Inside the November/December 2004 print edition of Canadian
HTX expands its
The Health Technology Exchange, based in Markham,
Ont., successfully helped strengthen the assistive device sector
in Ontario. Fueled by new government funding, its turning
its attention to medical tech developers, in general.
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.
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.
READ THE STORY
Alberta readies state-of-the-art cardiac centre
Officials of Edmontons 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.
READ THE STORY
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
READ THE STORY ONLINE
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
PLUS news stories, analysis, and features and more.
Ontario to promote wide range of health technologies through
By Jerry Zeidenberg
MARKHAM, ONT. Armed with an economic
development strategy that was successfully deployed to strengthen
Ontarios 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
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.
Its to do this with government funding of $1.5 million
annually for four years.
Weve 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
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 wed
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 wont 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 thats
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 & Womens
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 provinces
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
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.
Hospitals moving towards clinical systems that deliver real-time
By Andy Shaw
The statistics on bad clinical decisions are
grim: According to researchers at Queens 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
Here in Canada were going to study the
matter first. But at least theres 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 Queens
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 patients
interactions with the hospitals care providers.
This is an approach that has never been
used in a healthcare setting, said Dr. Samuel Shortt, director
of Queens 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 patients care
that results in an error. Whether the Queens 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 its needed, they are a highly
reliable way of ensuring that care givers make the right decision
at the right time with the right patient.
Ive been practising medicine and
consulting now for more than 30 years, and Im convinced
more than ever before that as a doctor trying to make the right
decision about a patients 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. Its 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 theres 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 Canadas 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
Its 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 theyre 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
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 doctors
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 hospitals system and get my appointments
or get test results, right from my office, said Dr. Lowenhaupt.
Hospital care, however, is just one part of
What were facing also is whats
been said of Ontarios healthcare system. Its 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 theyre discharged,
the services arent 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, weve 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. Its 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 patients
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 theres little or no delay in even making a
collaborative decision among the care-giver team about what to
Then later, when the crisis has passed, the
wireless network does other, if less dramatic work aiding decisions
at the patients 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 yesterdays information.
And even the most innocuous decision made without todays
information can sometimes be very damaging.
Dr. Goldstein, who also directs KGHs
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 thats 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
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
Albertas wellnet. Also, down at the more granular level
of hospitals and doctors offices, theyre working
on decision systems that are much more specific to their needs.
But what no ones made clear yet,
added Stuart, is how those different levels of systems
are going to interconnect.
Mount Sinai librarians devise search tool for evidence-based
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 Sinais 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 Torontos Dr. Sharon Straus and Mount
Sinai Hospitals 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, youre done,
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
Alberta readies state-of-the-art cardiac centre
By Andy Shaw
Youve gotta have heart, goes the
song one that could have been written by the creative
talents at Edmontons 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.
Weve 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
Childrens 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 institutes research centerpiece, known
as ABACUS, short for the Alberta Cardiovascular Stroke Research
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. Well
have population scientists working side by side with physician
investigators, as well as with microbiologists and educators.
And to help make that happen well be using some pretty
Among the coolest in the Imaging and Intervention
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
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
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, well use technology such as protein
chips to give us a Hubble telescope view, says Archer.
Well 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
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. Well 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
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
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
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 theyre 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.
Weve established a multi-disciplinary clinic here thats
shortened the waiting time down to one month. Thats partly
because we are starting to have patients come into local clinics.
We can see them remotely, even watch their EKG readings as they
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 thats 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, weve got the survey done and analyzed.
Or, lets say for a clinical trial, we could have 100 radiologists
in the room (and linked to others anywhere else via Albertas
SuperNet) and show them the picture of a diseased artery on their
laptops, and make sure that they all agreed on definitions before
To complement this outreach effort, other
new Capital Health projects include:
The purchase of a critical care information
system that will link the Institutes 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
Using the Institutes 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
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.
Weve 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, theyve 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.
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 agencys telehealth
program envelope and targeting interoperable investments, was
approved by Infoways 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 Infoways 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 Infoways 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 Infoways 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 Canadas healthcare system,
as well as a link to the EHR. This will benefit patients and
healthcare providers alike.
Dr. Sue MacLean, Infoways 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
Now, patients can call to see whether they can manage their
symptoms at home, or whether they require further assessment,
For its part, Canada Health Infoway is an independent, not-for-profit
corporation created in 2001 following a September 2000 commitment
of Canadas First Ministers to work together to strengthen
Canada-wide health infostructure to improve quality, access and
timeliness of health care for Canadians. Infoways
members are the federal, provincial and territorial deputy ministers
Infoways 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.
Infoways 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
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
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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