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Inside the October 2012 print edition of Canadian Healthcare Technology:

Feature Report: Developments in telehealth

Rash of privacy breaches in Newfoundland
Unauthorized access to patient information – also known as snooping – is unethical, as it strips away your right to privacy. Victims of such intrusions often become anxious and angry – they worry their secrets will become known and wonder if they can ever again reveal problems and anxieties to their caregivers.


TalkRocket offers innovation for speech impaired
Aakash Sahney and Alex Levy, co-founders of MyVoice Corp., produced a solution called TalkRocket Go while working at the University of Toronto’s Technology for Aging Gracefully Lab (TAGlab). The assistive software, which runs on iPads, iPhones and other devices, does the talking for people with speech impairments.


Telehealth agencies strive to turn their services into mainstream medical offerings
Like old soldiers, Canadian telehealth isn’t dying, but rather slowly fading away – as many of its proponents fervently hope. In at least three of the geographically largest healthcare jurisdictions championing it, there’s growing evidence that telehealth is simply morphing into better, wider-spread healthcare.


The power of analytics
A new study by IBM and MIT uncovers why organizations are shying away from high-powered business analytics software. In some cases, they lack the culture of data sharing that is a prerequisite.


eHealth in Rwanda
Canadians are hard at work building an eHealth infrastructure and applications in Rwanda. They’re helping the developing nation pioneer meHealth, a combination of mobile and eHealth with a person-centric focus.

Britain’s eHealth challenge
England has scrapped its centralized approach to eHealth; instead, it is allowing hospitals and health regions to choose their own solutions. Our British correspondent updates the state-of-affairs across the pond.

GIS at the Olympics
A predictive system for disease management was used at the summer Olympics in London to keep ahead of any possible outbreaks. The innovative system was devised in Canada using geographical-information technology, along with other advanced tools.

PLUS news stories, analysis, and features and more.


Rash of privacy breaches in Newfoundland

By Jerry Zeidenberg

Unauthorized access to patient information – also known as snooping – is unethical, as it strips away your right to privacy. Victims of such intrusions often become anxious and angry – they worry their secrets will become known and wonder if they can ever again reveal problems and anxieties to their caregivers.

What’s more, there’s blowback for healthcare organizations when outraged patients and their lawyers launch vigorous lawsuits.

Such is the case in Newfoundland and Labrador, where three of the province’s four health authorities have this year fired nurses and other healthcare workers for breaches of patient privacy.

In addition, patients have launched class action lawsuits against each of the three health authorities – Eastern Health, Central Health and Western Health.

The experiences in Newfoundland and Labrador may serve as a warning to other jurisdictions across Canada to increase their own vigilance of privacy intrusions. Of note, in two of Newfoundland and Labrador’s health authorities, investigations into improper access to information occurred only after patients complained of leaks – the authorities didn’t catch the problems through their own audits or policies.

This may signify that hospitals and health regions should beef up their own technological capabilities to spot breaches. And educating employees about the significance of privacy and confidentiality is just as important.

In July, Eastern Health announced that it had fired five healthcare workers, including a nurse who it says had accessed the records of 122 patients outside her care.

Vickie Kaminski, chief executive officer for Eastern Health, apologized to the 122 patients involved, and said the authority would be contacting them. She also said the authority, the largest in Newfoundland and Labrador, has clear-cut policies on privacy intrusions and for dealing with them.

“When we identify a deliberate breach of patient privacy, we take action to discipline the offending employee,” said Kaminski. “While the severity of the discipline is determined by the seriousness of the breach, there is zero tolerance for willful breaches of patient privacy.”

Eastern Health does conduct random audits to see if patient records are being accessed inappropriately, but in this case, the investigation started when a patient complained that someone knew too much.

For her part, Colleen Weeks, the fired nurse, responded that she had done nothing wrong in viewing the files of the 122 patients. On CBC television, she said among other things, that most of the instances consisted of looking up records on a computer “for two seconds” to obtain information for doctors or colleagues who were too busy or unable to reach a workstation.

In the few instances where she obtained more extensive information about patients who were not under her direct supervision, she did it “with good intentions,” she said. In one case, she obtained information about her ex-husband to comply with a request from a judge; in a few others, she was trying to help a friend and a former tenant.

She added that many of her colleagues also look at the records of persons who are not directly under their care, for compassionate reasons or to help over-worked or busy colleagues.

However, Vickie Kaminski, the CEO of Eastern Health, said there were originally 144 suspicious cases in which Weeks accessed patient files. “We took out 20 because there was a reasonable thought that she could have needed it in the line of her work but the rest were totally unconnected to anything she was doing or any time she was on a shift or any issue for her at all.”

In firing Weeks, Kaminski said Eastern Health didn’t consider lesser disciplinary actions because of the large number of files that were accessed.

Meanwhile, in August, St. John’s lawyer Bob Buckingham launched a class action suit against Eastern Health on behalf of the patients whose privacy was violated. He said that an apology wasn’t enough, and that Eastern Health hadn’t recognized the seriousness of the matter and its impact on the lives of patients.

According to Buckingham, Tammy Taylor, the woman who initiated the suit, has been so disturbed by the experience that she cannot speak publicly about it. “She has lost sleep. She has lost work. She hasn’t been able to focus,” Buckingham told CBC News. “She is presently on a leave of absence and this has been traumatic for her.”

Buckingham said many of the dozens of patients he has spoken with believe Eastern Health waited too long to contact them about the breaches. Buckingham asserted that Eastern Health was aware of the breach in November 2011, while Eastern Health denied the claim and said it couldn’t have apologized sooner, as it didn’t investigate until July 2012.

In August, Western Health disclosed that a nurse had inappropriately accessed the records of 1,043 patients – the organization said it would be contacting and apologizing to each of them.

However, one of the patients soon after launched a class action lawsuit as well, engaging Mr. Buckingham to lead the action. Barbara Hynes, of Corner Brook, initiated the suit after receiving a letter from Western Health stating that she was a victim of a privacy breach.

“I was distraught, upset and devastated to learn my very private and confidential medical records and personal health information had been accessed by an unauthorized person,” Hynes said in a release issued by Buckingham’s office.

Finally, in the last week of August, a St. John’s woman launched a suit against Central Health – with Bob Buckingham as her lawyer – claiming that the wife of her ex-husband had been accessing her history as a patient at the health authority.

Shawna Thompson says her medical records, including lab test results and other confidential information, were inappropriately accessed 22 times in the past seven years at Central Health.

“I’m very angry and I’m outraged,” said Thompson. “I know she shared it with my children, so that would give me an idea that she has probably shared it with a lot of people.” In the last year and a half, Central Health has reported several privacy breaches, and in March 2011, it fired an employee for accessing the files of 19 patients.

This July, the authority admitted it had two other recent breaches that it had not previously reported. In one case, an employee was suspended, and in the other, the employee resigned.


TalkRocket Go assistive technology helps with speech impairments

By Leslie Goodson

TORONTO – In little more than a year, an assistive technology spun out of the University of Toronto’s Technologies for Aging Gracefully Lab (TAGlab) has gained more than 12,000 users worldwide.

Called TalkRocket Go, it gives a voice to those who have trouble speaking or cannot speak at all – communication disorders caused by stroke, Alzheimer’s, autism and ALS.

Persons with these ailments can make themselves understood audibly by selecting from an easy-to-use menu of phrases on their iPhone, smartphone or iPad. The device then speaks the phrase, giving voice to the users’ thoughts and feelings.

There is certainly an urgent social need for new assistive technologies, confirms Alex Levy, CEO and lead designer of MyVoice, a company that last year grew out of TAGlab. In Canada, he explains, there are as many people with speech disabilities as there are in wheelchairs, but they don’t have technology to help them.

TalkRocket Go is available for both Apple and Android devices and includes dozens of free phrases and customized vocabularies that users or care-givers can easily drag-and-drop in seconds from any web browser, at any distance.

Features include:

 • Location-awareness – the software automatically finds relevant words and phrases, based on the user’s physical location. For example, if the user walks into a Tim Hortons coffee shop, the app will bring up ‘double double’ and latte to make it easy for the person to order his or her favourite item. Unique vocabularies can be associated with particular places.

• The ability to speak with ‘personality’ from a choice of four lifelike voices – male or female, American and British accents – and expressive capabilities such as emphasis, exclamation, and questioning inflections, laughs, whistles, coughs, and even um and ah.

• Physically accessible with integrated wheelchair-mounted switches. Anyone using wheelchairs and buttons or switch controls can talk out loud with less effort.

• Built-in scanning and a touch-screen switch.

• The availability of French – TalkRocket Go Francais! gives Quebecers the freedom to speak in their native language. MyVoice is also marketing to the speech-impaired in France, Switzerland, Belgium, and several African Francophone countries. All told, it’s estimated there are 1.5 million Francophones worldwide with serious speech difficulties who could benefit from an assistive technology.

Assistive technology is a burgeoning segment of the IT field, and TAGlab is at the forefront in developing software to enable full participation in society by aging senior citizens and individuals with special needs, such as Alzheimer’s disease, aphasia, mild cognitive impairment and/or physical impairments.

MyVoice and its TalkRocket Go emerged from TAGlab when Mr. Levy was a student researcher. He developed TalkRocket Go, initially named MyVoice, in response to a specific need. A senior who was afflicted with aphasia after a stroke approached TAGlab for help; he had tried a conventional communication aid that was cumbersome, complicated, slow and expensive – all factors that preclude widespread use despite the need.

TalkRocket Go was quickly developed and is the first of TAGlab’s projects to be commercialized. It is currently available at the iTunes store or Android Market for $99.

Formed in 2009, TAGlab’s initial research focused on seniors through projects at Sunnybrook Hospital’s Bayview Centre in Toronto, using digital multimedia with individuals with Alzheimer’s disease or mild cognitive impairment (MCI).

TAGlab founder Dr. Ronald Baecker recognized the emerging trend of Canadians wanting to age at home and stay socially active and independent, while facing challenges like isolation and home healthcare monitoring. As a result, TAGlab’s research progressed to include seniors with special needs, such as aphasia, stroke, or vision loss.

TAGlab’s research team collaborates with clinicians and researchers from the health sciences across North America and identifies sweet spots where technology could be relevant to human needs. Researchers envision ways in which technology could address a problem, then design, build, test, and where possible, commercialize the solutions.

Dr. Baecker also found an empathetic partner in Trish Barbato, Revera Inc.’s senior vice president of Home Health and Business Development, who contacted him, she says, “because there hasn’t been any innovation for people 75 years and older, and we should have.” Revera is a Canadian leader in seniors’ accommodation, care and services with more than 250 sites in Canada and the United States, and serves approximately 30,000 clients every day.

“In appreciation of TAGlab’s respectful and caring approach to help seniors and others with communication disabilities,” Ms. Barbato said, “we entered into a three-year, $50,000 a year research partnership to develop age-friendly technologies and offer tips to seniors who need encouragement to get online.

“We have lots of residents and at-home clients,” she added, “so we can support TAGlab in conducting focus groups to uncover where the most helpful innovations could be made, and offer our sites as living labs to test new technologies.”



Telehealth agencies strive to turn their services into mainstream medical offerings

By Andy Shaw

Like old soldiers, Canadian telehealth isn’t dying, but rather slowly fading away – as many of its proponents fervently hope. In at least three of the geographically largest healthcare jurisdictions championing it, there’s growing evidence that telehealth is simply morphing into better, wider-spread healthcare.

“Our vision is to make telemedicine a mainstream part of healthcare,” says Dr. Ed Brown, the chief executive officer of the Ontario Telemedicine Network (OTN). “We’re not there yet, but last year (2011) we had a 50 percent growth in the number of telehealth consultations and this year the rate is even more accelerated.”

And Ontario is not alone in its aim to make telehealth ubiquitous. Manitoba’s fledgling 21-site telehealth network of a decade ago has burgeoned to serve 124 locations province-wide today.

“We’re a large province with a small population that’s widely dispersed outside of Winnipeg; so that helped telehealth to really take off here in Manitoba,” says nurse Liz Loewen, now the director of coordination of care for Manitoba eHealth, overseeing the MBTelehealth program. “But now that telehealth is well established here, what we are pursuing is convergence of telehealth with the other tools of healthcare, such as the eChart Manitoba solution, our provincial electronic health record that we also have in place.”

Meanwhile in Quebec, a province where government was initially slow in spurring on telehealth, remote access initiatives have surged in the last few years, and now stretch from the suburbs of Montreal all the way up to native villages of the sub-Arctic.

A May telehealth conference in Montreal this year attracted over 200 care providers associated with McGill University’s Réseau Universitaire Intégré de Santé (RUIS) network. At the meeting, presenters offered a cornucopia of telehealth success stories for a vast region of western Quebec serving 1.8 million people.

The far-flung RUIS network spans nearly two-thirds of the province, running from West Island Montreal, skirting by Ottawa through the Outaouais region, on up to Abitibi-Temiskaming, ending ultimately at Hudson Strait and the Nunavik health region at the very tip of northern Quebec.

In that northerly sweep, RUIS, through the co-ordinating efforts of McGill’s Telehealth Office, links seven regional health authorities and 19 community care access centres with expert clinical, research and administrative staff at four partner Montreal teaching hospitals: McGill University Health Centre, Jewish General Hospital, St. Mary’s Hospital Centre, and the Douglas Mental Health University Institute.

“For almost a decade, RUIS has been a network in action, helping to improve access to healthcare, develop learning opportunities, promote training, and increase services and expertise in telehealth, says Dr. David Eidelman, the RUIS’s recently appointed president as well as McGill’s Dean of Health Affairs.

Moreover, this RUIS link-up is multi-lingual. English and French, bien sûr, but also RUIS telemed interpreters can understand what Cree patients are saying and also what a Nunavik elder might be explaining in difficult-to-learn Inuktitut.

RUIS’s multilingualism reflects the McGill University Telehealth Office’s mandate to implement a sustainable, multipurpose telehealth infrastructure. Some of its initiatives were trumpeted at the May conference:

• a nursing best-practices partnership involving the remote collaboration of six health jurisdictions

• three tele-ophthalmology initiatives screening for diabetic retinopathy, including one Health Canada-supported program for First Nations communities

• gynecology and obstetrics telemedicine partnerships linking the Rouyn-Noranda and Temiskaming regions, and a similar initiative for Nunavik

• a telehealth eating disorder consultation service, available at 11 sites on the RUIS network

• a three-region collaborative providing remote clinical supervision by “nurse navigators” in cancer and palliative care

• a remotely accessible “Cyber Learning” centre for professional mental health care givers hosted by the Douglas Institute

• other telehealth initiatives involving: dashboards and performance indicators; home telemonitoring of chronic disease patients; pediatric telecardiology and nephrology care; as well as virtual ambulatory and rehab clinics.

A very wide gamut, in other words, of regular healthcare.

Concludes Yves Bolduc, Quebec’s former Minister of Health and Social Services – somewhat bureaucratically but accurately: “By closely linking front-line support with specialized leading-edge care, research, training and practice, RUIS networks have achieved remarkable results. The RUIS structure has clearly led to new forms of co-operation and encourages the optimization of resources and state-of-the-art expertise.”

Perhaps nowhere in the world is telehealth more state-of-the-art than at OTN in Ontario.

“We’ve had a long history in our premier service of using leading-edge technologies such as videoconferencing and medical devices like hand-held exam cameras and digital stethoscopes that improve access and reduce travel, particularly for rural areas,” says OTN’s CEO Dr. Brown. “But more recently one of the really exciting developments for us is store-and-forward technology.”

And first out of the gate to use store-and-forward on the OTN have been dermatologists, referring physicians and their patients.

“If someone comes to their primary care provider with a funny rash or mole and needs a dermatology consultation, then the local physician can take a bunch of pictures, add some clinical information and send it all off to the dermatologist,” explains Dr. Brown. “That allows the dermatologist to find the time for full consideration of the case and send back a thorough diagnosis and treatment plan. That’s become very popular and we now have 250 referring physicians using the service.”

Based on that success, OTN is now planning similar store-and-forward services, the first for remote ophthalmology using locally snapped pictures of a patient’s retina that are then sent off to eye specialists. For the health of Ontarians, this is more than a nice-to-have.

“The eye and those retinal pictures can virtually tell a patient’s whole health history,” says Dr. Brown. “And it’s amazing how much pathology is being discovered this way for people who don’t have regular eye exams, particularly for diabetics.”

That’s one more example of a telehealth technique dissolving into the mainstream of chronic disease care.

It’s ironic that the same video-conferencing technology which spawned this kind of consultative telehealth is also one of the barriers to its expansion. The cost of its cameras, monitors, and high-speed links, as well as its need for a dedicated “studio” means that such telehealth can’t be deployed everywhere.

Enter Vidyo.

“Vidyo is our attempt to roll out a less expensive, PC-based video conferencing system,” explains Dr. Brown. “And we have close to 100 physicians now doing their video conferencing using the Vidyo application at their desktops. Also, we will be rolling Vidyo into a telemedicine portal which will make it not only available to physicians’ own computers but on their mobile devices, as well. That should be out to them this Fall.”

It’s yet another effort to make telemedicine mainstream, says Dr. Brown: “We want to keep making it simpler, easier to access, and less expensive. And most importantly, make sure that the service integrates readily into a physician’s workflow.”

Workflow was also top-of-mind, adds Dr. Brown, when OTN released this year its Telemedicine Directory: “The directory is a place where you can find consultants; see what they do and what sort of patients they would accept; and therefore make it simpler to organize your care.”

Similarly, OTN is releasing a Site Finder so that if a physician has a patient in a small community, the doctor can readily find the closest site that will accept the patient for a telemedicine appointment.

To help such remote doctors keep up their skills the OTN last year launched its first mobile app, dubbed the Learning Centre. “Right on your iPhone or other mobile device you can find the education event or courses nearest you that you want to attend or take,” says Dr. Brown. “You can also ask the Learning Centre to send you alerts. So if you are interested in cardiology, it will automatically email you the details as soon as the details of that cardiology event are made public.”

That service is also helping OTN move into the mainstream of medical education.

“We had 13,000 medical education events of one kind or another last year,” says Dr. Brown, “and the growth in those events was stimulated partly by the technologies we added to our education services, including multi-point video conferencing, live webcasts over the internet that can also be archived and watched later. We also added web conferencing, so anyone on our network who wants to can run live webinars for whoever wants to join them.”

These initiatives and others have made OTN grow every year.

“Our membership now includes over 300 community mental health agencies, over 100 family health teams, almost 100 long-term care facilities, and a number of native communities who have all set up OTN studios within their walls,” says Dr. Brown. “In all we have 1,500 physical “sites” as we call them on the OTN, but that number becomes less relevant as we move into store-and-forwarding as well as into mobile applications. On the videoconferencing side, we now have 2,800 platforms that have gone to the network. We also link with two other telehealth networks in northern Ontario that service the communities without roads stretching right up to Hudson’s Bay.”

With a large territory to cover, Manitoba has also seen financial benefits for government and for patients .

Distance is a challenge in Manitoba,” says Manitoba eHealth’s Liz Loewen. “Our recent benefits evaluation work demonstrated that in 2010-11 in terms of travel avoidance, our telehealth system saved about $2.6 million dollars in patient travel.”

In an example of telehealth becoming a more mainstream tool, says Loewen, Manitoba eHealth cited the work of the Manitoba Adolescent Treatment Centre and the psychiatric services it offers: “They’ve been working with youth living in northern and remote locations who are presenting in a crisis. In the past they would be transported south, maybe escorted by the RCMP or healthcare staff. But by time they get to an urban treatment centre, often the crisis has passed and they are judged no longer eligible for care at that centre. So they are returned back.”

Now through videoconferencing a rapid assessment of the patient and crisis can be made by remote experts working with local care providers – they can together determine whether the youth in crisis really needs to be transported out of the community. And if not, the remote specialist can help plan and monitor the care to be executed in the home community.

In 2011, Manitoba eHealth and the other care agencies involved in the program won a “service excellence” award from the provincial government for their efforts.

It’s an example of how Manitoba eHealth is integrating telehealth with mainstream care.

“We’re moving towards using technologies that are lower-cost, easy to use, mobile, and readily integrated into caregivers’ workflows,” says Loewen. “And oncology is certainly one of our biggest activities on the network. CancerCare Manitoba supports chemotherapy sites across the province. So we have telehealth technology in place at those sites to help address individual patient complications. That means patients can not only get their therapy but they can also see their specialists at the same time, and without an extra trip into Winnipeg.”

As in Ontario and Quebec, Manitoba is also using its telehealth network to lessen administrative burdens and to provide educational opportunities for its remote care-givers. Though it only uses up a small portion of network time, Loewen says the most heart-warming telehealth service her organization provides is its tele-visitation service: “We treat a lot of patients who are flown in from Nunavut in the far north. There’s actually a residential centre for them here in Winnipeg. So we have worked with Nunavut to put telehealth in that residence so patients can connect back home either to their primary care provider and to family and friends. And that’s hugely helpful, not only psychologically but when important decisions have to be made about their care, they need the support and wisdom of those back home.”



Difficulties in obtaining and sharing data can hamper the use of analytics

By Richard Irving, PhD

A recent study by IBM entitled, “The Value of Analytics in Healthcare,” addresses many issues of the use of analytics in healthcare. This report, based on a joint study by IBM Corp. and MIT, identified 11 barriers to widespread adoption of analytics.

The most frequently cited problem was the ability to get relevant data. This included not just a lack of data but also the ability to sift through a huge mound of data to find the relevant information. In order to overcome this barrier, organizations had to be able to integrate data from multiple sources and standardize it so that data definitions were consistent.

Another frequently cited problem was a corporate culture that does not encourage the sharing of information. This organizational barrier is reflective of a silo culture and is a huge stumbling block to the development of an integrated, fully networked organization. The report does not address solutions to this problem, but here are a few ideas.

First, review budgeting policies to identify areas where cooperation and information sharing can be rewarded through budget practices. Remove disincentives for information sharing. A second action is to identify individual reward processes. Identify any opportunities to create shared rewards between groups. Finally, make a point of identifying and celebrating successful collaborative efforts. All these activities take time; organizational cultures are slow to change, but they do eventually change.

A third barrier to the use of analytics was a lack of understanding of how to use analytics to improve the business. This is the most amenable to change since there are case studies and education programs that can demonstrate the value of business/healthcare analytics.

Among the remaining barriers were: lack of management availability due to competing priorities; lack of executive sponsorship; lack of skills internally; no case for change; don’t know where to start; and ownership of data is unclear or governance is ineffective.

The report describes a three-phase pathway to healthcare analytics adoption. The first stage is aspirational, where the organization is new to the use of healthcare analytics and is focused on analytics at the point of need. Often they turn to analytics to cut costs but lack the elements to use analytics effectively (e.g., people, processes and tools).

The second phase is experience, where the organization has an established base of users and is looking to move beyond cost management. They are seeking to expand their ability to share data, information and insights as a way of optimizing their corporate performance.

The third phase is the transformed organization. Here, the organization has realized many of the benefits of analytics and is beginning to outperform comparative organizations. They understand how to collect, manage and share data and have improved their operations with the insights gained from this process. According to the study, transformed organizations were three times more likely to outperform their industry peers.

Finally the report recommends five steps to adopting analytics:

• Focus on the biggest and highest value opportunities – these must be well defined so that appropriate questions can be framed and the right outcomes identified.

• Within each opportunity focus on the questions not on the data – identify the questions you would like answered. This will help identify the information needed and the data required.

• Embed insights to drive actions and deliver value – ensure that information gained and insights developed are embedded in an action oriented process.

• Keep existing capabilities while adding new ones – build on existing capabilities and ensure that your analytics are both scalable and flexible.

• Use an information agenda to plan for the future – this requires an overarching vision of how the organization can use the information derived from analytics to improve its performance. Without some integrated plan, there is a risk of a fragmented and ineffective analytics implementation.