INSIDE THE APRIL 2006 ISSUE:
It’s 11 pm: Do you
know where your doctors are?
While a schedule looks good on paper, the best paperwork can sometimes
go awry when physicians work in multiple locations and swap shifts with
their peers. A Sudbury, Ontario doctor who’s missed more than a few
shifts himself is behind an effort to help hospitals and clinics use
computers to improve their scheduling and internal communications.
HIMSS in San Diego
HIMSS06 was held February 12-16 in San Diego at the beautiful and
spacious San Diego Convention Center. The annual conference and
exhibition of the Healthcare Information Management and Systems Society
attracted more than 25,000 attendees this year for several days of
keynote addresses, hundreds of sessions by industry leaders, and many
hundreds of booths showcasing the latest products and services.
Editor's note: Redundancy works.
News: Patients can schedule appointments online;
EMR toolkit should arrive this fall; Managing patient info.
Tech: Logitech diNovo – a desktop with a difference; Norton Ghost
10; Belkin KVM switch is a real space saver; UMPC computers; Lexmark
E120n mono laser; Simply Accounting; Spyder2PRO for accurate, consistent
colours; Lexmark colour laser is versatile and powerful.
Chatroom: American doctors are now pushing for
It’s 11 pm: Do you know where your doctors
A Sudbury, Ontario doctor is behind an effort to help hospitals and
clinics use computers to improve their scheduling and internal
While a schedule looks good on paper,
the best paperwork can sometimes go awry when physicians work in multiple
locations and swap shifts with their peers. A Sudbury, Ontario doctor who’s
missed more than a few shifts himself is behind an effort to help hospitals
and clinics use computers to improve their scheduling and internal
Dr. Dennis Reich, a general practitioner affiliated with two clinics in this
northern Ontario city, founded Chyma Systems (www.chyma.net)
in 2000, inspired by his own experiences with mussed up schedules and a less
than satisfactory flow of information.
“I often double-booked myself or missed a shift I was supposed to work,” Dr.
Reich says, attributing much of the confusion to the use of paper for
maintaining large, often complex schedules involving dozens or even hundreds
of employees. “If doctors don’t have a copy with them, they can forget, and
administrative staff don’t always know who’s on duty if doctors have traded
shifts and not notified the front desk. The fact that physicians tend to
work in multiple locations and multiple institutions makes it even more
The web-based software, called Chyma, integrates individual physician
schedules into an overall group calendar, so doctors can access and manage
their own information and also see the bigger picture of an entire clinic or
hospital department. Physicians who have multiple work affiliations can
automatically import schedule information from each location into a single,
personal calendar. Users can create guest accounts so a spouse can enter
events such as evenings out or anniversaries, and assistants can input
meetings. “An audit trail will document who made the changes,” Dr. Reich
says. “This can be seen by schedule administrators and, when necessary,
other people on that schedule.”
The original version, Chyma 1.0, included the scheduling and calendar
functions, plus communications tools such as a contact manager, a system to
post messages to specific individuals or the entire group,
threaded-discussion areas, document-sharing options for PDFs, spreadsheets
and other files, and access to Stat-Ref, an online library that includes
Griffith’s 5-Minute Clinical Consult, Harrison’s Manual of Medicine, and
other references. Version 2.0, released in October, enhances existing
features, adds Mac compatibility and lets physicians use the same login and
password to access multiple communities to which they belong.
Dr. Reich says the notion for providing these online communications tools
came from his own experiences with a newsletter he started in 1999 for
physicians in Sudbury. The Stethoscope, affiliated with the Sudbury and
District Medical Society, promoted local medical and education-related
events but lasted only a few months in paper form. “Distribution was a
problem. However, we quickly realized we could put the newsletter online, so
we created a national portal called Canadian Physician (www.canadianphysician.ca).”
Dr. Reich discovered his target audience was mainly interested in events
close to home, and Canadian Physician morphed into Chyma. In its current
form, it resembles a private internet with a grassroots look and feel.
Participants need not be attached to a particular computer or location but
must be an authorized member of a group. For optimum access, Dr. Reich
recommends a PC with at least Windows 2000 and either Internet Explorer or
Mozilla Firefox, or a Mac with a Mozilla-compatible browser (Safari is not
currently supported and users could experience glitches).
Because Chyma is exclusively internal, involving only a particular
community’s authorized members, users cannot send or receive e-mail to or
from outside a particular community. “It’s both a strength and a weakness,”
Dr. Reich concedes. “You do not have any spam coming from outside, but you
won’t get any messages from people who are not part of the system.”
Privacy is a big deal. Even though the system isn’t intended to hold patient
data or other highly-sensitive information, Chyma secures its own servers
and employs 128-bit SSL encryption. Access is password enabled, and network
administrators can manage this on a need-to-know basis.
Reich says roughly 4,000 Canadian physicians are using Chyma through their
workplace. In January, some 60 Halifax physicians joined the ranks when
Family Focus implemented it across its four walk-in clinics. Owner-operator
Dr. Mark Fletcher oversees scheduling for the clinic’s practitioners, who
work as independent contractors, and says the old paper-based system was a
headache. “Doctors who traded shifts were supposed to ask the person keeping
the schedule to make the switch, but they (doctors) often lost track of who
they’d switched with and shifts would sometimes be missed or forgotten.”
Today, Dr. Fletcher has a lot less paperwork on his hands. “It’s taken me
out of the loop as the middleman for these shift changes. It’s simplified my
life.” Dr. Fletcher is hopeful missed shifts will be a relic of the paper
age. “It’s a lot less likely someone isn’t going to see their name on the
(web-based) schedule because there’s one page where their name is the only
Kensington Medical Clinic in Burnaby, B.C. also implemented Chyma in
January. The clinic consists of 50 physicians, with up to a dozen on duty at
any given time, and manager Jeremy Mickolwin says he used to update
schedules monthly with Microsoft Word. “I posted copies in multiple
locations around the clinic but this got confusing. Someone would change it
in one location but not in the others, so everybody was checking different
schedules. Doctors would sometimes not show up because they didn’t know they
were scheduled.” Now, users can check schedules from home and know if any
shifts have changed, and Mickolwin has less to worry about. “I can do a
schedule for the entire year in advance, post it, and people can see it.”
Mickolwin says Chyma was fairly easy to implement. While system
administrators can enter user data themselves either manually or using Excel
spreadsheet software and a data importer within Chyma, Chyma personnel did
this set-up work for the clinic. “I created an e-mail list for every doctor
and sent it to our contact at Chyma. Then, a couple days later, we sat down
for about an hour and I was trained on how to make schedules and do
everything else. I called back two or three times to follow-up on a couple
of minor glitches, but that was it.” When he was initially unable to access
Chyma from his home using a Mac, he learned the system is best accessed
using Mozilla, which he downloaded, rather than the more common Safari
browser. Three or four of the clinic’s doctors use Macs and none has
reported difficulty. Mickolwin says Chyma works well on 450 MHZ Pentium II
PCs, the clinic’s oldest machines. “These are bare–bones things that just
operate on the Internet. The ones up front have a bit more power because we
use billing software and such, but nothing here is even close to top of the
While he appreciates the access Chyma provides to online medical references,
the physicians at his clinic aren’t using the discussion areas or the
contact manager. They also prefer outside e-mail to internal messaging.
“That might change in the future, but I think the main thing is the
scheduler. The rest is just decorative.”
In Sault Ste. Marie, Ontario, Sault Area Hospital led an implementation that
now encompasses much of the area’s medical community, including 10 regional
health facilities and four local clinics. In early 2003, the hospital
decided to centralize its core communications and documents such as
policies, procedures and newsletters, says IT manager Julian Piwowarski.
With 130 physicians across the city, the hospital also wanted to streamline
its paper-based on-call scheduling system.
“We had an off-the-shelf package that gave us a development platform for our
own web site, but we quickly outgrew it,” Piwowarski says. He discovered
Chyma by chance while online, and city-wide implementation took two months,
with no significant hurdles. “It’s a very light-duty intensity type
application. It’s fast launching and we never have crashes connected with
The system caught on – so much so that the local coroner’s office and police
department have asked to be included. “We started with ten calendars for
different hospital departments (plus physicians), and now the coroner asked
us to put his schedule there. Now that people see a central location, they
want to be there,” Piwowarski says. The Algoma Health Unit has access, for
purposes of infection control, in case it needs to reach someone with
particular medical skills.
Piwowarski says the contact manager replaces a bulky, awkward paper-based
phone directory that constantly needed to be updated and printed, and forms
are kept online and printed as needed rather than stored in bulk. “We used
to stock them, and then they would go out of date before we’d use them all.”
An online drug formulary replaces books that were three inches thick.
So what lies ahead for Chyma Systems? Dr. Reich and his business partners
sold the company last June to Isaix Technologies, a Montreal-based
technology company. “It has a strong sales infrastructure and the financial
and human resource base to get the message out and take the product
further,” Dr. Reich says. “We needed the infrastructure to be able to take
this to the next level, and Isaix has a background in training, sales and
marketing, and access to a lot of different markets that we didn’t.”
The Chyma Systems division has retained its name and personnel, and Dr.
Reich – who continues as medical director – says he plans to add PDA and
hand-held functionality later this year. “We’ll have an application version
that will provide some of the messaging and shift-trading functionality we
have online, and it will also allow offline syncing of calendars and
contacts.” Stat-Ref includes the Micromedex USP DI drug reference guide, but
Reich says he’s looking to offer a Canadian one.
Meanwhile, Chyma Systems is courting government agencies. “We could help
with pandemic preparedness. One of the things about pandemic preparedness is
knowing where your human resources are,” says Dr. Reich. The company is also
conducting a feasibility study to address market potential and related
issues in the United States and Great Britain. “We need to determine any
special needs and requirements that may be different from ours, then we’ll
adjust our feature set accordingly.”
Costs depend on the size of the implementation. A hospital or other large
implementation pays $2.95 to $4.95 per user per month and a one-time
up-front fee of between $8,000 and $20,000, depending on its size. The
up-front fee is waived for clinics, even very large ones.
“It’s a matter of the number of users and the complexity of getting the
people on the system,” Dr. Reich says. “It’s to our benefit to have a clinic
of 50 doctors using the system because then they push the hospitals to get
on board as well. We’re going after getting good traction in the market and
potentially moving into medical education and other types of revenues we can
generate afterwards. The first step is getting the physician to actually use
(computer) technology on a day-to-day basis.” •
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HIMSS in San Diego
The biggest healthcare IT conference of the year was
in southern California this year and it was worth the long trip from
By Issie Rabinovitch
HIMSS06 was held February 12-16 in San
Diego at the beautiful and spacious San Diego Convention Center. The annual
conference and exhibition of the Healthcare Information Management and
Systems Society attracted more than 25,000 attendees this year for several
days of keynote addresses by national figures and celebrities, hundreds of
sessions by industry leaders, and many hundreds of booths showcasing the
latest products and services.
As far as information technology conferences go, 25,000 is not a huge
number. Comdex at its peak in the late 1990s attracted over 200,000 visitors
to Las Vegas every November. CeBIT, the mega conference that has emerged as
the most important IT event of the year, brings over 450,000 visitors from
Europe, North America, and the rest of the world to Hannover, Germany every
To place things in perspective, though, IT conferences and trade shows like
CeBIT (and the now defunct Comdex) have always attracted a large percentage
of non-professionals. At HIMSS06, almost everyone was either a healthcare
professional involved in IT, an IT professional involved in healthcare, a
vendor, or a member of the media. In many conversations during my four days
at the conference, I never heard anyone say that it would be better if it
were bigger. Whatever people arrived hoping to find at the show, they pretty
much found it.
The opening keynote on Monday morning, February 13 was presented by Dr.
David Brailer, National Health Information Technology Coordinator. Following
his talk, there was a press conference in a separate room for members of the
Dr. Brailer has a higher profile in the U.S. than any of his counterparts in
Canada. He is a charismatic and talented individual but there are other
reasons for his prominence. In April 2004, President Bush committed to a
10-year goal of providing Americans with an EMR, including prescription drug
records. The following month Dr. Brailer was appointed to his current
position and given the enormous task of making President Bush’s promise a
President Bush continues to talk about improving healthcare using
information technology, about the need to deploy IT systems to lower costs,
reduce medical errors, and improve the quality of care. This subject has
been in his last three State of the Union addresses and in many other
speeches. On each occasion, the national spotlight falls on Dr. Brailer,
since he heads up this effort.
The initiative faces the same obstacles that similar efforts in Canada face:
the need to re-engineer the current paper-based workflow in healthcare and
the huge upfront investments needed to reap the benefits down the road.
However, with the very public backing of the President and the recognition
that it is a national priority, the U.S. effort has a leg up on the Canadian
Dr. Brailer’s comments at his keynote were unsurprising and not particularly
newsworthy but the press conference immediately after was intriguing.
In a series of increasingly hostile questions, journalists pressed Dr.
Brailer on pertinent details. It seems that since his appointment, the
meaning of “everyone”, as in the phrase “everyone will have an electronic
medical record”, has been weakened in his speeches and interviews. According
to some journalists who have been following him since May 2004, he used to
mean almost everyone, over 80 percent, or the overwhelming majority. They
provided quotes to substantiate their assertions. He has backtracked, it
seems. While the commitment to an EMR for everyone remains in place,
everyone may now mean 50 percent of the population. Perhaps even less.
Dr. Brailer was also accused of waffling on key delivery dates. Time ran out
before all questions were dealt with in a way that satisfied “everyone” at
the press conference.
What I witnessed at the press conference reminded me of similar exchanges at
events and conferences in Canada. Politicians, political appointees, and
government bureaucrats use language creatively and can be difficult to pin
down, no matter how simple the questions. That seems to be the same in both
While journalists may be passionate about issues like the e-health record
for the masses and promises surrounding its deployment, the American public
at large seems to know little and cares less. A few days before Dr.
Brailer’s keynote, IDC’s Health Industry Insights released the results of a
survey of 1,095 consumers. They found that 70 percent of respondents were
unaware of the U.S. government initiative we’ve been discussing here.
Respondents, regardless of their level of awareness, were divided when asked
if the government will meet this goal, with 45 percent confident and 43
percent not confident.
“Consumers are both unaware of this Federal initiative and skeptical of the
value proposition associated with digital health care,” said Marc Holland,
program director of healthcare provider research at Health Industry Insights
and author of the report.
The IDC report contains many other interesting conclusions, but the key
message is clear. If you want to get the public behind any serious and
expensive healthcare IT initiatives, if you want to ignite enthusiasm, count
on doing a lot of work for many, many years. It’s a sobering message and
applies to Canada as much as it does to the U. S.
For a change of pace, I decided to visit some booths of interest and focus
for a while on technology rather than politics and policy.
Intel has produced a new architecture for mobile computers to succeed
Centrino. The most radical new feature is CPUs with two processors on the
same die. The older architecture boosted performance by increasing the clock
speed of the processor. Somewhere around 3.6 GHz it became clear that this
approach couldn’t continue. Processors running at that speed and higher were
using too much power and generating too much heat.
The new designs are referred to as Core Duo and they offer tremendous
benefits – better battery life (by virtue of lower power usage) and better
performance. Users of notebooks and tablet PCs built on this Intel platform
will notice improved multitasking. Running intensive processes in the
background on a computer with a conventional CPU can use nearly 100 percent
of the capacity and make the computer seem sluggish.
If you’ve tried to use a word processor while a backup or a virus scan was
taking place, you have experienced this phenomenon. With a Core Duo
processor, the background processes will run on one core and the foreground
applications will run smoothly on the other. I tried the new Toshiba M400 at
HIMSS but there will soon be Core Duo models from all manufacturers, big and
I finally got to try Vocera’s instant voice communications system at their
booth. Vocera products are in use in many industries, but they suit the
needs of healthcare particularly well.
The system consists of software running on a Windows server and a wearable
communications badge that weighs two ounces and can be worn like a memory
key or clipped onto clothing. As the photograph shows, there is no apparent
means of “dialing” a call. That’s because everything is done by voice. The
badge is controlled by natural spoken commands. It’s as easy to setup a
conference call as it is to call one person. If desired, you can send a text
message or alert to the LCD screen on the back of the badge. The system
requires a Wi-Fi network, which is already present in many hospitals and
The demo was thoroughly convincing to me. The Vocera system is already in
use in Canadian healthcare. We hope to profile some of these installations
in a future issue of Technology for Doctors.
Lexmark demonstrated several of their new multifunction printers. These MFPs
don’t so much introduce new features as enhance features that already
existed on the models they supersede.
These MFPs are able to print forms stored on a server and populate these
forms with patient data. These tasks are performed while standing at the
printer and choosing the desired forms and patients from the upgraded
control panel. A computer is not required.
The previous generation of Lexmark MFPs could do this too but the new units
have much bigger and brighter control panels and a better user interface. It
is now easier for busy and stressed users to specify and print forms in this
way. The ability to also scan, fax, and copy documents is a plus and these
functions were demonstrated in a simulation involving a patient, doctor, and
phamacist with the latter receiving a prescription by fax and questioning
As I continued to tour the showfloor, it became clear that the number and
variety of EMR software vendors continues to grow. We reported in the
January issue that EMIS, the dominant vendor in the UK with more than half
that country’s market, was setting up shop in Canada. Until we covered that
story in T4D, I had never heard of EMIS. That kind of experience was
repeated at HIMSS06.
I attended an AGFA briefing on ORBIS, the EMR product they acquired in 2005
by purchasing GWI, a German vendor of healthcare information systems and the
Electronic Patient Record. AGFA claims that ORBIS has 500,000 users in
Europe, more than any other system.
I heard about ORBIS for the first time during the briefing. Its customer
base is almost entirely in Germany, Austria, Switzerland and France. It
seems to be unknown outside those countries. No one I asked at the
conference, even vendors of similar software, had ever heard of ORBIS. It’s
interesting that new contenders are emerging on a regular basis. I think it
says that, even though there are many companies doing good business with
their healthcare information systems, there isn’t a player dominant enough
to scare off new investment. Another interesting detail about ORBIS is the
expected release date in the North American market – 2008. I think the
message there is that Agfa wants its loyal customers to know that a worthy
AGFA solution is on the way and to adjust their plans accordingly and to
wait for it.
I spent some time with Medsphere, a much different kind of company than AGFA
with a much different kind of healthcare management solution. The company
was founded in 2002 but it wasn't until November 2005 that Medsphere
appointed Dr. Ken Kizer as CEO and Chairman of the Board. Therein lies an
During the two decades prior to joining Medsphere, Dr. Kizer held some very
influential public positions. In particular, from 1994 to 1999, he was
Undersecretary for Health in the U.S. Department of Veterans Affairs (VA).
In effect, Dr. Kizer was the CEO of the VA healthcare system, the largest
healthcare provider in the U.S., with an annual budget in excess of $20
billion, approximately 200,000 employees, and more than 1,300 sites of care.
In that capacity, Dr. Kizer spearheaded major changes at the VA, including
the system-wide implementation of an electronic health record with a bar
code medication component. The software that was developed under his
leadership is called VistA, for Veteran Health Information Systems and
A few years ago it was realized that the millions of line of code that were
written for VistA (and subsequent upgrades) could be requested from the
government under the Freedom of Information Act. It wasn't long before
companies were formed to exploit the obvious business possibilities.
Medsphere is probably the best-known of the growing number of companies that
provide services for VistA. Medsphere has ported VistA to Linux and other
operating systems. It has also removed some of the aspects of VistA that
aren't relevant outside of veterans' healthcare and launched its version at
HIMSS under the name OpenVista.
To make clear the meaning of “open source”, Medsphere was giving away the
software on CD to anyone that wanted it. The software is easily competitive
with anything out there. It is comprehensive and integrated and has an
easy-to-use graphical user interface. The core system is sometimes enhanced
with proprietary modules that are not free. Regardless, the software costs
of an OpenVista implementation are either essentially zero or just very low.
Midland Memorial Hospital in Texas, a 371-bed hospital spread across three
campuses but operated as a single organization, was one of the earliest
institutions to evaluate a move to open source software based on VistA.
Talks with Medsphere began in 2003 and by early 2005 actual implementation
work began. Some applications went live in late 2005 and most of the system
should be in place by this summer. The hospital's information systems
director estimates that the total cost by then should be $7.1 million, less
than half the total costs of an implementation using commercial software.
According to Medsphere, the implementation costs of OpenVista are somewhat
lower, the software costs are dramatically lower, and the total costs range
between one-third and one-half of the total costs of a "proprietary"
Medsphere OpenVista is available in two flavours: Enterprise and Clinic. The
Clinic version consists of modules needed in small offices and
Other companies are working on the VistA-Office Electronic Health Record (VOE)
project with the Veterans Health Administration to develop an office version
VOE is targeted for use in clinics and small physician offices. It retains
many functions of the VistA system but is enhanced in such areas as office
patient registration, reporting of quality measures, and printing/faxing of
prescriptions. It won't happen overnight, but open source is going to have a
tremendous impact on healthcare.
Secure e-mail is another product category that I follow closely. I saw more
than a handful of worthy contenders but rather than discuss their features
in any detail I would like to pass on the hottest tip I heard at HIMSS.
During a demo of a mail product at the booth of a major vendor, I asked
about marketing plans in Canada. I was told that negotiations were taking
place with major ISPs, such as cable and phone companies. Deals are likely
to be made later this year and secure mail will be available to subscribers,
possibly on the same basis as virus and spam scanning. In other words, free.
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