Inside the May 2000 print edition of
Canadian Healthcare Technology:
Feature Report: Wireless technology and healthcare
Tele-homecare project launched in Toronto
The Hospital for Sick Children has established a pilot project
thats using telehealth technology to monitor 60 discharged patients with heart or
lung-related diseases in their own homes.
Consultants recommend SmartHealth be disbanded
A review of information technology projects in Manitoba has concluded
that SmartHealth a plan to electronically connect all care-givers in the province
has been a poorly managed effort that delivered a low return on investment.
The Nuclear Magnetic Resonance research centre, in Edmonton, will
install a 4.7 Tesla MRI system one of the most powerful machines of its kind in
Canada. It will be particularly helpful for brain imaging.
Newfoundland has launched the Integrated Emergency Medicine Network
(IEMN), which uses satellite technology to connect emergency-rooms in nine far-flung
hospitals and nursing clinics. It will also connect air and land ambulances en route to
Sogique on the move
Sogique Inc., a not-for-profit company based in Quebec City, has
developed medical call-centre systems that are well used across Quebec. Its now
marketing the technology to other provinces and locations outside Canada.
Image-based sinus surgery
St. Josephs Health Centre, in Toronto, is pioneering a technique
for sinus surgery that makes use of CT imaging. The minimally invasive procedure helps the
surgeon avoid brain tissue and the optic nerve during operations.
PLUS news stories, analysis, and features and more.
Hospital for Sick Children develops telehealth system for home care
TORONTO Theres been much theoretical discussion of late
about using videoconferencing and other telehealth technologies to monitor chronic-care
patients and those recovering from acute illnesses right in their own homes.
The technology would, so the argument goes, reduce the financial strain
on hospitals by sending some patients home earlier while still allowing doctors and nurses
to keep close tabs on them. It would also lower the pressure on home-care agencies, since
nurses would need to make fewer visits to home-bound patients.
Whats more, many patients would rather recover in the comfort of
their own homes, rather than in a hospital environment.
Now, the Hospital for Sick Children is showing how it can be done with
a six-month pilot project thats using telehealth technology to monitor 60 discharged
patients with heart or lung-related diseases. The test will determine whether the
technology is effective, and if patients actually like it.
The organizers of the project appear to be betting that their efforts
will receive thumbs up on both counts.
Its not only world-class, but a first in the world,
said Dr. Robert Filler at a news conference. There is no home care program as
extensive or as thought-out.
The TeleHomeCare Project links audio-visual and medical monitoring
equipment from the patients home to a nurse at a 24-hour monitoring centre in the
hospital, using an ordinary telephone line. A video camera lets the patient and his or her
parent see, hear and talk with specially trained nurses at the HSC Bell Home
A special device lets physicians and nurses periodically check the
patients vital signs, such as heart rate, blood pressure and breathing rate, and
record these in an electronic patient record.
Parents are taught how to set up the equipment and operate it while
their children are still at the hospital. Once their kids are back home, the parents work
with nurses at the HSC Bell Home Tele-Monitoring Centre to conduct the remote telehealth
Children who may be candidates for the pilot program are being
identified by clinical teams from the following departments: cardiology and cardiovascular
surgery, respiratory medicine, general pediatrics, otolaryngology (ears, nose and throat)
and the critical care unit.
If the family and physician agree, and the child meets the criteria for
the program, he or she is then able to participate.
Dr. Filler noted that initially the project will monitor patients who
have heart or lung-related diseases of a semi-acute nature. Children who need to be
monitored more than once every four hours wont be candidates.
The Tele-HomeCare Project has been funded by a research grant from the
federal Health InfoStructure Support Program. The HSC Bell Home Tele-Monitoring Centre was
established through a substantial donation from Bell Canada.
Other partners who have participated and made donations in kind to the
Toronto Community Care Access Centre, which assisted in the
service development and will provide the community health and personal support services.
Tecknowledge Healthcare Systems Inc., of Dartmouth, N.S., which
provided technical and development expertise in designing the service.
Home Care Evaluation and Research Centre at the University of
Toronto, which is assisting in the evaluation of the project.
Consultants recommend SmartHealth be disbanded
By Jerry Zeidenberg
WINNIPEG A review of information technology projects in Manitoba
has concluded that SmartHealth a plan to electronically connect all care-givers in
the province has been a poorly managed effort that delivered a low return on
investment. The report also contends that SmartHealth didnt keep up with new
technologies such as the Internet.
Whats more, according to the Deloitte & Touche study,
SmartHealth delivered $15 million worth of approved work under an agreement with the
government, but conducted another $14 million to $18 million of work without government
Contending that little of the project will be of lasting value, the
Deloitte & Touche consultants recommended the government pull the plug on SmartHealth
and write-off the roughly $30 million to $35 million that was invested.
Based on our evaluation, it appears that little of the work
delivered to date on this initiative will be useful for a contemporary health information
network, the report concluded. (The study, Information Technology, Major
Initiatives Review, can be found at www.gov.mb.ca/finance/dtfeb3rp.pdf)
SmartHealth was launched in 1995 as a five-year project to
electronically link hospitals, pharmacies, doctors and other caregivers across the
province. Innovative and ambitious for the time, the project had a five-year budget of up
to $100 million.
The organizers claimed they could save the province $200 million per
year in health costs by providing physicians with quicker access to patient information,
pharmaceutical data and diagnostic tests. By wiring up doctors to labs and clinics, the
SmartHealth managers argued that doctors would reduce the number of new tests they
ordered, since they could quickly obtain a patients latest results on-line.
Theyd also be able to call up longitudinal patient records to
obtain detailed information that the patient might have forgotten, or couldnt
provide if unconscious in an emergency room. Evidence-based outcomes would point doctors
and nurses across the province toward the most effective treatments.
Moreover, the SmartHealth team believed they could cut down on double
and triple doctoring, the habit of some patients to visit several doctors to collect
multiple prescriptions. Doctors and pharmacists would be able to call up the
patients electronic patient record and quickly see a history of prescriptions
obtained by the patient.
SmartHealth was created as a unit of the Royal Bank of Canada. A
majority of the company was later sold to EDS Canada, a subsidiary of the giant U.S.
systems integrator that was originally started by entrepreneur and political figure Ross
Perot. The company was to work closely with the Ministry of Health to build the
province-wide health information network.
But Deloitte & Touche say that SmartHealth ran into problems.
On the government side, the Executive Director position had been
unfilled for three years, resulting in a lack of direction and focus within the project.
And while the project began with a clear vision, changes in health
information technology and the emergence of Regional Health Authorities in Manitoba
required constant revision of the network. This did not occur on a regular basis.
According to the report, The health sector is dynamic and ever
changing. In order to meet its objectives, any health information network needs to adjust
and adapt to changing needs. It appears that the initiative did not have this approach.
For this reason, the HIN needed a risk management process, with
periodic reviews and a flexible adjustment process.
Deloitte & Touche criticized SmartHealth for creating network
components without a strategy for how they would be connected and fit into the health
system on the whole.
For example, the DPIN pharmaceutical network was given kudos as a
working system that offers information about prescriptions filled in retail pharmacies.
However, it was criticized for being a custom software project that would have to be
modified to work with the commercial software for electronic patient records used in other
parts of the health system.
Similarly, the consultants questioned whether the partially completed
Diagnostic Services Information Network (DSIN) will easily connect with other systems.
At the time of writing, no decisions had been made about the future of
the project or the SmartHealth company in Manitoba. A phone call from Canadian Healthcare
Technology to SmartHealth, asking for comment, was left unreturned.
In the review, Deloitte & Touche did recommend that the government
redefine its health information needs and re-start an initiative. Manitoba is one of the
few Canadian provinces that have updated privacy laws to address the issues that concern
usage of computer records in healthcare. As a result, the province is poised to continue
development of the HIN if and when the government chooses to do so.
Newfoundland pioneers satellite-based telehealth for hospitals, ambulances
By Jerry Zeidenberg
ST. JOHNS Newfoundland has created yet another innovative
project that involves the use of wireless technologies in healthcare.
This month, the province will power-up the Integrated Emergency
Medicine Network (IEMN), a pilot program that uses satellite technology to connect
emergency-rooms in nine far-flung hospitals and nursing clinics. The system provides
doctors and nurses with videoconferencing, enabling them to engage in real-time
consultations about patients in remote locations.
It gives hospitals access to specialists located in other
centres, and could mean that patients wont have to be transferred as often,
said Keith Sheppard, project manager of the Integrated Emergency Medicine Network, and
president of Collaborative Network Technologies Inc. (On the web at www.colabnet.nf.ca)
Furthermore, in what might be a first of its kind test in Canada, the network is tying in
four traditional ambulances and one air ambulance. By outfitting the ambulances with MSAT
satellite technology, paramedics can send and receive voice and data, including ECG, blood
pressure, and other information.
In Newfoundland, theres often a tremendous number of
kilometres travelled by ambulances before they get to hospitals, said Sheppard. He
explained that the new system enables paramedics to prepare emergency-room doctors and
nurses about the condition of patients before reaching the medical centre.
The project involves hospitals and nursing clinics in the following
locations: St. Johns; Goose Bay; Nain; Forteau; Twillingate; Port Aux Basques;
Gander; Cornerbrook; St. Anthony.
The test system is a joint effort between several organizations,
including: Collaborative Network Technologies Inc. of Newfoundland, Futureworks Inc. of
Newfoundland, Memorial University of Newfoundland TETRA, Telesat Canada, Industry
Canada (Communications Research Centre) and QTECH Hybrid Systems of Ottawa.
Funding is being provided by Operation Online Inc., CANARIE Inc., the
European Space Agency, the Canadian Space Agency and Health Canada.
An earth station is in operation at each of the nine hospitals and
nursing centres. Signals are beamed up to a Telesat Anik satellite and back down again.
On the mobile side, the ambulances make use of MSAT technology, and
wont use videoconferencing at the moment because of bandwidth considerations.
The IEMN is an expansion of an earlier project, the Remote Community
Services Telecentres (RCST). The RCST involved the same partners, who established
satellite-based videoconferencing systems at six different centres.
The purpose was to develop telecentres in rural communities that could
be used for telehealth, telelearning, business communications and high-speed Internet
Not only has the system been used for telemedicine, its also been
used by doctors for education and training.
On another front, Newfoundland is forging ahead with its Wireless
Homecare Project, which will use cellular-based technologies to connect visiting nurses
with their offices, and with hospitals, while they are checking on patients in their
The pilot project will test devices such as smart phones, palm
computers and wireless notebook systems. It will also implement a variety of leading-edge
software tools such as Java and Jini from Sun Microsystems, and the EPOC operating system
Sheppard is also manager for the Wireless Homecare Project. Another
Newfoundland firm called Computers and Communications Ltd. is taking part, along with
Siemens Business Services. Siemens will provide expertise in the development and
deployment of healthcare applications, and play the lead role in the commercialization of
the completed product.
Who ya gonna call? SOGIQUE are Canadas call centre experts
By Andy Shaw
You know youre gonna call Ghostbusters if your house has just
been haunted. And you also know that 911 is the number to call in an outright emergency.
But if youve just come home from work and your child has developed a mild fever and
youre not quite sure what to do about it Who are you going to call for a
quick yet informed answer?
Or youve just been told by your doctor that you have a serious
illness but not much else Where are you going to turn for more enlightenment? Or
if, in the middle of the night, you think you might be having an adverse reaction to a new
drug youve just started taking What are you going to do?
Well, in Quebec the answer is easy. You call your local community
health information and social services centre (CLSC). Within a few minutes, at any time of
day or night, youll be connected to a nurse specially trained and equipped to handle
medical and especially health queries from the public.
At his or her fingertips are about 4,000 computerized pages of reliable
health information organized into 400 different protocols, which the nurse can call up on
a simple 486-powered workstation from a Microsoft Access 8 database. Operational for the
past five years, this health information service is available in 147 CLSC centres
throughout Quebecs 18 health regions.
And something like it could be coming to a call centre near you.
Its something weve developed expertise in, so our
commercial arm is marketing our Health-Info product around the world, says Daniel
Jacques, project director for Société de gestion informatique SOGIQUE inc., a
not-for-profit company based at the Jeffrey Hale Hospital in Quebec City.
The bilingual Health-Info software and the training and annual
upgrading that SOGIQUE provides with it are now part of call centres in Matheson,
Cornwall, London, and the Ottawa-Carleton region in Ontario. Negotiations are under way
for its use in Toronto and Vancouver. Elsewhere, modified versions of Health-Info are
handling calls in Belgium, Brazil, France, Switzerland, and the United States.
But it is the rest of Canada that we are really focusing on now.
We can see a need for it in every province, adds Jacques.
Asked about its origins, Jacques explains that the Quebec ministry of
health set SOGIQUE up in 1986 to handle a specific problem. At that time, there were
private companies going around selling systems that were not quite working together the
way they should. So we were set up to act as a kind of ombudsman and to integrate those
Since its inception, SOGIQUE has developed 27 software applications
that integrate information and systems in primary healthcare, public health, mental
health, and hospital services. Over 100 Quebec hospitals, for example, use a
SOGIQUE-designed application that tracks their blood supplies from donor to patient.
A lot of our products are very customized, so we are only taking
a few of them to a broader market ones like Health-Info that can be used elsewhere
without much modification. In Brazil, for example, they are using Health-Info for a
centralized health information call centre service for the entire country. says
Our own labour board here in Quebec is also using Health-Info as
the knowledge base for its intervention plan with injured workers, says Jacques.
When people call in they can get advice and be referred, for example, to a good
physiotherapist or a good psychologist. As a result, people are getting back to work more
quickly and the board estimates thats resulting in savings of about $15,000 to
$20,000 per injured worker.
Also among its more impressive accomplishments, SOGIQUE has also built
a province-wide health information intranet. Currently, over 30,000 health care
professionals are communicating on the intranet using Lotus Notes and soon, says Jacques,
that count will rise to 60,000.
Were one of the worlds biggest users of the Lotus
Notes application. The province picked it because we felt it was the most secure
information sharing system, says Jacques.
This extensive network helps keep Quebecs medical and health
information services decentralized. It is usually less expensive to take a
centralized approach when it comes to call centres (as Brazil has done), but when they are
decentralized, people at the call centres have a better knowledge of the local resources,
so it is easier to maintain good information, says Jacques.
Taking the decentralized approach also keeps per unit costs down. The
Info-Health package, including three-days of training, and annual updates can be had from
SOGIQUE for about $5,000.
Depending on the size of the surrounding population, there may be as
few as five Health-Info workstations and nurses operating them in a CLSC the size of
Abitibis. Or as many as 25 in Montreals.
For all CLSCs, Jacques says incoming calls peak just after 5:00 p.m.
when people get home from work. And they continue to be heavy until about 10:00 p.m.
Overnight, when local CLSCs are closed, calls to it are automatically re-routed to
regional call centres, which are kept up and running around-the-clock and ready for just
Health-Info first of all works as a telephone triage
system, explains Jacques. The system helps the nurse determine whether the
call is an emergency. If it is, the nurse can immediately pass it on for a 911 response.
Or the caller can be referred to a local walk-in clinic or to a physician.
But over the five years we have compiled a lot of statistics with
the system, and weve found that 70 percent of the calls we get do not require
medical attention. Most people are simply looking for information, quite often out of
We have found that a lot of our calls are about children, so we
are constantly expanding health information about kids in our database says Jacques.
The information we put in is all scientifically reviewed by our council of experts
in various fields. So that has helped doctors accept the system.
Future developments include changing the Health-Info interface to a Web
browser to increase its ease of use. A drug interaction protocol is also being added. And
a revised marketing plan is aimed low, not high.
Weve tried to go in at the high levels of health
ministries, but that ends up often with more studies being done. Weve found
were better off going in and seeing real people at the operational level who simply
want better tools to do their job, says Jacques.
To see how SOGIQUEs Health-Info software works, visit the SOGIQUE
Web site at www.SOGIQUE.gouv.qc.ca