Inside the September 2001 print edition
Canadian Healthcare Technology:
Feature Report: Electronic commerce in healthcare
readies advanced system for e-patient records
Oracle Corp. is about to expand its healthcare software business with
the creation of a suite of clinical applications, including a sophisticated, electronic
patient-record system capable of connecting care-givers and patients across wide
OHA creates e-Health council
The OHAs new e-Health Council, headed by UHN CEO Tom Closson, is
calling on the federal government to pump $2 billion into the computer and communications
infrastructure of Canadian hospitals.
Wireless computer access to Internet offered to patients in Toronto
A pilot project at Torontos smallest downtown hospital is giving
one patient round-the-clock wireless access to the Internet.
Whither online medicine?
The malaise that recently struck U.S. based online medical services has
also affected Canadian outfits. Recently, WebMD Canada laid-off its editorial employees.
Other companies have also been hit.
Wireless Net for patients
A Toronto hospital is offering patients access to the Internet using a
wireless network. The service provides stimulation for patients, and revenue for the
Is your info secure?
A feature report looks at new trends in safeguarding the security and
confidentiality of electronic patient records. Solutions include outsourced computer
Innovations from Compaq
At a recent press briefing, Compaq outlined new product and strategic
directions. The company said healthcare is high on the agenda, with new solutions
forthcoming from the Houston labs.
PLUS news stories, analysis, and features and more.
Oracle readies advanced system for e-patient records
By Jerry Zeidenberg
TORONTO Oracle Corp. is about to expand its healthcare software
business with the creation of a suite of clinical applications, including a sophisticated,
electronic patient-record system capable of connecting care-givers and patients across
wide geographical areas.
The software is said to be different than other systems currently on
the market in that it will use a variety of communications technologies to link patients
with various types of healthcare providers including physicians in hospitals and
private practice, and pharmacists. It will also take advantage of Oracles strengths
in databases, customer-relationship management and transaction processing.
Not only will a physician be able to send prescriptions on behalf
of patients to pharmacists, but the system will also send messages from the pharmacy back
to the doctor, informing him or her about whether the patient actually picked up the
medication, said Dr. Thomas Jones, senior director, healthcare applications, for
Dr. Jones spoke to a gathering at the COACH/CIHI e-Health 2001
conference in Toronto last May.
Over and above that, the system will then connect to the
patients cell phone, reminding him to take his medication. It can even be programmed
to ask the patient to call back, confirming that he or she has done so.
As a result, the patient record system not only captures information,
but also plays a role in health promotion and compliance.
Ian Fish, Oracle Canadas national industry leader for healthcare,
said Oracle refined the design of the system earlier this year and that coding began this
summer. The company has already arranged pilot projects in the United States with
HealthSouth Corp.- and in the United Kingdom with the National Health Service. Oracle has
also been speaking with authorities in Canada to establish a pilot project here, said
For its part, the U.S. trial could lead to an extensive implementation.
HealthSouth has medical facilities in all 50 states, said Dr. Jones. The
goal for us is to become their information highway.
While other companies, such as HBOC and Cerner, have dedicated their
resources to the creation and implementation of electronic patient records, market
research shows that many hospitals and nearly all privately practicing physicians have yet
to install a system.
Moreover, even among hospitals and clinics that have implemented an
electronic patient record system, there is no clear market leader when it comes to
vendors. Instead, the marketplace is extremely fragmented.
Dr. Jones acknowledged the move into electronic patient records systems
is a significant step for Oracle, which has traditionally been a provider of back-end
systems such as powerful databases and enterprise resource planning systems.
Its a sea-change for us, he noted. But our success in ERP
applications persuaded us to enter another sector, and to produce healthcare
Earlier this year, Oracle announced that it would partner with
HealthSouth to build a digital hospital in Birmingham, Ala. The partners say
it will be the most highly computerized facility in the United States.
This will be the hospital model for the world, said Richard
Scrushy, CEO of HealthSouth, in a corporate release. By creating the first automated
hospital, HealthSouth and Oracle are taking an idea that many have talked about and making
it a reality. We will demonstrate how technology can lower healthcare costs, greatly
reduce human errors and provide patients with the best medical care available.
The hospitals technological features will include patient beds
with display screens connected to the Internet, electronic medical records storage,
digital imaging instead of traditional X-ray film, and a wireless communications network
that will permit healthcare professionals to securely access electronic patient records
while using handheld computers.
For its part, HealthSouth intends to invest US$100 million to US$125
million in construction of the 219-bed hospital. Work should begin in the first quarter of
2002 and end by mid to late 2003.
Oracle said the hospital will make use of the companys systems
for administrative and business processes, along with its new healthcare software,
including core clinical applications.
Other companies involved in the project include:
Carl Zeiss, a leader in the fields of optics, precision
engineering and electronic visualization.
Dade Behring, a provider of laboratory diagnostic products and
Datascope, a medical device company that manufactures and
markets products for interventional cardiology and radiology, cardiovascular and vascular
surgery anesthesiology, emergency medicine and critical care;
General Electric Medical Systems, a world leader in diagnostic
Hill-Rom, an international provider of healthcare products
including beds, therapy surfaces, room furniture, modular wall systems, medical gas
management systems, perinatal/neonatal products, staff/patient communication systems,
stretchers, surgical columns and lighting;
Pyxis, a provider of medication and supply dispensing systems;
Smith and Nephew, a leading provider of medical devices
principally in orthopedics, endoscopy and wound management;
STERIS, a supplier of infection prevention and contamination
prevention, microbial reduction, and therapy support systems, products, services, and
Visualization Technology, a world leader in electromagnetic
image guidance systems, specializing in ENT, cranial, spine and fluoro applications.
All of the participants have agreed to work together to ensure
full integration of equipment, Scrushy said. That is a revolutionary
development, and is a major step toward overcoming the biggest obstacles in healthcare
communications gaps created by incompatible computer systems, the over-dependency
on paper systems for documentation and inefficiencies in daily communications.
OHA launches e-Health council, calls on governments for funding
By Jerry Zeidenberg
TORONTO If the federal government is serious about creating a
modern, computerized health system, it must quickly establish an e-Health fund that will
pump an extra $2 billion into the technological infrastructure of hospitals and other
providers of medical services nationwide over the next four years.
Thats the prescription from the Ontario Hospital Association,
which recently announced the formation of its own e-Health Council. The council is headed
by Tom Closson, CEO and president of the University Health Network in Toronto.
The OHA also called for the Ontario government to separately infuse
$750 million into provincial initiatives to build the e-Health capabilities of healthcare
organizations during the next three years.
The OHA stresses that it should be new money over and above
programs previously announced.
The OHAs e-Health Council has produced a report, Building the
Foundation for e-Health in Ontario, that studied the potential gains of increased
investment in computer technologies. (The report is available at www.oha.com)
At a press conference, Closson said the new council is urging the
federal and provincial governments to increase spending on computerized solutions to help
speed up delivery of service, improve medical outcomes and reduce costs in the public
health system. He pointed to the chronic under-investment on information technology in the
healthcare system as a major problem.
The hospital sector spends 2 to 3 percent of its total costs on
I.T., compared with the banking sector, which spends about 12 percent on I.T., said
Closson. Its not surprising that were having troubles in our
The OHA report cites a myriad of benefits that can be obtained through
computerized healthcare systems, including:
A dramatic reduction in medication errors through physician
order-entry systems that are linked to pharmaceutical databases capable of detecting
Improved patient care at the point of delivery through better
access to patient and clinical information, such as electronic patient records containing
medication histories and other details;
Greater access to specialists, especially in remote and rural
regions through telehealth;
Evidence-based care through best practices, made possible by
integrated decision-support tools;
The OHA study probed the barriers to implementing computerized
solutions in hospitals, and found that to date, the number one hurdle has been a lack of
funding. This was followed by a shortage of skilled computer and communications
Disagreement about I.T. strategy is also a problem for many hospitals.
When it comes to creating a system-wide network, most hospitals cite a lack of common
standards as the main stumbling block. They also cited the absence of a shared vision and
leadership as significant barriers.
To address these and other issues, the OHA asserts:
The federal and Ontario governments must provide additional
money for computer infrastructure and solutions.
Centralized bodies such as Ontarios nascent Smart
Systems for Health and the Ministry of Health itself should take a leadership
position in establishing I.T. directions for the health system. According to the report,
this would help hospitals to better understand provincial priorities for the future
and to coordinate their own planning decisions accordingly.
The Ontario government should fund 100 percent of ICT
system-wide infrastructure and 85 percent of hospital ICT investments related to Smart
Systems for Health.
The council says it will soon appoint a Chief e-Health Strategist.
Whats more, it says it will produce an action plan this month. The plan will refine
priorities that the council established:
The immediate establishment of a task force to develop common
identifiers for all patients in Ontario;
The OHA and the Ontario government must quickly implement the
Smart Systems for Health (a secure network), to provide secure, real-time transmission of
confidential data. We recommend that it be set up at arms-length from government, so
we can make some quick movement, said Closson.
The OHA and member hospitals should work with the Ontario
government, other providers and stakeholders to quickly implement personal health privacy
legislation that protects patients against unauthorized and inappropriate disclosure of
The OHA and member hospitals should work with government, Smart
Systems for Health and other providers, to ensure common data and technology standards for
sharing of key information.
The Ontario Ministry of Health should provide $15 million in
start-up funding for the development of an Emergency Department Information System, as a
pilot project, and that the results of this project should be made available to hospitals
across Ontario as soon as possible.
Members of the Council stressed that steps should be taken immediately.
Weve got a year-long window of opportunity to start creating synchronized
systems across the country, said Sam Marafioti, chief technology officer at
Sunnybrook and Womens College Health Sciences Centre and a member of the e-Health
Council. If theres foot-dragging for longer than that, there will be a loss of
credibility [at the federal and provincial levels], and organizations will go back to
creating their own solutions in an unsystematic way.
To demonstrate a successful e-Health solution, Dr. Ed Brown, an
emergency physician at Sunnybrook and program director of the NORTH telehealth network,
participated in a videoconference with a patient at the Kirkland & District Hospital,
in Kirkland Lake, Ont.
The NORTH network was established four years ago to address the
shortage of specialists in remote and rural areas of Ontario. It uses videoconferencing
and remote medical instruments to connect specialists at Sunnybrook and other tertiary
care centers with hospitals in remote and underserved parts of the province.
Using the systems, physicians working in over a dozen areas of medicine
including orthopedics, dermatology and psychiatry have been able to examine
patients at a distance.
Weve conducted 1800 consultations, 200 educational events
and have had 300 physicians involved, said Dr. Brown. Our patient satisfaction
level is 94 percent, about as high as you can get in surveys of this kind, he said.
On a related front, Andrew Szende, CEO of the electronic
Childrens Health Network (e-CHN), described the system and noted that it has been
expanded to include a total of seven organizations. (Credit Valley Hospital and the
Bloorview-McMillan Centre were most recently added.) He asserted that e-CHN could become
the foundation for a province-wide electronic-patient record network.
You could expand the system to include, for example, cardiac,
cancer or geriatric patients, he explained. You could set it up any way you
eCHN was spawned under the leadership of the Hospital for Sick
Children, with the assistance of the Ontario government.
At the time of Szendes presentation in July, the system consisted
of a secure network that connected five locations, with a total of 25 different clinical
systems. eCHN brings data from different locations into a single view, said
Szende. The record goes with the child, whether that youngster is treated at
three or four different hospital sites.
By sending the records electronically, you reduce the duplication
of tests that goes on, said Szende. You also eliminate the need to search for
records at different locations, as the computerized information is quickly available
to doctors and other healthcare professionals across the network.
Wireless computer access to Internet offered to patients in Toronto
By Winton Cape
A pilot project at Torontos smallest downtown hospital is giving
one patient round-the-clock wireless access to the Internet. Until now, patients at
Toronto Grace Hospital who wanted to access the Internet had to use the Resource Centre
a mini-library with one computer. Access was limited due to staff usage and
volunteer availability. But thanks to wireless access cards, all patients will soon have
independent, hassle-free access.
Chronic-care patient Vanda Rocha is the test subject. I
didnt want to go through my life without a computer just because I was living in a
hospital, she said.
With roaming Internet access from anywhere in the hospital, she has
access to the outside world via her laptop.
The sense of independence and convenience she feels is tremendous.
I really appreciate the Resource Centre, but I wanted to answer my e-mails when I
felt like it. Rochas Compaq 100S notebook is equipped with an SMC wireless
network card. She can connect to the Internet from almost anywhere in the hospital
her room, the patient lounge, even the cafeteria.
For chronic care patients, keeping in touch with friends and
family is very important and we want to ensure patients have the best and most reliable
experience possible, says Anne Lawrence, Canadian Health & Education Manager,
Compaq Canada Corp. By supplying Compaq notebook technology and wireless access
cards, the Toronto Grace Hospital allows patients to connect with the Internet anywhere,
Recently, the technology infrastructure of the hospital was being
upgraded to include wireless. When one of our patients asked for Internet access in her
room, this created a win/win opportunity. We could improve the quality of life for
patients at our hospital while also positioning our technology infrastructure for the
future changes in the healthcare system.
The hospital already uses wireless technology in its administration
area, and moving the technology into the nursing areas was a natural transition. A
wireless access unit was added to the existing nursing hub and the patients wireless
access cards are configured to communicate with this unit. It was not difficult to create
this new service for our patients almost plug and play!
By taking advantage of our T-shaped building and placing the access
units at the intersections of two main corridors, a 1500-foot spherical field or cell was
created allowing for maximum access to the signal. Our patients are not the only ones to
benefit from this system the staff also has easy access to the Internet, e-mail and
the Intranet from anywhere on the unit.
For patients, the information systems department charges a small
monthly fee for this network access, not unlike the fee for cable television service.
Through innovative technology solutions, Toronto Grace has
provided a vital service to its patients a connection to the world from their
room, says Lawrence. In addition, Toronto Grace provides a service that
generates additional revenue for the hospital.
Toronto Grace Hospital is home to a number of chronic care patients and
the Internet is an excellent way for them to keep up to date by using e-mail, and to keep
in touch with electronic greeting cards and net-based discussion groups.
Winton Cape is the IS manager at the Toronto Grace Hospital.
Canadian healthcare dot-coms are undergoing a chilly reality check
By Dr. Alan Brookstone
The chill that has affected U.S.-based Internet healthcare services for
physicians and consumers has drifted north of the border to Canada. In June 2001, New
Jersey-based WebMD Corp. quietly pink-slipped its Canadian editorial staff.
WebMD, in conjunction with Scotia Bank, the College of Family
Physicians of Canada and the Royal College of Physicians and Surgeons of Canada had
launched the Canadian Doctors Network (CDN) less than one year earlier as a portal
service to Canadian physicians. According to Dr. Claude Renaud, director of professional
affairs for the College of Family Physicians of Canada, The Canadian Doctors
Network will continue to exist. Instead of being hosted in Canada, the new portal
service will be provided as customized version of the WebMD (USA) physician site.
Most Canadian content from the original CDN service will appear under a
Canada tab located on the new web portal navigation bar. The service will
continue to be provided at no cost to members of the CFPC and RCPSC.
Consumer health information services in Canada have been affected just
as significantly as their professional counterparts. Vancouver-based Medbroadcast.com, a
provider of Canadian consumer health information is desperately trying to survive. A
recent cash injection of $5 million by CanWest Global Communications Corp (18 percent
owner of Medbroadcast Corp.) has allowed the struggling company to carry on while a new
CEO is sought.
Meanwhile, Dr. Michael Pezim, a general surgeon and son of the late
stock promoter Murray Pezim, resigned as president of MedBroadCast to return to medical
While all of the rationalization has been taking place in the Canadian
Internet health space, the Canadian Medical Association has been developing its own
strategy. Larry Mohr, assistant vice-president of marketing for the Canadian Medical
Association, described the CMA strategy as being, A long term approach to
integration of the Internet into the organization in a manner that is sustainable.
As Canadas largest physician representative association, the CMA
sees its role as establishing a virtual national medical community built around the CMA
brand. In order to achieve this objective, the CMA acquired Montreal-based GlobalMedic
through CMA Holdings, the business arm of the CMA, in April 2001. GlobalMedic will provide
the technical expertise to the CMA as the organization moves towards implementing its
Currently, physicians continue to run primarily paper-based medical
offices, utilize the Internet very little in day-to-day practice and are just beginning to
adopt smidgens of technology in terms of handheld devices and electronic patient records.
What the past two years has provided is a health dose of reality. The
healthcare industry does not change quickly. It is like a giant pendulum that is
continually swinging from side-to-side with each arc taking about 10 years to complete.
Changes are often made in a knee-jerk fashion, affected by the long
cycles of change and generally out of synch with the reality of time. The Internet is a
fantastic tool and no one doubts that it will significantly change the way in which
healthcare is delivered in the future on both the physician and consumer side.
Unfortunately, in the early days of the Internet, the expectations were
too high, the changes too quick and the business strategies unsustainable.
Dr. Alan Brookstone is a physician based in Richmond, B.C.
Canadian hospitals seek better security as computer systems multiply
By Dianne Daniel
As Canadian hospitals begin to move towards electronic patient records
and centralized information databases, its somewhat ironic that the recommended
starting point when securing such systems is a return to the very thing they are aiming to
A lot of hospitals know of a security policy or say they have
one, but its not documented, not written and this is really the first step,
says Kevin Krempulec, enterprise sales manager, Canada, for Symantec Corp. of Toronto.
You need to have a written policy of the actual steps youre going to take (to
secure your data) and what actions youve taken to fulfil those.
It sounds elementary, but according to Krempulec if it ever comes down
to proving duty of care in the event of a security breach showing that a healthcare
institution did in fact take steps to ensure data remains confidential a written
security policy will prove invaluable. Even if such a document already exists, it should
be re-examined before any technology decisions are made, he adds.
When developing a security policy, Krempulec suggests looking at three
broad areas: a perimeter assessment, using software tools to scan your network for
vulnerabilities and implementing a firewall; an anti-virus program to protect against
known threats; and finally, intrusion detection software to guard the servers where the
patient data resides.
Steve Chapman, program marketing and sales manager at the Canadian
Imperial Bank of Commerce (CIBC) in Toronto agrees a documented security assessment is a
good place for hospitals to start. As the Canadian national affiliate of VeriSign Inc., a
provider of outsourced public key infrastructure (PKI) services, the CIBC operates a
business unit dedicated to helping organizations secure their data using digital
certificates. For a yearly fee (usually between $100,000 and $200,000), users receive a
completely managed solution, leveraging the CIBCs existing secure facility and
trained technicians to protect their data.
While there are many PKI products on the market, most designed to
assist an organization in building its own in-house PKI infrastructure, CIBC/VeriSign
differentiates itself by offering PKI services based on an outsourced model. All
thats required of a hospital, explains Chapman, is to ensure users who need access
to the secure data have a PC and an Internet connection. They then enroll for a digital
certificate, a small footprint that is integrated into the users desktop via the Web
browser and must be presented in order to gain access.
Typically, CIBC/VeriSign begins by analyzing an organizations
entire IT infrastructure in order to determine any security vulnerabilities that may
exist. In Chapmans experience, most healthcare organizations lack a written security
policy so a PKI discovery or assessment is first. Then, once it is
determined who needs access to what information, digital certificates, most often based on
two-factor authentication are issued, one to each desktop. As part of its service,
CIBC/VeriSign manages the certificates, ensuring they are renewed every year and that
users change their `factors frequently.
Based on what we see in the marketplace, healthcare providers are
really looking to have access to the necessary patient information where and when they
need it, but in a secure manner, says Chapman.
For the past year, Miyo Yamashita has been on a mission to do just
that; ensuring people have access to the information they require to do their jobs at
Mount Sinai Hospital in Toronto. In her newly created role of data security officer,
Yamashita manages access privileges across the hospital and takes steps to secure data
from area to area. Its also her role to serve as an internal resource on privacy,
legislative and data security issues, and to help various areas secure patient data and
understand the issues of patient confidentiality.
What gets complicated at large teaching hospitals is you have
people who play multiple roles and have different access privileges as a result, she
says. In healthcare, denying access could be a matter of life or death in a worst
case scenario, so you want to make sure individuals do have access to the information they
require to do their jobs.
On the other hand, you want to make sure thats balanced
with patient confidentiality concerns.
When Yamashita arrived in June 2000, Mount Sinai Hospital already had a
corporate confidentiality policy in place. All new staff are required to sign a waiver
outlining the policy and penalties for breaches. Interest in security has heightened, she
says, because of the great move towards integrating separate health information systems,
both within a hospital and among different care providers.
Another reason for the growing concern is the recent trend towards
health privacy legislation, which has already been passed in some provinces and is looming
on the horizon in Ontario. At the federal level, Bill C-6, the Personal Information
Protection and Electronic Document Act, will cover healthcare information by January 1,
2004, and will apply to any province that does not already have similar legislation in
place, explains Yamashita.
Regardless of the content of such legislation, Mount Sinai is taking
steps to ensure patient privacy using the standard multiple security layers such as
firewall, virus protection and intrusion detection, as well as by running regular random
audits on users.
With Bill C-6, its going to be required that hospitals show
theyve improved security for compliance, notes CIBC VeriSigns Chapman.
Probably the biggest hurdle we have to face is educating people that security is an
ongoing procedure; its not something thats a static event where you buy
something and youre secure.
That may be one reason why there has been growing interest in managed
security services, he adds, where a vendor like CIBC VeriSign will provide firewall, virus
protection and intrusion detection services for a monthly fee. Such outsourced services
can be a cost-effective alternative for hospitals that lack the internal resources to deal
with security issues and are faced with tight budgets.
The frustration is that even if they had an infinite amount of
budget, theyd never be 100 per cent secure, notes Chapman. So you have
to find that sweet spot where you balance off your costs how much youre
comfortable spending versus how secure youre going to be.