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Inside the November/December 2004 print edition of Canadian Healthcare Technology:


HTX expands its scope

The Health Technology Exchange, based in Markham, Ont., successfully helped strengthen the assistive device sector in Ontario. Fueled by new government funding, it’s turning its attention to medical tech developers, in general.

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Feature report: Clinical decision support systems

A number of experienced consultants to the healthcare systems in Canada and the United States firmly believe that clinical decision support systems and their like are the path to improved patient safety.

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Algorithm for researchers

Librarians and clinicians at Mount Sinai Hospital, in Toronto, have devised a methodology for doctors and medical students to conduct quick but comprehensive searches when looking for the answer to a medical problem.

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Alberta readies state-of-the-art cardiac centre

Officials of Edmonton’s Capital Health Authority and their supporters are putting heart and soul into a 250,000 square foot expansion of their University of Alberta Hospital to accommodate an expanded Alberta Heart Institute.

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Infoway targets telehealth

In September, the Canada Health Infoway board of directors approved a $150 million plan to bolster telehealth applications throughout Canada, with emphasis on rural and northern areas.

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Medicine on the go

Sophisticated medical programs are steadily emerging on handheld computers, such as the Palm. Among the most recent and useful applications is ebm2go, short for Evidence-based Medicine to Go, a program that enables mobile docs to check the latest therapies.


PLUS news stories, analysis, and features and more.

 

Ontario to promote wide range of health technologies through HTX

By Jerry Zeidenberg

MARKHAM, ONT. – Armed with an economic development strategy that was successfully deployed to strengthen Ontario’s assistive technology sector, the province now intends to beef up a wider range of healthcare technology developers – including medical devices, diagnostic imaging, I.T. and biotechnology companies.

The Markham-based Health Technology Exchange (HTX) has been given the lead role in the strategy to spur the commercialization of new healthcare products and increase exports. It’s to do this with government funding of $1.5 million annually for four years.

“We’ve got a two-fold mandate,” said HTX managing director Dr. Mickey Milner. “First, we intend to fund and support innovative research in the medical and assistive technology field. That includes innovations that are coming out of companies, hospitals, universities or even basement labs.”

The second part of the mission focuses on commercialization and marketing. Here, HTX plans to strengthen the business capabilities of organizations with promising technologies, providing expertise or hooking them up with the right businesses or agencies. “We plan to help them with all the steps from innovation to invoice,” quipped Milner, “and we’d like to see it become an international invoice.”

The funds for HTX are coming from the Ministry of Economic Development and Trade. Organizers of the drive to build medical technology clusters and expand exports are basing their efforts on a similar strategy that was successfully used at the Ontario Rehabilitation Technology Consortium (ORTC). Created in 1992 with government funding of $17.5 million over 12 years, the ORTC played a leading role in the development of a rehab technology industry in the province, fostering the growth of companies that have become world-leaders in areas such as mobility, prosthetics, and computerized solutions for person with low-vision and learning disorders.

ORTC had a hand in the development and commercialization of at least 32 products, many of which are sold in more than 15 countries. Some 14 additional products are still under development. Now, the plan calls for the ORTC to be folded into HTX, where it will function as one of several operating networks.

One of the main roles of HTX will be to act as a “linking” agency, one that connects emerging companies or inexperienced organizations with other outfits that can help them. “Often, they need help with licensing, regulatory matters, export assistance, marketing and sales,” said Dr. Milner. “We can give them a hand in all of these areas.”

HTX has put considerable resources into developing an “intelligent” web site at www.htx.ca, which Ontario developers of healthcare technology are encouraged to join. The site incorporates a variety of engines to help connect organizations with others that can assist them.

Dr. Milner noted that HTX won’t duplicate the work of any existing organization. Instead, it aims to point up-and-coming companies in the direction of the help they need, and to build alliances among companies and government organizations, including the National Research Council of Canada. “The NRC has great resources, and we have strong support from them through the Industrial Research Assistance Program (IRAP),” said Dr. Milner.

Of the $1.5 million in annual funding that’s been obtained by HTX for four years, $1 million annually will go towards funding research – essentially priming the pump for projects that have good business potential. Another $500,000 a year will be used for commercialization and marketing activities.

Dr. Milner said the ORTC was able to leverage its government funding to obtain additional project financing, through matching funds, cash and in-kind contributions. The same model will be used for HTX. As a result, he expects to see the investment of $6 million during the next four-years escalate through contributions from partners. At ORTC, for example, $17.5 million in funding was used to attract over $30 million in matching funds, including cash and in-kind contributions.

Dr. Milner said there are scores of technologies under development in Ontario that could become international successes. They include tissue engineering at the University of Toronto, imaging systems at Sunnybrook & Women’s College Health Sciences Centre, and robotic surgery technologies in London, Ont. “There are pockets of activity across the province that are very significant,” said Dr. Milner.

Moreover, he pointed to the province’s community colleges as untapped sources of creativity. “A lot of practical ideas are coming out of community colleges,” he said. “They are an extraordinarily important piece of the action.”

HTX is now a few years old, and was originally headed by Peter Goodhand. Earlier this year, Goodhand joined the Canadian Cancer Society, Ontario Division, as CEO. He maintains a role in HTX as a member of the board of directors.
Dr. Milner, previously director of the ORTC, has taken on the role of leading HTX and has the task of expanding its operations to nurture and commercialize all forms of healthcare technology. He said a recent study (available on the HTX web site) shows the province has enormous potential for new product development.

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Hospitals moving towards clinical systems that deliver real-time support

By Andy Shaw

The statistics on bad clinical decisions are grim: According to researchers at Queen’s University, some 185,000 Canadians every year suffer an unintended trauma during a hospital stay resulting in injury, death, disability, or a much longer stay than planned. Of those, an estimated 7,000 die. About 79,000 Americans also die needlessly every year as a result of some care provider making a poor judgement, said the National Committee on Quality Assurance, resulting in $1.8 billion in avoidable healthcare costs.

That U.S. Committee recommends drastic corrective action for medical errors: Require healthcare providers to report publicly what they do and tie their compensation to their patients’ outcomes.

Here in Canada we’re going to study the matter first. But at least there’s an aggressive edge to the reviews. This year the federal government launched six projects connected with patient safety. One of them, a $150,000 study called Governance in Patient Safety, is being conducted by Queen’s University. To find out who made the decision that resulted in a medical error, the study will examine sample cases – starting from the patient and working back through the patient’s interactions with the hospital’s care providers.

“This is an approach that has never been used in a healthcare setting,” said Dr. Samuel Shortt, director of Queen’s Centre for Health Services and Policy Research, and leader of the study. “We believe that hospital errors should be viewed in terms of an individual functioning within a system that permits such errors to happen...”

Of course, part of such a system is the technology that is at hand, or not at hand, when a care provider interacts with a patient or makes a decision about the patient’s care that results in an error. Whether the Queen’s study will illuminate the role clinical decision support systems, for example, play in that interaction remains to be seen.

In the meantime, a number of experienced consultants to the healthcare systems in Canada and the United States firmly believe that clinical decision support systems and their like are the path to improved patient safety. By automatically providing pertinent information when it’s needed, they are a highly reliable way of ensuring that care givers make the right decision at the right time with the right patient.

“I’ve been practising medicine and consulting now for more than 30 years, and I’m convinced more than ever before that as a doctor trying to make the right decision about a patient’s care, I can no longer rely just on my memory,” said Dr. Manuel Lowenhaupt, vice president and national practice leader with Capgemini Health Consulting, based in Boston. “It’s as if you went into a bank and the teller tried to tell you the balance in your account without looking it up. In healthcare, we have this unfortunate model of making decisions based on memory and paper tools that has not changed for more than 50 years.”

What Lowenhaupt proposes as a more modern model is hard to accomplish, he admits, but easy to grasp. “The ideal model would be somehow, right at the moment of care, individualized advice specific to what my patient really needs should be presented to me from the vast body of medical literature that exists.”

But there’s the rub. That vast body of medical literature does more than exist. It balloons.

“I heard Dr. Hugh Scully, the heart surgeon and former president of the Canadian Medical Association, say it first: The amount of medical knowledge in the world is doubling every 18 months,” said Neil Stuart, IBM Canada’s practice leader/partner in healthcare consulting. “You would have to be super-human to keep all that in your head.”

Adding to the complexity of assimilating and applying that ever growing knowledge base is a patient population that’s changing.

“It’s a double hit. While the knowledge base is growing and becoming more unmanageable, people are aging, suffering much more frequently now from chronic diseases, which require more complicated care,” said Stuart. “Often such patients suffer from multiple long-term conditions. So the day when most patients come in, have one prescription written for them and they’re fixed – is fast disappearing.”

That in turn, both Stuart and Dr. Lowenhaupt agree, places a third demand on whatever clinical decision technology solution comes along to help prevent medical errors – patient involvement.

“In one of the large academic hospitals we serve, they have created a model where patients build their own schedule for medical care,” said Dr. Lowenhaupt. “They log into a secure portal with their unique identifier and can make their own appointments, can access their own medical record online. They can view their lab results and even their doctor’s notes.”

Dr. Lowenhaupt reports the system has been a big hit with patients. Similar systems have been a big hit with care providers.

“I love it when as a primary care provider I can go in to a hospital’s system and get my appointments or get test results, right from my office,” said Dr. Lowenhaupt.

Hospital care, however, is just one part of the equation.

“What we’re facing also is what’s been said of Ontario’s healthcare system. It’s been dubbed ‘precipice care’,” said Stuart. “A patient can be in a hospital and receive just fabulous treatment and support. But all of a sudden, when they’re discharged, the services aren’t there for them anymore. If they need rehab right away, for example, there may be a six-month wait. Patients needing homecare may find themselves at the end of a very long waiting list. So consumers are either at the top of a care precipice looking down or at the bottom looking up.”

Both Stuart and Dr. Lowenhaupt, however, are hopeful about the attempts they see to create much more broadly based and distributed decision-aiding systems. Ones that can vault the gaps in precipice care and master the complexities of chronic disease.

“In New Zealand, we’ve built what I call a ‘complex, adaptive, decision support tool’ for the management of asthma,” said Dr. Lowenhaupt. “It is a very long, complicated algorithm. But in simple terms, it looks at the test results of an individual patient and uses that to guide what recommendations we make for their care. It lets me look at things like your white blood cell count, how quickly you can blow air out, what medications you are on – and from that pattern of test results and information, it helps me recommend what your next day of care should look like.”

Similarly, Stuart likes what he sees in decision-making developments here in Canada. “There are some wonderful tools coming on line, for example, to help people with prescription decisions and managing the whole drug regimen side of things. The Canadian Pharmacists Association also have an ‘e-Therapeutics’ project under way that is very exciting. It’s aimed at getting the latest prescription information to primary care physicians, right at the time they are making treatment decisions.”

At Kingston General Hospital (KGH) in Ontario, anesthesiologist Dr. David Goldstein heads up a leading medical informatics lab and is putting wireless technology to work, so that physicians can make better decisions sooner. Through 50 strategically placed wireless access points, Dr. Goldstein and other caregivers from almost any point in KGH can monitor a patient’s vital signs on their PDAs. Whenever a patient gets into trouble, care providers are alerted within 1.2 seconds.

With a glance at their handhelds, they know instantly who is in trouble, what is wrong with them, and where they are. So there’s little or no delay in even making a collaborative decision among the care-giver team about what to do.

Then later, when the crisis has passed, the wireless network does other, if less dramatic work aiding decisions at the patient’s bedside.

“As a physician, I need to have information at the bedside that is qualified in real time,” said Dr. Goldstein. “It is no good to have yesterday’s information. And even the most innocuous decision made without today’s information can sometimes be very damaging.”

Dr. Goldstein, who also directs KGH’s Acute Pain Services, cites the example of a physician deciding simply to administer Tylenol to relieve some patient pain.

“In patients with certain heart, cardiovascular, or diabetic conditions, giving a Tylenol can be very damaging to the liver and even result in death,” he said. “Not many people or even physicians know that.”

So that’s why, said Dr. Goldstein, he and his colleagues are intent on making up-to-the-minute patient information, combined with relevant drug alerts and precautions, wirelessly available whenever a KGH caregiver makes a bedside decision.

But the challenges of making such decision-support systems ubiquitous remain.

“Infoway is driving a sort of macro agenda across the country with its EHR initiative,” said Stuart. “And there are some impressive provincial systems including Alberta’s wellnet. Also, down at the more granular level of hospitals and doctors’ offices, they’re working on decision systems that are much more specific to their needs.

“But what no one’s made clear yet,” added Stuart, “is how those different levels of systems are going to interconnect.”

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Mount Sinai librarians devise search tool for evidence-based sources

By Jerry Zeidenberg

TORONTO – Mount Sinai Hospital has created an online tool for accessing top-rated sources of evidence-based medicine for clinicians and medical students who are researching medical questions. Using the system – which is called an algorithm by the developers – they can search step-by-step through four tiers of resources.

To create the algorithm, Mount Sinai librarians and clinicians conducted an assessment of resources available to researchers in the hospital library, and ranked them according to their use of evidence-based evaluation and scientific review.

“For many medical students and physicians, the first instinct is to turn to PubMed,” said Sandra Kendall, director of library services at Mount Sinai. “But PubMed will search through 5,000 or more journals that may not be reviewed.”

By contrast, Mount Sinai’s algorithm has compiled trusted sources of information into an easy-to-use hierarchy. Pubmed is contained in the fourth tier, and is treated as one of the last resorts for researchers. The highly ranked Cochrane Collaboration resources, Kendall said, have developed dramatically in the last few years and now consititute a superb tool for medical researchers.

In September 2004, the algorithm – essentially a flowchart with hyper-links – was posted on the web by the University of Toronto Libraries. It can be found at www.library.utoronto.ca/guides/ebm

Kendall would like to see other hospitals and medical schools adopt the algorithm. “It would be great if they use it and help to improve it,” she said.

For its part, Mount Sinai Hospital began working on the algorithm in 2000. At that time, vice president of education Jeannine Bannack was seeking a way to reduce the time needed to show medical students, doctors, and others, how to find answers to medical questions.

A one-on-one session, with a librarian and medical student or doctor, could take two or three hours. “The problem was that doctors do not have hours upon hours to search for evidence, or read hundreds of articles,” said Kendall.

With the assistance of physicians such as the University of Toronto’s Dr. Sharon Straus and Mount Sinai Hospital’s Dr. Stephen Lapinsky, hospital librarians began to create the flowchart of the most useful resources for conducting research. Those sources with the most rigorous procedures for assessing literature on the basis of scientific reviews obtained the highest rankings.

Using the new methodology, Mount Sinai librarians found that a search could often be done in five to 10 minutes, rather than three hours. And the results had a high degree of reliability. “If you get a valid answer, you’re done,” said Kendall.

On the other hand, in the cases where a clinician or medical student sends a query through all four tiers of the algorithm, and still ends up empty-handed, Kendall said the problem would likely be a good candidate for conducting an investigative protocol.

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Alberta readies state-of-the-art cardiac centre

By Andy Shaw

You’ve gotta have heart,” goes the song – one that could have been written by the creative talents at Edmonton’s Capital Health Authority. Officials of the multi-facility Authority and their supporters are putting heart and soul into a 250,000 square foot expansion of their University of Alberta Hospital to accommodate an expanded Alberta Heart Institute, which promises to be a Mayo Clinic of the North.

“We’ve long had both cardiac science and cardiology care programs here, as some of the more renowned centres do,” says Michele Lahey, chief operating officer for both the University of Alberta Hospital and the Stollery Children’s Hospital it contains, as well as the person in charge of Heart Institute construction. “So we will keep them together. The Heart Institute will be on the same site with the two hospitals, but it will have its own separate tower.”

Under active construction since October 2003, the $175 million project has seen the Alberta government contribute $145 million while hospital fundraisers are plucking at public heartstrings to come up the $30 million balance. By the time the Institute opens its doors in late 2005 or early 2006, some $25 million dollars of that budget will have been spent on its state-of-the-art clinical and information technologies. Many will be found in the institute’s research centerpiece, known as ABACUS, short for the Alberta Cardiovascular Stroke Research Centre.

Among the chief architects of the Abacus concept is head researcher Dr. William Archer. Dr. Archer says there will be four different “cores” of research at Abacus, but the keyword for all of them is integration. “There will be no unconnected silos of research going on here. We’ll have population scientists working side by side with physician investigators, as well as with microbiologists and educators. And to help make that happen we’ll be using some pretty cool technology.”

Among the coolest in the Imaging and Intervention core:

• a 64-slice CT scanner that will help bridge the research interests of cardiologists, neurologists, radiologists, and any other specialists concerned with heart, stroke, and vascular disease. The scanner is a tool that Dr. Archer says has the potential to revolutionize the treatment of such diseases and eliminate the need for invasive diagnostic angiography.

• A leading-edge cardiac MRI unit, where Archer has “brokered a deal” whereby two cardiologists, two radiologists, and one physicist are working as a team. “We believe cardiac MRI will be the way that pretty well all congenital heart disease will be studied in future,” says Archer.

• A research hospital within a hospital, featuring intensive-care holding beds that enable the study of what happens second-by-second to patients during a heart attack or stroke.

In its Vascular Biology core, Abacus multi-discipline researchers will team up to examine tissues emanating from patients, be they blood samples, biopsy specimens, or pathology slides.

“Instead of getting the Leonardo da Vinci look at patient anatomy, we’ll use technology such as protein chips to give us a Hubble telescope view,” says Archer. “We’ll be able to look into these tissues and see what genes are turned on, or what proteins are missing, or what new ones are there that we might use as biomarkers for spotting diseases.”

Vascular biology researchers at Abacus will also be using the latest two-photon confocal microscopes enabling them to peer into a living cell without damaging it.

The Population and Health Outcomes core in Abacus will feature databases and several large server rooms made physically and electronically secure for all cardiac patient registries – so that health trends or disease outbreaks can be tracked and researched in complete compliance with privacy legislation.

With all this going on internally, however, the Heart Institute will still be connected to the day-to-day work of saving lives.

“We have a state-of-the-art emergency room already built at the hospital, and we have direct communication between it and the Heart Institute,” says Archer.

Archer says some electronic mapping displays are planned to help people find their way through the Institute but, especially for the aged and ailing, there also will be some no-tech guides. “We’ll have greeters deployed too, because no technology replaces a smiling face.”

Other technology the Heart Institute will be deploying includes:

• Point-of-care test kits that obviate the delay inherent in central lab tests. These including finger-stick devices that give an immediate reading of blood peptide levels in hypertense patients as a marker of their potential for heart failure;

• Ventricular assist devices for both adult and pediatric heart transplant patients. These devices “buy” time for potential heart transplant patients and, until a suitable donor heart is found, improve their quality of life;

• Laser lead extraction, a minimally invasive procedure using pulsed laser energy to remove pacemaker and defibrillator leads from patients instead of open-heart surgery;

• Two three-dimensional mapping systems that use GPS-like technology. The NOGA system enables cardiac surgeons to place blood- vessel generating genes precisely where they are needed. The CARTO application shows the way for catheters heading to spots where damaged heart cells are causing irregular beats. The catheter then destroys them with a burst of microwave energy.

To stretch the reach of Abacus and the Institute further, new funds are flowing into telemetrics. Institute specialists, for example, are working on systems for treating heart attack patients while they’re still in ambulances.

“We can shorten the time to therapy for acute heart attack patients by over an hour,” says Archer. “The technology involved is a regional EKG system that is in the works, so that EKG information can be transmitted no matter where the patient is picked up by the paramedics.”

The Heart Institute is also constructing a telehealth network – specifically extending the reach of the EASE (easy access, speedy evaluation) initiative backed by the Alberta Innovation fund.

“EASE was founded essentially because we discovered that the average patient was waiting three months for a cardiology consult,” says Archer. “So we figured that period of waiting was at least as dangerous as bypass surgery. We’ve established a multi-disciplinary clinic here that’s shortened the waiting time down to one month. That’s partly because we are starting to have patients come into local clinics. We can see them remotely, even watch their EKG readings as they are taken.”

Then there is the jewel of the Abacus piece, its global classroom.

“Technically, we are calling it the data acquisition and transmission facility,” says Dr. Archer, “Using the global classroom we could bring in 100 patients, for example, and using the special software that’s been developed for us called ViviDesk, we will be able to ask the patients questions in a survey which they can all answer through a laptop on their individual desks.”

“By the time they leave the classroom,” adds Dr. Archer, “we’ve got the survey done and analyzed. Or, let’s say for a clinical trial, we could have 100 radiologists in the room (and linked to others anywhere else via Alberta’s SuperNet) and show them the picture of a diseased artery on their laptops, and make sure that they all agreed on definitions before leaving.”

To complement this outreach effort, other new Capital Health projects include:

• The purchase of a critical care information system that will link the Institute’s critical care (CCU) and cardiovascular intensive care (CVICU) units with all the intensive care units in the region;

• A Heart School based on self-directed e-learning for patients and families and available to them around the clock;

• Using the Institute’s wireless technology as a model for redesigning communications, work flow, and staffing throughout the region;

• A regional pilot of phone and intranet based cardiac care – to benefit patients who return to work quickly but who remain at risk or who may live far away from outpatient locations.

Fitting most of these pieces together is project manager Kathy Trepanier. Working directly for Lahey, Trepanier is a nurse by background but says the Heart Institute project makes her feel more like an air traffic controller.

“We’ve got to make sure what we are doing fits not just with other interests in the hospital,” she says, “but also in the region, in the province and in the rest of Canada.”

To that end, Lahey and other powers-that-be at Capital Health have consulted widely. They are linked with counterparts at other Canadian heart institutes in Ottawa and Montreal. As well, they’ve put together an international expert panel they regularly consult, comprising such renowned cardiac research and care outfits as the Texas Heart Institute, Harvard University, and the Mayo Clinic.

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Canada Health Infoway ready to become more active in telehealth

MONTREAL – Canada Health Infoway is ready to embark on a more pro-active approach to telehealth, particularly in remote and rural locations. Currently, there are more than 4,200 rural and remote communities in Canada, and studies show that only about 15 percent have telehealth coverage of any kind.

“If these communities are to benefit from telehealth initiatives, then existing networks need to be expanded, co-ordinated and sustained,” said Richard Alvarez, President and CEO of Infoway.

In January 2004, the Telehealth Investment Strategy I investment, covering approximately 4 percent of the agency’s telehealth program envelope and targeting interoperable investments, was approved by Infoway’s Board of Directors. In September 2004, Strategy II, covering the remainder of the investment envelope, was also approved by the Board. Strategy II targets jurisdiction and issue-specific investment projects.

The three main goals of Infoway’s telehealth program are to optimize the use of existing networks, maximize the use of telehealth in the clinical setting and to maximize the link between telehealth and Electronic Health Records, said Dr. Denis R. Tremblay, Infoway Program Director, Telehealth.

Since standards tend to make disparate systems more compatible, investment in their development forms an integral part of Canada Health Infoway’s telehealth program. To date, two planning phase projects have been completed – one in conjunction with the Canadian Institute of Health Information (CIHI) to define technical standards for interoperability of teleradiology systems, and another in conjunction with the Canadian Council on Health Services Accreditation to develop national clinical standards and accreditation programs, based on National Initiative for Telehealth (NIFTE) guidelines.

In addition, a project to document effective telehealth management models and best practices is ongoing with the NORTH Network in Ontario and MB Telehealth in Manitoba.

Telehealth is a complex area because of the cross-jurisdictional aspects involved, Dr. Tremblay said. “This means that when we identify projects, we have to look at them within the context of five dimensions: cultural, clinical, geographical, management and technical standards necessary to achieve our goals.”

“When considering remote areas, we must consider the culture and the languages of the people who live there – many of these communities are composed of Aboriginal or official language minority citizens – and we need to ensure the telehealth projects we work with take their cultural needs into account while also serving their health needs,” he added.

“The cross-jurisdictional nature of a telehealth network must also take into account the differences in medical practice regulations, licensing of medical personnel and privacy laws about sharing medical information,” Dr. Tremblay said.

“We have carried out many site visits and observed functioning telehealth networks. The knowledge that this is a viable healthcare delivery channel exists and those networks are proving it. We see Infoway’s role as a bridging one – investing in the projects that will build on the primary care reforms many of the jurisdictions are carrying out and help create a full-time, sustainable role for telehealth in Canada’s healthcare system, as well as a link to the EHR. This will benefit patients and healthcare providers alike.”

Dr. Sue MacLean, Infoway’s senior medical advisor, said the provision of nursing teletriage and information services in many provinces has created a quiet revolution in healthcare, by changing the point of access of the patient to the healthcare system.

“Now, patients can call to see whether they can manage their symptoms at home, or whether they require further assessment,” she said.

For its part, Canada Health Infoway is an independent, not-for-profit corporation created in 2001 following a September 2000 commitment of Canada’s First Ministers “to work together to strengthen Canada-wide health infostructure to improve quality, access and timeliness of health care for Canadians.” Infoway’s members are the federal, provincial and territorial deputy ministers of health.

Infoway’s approach is to invest strategically and work in partnership with stakeholders, including the private sector. According to Infoway, the organization acts as a catalyst, leveraging its financial resources through targeted investments and building on best practices. Funding is done on a gated basis – that is, the project must meet certain preset milestones at which time a portion of the funding is disbursed. This ensures value for money, and a project that meets its deadlines and objectives.

Infoway’s initial funding agreement with the federal government included $500 million and focused on infostructure, registries, diagnostic imaging, drug and lab information systems. In April 2003, the funding agreement was amended to include an additional $600 million, with $150 million for telehealth. In the spring of 2004, following the SARS outbreak, Infoway was allocated an additional $100 million for development of a public health surveillance system.

Canada Health Infoway is working to foster and accelerate the establishment of an interoperable electronic health record (EHR) for all Canadians and telehealth has an important role to play in this initiative.

“Telehealth is not a new concept,” said Richard Alvarez, Infoway president and CEO. “But it is a concept that needs to move forward, to develop into an interoperable nation-wide network that can be linked to the EHR. Telehealth has a very important role to play in bringing healthcare services to remote and rural areas.”

Healthcare experts across Canada tend to share this view. Dr. Kendall Ho, associate dean and director of the division of continuing medical education, University of British Columbia, said telehealth technology can play a crucial role in bringing healthcare benefits to Canadians in isolated parts of the country.

“Rural and remote communities, with the historical disadvantage in healthcare access due to geographic isolation, can now look to telehealth for improvement and equalization of access. This is thanks to modern information and communication technologies like broadband Internet, videoconferencing, and innovations in computing technologies,” Dr. Ho said.

“In addition, rural health professionals can also benefit from the electronic connectivity to obtain their continuing education in their own communities, thereby helping them in maintaining excellence in healthcare provision close to home, and increasing their professional satisfaction and decreasing their sense of isolation. ”

Dr. Jocelyne Picot, telehealth consultant and president of Montreal-based Infotelmed Communications, points to several success stories in the area of telehealth. Evaluation studies have shown that patients who use telehealth networks report a high degree of satisfaction with the medium. Though there are few randomized control studies reported in telehealth, one such trial carried out at Memorial University in Newfoundland showed that in 96 percent of cases, the diagnosis and treatment recommendations made via a videoconferencing system were the same as those made face to face.

“Telehealth networks have shown significant benefits for these patients as well as their healthcare providers,” Dr. Picot said. “What is needed is to expand these networks and to ensure their sustainability so that rural and remote areas continue to be well served.”

Dr. Mamoru Watanabe, professor emeritus at the University of Calgary, also sees the benefits that can accrue to both healthcare providers and patients using telehealth technology. “In Canada, Australia and the United States, the focus on telehealth is to help rural and remote communities gain access to medical care and consultation. Telehealth networks also open up a two-way flow of information, which creates opportunities for healthcare providers in rural and remote areas to receive support, continue learning and upgrade their skills.

“One of the unique and most human aspects of telehealth is televisitation, whereby patients displaced from their families for care in larger communities can maintain connections with family members via telehealth networks,” he added.

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