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Inside the May 2004 print edition of Canadian Healthcare Technology:


Feature Report: Developments in Surgical Systems


Ontario’s SSHA goes live

After running small-scale projects and trials for the past few years, Ontario’s Smart Systems for Health Agency has now launched the heavy-duty infrastructure designed for networking all of the province’s healthcare providers.

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Centre strives for excellence

British Columbia’s 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.

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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 acquisitions.


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.

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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.

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Advances in perfusion

St. Mary’s 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.

 

Ontario’s SSHA goes live with major computer systems

By Jerry Zeidenberg

TORONTO – After running small-scale projects and trials for the past few years, Ontario’s Smart Systems for Health Agency has now launched the heavy-duty infrastructure designed for networking all of the province’s healthcare providers.

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.

“We’ve 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.

“We’ve favoured an organized approach,” said Weaver. “We’re 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 weren’t 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 province’s 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. We’ve 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; it’s 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 province’s hospitals, and will soon link the remaining 20 percent.

This year, it also plans to begin connecting the province’s 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 they’re large hospitals or small clinics employing three or four physicians.
“We monitor the circuits to make sure they’re up,” said Weaver. “We’re watching on a minute-by-minute basis, because we know they can’t 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 Ontario’s 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. “We’re 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 Ontario’s 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. “We’re 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 provider.

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 Ontario’s 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.

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Vancouver’s surgery education centre strives for world excellence

By Andy Shaw

Reasoning, perhaps, that unless you set the bar up high, you’ll never achieve greatness, British Columbia’s 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 the military.

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 there’s 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 Centre’s 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 shouldn’t be using animals for teaching purposes either.”

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 VGH’s operating rooms. That enables students in the theatre to not only witness a procedure but also have two-way conversations with the surgeon. What’s 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 CSEI’s laparoscopic training room. (Apple’s 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 “telesurgery”.

“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.”

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Visuaide, Ottawa invest $13.1 million in tech for the visually impaired

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 by VisuAide.

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 capabilities.

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 company’s 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 data-intensive applications.

“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 for Canadians.

The mandate of Canada Economic Development is to promote the economic development of the regions of Quebec (www.dec-ced.gc.ca).

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Laser prostate surgery spells relief for patients in US, but not Canada

By Jerry Zeidenberg

TORONTO – A breakthrough laser technology for prostate surgery that’s 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 outcomes.

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.

It’s 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 Hospital’s 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. That’s 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, there’s no bleeding – or very little. That’s a major change from standard prostate surgery, which involves blood loss during surgery and the possibility of hemorrhage afterwards.

‘Bloodless’ laser procedures mean there’s 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 of stroke.

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.

“It’s 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 impotence.

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 they’re 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

 

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