Inside the September 2007 print
edition of Canadian Healthcare Technology:
Michael’s Hospital to implement innovative workflow solutions
As part of
its Soarian I.T. system, Toronto-based St. Michael’s Hospital will
benefit from a Workflow Engine that provides decision support and
can automate many tasks.
Abbotsford to invest
$84 million in new technologies
systems to be installed at the new Abbotsford Regional Hospital and
Cancer Centre include some of the most innovative and advanced in
READ THE STORY
A picture is worth...
displaying data as images, geographical information systems enable
healthcare managers to solve troublesome problems in new ways.
Skilled proponents have emerged in Sault Ste. Marie, Ont.
Smart IV pumps
generation of ‘smart’ pumps are showing their worth at the
Scarborough Hospital in Toronto. The programmable pumps alert nurses
when a possible problem arises.
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recent eHealth conference in Quebec City, Infoway CEO Richard
Alvarez noted that not only did the organization win $400 million in
the last federal budget, it also gained support from all major
eCHN connects the docs
electronic Child Health Network, in Ontario, integrates records from
86 hospital sites, 42 community care access centres, and more than
500 physician offices. Using the SSHA’s ONE Network, it gives
doctors access to patient records, province-wide.
PLUS news stories, analysis, and features and more.
St. Michael’s to roll out advanced systems, aims to optimize
TORONTO – St. Michael’s Hospital is preparing to install an advanced
‘Workflow Engine’ as part of their clinical information system –
essentially smart, computerized programs that will inform caregivers of
the best practices to follow when patients present to the hospital with
various medical problems.
This intelligent software also has the ability to provide alerts to
healthcare professionals and support staff, resulting in faster and more
appropriate care throughout the hospital.
“The system can automatically trigger calls to physicians, nurses,
infection control, admitting, dietary, and housekeeping,” said Dr. Dan
Cass, medical lead for I.T. and chief of emergency medicine. “It will
push these processes along, instead of leaving things to chance.”
As Dr. Cass explained, “At times in the past, some processes have broken
down; because the appropriate medical staff and team members haven’t
been notified in a timely way.” St. Michael’s expects care delivery to
become faster and smoother through use of Soarian’s workflow engine.
The workflow project is one of several components of the hospital-wide
Soarian clinical information system implementation at St. Michaels.
St. Michael’s Hospital is a high-profile academic health science centre
offering care for the sick and poor in Toronto’s inner city. Affiliated
with the University of Toronto, the hospital is a clinical leader in the
many areas, including heart disease, trauma and critical care,
neurosurgery, arthritis and osteoporosis, keyhole surgery, diabetes and
The hospital has 4,800 staff and 600 physicians. Each year St. Michael’s
teaches 1,800 students, performs 25,000 day surgeries, treats 600,000
patients in clinics, sees 57,000 patients in the emergency room and
provides round-the-clock care to 24,000 in-patients.
According to hospital executives, its all-encompassing Soarian Clinical
Information System is the most comprehensive installation of the Siemens
product in Canada.
Soarian has many components, but the workflow engine is especially
important to St. Michael’s. “This was the real distinguishing factor
when we looked at acquiring new information systems,” said John King,
executive vice president and chief administrative officer at the
The hospital examined a variety of systems, but determined that Soarian
and its advanced workflow solution had the most value for St. Michael’s.
Anne Trafford, chief information officer, noted that the hospital
intends to implement their first workflow, enabled by Soarian’s workflow
engine by the end of 2007. A second technology-enabled workflow is
expected by March 31, 2008.
Other workflow processes being considered include infection control
notification and management, and primary physician notification.
Andy Hind, vice president of the medical solutions division at Siemens
Canada, noted that currently 66 different technology-enabled workflows
have been implemented at Soarian customer sites worldwide. In time, more
workflows will be developed – many by the users themselves, such as St.
Organizations using Soarian can trade applications, customize the
solutions, and lend expertise to one another. “It almost becomes
shareware for Siemens clients,” commented Dr. Cass.
Hind added that the workflow engine offers ‘role-based’ security,
providing care-givers a different view or set of patient information,
depending on whether he or she is a physician, nurse or other healthcare
St. Michael’s launched Soarian in 2004, sunsetting their legacy solution
in March of this year. A wide variety of departments now operate using
Soarian – including nursing units, clinics, lab, pharmacy, cardiology,
radiology, and dietary services. By using Soarian Clinical Access,
physicians now have a single view and can obtain all lab, pharmacy,
radiology reports and images, as well as ECGs. “It provides us with a
single view of all the available electronic patient information,” said
In 2005, in concert with clinical transformation, Soarian Scheduling was
also implemented and now supports all 245 clinics throughout the
hospital. This has allowed St. Michael’s to address wait times, and
patient and staff satisfaction in the ambulatory care setting
Implementing the wide-ranging system, however, required buy-in from the
board of directors – which King says has given full support. It also
needed the confidence of physicians and clinical staff.
To that end, a great deal of education and change management work has
been done. “We spent a whole year building the trust of clinicians,”
said Trafford. Part of the conversion program included a mock shut-down
of the older system, to demonstrate the effectiveness of the new,
integrated Soarian solution.
As part of the multi-year project to implement new information systems
at the hospital, known as Project Gemini, St. Michael’s budgeted $7
million for education and training, e-learning and change management.
“It’s a major investment,” said Trafford.
The new systems are working well, and they have hospital-wide
acceptance, said King, who emphasized that a large measure of the credit
goes to Trafford and Dr. Cass. “We’ve got people with clinical expertise
and understanding leading the work,” he said, referring to Dr. Cass, the
head of the emergency department, Sally Remus, the hospital’s director
of clinical informatics, and Trafford, who at one time was employed as a
nurse at St. Michael’s.
On a related front, St. Michael’s is also getting ready to implement the
online documentation project, in which nurses will record patient
histories, vital signs and physical assessments in Soarian. The pilot
project will go live by the end of the fiscal year.
And as the next major step, with initial planning already under way, the
hospital intends to implement computerized physician order entry (CPOE)
for medications. “CPOE has the potential to have the greatest impact on
physicians, but it could have negative implications if it’s not done
correctly,” asserted Dr. Cass. “We’re taking great pains to do it
As part of that process, the team is looking at hospitals where CPOE has
been implemented effectively and others where implementation was not as
successful. It’s all part of the effort to learn what works, and what
Organizations that have deployed CPOE with great success, said Dr. Cass,
include the Cincinnati Children’s Hospital Medical Center, the
University of Pittsburgh Medical Center, and the Calgary Health Region.
If done correctly, he added, CPOE can have tremendous benefits for
patient care. “It’s not about saving time, because it won’t do that,”
said Dr. Cass, explaining that it may take longer for physicians to
enter medications and data into the computerized system than to scribble
an order and send it off to the pharmacy.
“But it will save time downstream,” he said. Medication errors often
have tragic consequences for patients. Well-designed and executed CPOE
systems have been shown to be effective in reducing the rate of serious
medication errors. Prevention of errors can be attributed to CPOE
systems with structured orders and medication checks that help to
prevent errors during the ordering, checking, dispensing and
What’s more, through the decision support capabilities of a CPOE system,
such as evidence-based medicine and suggested therapies, “you’ll have
better results,” he said. Patients will get better, sooner – resulting
in greater patient satisfaction, reduced complications and lower costs
to the health system.
Results like those should appeal to all caregivers. And it’s this
approach that St. Michael’s is taking to raise physician support for the
new systems – it’s all about improving the level of care. “This is
really a clinical project that’s supported by IT,” said Dr. Cass. “It’s
not an IT project, in and of itself, and that makes a big difference
when you’re working with physicians, nurses and other health
Abbotsford to invest $84 million in new
By Walter Hiller
ABBOTSFORD, B.C. – Technology systems to be installed at the new
Abbotsford Regional Hospital and Cancer Centre include some of the most
innovative and advanced in the country, and will enable healthcare
professionals to provide focused, patient-centred care in a world-class
When the hospital and cancer centre opens in summer 2008, it will
transform the delivery of healthcare services in the Fraser Valley.
The Abbotsford Regional Hospital and Cancer Centre is planned as a
300-bed replacement for the aging MSA Hospital in Abbotsford. This
$355-million project will be an important regional referral hospital for
the Fraser Valley and the fifth regional centre in the BC Cancer
Agency’s provincial cancer control network. About $84 million in new
equipment and technology will be installed in the new hospital and
In June 2007, the Province of British Columbia announced a $30 million
agreement with GE Healthcare to provide state-of-the-art medical imaging
equipment, patient monitoring systems and digital picture archiving
communications system (PACS) for the hospital and cancer centre. This
technology package also includes transitional, educational and
consulting services that will help streamline hospital operations and
allow staff to save time and bring an even greater focus to frontline
A variety of technology solutions will give healthcare professionals
critical decision-making information right at the patient’s bedside.
One innovative example is the anesthesia patient delivery and
physiological monitoring system. The GE Healthcare anesthesia delivery
system unites patient demographics and diagnostic information right at
the point of care. The anesthesia station is essentially comprised of
three different components that work together as an integrated unit.
The first is the anesthesia delivery unit, which provides sophisticated
ventilation options and a “fuel injection” delivery of anesthesia
medication using an electronic control. Patients will benefit from the
synchronized “gentle” ventilation parameters. As well, the
anesthesiologist can deliver full pressure control ventilation if
needed. This system also has the potential to significantly reduce the
use of expensive anesthetic agents.
The second component is a robust patient monitoring system that will
allow physicians to view vital signs and electrocardiogram rhythms of
their patients in the recovery room directly on monitors in the
operating room – similar to a picture on a television set.
In addition, patient laboratory data is going to be directly available
to physicians at the anesthesia workstation.
The third and perhaps most beneficial component is the electronic
anesthesia record. All of the data from the anesthesia delivery unit and
patient monitor is continuously recorded and made available to the
electronic record. “The anesthesiologist currently spends a lot of time
away from focused patient care, recording this data manually,” explained
Dr. Derek Campbell, head, department of anesthesiology at MSA Hospital.
“The electronic capture and reporting of this data will be critically
important in emergency cases, when there is little time available for
record-keeping. There is no doubt that a more complete and accurate
representation of the procedure will result.”
“It will be an exciting time for patients and physicians as we begin to
use this new technology. In the end, the goal is to maximize the amount
of time we spend on patient care and minimize the time spent focused on
machines and manually recording data. The ability to view X-rays,
laboratory data and electrocardiograms directly at the anesthesia
workstation will be a significant time saver,” said Campbell.
There are other examples of how technology is saving time and allowing
healthcare professionals to focus on patient care. The hospital and
cancer centre is being designed and constructed to accommodate
structured cabling and a complete wireless network infrastructure that
will enable the use of all forms of wired and wireless communication
Emergin will provide an integrated alarm management solution that will
route critical patient alarms from bedside monitors and ventilators to
the wireless phones being deployed to nursing staff, physicians and
technicians throughout the new facility.
This unique software platform uses dashboards, reporting tools and
services to help healthcare professionals manage critical alarms and
events. In addition, nurse call will be integrated with the alarm
management system to provide seamless communication between patients,
staff and equipment.
Another innovation is the installation of operating room message boards.
There will be five sets of 32-inch liquid crystal display monitors
mounted throughout the operating room areas that will contain
information about each of the nine ORs in the hospital. A quick glance
to any one of these screens will provide staff with critical information
about the status of activity in each OR, resulting in better time and
equipment management. This information will be displayed in both text
and real-time video through closed circuit television.
At the Abbotsford Regional Hospital and Cancer Centre, technology will
also be used as a tool to improve patient care and safety. Physicians
caring for cardiac patients in the hospital will benefit from the
wireless transmission of diagnostic cardiology exams directly from the
patient’s bedside, with the ability to review these exams electronically
from multiple locations throughout the hospital or from the physician’s
In addition, the GE Healthcare perinatal information system will provide
the labour and delivery area with central surveillance of labouring
mothers, resulting in significant improvements to nursing staff workflow
and patient safety. Moreover, the system is designed to capture and
store electronically, information from fetal monitors and other
physiological equipment to create a comprehensive clinical record about
mother and infant. Information can then be transferred from the mother’s
chart to the baby’s record without re-entering data. The result will be
less time spent on redundant, multiple data entries and more time spent
on direct patient care.
With the integration of a cancer centre and a hospital – a first in
Western Canada – residents of the eastern Fraser Valley will benefit
from the spectrum of world-class cancer care services closer to home. In
addition, the cancer centre will be the first radiation therapy
department in the province to solely use computed tomography (CT)
simulators for the planning of radiation therapy treatments. Treatment
planning is an important part of cancer care and outcomes and this
allows better visualization of anatomical structures within the areas of
Walter Hiller is the President and Chief Project Officer of Abbotsford
Regional Hospital and Cancer Centre Inc.
GIS techniques, when applied to healthcare, can solve many problems
By Jerry Zeidenberg
It’s remarkable what you can do with geographical
information systems (GIS) – if you’ve got enough data to work with and
the smarts to figure out what the information means.
Recently in Sault Ste. Marie, Ontario, a team of GIS experts provided
mapped data showing that about 65 percent of the city’s low birth-weight
babies were coming from low-income neighbourhoods. Using another set of
a data, it was also determined that these areas had a high number of
expectant mothers who admitted to smoking during pregnancy. This was the
kind of evidence that experts were looking for to show that smoking
mothers may be having smaller babies.
As low birth-weight often leads to health troubles later in life, public
healthcare officials took action by providing women in these
neighborhoods with anti-smoking literature and programs.
This sharp-shooting strategy was more effective, and cheaper, than a
shotgun approach which might blanket the whole city. “You don’t need to
send brochures to neighbourhoods that haven’t had a birth in five
years,” quipped Paul Beach, manager of the Community Geomatics Centre (CGC)
in Sault Ste. Marie.
Beach and Tom Vair, executive director of the Sault Ste. Marie
Innovation Centre, gave a fast-paced and fact-filled presentation at a
May conference on GIS in Healthcare, held in Toronto. The conference,
sponsored by GIS software developer ESRI Canada, involved a number of
speakers from government and healthcare organizations who are deploying
geographical information systems.
They showed how the rapidly growing field of GIS can provide new and
effective tools for health promotion. In a variety of ways, geographical
systems can be used to nip trouble spots in the bud – meaning that you
can prevent the outbreak of illnesses and thereby keep people out of
doctors’ offices and acute-care hospitals.
For its part, the CGC in Sault Ste. Marie has become a leader in the
application of GIS to healthcare. The centre has been mapping the city
and outlying regions since 2000, using advanced computer techniques.
Indeed, all 70,000 buildings have been photographed and mapped. So has
every stop sign and fire hydrant. As a result, Beach believes the
northern Ontario city now has the “most comprehensive municipal GIS in
North America, and perhaps in the world.”
Using several data sources, analysts at the CGC can determine where
people work, play and live, and who is young or old. Some of the data is
updated daily, and all is refreshed at least on a yearly basis.
Of course, it’s not how much data you’ve collected, but how you use it.
In the case of Sault Ste. Marie, they’re actively putting the
information to work.
Beach and Vair noted a host of healthcare problems the city has faced,
and outlined how GIS was able to crack various mysteries, leading to
solutions and the elimination of problems.
• Using geographical databases, it was determined that about 90 percent
of the kids presenting at the local hospitals with injuries were coming
from low income neighbourhoods, particularly from the social housing
complexes. The reasons for this are currently under investigation.
Possible explanations include a lack of parental supervision, and a lack
of accessible recreation facilities and programs. Now, city and YMCA
officials are preparing to bring sports and recreation programs closer
to where these children live. Also being suggested is a community bus
for children that would provide direct transportation from less
advantaged neighbourhoods to sites of organized activities like soccer
and swimming, or to libraries.
• Sault Ste. Marie has the second-highest rate of elderly people among
municipalities in Canada, noted Beach. But by collating records and
mapping the data, the city has identified the areas with the greatest
concentrations of seniors. Knowing this, they’ve been able to prioritize
these areas for quick salting and sanding after sidewalks are plowed.
That’s intended to prevent falls and hospitalizations. Similarly, the
city has embarked on a campaign to ensure that street corners are cut
and sloped in neighborhoods with seniors, to provide easier access for
the handicapped and people with walkers.
• By mapping the dwellings where people are wheelchair-bound, blind, or
have other mental and physical handicaps, alerts can be programmed to
pop-up at emergency services in the event of fires, floods or when
medical help is needed. This ‘special needs’ capability is currently
being developed in Sault Ste. Marie. As a result, “emergency services
will be better prepared,” said Beach, who observed that the city will be
“the first municipality in Canada to have a comprehensive system of this
• In the battle against West Nile Virus, which is transferred to humans
by mosquito bites, city officials sought to eradicate sources of
standing water – sites where mosquitoes are known to breed. While out
walking, Beach discovered, that mosquitoes were emerging from the grates
over electrical transformers, which had been built below sidewalks. “It
was a bad idea (to locate the transformers under sidewalks),” said
Beach. “They’re tripping hazards and water pools into them, where it’s
heated by the transformers.” He explained that the standing water
becomes a prime breeding ground for mosquitoes. With a database of the
location of all such transformers in the city, officials were able to
target them for larviciding.
• Large buildings, too, can be mapped and analyzed to resolve problems.
In 2003, the Sault Area Hospitals (SAH) had an outbreak of c. difficile.
The CGC was brought in to determine how the disease made its way around
the hospital. Vair noted that experts collected a wide variety of
information, including patient admission and discharge dates, the onset
of disease in afflicted patients, patient room movement, the
availability of washrooms, which patients were in private rooms and
which were in wards, the flow of clothing and food, among other factors.
The information will be used for future planning, to help prevent or
isolate diseases upon outbreaks.
Beach asserted that GIS databases require an extraordinary amount of
information. “The amount of data is tremendous, and you have to put in
role-based security,” he said. “A lot of our investment went into that.”
So far, he said, some 1 million documents are contained in the database.
And while the geomatics centre has only six employees, Beach observed
that a great deal can be accomplished with clever programming. “When we
change one address, it will affect 23 other variables in the database,”
he said. “We’ve built-in that kind of intelligence. It makes us much
Asked about data quality contributed by partner organizations, Beach
replied that “it can be quite poor, with a 20 percent to 50 percent
But he said that data quality problems can be overcome by using the
right collection techniques. “We go in and train the organizations,”
said Beach, “and soon enough, their data is clear and more valuable.”
‘Smart’ pumps reduce the incidence of IV medication mistakes
By Neil Zeidenberg
The Scarborough Hospital, a bustling two-site organization in Toronto,
has found an effective solution to the problem of IV medication errors
by implementing ‘intelligent’ pumps and software.
For the past year, the busy Scarborough sites have been using over 400
of Hospira’s new Smart IV pumps and their attendant MedNet software.
A resounding success, notes director of pharmacy Patricia Macgregor, as
the Smart pumps are catching and preventing potential errors. They’re
flashing alerts to nurses when the medication being dispensed goes
beyond or below the parameters set as ‘best practices’ for a particular
Although not widely publicized, IV-related adverse drug events (ADEs)
are quite common. In fact, approximately 35 percent of all medication
errors are IV related.
“IV errors can often be fatal because the medication goes directly into
the blood stream, and many patients are receiving high-risk drugs, such
as oncology medications, narcotics, high potency electrolytes,
anticoagulants, and insulin,” said Macgregor.
According to a 1995 study on ADEs, administering drugs represents one of
the most high-risk activities for nurses in healthcare facilities.
Many errors occur because nurses are working long shifts, see many
patients and become tired and stressed. Often due to staff shortages,
nurses are required to complete shifts in different patient-care units
with patient types that are less familiar to them.
Various patient types may require different dosages of the same
medication. For instance the dose of morphine tolerated by a surgical
patient will generally be far lower than that of a palliative patient.
Addressing this challenge, MedNet software is completely customizable by
patient-care area, such as pediatrics, ICU, and step-down. It permits
specific drug lists and dosing limits according to the needs and
tolerances of the patients in these units – thereby providing additional
“A nurse can easily go into a ward, accidentally give the wrong drug to
the wrong patient, or the wrong dose,” said Pascal Couture, product
manager for medication management systems, at Hospira Healthcare
Corporation (Canada), in Montreal. “Sometimes it’s fatal and sometimes
not. Even when it’s not, it may mean the patient stays in hospital
longer,” resulting in a poorer outcome and lower-quality experience for
the patient, higher costs to the healthcare system, and longer waits for
Before being deployed, the Smart IV pumps receive a Drug Library “push”.
The Drug Library is programmed centrally at the hospital pharmacy
through the MedNet software, then pushed out electronically to all the
pumps. The software allows the hospital to pre-configure appropriate
upper and lower dosing limits for intravenous drugs –- thereby setting
organizational protocols for such high-alert drugs as heparin, insulin
Pharmacists, nurses and physicians work together to develop ‘best
practices’ for various medications, using published evidence-based
medicine and their own population needs.
This process, along with the ease of programming through MedNet, enables
a consistent, evidence-based approach to patient care, with the ability
to respond quickly to changes in drug therapy reported in the
literature, Macgregor said.
The technology is relatively simple to use, and requires as little as
1-½ hours of training.
If the data entered by the nurse at the point-of-care doesn’t match
what’s been pre-programmed by the pharmacy, the IV pump will ask for
verification. In some cases, this can be overridden by the nurse, but it
always makes him or her re-think whether the patient is getting the
right medication, in the right dose at the right time.
Nurses and staff have benefited from this safety mechanism, but
patients, naturally, have been the biggest beneficiaries.
Macgregor said approximately 2,000 full-time and part-time staff at TSH
use the technology. Despite a few extra steps and additional time that’s
needed to operate the pumps (compared to a “rate + set + go” program
from a non-MedNet pump), the gains have been huge – making the extra
steps of data-entry well worth the effort. The patient is safer and
nurses provide care with more confidence.
MedNet – the software application for the pumps – is able to compile
daily, weekly or monthly status reports tracking the number of patients
infused, drugs dispensed, time and date, and problems that occurred,
such as keying errors or alerts and the response of staff to those
In the near future, the procedure will be simplified further by the use
of bar code scanners, which will eliminate some of the key entry. Next
year, Hospira expects to introduce MedNet N5. In addition to verifying
the 5-Rights (Right medication, Right dose, Right time, Right patient
and Right route), this software upgrade can also identify the nurse who
infused the patient and the particular patient being infused.
Staff will be required to scan not only the barcode of the drug being
infused, but the barcode on the patient armband and his or her ID badge.
All these data can help identify when and where errors happen – ICU,
emerg, pediatrics, oncology, or other departments. They can also help
determine if particular staff members need further training or
re-education on best practices, or if the patient-type or clinical
treatment regimens have changed on the patient-care unit. They may also
indicate that a review of the literature is required, along with a
potential revision of the drug monographs to meet the changing needs of