Inside the November/December 2007 print
edition of Canadian Healthcare Technology:
Rehab launches assistive tech R&D project
Dr. Geoff Fernie, vice president of research at the Toronto
Rehabilitation Institute, announces the official start of the $36
million iDAPT R&D effort. iDAPT’s 14 laboratories aim to produce
technological solutions that will improve the lives of persons with
patients with personal EHR
Innovators at Sunnybrook Health Sciences Centre, in Toronto, believe
that their unique ‘MyChart’ Personal Health Record could, and
should, one day soon be – your chart.
READ THE STORY
Province-wide EHR in
New Brunswick announced an investment of $36 million to kick-off its
provincial electronic health record system. Over the next 10 years,
the province plans to put $250 million into the project.
If everyone agrees,
then why can’t I see my record?
In late May of this year, a large percentage of the health and
medical informatics community in Canada met in Quebec City for the
2007 eHealth Conference. One regular feature of this annual
conference is the Great Debate. This year the debate centered on the
question “should patients have unfettered access to their health
READ THE STORY
An endangered species?
Health information managers convened a meeting in Toronto to discuss
their collective future – which doesn’t look bright. With the rise
of electronic patient records, how does a health information manager
make himself indispensible?
Healthcare providers are being assisted by a new generation of
medical devices that offer advice and checks right at the patient’s
bedside. They’re especially useful to tired or distracted
care-givers, and are leading to improved patient safety.
St. Michael’s Hospital, in Toronto, has become the first medical
centre in the country to implement an automated blood-smear analysis
system. The solution has reduced the time spent by skilled
professionals on a repetitive task.
PLUS news stories, analysis, and features and more.
Large-scale R&D effort for rehab technologies announced in Toronto
By Jerry Zeidenberg
Toronto is expected to become an international hotspot for the
development of assistive devices and other solutions for the
handicapped, infirm and elderly, due to the official launch of iDAPT, a
$36 million set of high-tech laboratories.
iDAPT, short for Intelligent Design for Adaptation, Participation and
Technology, has been in the works for several years and is the
brainchild of Dr. Geoff Fernie, vice president of research at the
Toronto Rehabilitation Institute.
Toronto Rehab is supporting the creation of the labs, spread across
three different sites in the city, as part of an overall capital
Far from being isolated ivory towers, or mere test sites leading to the
production of dusty academic papers, the unique R&D labs will connect an
entire chain of participants needed to move useful ideas from the
concept stage to commercialized products.
Working together will be academic researchers, patients, physicians,
therapists, and industrial partners, all of whom will provide the
insights that are necessary to produce real-world solutions aimed at
improving the quality of life for people with disabling injuries or
“At one time, the field of rehab medicine was considered a backwater,”
said Dr. Fernie at a jam-packed launch event, held in the auditorium of
the downtown Toronto Rehab Institute. “Now, we’ve got people wanting to
Corporate giants like Lenovo and IBM have dived into the project. So
have surgeons, computer scientists, therapists and graduate students.
There’s now a sense of excitement about the rehab field, with a plethora
of new tools and technologies being used to transform the lives of the
What’s more, added Dr. Fernie, there are demographic reasons behind the
surging interest in rehab medicine.
Baby boomers are now hitting the age where their bodies don’t perform
like they used to – but intelligent, affluent individuals aren’t willing
to put themselves on the shelf because of infirmities.
“People today don’t accept the argument that you can’t get around
because you’re getting older,” said Dr. Fernie. “They don’t want to
spend the rest of their lives in a 200-square-foot room in a nursing
He explained there are new solutions for hip fractures, falls, sleep
apnea, infection control and many other incapacitating conditions or
dangers that can lead to illness.
What’s more, he said, “stroke care has been revolutionized in recent
times,” noting that Toronto Rehab researchers are moving ahead with
thought process control over objects – something that most, until
recently, assumed couldn’t be done.
Dr. Fernie explained that in addition to the graying Baby Boomers and
the elderly, people of all ages have disabling accidents. Even so, “They
still want to get back to things, they want to have fun.”
Indeed, Toronto Rehab estimates that over 3.6 million Canadians have a
disability affecting their mobility, agility, hearing, vision or
learning. Some 170,000 Canadians use manual and powered wheelchairs and
scooters to get around, and about 35 percent of Canadians over the age
of 75 use assistive devices.
The hardships facing these people shouldn’t be underestimated; yet, even
a small improvement in the equipment can make a major difference in
their day-to-day lives.
It’s the goal of iDAPT to make many such improvements, small and large.
Perhaps the centerpiece of the iDAPT project, which includes 14
different labs, is a state-of-the-art, subterranean facility called CEAL
– the Challenging Environment Assessment Laboratory. Built deep below
the Toronto Rehab Centre, CEAL will consist of a giant hydraulic
simulator that can generate winter-like conditions, including ice, snow,
gusty winds and slopes.
Resembling a huge flight-simulator from the aviation industry, the
machine will enable researchers to test people’s balance in inclement
weather conditions – something the disabled would have to contend with
during the Canadian winter.
A motion simulator will allow researchers to test people’s balance under
these conditions, enabling them to refine and improve the devices
Another large lab will consist of a typical hospital patient-care room,
but it will include an overhead catwalk for observation. This lab will
devise new solutions to reduce or eliminate injuries to caregivers who
are looking after the elderly or infirm in hospitals or nursing homes.
A modest, single-storey house serves as a lab where researchers can
develop artificial intelligence and smart home technologies. These
solutions will be of immense help to people with dementia and other
disabilities, allowing them to live as independently as possible.
And a movement evaluation lab is advancing research on treatments for
paralysis from stroke and spinal cord injury.
A fast-paced video presentation showed Dr. Fernie visiting a couple
other iDAPT labs. In one, he visits the centre’s ‘swallowing lab’, which
investigates how people with an inability to correctly swallow can waste
away, choke or swallow food into their lungs, potentially causing
pneumonia. It’s one of a few such labs in the world, and it’s doing
Captured on video, Dr. Fernie also visited iDAPT’s industrial design and
rapid-prototyping labs. Here, designers and students transform ideas
into real-world products, making them useful and attractive.
The devices can be quickly produced for testing as prototypes by a
computerized milling machine and lathe system – all state-of-the-art.
Some of the iDAPT labs are currently open with research under way. The
centerpiece CEAL facility, along with several others, won’t be ready
until 2011, when Toronto Rehab’s own capital redevelopment is expected
to be complete.
About $14 million of iDAPT’s $36 million budget has been supplied by the
Canada Foundation for Innovation. Speaking at the October launch, CFI
president and CEO Dr. Eliot Phillipson called iDAPT a “highly creative
and imaginative undertaking… with substantial societal benefits.” He
continued by saying, “It will result in new knowledge, ideas, technology
transfer, and an improvement in the quality of life for Canadians with
Mark Rochon, Toronto Rehab’s president and CEO, commented that the $36
million investment in iDAPT is the largest investment ever made in
Canada in rehab technology.
At the iDAPT launch, one of the speakers made his comments from his
wheelchair. John Shepherd is a Harvard MBA student who suffered a
catastrophic car crash. “Four-and-a-half years ago, I broke my neck,”
said Shepherd. But the well-spoken student hasn’t let that derail his
career plans, and is well on his way to completing his studies at the
Ivy league university.
The former Toronto Rehab patient is also involved in iDAPT as a project
consultant. His advice for researchers and industrial partners currently
developing solutions is to listen closely to the users of the devices –
people who have ‘skin in the game’ and the best knowledge of whether
something is useful, or whether it could be further improved.
“We’re the consumers of assistive devices,” said Shepherd. “We have the
expertise, and this expertise needs to be brought into the R&D process.
Consumers have a role to play in the research enterprise.”
Sunnybrook empowers patients with personal EHR
By Andy Shaw
Innovators at Sunnybrook Health Sciences Centre, in Toronto, believe
that their unique ‘MyChart’ Personal Health Record could, and should,
one day soon be – your chart.
All Sunnybrook patients are offered the web-based MyChart to not only
view their record of diagnoses, treatments, and test results, but also
to help create, manage, and in effect, own their own personal health
Developed relatively inexpensively in less than a year, Sunnybrook is
now extending MyChart beyond its sprawling campuses to care agencies in
the surrounding community and, if its developers have their way, to the
rest of the province and the country.
“We only spent about $150,000, mostly on staff costs to develop it, so
we don’t need to recoup our costs and we can therefore offer MyChart to
other users at no expense,” says Sam Marafioti, Sunnybrook’s vice
president of corporate strategy and development, as well as its CIO.
“Now, we know there are other personal electronic health record systems
out there, but none that we’ve seen is really a complete health record.
What MyChart users at Sunnybrook can access or do with MyChart is
• see and keep records of their care at Sunnybrook, including all test
results, such as labs, CT and MRI reports gathered by the hospital’s
electronic patient record (EPR) system;
• store and amend personal and family health information, including
symptoms, diets, exercise programs, allergies, medication history, and
• add care provided by other care teams including private clinics;
• view clinic visit notes;
• request and schedule appointments;
• request prescription refills;
• maintain and add to a name-and-address book of caregivers, physicians,
labs, and clinics;
• keep a personal diary;
• message physicians and clinic administrators who indicate they accept
• complete online questionnaires;
• find links to frequently asked questions (FAQs), procedure
descriptions, videos, events, and other content provided by Sunnybrook
that is specific to their diseases.
In addition, Sunnybrook patients can grant online access to some or all
of their MyChart record to family, primary care givers, community care
centres, pharmacists, and others.
“We like to tell the story of the 84-year-old farmer we call Percy. He
gave access to his offspring who live some distance away, and who were
concerned about his health after he fell off a roof while repairing it.
But with them monitoring his medications, appointments, and other care
carefully via the Internet, it’s enabled Percy to continue living on and
tending his farm independently,” says Sarina Cheng, the director of
eHealth strategies and operations at Sunnybrook. “In another case, one
of our patients in palliative care gave access to their
power-of-attorney, which is something we hadn’t thought of, but it makes
a lot of sense.”
Technically, Cheng and her development team built MyChart with
off-the-shelf applications, including Adobe’s ColdFusion MX 7, Flex 2.0,
and Flash 8 software. Microsoft Internet Information Server 6.0 hosts
the MyChart site, while its database runs on Sybase 12.5, held by a
Microsoft SQL 2000 server. To guarantee security, MyChart uses Microsoft
Windows 2003 Active Directory for authentication and Verisign
certificates for encryption. The latter is the same system used by
The benefits of MyChart, say Marafioti and Cheng, are not limited to
Sunnybrook patients. Staff are also experiencing improvements:
• no disruption to their current ways of doing things;
• a reduction in the number of phone calls and forms needed for
referrals and consultations with frequent-user patients;
• streamlining of workflow, thanks to MyChart’s appointment scheduler;
• a better informed, more readily treatable patient who has read
MyChart’s educational content and FAQs;
• and soon, for all 12,000 full and part-time staff members, the use of
MyChart for their own personal health records.
All that has given Sunnybrook the confidence to offer MyChart to others.
Patients, or “clients” as many community care agencies prefer to call
those they serve, with the Senior Peoples’ Resources in North Toronto
Inc. (SPRINT), a non-profit home healthcare agency, are also now in
control of their own records.
“I think what’s important to stress about MyChart is not just the access
to information it gives, but also the integration of care,” says Sandy
Seary McKinstry, a senior director at SPRINT.
“That’s especially important to community care providers who are more
numerous and more active in clients lives than their counterparts in
hospitals are,” says Seary McKinstry. “MyChart allows us to know more
about our clients, share their information, and thus provide them with
better overall service.”
Back at Sunnybrook, Marafioti and Cheng are continuing to adapt MyChart
to better suit different Sunnybrook departments and sufferers of
specific diseases. In the process, there have been lessons learned.
“The patient often gets test results before the physician has found the
time to look at them. So they can be quickly on the phone to the
physician’s office looking for an explanation of the results. And that’s
probably a good thing in most instances,” says Marafioti.
“But in really sensitive cases, such as the pathology results from a
biopsy that could spell cancer, perhaps it isn’t,” he adds. “In one
instance, for example, a patient saw the results of a test and concluded
that their condition had worsened – when it in fact it had improved.
“So our oncologists asked us if we could build in a time delay for
certain results before the patients sees them, enabling the physician to
make the call to the patient first if needed. So for oncology, we have
built that time delay in.”
Concludes Cheng: “MyChart helps with education, access, monitoring,
tracking, wait times and can be expanded to include all personal health
data, status, and medical history for an entire family – even pets, if
“It’s interactive, not a viewer. MyChart is a personal communication and
management tool for the health consumer and it is at its most powerful
for the continuity of care outside of hospitals. MyChart keeps the
primary care physicians, community services and other care providers
informed and it enables patients to have all their information at their
finger tips at all times – sharing it when they choose.”
‘One Patient, One Record’ system ready for
take-off in New Brunswick
By Jerry Zeidenberg
The province of New Brunswick announced in September that it will invest
$35.9 million over the next three years to establish a province-wide
electronic health record system.
Canada Health Infoway will contribute $18.2 million to the project, with
the remaining $17.7 million coming from the province.
The money will be used to put the essential building blocks in place for
the ‘One Patient, One Record’ (OPOR) system. The core components, as
announced, will consist of:
• an Interoperable Electronic Health Record. The Interoperable
Electronic Health Record is considered a foundation piece for the One
Patient One Record (OPOR) system. It will provide the infrastructure and
functionality required to link, capture, store and view relevant patient
• a Client Registry. The Client Registry system is essentially the
one-patient component of the OPOR system. With this system, each patient
will have a unique provincial identifier that will tie together patient
information from various clinical systems.
• a Provider Registry. The Provider Registry system will contain
information on healthcare providers in the province.
• and a Provincial Diagnostic Imaging Repository. The Provincial
Diagnostic Imaging Repository will consolidate a patient’s diagnostic
imaging reports and images for procedures such as X-rays, CT scans,
ultrasounds and MRIs, into a provincial repository.
The Department of Health has signed agreements with Initiate Systems
Inc. for a Client Registry solution ($1.9 million over two years) and
Orion Health for the Interoperable Electronic Health Record and Provider
Registry systems ($4 million over three years).
A third contract awarded to xwave for system integration and maintenance
services is worth $5.6 million over three years. The contract to create
a diagnostic imaging repository has been awarded to Agfa Inc., in the
amount of $9 million over two years.
Change management and training programs will also account for a large
measure of the investment. And as Canada’s only officially bilingual
province, New Brunswick is committed to developing solutions that work
in both English and French.
“These systems are key building blocks along the journey to a complete
electronic health record that will ultimately link all patient
information from across the healthcare system – from hospitals, from
your family doctor, from your local pharmacy and elsewhere,” said Mike
Murphy, New Brunswick’s health minister.
In terms of architecture, the province doesn’t intend to pioneer new
technologies or methodologies; instead, it wants to implement
time-tested solutions that have a track record.
It’s hewing closely to Infoway’s standards and solutions, and it has
watched carefully as other jurisdictions – Alberta and British Columbia,
in particular – have gotten their own province-wide programs off the
“We’re not the first to do this, but we’re going to catch up quickly to
the other provinces,” said Gordon Gilman, assistant deputy minister for
corporate services. “We’re a small province, which makes things easier
in many ways. We think we can catch up to the others in two or three
Many of New Brunswick’s hospitals are already sophisticated users of
electronic health records. However, the OPOR system will provide a large
measure of interoperability between the hospital systems, which are
provided by many different vendors and often lack an ability to talk to
The electronic health record from Orion will act as a kind of umbrella
solution, accepting information from all systems and providing a viewer
to healthcare providers across the province.
Carole Sharp, assistant director for projects, corporate services, at
the New Brunswick government, said that a central repository will be
established, housing patient data from disparate sources that will
result in a comprehensive single record for each person in the province.
Healthcare organizations will keep ownership of their data, but some of
it will be sent to the repository. “That will allow doctors and nurses
across the province to use a viewer to see an integrated record,” she
said. Sharp noted that not all data will be sent to the central
repository, only that which doctors, nurses and other healthcare
professionals consider to be essential.
For its part, xwave will provide system-integrator services, tying
together the various solutions so that disparate systems mesh in the
“xwave has over 30 years experience in building healthcare systems,”
said Paula Hatty, account executive with the company. “We’ve created
client registries and we’ve played a key role in developing the patient
wait time system in Ontario.”
Gary Folker, managing director of clinical management systems at xwave,
commented that the company is well-versed in interoperability issues and
Infoway’s blueprint for the design and construction of healthcare
“We’re also experienced in project management, and we’re well-positioned
to keep things on time and to deliver the best solution.”
Gilman commented that in addition to the four core projects, New
Brunswick has also embarked on a Prescription Drug Monitoring Program,
which will collect pharmaceutical prescription information at the point
of dispensing – that is, at the province’s pharmacies.
The program will track dispensing of some six or seven drugs – such as
oxycontin – that have been sources of concern in New Brunswick and other
provinces. “We’re going to monitor selected drugs that appear to be
problematic,” said Gilman. “We’ll likely share information with
addiction services and police forces.”
The province has completed an RFP for the Prescription Drug Monitoring
Program, and expects to select a vendor before the end of the year.
Moreover, New Brunswick will be implementing a full-scale pharmaceutical
monitoring program, which will deliver information to health service
providers at the point of care.
It will track the drug history of patients, provide physicians with drug
interaction information and allergy warnings, in a bid to improve
patient safety and the effectiveness of therapies.
Gilman noted that New Brunswick is currently in the planning stages of
the project, and that planning is being conducted in conjunction with
the province of Nova Scotia. “They’re developing the same kind of
system, so why not do the planning together?,” Gilman commented.
He observed that it’s much easier to bring experts to the Maritimes for
meetings once, rather than to request visits to different Atlantic
provinces on separate occasions. While the One Patient One Record
project is, for the most part, starting with large organizations such as
hospitals, the long-range plan is to include all healthcare providers,
such as doctors’ offices and clinics.
“The ultimate goal is to connect all sources of patient information,”
said Gilman. “That includes public health, mental health services,
doctors’ offices and others.” That will require additional investments
in new systems. Indeed, the province estimates it will need to invest
some $250 million in eHealth over the next 10 years.
If everyone agrees, then why can’t I see my record?
Kevin Leonard, PhD
In late May of this year, a
large percentage of the health and medical informatics community in
Canada met in Quebec City for the 2007 eHealth Conference. One regular
feature of this annual conference is the Great Debate. This year the
debate centered on the question “should patients have unfettered access
to their health information?” I was very fortunate to be invited to be
one of the debaters – on the pro side.
Before the debate even took place, the audience, of about 800 attendees,
were asked whether they agreed or disagreed with the debate question. It
was estimated at the time that approximately 90-95 percent of the
delegates responded in favour – yes, patients should have access to
their health information! And this was before the debate even started.
If so many people agree, then why can’t I see my record today? What is
the hold-up? What is stopping us from moving ahead in a direction where
there is overwhelming support – and this support is coming from
These are great questions that have been asked before, and we know that
the answers are not that straight-forward. One major reason is seemingly
banal, but overpowering: our delivery system has not accepted the idea
of patient access to their own medical records.
I know, how can this be? Is this not in direct contradiction to what was
stated in the preceding paragraphs? Well, yes and no.
In the abstract, yes it makes perfect sense that patients should have
full access to all of their health information. In an era where
consumers are becoming more involved in most every other aspects of
their lives, it is reasonable to assume that the same consumers would
want the same powers and freedom while managing their healthcare.
However, dealing with one patient at a time, considering the very nature
of the contents of a PHR (patient or personal health record), addressing
issues surrounding relevancy and privacy, the acceptance of full patient
access is not as readily forthcoming. More specifically, the resistance
is not, for the most part, technology-based but rather driven by a
health system infrastructure and culture that cannot change… at least
the way it is structured today. In other words, the system will not
change until a number of issues are addressed. Below, I outline three.
First, the healthcare culture, certainly when it comes to dealing with
patients, has been operating for generations with a paternalistic view.
The consensus is that most patients cannot be trusted to manage their
To some degree, this perspective is warranted. Further, some patients
appear to even go out of their way to provide evidence in order to
support this thinking. Smoking is one obvious case where there is
widespread poor health management by patients.
However, it must be emphasized that this is not the case for all
patients. There are many patients with chronic illness who truly want to
be more actively involved and empowered. I know that, as a patient, I
want to know all the facts no matter how tough they may be to deal with;
sometimes understanding the situation does indeed make it easier to
Second, the reimbursement structure within the Canadian healthcare
system does not motivate doctors (certainly not general practitioners)
to provide medical records access to their patients. While doctors most
assuredly want their patients to be informed, so as to improve their
health outcomes, in the end, there really is no reason to spend much
time or effort, not to mention funds, to provide this access.
In fact, one could argue, that the system today actually promotes and
reinforces an environment of face-to-face, one-to-one, healthcare
information delivery (as opposed to electronic communication) by
creating a simple payment formula – fee for service (i.e., see a
patient, submit a claim).
If patients get access to information through electronic means, there
will be fewer patient visits – no ifs, ands or buts! That is one of the
major benefits of IT – fewer visits, lower costs overall. While it is
true that the benefits of eHealth go well beyond the financial (i.e.,
patient safety, increased efficiencies), this is still an important
consideration that needs to be addressed. In the end, what would
motivate a clinician to earn less money?
Third, it is not yet an accepted fact that patients having access to
their own health information improves their health outcomes. The
research is still going on “in the labs”, but each month there is more
and more evidence demonstrating that the empowered patient is healthier.
So, where does that leave us? It would appear that no matter how much IT
development has taken place, or how much system interoperability is
created or informatics training is done, I won’t get to see my record
1. The overall system appreciates the role of the patient as an
individual and as a key stakeholder who must become active in healthcare
2. The financial framework begins to motivate clinicians to support
patients’ migration to feasible access of their own health information.
3. More research is funded to prove the hypothesis that informed
patients are healthier.
Kevin Leonard, MBA, PhD, CMA, is an Associate Professor, Faculty of
Medicine, University of Toronto.