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Inside the September 2005 print edition of Canadian Healthcare Technology:


Feature Report: Hospitals of the future


Neurosurgery breakthrough

Trillium Health has acquired new imaging systems for minimally invasive procedures in cardiac and neuro surgery. The Toshiba systems enable surgeons to perform a wider range of procedures, and to run more effective post-op checks.

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Top hospitals increasingly use IT systems

Connected systems are key to obtaining information about patients as they flow through the continuum. In Montreal, Toronto, Winnipeg and elsewhere around the world – most notably in Australia – there’s clear evidence that hospitals and their resources, even in the immediate future, will reach further and far more usefully into the communities they serve.

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Alberta’s building boom

Over the next three years, Alberta will launch five new hospitals, each boasting innovative technologies. New uses of IT and methods of caring for patients will likely propel the province to the forefront of healthcare delivery.

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Rehab ratings in Ontario

The Ontario Hospital Association has released its latest hospital scorecard, Hospital Report 2005: Rehabilitation. For the first time, the study identifies benchmark organizations – those with top scores in more than one area.

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Wireless reporting for diabetes patients

Since 1998, Steve Goldberg’s INET International Inc. has specialized in fast tracking the commercialization of wireless healthcare delivery tools.

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Interview: Sam Marafioti

Sunnybrook’s CIO, Sam Marafioti, talks with our correspondent Andy Shaw about his role at the Toronto teaching hospital. Key tasks are building creative partnerships with users and vendors, and motivating physicians to get involved with IT.


PLUS news stories, analysis, and features and more.

 

Trillium’s new neuro imaging gear enables wider range of surgeries

By Andy Shaw

MISSISSAUGA, ONT. – The Trillium Health Centre and Toshiba Medical Systems have revitalized their partnership in ways that both hope will one day improve cardiac and neurology patient care worldwide. Working with each other since 1998, Trillium’s clinical leadership in “beating heart surgery” and neurosurgery, and Toshiba’s widely recognized excellence in advanced imaging techniques for both, sustain their mutual attraction.

To further its surgical leadership, Trillium, which serves over one million people on the western outskirts of Toronto, recently bought Toshiba state-of-the-art diagnostic imaging equipment that Trillium’s surgeons and radiologists had a hand in designing.

Trillium officials say their new $1.8 million Aquilion 64 Slice Multi-Detector computed tomography (CT) scanner and the $1.75 million Neuro Bi-Plane Endovascular Unit are already transforming Trillium’s care for its cardiac and neurology patients – shortening their stays, improving their outcomes, and boosting the hospital’s capacity to handle more.

In return, Toshiba has donated $500,000 to pay for the world’s first comprehensive study comparing traditional “on-pump” bypass coronary surgery with the “off-pump” beating heart surgery – a technique which Trillium physicians have pioneered and now carry out extensively. Some 250 cardiac patients undergoing surgery will participate in the 18-month study, with Toshiba money going towards a dedicated researcher, examinations of patients, and the production of research papers made available internationally.

The patients’ recovery from cardiac surgery will be checked with a new non-invasive technique enabled by the three-dimensional images that the Aquilion 64 CT scanner can generate. The results of the study will certainly guide and perhaps revolutionize complex cardiac surgery at every hospital around the globe.

“Beating heart surgery has the potential to reduce complications and mortality as well as improve long term survival,” says Dr. Gopal Bhatnagar, Trillium’s chief of cardiac surgery and the study’s co-principal investigator. “We believe the study will demonstrate these outcomes to be true.”

Ian Chappell already knows a personal truth about better outcomes at Trillium – in his case, from the sophisticated, minimally invasive neurosurgery enabled by the Toshiba Neuro Bi-Plane unit (the first in Canada at a non-teaching hospital). Its twin spinning cameras capture images 90 degrees apart as they circle about the patient’s head. This resulted in the exquisite, three-dimensional images revealing the exact damage done to Chappell’s brain when he suffered a potentially devastating aneurysm.

“Time is of the essence in brain disorders,” says Dr. Dominic Rosso, Trillium’s chief neuro-endovascular specialist and the physician who conducted the surgery on Chappell that closed off his aneurysm. “Mr Chappell’s aneurysm was in a position that, in the past, would have been almost impossible to treat. However, with the Bi-Plane we could see within minutes from the images that had been transferred to our Viscan workstation precisely where it was and the pathology connected with it. So we knew what to do right away, and did it right there on the spot.”

Had surgeons attempted to get at Chappell’s aneurysm even with today’s advanced micro-surgery techniques, they would have had to open up his skull and extract a portion of his brain. Instead, Dr. Rosso, guided by the constantly updated images flowing from the Bi-Plane, sealed off the aneurysm using a catheter threaded through a small hole in Chappell’s groin.

“We push a conduit from there up to the brain and through it we pass up special platinum rods that we insert into the aneurysm to prevent blood from flowing back into it, effectively closing it off,” says Dr. Rosso.

So what could have been a day long operation followed by several weeks if not months of recovery, instead was done in two hours and Chappell recovered from the surgery itself in two days.

“It did take a couple of weeks more for him to completely recover from the shock created by suffering the aneurysm,” says Dr. Rosso.

Nonetheless, Chappell was more than grateful. “I could have been permanently incapacitated, but instead I went home – fully functional and fine.”

The operation on Chappell demonstrated the Bi-Plane’s ability to be both a diagnostic and an interventional tool.

“I think the biggest change we’re seeing in our world right now,” says Behram Engineer, vice-president and general manager of Toshiba of Canada’s medical division, “is the move of imaging technology from diagnostics to therapy.”

Canadian physicians have been very much part of that shift, adds Engineer. “Because of the long partnership we have had with Trillium, we listened to what their clinicians had to say, what they wanted to see in the end product, how they wanted to segment the heart, the resolution they wanted in the images, and how fast they wanted to see them. Then they went to Japan and gave their ideas to our designers. And that was well received because Canada has been avant garde for many years when it comes to ideas for clinical imaging.”

Chris Power, Trillium’s vice-president of patient services, is already seeing the benefits of those good ideas today.

“The 64-CT is revolutionizing cardiology,” says Power. “In the past, if our cardiac patients came back in after surgery and were complaining about chest pain, they’d have to be examined with an angioplasty procedure. They’d be on the table 30 to 40 minutes and even though it is minimally so, it is still invasive and carries some risk, as well as some recovery time. So angioplasty takes up pretty much a whole day. With the new Toshiba CT, patients are in, done, and headed out of the hospital in 10 minutes (the Aquilion 64 works at four times the speed of its fastest predecessors).”

By either technique, explains cardiovascular radiologist, Dr.Tarang Sheth, what physicians are looking for is the state of the coronary grafts or “patency” accomplished during surgery. “The cardiac CT gives exceptional image quality for examining patency in a graft and optimal patient comfort that is unprecedented. So I think it is ushering in a whole new era of non-invasive diagnosis in cardiovascular disease.”

Dr. Sheth, teaming with Dr. Bhatnagar, is co-principal investigator of the Toshiba study. If it reflects what is already happening at Trillium, then the boon for healthcare and its costs in future will be that cardiac care becomes less acute and more ambulatory. Dr. Sheth says Trillium now does up to 70 percent of its cardiac operations using off-pump, beating heart techniques. Coupling that with 64 slice-CT scanning of the results not only gets patients out the door one day earlier than conventional techniques but promises, with its faster, safer, more accurate checks on patency to keep them out.

It will also, Drs. Sheth and Bhatnagar fervently hope, greatly aid gathering patient recovery data during the ground-breaking Toshiba study.

“It’s always difficult to get patients to volunteer,” admits Dr. Sheth. “In bypass studies, patients say to themselves: ‘I’ve had my surgery, I am feeling fine. Do I want to go in and do angioplasty for a whole day?’ But the CT scan is so fast and painless it takes more time to get the patient on and off the table than it does to do the examination.”

That speed caught the eye of more than clinicians at Trillium – including Mr. Harold Shipp, chairman and CEO of Shipp Corporation, and a benefactor associated with the hospital for 35 years. When Toshiba announced its $500,000 donation, Shipp matched it instantly.

The kinds of things they can do with both the Aquilion 64 CT and the Neuro Bi-Plane at Trillium will be more wide ranging than ever before. The Aquilion can help find and nullify aneurysms; it can also be used to treat brain tumours, strokes, and blood vessel malfunctions, as well as aid spinal surgery.

“With the Bi-Plane we are opening up both our capacity and the kind of work we can do,” says Dr. Rosso “We handle 50-120 aneurysms a year, but will be able to treat the ones we could not treat before, as was the case with Mr. Chappell. We’ll also now be able to treat patients suffering from cerebral fractures that we couldn’t do before. And we’ll be able to do invasive biopsies that previously weren’t possible.”

Further down the road, Trillium’s own experience with its new equipment, and particularly the results of the Toshiba-backed beating-heart-versus-bypass study, will improve surgical and radiological techniques for clinicians everywhere who wish to embrace them.

“Dr. Bhatnagar and Dr. Sheth, for example, will be able to look at as many as 250 outcomes and be able to say this type of coronary graft is clearly healing more quickly than this type,” says Dr. William Magnusson, Trillium’s chief radiologist and head of diagnostic imaging. “And from those results, they’ll be able to ask on behalf of all radiologists and surgeons: What are we doing wrong and what can we improve on?”

The world awaits their answers.

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Top hospitals increasingly use IT systems to improve quality of information and care

By Andy Shaw

To the casual passer-by, hospitals in the years to come may look much the same as they do today, at least from the outside. But to the caregivers and patients inside, hospitals of the future will no longer be contained by their walls. In Montreal, Toronto, Winnipeg and elsewhere around the world – most notably in Australia – there’s clear evidence that hospitals and their resources, even in the immediate future, will reach further and far more usefully into the communities they serve.

More specifically, the hospital of the future will be less of a hub of healthcare and more of a specialized, acute-care stop along the way of a better connected continuum of care. Hospital operation will no longer be characterized by vertical departments topped with bureaucracy, but by collaborative teams of clinicians and administrators focused horizontally on disease management and patient flow through their facility.

But as comforting as that sounds, hospitals will also become more competitive places. They will align themselves more closely with vendors to gain competitive advantage. They will strengthen their strengths and drop their weaknesses. They will work harder at attracting the top clinicians and researchers they need to sustain their status and funding. They will strive to become a talent magnet.

And the enabler of all this much anticipated transformation will be technology. But not technology yet to be dreamed up and tested. Rather, it is the sophisticated clinical and back office already proven and available today – that will be the foundations of hospitals tomorrow.

In Montreal, through physician-led multi-disciplinary team collaboration, Quebec’s two super-hospitals are both implementing clinical information systems the are based on an electronic health record (EHR) system called Oacis from Ottawa-based Dinmar Inc., running on Sybase servers. The system will integrate existing laboratory, radiology, and pharmacy systems and enable caregivers to instantly access the full EHR record at any encounter as the patient moves through hospital care. Benefits include providing care givers with better decision support, a more efficient care process for the patient, and better evaluation of outcomes that should lead to improved quality of care.

“We involved clinicians right from the start. They selected the system. They selected the vendor,” says Jean Huot, who is the super-CIO for both the McGill University Health Centre (MUHC) and the Centre hospitalier de l’université de Montréal (CHUM). “And they continue to be involved, deciding how data is to be presented on the system, what the screens will look like, and even how they will be implemented on our PCs, handhelds, and wireless set-up.”

In Toronto, Sam Marafioti presides over a wide range of information technology (IT) initiatives at Sunnybrook and Women’s College Health Sciences Centre (Sunnybrook & Women’s) all aimed at better enabling what he terms the “healthcare consumer” both inside and outside hospital walls.

“By that term we mean both the patient and the care provider,” says Marafioti, who is Sunnybrook & Women’s vice president of eHealth and chief technology officer. “And we have the opportunity now to strengthen the relationship between the two with technology. It is, after all, the most important relationship in healthcare. And we have the technology. The electronic patient record was our big challenge, but now it is done. So it is time to move on to serve the community better, as we should and now can.”

With Marafioti’s guidance and under various clinician champions, Sunnybrook & Women’s is moving on to pilots and projects that will extend the hospital’s capacity to care further into the community, including among others:

• ePrescribing – aimed at helping to reduce the 700 hospital deaths a year in Canada resulting from medication errors;

• a patient and provider Web portal – enabling both, in different views, to examine the patient’s EHR;

• eICU – electronic intensive care unit project using inexpensive video and audio devices to monitor from Sunnybrook & Women’s not only their own ICU patients but also those at other institutions;

• Home Plus – renal dialysis assessment that can eliminate waiting lists and be adopted by other hospitals.

“Because we know we’ve got proven technology now, we’re taking a new approach to projects like ePrescribing,” says Dr. Bill Sibbald, Sunnybrook & Women’s physician-in-chief. “We know that ePrescribing is already a reality in Australia, in the United States, and in the UK, so we know it can be done. We’ll run our pilot here. And if it works, we’ll adopt it. No great long studies or analysis or debate. Indeed, it’s our new slogan: ‘Just do it.’”

Dr. Sibbald personally recruited the 50 Sunnybrook & Women’s physicians who are participating in the pilot. Marafioti’s department has issued them all with PDAs from a variety of manufacturers. But all will be able to receive the wireless alerts from the hospital’s Oacis system that something may be awry with the medication they are contemplating.

In Winnipeg, a hospital very much of the future is shaping up on the 32-acre mid-town campus of the Winnipeg Regional Health Authority (WRHA). Rising from it soon will be the 100,000 square foot Siemens Institute for Advanced Medicine, which will focus on elevating further WRHA’s current expertise in neurosciences, infectious diseases, advanced imaging, and medical informatics. The alignment with Siemens – who paid $3.5 million for naming rights alone – is part of an unabashed WRHA attempt to be a talent magnet.

“We have the country’s first Gamma knife and the newest generation crystals for our PET scanners here,” says WRHA’s chief innovation officer, Harry Schulz. “And that’s attracted some very talented clinicians. Using those tools, they’ve been able to transform neurosurgery for some types of brain tumours. One woman with re-occurring tumours, for instance, was utterly amazed at her recovery from her minimally invasive operation. For the first time, she was able to go home the same day and join her family for dinner.”

The opportunity to develop such new techniques does not go unnoticed among budding clinical superstars.

“One way you can attract world-leading talent is with a pay cheque, that’s for sure,” says Schulz. “But even so, they might end up competing for time on the high-grade tools. Here, we offer them a lot more access and a better chance to catch fire as researchers and win that Nobel prize.”

But likely nowhere has hospital transformation caught fire more than in South Australia. There, hospitals have borrowed a term from the IT world and made a human reality of “life-cycle management”. Patients throughout their lives can now flow seamlessly through the full continuum from primary to acute to long-term care and have their records come right along with them – even while aboard ambulances.

The transformation began back in 1995 when the South Australia Department of Health went out looking for help in improving the renal care in four facilities across the state. By 2000, that project had expanded to include all specialty units across eight major teaching hospitals which served 75 percent of the population. By that time, Accenture had also been called in.

With its extensive global reach – 6,000 staff employed in healthcare development around the world – Accenture knew where to look for a system that might suit down under. The Oacis system, with modifications, proved to be the answer not only for the renal facilities but has gone on to pass many more and bigger milestones. With its Clinical Display, Clinical Order Management, Separation Summary (discharge), and Clinical Reporting modules at work, Accenture reports that in South Australia:

• 1.8 million patients are profiled on the Oacis system;

• More than 260 million lab and other clinical service results are kept online;

• More than 12,000 nurses and doctors can access Oacis;

• More than 70 clinical specialities from renal to cardiac to pediatrics are covered;

• 80,000 messages per day are moved a day between patient admissions, laboratory, radiology, and other departments.

As a result, duplicate test reductions, fewer errors, and other mistakes the system has prevented are expected to save up to 45 million Australian dollars in the first five years of operation.

“But getting to that level was painstaking,” says Jerry Garcia, managing partner for Accenture Life and Health Sciences Canada, “It meant taking a very detailed look at patient pathways and patient flows right down into hospital wards and clinics. We were mapping care for an entire region. It even meant tracing ambulance routes.”

It’s a route that the rest of the world is beginning to follow, adds Garcia. “That’s a key trend we see globally. We see it most noticeably in Spain, Germany, France, Singapore, and in Britain. Health authorities in those places are all designing care around the patient and around where patients flow, rather than around where the care providers sit.”

Garcia says different countries and regions have taken different approaches to their re-engineering of healthcare and the role hospitals play in it. “Singapore has taken a top-down approach and is enforcing the change to patient flow. The Scandinavian countries, on the other hand, have been remarkably collaborative.”

In the United Kingdom, the National Health Service has left room for both. The national government has designated who its leading service providers (LSPs) will be in transforming healthcare in five regions of England. (Accenture is an LSP for two of the five). But has left it up to the regions and its Hospital Trusts to select other suppliers.

Mariana Catz, an associate partner for Accenture Canada’s health and life sciences practice, says the efficiencies of the patient flow model become most evident when they are applied region wide. Catz is an expert in clinical transformation and EHR work, stemming partly from her days as a vice president for Infoway and for the Baycrest Centre for Geriatric Care.

If patients are to flow through all the facilities of the region they live in, agree Catz and Garcia, you’ve got to make sure that up-to-date patient information is always accessible by the very next care provider they encounter – be it in hospital or out. Technology makes that possible, but human nature often mitigates against it.

“Generally, the healthcare industry hasn’t done a very good job of change management, especially when it comes to clinician adoption of technology,” says Catz.

Consequently, Accenture engaged Vanderbilt University to conduct a study that included interviews of nearly 50 executives and clinicians at 22 hospitals in five countries, all of whom that had implemented clinical IT systems. The Vanderbilt study’s most important finding was that “physician engagement and support is a critical variable in the overall success of an IT implementation.”

It went on to identify seven critical success factors:

• Alignment of clinical and executive leadership-a common vision with agreed goals and expected results;

• Effective early engagement of clinicians-during the planning phase as well as throughout the project;

• Recognition of the unique relationship between physicians and the institution-as the face of the medical institution and major bearers of the burden of IT adoption;

• Unwavering commitment to success from the organization’s leaders, who must emphasize the strategic imperative of the project;

• Deployment to new places when the benefits are clear to clinicians, and only move ahead when there is agreement that implementation would be a win for all parties;

• Individualized approaches to training and support-to fit in with clinicians pressured schedules;

• Tight feedback and enhancement cycles, to gather input after the initial rollout and enhance the technology based on the experiences of early adopters.

Seven principles, that at MUHC and CHUM as well as at Sunnybrook & Women’s hospital in Toronto and WRHA in Winnipeg, seem already well entrenched. Super-hospital CIO Jean Huot endorses them succinctly with his own motto for clinicians: “Do everything to ensure that you keep their trust.” Hearing this and seeing what she examines daily makes Irene Podolak cautiously optimistic about future hospitals and future hospital care in Canada. Podolak is a veteran healthcare observer in her consulting job as partner, National Health Services, at Deloitte.

“In healthcare, we’ve become quite sophisticated with drugs and diagnostic tests so hospitals can tailor a far more detailed regime of care for patients,” says Podolak. “And that’s going to be needed. As the patient population ages, hospitals are going to be more acute, see much sicker patients, to whom they can offer more complex treatments.

But that comes with a price. So increasingly hospitals will only be able to afford providing just a slice of the patient’s care. As a result, connectivity is going to be more in demand. That, in turn, means hospitals of the future are going to be less autonomous and more integrated.”

Early evidence of that integration trend, says Podolak, is the Hospital Business Services initiative launched by 14 Ontario hospitals using their collective buying power to reduce the costs of their back office systems and supplies.

“There’s been an emphasis to date on clinical integration, but now you’re going to see hospitals integrating their supply chain, payroll, facilities management, and other non-clinical systems,” says Podolak.

There will be pressure to do that as another trend shaping hospitals-to-come accelerates – i.e., the downward shifting of accountability and responsibility to regionalized health authorities – such as the 14 Local Health Integration Networks (LHINs) now established in Ontario.

“The real barriers facing hospitals of the future will still be money. Politically, funds will always be driven to the clinical side. But things won’t change as much as they should for hospitals or healthcare generally, unless the IT side gets the support it needs too,” says Podolak.

Nonetheless, Podolak notes other trends in the hospital environment that are encouraging. “We’re hearing more of a consumer voice now from patients, and we are starting to see doctors take a very strong leadership role.”

Still, precisely how hospitals will evolve is difficult to predict. The pressures shaping them are many and complex.

Changing demands placed on hospitals by their users, the impact of a growing array of technologies now useful in a healthcare setting, wider societal pressures, particularly the economic climate will all have a definite if unknown impact on hospitals of the future.

In an attempt to at least identify these pressures and some of their likely outcomes, the European Observatory of Health Care Systems has issued an illuminating Policy Brief on the future of European hospitals:

• decreasing the number of hospital beds does not result in significant savings;

• hospital re-organizations have worked best when several hospitals have been placed under one management structure (such as a LHIN);

• change has been more difficult in areas where hospitals were given procurement autonomy;

• improving overall hospital performance is best stimulated when incentives are given for better clinical performance and the organizational environment is changed to a more collaborative one between clinicians and administrators.

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IT a big part of the plan at Alberta’s new state-of-the-art hospitals

By Dianne Daniel

Over the next three years, Alberta will launch five new hospitals, each one boasting state-of-the-art medical equipment and innovative approaches to health and wellness. All of them are planning to deploy high-profile medical advances such as surgical robots and developments in nanotechnology. But it’s the use of innovative information technology (IT), coupled with new methods of caring for patients, that’s most likely to propel the province to the forefront of healthcare delivery.

“If you think about your classic hospital, you walk in the door and you’re lost and confused, and you get bumped from one spot to another spot,” says Bill Trafford, vice-president, advanced technologies, for the Calgary Health Region. “Our objective is to create these new facilities in a very patient-centric way – the first being to have technology in place, so when the patient comes in the door, the system knows about it and can guide them to where they need to be.”

The Calgary Health Region, in conjunction with the University of Calgary, is currently building a $253-million Alberta Children’s Hospital that’s slated to open next year. It plans to launch another facility in south Calgary that will include ancillary services such as learning facilities, research areas, medical and wellness offices, a hotel and restaurants.

In addition to promoting a patient-centric experience, a secondary goal for both initiatives is to create an environment that is conducive to high-quality workflow and physicians “spending more time with patients versus trying to find patients,” comments Trafford.

Two technological developments that are key, he adds, are an extremely high-bandwidth network to support the flow of diagnostic images and patient information records – even to bedside devices – as well as a ubiquitous wireless network so that patients can be “tracked” using technology like radio frequency identification (RFID).

Rather than the traditional approach, where each department within a hospital assumes responsibility for its own patients, Calgary Health is creating an integrated model based on a Patient Care Information System designed and tested by a group of 450 clinicians.

Implementation details have yet to be finalized, but one plausible scenario, according to Trafford, is that patients might enter the hospital, swipe a smart provincial healthcare card through a machine (that authenticates they are who they say they are) and then verifies that their personal information is correct. They would then be assigned a patient advocate who would help build a computerized plan for their entire hospital stay and who would guide them through each stage.

Ideally, the detailed patient record travels with patients, so that information never has to be re-keyed, he explains. “That proceeds all the way up to a bed, where in your room there’s the capability for both your care team and yourself to understand what’s going on” using a large, bedside plasma display.

Although IT plays a role in supporting these initiatives, Trafford stresses they are really clinical process and workflow projects. “Whether it’s a new or existing hospital, you’ve got to get the people involved who understand those two things,” he says. “They design from a quality, safety and access perspective, and then the software comes in behind to support that.”

One of the most exciting opportunities in a new hospital environment is that the latest medical equipment, from simple stethoscopes to MRIs, comes equipped with an electronic interface. This allows real-time, high-quality delivery of patient information over the high bandwidth network so that physicians are always working from the most current data available. “If you can present the physician will all the facts at the time that he needs them, then he can make a good decision,” stresses Trafford. “… If you don’t have the facts, it just creates more work.”

At Capital Health in Edmonton, where plans for new hospitals include the launch of the Alberta Mazankowski Heart Institute, plus a women’s hospital and a joint university hospital and ambulatory centre in conjunction with the University of Edmonton, chief information officer Donna Strating shares her colleague’s credo.

“I believe the power of technology is about making it more simple, more streamlined for the physicians to get the information they need to use their clinical judgement,” says Strating. “We have very good clinicians, we know that. What they don’t have is the information at their fingertips to make the right decisions, to see the comprehensive picture of a patient.”

At the heart institute, for example, Capital Health is creating a fully enabled digital environment. According to Strating, any image generated – including X-rays, electrocardiograms and angiograms – will remain electronic. The region’s electronic health record (called NetCARE) will then be used as the delivery vehicle to get the results to physicians.

“Doctors will be able to open NetCARE, look at information about a patient – what their labs are, any history within our system – and look at that side-by-side images of current and past state,” she explains. “That presents an extremely powerful history about a patient and allows clinicians to draw better judgements on why a patient is presenting with a specific problem.”

Capital Health has selected Agfa-Gevaert, N.V., of Belgium, as its PACS and cardiology imaging partner – implementing the company’s Heart Lab, high-resolution monitors and PACS/RIS. Supporting the transport of huge volumes of digital information is a dedicated, Gigabit communications backbone that runs between the region’s sites.

According to Dr. Bill Anderson, Capital Health clinical director of diagnostic imaging, the ability to perform diagnostic work will be greatly enhanced in the new environment because the digital images can be reconstructed as three-dimensional views. “A CT scan of an abdomen 10 years ago may have had 30 to 50 images, whereas now they can consist 3,000 or more images,” he explains. “It’s about trying to present that information in a way that the radiologist can get enough information about that patient to make a diagnosis without having to scroll through images.”

Equally important, he adds, is the ability to share those images, either as thumbnails or full-blown exams, with referring physicians and teaching environments. “It’s not just one hospital, it’s all hospitals in our region, so that any image, anywhere can be accessed by clinicians whenever, and wherever they need it.”

Another component to Capital Health’s strategy is the use of interactive bedside terminals. According to Strating, the units will serve as both revenue-generating entertainment devices and personal computers. Patients will be able to watch videos or TV, or access the Internet, while physicians will use a secure log-on to access patient information. In order to control the spread of infectious diseases, physicians will use their own wireless keypads, she adds.

While many of the developments will be implemented initially at new facilities, both Capital Health and Calgary Health are taking a region-wide view, with plans to roll out the IT initiatives to all sites. “It may not be the high-tech stuff like a digital OR, but in many ways, it’s much more functional in what it can bring across the organization,” points out Capital Health’s Strating.

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Ontario’s latest hospital scorecard reports on rehabilitation centres

TORONTO – The Ontario Hospital Association announced the release of its latest scorecard report, Hospital Report 2005: Rehabilitation. For the first time, the report identifies benchmark organizations – those that have performed above average in more than one area of the scorecard.

Benchmark hospitals are: Penetanguishene General Hospital/North Simcoe Hospital Alliance, Providence Continuing Care Centre (Kingston), St. John’s Rehabilitation Hospital (Toronto), Trillium Health Centre (Mississauga), and West Park Healthcare Centre (Toronto).

Hospital Report 2005: Rehabilitation includes scores for individual hospitals as well as a provincial average. Results are reported by region as designated by the Ontario Hospital Association.

Ontario hospitals participate voluntarily in the hospital report process because they see the potential for the project to lead to better healthcare. Not all hospitals participate in every report. However, 45 out of 54 hospital corporations with designated, publicly funded, adult inpatient rehabilitation beds participated in Hospital Report 2005: Rehabilitation. The report does not include information on rehabilitation services in acute care, or outpatient or community settings, or home-based care.

First issued in 1998 by the Ontario Hospital Association (OHA) and issued jointly since 2001 by the OHA and the Ministry of Health and Long-Term Care, Hospital Reports are a quality improvement tool. The information for all reports is gathered and analyzed independently by researchers from the Hospital Report Research Collaborative (based at the University of Toronto).

Ontario’s electronic platform for hospital performance measurement and analysis was developed in collaboration with ABS System Consultants Ltd., of Toronto.

It is the primary medium with which hospitals will receive their hospital report indicators and component data. The e-Scorecard was devised using Metrics3D, a performance management and analytical software solution from ABS.

Ontario’s e-Scorecard is a web-based, stand-alone, password-protected, multi-dimensional application that allows hospitals that are participating in hospital reports to:

• View Standard Executive Reports that contain a graphic snapshot of a hospital’s performance across all quadrants and sectors simultaneously;

• Customize analyses and reports;

• Select comparator hospitals;

• Choose indicators to examine in greater detail;

• Track performance over time;

• Identify hospitals with potentially best practices;

• View results using a variety of innovative graphics, including gauges;

• Examine definitions, indicator formulae and cautionary notes;

• Download reports to other applications and save, print and reformat.

For the first time, the e-Scorecard allows hospitals to view their actual performance scores for each indicator, in comparison to minimum, maximum and average provincial scores.

Ontario’s hospital boards and senior leaders use the reports to compare their hospitals’ performance with other hospitals of the same size or those that provide the same type of services. Strengths and areas for improvement can be identified, and changes made to bring about improved services. In turn, healthcare providers use the reports to learn what other hospitals are doing and also assess whether any changes they have implemented have led to improvements.

Government uses the reports to help ensure hospitals are accountable for their use of public resources. The public uses the reports to understand more about how their local hospitals are doing.

Some of the key findings from Hospital Report 2005: Rehabilitation:

• Clinical Utilization and Outcomes (Patient care). Overall, patients recovering from stroke, hip fracture, and total joint replacement are achieving significant improvement in function.

Patients with stroke or hip fracture require a longer length of stay to achieve the same progress in function as patients undergoing elective joint replacement. Overall for all rehabilitation inpatients, the provincial average for active rehabilitation length of stay (a measure of the number of days clients required an inpatient stay to become ready for discharge) was 26.4 days.

• Client Perspective (How patients feel about their care). Patients indicate that they are satisfied with the care they have received in hospital. However, the scores for continuity and transition to community (continued care after transition to community) are significantly lower than for other indicators. Hospitals could be performing better with respect to providing patients with the information they need to manage their conditions after being discharged.

• System Integration and Change (Dealing with change). Most hospitals are performing well with staff development – an improvement from results indicated in the report on rehabilitation services in 2003. There is considerable variation across the province in performance for best practices, continuity of care and client-centredness (focus on the client), suggesting a potential for improvement among a number of facilities.

• Financial Performance and Condition. Hospitals with designated rehabilitation beds are concentrating more of their efforts toward patient care. They spend 75 percent of their expenses on direct patient care. While this percentage has remained fairly constant over the last four years, the actual dollars spent on direct patient care has increased by 42 percent since 1999/2000. Eighty-five per cent of the hours worked by nurses and therapists are spent on patient care activities.

• Women’s Health Perspective. More women than men use inpatient rehabilitation care – for example, 70 percent of orthopedic patients are women. Women generally have a less favourable perception of the quality of care than men for inpatient services and post-discharge care transition. Also, women spend an average of five days less in hospital for rehabilitation care than do men.

ABS System Consultants prides itself on producing solutions that enable non-technical users to intuitively plan, monitor, evaluate and control expenditures and activities. The project team noted how different business intelligence technology is for the broader public sector in general and in the healthcare space specifically. It must be sophisticated, but easy to use. “On the one hand there is an absolute need to develop a very rich and robust environment which will support the accelerated drive in healthcare today,” said Hannan Chervinsky, ABS president and CTO. “On the other hand, you can’t expect a hospital CEO or the head of an Emergency Department to become a “techie”, and to spend time learning and running IT-like tools which require a time commitment that is unrealistic.”

Chervinsky said the e-Scorecard will become a strategic tool that helps hospitals with local planning and priority-setting, as well as monitoring the achievement of objectives.

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Wireless reporting for diabetes patients offers up dramatic results

By Andy Shaw

Dr. Sheldon Silver admits that when he first started out four years ago to improve the lot of fellow family physicians and their patients, he knew little about mobile technologies.

“I didn’t even own a PDA at the time, but I went to Palm Canada and said, ‘I think I have an idea for better chronic disease management that might be useful to Palm,’”explained Silver at the 7th annual INET Mini-Conference on wireless technology in healthcare held in Toronto this summer.

Palm officials listened and noted that Dr. Silver had developed a protocol that used wireless technology to reduce the wait times for receiving radiology reports from hospitals. That prompted Palm to put Silver together with Steve Goldberg. Since 1998, Goldberg’s INET International Inc. has specialized in fast tracking the commercialization of wireless healthcare delivery tools.

The upshot of the Silver-Goldberg collaboration was a two-month pilot project involving five of Dr. Silver’s diabetic patients, specially-programmed cell phones from Palm, Audiovox and others in the hands of the patients. On board their phones was a custom patient record application written in wireless mark-up language (WML) and WMLScripts for Wireless Application Protocol (WAP) Browsers.

A Blackberry from Research in Motion (RIM) in the pocket of Dr. Silver, carried a custom Java application. Only his application could view the patient data using 128-bit Secure Sockets Layer (SSL) encryption. But no patient data was stored on the Blackberry.

Connecting physician to patient was a wireless CDMA (Code Division Multiple Access) 1X wireless network supplied by Bell Mobility. Its secure architecture meant that no identifiable data was transmitted to and from the patient application. Back-end servers stored patient and physician data in separate databases to ensure patient privacy.

“What this project was really all about was patient acceptance,” says Dr. Silver.

Such was the enthusiastic acceptance of his patients during the pilot that Dr. Silver had four of them on hand at the INET conference as testimonial support for a full-fledged protocol he and Goldberg launched that day.

Dubbed a “Wireless Disease Program: A Model for Chronic Disease Management,” the copyrighted protocol is a tool fashioned out of the objectives of the original pilot, namely to:

• streamline the communications and information exchange between a family physician and patients with diabetes;

• achieve treatment goals more rapidly;

• avoid complications associated with diabetes that might lead to hospitalization or other more expensive care; and

• encrypt and keep private all patient data streaming back and forth across the airwaves.

For Dr. Silver and his patients alike, the pilot’s procedures couldn’t have been much simpler. Using his RIM, Silver could access each patient’s recordings of their blood sugar levels and react if needed to significant changes with either a call, email, or a text message.

At the patient end: “All I had to do was pick up my phone and dial, punch in my ID, put in the number for my blood sugar level, and hit enter. That was it. Did it twice a day,” said patient Jim Pott at the INET conference. “It gave me the feeling of constantly being looked after because, if I forgot to do it, Dr. Silver would be on my case, sending a text message to remind me.”

For patient Dave Rowan: “I’m in the computer industry, so using an input device like my Treo phone is something I am very used to. Even so, to have it confirmed that my information was received and have subsequent interaction with Dr. Silver was terrific. And I could do it from all over North America.”

For Joy Merritt, the trial has been life transforming. “Dr. Silver saved my life with this system. I felt totally out of control before. But now I feel I can control my life. And because I see my levels every day, and I know the doctor does too, that’s motivated me to exercise more and try to bring them down.”

It is this self-care impact that holds the most promise for Dr. Silver’s new protocol, not just for diabetes but potentially for other chronic diseases. Among the benefits for its widespread use Goldberg’s conference handouts say it will:

• enhance compliance with prescribed treatments;

• enhance patient outcomes with reduced healthcare costs;

• shorten healthcare delivery and wait times; and

• reduce data collection time and costs as well as improve data quality.

Goldberg and Silver are first to admit that the main data flowing from the initial five-patient pilot was largely anecdotal and of too short duration to measure any substantive improvement in outcomes or lowering of costs.

“What we did in the pilot was to get everyone, patients, Dr. Silver, our company, Bell, RIM and our other supporters to contribute their time and resources without charge to prove the concept,” says Goldberg, “But now we are going after funding for a much bigger wireless monitoring project involving many more patients. And from that we’ll draw the hard data and research we need.”

Right at the INET conference, Goldberg and Silver started discussions with a potential main backer of the next phase, the Credit Valley Hospital on the western edge of Toronto, where Dr. Silver is a staff physician. Credit Valley already has an extensive diabetes education program in place.

“The Credit Valley Diabetic Education Centre took on 320 new diabetic patients in just one month recently,” says Silver. “So we’re hoping we can get many of those on our wireless diabetes program.”

He may get more than a few patients as well as backers, partly for pure economic reasons.

“The cell phone has become pervasive in our society,” said Larry Baziw, the services planner for Bell Mobility who also spoke at the INET conference. “We’re up to about 50 percent penetration of the market now with cell phones. And in a shameless plug, I can say we at Bell have the secure private network you need for wireless healthcare. RIM also has the technology right, being able to send both email or text and voice over the phone. That all means you don’t need to build a new technology infrastructure to make something like the diabetes wireless program work right across the country.”

Add to that, continued Baziw, the fact that you’ve got broadband wireless coming soon with much higher capacities in the form of 2G and 3G networks. Also wireless hotspots are becoming more popular in Canada, paving the way for data-rich, wide-ranging interactivity between physician and patient.

If the new Silver protocol can achieve a statistically significant improvement in blood sugar control, then it holds even greater promise. As INET speaker, Dr. Hertzel Gerstein, a diabetes research expert pointed out, diabetes is just the tip of the glycemic iceberg. “Elevations of glucose levels, even if they are not at the diabetic level, are associated with all sorts of other metabolic diseases. And many, many more people than just diabetic patients have them.”

Monitoring such patients wirelessly would reduce their heightened risk for more serious health consequences. That’s part of the reason Goldberg thinks such wireless monitoring of chronically afflicted high risk patients could grow “organically” into something truly widespread in healthcare.

To begin with, Goldberg and Dr. Silver have set their sights on attracting interest in the new wireless protocol from the likes of local community care centres and home care providers, as well as from care practitioners active in diabetes management. Improving diabetes care wirelessly, INET calculates, could save Ontario alone over $1 billion in healthcare costs over a three year period.

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