Inside the November/December 2008 print
edition of Canadian Healthcare Technology:
community-care providers revitalize IT systems
Ontarios Community Care Access Centres (CCAC) have launched a group
of new IT systems that are expected to enhance the way case managers
and staff serve their clients.
Safer Healthcare Now!
reaches homecare sector
A nation-wide medication safety project has been launched by the
Victorian Order of Nurses in partnership with the Canadian Patient
Safety Institute and the Institute for Safe Medication Practices
READ THE STORY
Decision support for
Hospitals in Ontario are piloting the use of a new dashboard-driven
system that shows them how their DI departments are performing.
Armed with this kind of information, management should be able to
reduce wait times.
New technologies are throwing wrenches into the security plans of
hospitals, with data losses occurring in ways that are often
unexpected. The privacy and security chief at Ontario eHealth
provides advice on how to reduce the chances of such accidents.
READ THE STORY ONLINE
The use of iCongos MediChain solution for hospital procurement has
cut ordering errors by 98 percent at the CHUQ, in Quebec City.
Whats more, the hospital group is on track to reduce supply
ordering costs by 20 percent.
Vancouver General Hospital has become the first hospital in Canada
to test the new P10 ultrasound, from Siemens. Six specialists will
evaluate the device over a two-year period.
PLUS news stories, analysis, and features and more.
Ontarios community-care providers revitalize IT systems
TORONTO Ontarios Community Care Access Centres (CCAC) have launched a
group of new IT systems that are expected to enhance the way case
managers and staff serve their clients.
Among the solutions being deployed is a new case management system
called CHRIS (Client Health Related Information System). CHRIS is
designed to give case managers and administrators a common system to
enter and track patient information and service plans across the
Through what is referred to the Health Partner Gateway, or HPG, which
was also developed for the CCACs, CHRIS is able to link electronically
with the many healthcare service providers across the province who
deliver nursing and personal support services.
This goes a long way in eliminating earlier solutions using automated
fax machines and other less attractive communication methods, which in
todays technology landscape are clearly outdated.
The Community Care Access Centres (CCACs) in Ontario are operating in
over 200 offices/locations throughout the province and employ more than
8,000 people. They serve more than 500,000 clients, and provide more
than $1.6 billion worth of health services annually to the citizens of
The CCACs case managers co-ordinate the delivery of nursing and
personal support services to patients at home and provide assistance to
clients when they need to enter a long-term care facility. They also
assist the public by directing them to the right health-related support
services available to them in their community.
CHRIS is a replacement system for a number of the existing legacy
systems, which lacked many of the more advanced capabilities including
support for Ontarios healthcare transformation and eHealth
strategy.There were some systems in use that were 20 years old,
commented Kevin Arbour, vice president and CIO of the Ontario
Association of CCACs.
By modernizing, automating, and better supporting case management
processes through CHRIS, the case managers will be better able to
coordinate client care, and spend more quality time with their clients.
Getting CHRIS up and running in each of the CCACs is a substantial task,
as historical patient data must be migrated to the new solution at each
location. As well, training and change management coaching must be
conducted as staff become familiar with many of the new capabilities.
Interestingly, CHRIS was developed in-house at the OACCAC. Arbour says
it was an unusual move, taken after a review of available market
solutions found that none readily fit the needs of the CCACs.
More functionality is expected to be added to CHRIS, for which
off-the-shelf solutions will probably be needed. But for the core case
management system, we couldnt find anyone who had what we needed, so
we decided to build it ourselves.
For his part, Arbour is an experienced IT executive who worked at Bell
Canada, Nortel Networks and several entrepreneurial startup companies,
in Canada and the United States before joining the OACCAC and the
Remarkably, and in the short span of a few years, Arbour has created
within the OACCAC an eHealth Services team focused on supporting the
business and operational needs of the CCACs across Ontario. In close
partnership with the CCACs, the team completed the initial development
of CHRIS and began the provincial roll out in March of 2008. Its the
unique partnership and level of collaboration we have with all the CCACs
across the province that make this a success, says Arbour. It is truly
a privilege to be part of the CCAC transformation in the delivery of
healthcare services to the people of Ontario.
Other IT systems introduced to CCACs of late include automated client
assessment tools based on international assessment standards, that help
determine the right care plan for clients on CCAC service; an
enterprise-wide data mart, which helps CCACs analyze care plans and
client outcomes, and continually refine and improve services delivered
to their clients; an enterprise wide solution that ties together a
variety of different databases of community services, in order to more
easily direct clients to any community service available within Ontario;
and a modernized Voice over IP telecom system that eases internal CCAC
operations, enhances communications with partner organizations, and
supports Client access to case managers whether they are in the office,
To modernize and secure the flow of information among the CCACs, the
organization revved up an effort to install new computers and laptops
across the province. Additionally, the OACCAC modernized the CCAC
computing environment using Dells virtualization technology. All new
CCAC systems are being located in Class 5 data centers and take
advantage of the SSHA provided network backbone.
New computers are going into CCAC offices, pre-configured with the
software and enterprise class services such as email, messaging, and
desktop video conferencing, together with access to all CCAC IT systems
needed by staff.
The modernized systems are helping case managers to be mobile and
productive while working in different care settings such as nursing
homes, primary care settings (namely, Family Health Teams), hospitals
Said Arbour: Dell, Microsoft and Allstream continue to be among our
more strategic private sector partners. Theyre playing a key role in
fulfilling the CCAC provincial eHealth Strategy and supporting our IT
infrastructure, access services and unified communications and mobility
The deployment of a new, province wide, voice-over-IP network is just
one such example of the infrastructure solutions devised in conjunction
with these technology partners. According to Arbour, its a key enabler
in supporting the CCAC front line as case managers work in various
community care settings.
Pilot brings Safer Healthcare Now!
campaign to the home-care sector
Several Canadian organizations have joined forces to bring the benefits
of the Safer Healthcare Now! campaign into the home-care arena.
In September, a patient-safety pilot project for home care, with sites
across Canada, was launched by the Victorian Order of Nurses (VON), in
conjunction with the Edmonton-based Canadian Patient Safety Institute
and the Institute for Safe Medication Practices Canada of Toronto.
In particular, the project will seek to explore and enhance medication
reconciliation in the home-care sector. The plan is to launch with 20
teams located at sites in all provinces.
To date, the nation-wide Safer Healthcare Now! project which aims to
improve outcomes and reduce medical error has focused on hospitals and
With buy-in from large-scale medical centres across Canada, Safer
Healthcare Now! (www.saferhealthcarenow.ca)
has had considerable success in 10 different interventions, including
the prevention of ventilator-associated pneumonia, disseminating best
practices for myocardial infarction and boosting the use of medication
reconciliation to reduce drug-related medical errors.
But medication reconciliation is an important issue in the home care
sector, too. Prescription-drug troubles often start at home, where
patients are away from the supervision of professional care-givers for
days or weeks at a time.
Medication error in the home setting is a huge problem, commented
Philip Hassen, president of the Canadian Patient Safety Institute, a key
supporter of the Safer Healthcare Now movement. In hospitals, the
management of medications is all controlled. At home, youre on your
Hassen noted that many problems occur with prescription drugs once
patients leave hospital problems often leading to sickness and
re-admission. A major challenge occurs right upon discharge from
hospitals, as many patients dont understand when or how to take their
We know that after six months, less than 40 percent of patients are
taking their medications, commented Hassen.
Other patients tend to take too many medications. They visit a variety
of physicians and care-givers and will obtain multiple prescriptions
which can lead to medication conflicts or over-doses. The classic case
is the cardiac patient who is discharged from hospital with a
prescription for warfarin. But the doctors didnt know the patient was
already taking coumadin at home, said Hassen, in reference to a
commonly used heart drug that is known by several names.
He also cited a study by Dr. Alan J. Forster, co-director of the Ottawa
Hospital Center for Patient Safety, who found that 23 percent of
patients discharged from hospital suffer an adverse event, and of those,
72 percent were drug related.
This is why weve got to look at home care, Hassen said. We need a
better understanding of how home-care patients are taking their meds
what theyre taking and how theyre taking it.
According to Safer Healthcare Now!, medication reconciliation is a
formal process of:
Obtaining a complete and accurate list of each patients current home
medications including name, dosage, frequency and route;
Using that list when writing admission, transfer and/or discharge
medication orders, and;
Comparing the list against the patients admission, transfer, and
discharge orders, identifying and bringing any discrepancies to the
attention of the prescriber and, if appropriate, making changes to the
As part of the project, home care nurses will work to clarify which
medications their patients are taking, creating a complete and accurate
list called the Best Possible Medication History, or BPMH. They will
then identify discrepancies, especially at the transitions of care, when
patients are handed-off from one provider of care to another.
The discrepancies will be reported to the patients physician, so that
changes will be made to the orders, when appropriate. Moreover, the
medication list, and any problems encountered, will be communicated to
the patients themselves, along with their families and allied
The homecare pilot will design and test strategies for implementation of
medication reconciliation in client settings across the country. As
well, the teams will measure actual patient results, and develop a
structured and sustainable framework for use in the long-term.
The project will build on a mini-pilot conducted by Safer Healthcare
Now!s western Canadian node over a one-year period that ended in April
of this year. The project, known as the medication reconciliation
collaborative, involved acute-care hospitals, long-term care centres and
home care providers.
Were using their learnings to advance this pilot, commented Anne
MacLaurin, project manager for the Canadian Patient Safety Institute. In
particular, expertise developed in Saskatoon and Vancouver will be
relied upon to help jump-start the project. They were our star
performers, said MacLaurin.
The Victorian Order of Nurses is spearheading the new project, but
MacLaurin noted that several other home nursing agencies are also
participating. They include Paramed, Cancare, VHA Home Healthcare and
St. Elizabeth in Ontario, and the Centre de Sante et Services Sociaux
Jeanne Mance, in Quebec.
The announcement of the home care pilot project came during Patient
Safety Week, in September. Its an annual event, and this year the theme
was better communication as a way of improving patient safety.
The week will encourage patients to become involved by speaking up and
asking more questions, communicating with healthcare providers, and
understanding the important role they play in providing accurate
information about their current medications, said Hassen.
The Canadian Patient Safety Institute is urging all Canadians to keep an
updated list of their medications both prescription and
non-prescription drugs and to always take this list with them when
they visit a healthcare provider.
Moreover, Hassen said that if the patient is unable to do so, its
important to have a family member be aware of the medications they are
taking and to accompany them when visiting the healthcare provider.
He lauded the efforts of various provinces to create electronic drug
information systems, which will log the drug profiles of patients and
provide secure access to physicians and other care-givers, as needed.
The goal is to develop a secure e-record, said Hassen. It should
include all patients, all drugs.
Hassen noted that one of the biggest trouble spots for adverse drug
events concerns the communication of medication information to patients.
This often occurs at discharge from hospital, when a patient feels
stressed or disoriented, or is inundated with information and cant
process it all at once. As one strategy for dealing with this, Hassen
said doctors at some hospitals are now asking patients to repeat back to
them the instructions they have given for taking meds. This helps ensure
the patient has understood what was said.
Analytic system for DI aims to improve performance and patient care
By Dianne Daniel
In Ontario, there are four times as many CT scanners
and 12 times as many MRI machines in use today than 15 years ago. Yet,
patient wait times for these types of medical imaging tests still range
anywhere from five to 14 weeks.
Thomas Hough, founder and president of Mississauga, Ont.-based True
North Consulting & Associates Inc., is aiming to improve those
statistics with the release of Clearica3 (pronounced Clearica cubed), a
web-based decision support tool his company has developed.
The system is designed specifically to increase operational efficiencies
within Diagnostic Imaging (DI) departments.
Weve now got an environment that is ripe, where weve got all
transactions occurring electronically, says Hough, referring to
widespread use of picture archiving and communication systems (PACS) and
radiology information systems (RIS) within Canada hospitals. Now,
business intelligence can collect information on the fly as it occurs,
and show it on a digital dashboard with dynamically changing gauges.
Clearica3 is to be officially unveiled this month at the OHA
HealthAchieve conference in Toronto. It represents 18 months of
development work with Halton Healthcare Services Corp., a multi-site
healthcare organization in Ontario serving Oakville, Milton and
Georgetown. It is designed to give users a real-time view of everything
from utilization rates for imaging tests (modalities), to patient wait
times, to number of exams completed, to number of exams ready for
reporting, and also provides drill-down capabilities for further
For example, a gauge may indicate an MRI is running at 21 percent
efficiency. By double-clicking on the screen image, a user is presented
with more detailed information, such as the number of exams performed on
that machine so far that day, accompanied by a list that may include the
patient name and hospital ID, session number, clinical area, time of
completion, who ordered the test, who the radiologist was and who the
Another gauge may indicate the number of outstanding cases waiting to be
reported by the radiologist. And yet another gauge may show estimated
patient wait times.
In the past, radiologists would have an exam done on a Monday but not
report until Tuesday or Wednesday, notes Hough. The objective is to
get to just-in-time radiology, so they are doing the exams, reporting
them and getting them signed off on the same day as the image
Karen Worlidge, DI informatics system administrator at Halton
Healthcare, says Clearica3 not only enables users to react to day-to-day
operations, but also allows them to harvest information for reporting
purposes. A lot of the work we do in digital imaging is analysis after
the fact, looking at what you did last month as opposed to being
proactive and being able to determine what will be good for tomorrow,
she says. The information provided by this tool is key to being able to
redistribute resources, staffing and caseload in a real-time situation.
From Worlidges viewpoint as an alpha user, Clearica3 has the potential
to achieve better turnaround times for patient care by identifying and
improving bottlenecks in imaging. Patient days of stay is really
important to try to minimize, she says. If theres any way you can
reduce those patient days because theyre waiting for imaging they
cant get an imaging test so theyre being held over it will help to
reduce overall expenses for the hospital.
Clearica3 improves workflow by giving users a live look at cases
waiting to be done, cases completed, and cases waiting to be reported.
It enables administrators to see where usage is down and to shift staff
accordingly in order to avoid the peaks and valleys in activity that
cause inefficiencies, she says. It also enables hospitals with multiple
sites to move patients to where they can get their exams done faster.
Another advantage is the ability to monitor work in progress. If a
physician office phones to inquire about a specific patient, employees
in the DI department can find out whether the test has been completed,
or provide an approximate wait time if the patient is still in the
On the reporting side, the software helps hospitals to measure their
productivity in terms of workload units specified by the Canadian
Institute for Health Information (CIHI).
As Hough explains, every exam, test or function is assigned a certain
number of workload units. By comparing actual times to target times, a
hospital can get a better picture of its performance and can start to
make improvements or changes to bring those numbers more in line.
Through a regional reporting facility, they can also compare themselves
to other hospitals, he adds.
Any hospital with a PACS and electronic informatics system or RIS can
use the decision support tool, which is designed to interface with DICOM
and HL7 standards respectively. True North Consulting is using a
software-as-a-service model to offer the product, which includes
hardware, software, customer support, application training and
ever-greening services for one monthly fee.
We install it and allow them to run for six months; then we will send
in a consultant to do a two-day review of workflows and look at how they
can improve their productivity, explains Hough.
The companys intent, he adds, is to roll Clearica3 out nationwide
before investigating decision support opportunities in other ologies
of medicine such as pathology or pharmacology. Meanwhile, Halton
Healthcare is still in the alpha stage but intends to move forward
with a full implementation in the future.
This tool is really what is needed in Diagnostic Imaging in order to
improve services, says Worlidge. Were really a hub to the hospital;
so the fact that we have something thats DI-centric that can help
patients get better care is key.
New technologies lead to unexpected breaches of privacy and security
By E. Michael Power
Last year, a CBC reporter was tipped off to an
unusual privacy breach outside a Sudbury health clinic. Any nearby
vehicle with a rear-view backup camera, an increasingly common wireless
device, was able to intercept images from the clinics unsecured Wi-Fi
video surveillance system of methadone patients giving urine samples.
The incident embarrassed the clinic publicly, forcing it to switch to a
secure wired system, and prompted Ontarios privacy watchdog to urge
healthcare providers to immediately review any wireless surveillance
Just months before that 2007 incident, a laptop computer with personal
health information on 2,900 patients at Torontos Hospital for Sick
Children (SickKids) was stolen. An investigation revealed the laptops
highly sensitive information was unencrypted and not even relevant to
the researchers work.
More recently, a consultant working from home for Newfoundland and
Labradors Provincial Public Health Laboratory was shocked to get a
message from a stranger that sensitive health data on his laptop was
connected to a file-sharing program and exposed to the Internet through
an open computer port.
The common thread? Unintended privacy and security consequences in
leveraging technology. Telecommuting, high-capacity USB drives,
GPS-enabled cell phones, cell phone cameras, Wi-Fi hot spots, Radio
Frequency ID (RFID) and other technologies in the healthcare sector are
raising new and complex issues for care providers, administrators and
patients concerning the safety of personal health information.
A major challenge ahead for healthcare providers is balancing the
benefits of new technologies with potential privacy risks. Thankfully,
some best practices are beginning to emerge to help healthcare
providers, organizations and industry vendors bring a new level of due
diligence to ensuring privacy is maintained when healthcare technology
intersects with personal information.
Everywhere: Not long ago, most technologies storing
personal information (PI) were safely behind a healthcare facilitys
administrative, IT or finance doors. That fact has driven the existing
privacy and data security measures or policies in many organizations.
Today, however, PI-enabled technologies play an increasing role in the
direct care of patients. As such, administrators may be blindsided by
old school thinking that privacy is only a concern for the file
storage room, data centre or back-office computers. From handheld
devices with access to medical histories to Wi-Fi networks, the new
reality is technology and privacy concerns are everywhere. For example:
Telecommuting and Mobile Data: Among the biggest privacy risks in
healthcare organizations is allowing data to move or flow outside the
confines of the organization. Laptops can easily be stolen or accessed
by others inappropriately. Employees may have out-of-control curiosity,
causing them to access personal information on family, ex-spouses,
friends, community leaders or celebrities treated in their facilities.
Does your organization protect, encrypt or block access to PI wherever
USB Flash Drives: A 2007 U.S. study polled 370 IT professionals and
found 38 percent believe USB drives and portable storage devices are
their top security concern above even malware or viruses. And, 80
percent of respondents said their organizations had no measures in place
to combat unauthorized use of portable storage devices. Does your
organization control portable storage?
Cell Phones: Hardware and software applications in cell phones make them
as powerful as desktop computers. Many organizations have policies on
the use of cameras in phones, but few have policies on the use of
find/seek GPS features in the latest phones that allow people to be
On the issue of tracking, a technology being touted as the next big
thing in healthcare is the use of RFID to monitor medical supplies,
devices and even people. A Singapore hospital, for example, is using
RFID in its emergency ward. Fueled by a SARS scare, the hospitals
system issues all patients, visitors, and staff a card embedded with an
RFID chip, which records when and where a person enters and leaves the
facility. The information is stored in a computer for 24 hours and can
track who has had direct contact with whom.
Recently, Ontarios information privacy commissioner, Dr. Ann Cavoukian,
issued a detailed analysis of the potential privacy risks and benefits
in using RFID in healthcare. While endorsing its use and potential to
save lives, the commissioner also noted privacy concerns heighten as
RFID is used to tag people or things linked to people, such as patient
Examples of potential concerns are RFID tags used to monitor
hand-washing compliance or track the use of smart cabinets storage
cabinets with RFID interrogators that detect specific ID numbers
before allowing access. While the hospitals intention may be to track
compliance with its rules, RFID could also be used to create a
surveillance record of every individual.
The commissioner also expressed concern over RFID tags that are
re-writable or vulnerable to identity theft, recommending organizations
take steps to ensure RFID data cannot be copied in an unauthorized
Quoting a recent European study on RFID technology, the commissioner
notes technologies that involve privacy issues exacerbate a power
imbalance between the individual and the collecting organization.
Among fears commonly cited are: surreptitious identification of staff
members without prior knowledge or consent; systemic tracking and
surveillance; compilations of histories of individuals and interactions;
and incorrect inferences about individuals arising from the data.
Out of the commissioners analysis of RFID usage, however, emerge some
useful ideas and best practices for implementing new technologies of any
Best practices for privacy and security: First, it is important to note
the International Organization for Standardization (ISO) offers two
valuable standards for security controls and operational processes ISO
27001:2005 and ISO 27002:2005. They typically target security in three
Physical safeguards (locked cabinets, restricted office access,
Technical safeguards (passwords, encryption, firewalls, etc.)
Administrative safeguards (policy statements, clear responsibilities,
access restrictions, staff training, confidentiality agreements, etc.)
Beyond these or other standards, the next best practice is to
understand your own privacy and security risks. As the Commissioner
suggests, compile an information life-cycle for your organization,
which follows PI as it flows through your systems. Learn what and how
data is collected, for what purposes, how it is stored and used, and
with whom it is shared.
Next, ask some tough questions about how your technology affects PI.
When reviewing portable storage or communications technologies, for
example, one might ask:
Is there an authorization procedure in place for PI to be taken from
If PI is removed, is it encrypted or otherwise made anonymous?
If a device or data is lost or stolen, could you identify what PI is
stored on it?
After asking enough tough questions, other best practices will become
apparent, such as:
Ensuring staff and outside contractors have training on and access to
written privacy and security policies, as well as signing
Ensuring staff and outside contractors understand they may not copy or
transmit PI of third parties from computers unless authorized (including
e-mails or instant messages)
Providing facilities (e.g., shredding machines for CD-ROMs) to
securely destroy or dispose of PI no longer required
Removing or changing access to physical facilities and IT assets as
soon as staff leave or change responsibilities
Creating operational and systematic controls that can be measured and
Regularly monitoring the effectiveness of these controls
Another effective best practice is launching an internal awareness
campaign to foster a culture of privacy. At eHealth Ontario (formerly
Smart Systems for Health Agency), for example, employees were
extensively trained on privacy policies and then exposed on a regular
basis to a poster campaign reinforcing our privacy and security