Inside the September 2004 print edition of Canadian
to create intelligent healthcare portal
A group of Ontario hospitals, universities
and private-sector partners have joined forces to solve one of
the biggest problems in healthcare I.T. the inability
to access data quickly because of incompatible systems.
Exclusive interview: Richard Alvarez, CEO, Infoway
Recently, CHTs contributing editor,
Andy Shaw, caught up with Mr. Alvarez to check on his progress
at Infoway after six months on the job.
HR outsourcing in Calgary
The Calgary Health Region has created an innovative
human resources partnership with Telus. As part of the deal,
the region gains $20 million in new infrastructure.
READ THE STORY ONLINE
Ottawa hires safety expert
The Ottawa Hospital Research Institute, part
of the Ottawa Hospital, has recruited a high-profile expert in
medical error issues, as part a drive to take a leadership position
on patient safety.
Accountability and more effective use of resources
have emerged as top issues for hospital administrators, leading
to increased use of performance management systems. We find that
its not the software that's so important, but the methodology.
READ THE STORY ONLINE
Ready for wireless?
A panel of physicians and communications experts
recently outlined ways in which wireless solutions are transforming
healthcare in hospitals. However, they concurred that wireless
technology is not as prevalent as it could or should be, and
that hospitals have much work to do in this area.
PLUS news stories, analysis, and features and more.
Consortium aims to create intelligent healthcare portal
By Jerry Zeidenberg
TORONTO A group of Ontario hospitals,
universities and private-sector partners have joined forces to
solve one of the biggest problems in healthcare I.T. the
inability to access data quickly because of incompatible systems.
Clinicians who move between healthcare organizations are
forced to contend with information silos and disparate clinical
information systems daily, said Dr. Lynn Nagle, senior
vice president, technology and information management at Mount
Sinai Hospital, one of the participating organizations. This
initiative just might be the solution were seeking.
Funded with $2.4 million from government agencies and partner
contributions, the group aims to create the first intelligent
web portal one that can bring forth a host of relevant
information related to particular patients and their conditions.
Phase one of the project is expected to be up and running this
Using the Internet for connectivity, the partners plan to employ
unique middleware and database technologies to pull together
various types of medical information from a variety of sources
lab, radiology, ADT, pharmacy, regardless of the location
or data format.
Whether the records are stored in Meditech systems, MediSolution,
Cerner or any others, it makes no difference, as the new solution
will be able to access them all and present data in a way that
make sense to the doctor, nurse or administrator who needs information.
Billions of dollars have been spent on collecting data
in the healthcare system, but its very difficult to get
at it and bring it to the user, said Ehud Cohen, a partner
with Data Glider Ltd. of Richmond Hill, Ont., an R&D company
and project leader for the consortium. The problem is that
were data rich and information poor.
We want to be able to access different data sources and
give healthcare professionals the right data at the right time,
at the point of care, said David Lewis, director of marketing
with Data Glider.
In addition to DataGlider and Mount Sinai Hospital, members of
the consortium are Lakeridge Health Corp., Oshawa; Credit Valley
Hospital, Mississauga; Department of Medicine, University of
Toronto; Computer Systems Group, University of Waterloo; Centre
for Global e-Health, University Health Network, Toronto; and
Compugen, Inc., Richmond Hill (a large, systems integration company
thats handling project management and commercialization
of the system.)
The group recently obtained project funding of $800,000 from
Precarn Inc., an Ottawa-based economic development agency, and
$150,000 from Communications and Information Technology Ontario
(CITO), a division of Ontario Centres of Excellence Inc. The
remainder of the $2.4 million development budget will be provided
by the member organizations.
The plan is to commercialize the technology, when it is completed,
and to market it to hospitals across North America.
Web portals to access information are not new, and many hospitals
are already using them. But Cohen noted there are significant
differences between these existing portals and what DataGlider
and its partners are envisioning.
First, he asserted, most portals can only access information
thats contained in the hospitals own information
system. By contrast, the consortiums system will be able
to quickly access data stored in any repository, regardless of
the vendor or location.
Moreover, the groups portal will enable the end user to
customize his or her view, altering the interface so that only
the information sources that are needed are presented on-screen.
Most portals today present a fixed view that cant be changed
by the end-user.
Finally, some hospitals and health regions are using middleware
or integration engines to bridge disparate islands of information.
But Cohen said its an inefficient way of doing the job,
as integration engines usually copy all of the data onto a central
site. That creates storage, synchronization and timeliness problems.
These problems multiply as you extend the reach of the system
to long-term care, pharmacies, physician practices and other
providers. Copying all of the data becomes a massive, unwieldy
project, he said.
For its part, the consortiums technology will leave information
wherever it may be, and pull it together as needed. A better
approach is to leave data where it is, and to link it in real-time,
said Cohen. In this way, we create a virtual
Finally, there are other approaches to integrating incompatible
systems. For example, the U.S.-led Integrating the Healthcare
Enterprise (IHE) is establishing standards by writing profiles
for thousands of transactions that occur in the hospital and
healthcare setting. (See article in Canadian Healthcare Technology,
June/July 2004.) While the IHE is making progress, its
a time-consuming and painstaking process.
DataGlider and its partners are taking more of a big-bang approach
that seeks to establish connectivity in one fell swoop. Intelligent
middleware and web portals not only ensure that all information
is accessible, but also that it can be personalized for each
and every user.
Simply put, the users computer screen is divided into blocks
representing portlets, which access various streams
of information. For example, a physician who needs access to
lab, pharmacy, ADT, patient histories, and orders can select
these for display on his or her screen.
The information for all of these applications will be available
within seconds, with no need to log-in or log-out. Its
there simultaneously and seamlessly, said Lewis. Its
all done with single sign-on. You dont have to bother with
log-ins to various systems.
Cohen said the project was originally sparked by visionaries
at the three hospitals that are part of the group Dr.
Lynn Nagle at Mount Sinai Hospital; Jamie Bowie, director of
information technology at Credit Valley Hospital; and Deborah
Anthofer, program leader, information technology, at Lakeridge
Health Corp., as well as by Dr. Alejandro Jadad, director of
the Centre for Global e-Health, part of the University Health
Network and the University of Toronto. They realized that costs
for accessing information sources were escalating, with no quick
solutions in sight.
They got the ball rolling on the new solution, one that would
create a virtual electronic record on a regional basis to start,
and possibly integrating records province-wide or even nationally.
The hospitals and the Centre for Global e-Health are conducting
the research into what physicians, nurses and other professionals
need from the system, so the right sources of information can
The Department of Medicine at the University of Toronto is providing
research into the way the system can be optimized for physicians
workflow, while the University of Waterloo is developing a declarative
reporting engine for presenting information to physicians in
Said Dr. Nagle: The intelligent e-health portal will also
provide clinical decision-support tools such as reference databases
and best practice guidelines. Future applications of this solution
Moreover, by pulling up disparate sources of data, such as ADT,
lab reports, medication histories, diagnostic images and radiology
reports, it will save physicians the time and trouble of logging
in and out of these systems. This is where we improve the
workflow issue for doctors, said Lewis. Bringing
information together in this way will also help reduce medical
error, which lowers costs for the hospitals and improves the
quality of care for the patient.
Dr. Nagle noted that by creating a common front-end interface
for doctors and other healthcare professionals, substantial training
costs can also be controlled. As clinical applications
have evolved, weve been asking more of peoples time
for training, she said. And weve been competing
for training time with other things, like clinical education.
Conceivably, if the portal concept were to be widely adopted,
clinicians could be trained once on the intelligent e-health
portal and easily adapt to many different systems, in many different
healthcare organizations, said Dr. Nagle. She is also delighted
with the technologies developed by DataGlider. The potential
for their solution to address a system-wide problem is enormous,
Q & A: Alvarez outlines strategic vision for Canada Health
By Andy Shaw
When the Board of Directors of Canada Health
Infoway Inc. (Infoway) announced the appointment of Richard Alvarez
as Infoways new CEO in January this year, he was lauded
for bringing a unique blend of senior leadership experience
and passion to his new role that would help move
Infoway to the next level in its efforts to create a pan-Canadian
electronic health record (EHR).
Mr. Alvarezs leadership experience includes heading the
Canadian Institute of Health Information (CIHI), and serving
as assistant deputy minister with the Alberta governments
Information Technology and Health Care Insurance divisions.
Recently, CHTs contributing editor, Andy Shaw, caught up
with Mr. Alvarez, to check on his progress at Infoway after six
months on the job. They spoke in London, Ontario at St. Josephs
Health Care, on the heels of short ceremony celebrating the first
phase completion of the Southwest Ontario Digital Imaging Project.
At the event, Alvarez presented an Infoway cheque to St. Josephs
CHT: Richard, you clearly relish rewarding
Alvarez: Yes, Andy, we do. The money that
I handed out today was the reward for the projects success.
It was not money for what St. Josephs might or what they
plan to do next. It said in effect, we have seen the system that
we both agreed to, in action. You also promised you would get
your clinicians on side with the new system, and you did. It
is all there and it all works. So now, here is the cheque. In
effect, that represents a way of doing business in healthcare
in Canada that is so far unique.
CHT: Speaking of doing things differently,
has Infoway changed in other ways as a result of your arrival?
Alvarez: I would say my arrival has not changed Infoway so much as it has sharpened its vision. I helped our
Board of Directors set some new priorities, and now were
working hard at communicating those priorities. Fortunately,
because of what I was able to achieve previously at CIHI and
in Alberta, people seem to be listening. And I think that has
helped Infoway, in particular, get its message through that we
are not a grant-funding organization, but rather a strategic
CHT: Why is that message such a priority?
Alvarez: Well for one thing, there is an impression out there
that Infoway has been sitting on its money. But you know, in
this business we could just sit back and throw money and technology
at a healthcare problem and not hold people very accountable.
But we would then be in grave danger of building a system and
then no one comes because they have not bought in. And
for some that is a real struggle, because we insist that hospitals
do what they have to do, as they have done at St. Josephs,
to get total clinician buy-in. We do not give away money without
that kind of accountability.
CHT: What are your other priorities then,
speaking both personally and for the organization?
Alvarez: (with a grin) Well personally, I
have just three priorities in my job: communicate, communicate,
and communicate. For Infoway, we have two fundamental priorities
and they are to improve the quality of care and to heighten the
healthcare systems level of safety. They form our bottom
line. But there are a lot steps needed to get to that bottom
line. The biggest one is to get people in the system to change,
to adapt, and to adopt new ways of doing things that technologies
CHT: How do you avoid that then?
Alvarez: Through another one of our priorities:
partnerships. We are not doing this alone. We are making partners
with provincial healthcare policy makers and their administrators.
We are making partners of regional health authorities, and most
importantly, we are now also striving to make partners of the
individual clinicians out there. And that is absolutely key.
As you know, we as a national agency do not have direct control
over them or their businesses. So we have to find other means.
CHT: What has Infoway learned from its experience,
Alvarez: That if an EHR project is to be successful,
you need a clinician-leader. Someone who has been converted.
Someone who has seen the light. Thats why weve brought
in a clinician from Kamloops, for example, to serve on our Board.
We need to hear that voice. And its why weve also
brought in a Toronto-area physician who is a convert to technology.
She will maintain her own practice, but also work for us as a
consultant, four days a week. Shell help us figure out
how we motivate other Canadian physicians to adapt to new systems,
remembering that the great bulk of them were trained in medical
schools long before computers were part of the curriculum. So
we need to teach them new tricks. Thats really the next
level weve got to get to.
CHT: What other goals have you set for Infoway?
Alvarez: Our overall goal is to have 50 percent
of Canadians on some sort of electronic health record by 2009.
Basically by then, we want at least half the population to be
able to walk into a physicians office anywhere and have
a variety of information about them pop up on the physicians
screen so that he or she knows at least: what medication the
patient is on; what tests have been done; and what the results
of those tests are. From there, we then want to build on systems
that enable the community physician to order more tests if needed,
prescribe electronically, move diagnostic images to specialists
for referrals, and get their feedback. These are among the six
or seven basics weve identified as constituting the electronic
health record we want in place by 2009.
CHT: Is that achievable?
Alvarez: No and I hope yes. I showed our plan,
for instance, to my counterpart in the United Kingdom (where
the government is spending about $15.2 billion on developing
a national EHR). He asked how much we had to spend to accomplish
the plan. I said $1 billion and he said with only $1 billion
your plan is going to fail. And hes right. Our Infoway
money, for instance, doesnt go at all towards putting computers
into physicians offices, where the whole system has to really
start. So when you add everything up that you need to have in
place for a country-wide electronic health record to work here,
we estimate it will take something on the order of $8 billion.
Thats a lot more money than we have available now.
CHT: So what can you do about that?
Alvarez: Well, first we are working on a thorough
costing of what it truly will take. And then we are going to
draw those costs to the attention of the Deputy Ministers of
Health who are our members. Were going to make it clear
to them that if they are talking about reforming the healthcare
system, and improving the quality of care, they cant do
it without introducing more technology throughout the system.
And that cant be done for $1 billion. However, since Infoway
operates on the principle of 50 percent shared investment, then
through our partnerships I believe we could leverage $4 billion
up to the level of funding we actually need.
CHT: What would you put that extra money
Alvarez: So far, weve been supporting
things like the development of electronic drug information, lab
information, patient registration, diagnostic imaging, telehealth,
and health surveillance (think SARS) systems. And we would continue
to do that. We would fund more initiatives that meld those systems
together. But weve already found that a high proportion
of new technology costs, at least one-third of them I would say,
are people costs. It does take a lot of familiarization and training
to make sure that people use the new systems. So we would invest
substantial funds on the human side of the equation in order
to encourage the uptake of technology.
CHT: How then do you plan to meld these systems
Alvarez: One of the things we are planning
to do soon is to develop a three-year investment and jurisdictional
plan at the provincial level. So we and the provinces can say,
if our goal is an EHR for 2009, heres what weve done,
but heres whats still missing. So here, and here,
and here, is where we have put our money and our efforts if we
all are going to get there in time. While doing that, well
be investigating what they can save, and it promises to be very
significant, from banding together and using their collective
buying power to purchase the new technology.
Calgary Health Region outsources HR to Telus, brings in PeopleSoft
By Jerry Zeidenberg
The Calgary Health Region recently struck
up a partnership with Telus to create a human-resources outsourcing
company called Telus Sourcing Solutions (TSS), and subsequently
outsourced many HR staff to the new organization.
Earlier this year, 170 members of the Calgary Health Region human
resource team became employees of TSS, which focuses on HR services
in the healthcare and public sectors.
The non-financial limited partnership is said to offer many benefits
to both parties, including the modernization of the HR infrastructure
for the Calgary Health Region.
While Telus seems on first glance to be an unlikely candidate
for an HR outsourcing venture, in truth, the company has won
plaudits for its expertise in human resources, with its managers
speaking on the topic around the world at HR conferences. Moreover,
the company is well-versed in the technologies that are revolutionizing
HR, such as the Internet and Web solutions, and sophisticated
information systems like PeopleSoft.
For its part, Telus won out over many others in reaching an HR
deal with the Calgary Health Region There were 15 responses
to our request for information, and three finalists, said
Duncan Truscott, vice president of people and learning with the
region. The Telus consortium offered the most benefits
to the region.
As part of the 15-year deal struck with the Calgary Health Region,
TSS is investing $20 million in technological infrastructure
to upgrade the workings of HR in the region. The investment,
which will be made in the first three years of the contract,
includes an extensive PeopleSoft implementation.
For us, its a major capital-cost avoidance,
said Truscott. He noted that the region will obtain all of the
benefits of upgraded equipment and PeopleSoft software, along with
implementation and change management services.
For the health region, its a superb way to reduce
costs, improve quality in HR, and it also lets them concentrate
on what they do best which is healthcare, said Stephen
Bayliffe, who leads Calgary-based TSS. Bayliffe, a recent arrival
from the United Kingdom, has a long history of success in human
resource management with a variety of consulting and telecom
companies throughout Europe.
Moreover, the issue of upgrades, training and maintenance is
no longer a problem for the region. Its our headache
now, quipped Bayliffe. And the learning curve is expected
to be speedy, as Telus brings its own expertise in PeopleSoft.
As a company specializing in HR services, TSS will also be able
to continuously bring best practices into the workforce,
especially in the area of technological solutions to HR information
The Calgary Health Region is going live with phase one of its
PeopleSoft implementation in October 2004, followed by phase
two in April 2005. Truscott says phase one will focus on transaction-based
activities, like payroll and benefits, while phase two will bring
more strategic functions into play, such as succession planning
and recruitment planning.
The Calgary Health Region is paying TSS for running various HR
operations. However, the pressure is on TSS to meet performance
targets, such as quality and accuracy indicators. Examples include
accuracy in processing payroll for the 23,000 healthcare employees,
and the speed of handling customer requests for information.
Customer satisfaction will be part of the matrix, with the customers
comprising the 23,000 regional employees.
The Telus-Calgary Health Region deal is a good example of a public-private
partnership that will ultimately produce significant benefits
for both organizations, the participants say.
Truscott noted the 2002 Mazankowski Report recommended
that hospitals and health regions look to opportunities to ally
with the private sector in non-clinical areas, when the evidence
shows a clear advantage to the healthcare system. The report,
named after former federal Finance Minister Don Mazankowski and
commissioned by the Alberta Government, examined the sustainability
of the Canadian healthcare delivery system and made suggestions
Truscott said the partnership with Telus provides a means to
cost-effectively modernize HR in the region. Previously,
we had only basic payroll, with no real HR functionality on a
regional basis, he noted.
Now, in partnership with TSS, and through the use of PeopleSoft
solutions, the stage is set for a wide range of improvements
in HR activities across the region, from payroll and benefits
to collective bargaining, on-going education, and workforce planning.
The partnership puts the Calgary Health Region in good shape
to deal with future growth in services and staff. The CHR is
currently the only region in Canada to be constructing two standalone
hospitals. The Alberta Childrens Hospital, scheduled for
completion by August 2006, and the new South Hospital, which
is expected to be opened in 2009. The high-tech South Hospital
will contain 350 beds in its first phase, but could be expanded
to 800 beds as early as 2013, if needed.
Performance management: software is only one part of the
By Dianne Daniel
When it comes to improving the quality of
Canadas healthcare system, a growing number of organizations
are embracing performance management software as a means to measure
where they are today and understand where they need to head in
the future. As Terence Atkinson, director of public sector industry
solutions for Cognos Inc., of Ottawa, suggests, theres
a realization that in order to improve performance, hospitals
need to better understand their business.
They have been collecting data in a variety of systems
for a long time, but they just havent been able to turn
it into information that helps them to run their hospitals better,
While performance management software products like Ottawa-based
Cognos Enterprise Business Intelligence (EBI) and Toronto-based
Panorama Business Views pbviews balanced scorecard solutions
are important, the transition from a data rich organization to
an information rich one involves much more than a technology
Buying software is one piece, says Don Gordon, president
of Toronto-based Praxia Information Intelligence, a technology-independent
consultancy specializing in decision support for healthcare.
What fundamentally makes (performance management) work
or not work is an organizations ability to translate the
data into relevant information, he says.
According to Gordon, hospitals need to first create a culture
of evidence-based decision making that involves understanding
what they need to measure, where the information is located,
how to get it into a performance management system and how to
massage it in order to produce good information.
Frankly, to me the technology purchase comes last and its
not that significant, says Gordon, whose company has worked
with clients to implement software from Cognos, Panorama, Microsoft
Bloorview Macmillan Childrens Centre, a childrens
rehabilitation hospital in Toronto, is successfully using Cognos
Power Play and Matrix Manager products to help create a central
information resource for executives. Getting the senior management
team to speak the same language was the first hurdle to overcome,
says director of decision support and planning Hakim Lakhani.
In healthcare we have pockets of information among finance,
health records, information technology and human resources; they
all keep their own data and there are political- and turf-related
boundaries, he says.
At the corporate level theres no structure that promotes
the sharing and optimizing of information.
To change that, Bloorview Macmillan took the important first
step of creating a decision support framework to serve as a central
information resource. Whereas in the past, user requests for
information would be sprayed and prayed, meaning
business analysts would start by sending requests out to various
departments and then sit back and hope for an answer, now all
disparate data sources are pulled together using Cognos software
so all data can be accessed from one place.
As Lakhani explains, executives at the vice-president, director
and manager levels across the hospital are given a desktop icon
enabling them to go to one central site on the network in order
to retrieve data. By clicking on folders such as Finance, Workload,
In-patient Data or Human Resources, for example, they can either
scan predefined views of information or create their own custom
One of the biggest changes, he says, is that various departments
have started to work together. Theyre actually working
as a decision support team which is very encouraging for me.
We get answers together and people dont have to spray and
One key advantage for Bloorview Macmillan is it already had much
of the data required to support its performance management system
linked together in a central data repository. Otherwise, having
the IT manpower and technology required to sustain ongoing data
integration can be a significant stumbling block, says Praxias
At William Osler Health Centre, a hospital corporation serving
the communities of Brampton, Etobicoke and Georgetown, Ont.,
the lack of a computerized interface to automatically populate
Panoramas pbviews slowed widespread acceptance of the software
prior to the amalgamation of the three hospitals it encompasses.
Initially ... there was a lot of labour put into populating
it and maintaining it, and in terms of a monthly monitoring tool
it was very difficult to maintain, says director of planning
and decision support Gary Spencer. For us, things really
took off when we purchased our data repository and it allowed
us to link information from our clinical systems.
William Osler Health Centre uses its balanced scorecard tool
to measure four main quadrants of information, similar to those
monitored by the Ontario Hospital Association: financial performance,
utilization and outcome, patient satisfaction, and integration
and change. By mirroring its performance indicators after the
OHAs measures, the centre is able to stay ahead of the
curve, says Spencer, and be proactive in dealing with information
that will eventually be public knowledge.
That was a good starting point, but we further massaged
it by holding focus group sessions with our manager, director,
VP group to identify what were the critical indicators
of performance that fell within those four quadrants, says
Spencer, adding that the financial indicators were easy to provide,
while the others presented more of a challenge.
One lesson learned by William Osler Health Centre: you need to
start small when implementing performance management software.
Through ongoing discussions with its user community, the IT staff
realized that too much information is sometimes an inhibitor
rather than an enabler.
When we did our customer satisfaction survey with our managers,
they said bells and whistles are great, but all we need to know
is, what do we need to look at in terms of our performance and
make it as simple as possible, says Spencer. If we
have time we can use these other features, but first and foremost,
make it easy for us to find what we need in order to manage.
With the growing push for accountability in healthcare across
the country, Praxias Gordon predicts the need for good
information within hospitals is only going to get stronger. He
advises hospitals to think of performance management system implementations
as a three-pronged approach that requires understanding what
to measure and why, selecting a robust performance management
system, and finally, creating a shift towards evidence-based
decisions so that managers are comfortable with and know how
to use the information provided.