INSIDE THE JANUARY 2006 ISSUE:
high-speed access in northern BC
Doctors in northern BC are making heavy use of chronic disease
management tools, hospital records and online decision support systems.
Given the chance, many doctors would like a high-speed Internet
connection – especially one that provides a secure link to colleagues,
local hospitals and government resources. Access to test results,
patient records and ‘best-practice’ databases would make life just that
We talk to doctors in Quebec, Ontario, Saskatchewan, Alberta, and BC
that are fighting against drug errors.
Physicians in three buildings adjacent to Richmond Hospital gain secure
access to clinical information via a high-speed internet network.
Editor's note: Issie – rhymes with dizzy.
News: Bell’s wireless broadband boards the health
bus, Online courses for busy physicians, EMIS hopes to duplicate its UK
success in Canada.
Tech: Nikon CoolPix P1; Iomega external drive; Dell Latitude X1
notebook; Adobe Acrobat 7.0 Pro; Microsoft Natural Ergonomic Keyboard.
Chatroom: Electronic Communication: secure systems
Doctors get high-speed access in northern BC
Doctors in northern BC are making heavy use of chronic disease management
tools, hospital records and online decision support systems.
By Jerry Zeidenberg
Given the chance, many doctors would
like a high-speed Internet connection – especially one that provides a
secure link to colleagues, local hospitals and government resources. Access
to test results, patient records and ‘best-practice’ databases would make
life just that much easier.
The dilemma in rural areas, for many docs, is that high-speed lines just
aren’t available. It usually boils down to the problem of the ‘last mile
connection’. While high-speed trunk lines might be available across Canada,
the branches to doctors’ offices often consist of low-bandwidth lines. So
what’s a physician to do?
Northern Health, in British Columbia, recently solved the problem using a
When dropping fibre to doctors’ offices is too expensive or troublesome,
Northern Health is employing a microwave technology from Wi-Lan, Inc., of
Calgary. The microwave system beams high-speed signals from base stations to
physician offices and back again, often over long distances.
It’s a licensed wireless technology that operates in the 3.5 Gigahertz
frequency. When connected to the doctors’ offices, it delivers up to 12 Mbps
to each location, enough for fast downloads and demanding applications such
as videoconferencing. By way of comparison, that’s better than the
widely-used DSL or cable services.
Northern Health covers a huge area at the top of British Columbia. It
comprises a geographical territory that’s larger than France. There are over
24 acute care facilities in centres like Prince George, Kitimat and Fort
Nelson, along with 445 independent physicians serving a population of some
380,000 people throughout the region.
The broadband network that’s now fanning out across Northern Health, a
project dubbed Physician Connect, offers a whole host of benefits.
Not only do the doctors obtain high-speed internet services, but the network
is basically a closed system, or intranet, that comes with three layers of
security. Those security features take a load off the minds of many doctors
who are worried about patient information floating around the internet.
It’s also simple to use.
“With respect to connectivity and authentication, we treat the doctors just
like staff members,” says Joseph Mendez, chief information officer for
Northern Health. “Like everyone else, they log-on with a user name and
password, and they’re authenticated and gain single sign-on to the Northern
Doctors can obtain access to Northern Health’s help desk and I.T. support
services, in case they’ve got a snag with their network connectivity. It’s
re-assuring to know that help is just a phone-call away.
A key feature of the system is that it’s relatively low-cost. Northern
Health used a $1.2 million contribution from the federal government’s
Primary Healthcare Transition Fund, funneled through the province, to foot
the bill for the wireless infrastructure.
It’s a one-time investment in equipment that will provide service to the
region’s doctors for at least 10 years.
And the on-going operating costs, to pay for the wireless spectrum rental,
are cheap – about $25 per month per doctors’ office. If there are five
doctors at a site, they simply split the $25 monthly fee – about $5 a month
for each physician.
That compares with the typical $50 monthly bill that an office would
otherwise pay for DSL or cable in a large city.
“This is a cool part of this project,” says Mendez. “We were able to
leverage an ‘industrial grade’ technological strategy that’s based on a
one-time cost. For just over $1 million, we have broadband access for 500
docs for the next ten years.”
So far, Mendez and his team have worked with ABC Communications, a local
company, using Wi-LAN products to connect 25 physician offices to the
high-speed network using microwave technology. And they’re set to link
another 15 offices.
As just one example, a microwave base station at the Fort Nelson Hospital, a
remote site on the Alaska Highway, currently provides high-speed internet
services to doctors at the Airport Way Medical Clinical, also in Fort
Each microwave base-station – the central tower that beams signals – costs
on the order of $40,000. But that system can serve multiple locations,
sending/receiving signals to multiple offices, each with several doctors.
Mendez says the $1.2 million is a marvelous investment, one that provides
the region’s physicians with a variety of tools to improve the delivery of
healthcare. The doctors apparently agree, as over half of them are already
connected and Mendez expects that 95% will be aboard by early 2006.
The broadband network has proven to be a springboard for the use of
electronic solutions by docs in Northern Health.
For example, Northern Health’s physicians have become heavy users of the
provincial online toolkit for chronic disease management. (More information
about the system is available at
In a nutshell, the toolkit is a web-based service that allows doctors to
maintain comprehensive records for their patients with chronic disease, “in
addition to paper-based records and memory,” comments Paula Young, project
manager for Northern Health’s Physician Connect program.
She adds that the toolkit also keeps track of patient information for a
variety of chronic medical conditions, tests, medications and recalls, as
well as protocols for the best care.
Uptake of the toolkit by Northern Health physicians stands at 63 percent.
That compares with just 17% when looking at the province as a whole! Access
to a high-speed, secure network is given a good deal of the credit, as the
docs can access records quickly and securely.
The CDM toolkit covers a limited number of diseases and conditions, but has
been an excellent introduction to using technology in the medical practice.
Seeking a more comprehensive solution, Northern Health’s docs have also
embraced full-fledged EMRs to an astonishing degree. Again, access to a
low-cost, high-speed communications network is cited for spurring the use of
yet another electronic solution.
“Secure, reliable, fast internet access is a prerequisite to having an
electronic health record,” says Terrace family practitioner Dr. Bill Redpath.
About 50% of the physicians currently using the high-speed network are also
using full-bore electronic medical record (EMR) systems. That compares with
industry estimates of just 10% for doctors across Canada and the United
Paula Young noted that most of Northern Health’s physicians use a solution
from local supplier MedOffIS (Medical Office Information System), which is
based in Prince George, B.C. (See
A few other systems are also being used, almost all of them developed in
Western Canada. They include Wolf Medical Systems Corp., of Surrey, B.C.,
Osler Systems Management Inc., of Sidney, B.C., Jonoke Software Development
Inc., of Edmonton, Clinicare of Calgary and Montreal-based Purkinje of
Montreal (which recently merged with Wellinx, of St. Louis, Mo.)
MedOffIS, is now used in more than 100 physician practices in British
Columbia, including clinics with multiple doctors. One clinic has over
130,000 registered patients seeing about 150 patients per day, seven days a
It’s a sophisticated system that in addition to supporting clinical
documentation (progress notes, lab data, imaging reports, etc.), provides
the ability to quickly re-work the data to assist with chronic disease
management and health maintenance at the patient and practice level.
MedOffIS is developed and implemented by Prince George physician Dr. Bill
Clifford, who says the emergence of the secure, broadband network has done
wonders for the uptake of EMRs and usage of online resources.
“As a result,” says Dr. Clifford, “adoption of the technology has blossomed.
Fifty percent of primary care practitioners in the Prince George area use an
EMR, with no subsidy other than that provided by the NHA for the network
It should be noted that some of the EMRs used by Northern Health physicians,
such as MedOffIS, contain links to the provincial toolkit for Chronic
Disease Management, and will automatically copy information from one to the
other. That saves the doctors the problem of double entry for records. Many
of the EMR vendors working in British Columbia that don’t currently offer
this capability are working on it.
Dr. Clifford and his colleague, Dr. Redpath, are no doubt correct in saying
the high-speed network has stimulated the rapid uptake of electronic
solutions. But other areas of Canada have had this infrastructure for years,
yet their physicians have been slow to adopt computerized applications.
In addition to the high-powered infrastructure, you’ve got to credit the
healthcare leadership in Northern Health – they include Dr. Clifford, Dr.
Redpath, the staff at the Northern Health Authority, and CEO Malcolm Maxwell
and many others – with believing in the technology and convincing physicians
across the region to use it.
As well as the provincial toolkit for Chronic Disease Management, high-speed
networking allows for access to tools such as UpToDate Online.
Decision-support systems of this sort give rural physicians, like those in
Northern B.C., a quick second-opinion on many difficult medical issues. That
kind of feedback might take hours or days to obtain by traditional means,
such as phoning or even e-mailing colleagues.
UpToDate Online (www.uptodate.com) is
a web-based service that answers clinical questions that arise in daily
medical practices, including information pertaining to 15 different
specialties such as pediatrics, cardiology, oncology and infectious
While developed in the Boston area, UpToDate online has been rated highly by
physicians working at Canadian hospitals like St. Joseph’s Healthcare, in
Hamilton, Ont., a teaching hospital affiliated with McMaster University, and
the University of Alberta.
Young observed that decision support tools like UpToDate really only become
feasible for a doctor when he or she has access to high-speed services.
Those online resources are tremendous resources for physicians who work in
remote locations, as they benefit from quick access to the latest thinking
on various diseases and conditions. It’s a tremendous support tool for
physicians who might otherwise feel isolated.
Again, it should be stressed that usage of a system like UpToDate hinges on
the availability of a high-speed network. Dialup access just wouldn’t work,
as a busy doctor can’t sit waiting for screens to download. They need
answers in seconds, and that’s exactly what the high-speed network is giving
Of course, the broadband system is also making access to hospital systems
By tapping into the hospital portal, the physicians can now obtain access to
diagnostic images in Northern Health’s Picture Archiving and Communication
System – its repository of X-rays, CTs and other scans. Those test images
currently reside in PACS supplied Agfa and McKesson.
What’s more, in 18 months, when Northern Health will convert its current
electronic record systems over to leading-edge Cerner applications, the docs
will begin to have access to lab reports, pharmacy records and general
electronic medical records.
That information – such as lab test results and discharge summaries –
currently takes days or weeks to arrive by fax or mail. Once the electronic
connections are in place, it will be available in seconds.
In the future, Mendez expects that telemedicine will become a fast-growing
application in the doctors’ offices. Remote physician offices will be able
to use high-speed videoconferencing to connect with specialists in urban
centres for real-time assistance with issues like pain and wound management,
psychiatry, and consultations about diagnostic images, including
echocardiography. “With the bandwidth we have, there’s no trouble for
doctors to see and hear each other over the network,” said Mendez. “These
applications are really going to grow in the next few years.”
Mendez also expects the system will be extended to reach nursing stations
serving aboriginal peoples. Videoconferencing and access to specialists will
help nurses tremendously.
The significance of the Physician Connect project is expressed succinctly by
Malcom Maxwell, the CEO of Northern Health. “Because of our geography and
rural setting,” says Maxwell, “Northern Health, more than any other health
authority in British Columbia, needs to take advantage of e-Health
applications and strategies.”
Because of the impact on the delivery of primary healthcare, Maxwell
concludes that “our Cerner clinical information systems project, along with
these types of initiatives, will be the most important project we will
undertake in the next five years.”
Regional CIO Joseph Mendez points out that the methods learned in the
Physician Connect project – with the combination of microwave technologies,
security systems, and useful interfaces to EMRs, Chronic Disease Management
systems and resources like UpToDate Online, could be replicated in other
regions of BC, and in many cases, across the country. What it will take, as
Northern Health has shown, is local leadership and collaboration among
physicians, hospitals and health regions, as well as provincial and federal
THE CONTENTS LISTING
Improving drug safety
We talk to doctors in Quebec, Ontario, Saskatchewan,
Alberta, and BC that are fighting against drug errors.
By Saul Chernos
When it comes to drug safety, a tiny
slip-up can be a dangerous thing. However, by using desktop computers and
hand-held PDA devices to receive alerts and to access online tools,
including new provincial government databases, Canadian physicians are
reducing the odds of life-threatening errors and side effects from
legitimately prescribed medications.
Interactions between medications can not only impact their efficacy, but
also harm patients. The Canadian Adverse Event Study, published in the
Canadian Medical Association Journal in 2004 and led by Dr. Ross Baker and
Dr. Peter Norton, examined AEs (adverse events) in Canadian acute care
hospitals. Using year 2000 data, their analysis lead them to conclude that
at least 9,250 and as many as 23,750 deaths could have been prevented.
Furthermore, medication-error was one of the major factors in these
Federal government regulations require that pharmaceutical manufacturers
report adverse drug reactions. However, warnings generally aren’t issued
until some people have already experienced complications, and doctors don’t
always have a full list of every medication their patients are taking. Every
so often there is talk of encrypting this information on national health
cards or within some kind of secure central database. For now, though, the
mantra for physicians is to Know Thy Patient – and their medications.
To this end, both standalone and web-based applications have been developed
to allow physicians to reference and cross-reference prescription drugs.
Epocrates, Lexi-Comp and Micromedex provide web-based databases, discussed
recently in these pages (see July 2005 issue), which can be accessed using
hand-held Palms and other PDAs.
MCS Health (www.mcshealth.com)
publishes MCS Physician Drug Solution, a web-based application that works on
BlackBerry handhelds. A physician clicks on an icon, types the name of a
drug and uses a drop-down menu to look up interactions, indications,
contra-indications, side effects and dosing. The physician then enters
additional, relevant information, such as the name of other medications a
patient is taking, and the system searches for relevant information.
“It tells you if there is an interaction and the degree of severity, and it
allows you to access the product monograph,” says Dr. Joseph Yermus, a
Montreal general practitioner who developed the application with a Toronto
business partner. The database, largely gleaned from First DataBank, a U.S.
medical data supplier that provides Canadian content, is updated every month
or so, as new products are released and new information comes to light.
Currently, MCS Physician Drug Solution lists roughly 37,000 pharmaceutical
and ‘natural’ healthcare products, including prescription and
over-the-counter medications. As with other products of its kind, the onus
remains with the user. The MCS Health application will look up medications
that are specifically requested, but it is not intuitive and will not
produce a full list of every medication a particular drug interacts poorly
with. Yermus says MCS Health is currently upgrading the system to
automatically relay U.S. Food and Drug Administration warnings and alerts.
Much of this information, minus the alerts, is already available to
physicians who reference the Compendium of Pharmaceuticals and Specialties
either in paper form or through a desktop or notebook computer. “What we
do,” Yermus says, “is allow physicians to list the drugs they want to
prescribe, using their BlackBerry at the point-of-care while they’re with
patients,” Subscriptions cost $169 annually, and there are currently about
500 users, including physicians, nurses, pharmacists, emergency personnel,
and pharmaceutical company representatives.
Physicians who want to keep abreast of safe prescribing practices can access
alerts, articles and other information for free through the Institute for
Safe Medication Practices Canada (www.ismp-canada.org),
which reviews incidents reported by practitioners and publishes reports on
its website on a regular basis. ISMP Canada receives funding from Health
Canada and issues the same reports directly to Canadian hospitals and
professional medical, nursing and pharmacist associations. Over the last few
years, ISMP Canada has covered topics such as drug names that look or sound
alike, the safety of drug use in long-term-care facilities and nursing
homes, and medication errors and risk management in hospitals. “We get
reports from doctors, clinics and emergency departments about events that
they encounter,” explains ISMP Canada president David U, a pharmacist by
profession. “We analyze this information and then share it with our
U says drug interactions, while serious, are part of a wider problem when it
comes to errors in healthcare. Nearly illegible physician handwriting, with
abbreviations and sometimes incorrectly-placed decimal points, make paper
prescriptions highly vulnerable to misinterpretation by pharmacies, he adds.
“Printing out prescriptions would be a good idea. We also encourage doctors
to write an indication of what the drug is for, on the prescription itself,
because pharmacists will notice that and be more likely to supply the
Ultimately, U believes, electronic prescribing is needed to significantly
reduce the risk of medication error. “In the U.K., all community physicians
are using electronic prescribing, and as far as I know very successfully.
They’re now trying to get hospital physicians to do the same.” U says 10
percent of U.S. hospitals employ computerized physician order entry, yet
very little of this has spread to Canada even though CPOE and e-prescribing
can help pinpoint repeat prescriptions and possible contra-indications.
As provincial government health ministries develop centralized
Internet-based patient databases to help healthcare providers better inform
themselves about the people under their care, electronic prescribing might
soon become a reality. However, while British Columbia, Alberta and
Saskatchewan have launched basic patient drug databases, e-prescribing
remains several years away at best, according to Richard Alvarez, president
and CEO of Canada Health Infoway, a national non-profit organization owned
by the federal and provincial governments to promote and help fund these
Alvarez says B.C.’s PharmaNet database is currently the most advanced in
Canada, linking the province’s community pharmacies, hospital formularies,
emergency departments and medical practices and supporting drug dispensing,
monitoring and claims processing. When a resident goes to fill a
prescription, the pharmacy can check their drug history to determine
possible interactions. Alvarez says the province plans to extend the
system’s capability to include e-prescribing.
Alberta’s Pharmaceutical Information Network (PIN) database has been
operating for several years. Dr. Nigel Flook, an Edmonton family doctor who
participated in its implementation, says it automatically checks for
interactions, allergy risks, dosage appropriateness and possible
duplications. “I don’t have to suspect an interaction. It’s checking
automatically,” says Flook, whose clinic has computers and monitors in every
examining room. “I’ve been using this for two and a half years in my office
PIN does not include all residents. Pharmacies must submit prescription
records for insurance purposes for seniors, and this data is harvested for
PIN. Flook says more than half the province’s community pharmacies are
volunteering dispensing information for younger patients, and the province
plans to include Alberta Cancer Board prescriptions early next year.
Hospital formularies have not yet been integrated, but Flook says they send
discharge summaries to physicians, so there are ways to obtain a list of
medications that have been administered in hospital. “There are holes in the
system, but at this point that’s the stage we’ve gotten to.”
Other provinces are in various stages of planning and implementation.
Saskatchewan is the newest kid on the block, launching its Prescription
Information Program (PIP) in October. Kevin Wilson, executive director of
Saskatchewan Health, says the system emerged in part from an inquest into
the death of a Saskatoon man who died following an overdose of prescription
drugs. Darcy Dean Ironchild received 300 prescriptions in the year before
his death, and a coroner recommended that physicians and other healthcare
providers have access to the entire medication profile of their patients.
All residents are included. Community pharmacies are required to list every
prescription filled, and community and emergency room physicians can access
patient data by name or provincial health services number. However, PIP is
far from complete. Hospital formularies, unlike community pharmacies, don’t
presently provide data for the system. However, they do have the same
viewing rights as physicians.
And, patients can invoke a masking option to protect their privacy. However,
Wilson says physicians can seek a patient’s consent to view their data, and
a list of drugs deemed potentially harmful or frequently abused - including
narcotics - will not be masked. Acknowledging the limitations, Wilson says
the province had to start somewhere. “This is a big plus over what we have
had until now.”
Dr. Mark Cameron, a Regina family doctor who was involved in test
evaluations of PIP, says he uses it to see if prescription lists match what
he believes his patients are taking. “If my chart says a patient is on five
or six medications, and the pharmacy information program says they’ve only
had two medications filled, there’s a disconnect there.” He says PIP is
helpful when specialists prescribe or change a patient’s medications. “If
the patient comes back to see me before I get the specialist’s report, I can
see what they have prescribed.”
Cameron, who has desktop computers in his clinic and a Palm Tungsten T3,
uses applications outside of PIP to check for interactions and other issues
involving medications. He uses Calgary-based Clinicare’s EMR, an electronic
medical records application which - since July - includes a
prescription-writing feature that uses First DataBank and searches
automatically for interactions, allergy alerts and other causes for concern.
Cameron says the Clinicare (www.clinicare.com)
application offers an interface with selected laboratories, with an
interface connecting to them electronically. While the application is best
accessed using a desktop, it also works with tablets and over a wireless
network. Cameron has a module where he can download some information onto
his Palm, and says this can be helpful in a hospital or other point-of-care
setting. He also uses Lexi-Comp, Lexi-Interact, and Lexi-Calc products over
Bill Pascal, chief technology officer with the Canadian Medical Association,
says the healthcare system has much work to do to make good use of the
provincial databases. “They’re great databases but they’re of minimal value
to clinicians if the clinicians are not connected or don’t have an automated
system in their office to get at the drug database. So, while you’ve got a
richness there, the connectivity down to the point of care is not there.”
This area deserves more time and funding, Pascal says. “We should really be
focusing some of our investments to help the point-of-care folks really get
themselves up-to-date and have the tools available to actually use some of
this information in a more proactive way when they are encountering
THE CONTENTS LISTING
Connections in Richmond, BC
Physicians in three buildings adjacent to Richmond
Hospital gain secure access to clinical information via a high-speed
By Dianne Daniel
Decision-makers at Vancouver Coastal
Health (VCH) are hoping a pilot project currently under way at Richmond
Health Services in Richmond, B.C., will help determine the best way to
provide “last mile connectivity” to primary care physicians and specialists
throughout its region and perhaps even the province.
“How we actually provide physician connectivity is going to be a problem
that I think we have to solve within B.C. as a whole,” says VCH chief
information officer Greg Feltmate. “What we’re trying to do (in Richmond) is
take a look at how the physicians are actually going to connect into our
acute care facility and, while doing that, take a look at how they’re going
to be using technology.”
The pilot, which involves physicians located in three buildings adjacent to
Richmond Hospital, aims to provide secure access to clinical information via
a high-speed internet network. It’s considered the last mile because more
often than not, efforts to implement patient care information systems within
hospitals stop at the hospital door whereas in Richmond, Vancouver Coastal
is taking the next step of providing physician office connectivity as well.
Project manager Cheryl Wheeler refers to it as a “learning lab” because one
of the key objectives is to assess the viability of an ongoing connectivity
model that can be replicated elsewhere. “The expectation is that we will be
successful but this is the opportunity to prove it and, once we are
successful, to deploy it further and make it a broader regional model,” she
Starting with a handful of physicians and then rolling out to a broader
group, the connectivity pilot is focused on providing two significant pieces
of technology: an external security infrastructure and an external directory
for authentication. Although in its early stages, the conceptual
architecture involves building an n-tier extranet for security and using
Microsoft’s Active Directory for authentication.
As Wheeler explains, “n-tier” means the first step will be to provide access
to VCH through a secure public Internet zone protected by firewalls that
doesn’t require physicians to identify themselves. In order to move beyond
the public zone to where applications reside, they’ll need to authenticate
against the external directory. Once authenticated, they will be granted
access to the “data zone” where clinical applications and patient
“There’s a lot of work associated with that,” points out Wheeler. “`Hi, I’m
Dr. Jones and I’d like you to create an ID for me’ isn’t good enough. We
need to confirm and validate your credentials and the fact that you’re
authorized before we set you up.”
Indeed, nothing’s simple when it comes to granting external users access to
internal systems. While some health authorities have solved the connectivity
issue by giving primary care physicians internal IDs and then providing
access to hospital information systems via a virtual private network (VPN),
VCH is avoiding that route due to governance issues, says Wheeler.
“We’re not in a position, nor is it appropriate for us, to treat primary
care physicians as internal users,” she says. “We can’t enforce policies,
nor do they want to be enforced by our policies.”
The analogy Wheeler uses is to liken VCH’s overall Primary Care IT Strategy
– which includes other initiatives such as the establishment of an
electronic health record and a Primary Care information portal – to a resort
on an island. The Physician Connectivity Project in Richmond is building a
bridge to that island, “but it’s a private resort so you have to have an ID
and we’re going to stop you at the door to make sure you are who you say you
are before we let you on,” she describes.
In essence, the external connectivity piece is the enabler to all other
primary care initiatives, says Wheeler. “This is the deployment arm to all
of those strategies because without connectivity they aren’t able to deploy
new services and systems to physicians.”
Dr. Alan Brookstone, head of the Richmond Physician User Group, says he
hopes the effort to provide a single, secure log-on for physicians via an
external directory proves successful. “As a physician in a private practice,
I don’t have an internal identity within the health authority,” he says.
“I’ve got admitting privileges to the hospital, but from an IS perspective
they have no way to actually identify me and authenticate me externally to
Advocates for change, the Richmond Physician User Group is arguably the most
important factor behind Vancouver Coastal’s decision to select Richmond as a
test site for connectivity. As chief operating officer Dr. Jeff Coleman
points out, the group was already organized, meeting and reviewing
technology long before the pilot was suggested.
“That leadership has probably been the single most attractive reason for
doing this,” says Coleman. “We didn’t have to go out there and beat the
bushes, they were there already, just waiting for us.”
Described as a “champion of change,” Dr. Brookstone views the Physician
Connectivity Project as the first piece in laying the groundwork for future
applications of technology. One of the challenges, he says, is to balance
the different bandwidth requirements and information needs of different
categories of physicians. For example, a specialist may require instant
access to images on his or her office PC in order to review X-rays, while a
family physician requires instant access to text in a report, and only
occasionally needs to view larger image files.
“Part of the project is to actually determine requirements around how big
those pipes need to be in order to deliver what is necessary for physicians
to do their jobs,” he comments.
From his vantage point, Dr. Brookstone sees the pilot as an opportunity to
cut a horizontal line across various IT projects currently happening within
the health authority, integrating the different technologies in order to
facilitate the delivery of information to the physician desktop or point of
care. While physicians typically spend 90 per cent of their computer time on
tasks such as taking clinical encounter notes, prescribing drugs or writing
referral letters – things they can complete in an electronic medical record,
he says – the five to 10 per cent they need to access via an external
clinical view is also extremely important.
“That’s the piece that we have the capability to focus on right now,” he
says. “Although most physicians say give me an electronic medical record,
this (external access) doesn’t help me a huge amount, we know it’s a piece
that has to be done.”
As it stands now, Richmond physicians have no choice but to wait for
critical patient information to be phoned, faxed or mailed, a scenario Dr.
Coleman is all too familiar with. As an emergency physician, he has worked
in healthcare settings where just about everything was on-line, providing
instant access to records, X-rays, lab results and summary reports. “I can’t
imagine functioning without it anymore and I think that will be the same for
physicians involved in this connectivity project,” he says. “... All of a
sudden, ‘WOW!’ you’ve got this incredible access to information.”
The ultimate goal of Vancouver Coastal’s overall primary care strategy, adds
Wheeler, is to move Richmond physicians up the IT adoption model. Physicians
are mapped against four levels of technology adoption, ranging from level
one which means they don’t have a computer at all to level four meaning
they’re completely computerized. While most physicians in Richmond are a
level two – indicating they have computers but aren’t using them for point
of care initiatives – she’d like to see them reach level three where they’re
using clinical decision support tools and accessing lab results on-line.
To ensure physician adoption is a success, Wheeler has placed a great deal
of emphasis on change management. Once the connectivity infrastructure is in
place, for example, and the broader group of physicians is brought on-line,
the intent is to “support them, provide training and learn from them, and
constantly update our solution and processes based on their feedback,” she
At the end of the project, VCH aims to deliver a physician connectivity
deployment and sustainment toolkit that will contain everything other
hospitals and health authorities will need to know in order to replicate the
“Once we have the living lab in place, we’ll actually be able to bring other
people into it to take a look,” notes Feltmate, referring to the Richmond
pilot. In particular, he hopes to demonstrate how the integration of point
of care technologies with external access to the acute care facility is
effective in improving patient care.
Key to it all, he underscores, will be the single factor authentication
through Active Directory. “Single log-on is the goal,” he stresses, “because
we really can’t afford to have physicians walking around with six secure ID
tags and having to key in six different numbers.” •
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