Inside the May 2001 print edition of
Canadian Healthcare Technology:
Feature Report: Internet trends and healthcare
The Internet enables quick establishment of e-commerce networks for
healthcare. Meanwhile, healthcare providers debate how to best use Web to convey clinical
information to the public.
hospitals test new health-record software
Dr. Sami Aita, president of MedcomSoft Inc. announced in April that
Torontos Sunnybrook & Womens College Health Sciences Centre, and Johns
Hopkins Hospital in Baltimore, are set to test the companys MedWorks electronic
READ THE STORY ONLINE
Ottawa announces CHIPP awards for telehealth, EMRs
Ottawa has started to announce the winners of its CHIPP awards, the
telehealth and electronic medical-record program that has been eagerly anticipated by
hospitals, health regions and vendors alike.
READ THE STORY ONLINE
e-Health 2001 this month
COACH and CIHI have experienced overflow requests from speakers and
exhibitors, all seeking a place in the spotlight at Canadas largest healthcare I.T.
conference of the year. Theyre also expecting record attendance.
Prairies start MDS project
Work has begun on a trial of MDS 2.0 software in Manitoba, Saskatchewan
and Alberta. The test of the new assessment software involves 3,600 beds, making it the
largest pilot of its kind in Canada.
Bluetooth needs brushing up
Technology columnist Issie Rabinovitch reports that wireless Ethernet
networks have made rapid gains in the marketplace. On the other hand, Bluetooth
hasnt lived up to expectations, and new products arent expected in the near
READ THE STORY ONLINE
Home telehealth systems
Telehealth networks that connect medical professionals to patients in
their homes have many advantages including convenience and cost. We examine some of
Canadas groundbreaking pilot projects.
PLUS news stories, analysis, and features and more.
The Internet enables quick establishment of e-commerce networks for healthcare
By Andy Shaw
The eHealth Solutions Group at BCE Emergis now processes health
insurance claims for a lions share of the North American market including the
claim transactions of 20,000 hospitals, clinics, and other care-provider groups, as well
as 150,000 physicians in the United States. But the roots of this Ma Bell spin-off,
headquartered in Mississauga, Ontario, are all-Canadian. Its work continues here at a
billion-dollars-a-year clip. The eHealth Group grew from Assure Health, founded by Ron
Loucks in 1989, and taken over by BCE just two years ago. Loucks now runs the Group.
At Assure, we basically took paper-based insurance claims, be
they drug or dental, and turned them into electronically adjudicated, real-time
claims, says Loucks. So now (at the eHealth Group) we have all the pharmacists
in Canada and about 9,000 dentists hooked up. Last year, we processed about $750 million
worth of drug claims and about $250 million of dental claims on behalf of nine Canadian
insurance companies. And that makes us bigger than all of our competitors combined.
An 800-pound gorilla though it might be in its field, the eHealth
Group, since Assure Health was taken over, has been nimbly entering nearby territory.
We now have a suite of what you might call horizontal products
for the whole healthcare market place, says Loucks. Were offering
electronic procurement, invoicing, and CRM, that is, customer relationship management
services. And for all those new services we bring to market, the Internet is now the
Of course, the old services werent based that way, and still
arent. In pre-Internet days, Assure spent nearly a decade laboriously hardwiring
their nation-wide strings of pharmacies and dentists via third-party data transmission
services into its shop.
It took us about seven years to get all our pharmacists on
line, says Loucks. But one of the first Internet-based applications we devised
at Emergis was for optometrists. To get all 6000 of their offices on line, took us only a
Loucks says this ease of establishing lines of communication has placed
the Internet squarely at the centre of BCE Emergis technical and marketing
B2B New Web-based claims system: Were
currently developing the first Web-based claims exchange marketplace in Canada
and we will have it launched by the third quarter of this year, says Loucks.
Unlike the EDI (electronic data interchange) set-up we use to have where you had to
have the pharmacist or other provider hooked up to the adjudicator in order to pay a drug
claim, insurance companies have now outsourced that to us and claims can be processed
entirely electronically at a fraction of the cost.
Loucks says about 50 percent of such claims are already being processed
electronically, but the new Web exchange will also be able to handle the payment end of
traditional paper based claims where an employee might save up a batch of
prescriptions in a shoe box before submitting a claim to his or her organizations
health plan office.
Insurance companies are still maintaining their expensive
mainframe set-ups for processing paper claims, but the volume they handle is down by 50
percent so they are now doubly expensive, says Loucks. When the Web-exchange is up
and running, however, you can go the local pharmacy, pay cash for, and get their
prescription. The pharmacist will then ask: Do you want to submit this electronically? If
so, the pharmacist will give you a code number on the drug receipt. You then go home,
visit the company Web site, pull down an electronic claims form, and enter the particulars
of the prescription, the code number, and the co-ordinates for your bank account. Soon,
back will come an e-mail confirming your claim, the deductible you pay, and the final
amount that has just been placed in your account.
And Loucks says, for those that are not that computer literate, the
pharmacist will be able to make it all happen for you too.
This BCE Emergis example alone suggests just how healthy the
business-to-business, or B2B, side of electronic healthcare is these days. Theres
more uncertainty, however, on the human side of the equation at the B2C, or
B2C Not the mainstream: Even though a Harris
Poll has found that a whopping 70 million people have used the Internet to seek healthcare
information, theres no convincing evidence in yet that the Internet has become a
vital medical or wellness tool. As Dr. Gerald Brock, a urologist at the St. Josephs
Health Centre in London, Ontario, and one of Mediconsult.coms on-line,
fee-for-service MediXperts told Family Practice magazine, Maybe 30 years
from now this (seeking professional medical advice over the Internet) will be a mainstream
of medical care. I dont see it that way. I dont think this will ever replace
to any great extent the patient-physician relationship. This is just another part of the
Establishing more of those profitable physician-patient relationships
via the Internet was also the hope of Torontos Mount Sinai Hospital. Using a
U.S.-based medical chat service, Mount Sinai offered up its top people to the
world as hosts for on-line discussions with consumers interested in their various
specialties. Mount Sinai has since quietly ended its participation in the service.
It did not lead to the kind of out-of-country demand for the
services of our experts that we had hoped for, says Lynn Nagle, Mount Sinais
If that Internet strategy failed for Mount Sinai, they are not alone.
Though its attempt to reach out to the public was perhaps more imaginative, others have
been less so. Writing in the COR Healthcare Market Strategist (www.corhealth.com), Dr. Jeff C. Goldbloom, PhD,
concludes: The Internet and hospitals appear to be creatures of two different
geological eras. Like automobile factories, hospitals are very much creatures of the
industrial-era old economy.
Goldbloom goes on to say that an Internet strategy for most hospitals
has amounted to not much more than creating a Web page and re-packaging content from
rather shallow commercial databases. Too many hospital Web sites, he says, are full of
re-formatted hospital brochures. And comments Goldbloom: There doesnt appear
to be a large, unslaked thirst for reformatted hospital PR messages.
On a more upbeat note, Goldbloom observes: However, progressive
hospitals realize that what the Internet represents is a fundamental shift in power toward
patients/families, and away from institutions and professionals.
A Canadian expert heartily agrees. Dr Alejandro Jadad, not yet out of
his 30s, has already had a distinguished career in health informatics. The Colombian-born
physician, has a Ph.D. from Oxford University. He was one of the first physicians in the
world to hold a doctorate in knowledge synthesis. First landing at McMaster University in
Hamilton, Ont., Dr. Jadad, or Alex as he prefers to be called, is now at the University of
Toronto. There he is a senior scientist in healthcare research, a professor of health
administration, and head of the Program in eHealth Innovation.
Our health system is very conservative because its built on that
industrial age model. So it needs to be re-created to match the needs of the information
age, says Dr. Jadad. And theres no choice about it. We will have to change the
system because people want it to change. They know what is possible. So, we need to
re-create our relationship with the public because it is expecting more and demanding
The challenge then becomes, adds Dr. Jadad, not whether hospitals and
other healthcare providers will get on the B2C Internet bandwagon, but how.
The change needs to be made efficiently, equitably, and
responsibly. But right now we have different projects going all over the world in
different directions. Theres lots of duplication, lots of wasted effort, and plenty
of missed opportunities for collaboration, says Dr. Jadad.
As a result, Dr. Jadad is striving to bring order to this global chaos.
At the U of T, hes building up a network of like-minded innovators. We want to
develop a mini-model of the world in Canada. Well be working with communities from
over 150 countries. Well find out whats working where in a very rigorous and
research based way, says Jadad.
Dr. Jadads Centre for Global eHealth Innovation, for which he is
now seeking financial and academic partners, will feature labs to conduct experiments in
simulated conditions as well as provide support to real-world hospitals, physicians, and
community care providers faced with making decision about IT. Generally, the Centre will
strive to accelerate the study of the role of technology in the health system and
society, in Canada and worldwide.
Still nothing like a story well told.
Despite those lofty aspirations, Dr. Jadad has his feet still planted
firmly in the reality of how humans actually communicate. He believes the Internet, with
its multi-media capabilities, maybe our modern times best way to revive an ancient
yet still effective way of conveying knowledge story telling.
Stories can convey a message, a truth beyond factual truth. Vivid
stories and anecdotes are among the most powerful tools that humans use to make
decisions, writes Jadad. Although there has been some recognition of their
importance in healthcare ... they tend to be misused, undervalued and relegated to the
bottom of the evidence hierarchy.
In the end, however much of a effective story teller the Internet turns
out to be for either B2C or B2B communications, Dr. Jadad reminds us of what messages such
stories should convey and what facts about human nature they must heed in an
article (The new alchemy: transmuting information into knowledge in an electronic age (see
he co-wrote while at McMasters Health Research Information Centre with Dr. Murray.
Phenomena we witness with our own eyes make a greater impression
than second-hand data. Face-to-face recommendations are more influential than hard data
presented impersonally. Recommendations by a respected colleague are a more powerful force
for change in clinical practice than evidence-based guidelines published nationally.
Clearly, anecdotal and research evidence should play complementary rather than competitive
roles in healthcare decision-making.
Major hospitals ready to test MedcomSofts electronic patient software
By Jerry Zeidenberg
TORONTO MedcomSoft Inc. announced that two major medical centres
Torontos Sunnybrook & Womens College Health Sciences Centre and
Johns Hopkins Hospital in Baltimore will soon test its electronic patient-record
Moreover, Jim Gordon, the mayor of Sudbury declared at a meeting held
here that his city intends to test the software on a community-wide basis, using its new
high-speed, fibre-optic system for data communications.
MedcomSoft president and CEO Dr. Sami Aita said the tests are a method
of introducing the software to key users and of raising its credibility. He predicted that
10 to 20 hospitals across North America will experiment with the software this year.
Medcomsofts software called MedWorks is the first
complete system to make use of the Medcin database, which was developed by Medicomp
Systems Inc. of Chantilly, Va. Medcin contains 200,000 data elements, including symptoms,
tests, diagnoses and therapies that are logically linked.
For its part, Medcomsoft used the Medcin software as the core of its
own medical record system, and created a user-friendly application and platform around it.
Overall, the software is said to be much faster and easier for doctors
to use than other systems on the market. Dr. Aita claims a patient encounter can be
documented in 1.5 minutes instead of the 15 minutes typically needed when using
traditional patient record software.
Thats because the software will automatically display a series of
pop-up choices for the physician to drill through and create a record of the encounter.
These pop-up choices can be quickly checked with a stylus or on a keyboard.
The result is an extensive, computerized, text record for the
physician. Whats more, the Medcin database is updated every six months, thereby
presenting the physician with the latest diagnoses and therapies.
If a doctor is unfamiliar with any of the new information, web links
can connect him or her to appropriate sites on the Internet or on a hospital-based
The system can also be used for hospital or region-wide outcomes
analysis. Information from multiple encounters could be loaded into a data warehouse,
showing healthcare managers the best medical treatments, and their costs.
We can verify the outcome of various therapies, so we understand
whether were doing the right thing, said Dr. Aita. We can then adjust
He said this will reduce the cost of delivering medical care more than
de-listing services, one of the current strategies used by healthcare systems.
Dr. Aita also announced that MedcomSoft has struck an agreement with
Mytec of Toronto, to build biometric security into the system. Medcomsoft will make use of
Mytecs fingerprint authorization software and readers to safeguard access to the
medical record system.
MedWorks also makes use of other security procedures, such as digital
certificates and encryption for the transfer of information. It will log the users,
as well, to determine who accessed a record, and who looked for longer than 15
seconds, said Dr. Aita. It can also lock the data after a certain number of
days, whatever the local laws are, so that data can only be added and the original data
cannot be changed.
One of the features about MedWorks that doctors appear to like is the
ability to customize it. Instead of searching through all 200,000 data elements in the
system, templates or protocols can be made for various specialties, such as
Indeed, Johns Hopkins will be testing the advanced electronic medical
system in connection with the centres orthopedic clinic.
Weve found the software to be open, malleable,
expandable, said Dr. Peter Evans, director of orthopedic research at the Johns
Hopkins Bayview Medical Center. He said the goal is to use MedcomSofts system to
create a total orthopedic electronic medical record.
Dr. Evans, originally from Canada, is now moving to the Cleveland
Clinic. He plans to implement the MedcomSoft software there, as well.
Meanwhile, Torontos Sunnybrook hospital this year launched the
Centre for Applied Health Informatics with start-up funding of nearly $1 million. It will
test electronic medical records, and the intention is to examine MedWorks to see if it is
effective across the various specialties of the hospital. That will include departments
such as surgery, orthopedics, critical care, long-term care, and the various medical
clinics run by the hospital.
We want to see the results from a broad perspective, said
Dr. Glen Geiger, director of the new center, from many departments, and from people
who have various levels of commitment [to using electronic patient records].
Sunnybrook will look at the effect of the electronic patient record on
information flow and patient care. A neo-natal ICU might have just two hours to
prepare all the documentation to discharge a baby. We want to see, for example, if
theyre better off using electronic systems, and what the difference actually turns
out to be.
Ottawa announces CHIPP awards for telehealth, EMRs
By Jerry Zeidenberg
Ottawa has started to announce the winners of its CHIPP awards, the
telehealth and electronic medical-record program that has been eagerly anticipated by
hospitals, health regions and vendors alike. The government-run program will pump $80
million of federal money into the development of distance-medicine and EMR projects across
As a shared-cost program, the winners are required to provide matching
funds. Overall, the infusion of cash and government expertise is expected to re-energize
the telemedicine sector, which has been in a lull for the last year as project organizers
waited to see if they would qualify for CHIPP funding.
Its going to have quite an impact, predicted Sandra
Chatterton, a senior policy advisor with the Canada Health Infostructure Partnerships
Program (CHIPP) in Ottawa. She stressed that Ottawa will not only contribute cash to the
projects, but will also lend management consulting expertise.
Over 180 projects applied for financing through CHIPP, requesting more
than $500 million worth of financial support. Under the terms of the program, the
applicants must be not-for-profit or government organizations engaged in healthcare
The government selected about 30 winners, and by early April, had
publicized five of them. There has been no official launch event in Ottawa or elsewhere in
the country. Instead, local members of parliament and senators have been holding smaller
meetings in their ridings.
There are a few reasons for the low-key approach. First, the exact
number of winning projects has not yet been determined, as some of the consortiums given
the go-ahead did not receive as much funding as they expected. These groups are still
deciding whether to proceed with their plans.
Second, Health Minister Allan Rock has been recovering from prostate
cancer surgery, and during his recovery has been unable to make major announcements,
Details about five projects given the green light can be found by
searching the Health Canada web site.
In brief, they are:
Ottawa will invest $8.5 million in the Northern Ontario Remote
Telecommunications Health (NORTH) Network, allowing it to move into its second phase of
implementation. NORTH plans to expand the number of sites that are linked by
videoconferencing and remote medical instruments. The project will connect rural and
remote communities in northern Ontario, and referral centres such as Thunder Bay and
Sudbury, to academic health science facilities in southern Ontario and Winnipeg. The NORTH
network will provide residents in rural and remote communities with access to over 30
medical specialty services, including cardiology and dermatology.
The federal government will contribute over $3.86 million to
Manitoba community health and research initiatives. (In this case, CHIPP is one of several
organizations providing funding.)
Up to $3 million for development of the British Columbia
Telehealth Program in partnership with the Health Association of B.C. The expansion of the
B.C. Telehealth Program is designed help deliver more accessible healthcare to communities
across the province. In particular, the goal is to provide care closer to home. Partners
include the Childrens and Womens Health Centre of B.C., Canuck Place, the
Vancouver Hospital and Health Science Centre, and the University of British
Columbias Faculty of Medicine.
Participating communities include the Okanagan-Similkameen Health
Region, the East Kootenay Community Health Councils, the Capital Health Region, Northern
Interior Health Region, Northwest Area Community Health Councils, and child development
Provincial and national supporters include the B.C. Childrens
Commission, B.C. Research Institute for Childrens and Womens Health, the B.C.
Medical Association, and Dieticians of Canada.
CHIPP is also providing up to $410,000 to develop the
Okanagan-Similkameen Health Regions HealthLink initiative. This integrated
information system is designed to assist seniors and their care providers in accessing
community services from home, and allow nursing staff to coordinate health services for
$3.7 million to develop an information technology network in
partnership with the Nunavut Department of Health and Social Services. The investment in
the Ikajuruti Inungnik Ungasiktumi (IIU) Network, which in Inuktituk means a tool to help
people who are far away, will enable Nunavut to expand telehealth services to all
communities. The program will establish links with the Northwest Territories, Alberta,
Manitoba and Ontario to provide improved access to services for Nunavut residents. The
primary roles of the IIU Network are to establish a comprehensive telehealth program and
support the delivery of health care and related social services to Nunavut residents, such
as diagnosis/care, telepsychiatry, teleradiology, dermatology, mental health counseling
and education, and prenatal and family visits.
Chatterton noted that the projects were assessed strictly on
merit and that no attempt was made to spread the winners evenly across Canada.
The review process was not about regional development, she said.
She added the government plans to assess the impact of the projects as
they proceed, to determine whether they result in healthcare improvement and technological
innovation. We want to see if the public uses the technologies, if they adapt them
to their lifestyles or see them as intrusive, said Chatterton. Well
measure whether the systems have improved healthcare delivery, and by how much.
She added that a successful outcome could result in further rounds of
CHIPP funding for telehealth and development of electronic medical records.
Wed like to see it go beyond its two-year lifespan, said Chatterton.
It could become a ten-year-long program.
Wireless Ethernet soars, but vendors are late with Bluetooth
By Issie Rabinovitch, PhD
Several months into 2001, it has become clear that the focus of
attention in IT is shifting. Many formerly interesting topics have receded into the
background. For example, a major U. S. networking publication has decided that the annual
review of 10/100 Mbps Ethernet cards in the current issue will be its last.
Its not that this category of equipment is unimportant. Far from
it. The reason is simply that it has become a commodity. The differences between the
dozens of brands on the market have disappeared, to the point where a comparative review
Whats hot? In 2001, anything thats small, portable, and
wireless qualifies. In fact, just being wireless is enough. Case in point? Wireless
Until the IEEE ratified the 802.11b protocol for Wireless Ethernet in
2000, wireless networks were risky and expensive.
With Wireless Ethernet, all that has changed, although prices are still
on the high side. Compatible products supporting 802.11b are available from 3Com, LinkSys,
DLink, SMC, and IBM, to list a few. Ive installed a 3Com Wireless Gateway in my
house. It can accommodate up to 35 wireless clients, so it is a solution for small
networks wherever they may be.
Since I already had a 100 Mbps Ethernet network, I connected the 3Com
unit to my existing hub. Now I still have one network, and all of the computers that
connect to it have access to the same resources. Some connect via an Ethernet cable at 100
Mbps, while others (with a wireless Ethernet card) connect from wherever they are in the
house or backyard without the need of a cable.
Wireless Ethernet is rated at 11 Mbps at a range of up to 100 metres
indoors and 300 metres outdoors. Whereas I can confirm the bandwidth, the range
specifications seem a bit optimistic. I took my notebook with me for a brief walk. The
strength of the signal dropped once I was about 40 metres from the house. On the other
hand, I have an 11 Mbps connection to my network wherever I wander in the house and in the
There is no widespread deployment of wireless Ethernet in Canadian
healthcare. I have spoken to consultants who specialize in healthcare technology. They are
aware of a sprinkling of small pilot projects, but nothing more for now. In business, the
acceptance of wireless Ethernet has been dramatic in the short time it has been available.
There is no reason to expect that the situation will be any different in healthcare.
It is well known that cell phones cannot be used in hospitals. Are
there any prohibitions against wireless networks? It turns out that there is no problem
with wireless Ethernet, since the energy put out by an entire network of 802.11b devices
is much less than that of a single cell phone. Even though wireless Ethernet uses the 2.4
GHz frequency, which is used by other equipment in many hospitals, I have been assured by
several experts that there is no conflict. I have not been able to confirm this from a
sufficient number of independent sources to feel totally confident.
Theres another wireless protocol on the way, called Bluetooth.
Ive written about it in this column. It is supported by every company of any
significance in computers and communications, from IBM, HP, Compaq, Microsoft, Nokia,
Motorola, and Ericsson all the way down to companies no one has heard of. Bluetooth is
very much like a low-cost wireless Ethernet. It is much cheaper, with about 1/11 the
bandwidth and 1/10 the range. It is designed to allow devices like phones, headphones,
PDAs, printers, MP3players, and networks to communicate when they are in close proximity.
After several years of basically upbeat news from the Bluetooth
consortium, the message has recently turned negative. It turns out now that the original
specification was inadequate. Version 1.1 was ratified in February 2001,pushing back the
launch of usable products into 2002. The first Bluetooth devices to appear will be
headphones, which dont solve really important problems, in my opinion. They may
reach the market later this year.
Of greater concern than this delay is the possibility that Bluetooth,
which also uses the 2.4 GHz frequency, may interfere with wireless Ethernet. I have yet to
get my hands on a Bluetooth device (outside of a trade show, and then only for a few
minutes), so I have no direct experience in this matter. Ive heard opinions on both
sides of this issue, but I expect to be able to offer more information in a future column.
A few days ago I received a new IBM ThinkPad notebook computer to test.
It came with integrated wireless Ethernet. I unpacked it, did two minutes of
configuration, and immediately I was able to connect to my network, open files, and browse
the Internet through my broadband Internet connection. Thats the beauty of 802.11b
and similar communications standards. They work.
Issie Rabinovitch, PhD, is a Toronto-based computer consultant and