Inside the May 2004 print edition of Canadian
Feature Report: Developments in Surgical Systems
After running small-scale projects and trials
for the past few years, Ontarios Smart Systems for Health
Agency has now launched the heavy-duty infrastructure designed
for networking all of the provinces healthcare providers.
Centre strives for excellence
British Columbias Centre of Excellence
for Surgical Education and Innovation (CSEI) has set for itself
a lofty goal: nothing less than to unite medical education and
medical education research within B.C., as well as with the rest
of Canada, and then to take on the remainder of the planet.
Raising medical cash on TSX
A group of surgical hospitals based in South
Dakota have raised $221 million on the Toronto Stock Exchange.
They plan to use the money to fund future OR expansion and hospital
Tech for visually impaired
The government of Canada is contributing $4.7
million to a $13.1 million project that will develop new reading
and geographical information systems for the visually impaired.
Quebec-based VisuAide, a specialist in assistive technologies,
is leading the charge.
New ways in prostate surgery
Two Toronto-area hospitals are running tests
of a new, laser-based technology for prostate surgery that offers
dramatically better medical outcomes while reducing overall surgical
costs by 50 percent or more.
READ THE STORY
Advances in perfusion
St. Marys General Hospital has installed
new perfusion technology for heart and lung surgeries. The computerized
system is said to contain a radical new design that results in
far lower incidence of post-operative bleeding.
PLUS news stories, analysis, and features and more.
Ontarios SSHA goes live with major computer systems
By Jerry Zeidenberg
TORONTO After running small-scale projects
and trials for the past few years, Ontarios Smart Systems
for Health Agency has now launched the heavy-duty infrastructure
designed for networking all of the provinces healthcare
Quietly, without much fanfare, the major components went live
last November the testing and launch converged at that
time as the solutions were designed to work in conjunction with
one another. All in all, the design, build, testing and approval
process took about two years.
Weve been steadily buying and building the infrastructure,
said Linda Weaver, chief technology officer for SSHA, who pointed
out that the strategy in Ontario has been to create robust, common
systems for healthcare providers, rather than promoting the growth
of uncoordinated projects.
Weve favoured an organized approach, said Weaver.
Were not just letting a lot of systems spring up
and hoping that they work. Instead, the goal has been to
ensure that everyone is getting the same kind of secure
and reliable service.
Sectoral e-health councils such as the hospital
and physician e-councils will now enlist the systems for
a variety of projects, including secure e-mail and messaging,
gaining remote access to lab and drug information, tapping into
infectious disease tracking systems, and many more.
The Smart Systems for Health program was announced in 2001 and
gained agency status from the provincial government in early
2002. Total spending figures since that time werent available,
but a SSHA spokesperson said the 2003-2004 budget was $78 million.
In November, the agency launched:
Two data centres in the Greater Toronto Area, including
servers and storage systems capable of serving the needs of hospitals,
physicians, labs, pharmacists and other providers. The secure
space has been leased from Hewlett-Packard (Canada) Ltd., at
a cost of $30 million over a 10-year period. It should be noted
that the agreement with HP covers only the space for the data
centre. In addition, the agency has acquired its own data-centre
equipment, at a cost of another $30 million, from a consortium
consisting of EDS Canada, Dell, EMC and others.
A secure e-mail system using Microsoft Exchange technology.
There is currently capacity for 30,000 e-mailboxes enough
for all of the provinces physicians and many of the long-term
care workers. As demand grows, the system can be expanded. We
need to move information around in a secure manner and e-mail
is the most practical solution, said Weaver. But
the core underlying system must ensure that the message comes
from the right person, is sent to the right person, and could
only be picked up by that person. Weve done that.
A Public Key Infrastructure (PKI) security and encryption
system, using Qunara as the core technology. The application
includes a registration system.
A Web portal infrastructure, designed and delivered by
Xwave. The system provides a baseline portal, with reusable modules
that can be incorporated into different projects. The first of
these, a physician portal, was launched in November as a pilot
project with 500 Ontario physician users; its scheduled
to be expanded to thousands more doctors, starting this month.
The portal infrastructure allows all of our clients to
build these types of doors, said Weaver.
Moreover, Smart Systems for Health Agency has been creating the
pipes that link hospitals, doctors and other providers
into a virtual private network. Its main partner in this project
has been EDS Canada, as well as carriers like Allstream, Bell,
and smaller companies such as Greater Sudbury Telephone Co.
About 20 to 25 percent of our budget has been spent on
connectivity, said Weaver. The agency has connected 80
percent of the provinces hospitals, and will soon link
the remaining 20 percent.
This year, it also plans to begin connecting the provinces
26,000 physicians, residents and medical students, along with
up to 5,500 community care workers.
While healthcare providers are free to make use of other networks,
Weaver said that SSHA offers high levels of security and reliability
to all users, whether theyre large hospitals or small clinics
employing three or four physicians.
We monitor the circuits to make sure theyre up,
said Weaver. Were watching on a minute-by-minute
basis, because we know they cant be down. SSHA has
two data centres so that one acts as a backup; the agency has
also developed disaster and business continuity plans for users.
In the past, SSHA built a mini data centre on its
own premises to provide network services to a number of healthcare
organizations, including the NORTH telehealth network, which
links specialists at teaching hospitals in southern Ontario to
community hospitals and clinics in northern and rural Ontario.
It has also provided network and email services for Ontarios
Community Care Access Centres and public health units, along
with hosted services for an e-Physician project in Chatham, Ontario.
These projects and services are all being switched over to the
new data centres. As well, the Web portal and secure email services
for doctors, formerly in the pilot stage with 500 physicians,
will be expanded to thousands of physicians this year, up from
just hundreds. Were expanding our services to physicians
on an order of magnitude, said Sue Wilson, vice president
of client services for the SSHA.
Several hospital groups have also been using SSHA as their network
provider, including the Lakeridge Health Corp. in Oshawa and
the surrounding area, the NEON group that ties into Sudbury,
the NORrad teleradiology group in northern Ontario, the Niagara
Health System, as well as Ontarios CCACs.
Now that the core infrastructure is in place, much of the work
will be application driven. Many of these apps will be proposed
and directed by the various e-health councils.
Some members of the healthcare IT sector have long wondered whether
it might be more effective to allow hospitals and groups of physicians
to establish and grow their own computerized projects
with the best of the lot winning adherents on their own merits.
Asked for comment on whether this small-scale, community-based
approach to growing healthcare IT applications might be more
effective than many of the top-down solutions proposed by governments,
Sue Wilson noted that small-scale projects are important for
generating innovative ideas. But in my experience, the
problem they run into is when they try to connect to other projects,
because there are no common standards, she said. Were
providing a common network that they can all use.
Wilson added that on the issue of electronic health records,
SSHA has been working with the Canada Health Infoway to define
the components of a common record that can be shared by healthcare
This project, formerly called the Emergency Health Record by
SSHA, has been recast as the Electronic Health Record and is
aimed at more than ER usage. According to Wilson, a great deal
of work has been put into the project in recent months.
In June, SSHA will roll out an Integrated Public Health Information
System to most of Ontarios 37 public health units, giving
them a secure way of receiving and sending information, and accessing
databases. One important application will consist of tracking
infectious diseases a solution that would be of great
use in the event of another SARS outbreak, or in the case of
another epidemic. Health officials would more easily be able
to track diseases and the condition of patients avoiding
the paper and telephone methods that proved so unwieldy in the
SARS crisis that hammered the Toronto region in the spring and
summer of 2003.
Vancouvers surgery education centre strives for world
By Andy Shaw
Reasoning, perhaps, that unless you set the
bar up high, youll never achieve greatness, British Columbias
Centre of Excellence for Surgical Education and Innovation (CSEI)
has set for itself a lofty goal: nothing less than to unite medical
education and medical education research within B.C., as well
as with the rest of Canada, and then to take on the remainder
of the planet.
The CSEI opened last year and now occupies 3,000 square feet
of the Jim Pattison North Pavilion at VGH. It is supported by
a partnership between the University of British Columbia (UBC),
Vancouver General Hospital (VGH) and Vancouver Hospital &
Health Sciences Centre, as well as industry representatives and
Notable among its information technology boosters is Apple Canada,
supplier of 22 iMac flat-panel computer systems, a network server,
a dedicated video-editing station, as well as some PowerBook
G4s and Airport wireless hubs. Clinical staff at the Canadian
Forces Trauma and Training already based at VGH will train themselves
at the CSEI and help operate its centrepiece of equipment.
The Human Patient Simulator (HPS) is a mannequin that can simulate
many disease and emergency conditions and unlike the real
patient theres no charge to the provincial health insurance
scheme to treat it. It is roughly the same size as a human and
reacts to drugs and medical gases. The HPS lies in surgical splendour
in its own operating room complete with surgical lights and table.
The main purpose of our technology is to bring more benefits
to our students, says Dr. Karim Qayumi, the Centres
Afghanistan-born director. We are trying to shorten their
learning curve first of all. We are giving them as much practice
time as they want, virtually any time the want it, and in an
environment where they can make mistakes without any repercussions.
The CSEI is meant to also address a number of other practical
and even ethical issues when it comes to the teaching of surgery.
We know now that it is impossible to teach the way we did
before, says Dr. Qayumi. With the greater emphasis
on ambulatory and home care, fewer patients are presenting themselves
as potential teachings subjects these days. There are now more
legal restrictions on what we can and cannot do with live patients.
And we really shouldnt be using animals for teaching purposes
So the CSEI is already demonstrating that the education of future
surgeons and upgrading of current ones need not occur by happenstance.
Their instruction does not have to be scheduled around a particular
condition walking in or rolling through the hospital doors.
Even when the real thing does show up, CSEI educators can extend
the reach of their surgical pedagogy.
The Centre has a 40-seat lecture theatre at its centre that is
equipped with visual and aural fibre-optic links with the VGHs
operating rooms. That enables students in the theatre to not
only witness a procedure but also have two-way conversations
with the surgeon. Whats more, the Centre has extended those
links to other university health centres in Victoria and Prince
George. Indeed, its infrastructure allows the CSEI to be connected
electronically with any acute or primary care unit in the province.
Back at the CSEI, medical students or physicians upgrading their
skills can also learn bloodlessly basic surgical
techniques such as inserting laparoscopic instruments and tying
sutures using computer-simulated models of patients in the CSEIs
laparoscopic training room. (Apples graphics capability
brings up a highly-detailed model of the human body using streaming-vector
animation along with text-based teaching aids.) There they can
also delve into an interactive teaching program called Cyberpatients
that was developed by Dr. Qayumi himself. It lets students examine
a virtual patient suffering one or more of nearly 200 possible
medical disorders, while stepping students through a process
of diagnosis and treatment.
I think our centre is unique that way, says Dr. Qayumi.
We encompass not only teaching but also the development
of new teaching and surgical tools. We also evaluate other new
tools that appear and new teaching curricula.
Another area of CSEI focus is telehealth.
I think the Romanow report (to Parliament on the health
of the Canadian healthcare system) really made clear the importance
of telehealth to this country, says Dr. Qayumi. He
pointed out that telemedicine is the cheapest and fastest way
to deliver healthcare to Canadians given the separated pockets
of population we have here. That probably explains why we are
more advanced in this field than anyone else in the world. And
it is going to be one of the most important aspects of medical
practice in future.
Consequently, Dr. Qayumi and the CSEI are taking a keen interest
in various aspects of telemedicine including teleconsultation
and telediagnostics and, of course, the tech-sexy
Teleconsultation means I can send junior surgeons to any
part of B.C., follow them, and be with them at all times when
needed, says Dr. Qayumi. I can draw things on the
screen for them, for instance, if they have a problem during
surgery. It is just like standing beside them.
Visuaide, Ottawa invest $13.1 million in tech for the visually
DRUMMONDVILLE, QUE. The government
of Canada has announced a $4.7-million investment in VisuAide
to support the development of assistive technologies for persons
with visual disabilities.
The federal government investment is funded through Technology
Partnerships Canada ($3.9 million) and Canada Economic Development
($800, 000). It is part of a $13.1-million project being undertaken
The project, aimed at developing innovative digital devices for
persons with visual disabilities, will further the development
of accessible and affordable technologies.
VisuAide is said to be a world-leading innovations firm in its
respective field. The benefits of the next-generation computing
platforms and portable solutions will allow many Canadians to
join the work force, to excel at their jobs, and to enjoy the
freedom and independence the sighted take for granted.
This government investment will support the development of four
new technology platforms: multimedia e-books; orientation aids;
braille/graphic displays; and low-vision technologies.
The hand-held multimedia e-books involve downloading magazines
or books onto a portal device and reading the text in synchronization
with the audio component, while offering the ability to browse
through the article, skip sections or bookmark a specific page
or paragraph. It will be a useful tool for the print disabled
and dyslexic users.
The global positioning system-based portable orientation
aid, called Trekker, mixes voice and text contents with geocentric
database search functions to guide the visually impaired in urban
and rural environments, but does not replace the familiar guide
dogs or white canes.
Braille/graphic displays will redesign and revolutionize
braille cell technology for inclusion through a very innovative
note-taker for educational and professional uses.
Digital vision uses digital camera technology with read-aloud
VisuAide is a private company established in 1988, headquartered
in Drummondville, with offices in Longueuil and Toronto. VisuAide
currently employs 85 individuals, 25 of which are engaged in
research and development. More than 10 percent of the companys
employees have visual impairments, which keep the needs of the
visually impaired constantly in focus. In September 2002, VisuAide
was honoured with the Winston Gordon Award for technological
advancement in the field of blindness and visual impairment,
and has also received the ADRIQ award for innovation for designing
the Victor Reader talking book player.
The goal is to ensure that the benefits of technology touch
every Canadian, said Lucienne Robillard, the industry minister.
As a world leader in the knowledge-based economy, we strive
toward the creation of an e-inclusive information society.
Accessing information and navigating in the world are among the
most difficult problems for the visually impaired. Under the
proposed research and development project, VisuAide will develop
new, affordable technology platforms to assist blind or visually
impaired persons access print, electronic or directional resources.
These developments will give rise to increased personal independence
to venture down unknown streets, to navigate all levels of complexities
of print or electronic material, and to enable note taking of
Our company is committed to developing new technologies
to enhance daily life and increase independence for the visually
impaired, said Gilles Pepin, president of VisuAide. Through
government of Canada support, we optimize our capability of offering
high-quality innovative products.
Digital technology is opening the doors of equal access
for all, and giving the blind and visually impaired the necessary
tools to be active contributors in a sighted world, said
Jim Sanders, president and CEO of the Canadian National Institute
for the Blind. Enhanced access to computers, communications
and the environment fosters personal growth and productivity,
while making e-inclusion a reality.
Technology Partnerships Canada is a special operating agency
of Industry Canada, with a mandate to provide funding support
for strategic research and development, and demonstration projects
that will produce economic, social and environmental benefits
The mandate of Canada Economic Development is to promote the
economic development of the regions of Quebec (www.dec-ced.gc.ca).
Laser prostate surgery spells relief for patients in US,
but not Canada
By Jerry Zeidenberg
TORONTO A breakthrough laser technology
for prostate surgery thats widely used in the United States
has yet to be funded by hospitals in Canada despite its
ability to cut hospital costs and to produce better clinical
Known as Green Light PVP (photoselective vaporization of the
prostate), the technique transforms the traditional hospital
stay of two-to-four days for prostate surgery into a 45-minute
procedure. Counting preparation and recovery time, patients are
in and out in a matter of hours.
The laser procedure also enables most patients to walk out of
a hospital or clinic without bleeding or pain and to return to
work within 48 hours.
Its estimated that 50 percent of men over the age of 60
will suffer from enlarged prostate glands, which squeeze the
urethra and make it difficult to urinate. The condition also
results in loss of control of urination, leading to incontinence.
Without surgery to remove excess prostate tissue, these men face
years of discomfort.
Tests of the Green Light laser technology started this year at
two Canadian hospitals Southlake Regional Health Centre
in Newmarket, Ont., and at Scarborough Hospitals General
Division, in Scarborough, Ont.
Results have been so good at the Scarborough site that urologist
and former chief surgeon Dr. William Baldwin is preparing his
own paper for the hospital, in a bid to convince its executives
to invest in the system.
The problem, notes Dr. Baldwin, is that the laser technology
requires a capital outlay of approximately $120,000, and each
operation requires a $1,200 disposable laser fibre. Thats
a bit of a shock to cash-strapped hospital administrators, who
compare the cost of the laser procedure with standard prostate
surgery that requires only $112 in supplies and equipment.
However, Dr. Baldwin maintains that by freeing up hospital beds,
which cost on the order of $1,000 a day, the PVP laser would
actually save the hospital money.
The older surgical method keeps patients in hospital for
an average of three days, costing $3,000 plus surgical supplies,
said Dr. Baldwin, who compared this with the $1,200 expense of
the laser treatment. Overall, he noted, the case cost is effectively
halved when using the laser procedure.
Just as importantly, the clinical results of PVP laser surgery
are an improvement on traditional prostate gland surgery.
Since the laser vaporizes tissue and cauterizes blood vessels,
theres no bleeding or very little. Thats a
major change from standard prostate surgery, which involves blood
loss during surgery and the possibility of hemorrhage afterwards.
Bloodless laser procedures mean theres less
demand for blood transfusions during surgery, and translates
into a lower incidence of infection.
Dr. Baldwin commented that as enlarged prostate glands are associated
with aging, many of the patients also have hardening of the arteries
and take blood thinners, such as Coumadin, to reduce the chance
However, since drugs like Coumadin prevent blood from properly
coagulating when tissue is cut, patients are instructed to stop
taking them before standard surgery. That unfortunately has left
them more susceptible to blockages in their arteries.
With laser surgery, however, patients can continue taking their
medications. I recently performed laser surgery on an elderly
patient, and he was able to stay on his blood thinners,
said Dr. Baldwin, who had conducted a total of 14 PVP laser surgeries
at the time of writing. He started using the pilot system at
his hospital in January.
Its a procedure that has many benefits, commented
Jay Herman, president of Toronto-based Sigmacon, which distributes
a variety of surgical laser systems, including the GreenLight
PVP technology. It frees up hospital beds, meaning you
can use them for other surgeries, like cardiac operations.
Herman noted that because laser-based PVP surgery has a far lower
rate of complications such as infection or hemorrhage
there are virtually no returns to hospital ERs. Post-operative
results for PVP laser surgery have been much better than conventional,
invasive prostate surgery, which often produces serious post-operative
problems, including incontinence, impotence, infection, and painful
urination. Such problems result in a poor experience for the
patient, and are expensive to treat if the patient is re-admitted
to hospital. By contrast, a five-year study by physicians at
the Mayo Clinic, in Rochester, Minn., published in the U.S. Journal
of Urology in April 2003, found the PVP procedure resulted in
virtually zero post-operative pain, bleeding, incontinence or
Immediately after the green laser-based PVP procedure, the urine
stream of the patient is clear. It surprises nurses whenever
they first observe this procedure, because theyre used
to seeing blood in the urine, commented Herman. With
laser-based prostate surgery, the urine is clear. Additional
information is available at www.greenlight-pv.ca