Inside the November/December 2006 print
edition of Canadian Healthcare Technology:
Feature Report: Regional integration issues
B.C. spearheads development of disease tracking system
A trail-blazing public health surveillance system
is now under development in British Columbia that will boast many
leading-edge features for tracking and combating the outbreak of
Getting information to clinicians at the point-of-care
Mount Sinai Hospital, in Toronto, has made
pharmaceutical information available to clinicians at the
point-of-care in a variety of ways – PDAs, the hospital intranet and
READ THE STORY
Wireless PDAs – such as the BlackBerry and the
Palm Treo – have been catching on among physicians. The devices
combine telephones and organizers, and now are offering useful
applications such as drug information and management programs.
IHE catching on
Hospitals across Canada and the U.S. are turning
to IHE profiles as a ‘standard of standards’ for connecting various
systems. The benefits have been manifold, including improved patient
safety and smoother project management.
READ THE STORY
Remote access solution
The South East Regional Hospital Authority, based
in Moncton, N.B., has been using a remote access solution that not
only connects healthcare professionals to the hospital’s IT systems,
but also plays a big part in disaster planning.
Capital Health expands EMR
Capital Health, based in Edmonton, has awarded a
contract to Epic Systems for an ambulatory care EMR system. The
wide-ranging solution will provide in-depth data at the point of
PLUS news stories, analysis, and features and more.
B.C. spearheads development of disease tracking system
By Jerry Zeidenberg
VICTORIA – A trail-blazing public health surveillance system is now
under development in British Columbia that will boast many leading-edge
features for tracking and combating the outbreak of infectious diseases.
“There’s currently no system like this anywhere else – it will be a
world-leader when it’s done,” commented Clyde Macdonald, executive
director of information technology for the B.C. government’s Ministry of
In September, British Columbia announced it had awarded a $24.7 million
contract to a consortium led by IBM Canada to design and build the
advanced surveillance system. B.C. is spearheading the development of
the solution, which is part of a national initiative that will be rolled
out to other provinces.
While British Columbia is managing the project, every Canadian province
and territory is involved. “It may be the first I.T. project in Canada
that has been designed with the active participation of each province
and territory,” commented Todd Kalyniuk, a partner in IBM Canada’s
healthcare consulting practice. “This will ensure that the system meets
the needs of partners across Canada.”
Canada Health Infoway has earmarked $100 million to help develop the
technology and implement it across the country. It’s expected that the
solution will be ready to install in 2007.
The surveillance system is being designed as an easy-to-use web portal
that will allow public health professionals to log-on and quickly enter
or access information about cases, symptoms and outcomes.
It will include advanced features for tracking outbreaks, such as links
to provincial laboratory systems, which will automatically feed abnormal
test results into the database. Future plans include connections to
pharmacy databases, to track surges in the use of tell-tale medications
and remedies. “If there’s a run on diuretics, for example, it will be
monitored,” said Macdonald.
As well, the system will be able to quickly add databases and lists from
multiple sources – such as airplane flight manifests or classroom
student lists. In this way, if there’s a passenger who presents with
signs of an infectious disease after disembarking, or a student who
shows signs of a communicable disease, it will be possible for public
health officials to quickly determine who else is at risk and to contact
Overall, the public health surveillance system will have six major
• communicable disease surveillance and management
• outbreak management
• workload management (scheduling)
• vaccine inventories and management.
The immunization component will allow physicians to keep closer tabs on
the patients, especially when they have only partial records of a
patient on hand. Using the centralized database in the public health
system, doctors will be able to see when patients were last inoculated
and if they’re due for new rounds of immunization. “Doctors will quickly
be able to tell if a patient’s immunizations are up-to-date,” said
Public health planners will also be able to better organize campaigns,
as they’ll be able to plot geographical areas – down to postal code
areas – where local populations are in need of immunization updates.
Kalyniuk noted that the system offers interfaces to geographic
information systems (GIS), which are used by most provinces. Moreover,
he said the solution will make use of HL7 v.3 as a communication
standard. “It will be one of the largest implementations of HL7 v.3 in
Canada,” he commented.
The new surveillance system will be used by public health practitioners,
including physicians, nurses, epidemiologists and government officials.
Across Canada, Macdonald estimates there will be tens of thousands of
Macdonald noted that the solution will be among the first public health
surveillance systems that’s national in scope. It will provide linkages
across the country; in the future, it’s hoped that connections can be
built to other countries, as well.
“Communicable diseases don’t respect international borders,” said
Macdonald, who foresees the day when electronic links will be
established with facilities like the Centers for Disease Control and
Prevention, in Atlanta, and others around the world.
One of the difficult issues on this front, said Macdonald, is the
privacy of personal data. However, progress is being made, with
agreements being reached about the use and protection of personal
information. As a result, it is likely only a matter of time before
public health databases can be linked internationally.
Macdonald said IBM was chosen as the lead vendor after an intensive
procurement process that began with nine groups bidding for the
contract. “There was an international response,” he said.
IBM’s consortium partners include Scientific Technology Corp., of
Tucson, Ariz., a leading developer of web-based software systems for
public health applications; Science Applications International Corp., of
San Diego, a systems integrator that has done work with the Centers for
Disease Control and Prevention in the United States; Amaranth Consulting
Group, of Victoria, B.C., which has been involved in the design of
Canadian disease surveillance and public health systems for many years;
and Sotern, of Brussels, Belgium, a developer of workload scheduling and
For its part, IBM has extensive experience in the design and
construction of healthcare I.T. networks in both Canada and the United
States. The upcoming Canadian surveillance solution will also include
IBM software products such as Websphere, Tivoli and DB2.
The IBM-led consortium will also tap into software developed by the
federal government’s Public Health Agency of Canada, in Winnipeg. “It’s
innovate software for the management of alerts,” said Kalyniuk.
At its peak, the Canadian project development team will likely number 75
to 100 people. The primary development office is in Victoria, but work
is also occurring in Montreal, Ottawa, Regina, Vancouver, and several
For it s part, IBM hopes to market the solution developed in Canada
around the world; sales abroad will help fuel ongoing development of the
surveillance system in the years ahead.
“SARS taught us that it was time to invest in a new generation of
surveillance systems to track infectious diseases,” said Federal Health
Minister Tony Clement, in a news release issued by the partners. “The
better our information is, the better prepared we are. To fully protect
the health of Canadians, we must develop the necessary tools to allow us
to coordinate our responses to emerging disease threats.”
Bringing online drug data to the point-of-care
By Sandra Kendall
As with all academic hospitals, the medical library
is an essential part of Toronto’s Mount Sinai Hospital – a 472-bed acute
care centre affiliated with the University of Toronto. To meet the
clinical information needs of staff, Mount Sinai’s Sidney Liswood
Library has assembled an electronic and print collection focused on the
hospital’s clinical specialties and subspecialties. In addition, Mount
Sinai’s affiliation with the University of Toronto gives clinicians
access to thousands more journals and monographs. This comprehensive
collection encompasses vital clinical findings physicians need for
establishing diagnoses and providing evidence-based treatment options;
information so vital that the library staff’s expertise at helping
clinicians find it and use it makes them – and the connection they form
with physicians – a key success factor in quality patient care. The
point at which they converge is the patient’s bedside.
Mount Sinai’s pharmacists operate as part of an interdisciplinary care
team that includes physicians, nurses and other allied health
professionals as appropriate. Each unit has a dedicated pharmacist who,
like the other members of the care team, can and often does provide care
at the patient’s bedside.
Understanding the importance of clinical decision support data, in 1991
the MSH pharmacy department invested in Thomson Micromedex, one of the
leading providers of evidence-based clinical knowledge solutions.
However, they were not able to easily access this information at the
bedside, where they needed it most when providing care or guidance.
There was valuable information on workstations in the pharmacy
department. But pharmacists at the point of care or on call could not
get to it. In fact, the on-call pharmacist was lugging home a large
duffel bag full of textbooks, loose-leaf papers and a Micromedex CD-ROM
to provide essential drug information to staff outside regular pharmacy
One day, duffel in tow, a frustrated on-call pharmacist grumbled to me
that he wished all the data in the bag could be more portable. I
responded that it might, indeed, be possible for our Technology
Application Unit, led by Dr. Stephen Lapinsky, to load the material onto
personal digital assistant (PDA) devices.
At the time, PDAs were a new idea in healthcare. Evidence-based care
data formatted for PDAs was virtually non-existent. However, the library
brought pharmacy, Dr. Lapinsky and Micromedex together and the rest was
In 2002, MSH rolled out a hand-held, portable computer support
system for the on-call pharmacist. It contained a newly developed
PDA-enabled version of the evidence-based drug data, an electronic
version of the hospital formulary handbook, hospital contact addresses
and medical calculators to help adjust dosages for patients with kidney
or liver problems. This information was updated regularly by
synchronizing the PDAs with a desktop computer. This gave MSH mobility
at the point of care and continuous access to the data needed for
clinical decision support.
The success of the pharmacy department’s on-call program begged the
question: Wouldn’t clinical decision support information be valuable to
other clinicians, too? The answer seemed clear. Again, working with
pharmacy and the vendor, the library brought the data up on the hospital
intranet, making it available to the entire MSH community.
However, though definitely an improvement over books, intranet access
alone didn’t completely solve the point-of-care decision-making problem.
Like pharmacists, physicians and nurses don’t always have access to
computers – and thus, the information on them – at patients’ bedsides.
Yet, in this age of electronic intelligence, clinicians simply don’t
make decisions without evidence. They rely on it and they expect it.
So, once again, MSH turned to mobile devices, this time loading the data
on laptops and wireless rounding carts, in addition to PDAs. The library
established a link on the hospital’s intranet to download these tools to
portable devices, giving physicians and nurses easy access to patient
treatment information when and where they needed it.
It has made a decided difference. Recently, a patient presented with an
infection by a multi-drug resistant organism. The infection required
treatment with meropenem. However, as the patient had allergies to
penicillin and ceftriaxone, there was potential for an allergic reaction
to other antibiotics. PDA access to the database allowed the care team
to quickly assess the risk and find another way to administer the drug
that minimized the chance of potential anaphylaxis.
Data when physicians need it is improving patient care at MSH. And
what’s good for Mount Sinai could be good for the Greater Toronto Area (GTA),
and perhaps even the province of Ontario.
In clinical information, as in life, you get what you pay for. Data has
a price and best-practice knowledge is an investment. Yet, not all GTA
hospitals have made this investment. Part of the reason is cost.
In Ontario, each hospital purchases or licenses such resources as
Micromedex independently. In addition, because the data resides on
single PCs in one or two locations, pharmacists are often the only
allied health professionals with access. However, with the advent of
Local Health Integrated Networks (LHINs), now is the time for Ontario to
do something about that.
By centralizing the annual subscriptions held by departments such as
pharmacy in the teaching, partially affiliated and community hospitals,
the GTA could expand access to valuable drug data to other allied health
professionals both within hospitals that have it and to hospitals that
don’t. The benefits of data sharing would be significant in terms of
safety and costs.
Access to such an authoritative tool for assessing harm could mean a
reduction in medication errors. For those hospitals already paying for
access, centralized licensing would produce economies of scale that
could streamline processes to improve efficiency and facilitate group
purchasing, reducing costs.
And GTA-wide access is just the beginning. A province-wide site license
would expand access even more, making desktop and mobile access to the
best evidence-based drug referencing tools a reality at even the most
remote hospitals. In Nova Scotia, New Brunswick and Saskatchewan,
similar information initiatives are under way. Ontario, the last of
Canada’s provinces to introduce regionalized healthcare services, could
benefit by following suit.
Centralizing annual subscriptions assures standardized, seamless and
affordable access to evidence-based drug references for those who
benefit from it and those that might. The outcome is the right data in
the hands of the right people at the right place to make the right
Sandra Kendall, BA, MLS, is Director, Library Services, at Mount
Sinai Hospital in Toronto.
Wireless drug alerting solutions are making waves with physicians
By Dianne Daniel
For years Dr. Andrew Thompson has relied on electronic medical
references in order to check dosing information and drug interactions
when prescribing medications for his patients. What’s different these
days is that instead of juggling both a cell phone and a personal
digital assistant (PDA) in his lab coat pocket, the London, Ont.-based
specialist in internal medicine is using one device for everything,
including his phone, e-mail, and on-line reference guides.
About six months ago, Dr. Thompson began to use a Blackberry 8700 from
Waterloo, Ont.-based Research in Motion (RIM) Inc. The most significant
change apart from the integrated voice and data features, he says, is
that instead of having to synch with his computer to ensure the
information on his handheld is up to date, he now receives automatic
“It’s one source for everything and I don’t have to remember to charge
two devices,” adds Dr. Thompson, who says with his busy lifestyle it’s
easy to forget. “It’s kind of a dumb reality, but it’s there. How many
times have I picked up my (PDA) and it’s been dead.”
Dr. Thompson is among a growing number of physicians who rely on
wireless devices in their medical practice. Over the years he’s used
everything from a clunky Sanyo organizer to a Palm Pilot with a stylus,
and says at first he was hesitant to switch to the Blackberry, a
relative newcomer to the market.
“The Palm entrenched itself early on in this space,” notes Jeff
McDowell, vice-president, global alliances at RIM, “so they have the
advantage of existing for a longer period of time.”
Over the course of the last year, however, RIM has turned its attention
to the healthcare arena and now has eight independent software vendors
offering medical references and on-line functionality for its Blackberry
devices, including two guides used by Dr. Thompson: the Tarascon
Pharmacopoeia and Sanford Guide for Antimicrobial Medicine. According to
McDowell, the company is aiming to leverage its enterprise experience in
the healthcare space.
“In the last year it’s become clear to us that everything we’ve done
that was important for enterprises is as important, if not more
important, in the healthcare environment,” he says. “We’re not just an
individual user platform, we’re something a hospital can invest in from
a strategy perspective.”
The intent is to get software vendors to take existing information
written for other electronic means – normally accessed via a web browser
– and work with the Blackberry open development environment to create a
Blackberry version based on a Java client. While the web-based versions
will work on a Blackberry, it’s the Java client that enables software
vendors to add more functionality such as caching of data, automatic
updates and easier access to databases, notes McDowell. Once a
Blackberry version is created, it will operate on any Blackberry device,
from the newly announced Pearl to the more robust 8700.
RIM is also working with legislative groups and different hospital
communities to ensure it understands the unique requirements of
healthcare professionals. For example, the robust security features that
are necessary for compliance with privacy legislation are inherent in
the Blackberry platform, making it easier for hospitals to consider it
as part of an enterprise-wide mobile strategy.
Lexi-Comp Inc. of Hudson, Ohio, is one of the eight software vendors
currently supporting the Blackberry. A beta program of Lexi-Comp ON-HAND
software was expected to be complete in October, and Dr. Tina Go, an
epilepsy fellow in the Department of Neurology at Toronto’s Hospital for
Sick Children, was one of the first to jump on board.
According to Dr. Go, the user interface for the Lexi-Comp software is
easy to navigate on the Blackberry and there’s no need to open multiple
databases when looking for drug doses and interactions. “With the
Blackberry version… you can type in the name of a drug and get a choice
of adult or pediatric dose,” she explains.
Dr. Go had been using a Blackberry as her cell phone and e-mail/web
browser device for about two years, but also carried a Palm in order to
access the Lexi-Comp drug database and medical references she needs for
her clinical work. “For four months now I’ve been using my Blackberry
and leaving my Palm at home,” she says. “It’s my phone, e-mail, PDA –
Moving to “all-in-one” devices is a growing trend among physicians, says
Zak Bhamani, associate principal, market strategy, for Telus Business
Solutions. In June, 2006, Telus launched the first solution under its
Wireless Physician program: Epocrates Essential on the Palm Treo 650.
Like RIM, Telus is also taking a deeper look at the wireless needs of
the healthcare sector.
“We thought in order to start adding value immediately, let’s go with
something they already know and already love,” says Bhamani, noting that
Epocrates on a Palm came up as “almost a mainstay” in the Canadian
physician community when Telus researched the market. Like the
Blackberry platform, the Telus version of Epocrates offers automatic
updates so doctors no longer have to worry about downloading and
synching, as well as access to e-mail, calendars and schedulers. It also
features a newer version of the software that supports Canadian drug
“The Palm Treo 650 takes all of the things they were doing on their Palm
to the next level,” says Bhamani. “We’re giving them more functionality,
but avoiding the whole pain of adoption.”
Dr. Alan Brookstone, head of the Richmond Physician User Group in
British Columbia, has signed up for the Telus Wireless Physician and is
using the Palm Treo 650 as both his cell phone and PDA. The advantage,
he says, is that he has the device with him at all times and can quickly
access a current summarized database of drug information when needed, or
refer to services like Lexi-Comp’s Lexi-Interact on the web. He also
uses it to quickly review alerts, asking for more detailed information
to be sent to his e-mail address.
“I can see this type of wireless capability being very useful with
public health alerts,” he notes.
Bhamani expects to see an evolution of the wireless programs for
healthcare in the future as new devices continue to come onto the
Dyan Conrad, director of product management at the Canadian Pharmacists
Association (CPhA), agrees. “We’re going to be looking at the evolution
of the technology and adapting our content to make sure we keep up,”
says Conrad, adding that integrated devices like the Palm Treo 650 and
Blackberry are “coming on fast.”
The CPhA’s eTherapeutics clinical decision support software has a Mobile
Companion that supports Palm and Pocket PC handheld devices, and offers
access to drug information tables as well as a link to Lexi-Comp’s Lexi-Interact
to check for drug interactions. Right now there is no support for the
Blackberry. According to Conrad, automatic updates are available to
Pocket PC users via IBM’s WebSphere Everyplace Access technology, while
Palm users still need to hot synch with a desktop computer in order to
In terms of future developments, she expects to see mobile solutions
extended to include access to electronic medical records and hospital
information systems as well. “Physicians don’t want to log into multiple
applications,” says Conrad. “For us it would mean developing
relationships with EMR vendors. We’re aware of who’s out there and we’re
looking at technically how we can tie the content together.”
Use of IHE profiles eases network integration and spurs patient
By Jerry Zeidenberg
TORONTO – Not only can I.T. standards help connect
various healthcare systems and make the bits and bytes work effectively,
but they can also speed up the project management that’s needed to put
all of the pieces together. When the Thames Valley Digital Imaging
Network, in southwestern Ontario, employed IHE profiles to help mesh the
radiology systems of eight different hospital corporations, the use of
standards accelerated and smoothed the whole process of project
“It took away the emotion,” said Beth Goodhew, managing consultant with
Peninsula Consulting Group, which assisted the Thames Valley Hospitals
with the large-scale project.
As a result, the project managers didn’t get bogged down in arguments
about which method of connecting systems was best. Once they decided
what their priorities were, the ways of doing it were pretty well mapped
out by the IHE profiles – which are standard methodologies for solving
“It wasn’t a matter of how site A does it, or how site B does it – it’s
how the IHE does it,” said Goodhew, who spoke at a recent conference on
standards organized by the IHE and ITAC Ontario.
“IHE gave us the means to conduct discussions without finger-pointing,”
said Goodhew. “And that drove decision-making and productivity.”
IHE – short for Integrating the Healthcare Enterprise – is a movement
that emerged out of the radiology world, to help connect diagnostic
imaging systems. But it’s now extending to cardiology, laboratories,
pharmacies and throughout the healthcare enterprise.
Based in Chicago but gaining adherents around the world, IHE is made up
of healthcare professionals in hospitals and clinics, consultants and
vendors. Together, they’re devising ideal methods of getting disparate
IT systems to talk to each other, thereby promoting organizational
efficiency and patient safety.
Essentially, the IHE members are taking existing standards such as HL7
v3, DICOM and others, and creating ‘profiles’, which are set methods of
accomplishing specific tasks. These tasks include scheduled workflow,
patient information reconciliation and the consistent presentation of
images, among others.
Last year, IHE Canada was launched. Its web site can be viewed at
At the IHE/ITAC Ontario workshop on standards,
Goodhew noted that IHE profiles helped the Thames Valley Digital Imaging
Network integrate the PACS networks at eight sites in southwestern
Ontario in just two years. The first phase of the project, connecting
the eight hospital radiology departments, was completed in December
The sites include the London Health Sciences Centre and St. Joseph’s
Health Centre, both in London. These two large teaching institutions
produce 50 percent of the 750,000 DI exams produced annually by the
group. The remaining exams are generated by six outlying community
Together, the group has 55 radiologists, 10 residents and eight nuclear
medicine physicians. Over 200 systems were connected as part of the
In the first year of the project, sites in London were connected; and
with the lessons learned, the six other sites were all connected in the
The key IHE profiles used were scheduled workflow (“the basis of
radiology,” said Goodhew); patient information reconciliation (“the key
to data integrity”); consistent presentation of images; and charge
posting (billing systems.)
Also providing insights at the IHE/ITAC Ontario conference was Dr. Nogah
Haramati, a leader in the IHE movement and chief of radiology at
Montefiore Medical Center, a New York teaching hospital with 1,400 beds.
It has 100 radiologists and handles 450,000 diagnostic exams annually.
The Montefiore Medical Center has multiple off-site clinics and a data
centre located 30 miles away from the main site. Dr. Haramati explained
that since the terrorist catastrophe of 9/11, his hospital has been
de-centralizing services and sites as a disaster planning strategy.
Dr. Haramati asserted that the use of IHE profiles at the organization
has resulted in a multitude of benefits. Among them, he said, “are
patient safety issues, to look at just the low-hanging fruit.”
He noted that by implementing the IHE’s patient information
reconciliation (PIR) profile, rather than using free typing of patient
names and identifiers, the hospital has virtually eliminated the
misidentification of patients.
“PIR is very important to us,” said Dr. Haramati. “We need it because
people make mistakes. They’ll pick the wrong name from a worklist. A
tech will take a man’s name from the worklist and put a woman on the
table. It happens – they’re only human.
“But the IHE profile can catch this,” he said.
At another point in the conference, when audience members were asking
questions of panelists, a company rep noted that the process of building
standards like IHE profiles into their systems will cost money. He
wanted to know how much hospital executives are willing to pay for such
Dr. Haramati – who urges hospitals to demand in contracts that I.T. and
radiology suppliers build IHE profiles into their solutions –
acknowledged there are costs to vendors. However, he said that at his
hospital, they’re willing to join with the other healthcare providers to
create a list of top IHE requirements. “We’ll go along with them,” he
said. In this way, vendors aren’t working in numerous directions to
please individual clients, but are creating solutions that can be used
by a large group of customers.
Dennis Giokas, chief technology officer for Canada Health Infoway,
asserted that “standards will play a key role in interoperability,” and
in getting the myriad of healthcare systems across regions talking to
each other. He estimated there are some 40,000 healthcare I.T. systems
across Canada – an enormous systems integration project.
He pointed out that integration is a complex task, as to obtain real
value from interconnectivity, it will involve not just standard
information models, data types and terminologies, but semantic abilities
among computers, as well. “So that information can be understood when it
is exchanged,” he said.
Giokas observed that by the time Canada Health Infoway finishes its
initial mandate in 2009, it will have spent $50 million on standards
creation and promotion. Its total budget for spurring the rise of
electronic records and networks in Canada is $1.2 billion.
However, Giokas said an investment on the order of $10 billion will be
needed to create a completely integrated system, with much more than $50
million spent on standards. He said it’s far better for organizations to
work through Infoway on the creation and dissemination of standards than
to try creating I.T. standards for themselves – which may work in their
hospital or community, but not necessarily in their greater region or
One audience member asked whether it’s worth investing in standards or
shareable electronic patient records, at all, based on the premise that
most care is delivered locally and that records wouldn’t have to travel
Giokas answered that a good deal of care actually requires patients to
travel considerable distances, and that interoperable records could help
them immensely. He quickly mentioned three examples – the Maritimes,
where patients throughout the region will often travel to Halifax for
specialized treatment; the Electronic Children's Health Network (eCHN)
in Ontario, which connects pediatric patients and their caregivers
across the province to specialists in Toronto; and Capital Health in
Edmonton, which includes several tertiary-care centres that regularly
treat thousands of patients traveling from British Columbia, Yukon, the
Northwest Territories and Nunavut.
David Koff, a radiologist at Sunnybrook Health Sciences Centre, in
Toronto, noted that interoperability is desperately needed in I.T.
systems. Many physicians simply won’t use computers, even today, as it’s
too difficult to access the information they need from disparate
“We’ve got 170 different software systems at our institution,” said Dr.
Koff. “A lot are old, and they don’t communicate. Perhaps we are victims
of our early enthusiasm with computers.”
Because of this communication gap, many doctors don’t bother. “If they
have to go through different systems, log-in each time and work with
different GUIs, change their passwords every five days for each of them
– no way, it won’t happen.”
It must be much easier to access information, he said, with seamless
integration between disparate systems. This could be done, in the
future, at least, through the use of commonly accepted standards.
Dr. Koff said the roadblocks are not just technological, however, as
some doctors still have a psychological aversion to computers.
“Some think computers are a waste of time, and won’t use a keyboard.” He
asserted that “we must educate the users,” about the benefits of
clinical systems. “We need strong leadership,” he said.