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Inside the October 2011 print edition of Canadian Healthcare Technology:


Feature Report: Developments in telehealth


SunnyCare integrates all clinical systems in hospital
Despite the complexity involved in fully integrating a large research hospital’s myriad of clinical information systems into one electronic whole, the team at Sunnybrook has pretty much done it.

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eHealth Ontario invests $5M in ClinicalConnect
Hamilton, Ont. physician Dr. Barbara Teal has been using ClinicalConnect to check on test results and medical histories of her patients, with the ability to access the records at 28 hospitals and two community care organizations in seconds.

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IT innovation boom
The new International Centre for Health Innovation is actively assisting innovators turn their health IT projects into real products. Meanwhile, Infoway has launched a group that will help the health sector assess new technologies.

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Medical ed for patients
A new, computerized system makes it easier for doctors and nurses to explain medical conditions and treatments to patients. Over 300 units are installed in hospitals and clinics across Canada.

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Real Time Medical bridges the ‘capacity gap’ with eDiagnosis
eDiagnosis is moving healthcare beyond telemedicine. It completely automates the processes involved in diagnostic workload and workflow management, and transforms them into easy-to-use cloud applications that are available anywhere, anytime.

READ THE STORY ONLINE


Bridging the diagnosis gap
After successfully creating a tele-radiology solution, a Canadian company has expanded its platform to provide remote reading and reporting of other diagnostic disciplines – such as pathology, dermatology and ophthalmology.


Connecting clinicians
ClinicalConnect now links doctors and nurses to electronic health records in 28 hospitals and two community care networks in the Hamilton, Niagara and London, Ont., regions. The system is poised for further expansion.


PLUS news stories, analysis, and features and more.

 

SunnyCare integrates all clinical systems in hospital

By Andy Shaw

TORONTO – Despite the complexity involved in fully integrating a large research hospital’s myriad of clinical information systems into one electronic whole, the team at Sunnybrook has pretty much done it. What’s more, the final result is so easy-to-use, clinicians won’t need any training to use SunnyCare.

“Yes, that’s right,” says Sam Marafioti, rather proudly. The vice president of corporate strategy and development for the sprawling Sunnybrook Health Sciences Centre, in north Toronto, says that, “SunnyCare is the one system our clinicians will go to for all their clinical information. But if we have to train people on what SunnyCare should mean to them or how to use it, then we will stop with it right there and take it back to the drawing board.”

During an interview to introduce the new system, Dr. Edward Etchells has an iPhone in hand to demonstrate what the working prototype of the SunnyCare integrative platform can do, especially to streamline Emergency Room workflow.

Dr. Etchells is the physician lead on the SunnyCare project and a staff emergency room consulting physician. Despite doubling as the hospital’s medical director of information services, Dr. Etchells describes himself as an information technology Luddite.

As such, SunnyCare had to satisfy his demands for ease-of-use, along with those of other clinicians at the medical centre.

“SunnyCare involves three over-arching concepts: access, integration, and user centricity,” says Dr. Etchells. “In terms of access, we believe mobility is the top requirement. So we’ve designed SunnyCare so you can access it while you’re on the go. You can access it while you’re walking around,” displaying the SunnyCare icons on his iPhone as he chats.

“The information you need to do your work is always there, regardless of how remote your are from it. Meaning for me, when I am on call and at home, for example, I can get instant access through SunnyCare to the ER data on a patient I need in order to perform a consult.”

SunnyCare’s embrace of the “integration” principle includes both workflow and software integration, adds Dr. Etchells: “So it doesn’t make us log into four different applications to do one simple task.”

Before SunnyCare goes fully operational within Sunnybrook, a single consult on what should be done with a problematic ER patient could involve, for Dr. Etchells, as many as 19 workflow steps, with several important ones still involving paper, and entry into as many as five separate electronic information databases.

After SunnyCare, all that complication will disappear, leaving just one point-of-entry and single sign on to enter a fully integrated information environment within Sunnybrook.

The platform will also enable SunnyCare users, via their iPads, BlackBerrys, or Playbooks, to integrate seamlessly with the world of work and information beyond the hospital’s walls. The planning includes: WTIO, the Ontario health ministry’s wait time information office; ConnectingGTA, the $72 million project to electronically link up 700 healthcare providers in the Greater Toronto Area; and the province-wide Ontario Laboratory Information System.

But it is the “user centric” approach where SunnyCare may be at its most eye-popping.

“We have one golden rule for SunnyCare: No training required!” says Dr. Etchells with enthusiasm. “If I have to go to a two-hour class in order to learn how to perform a simple task on SunnyCare, that’s unacceptable. So we are at the stage right now where we are testing the platform to make sure there is no training required to use it.”

Aside from gaining near-instant acceptance from Sunnybrook’s clinical users, as it already has so far in SunnyCare trials and one initial deployment, this no-training-required simplicity has Dr. Etchells and Sam Marafioti expecting it to produce significant workflow and productivity benefits to Sunnybrook.

“I’ll give you a concrete example,” offers Dr. Etchells eagerly. “Let’s say I get a call from an ER doctor for a consultation on what to do with his or her patient. Well, to manage that person in the next few hours means that I have to get access to at least four different information systems and several paper forms. So I will probably waste 20 minutes just doing that. And it’s wasted because that time has not really helped the patient, not really helped me, nor the hospital. SunnyCare is about solving those problems.”

Dr. Etchells notes that SunnyCare does more than give access to clinical systems. It also assists with workflow.

“If I want to look at the patient’s current vital signs, I first need to know where the patient actually is at the moment in the hospital,” explains Dr. Etchells. “But even when I find patients, I then have to enter yet another system to get their vital signs. Then if I need to assign one of my team doctors to that patient, I have no mechanism for doing that. So I might need to page them, and that of course is yet again another separate system I have to access. Then I might need to write orders for tests, and then look for their lab results, meaning two more systems I have to know how to use.”

SunnyCare, says Dr. Etchells, is about overcoming all that: “Oh, I see from SunnyCare’s Mobile Consult Manager on my iPhone that I have a consult. What were the patient’s vital signs in the triage? I go to SunnyCare for that. Who am I going to assign to that patient and how do I reach them? I go to SunnyCare for that. What are the patient’s lab results? I again go to SunnyCare for that. I or one of our neurosurgeons needs to look at diagnostic images on our iPhones or tablets? We go to SunnyCare for that.”

This streamlining of emergency patient care is more than just gratifying to Dr. Etchells, his colleagues, and potentially life-saving to their patients. It is also important to hospital performance and consequent government funding.

“We have performance criteria laid down that tell us our patients need to be seen within four hours of their arriving in ER,” explains Dr. Etchells. “And in the past I would sometimes get a page at three hours and 40 minutes into that timeframe, asking me what has happened so far to that patient. But with SunnyCare, it will be unambiguous. Everyone on the system will know at all times where patients are in their progress through the system and how much time they’ve spent where.”

Such a universal-sounding problem and its SunnyCare solution, begged an interview question to Sunnybrook systems

major-domo Marafioti: Sam, is there nothing on the shelf out there that could have done what you’ve built with SunnyCare?

“No,” replies Marafioti flatly. “We went down the SunnyCare development path because we found that something like it doesn’t exist. It was as simple as that.”

Simple decision for a simple-to-use platform, but one underlain with impressively integrated architecture.

“Our architectural approach was first to take full advantage of what is available internally in all the information systems that Sunnybrook has already invested in and developed, such as our ER information system, our patient record system, our eDischarge system, our MyChart system for patients,” says Oliver Tsai, the director of information technology at Sunnybrook. “Technically, it is a Wintel-based architecture, but we are using it to play more and more toward a Cloud-like service. So we are able to share knowledge by manipulating and exchanging data seamlessly, just as Cloud computing does.”

As Mr. Tsai explains, that seamlessness extends to all desktop, mobile phone, and tablet users through a web server interface. An HL7 eBiz interface engine pulls in Sunnybrook data from Labs, Radiology, Pharmacy, and future external connections.

“We are always monitoring what is going on in the Ontario (healthcare) landscape,” says Marafioti, “so that we can be ready to integrate with any of the information system initiatives the government now has under way. We’ve done a lot of work on provincial standards and made sure we are compliant with all of them.”

Such technical diligence and the consequent wider potential deployment has interested onlookers monitoring Sunnybrook’s progress with SunnyCare.

“We just went live with SunnyCare in our Cancer Centre in late July and we will be building it out from there throughout the hospital,” says Marafioti. “So we are ready to talk about it publicly and I admit we have been talking to three telecom companies already, who are involved or interested in healthcare, about SunnyCare’s commercialization and potential sales to other hospitals.”

Early results from SunnyCare’s deployment at Sunnybrook should impress them.

“It is already eliminating 5,000 re-enters of data we used to experience every week here,” says Marafioti. “So that is not only a boost in productivity, it also means we have eliminated 5,000 potential medical error mistakes a week.”

Compelling though that safety record might be, especially to Dr. Etchells who also is an associate director at the University of Toronto’s Centre for Patient Safety, the simple, just-touch-this-icon access to a fully integrated view of all the information you need to do your work is what will likely sell SunnyCare the most.

“We built it partly to help end what we’ve been calling ‘eFragmentation’ in terms of how hospital information systems tend to develop separately,” says Marafioti. “But we also built SunnyCare conscious of what’s gone on in consumer technology and how easy it has become to use. So we are promising that SunnyCare will be even better than the user’s experience of technology at home.”

In brief, there will be no training required.

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eHealth Ontario invests $5 million in upgrade of ClinicalConnect

By Jerry Zeidenberg

HAMILTON, ONT. – eHealth Ontario is funding a major expansion of a web-based portal that enables physicians and other caregivers in the Hamilton, Niagara and Waterloo regions to view the records of patients at 28 hospitals and two Community Care Access Centres.

In August, eHealth Ontario president Greg Reed announced a $5 million investment in ClinicalConnect while speaking at a medical centre in Hamilton, with a live videoconferencing hook-up to a group in Kitchener-Waterloo.

More than 2,500 healthcare providers currently use ClinicalConnect and have immediate access to over 2 million patient records and reports in hospitals and CCACs across the two LHINs. The new investment will allow for 600 additional physicians to join the system; it will also be used for upgrades to the network’s infrastructure.

Reed explained the eHealth Ontario’s new strategy is to support and enhance existing EHR networks across the province. “We decided we’d make faster progress if we didn’t build one big monolithic network, but instead, took advantage of all the existing regional systems out there.”

“ClinicalConnect has proven to be a terrific tool for enabling clinicians to look at patient records,” he said. “What makes sense is to say, let’s use that, it’s a proven solution.”

ClinicalConnect is an example of a regional initiative that started out modestly and is now being scaled up. It was first implemented in the Hamilton-area and was later expanded to the Niagara and Waterloo regions.

Healthcare providers can now access and share patient medical information across Local Health Integration Network boundaries, regardless of whether the patient was admitted to hospital in Hamilton or received a diagnostic test in Kitchener.

In a presentation at the Hamilton medical centre, Dale Anderson, a senior consultant with the Hamilton Niagara Haldimand Brant LHIN, noted that Medseek portal technology is at the core of the network. It’s enabling clinicians in hospitals to see records of their patients at other hospitals; it’s also allowing front-line physicians in the community to access hospital and CCAC records.

“It’s getting information to clinicians faster, and it does improve care,” said Anderson. “Clinicians are spending less time tracking down information.” And because they’ve got quick access to information, “There are no duplicate tests needed, and there are fewer medical errors made.

Dr. Robert Lloyd, a pediatric intensivist at Hamilton Health Sciences is a staunch supporter of the system. In a presentation at the Hamilton medical centre, Dr. Lloyd recounted numerous scenarios in which access to the ClinicalConnect network has helped in the treatment of patients.

“Each of my patients comes to me with a past history, but they come with very little information,” he said. “We could spend days trying to collect information about them contacting doctors by phone and fax, and gathering disks. Often, we don’t get the information at all.

“Now, we get all of the patient’s information from across the LHIN,” he said, and it can be gathered within minutes. “That’s revolutionary,” he said.

Dr. Lloyd showed an audience just what physicians are looking at when they call up the ClinicalConnect viewer. There is an interface that has tabs for allergies, blood bank, lab, microbiology, pharmacy, radiology, orders and more.

“We can see all of the patients’ visits. We can see all of the patients’ conditions and what has been investigated [at the different hospitals],” he observed. “That’s an enormous benefit.”

He noted that until the fall of 2010, the system mostly provided information about the Hamilton Health Sciences hospital network. At that time, however, hospital managers and partners at two Local Health Integration Networks agreed upon an expansion. In less than a year, 27 more hospitals were added, enabling physicians to see records in hospitals across the Hamilton, Niagara and Waterloo regions, as well as in two Community Care Access Centres.

That was a remarkably fast expansion, one that is giving doctors the information they need to make better clinical decisions. “The value proposition went way up,” said Dr. Lloyd.

He projected onto an overhead screen the record of a patient who was born in 1928 and has had dozens of hospital visits in cities across the region. The system offered up a plethora of data about the patient – for example, his previous ECGs. “That’s important for ER doctors, who want to compare his past and present ECGs,” said Dr. Lloyd.

Also available for comparison are things like creatinine levels, an important indicator of kidney function, which can be converted into a graph with a few mouse clicks.

Checking the microbiology tab, Dr. Lloyd pointed out that “this patient has had lots of infections.”

“We can look at what he was treated with, and then tailor the antibiotics in accordance with what he’s had before,” ensuring an effective therapy.

Diagnostic images are not yet part of ClinicalConnect, but they are available on a different system, if needed. “But we can read the report, which is often all we need,” said Dr. Lloyd.

Mark Farrow, CIO at Hamilton Health Sciences, observed that “the uptake of ClinicalConnect has been huge.”

“It’s the first time in my career that I’ve had doctors knocking on the door and asking, when can I get this?”

Farrow noted that the system works very quickly, an important feature for harried physicians. “It takes place in seconds,” he said.

In terms of architecture, he explained, the data resides in all of the original locations and is not consolidated in a central repository. When doctors and nurses call up the file of a patient, the system pulls together data from all of the sites the patients has visited – creating a real-time, up-to-the-minute record. “That means it’s always current data that you’re looking at,” said Farrow. “You can even tell if an order is under way.”

Farrow said that in addition to desktop access, ClinicalConnect is also available to care-givers using iPads and iPhones.

Not only is the information they obtain from ClinicalConnect useful to clinicians for making faster, more accurate decisions, but it’s also popular with the participating hospitals. “It’s reduced the need to send transcribed reports to doctors,” said Farrow. “Doctors can go in themselves and download what they need, right into their EMRs.”

Dr. Barbara Teal, a family physician in Hamilton, is also a proponent of ClinicalConnect, and spoke at the Hamilton meeting. “I’ve been in practice for 26 years, and this is the best innovation I’ve seen,” she said. “We’re so used to not getting information; now, we’re getting a lot. I like it, and my patients like it.”

Dr. Teal brought to the meeting one of her patients, Susan Barnard, who recently had a colonoscopy and biopsy. Using ClinicalConnect, Dr. Teal was quickly able to obtain the results.

“Two days later, Dr. Teal called me and said everything was clear. I didn’t have to wait long and I didn’t have to worry,” said Barnard.

Not only can Dr. Teal obtain test results and reports about her patients from hospitals more quickly, she can also see what kind of home care services they are obtaining from the Community Care Access Centres.

“I can look at their files with the CCACs, and if they’re not getting the services they need, I can order them,” she said, emphasizing that this has been a very useful feature of ClinicalConnect. At the same time, about 50 visiting nurses are using the system, a number that will soon increase.

Dr. Mohamed Alarakhia, a family physician at the Kitchener Centre for Family Medicine, spoke via video from Kitchener, and commented that he, too, has found ClinicalConnect to be invaluable.

“Many patients who leave hospital are given prescriptions, but when they come to see me, all they can remember is that it’s a little white pill,” he said. He noted there are over 2,000 pills that are little and white, which leaves the doctor in the dark about what the patient is taking.

However, using ClinicalConnect, “I can access the patient’s record right away.”

He discussed the experience of one patient who had been seeing a rheumatologist and was prescribed several medications. The patient had stopped taking all of these meds, and could no longer remember what they were.

“I was able to go into the electronic records to see what they were,” said Dr. Alarakhia. “Two of them were important, and we were able to re-start him, minimizing the interruption.”

Just a year ago, before he had started using ClinicalConnect, he would have had to phone the rheumatologist’s office about what had been prescribed and then wait for a return phone call. The patient would have been required to come back to the family doctors’s office to obtain a new prescription.

Using ClinicalConnect, the information was obtained in seconds. “I for one never want to go back,” said Dr. Alarakhia.

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Centre taps into sources of health innovation, helps develop them

By Jerry Zeidenberg

LONDON, ONT. – Just 18 months after it was created, the International Centre for Health Innovation, at the Richard Ivey School of Business, is already churning out IT inventions that are capable of transforming the way healthcare is delivered.

“We can barely keep up with demand for our services,” commented Dr. Anne Snowdon, the newly appointed chair who arrived after they federal election in May, when the previous director, Dr. Kellie Leitch, was elected to Parliament.

Dr. Snowdon, who has a PhD in nursing and was at one time Associate Dean of the School of Nursing at the University of Windsor, is a professor in the Odette School of Business in Windsor. An inventor in her own right, with products that have led to increased safety for passengers in vehicles, she combines theoretical and academic skills with real-world, entrepreneurial savvy.

Dr. Snowdon points out that the centre currently has 12 active projects on the go. They include:

• A web-based system for detecting early signs of Alzheimer’s and other forms of cognitive impairment that was developed in partnership with the Alzheimer’s Society of Canada. With the waiting list to see a geriatrician running as long as two years, it’s crucial to be able to monitor the health of friends, family and loved ones.

This tool, called e-MoCA (based on the Montreal Cognitive Assessment tool), enables general practitioners and even members of the public to assess themselves, their friends and loved ones using the Internet and a browser.

“As part of the project, some family practitioners are now doing the test on all of their patients,” said Dr. Snowdon. “That’s so we can establish a baseline and know what ‘normal’ scores are like. It will then make it easier to know what abnormal is, and what the signs of dementia are.”

She commented that e-MoCA has already aroused great excitement in the healthcare sector, as dementia is a growing concern. Healthcare professionals and the public alike are trying to gain a better understanding of its early onset.

• With the assistance of Telus and BlackBerry-maker Research in Motion, Dr. Snowdon’s centre is developing a remote monitoring application for cardiologists. The project was sparked by a cardiologist who wondered why, in this age of smartphones, he had to drive into the hospital at night to read EKG tapes to check on his patients, or why he needed to receive blurry faxes that he couldn’t decipher.

A BlackBerry smartphone app seemed like a clever solution, and that’s just what’s under development. It will enable cardiologists – anywhere, anytime – to remotely monitor their patients.

• A software tool that allows managers and healthcare professionals to search databases across a Local Health Integration Network (LHIN) to obtain the ‘business intelligence’ they need. For example, the system can search across all hospital, ER, CCAC and Ontario Telemedicine Network databases to determine which residents of a LHIN complained of pneumonia one week, or how many residents visited an ER another week.

“It’s an advanced analytics tool,” said Dr. Snowdon, “and there’s nothing else out there like it. It gives real-time answers to these questions, across an entire LHIN.”

Real-time is a key phrase for Dr. Snowdon and her team. She emphasizes that it’s critical for healthcare professionals to obtain the information they need quickly. “Healthcare has long relied on information. But by the time you get it, the situation you needed it for is long past. There’s a tremendous advantage to using technology in real-time, so you can make decisions right away.”

She says there’s a slew of technologies available now that can make instant access to information possible – including smartphones, RFID sensors and bar-coding systems.

She laments the slow uptake of technology in hospitals and healthcare in general, but suggests that vendors haven’t provided clinicians with the tools they really need. “I’ve been a nurse working on the wards, and I’ve seen new charting systems come into the hospitals,” she said. “But when they force you to go through 17 different screens to get to what you need, clinicians will simply not use them. We don’t have the time.”

She says there must be much closer development of healthcare IT systems in partnership with clinicians – something the International Centre for Health Innovation is practicing.

“We’re working closely with clinicians, but also with policy makers, private companies, and academics. You need all of them involved to create solutions that will work, in different parts of the country and different parts of the world.”

She explains that the centre has a mandate to develop innovation and leadership – for Canada, but also internationally. In addition to creating solutions that improve the effectiveness of Canada’s medical system for providers and patients, the centre is also attempting to prime the economic pump. It’s striving to nurture Canadian companies that can compete on the world stage.

The innovative ideas are coming from a variety of sources – companies, hospitals, LHINs, Community Care Access Centres, and others. In all cases, the centre uses a multi-partner strategy to create solutions to real-world healthcare problems. “We’re crafting innovation together,” she said.

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Visual system for patient education becoming popular across Canada

By Jerry Zeidenberg

TORONTO – Communication is often a difficult issue for physicians when talking to patients. The doctor may believe he or she is clearly stating the problem and diagnosis, but the patient just doesn’t get it.

It’s a lot easier if the patient can also visualize what’s going on. Enter iMD Health Canada Corp., a company that devised and is now marketing a visually oriented computer system for doctors’ exam rooms. Using pictures, text, animations and videos – and a digital whiteboard for drawing – the solution lets the doctor show the patient what the problem is, and what the best therapy is to follow.

“This is a big breakthrough for organizations that want to put information and literature in the hands of physicians, nurses, educators and patients,” said Kevin Delano, president and CEO of iMD Health.

At a lively office and warehouse in a semi-industrial area of Toronto, there’s a definite sense of optimism and excitement about the made-in-Canada technology. An enormous, wall-size board charts orders for the system. “It’s just about to go into sites in Saskatchewan, New Brunswick and Newfoundland,” notes Kevin Delano. “It’s aimed at physicians and nurse educators in primary care and specialty care.”

After just a year-and-a-half in the marketplace, iMD already has over 300 units installed in clinics and hospitals across Canada – including Sunnybrook Health Sciences Centre in Toronto, Victoria General Hospital in Halifax, University of Alberta Health Centre and Montreal General Hospital.

And terminals are soon to go into the counseling rooms of a major retail pharmacy chain across Canada.

There’s a variety of medical conditions covered by the iMD Health Network, including diabetes, gastrointestinal diseases, pain and oncology. Content continues to be developed. “We’ve had requests for dermatology and respirology,” says Delano. The various topics are produced in conjunction with medical associations, hospitals and a board of physicians.

“Everything is peer-reviewed,” says Delano.

When it comes to GI, content has been developed in partnership with the Canadian Digestive Health Foundation; diabetes information has been created through an alliance with experts from Trillium Health, a two-hospital organization in the Toronto area.

“There are 50 different teaching modules in the diabetes section alone,” commented Delano. They include introductory units such as ‘what is diabetes’ to more advanced topics like foot care and blood sugar management. Certain content in diabetes is available in multiple languages, such as Punjabi, Tamil, Polish for hospitals and clinics with ethnic populations.

All of this is welcome news at a time when diabetes has become rampant in North America, and a surge in cancer and other chronic diseases is anticipated. Medical professionals are spending more of their time educating patients, and tools that will help get ideas across quickly and effectively are needed.

The iMD system is organized using tabs for different functions and diseases. It’s operated by touch-screen, and users can write and draw on images, zoom in on images, and even e-mail images, explanatory notes, and videos to patients so they can see them again once they’re at home.

Delano stresses that the system is only placed in the exam rooms of physicians and nurses – patients can’t obtain information on their own. That’s because there’s an extensive amount of medication information on the system, and in Canada, according to various laws and industry rules, physicians must be present with patients when claims are made about medications.

The iMD Health Terminal itself has a unique design – the 19-inch monitor also encloses the computer processing unit, so there are no separate towers or wires hanging about. “All the doctor needs is a power outlet and an Internet connection,” said Delano.

While iMD Health Network and terminals require access to the Internet, it’s only to update the information at night. Otherwise, the system operates as a local solution, with all the data contained in its CPU. “We use a lot of images and videos,” says Delano. “There’s no way you could run them for patients without buffering and a time-delay if you were downloading on the net. Our system delivers everything without delays.”

He emphasized that this is extremely important for time-harried physicians – and also for worried patients. No one wants to wait 30 seconds, which can seem like an eternity when sitting in front of a computer terminal.

“Response time is immediate,” says Delano.

In addition to the extensive visual and textual descriptions of diseases, iMD Health Network also contains copious amounts of information about therapies, including medications. Indeed, this is where iMD intends to earn a return on the system.

The pharmaceutical data is valuable to physicians and patients – physicians obtain up-to-date information which they can then relay to their patients. As well as drug monographs there are easy-to-read brochures that can be e-mailed to patients.

iMD is selling sponsorships on the site to pharma companies – those which take sponsorships obtain top billing on the drug therapy sections of the system. So far, there are 40-50 sponsors, says Delano, including names such as Roche, Pfizer, Ferring, Abbott and Takeda.

However, in the interests of objectivity – and to conform with the law in Canada – all makers of drug therapies are listed, Delano emphasizes.

The company believes the pharmacy sponsorships are an ideal way of delivering information to physicians at a time when it’s becoming increasingly costly to put reps on the road, and when many physicians just don’t have time for reps during their busy days.

“Forty percent of physicians in Canada are ‘no see/limited see’ doctors,” says Delano. “They won’t see reps.” But he believes they want pharmaceutical information, and iMD solution provides it to them, whenever they want or need it.

What’s more, a menu on the screen has buttons that will connect them with various pharma sponsor companies – in an instant, they can be connected with the marketing department of a company, obtain literature or request samples.

“The doctor communicates with the drug company when he or she wants to,” says Delano. “There’s no rep involved. We’re turning the old model on its head.”

How do clinics and hospitals obtain the iMD Health Network? There is a subscription model that consists of $50 a month per terminal. That includes all of the hardware and software and unlimited upgrades and current teaching models for certain disease states.

He pointed out, however, that physicians will actually earn money using the system, as it collects anonymous data for sponsor companies through surveys of patients and simple usage of the system.

While iMD aims to have 1,000 units in place in Canada by September 2012, it’s also targeting worldwide sales (soon to be launching in Italy and Britain). He asserts that if the company can make it here, it can make it anywhere. “Canada is a launching pad for us,” says Delano. “It’s known for having the most stringent market in the world, with very tough rules.”

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Real Time Medical bridges the ‘capacity gap’ with eDiagnosis

By Nadine Koff, MD

eDiagnosis is moving healthcare beyond telemedicine. It completely automates the processes involved in diagnostic workload and workflow management, and transforms them into easy-to-use cloud applications that are available anywhere, anytime.

Our Canadian company – Real Time Medical – is pioneering and expanding the field of eDiagnosis, creating software, solutions and services that are being used around the world. Real Time Medical began as a Canadian teleradiology company under the name of Real Time Radiology in 2008. It was founded by three radiologists who saw an urgent need to develop a truly Canadian solution to the issues of equalization of care, wait times reduction, and bed utilization.

Building on the original vision, the company has since grown to offer collaborative reading services in radiology and cardiology to dozens of sites across Canada. It has also provided its innovative eDiagnosis software platforms in medical diagnostic disciplines in five countries to date.

eDiagnosis software solutions and benefits: Real Time Medical’s suite of cross-platform, cloud-based, patent-pending eDiagnosis software solutions (led by RADShare®, its flagship software solution for radiology collaboration) enables pools of licensed and credentialed specialists to shorten the time needed to provide a final report on diagnostic studies.

They can optimize the use of existing infrastructure investments (for instance, a cardiology RIS/PACS), improving patient care, reducing costs through system-wide efficiencies, and yielding more productive interactions between clinical resources. Medical diagnostic disciplines such as radiology, cardiology, dermatology, pathology and ophthalmology could all benefit from our platforms’ functionalities.

The suite adds value by dynamically automating collaboration, quality improvement, and workload sharing and balancing. It provides rules-based intelligence to the existing digital infrastructure, including:

• active case management functionality to the workflow;

• it makes immediately available active specialists located anywhere on the network, who then become members of the local care team;

• it turns final diagnostic reports for STAT cases around in as little as 30 minutes regardless of when or where the test was done;

• it incents desirable behaviour (long-term scheduling, dependability, no ‘cherry picking’, etc.)

Successful eDiagnosis deployments: Real Time Medical has teamed with Accenture to sell, deploy and implement this unique collaborative workload balancing software platform in several pilot and commercial projects in Europe. In many of these projects, our solutions allow care teams to access sub-specialities, even though their volumes would not normally support a full time sub-specialist team member.

For instance, in Madrid, Spain, eight hospitals have aggregated their specialists by using RADShare® to reduce report times and increase the scope of their services.

In Belgium, a pool of radiologists are sharing the workload to provide rapid eDiagnosis services within Belgium and other partner countries that do not have access to qualified sub-specialists.

Qualification of specialists and quality issues: Our suite of software solutions are rules-based, meaning that only qualified specialists from the available pool can provide a specific service at a specific time. It also ensures that all licensing and credentials required by care providers and professional associations are being satisfied.

Adding to our collaborative, rules-based software solutions, Real Time Medical’s Quality Assurance and Improvement programs offer critical feedback to service provider groups, to assist in determining when mentoring and continuing education programs are required. They are useful tools for effective collaboration protocols and benchmarking for all group members.

The eDiagnosis capacity gap: The eDiagnosis capacity gap has been created by a number of factors:

• Healthcare service providers and governments have spent billions of dollars on the infrastructure and systems needed to acquire, store and transmit medical information in a secure digital format, 24 hours a day. This explosion of data has put a tremendous amount of pressure on the specialists who use this information for diagnosis;

• Non-invasive diagnostic techniques, such as imaging, are preferred by the medical community, leading to a rapidly increasing number of studies generated. In contrast, the number of specialists qualified to read digital studies is growing at a much slower pace than the number of studies generated;

• Specialists prefer to locate in large urban centres, leaving rural and remote areas generally underserviced; and,

• Critical diagnostic services are ‘on-demand’ by nature, with significant differences between peaks and valleys, making 24/7, on-site coverage and scheduling impractical and inefficient.

Dr. Nadine Koff is President, Real Time Medical.


Accenture and Real Time Medical connect Middle Eastern hospitals and clinics to Belgian radiologists

A large group of Belgian radiologists recently won an important eDiagnosis radiology collaboration contract with a fast-growing network of Kuwaiti, UAE and Saudi hospitals and clinics. The group’s offering to these vast Middle Eastern healthcare networks set itself apart from fierce international competition because of the depth and breadth of sub-specialties it proposed, the quality and reputation of its radiologists, its long-term track record, and the superior software platform it used.

The Belgian group’s software platform is Real Time Medical’s eDiagnosis collaboration and quality improvement solution for radiology, RADShare®. It selected it following a recommendation by Accenture, the radiology group’s IT consultants. Real Time Medical’s solution was presented as the most appropriate, scalable, flexible, feature-rich software platform by Accenture because it concluded the same for its own purposes, after a three-year search and the thorough technical evaluation of over a dozen solutions. Accenture is undertaking several initiatives and projects globally with Real Time Medical.

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