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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. 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.  READ MORE

Improving drug safety
We talk to doctors in Quebec, Ontario, Saskatchewan, Alberta, and BC
that are fighting against drug errors. READ MORE

Connections in Richmond, BC
Physicians in three buildings adjacent to Richmond Hospital gain secure
access to clinical information via a high-speed internet network. READ MORE

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.
Nikon CoolPix P1; Iomega external drive; Dell Latitude X1 notebook; Adobe Acrobat 7.0 Pro; Microsoft Natural Ergonomic Keyboard.
Chatroom: Electronic Communication: secure systems needed.




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 J
erry 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 made-in-Canada solution.

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 Health network.”

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 Nelson.

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 www.healthservices.gov.bc.ca/cdm/cdminbc)

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 States.

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 www.pgfamedres.bc.ca/mois/moisindex.htm)

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 week.

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 infrastructure.”

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 diseases.

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 them.

Of course, the broadband system is also making access to hospital systems possible.

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 governments.  •



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 fatalities.

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 readers.”

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 correct medication.”

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 systems.

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 now.”

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 his Palm.

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 patients.” •



Connections in Richmond, BC

Physicians in three buildings adjacent to Richmond Hospital gain secure access to clinical information via a high-speed internet network.
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 says.

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 information reside.

“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 the system.”

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 says.

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 technology.

“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.” •