive procedures with greater accuracy and speed.

The Centre for Surgical Invention and Innovation (CSII) in Hamilton has incubated a surgical robot to do image-guided, minimally invasive breast surgery. The Centre, which is located at McMaster University and St. Joseph’s Healthcare, has been working on the Image Guided Automated Robot (IGAR) project since 2009, in partnership with MacDonald, Dettwiler and Associates Ltd.

The Centre’s researchers have spent close to $10-million on development of the robot, tools and patient support.

“We’re developing the use of robots to do very precise interventions, using imaging to provide eyes for the robot in an automated fashion,” says Dr. Mehran Anvari, scientific director and CEO of CSII and a leading surgeon specializing in minimally invasive procedures. “Basically, we want to remove the surgeon from performing the task but put them at a higher level of supervising, planning, and controlling the [robot’s] movement.

“This allows the robot to perform the specific task with a far greater degree of precision than the surgeon’s hands can, using imaging as a means of seeing what it’s doing and assuring that it’s following the right trajectory and completing the task accurately.”

CSII researchers “looked at where in the field of medicine such a system could pay dividends immediately in patient care,” says Dr. Anvari. “One of the areas we identified was the treatment of breast lumps and breast cancer.”

The robot attaches to a magnetic resonance imaging (MRI) machine. If a lump is discovered in the patient’s breast, the physician gives the co-ordinates to IGAR, which performs a precise biopsy to determine if the lump is benign or malignant. At virtually the same time, the robot does an ablation of the lump.

The main advantage, in addition to the system’s accuracy, is its ability to scan, biopsy and ablate the lump all in one session instead of patients needing a separate appointment for each step.

Without IGAR, mammography can identify lesions which are very small, says Dr. Anvari, “but still the patient needs to undergo a reasonably large biopsy procedure or sometimes even surgery to rule out the possibility of cancer. That is quite worrisome for the patient, it takes time and it leaves an unwanted scar.”

“With ablation, though, we destroy the [lump] and some of the surrounding tissue without causing a scar,” he says. “It’s significantly less invasive than a lumpectomy would be.”

The IGAR robot is to undergo a clinical trial among 120 patients in Quebec, Ontario, and the U.S. First, however, it must complete the regulatory approval phase in both Canada and the U.S.

Dr. Anvari hopes this is only the first of several specialized surgical robots that CSII will develop. He cites back surgery, other forms of cancer surgery and trauma surgery as therapies for which the technology could be adapted. “We are at the early phase of development,” he says. “We’re still going through the regulatory process. We’re not ready to sell the technology. We’re nowhere near commercialization.”

The Centre for Image-Guided Innovation & Therapeutic Intervention (CIGITI), at Toronto’s SickKids Hospital, has been developing the KidsArm, an image-guided robot designed to enable surgeons to safely and efficiently do less invasive surgical procedures on children. One of its goals is to reduce the average time of such surgeries by up to 90 percent.

The project, launched in 2010, has received $12-million in funding from the Canada Foundation for Innovation, the Ontario Research Fund, SickKids Hospital and private sector partners.

KidsArm is part of a larger group of projects that are integrated together and synthesize robotics, simulation and imaging,” says Dr. James Drake, chief of neurosurgery at SickKids and the head of CIGITI. “It grew out of the recognition that there’s no advanced technology suitable for pediatric patients. It’s intended to be more than just a smaller da Vinci robot.”

The robotic part of the project focuses on new “smart tools” that can be used for laparoscopic surgery on infants. The KidsArm device is a roboticized suture tool which can apply stitches in awkward locations. “It’s smart,” says Dr. Drake. “It has the ability to take visual images, identify important features in them and then direct the robot to those locations to do the suturing.” The device was built in tandem with MacDonald, Dettwiler and Associates Ltd.

“It’s been developed to the point where it is able to do the image recognition process,” says Dr. Drake. “At the moment, this is for synthetic suture pads and simulated vessels. We’re just integrating it with other parts of a surgical system which would include automatic knot-tying and other smart tools which we have developed, such as a special pediatric endoscope.”

Not only must the technology be safe, but it must also prove its worth beforehand, says Dr. Drake. “So we have a large simulation platform which has been developed with L3 Communications. They are finalizing a laparoscopic simulator which will be integrated into the KidsArm.

CIGITI has also built physical models of specific pediatric conditions on which the new technology could be used. These include pyeloplasty (where the drainage system off the kidney is blocked), choledochal cyst (where drainage of the bile system is blocked) and tracheo-esophageal fistula (where the esophagus doesn’t form properly in a newborn). All of these conditions are difficult to repair laparoscopically.

The KidsArm will not be just one robot for all applications, says Dr. Drake. “We’re working on an MRI-compatible robot that will work inside the MRI for biopsies and injections. We’re also developing a neurosurgical robot that will help us work in and around the base of the brain.”

Dr. Drake expects that clinical trials for the smart tools will start at SickKids within the next 12 to 18 months. “We’ve embarked on animal testing, and we’re now building the tools to Health Canada standards,” he says. An initial safety study will comprise a group of 10 patients, with follow-up studies on larger groups to prove clinical efficacy.

CIGITI has filed three patents based on the technology, and is in the process of filing four more. Based on its experience with previous inventions, the Centre is likely to license the KidsArm technology to a medical device company, “but we’re available for any kind of corporate model that makes sense,” says Dr. Drake.

Researchers at Vancouver General Hospital (VGH) and the University of British Columbia have been conducting experiments with two da Vinci surgical robots for two years. (The hospital has had another da Vinci for clinical use for five years.)

The research robots are located in the Surgical Technology Experimental Laboratory and Advanced Robotics (STELLAR) lab at Vancouver General Hospital and at the Robotics and Control Laboratory (RCL) in Electrical and Computer Engineering at UBC. Teams of surgeons and engineers at both sites are designing, developing, and integrating leading-edge surgical solutions.

The robots were obtained as part of a Canada Foundation for Innovation/BC Knowledge Development fund award coordinated by the Institute for Computing, Information and Cognitive Systems (ICICS) at the University of British Columbia.

“Our focus is on image-guided surgical therapy, meaning we will fuse pre-operative images, including MRI and ultrasound, with the surgical system to allow for a 3D view both inside and outside organs during surgery,” says Dr. Chris Nguan, a kidney surgeon at VGH and assistant professor, Dept. of Urologic Sciences, UBC Faculty of Medicine.

The Vancouver-based robotics research program is one of only three centres in the world that have a dedicated research da Vinci robot with both a clinical and technical research partnership with Intuitive Surgical Inc, the robot’s maker. The Vancouver researchers are in frequent contact with the Silicon Valley-based technology company, which is looking at ways to commercialize their research.

“Our primary goals in having these research robots here is developing new ways to leverage the robotic platform itself, not necessarily using the robot in a unique or different way,” says Dr. Nguan. “The intent is to add new visualization methods, add in almost GPS-like qualities, the whole idea of multi-modal imaging and whether we can co-register this to the robotic operating environment.”

Two of the main targets at the moment are prostate cancer and kidney cancer operations. “Some of the things we’re developing will help us visualize where the cancer is in the prostate gland and where the critical structures are around the gland, so we can avoid those things while cutting the cancer out,” says Dr. Nguan. “This should improve patient outcomes.

“It’s the same with the kidney. You visualize where the cancer is in the kidney, even if you can’t see it with your eyes,” he explains. “We use ultra-sound or an X-ray technology to show it through the robot console while doing the operation.” That’s unique, says Dr. Nguan, because currently the surgeon operates almost blindly, cutting out the portion of the kidney that they think has the cancer (or the entire prostate) without actually seeing the cancer during the operation.

“Currently, we’re conducting clinical trials with that same technology,” says Dr. Nguan. “We’ve been gathering data from it through the use of ultra-sound or X-ray, but not displaying it to the surgeons in real time, because the company needs to see it and help us integrate it.”

The integration of imaging into real-time operations isn’t new, but Dr. Nguan says that no trials have been run to show that the use of real-time imaging improves clinical outcomes. That’s something Dr. Nguan and his team are now doing, partly to prove the worth of the expensive systems to hospital administrators.



Southlake backs program to foster rise of healthcare IT

By Jerry Zeidenberg

NEWMARKET, ONT. – Southlake Regional Health Centre, a full-service community hospital north of Toronto, has teamed up with a regional innovation centre to boost the development of healthcare technologies. The hospital recently formed an alliance with ventureLAB, a publicly funded facility in Markham, Ont.

ventureLAB is the York Region partner in Ontario’s Network of Excellence (ONE), a network of organizations across Ontario that help entrepreneurs and start-up companies commercialize their ideas.

For its part, the hospital has a double mission; in addition to helping ventureLAB spur the rise of local innovators, the medical centre is seeking new solutions to some of the technological challenges that face all modern hospitals as they deploy information technologies to improve the delivery of care.

In January, Southlake and ventureLAB hosted a session at which 17 regional technology developers gave quick pitches about their innovations. The firms hoped to attract the attention of hospital managers looking for brilliant new solutions to pressing problems.

Also in the audience were a host of funding sources, both government and private, along with companies able to provide various types of coaching and mentoring.

As the project brings together a variety of resources to assist healthcare technology developers, the alliance has been dubbed the Healthcare Ecosphere.

At the January meeting six areas were identified as needing solutions to problems the hospital is trying to solve. The companies are at the right level of development to see if their technologies can be tested and refined at Southlake.

For its part, Southlake had alerted the innovators that it seeks solutions in the following areas:

• Chronic disease management

• In-home remote monitoring devices

• Health informatics and analytics

• Health systems and process re-engineering

• Imaging

• Mobile applications

“The idea is to link small-to-medium sized enterprises with hospitals to accelerate the commercialization of their ideas,” said Dan Wasserman, entrepreneur in residence at ventureLAB. He noted that in the United States, the United Kingdom and Europe, there is mandated spending on products from small business, in order to give them a boost. In Canada, however, there are no such programs.

Wasserman believes the federal and provincial governments should follow the example of other jurisdictions. Meanwhile, the alliance with Southlake is being done in the same spirit – to give small companies with unique technologies the lift they need.

Other hospitals may soon follow suit. “We’ve got three excellent hospitals in York Region,” said Wasserman. “Markham Stouffville and Mackenzie Health (formerly known as York Central) are also interested.”

Wasserman noted that Southlake’s president and CEO, Dr. Dave Williams was instrumental in launching the agreement with ventureLAB and making the Health Ecosphere possible. Dr. Williams is by background an accomplished emergency room physician who became an astronaut and went on two space missions with NASA. More recently, he was the director of the McMaster Centre for Medical Robotics, where he led a team dedicated to developing innovative technologies. As president and CEO of Southlake, Dr. Williams is a firm believer in nurturing the greater Toronto region’s home-grown innovators.

The Toronto area is a hotbed of technological development, but often enough, engineers, inventors and entrepreneurs don’t have the resources to get their businesses off the ground.

The buying power of hospitals, and the references they can offer to other medical institutions, should be of great help.

Not only is the hospital involved, but so are ‘hothouse resources’ such as angel investors, government funders, law firms and consultants. Indeed, as an outcome of the January meeting, the angel investors said they wished to arrange further meetings with four of the companies.

Further sessions are to be held in the future. “Just because a company didn’t make it this time around, they might be accepted the next time,” said Wasserman. As well, companies who see themselves as competitors are being encouraged to cooperate, in some cases. “There’s nothing wrong with competing on one level and cooperating on another,” said Wasserman.”



Sharing systems in Northern Ontario paves the way to better care

Health Sciences North is a 454-bed full-service hospital with 250 physicians. The organization anchors two northern Ontario hospital groupings, where Gaston Roy directs close to a 100-member IT staff with a $11 million annual budget. In this conversation with CHT contributor, Andy Shaw, Roy talks about the exemplary IT work he has led in the north, while still casting an envious eye south of the border.

CHT: Gaston, can you tell us about what major IT projects you have under way right now at Health Sciences North and what your strategy is for implementing them?

Roy: At present, we have two major IT initiatives in place. The first is our North Eastern Ontario Health Services Alliance ( where we share our PACS system. The second initiative is what we are best known for and involves getting the most out of our hospital information system (Meditech) via NEON or North East Ontario Network, linking more than 19 hospital corporations.

What we have been trying to do as a group is to leverage all our procurements and all our licences in order to build our infrastructure up to a critical mass that will sustain a LHIN-wide electronic patient record and increase our EMRAM (electronic medical record adoption model) matrix score.

CHT: So how do you do that collectively?

Roy: There are a number of models that can be used to accomplish this. The “CDR” or Clinical Document Repository approach involves making another copy of the patient record in order to share it. But we are really striving to avoid this model because of several complexities, including questions about the timeliness of the data you get out of CDRs, and the need to manage another patient record, which adds a layer of overhead.
The model we are pursuing is really more about working with data in real time, at the source, as well as sharing and standardizing our practices by leveraging the investments we have already made in the hospital information systems we have at hand.

CHT: And what are the advantages of this approach?

Roy: Several. For example, if our LHIN shared just one voice recognition system, it not only saves the cost of each of us going out and finding a suitable product but it also offers collaborative cost-savings. With just one system to deal with, each corporation can decide whether they want to consolidate their health records, or their transcriptionists, and any other services.

For Health Sciences North, there are advantages to sharing our systems with our partners. We do charge a fee so there is a financial advantage. But more importantly, it allows us to receive the patient records from our partners in real time.

CHT: Is this sharing of systems something you can accomplish swiftly?

Roy: No, this approach takes time. In everything we do, we have been taking an incremental, steady approach to this kind of integration. We avoid the ‘big bang’ in implementing anything new unless it is fully funded, which is rare. Rather we follow slower but steadier paths that are sustainable.

CHT: And what would you say makes for sustainability?

Roy: One big piece of sustainability is standardizing. Possibly aside from one other hospital group in Ottawa, I’m not aware of any others in Ontario that have had the same success in defining standards as we have. We consistently define what data we must collect in our Hospital Information System; we figure out how this data will impact processes; and then we design the screens and the systems to reflect the standards we have all agreed to.

These investments in developing standards are very much worth the effort because any new NEON partner, or even new staff member who joins us, can understand right away how we designed the system and how to make it work. We see a lot of opportunity for growth in the momentum that comes from this common understanding.

CHT: What would you say, then, are the challenges you face that might restrain that momentum?

Roy: One is ensuring we have the right human resources to meet the demand. We’ve doubled our staff in the past five years. I’ve been striving to avoid having a consultant because of the cost and timeliness. At times when we do have consultants, I find that they extract the knowledge of our staff and put this knowledge into a document. So we must find a way to “in-source” that, if you wish, so we can do it ourselves. We need that capacity built-in because we are constantly re-designing our methods and processes.

The other challenge is external in the form of the multi-corporate environment we must deal with. In our LHIN, for instance, we have 26 independent hospital corporations, including my own hospital, and the LHIN organization itself on top of all that. So it is a complex situation.

CHT: Yet you are making progress. What would you say are the major benefits for patient care and hospital productivity you’ve generated so far?

Roy: The major benefit is that most of the systems we offer to our partners operate in real time. We have a real time oncology system shared between two corporations, for example, that involves operating a radiation bunker that is about 320 kilometres (200 miles) away from us. Between these two hospital sites, we offer an integrated patient record for oncology that comes with built-in efficiencies because we have just one software system controlling that bunker. Also we have seen over and over again that as we build these systems and start sharing them, the cost of using them per partner tends to be lower.

As we start building the infrastructure we need, adding new services creates efficiencies for all partners right across the system. It’s to the point now with our NEON group that every time we add a partner we create financial efficiencies. So it is no surprise that my CEO group within NEON are very supportive. We are, after all, a single hospital information system with strong products that not only attract more partners but also more funding. In some instances we can actually say to our partners, “We are going to reduce your partner payment” or “We have funds to add new services at the same price.” So it’s a compelling financial model.

And to the patient it is all the benefits that go with a standardized real-time record. One that blends very well, I might say, with our extensive use of telehealth.

CHT: So then what does the future hold for you and Health Sciences North?

Roy: We’re focusing on segmenting hospital IT services into three different models. One we call “Connectivity” in which you install the infrastructure, keep the lights on, and the emails flowing.

Second is the “Advanced Systems” model for the needs of our financial, HR, and clinical departments. Then there is the model that’s the most exciting called the “Excellence” model. It is really about making gains on the evidence, the measurement, the outcomes, and the clinical decision-support fronts. That is where most of my time is being spent now and in the foreseeable future.

In addition, when you look at the EMRAM matrix adoption, Ontario hospitals continue to be in the middle-bottom of adoption rankings. The provincial average is about 2.6 on a 0-to-7 scale, therefore we have a lot of work ahead of us to move us to a meaningful electronic patient record.

CHT: Are there any new technologies or trends out there – social media, mobile systems, disease registries, for example – that might speed the progress of your three models?

Roy: Not really. But a patient portal so that patients can access their own records and data marts for decision support are initiatives to consider in the future. However, they will take a lot of time and effort at the macro level. It has been my experience that we tend to under-utilize new and existing technologies.

So, also given our funding challenges, our priority is to continue to optimize what we already have in place. However, if Ontario and Canada want to advance our country’s EMRAM score, which in essence accelerates the electronic patient record adoption and patient safety, it’s worth following what’s happening in the United States, where the EMR adoption model is based on “sustainable” funding versus our Canadian one-time funding approach. With the average EMRAM hospital score in the US standing at 4.0 (compared to Ontario’s 2.6), obviously Americans have a more meaningful patient record and their model is definitely worth evaluating.