Inside the November/December 2009 print
edition of Canadian Healthcare Technology:
report: Hospitals of the future
eludes many large healthcare IT projects
It’s not just eHealth Ontario that has run into trouble of late.
Large-scale healthcare IT projects in many locales – including
Britain and the United States – are floundering. Often, they’re
missing deadlines by years, running over-budget or simply failing to
advanced Osler gets back on its feet
Ken White says his goals as supervisor of the William Osler Health
System, in Brampton, Ont., have been accomplished, as the hospital
corporation is now operating effectively and efficiently. Its
flagship Brampton Civic Hospital had opened in October 2007 amid
controversies concerning shortages of staff and beds, wait times,
quality of care and lack of proper training.
READ THE STORY
A new pandemic surveillance system in Hamilton, Ont., that connects
five major hospitals to the city’s public health computers is up and
running – just in time for the possible resurgence of the H1N1 swine
READ THE STORY
The move to early diagnosis and the identification of ‘pre-disease’
will drive the merging of laboratory medicine and radiology into a
super-specialty, according to lab science experts at a recent
READ THE STORY
Since June, a group of cardiac patients in Montreal have been
engaging in anti-coagulation self-testing from the comfort of their
own homes, using a pocketbook-sized kit from Roche Diagnostics.
A new generation of bedside terminals,using a single communications
network, is delivering both clinical information and entertainment.
The systems can connect to electronic patient records and display
X-rays, and also run the latest episode of Grey’s Anatomy.
PLUS news stories, analysis, and features and more.
Success eludes many large healthcare IT projects
By Jerry Zeidenberg
It’s not just eHealth Ontario that has run into trouble of late.
Large-scale healthcare IT projects in many locales – including Britain
and the United States – are floundering. Often, they’re missing
deadlines by years, running over-budget or simply failing to work.
It all goes to show how complex these massive projects really are, and
how difficult it is to succeed at them. Perhaps there is something to be
said for a ‘small is beautiful’ philosophy in healthcare IT, a strategy
that concentrates on modest-sized ventures and carefully scales up.
In October, the auditor general of Ontario reported that the province
had spent $1 billion on e-health projects over the past seven years,
with virtually nothing of value to show for the investment. The impact
of the report sent the provincial government reeling and resulted in the
resignation of the minister of health.
But other organizations and jurisdictions are having their share of
disasters with large scale healthcare technology projects – what might
be called over-arching healthcare IT solutions.
The Veterans Administration in the United States is a case in point.
Just a few years ago, the Vista health information system at the U.S.
Department of Veterans Affairs (VA) was touted as the very model of a
modern EHR system. The VA is a huge organization – it runs 153 hospitals
and 1,140 outpatient clinics – and the Vista system was credited with
boosting quality and customer satisfaction, along with reducing medical
Lately, however, it seems the VA can’t do anything right when it comes
In July, the VA suspended work on 45 IT projects with a total value of
US$200 million, as they were running late or over-budget. One project
was 17 months behind schedule and 110 percent more costly than planned.
The department is re-evaluating the projects to see if they should be
cancelled or re-started.
Even earlier this year, the VA scrapped a US$167 million project to
build a new patient scheduling system. The project, known as the
Replacement Scheduling Application (RSA), has been in the works since
2000. But by 2007 it had run into serious trouble. That year, the VA
brought in a sister agency – the Space and Naval Warfare Systems Command
– to help out. That effort, too, ran into logjams and the project was
finally cancelled in March of this year. The project spent $120 million
and has little to show for it.
A review of the RSA project, published in August, was particularly
damning. It found there was a lack of program and requirements planning
throughout the nine years of the project. Moreover, it concluded that
the VA didn’t have the in-house expertise to execute large-scale IT
projects. Finally, it found that management of the project changed too
often – four times between 2000 and 2009.
The reputation of the VA IT shop was further damaged during the year by
revelations of misspending on bonuses and awards, as well as nepotism
The VA’s Office of Inspector General found $24 million in questionable
awards and bonuses were handed out to staff during 2007 and 2008.
According to the OIG’s report, “The frequent and large dollar amount
awards given to employees were unusual and often absurd.”
Four high-level employees received about $60,000, $73,000, $58,000, and
$59,000, respectively, according to the report, without sufficient
justification. Another employee received a $4,500 performance award
within the first 90 days of her employment from a manager who said that
she did not even remember her.
On a related note, one high-ranking VA official is currently being
investigated for using her influence to have a friend hired, and to have
her office transferred to Florida when most of her work needed to be
done in Washington. The VA was picking up the tab for her commuting.
Nevertheless, Washington is pouring even more funds into the VA’s
information technology efforts. In July, the Senate Appropriation
Committee proposed that US$3.3 billion go into the 2010 budget for IT at
the VA. That’s nearly US$767 million more than in the current year.
The money is to go into modernizing the VA’s electronic health record
system, process claims electronically, and integrate medical records
from the Defense Department with those of the VA – something that is
proving harder to do than first thought.
But change is under way at the VA. New management has instituted an
oversight system to deal with runaway IT projects. The Program
Management Accountability System, according to the VA, will “ensure that
progress is demonstrated and non-performing projects are identified and
Across the pond, the ‘Connecting for Health’ program in England is also
a source of frustration. To borrow a phrase from the Queen, it appears
that Britain’s national programme for healthcare IT is having an ‘annus
horribilis’. The £12.7 billion programme – billed as the world’s largest
civilian IT project – is running four to five years late, possibly more.
It suffered several highly publicized and embarrassing site failures in
2008 and 2009. And to top it off, the opposition Conservative party
boffins are now saying they’ll scrap much of the program if they’re
brought to power in the next general election – an increasingly likely
event, given the unpopularity of the current Labour government of Prime
Minister Gordon Brown.
“Quite clearly the government went about it entirely the wrong way, this
centralized top down system,” said Andrew Lansley, the shadow health
secretary, in a report published in the Daily Telegraph newspaper in
In a policy statement published that same month, the British Tories
critiqued the existing healthcare IT programme, now known as ‘Connecting
for Health’, and asserted that if it wins the next general election,
expected in June 2010, a Conservative government will:
• Seek to dismantle the IT central infrastructure, delivering its
benefits through local systems instead.
• Allow hospitals to use and develop the IT they have already purchased
and developed, within a rigorous framework of interoperability.
• Encourage the use of open source across the public sector.
What’s more, the Tories are saying that much of what the Labour
government has tried to accomplish with its expensive and bureaucratic
IT program could be implemented far more easily – and cheaply – by using
personal health record solutions like Google Health and Microsoft
To be sure, the Conservatives may be jumping the gun on personal health
records, as Google Health and Microsoft HealthVault are still works in
progress, and generally unavailable outside the United States.
Nevertheless, numerous reviews and observers have made the point that
despite years of work and substantial spending, the British healthcare
IT programme has fallen far short of its original goals and has missed
its timelines by a long shot.
At the core of the whole system will be the electronic health record,
housed in centralized databases that are referred to in Britain as the
spine. In theory, they’re designed to give caregivers throughout England
access to the charts of all patients. Two providers have been awarded
responsibility for installing EHRs across the realm – iSoft, with its
Lorenzo system, and Cerner, which is delivering its Millennium system to
However, here is where a great deal of the difficulty lies. Very few
Lorenzo and Millennium systems have been implemented in hospitals.
According to analysts, Cerner has a respected EHR in its Millennium
system, but the Kansas City-based company has had to revise its
administrative systems to suit the British way of doing things – a
time-consuming process. And while iSoft had excellent administrative
software, it lacked a clinical record. It has taken the company years to
produce one, and they’re just starting to be introduced to English
Not only have there been software delays, but according to observers,
the National Health Service has failed to adequately invest in training
and change management. It has been pointed out that organizations like
Kaiser Permanente in the United States, which has had some success with
its EHR, have invested as much in training as in hardware and software.
Moreover, many in England feel that the NHS has imposed Connecting for
Health and its systems on hospitals. Many physicians and allied
professionals haven’t bought into the program, another ingredient needed
Indeed, due to mounting political pressure on top management, the
National Health Service has informed its two major system integrators,
British Telecom and Computer Sciences Corporation, that they must
achieve a working installation at a major acute care hospital by
November 2009 and March 2010 respectively. If they don’t, the NHS says
it will “look at alternative approaches.”
Christine Connelly, the NHS director general for informatics, was
reported in the Guardian newspaper as saying: “If we don’t see
significant progress by the end of November 2009, we will move to a new
plan for delivering informatics to healthcare. “
Meanwhile, back in Canada, Quebec’s province-wide EHR is experiencing
labour pains. The $563 million project appears to be running late.
Initially, the project was scheduled to be deployed over four years,
from 2006 to 2010. The completion date has been postponed to June 2011,
but some doubts have been raised as to whether that deadline will be
This spring, the auditor general of Quebec released a report on the
Dossier de Sante du Quebec, the name by which the project is known, and
stated that, “All of the projects that make up the DSQ have fallen
behind by several months, even years, and a good portion of these
projects will not be completed before December 2010.”
What’s more, the auditor general questioned whether doctors, nurses and
pharmacists will buy into the new system. He noted that several regions
are moving forward with their own electronic health record systems as
they’re seen as offering more short-term benefits than the DSQ.
The Auditor commented that the $563 million budget of the project needs
to be reassessed in the light of scope and timetable changes. As well, a
previous investment of $327 million should be added to the total.
Finally, the Auditor points out there will be recurring costs of some
$85 million annually which will have to be budgeted for. Overall, the
Auditor General is saying, it’s going to be a more expensive project
than originally suggested.
Renamed William Osler Health System looking for a ‘new
By Martin Slofstra
BRAMPTON, ONT. – The man appointed by the Ontario government two years
ago to sort out problems with the opening of the new Brampton Civic
Hospital says his job is done, while re-affirming a commitment to the
huge role technology will play.
At an event last month called New Beginnings – intended to herald a new
start for the hospital and attended by 700 local people – Ken White
provided an update and introduced a new long-term vision. The changes
also include a new name, William Osler Health Centre is now called
William Osler Health System.
The flagship Brampton Civic Hospital opened its doors in October 2007
amid controversies concerning shortages of staff and beds, long wait
times, poor care and lack of proper training. (William Osler also
includes Etobicoke General Hospital in west Toronto.) Soon after his
arrival, White embarked on a program of reform featuring a shake-up of
hospital management, measures aimed at increasing efficiency and
improving patient care.
A final report will be submitted to government later this year.
“As we found out when we opened the new building here, the technology
component is much bigger than people expect,” says White, the
government-appointed supervisor in an interview immediately after the
White outlined several technology initiatives:
“The biggest challenge is keeping up with the manpower needs. As the
technology expands, we need more training programs.”
“But there is more to be done,” he added, “especially in emergency care,
not just here, but province-wide, the whole network and interface with
“The province is working towards the electronic health record, and we
will establish that sort of linkage across the province.”
White said he put out a vision for advanced, ambulatory (walk-in) care
and it was a tough push because the government was not totally sold on
the concept. “We now have a leading-edge ambulatory care centre that
they come from all over Canada and the world to see. This one I think we
can take further. I believe it is the future of healthcare.”
And information technology will be a big part of the hospital’s strategy
going forward, he confirmed.
“The organization has just started a transformation project, and it’s
going to look at every major business process that we have in the place.
IS really has to step up to plate for it to be able to do that,” says
Stephen Hall, chief information officer at William Osler Health System.
“The vision behind that is the quality of the patient experience is
going to be optimal or as best as possible,” says Hall, who took over
the CIO position at William Osler in March of this year.
Hall says the hospital is now in a good position to leverage its IT
“It’s pretty much a state-of-the-art hospital from a data and voice
perspective,” he says.
“We have voice over –IP with a smattering of TDMA where high
availability is required. We have wireless throughout the whole
facility, not only for staff and clinicians, but for visitors.”
“We have a state-of-the-art data centre which is something not a lot of
hospitals are building these days. But I’m glad that the people who
conceived of it put it in the plan, because that is paying huge
dividends to us.”
“And we have a huge storage-area network with 150 TB of ‘live’ data, up
from 100 TB a year ago.” (The total includes diagnostic imaging.).
Hall acknowledged that there are some challenges. “As part of the LHIN
we are in, Osler is by far the largest provider of health services. This
is the mothership. When you go beyond Osler’s walls, the complexity and
quality of IT support that is available drops off quite markedly, so
many community agencies and other health service providers don’t have
much in the way of capability. Part of the strategic plan is to leverage
the assets for them as well, and make these services available to them
on a cost-recovery basis.”
Hall affirmed that the idea of changing the name from centre to system
makes sense, since these days, a hospital is much more than a building,
it is all about networks and systems, and what may not be as well
understood is how much depends on the central IT infrastructure.
“This is part of the build of Brampton Civic Hospital,” said Hall, “and
all around that is tons of IT, from sophisticated monitoring devices
beside the patient, to what the anesthetist is doing, to nurse’s
applications including browsing and e-mailing, to video and images, to
staff scheduling, patient scheduling, physician access to electronic
records both on and off-site.”
In addition, healthcare is designed for high availability. “The systems
have to work without fail,” he said. “We have dual paths between
facilities, a diesel generator, back-up IT infrastructure and a 7X24
ability to recall staff. We have had 100 percent availability since we
Hall says his biggest challenge is funding. “There is really significant
demand for data and systems and computer services from the clinical
folks and IT budgets are finite in size. Matching supply and demand is
“The truth in healthcare is that there is always a good reason for
providing data or a service, but you just can’t get to it all.”
“The physicians and nurses we have here are really willing adopters of
technology. The biggest challenge is keeping up with it. It’s a money
Hall insists also that all changes are going to be led by clinical
people, and “it has to be led by clinical people. The single biggest
mistake that people in IT in health are make is that they don’t ask what
the clinicians want often enough.”
Hall detailed a number of initiatives now underway:
Electronic Health Records. Currently, BCH produces 1.6 million pages of
patient results per year, which includes copies of results that are sent
to physicians by mail. “We are trying to get automated fast. Most
physicians don’t have electronic health records, but the ones that do,
we will send electronically.”
Software integration. BCH has 150 specialized applications, but
relatively speaking, it has only a small team that does application
development. The lion’s share of development work, he says, involves
integration, that is, moving data from one system to another.
Document management. BCH took an inventory and found two million
documents on all of its computer hard drives. “Although it’s a huge,
unmanageable number, when physicians saw this, they wanted us to do
something to manage this.” To deal with the volume, the hospital is
planning to implement a SharePoint Document Management System.
Business reporting. In accordance with government regulations, BCH plans
to develop more reporting systems around patient satisfaction, wait
times and surgical patient care. “We are re-inventing the technology
under that and the intent is to provide really relevant business content
right to the desktop, from doctor to clerk. No more big fat reports
coming in the mail, it will be focused and relevant to what you do.” The
hospital has also developed a Web-based patient satisfaction form and
the results are fed into a central system.
IT-supported surgery. Surgical operations that required a huge opening
are now being replaced by minimally invasive procedures using small
slits in different locations, with instruments and cameras inserted on
catheters and endoscopes. The benefit is that the patient recovery time
is much quicker, says Hall.
Although not with the hospital at the time, Hall says the healthcare
facilities’ previous problems need to be put in perspective.
A lot had to do with unanticipated volumes. Brampton Civic Hospital is
believed to have Canada’s busiest emergency department, with 149,000
visits last year.
Commenting on the move in Oct. 2007, he says. “It was a nightmare. It
was characterized by trying to make too many changes at one time. Even
with all the training, there was too much change in one shot. They moved
a hospital in 24 hours. Can you imagine?”
Pandemic surveillance system connects five
hospitals in Hamilton
By Rosie Lombardi
HAMILTON, ONT. – A new pandemic surveillance system connecting five
major hospitals in Hamilton to the city’s public health computers is up
and running – just in time for the possible resurgence of the H1N1 swine
The timing is fortuitous, says Nancy Greaves, surveillance unit manager
at Hamilton’s public health department. The city has actually been
planning the implementation for the past two years.
“This system will save us a lot of time, as we can detect patterns and
syndromes popping up at hospitals sooner and we can formulate a response
to prevent their spread,” she says.
The facilities using the new system are:
• McMaster University Medical Centre
• Henderson General Hospital
• Hamilton General Hospital
• St. Joseph’s Healthcare Hamilton –
• St. Joseph’s Healthcare Hamilton –
King Campus (Urgent Care)
Hamilton’s new Acute Care Enhanced Surveillance (ACES) system is the
latest refinement of the original open-source system called RODS
(Real-time Outbreak Detection System) developed by the University of
Pittsburgh after the SARS epidemic in 2003. In 2006, it was Canadianized
and implemented in nine hospitals in the Kingston region by local system
integrator Cissec Corp., with the support of the Ontario Ministry of
At a high level, the system’s workings are fairly straightforward.
Information is collected from hospital ER triage computers and
transmitted via the secure eHealth Ontario network to the public health
department’s Oracle database. The ACES application then mines the data
and categorizes patients’ chief complaints into eight main syndromes
such as gastro-intestinal, respiratory, fever ILI (influenza-like
illness) and so on, explains Justin Rimmer, director of customer
relations at Cissec.
“Basically, it takes the narrative the ER nurse types in, puts it
through a classification engine, compares the counts to seasonal
averages, then produces reports and alerts,” says Rimmer. “The system
uses algorithms to sniff out all variations of medical terms, so nurses
can just type in stuff as they normally do.”
At the public health department end, epidemiologists review the hospital
data on a daily basis to discern anomalies in illness patterns. This can
speed up responses to potential outbreaks considerably, and creates a
big picture view that hasn’t existed before.
In the past, public health officials typically had to wait weeks for
laboratory tests to confirm an outbreak – which might not be conducted
for minor illnesses, explains Greaves.
“For example, with E.coli, there may be people with diarrhea showing up
in ER, but physicians may not necessarily order the stool tests that
would confirm the cause. But if we see a spike, we can communicate that
to our hospitals and ask them to get stool samples for all cases of
She says sending information to a central site for processing also
improves communications across the hospital network, as hospital A may
not be aware of an outbreak showing up at hospital B. “The system helps
us strengthen all that messaging.”
While ACES can be set up to receive electronic information from family
physicians, pharmacists and other sentinel sources, many of these feeds
aren’t automated yet, says Alex Carlassara, senior business support
analyst at Hamilton public health. “It’s our first step in pandemic
surveillance and one of many layers of defence. But other sources of
information could be incorporated into the system in the future.”
Consensus is harder than technology: From a technology standpoint,
implementing ACES isn’t difficult, says Carlassara. “At our end, it
meant installing an application on a server in our data centre. At the
hospital end, it involved writing scripts that’ll go into their
databases and pull out the specific fields we need out of their records
and sending HL7 feeds in the proper format.”
Hospitals are already collecting data in HL7 format, and are only
involved in transmitting it to ACES, says Rimmer. “The technical
components aren’t hard. But we did need to create a HL7 parser, as HL7
protocols aren’t implemented in the same way at all hospitals.”
But there are many organizational and management issues to contend with
in this type of project, says Carlassara. “The biggest challenge was
ensuring all parties really understand what they have to do. This is why
we hired Cissec to work with our IT areas and the hospitals, to talk
their talk and get the right people connected.”
Rimmer agrees most of the real work in the project was in the
back-and-forth of coordination with multiple organizations: getting all
parties to agree on the rules of the system, and then getting the right
experts involved in the actual implementation.
There are many data-sharing and governance agreements to hammer out,
says Greaves. “How the data is used and stored, what communications
routes will be used and so on – those are all issues that need to be
worked through. And there are privacy issues: Although we don’t get
personal information about individuals, hospitals have to meet privacy
legislation requirements in Ontario. Also, we had to develop partnership
arrangements between two hospital corporations and public health so all
parties could sign a data sharing agreement.”
The agreements developed in the previous Kingston pilot implementation
were useful, but there are some differences in Hamilton’s scenario that
had to be worked in, she says. “We did actually use significant chunks
from Kingston as templates, but the 10 percent that’s different in
Hamilton required work. There have been changes in privacy legislation
since Kingston did its implementation, and it was also set up as a
research project whereas ours is an ongoing one. All of that had to be
The Niagara region and other jurisdictions are considering a similar
system, says Rimmer. While future implementations will likely be easier
for hospitals building on Kingston’s and Hamilton’s experience, there
will still be differences to work through. “What’s different in each
region are the hospital structures and their relationship with public
health. Establishing and developing that relationship is a big part of
the work,” says Carlassara.
Panoramic future: There are many questions about the rollout of
Panorama, a public health surveillance system being developed by the BC
Ministry of Health (MoH) for Canada Health Infoway, and how systems such
as ACES will fit in later.
As Panorama is still in the works, Hamilton’s ACES and other systems can
serve as interim, stop-gap measures that can likely be used as a
foundation later with Panorama.
According to the BC MoH, hospitals should go ahead with interim systems
In an e-mail exchange, Ministry staff said: “Hospitals should not wait
for Panorama, since it very unlikely that Panorama would be implemented
in a hospital acute care setting. Panorama has been developed to address
the needs of public health in Canada, not the needs of hospitals.”
No definitive timeline for Panorama’s rollout was provided in the
exchange. “Panorama will be offered to each Canadian jurisdiction, who
will implement Panorama based on their own timelines and roll-out
Experts predict closer collaboration among
radiologists and pathologists
By Jerry Zeidenberg
TORONTO – Radiologists and pathologists will probably merge their
specialties in the future, creating a super-specialty called ‘diagnostic
medicine’, says Dr. Bruce Friedman, professor emeritus of pathology at
the University of Michigan in Ann Arbor, Mich.
Dr. Friedman spoke in October at the Executive Edge forum (www.exec-edge.com),
an event organized regularly in Toronto by QSE Consulting, and the Dark
Report, of Austin, Tex., consulting and intelligence companies that
concentrate on issues of laboratory management.
Dr. Friedman asserted that medicine is moving from the treatment of
disease to the promotion of wellness. Part of that process will be the
very early diagnosis of disease – something he refers to as the
discovery of ‘pre-disease’ – so that treatment and preventive measures
can begin at the earliest stages.
The techniques used will involve a combination of lab-based molecular
diagnostics and genetic testing with radiological modalities like PET
scanning, to uncover abnormalities and growths in their earliest stages.
He observed that outfits like GE Healthcare and Siemens, traditional
titans of the radiology world, have both acquired laboratory companies
to prepare for this development.
“We’re entering the golden age of diagnostics,” said Dr. Friedman.
“We’re starting to diagnose disease before it becomes symptomatic.”
“And who are the specialists diagnosing pre-disease?” he asked. “It’s
radiologists and pathologists, so the prize is there for us to take.”
Dr. Friedman noted that patients are trying to seize control of their
health, saying they’re becoming “proactive and pre-emptive”.
“Yuppies want to know what’s going to happen to them downstream, and
what preventive actions they can take.”
Drilling down, he explained that when cells are diseased, they
communicate by releasing proteins. “In proteomics, that’s what we’re
detecting,” he commented, referring to a newly developing branch of
He said the rise of diagnostic medicine will require much more workflow
integration, with the melding of IT systems in hospitals – namely, the
laboratory information systems (LIS), radiology information systems (RIS)
and picture archiving and communication systems (PACS).
All of these, he said, will be connected to the electronic medical
At the moment, there isn’t a good deal of integration of this sort, at
least in the U.S. “EMRs in the United States are not capable of
integrating complex data from lab and pathology systems,” he said.
In the future, however, the fusing of radiology, laboratory medicine and
pathology into a super-specialty will drive this kind of integration
Additionally, he pointed out that ‘nighthawk’ services, in which remote
radiologists perform readings of studies for hospitals whose rads have
left for the evening, are already expanding to daytime services,
becoming ‘dayhawk’ service providers. They’re filling gaps at hospitals
that have shortages of skilled radiologists around the clock.
Dr. Friedman said that in the future, such remote services could be
provided for laboratory and pathology services, as well. “We could have
a super-national diagnostic network,” he said, providing both tele-radiology
and tele-pathology services.
On a more ominous note, Robert Michel, editor of the Dark Report,
observed that Canada’s continuous under-funding of laboratories over the
years is now wreaking havoc with the delivery of medicine across the
Michel, a respected analyst, asserted that lab medicine is the lynch-pin
of the medical system, with up to 80 percent of the medical records of
patients made up of lab test results. Physicians, he noted, rely on lab
information to make their diagnoses and to prescribe various treatments
However, he said, “For the last two decades, Canada has underfunded lab
medicine, and we’re now seeing the disruption that happens.”
He outlined some of the lab catastrophes that have occurred in recent
years in Canadian provinces:
• 2005: breast cancer testing errors in Newfoundland and Labrador;
• 2008: pathology testing problems in Ontario, Manitoba and New
• 2009: breast cancer testing problems in Quebec, with serious quality
Michel explained that labs are complex operations, with hundreds of
different assays being performed. “When the budget knife cuts too deep,
there’s damage to the lab’s ability to produce accurate results and
patients pay the price.”
Dr. Jagdish Butany, director of autopsy services with the University
Health Network in Toronto, and past president of the Canadian
Association of Pathologists, further analyzed the problems that Canadian
labs have experienced in recent years. He also outlined the challenges
that will face lab professionals in the future.
Until very recently, commented Dr. Butany, medicine has been dominated
by a ‘blame and shame’ culture, in which mistakes were hidden. He
contrasted that with the airline industry, which analyzes each and every
plane crash to help prevent similar crashes in the future.
What’s more, quality control systems weren’t in place in many Canadian
labs, especially in eastern Canada. “Quality means doing it right, every
time, even when no one is looking,” commented Dr. Butany. As well,
Canadian labs have been plagued by morale problems. Often, they’re
located in basements with no windows. “They’re lumped in with the
kitchen and the laundry,” he said, adding that “salaries have been the
pits, positions have been cut, there’s been a lot of blood-letting with
lab budgets cut. There is antique equipment, and of late, university
medical schools have de-emphasized pathology.”
All of these problems have combined, said Dr. Butany, to create a
‘perfect storm’. The result has been medical error and mistakes in
several Canadian labs – mistakes that have taken a toll on the health of
However, Dr. Butany said moves are afoot to increase salaries and
improve working conditions, which will raise morale. In addition, there
is a plan to accredit all labs in Canada, to improve quality. As well,
there are recommendations to design quality frameworks for all tests and
to improve the instruments used in labs, to produce uniform results.
Dr. Butany did emphasize that there will be serious challenges in the
future – which will continue to stretch the resources of labs.
He noted the field is quickly evolving with the rise of personalized
medicine – the genetic and molecular testing to which Dr. Friedman also
referred. This will require new skills and equipment in the near future.
However, Dr. Butany observed that it takes a great deal of time to
become a skilled pathologist, and Canada’s cohort is up in years. Most
pathologists in Canada, he said, are over 50 years of age – while some
are working past the age of 75 and into their 80s. “A few are 40 to 50,
and none are under the age of 30.”
The pressure will be on them to stay current, as pathologists are going
to be hit by the coming of many new technologies – genomics, proteomics,
informatics and robotics.
In the face of these developments, and to remain at the centre of
medicine, Dr. Butany said that pathologists will have to re-invent
themselves by learning new skills, including working more closely with
the diagnostic imaging departments.
Pathologists must also work in new ways with other physicians and
patients. “We must go back to being consultants,” he said. “We must meet
with physicians, and we must meet with patients.”