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Inside the February 2004 print edition of Canadian Healthcare Technology:


Feature Report: Developments in diagnostic imaging


Alberta expands its e-Health network province-wide

After several years of pilot tests, Alberta announced that it’s now rolling out an electronic health record system to care providers across the province.

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Chronic care IT in Calgary

Calgary Health Region has implemented a chronic care system that provides clinical guidelines, reminders, alerts and real-time decision support to care-givers.

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Computerized integration a leading trend at Medica

A report from the world’s largest annual medical technology trade show, featuring nearly 4,000 exhibitors and 132,000 visitors.

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New medical imaging technologies set to appear

Innovative imaging technologies have recently come to fruition and are expected to make their way into the hospital sector in 2004. Among them are PACS/RIS integration, as well as the integration of PACS with cardiology departments.

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Computed radiography

To obtain more bang for the bucks they spend on PACS, hospitals and health regions need to implement computerized solutions for general X-rays, which have traditionally required film. The Calgary Health Region opted for Computed Radiography as a solution.


Hosted solutions for LTC

Nursing homes are finding that a new, hosted solution for their clinical and administrative needs can be a cost-effective solution to the challenge of computerization.

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Glimpse of the future

The recent Medica trade show in Dusseldorf, Germany attracts thousands of medical technology developers, many of whom showed innovative solutions to the problems faced by hospitals. Writer Andy Shaw attended the event and provides an overview of new developments in the medical IT sector.


PLUS news stories, analysis, and features and more.

 

Alberta expands its e-Health network province-wide

By Jerry Zeidenberg

EDMONTON – After several years of pilot tests, Alberta announced that it’s now rolling out an electronic health record system to care providers across the province. The system will enable the sharing of patient charts and test results by professionals in hospitals, labs, pharmacies, doctors offices, continuing care organizations and other facilities.

It’s said to be the first working system of its kind in Canada – a network that can deliver key medical information to healthcare professionals across a province.

Initially, the three key components of the system will consist of patients’ lab test results, drug and allergy records, and demographic data such as name, age, gender, etc.

By this spring, the province will have invested $59 million in the system, including $15.7 million from the Montreal-based Canada Health Infoway, which is funding electronic health record projects across the country. Infoway’s contribution is being used largely to fund the roll-out, and for change management and training services for Alberta physicians and other care-givers who are new to the system.

An underlying technology, making much of the project possible, is the provincial SuperNet, a new, high-speed communications backbone that can carry computerized data throughout the province. Bell Canada, Axia SuperNet Ltd. and IBM Canada have been key partners in the creation of the infrastructure.

Overall, Alberta appears to be far ahead of most other provinces when it comes to the development of an integrated health information network.

“The stars have aligned here in Alberta,” commented Todd Herron, assistant deputy minister at Alberta Health and Wellness, and the provincial CIO for health. “It’s absolutely incredible. We’ve had a huge amount of political will from the Minister (Gary Mar) to move forward. He’s the one who triggered the whole health reform initiative, based on the Mazankowski Report.

“We have incredible management will from our Deputy Minister, Roger Palmer. He happens to be the same guy who helped launch the SuperNet project to get broadband access out. Without that project, this wouldn’t be happening – this is the flagship application running over that network.

“We also have a tremendous amount of professional will from the associations – doctors, pharmacists and colleges. They’ve all identified information technology as a cornerstone for moving forward.”

Herron explained that consolidation of Alberta’s healthcare facilities into nine regions has also helped make the electronic health record project possible.

“Getting everybody coordinated, and in a room to speak with one voice is difficult,” he said. “We would have had more of a challenge even two years ago, when we had 17 regions. Now we’re down to nine. That makes it much easier to move forward on province-wide agendas.”

All in all, the system is designed to improve the delivery of healthcare in the province by speeding up access to important data and thereby enhancing the accuracy of decision-making. “The goal is to improve patient outcomes and safety,” said Health Minister Gary Mar, at a conference marking the official rollout of the system last October.

He noted that some cost savings may also accrue from the network. Quick access to lab results and histories, for example, may lead to fewer duplicate tests being ordered by physicians.

It’s the improved outcomes, through decision support tools, that are key to the system.

• Physicians will have access to drug histories for their patients, showing drugs that have been prescribed by other doctors. This will enable them to prescribe more accurately and avoid dangerous drug interactions and contraindications.

• They’ll also be able to fine-tune the doses by monitoring drug and lab information. By seeing the patient’s complete drug record, including prescription from other sources, he or she will be able to account for fluctuations in lab results and adjust accordingly.

• Patient compliance. The physician will be able to tell if patients have filled their prescriptions regularly.

• Electronic printouts of prescriptions, so they’re clear and legible to both patient and pharmacist. As well, instructions for taking the medication can be printed out for the patient’s benefit.

• Electronic prescriptions will soon be possible, since hospital clinics, physician practices and pharmacies will all be connected. (While technically viable, the issue of electronic prescribing needs legal approval in Alberta, as it does in many other provinces.)

On the drug database front, Alberta Health and Wellness has already been collecting medication information for seniors. It’s now extending the project to all of its citizens, drawing prescription data from large chains such as Shoppers Drug Mart, Safeway and Walmart. Over time, it will be extended further.

The data are stored in a central repository, and can be accessed by authorized care-givers.

Laboratory information is being organized on a different model, with regional repositories.

According to Alberta Health and Wellness, 40 percent of all laboratory data in the province was available on the EHR system at the end of October 2003, and 80 percent was expected to be available by the start of 2004.

And while physician practices have been slow, in most provinces, to adopt the use of computers for clinical purposes, Alberta has made significant strides in this area. The province has been funding the acquisition of computers equipped with clinical information systems.

Called the Physician Office Systems Program, the project subsidizes 70 percent of the cost of clinical systems and training in physician practices. As a result, over 1,200 of the province’s doctors working in physician practices are now using computers equipped with clinical software.

As general practitioners and specialists form the base of any healthcare system, it’s imperative that they use the healthcare information network. By accessing and sharing information, it’s widely believed that they can dramatically improve the quality of care delivered to the public.

Health Minister Mar said that by the spring of 2004, the goal is to have all of Alberta’s health regions (including hospitals) hooked up to the system, along with one-third of physician offices and half of all pharmacies.

Security is a high priority of the network planners. “There are penalties of up to $50,000 for improper use of the system,” stressed Mar. “We’ll be auditing the system regularly to see who has been using it,” he said.

Each user must pass a two-level authentication process for accessing the system – users will be assigned a unique ID number and an electronic tag with a constantly changing digital number; to access the system, the user must enter the ID number along with the current digital number on the tag.

As well, each user’s unique ID number determines the level of access to information. For example, a pharmacist’s ID number allows access to drug information only. All other data is blocked.

Mar noted that security and confidentiality are of concern with all systems, including those using paper records. He explained that the paper records used by the majority of healthcare providers today are also highly vulnerable to unauthorized access.

The system will be accessible to authorized healthcare providers with computers and high-speed Internet lines. In November, it was implemented in several health authorities, including the Capital Health Authority, the Calgary Health Region and Aspen Health Region. It was also available at physician offices in Edmonton, Leduc and Westlock.

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Calgary Health Region creates a leading-edge chronic care system

By Andy Shaw

Calgarians, with the Rocky Mountains close at hand, are used to facing up to challenging peaks. So when Calgary Health Region (CHR) officials set out to build a multi-faceted, region-wide electronic health record (EHR), it was no surprise that they chose to scale the highest peak first. With the help of a system supplier from New Zealand (another spot with close-at-hand mountains) and a Canadian integrator, the CHR has created what’s believed to be the world’s first regional chronic disease management system.

“Chronic care is the most challenging because it cuts across so many healthcare stovepipes,” says CHR’s Jeremy Smith, the director of the EHR project. “In other provinces and jurisdictions, I know, there are similar systems for individual chronic diseases (such as Edmonton’s Capital Health diabetes management system), but none that I know of that cross over multiple chronic conditions.

“We chose to go that way, however, because if you can make it work for chronic care, you can make it work for anything else.”

Another good reason for attacking chronic-care first – the bills it piles up. According to a 2003 survey conducted by the American Medical Association, about 50 percent of North Americans have some kind of chronic disease and their care accounts for 67 percent of all healthcare spending.

Patients with more than one chronic condition run up hospital bills like credit card thieves. A U.S. survey showed that a patient with one chronic condition costs $1,900 a day on average, more than double the normal rate. Patients with five chronic conditions ring up a daily $11,500 tally!

The Calgary Health Region’s response is officially known as the Chronic Disease Management Infostructure (CDMI) system. It will share minimum data sets for chronic conditions eventually across all the acute and community-care institutions that serve the healthcare needs of more than a million people in southern Alberta.

At the heart of the CDMI are the Concerto Medical Applications Portal, coupled with the Soprano Clinical Workflow software, both supplied by Orion Systems International of New Zealand.

Together they will bring co-ordination and integration of information about chronic care patients. Integrated and implemented by Vancouver-based Sierra Systems, the CDMI will combine patient data with chronic-care clinical guidelines, reminders, alerts, and real-time decision support for chronic disease caregivers.

But why so much focus on chronic care?

“Historically, healthcare was dominated by acute disease, but now it’s not.

The leading cause of death today is complications arising from one or more chronic conditions,” says Dr. Peter Sargious, a general internist who leads the CDMI initiative. “But our healthcare system is still focused very much on acute care. We need to change our systems so that healthcare providers can help patients manage their disease and prevent acute illness.”

In order to do that, Sargious says there’s a need for technology. “In the acute setting of a hospital, the network was informal and that was sufficient. But now caregivers are spread throughout the community and they can’t speak to each other as regularly. So they need a system that allows them to share common data sets.”

Precisely the CDMI’s aim.

Security of the CDMI and the confidentiality of its patient information will be assured by force of Alberta’s Health Information Act. Only healthcare providers involved in a patient’s care will be allowed access to their electronic record. Similarly, when the system eventually allows patients themselves to update their CDMI records, as is planned, their access will be strictly controlled.

“You can look at healthcare as having three levels that you can invest in,” says Smith, “primary, secondary, and tertiary. With primary you’re basically in the area of prevention, and tertiary is hospital care. Chronic disease is a secondary level in-between, where you are concerned with most often keeping a condition from getting worse.

If you can do that, and keep people out of hospital, then you get a tremendous return on your investment.”

Sarah Graham knows about such ROI. Now Orion’s Senior Vice President, Graham is a former client of Orion’s who liked what the products did for her as a healthcare organization manager in New Zealand so much, she joined the company. Smith points to the example of what a similar chronic disease project using Orion software has accomplished in New Zealand.

Successful cross stove-pipe sharing of information for a group of diabetes sufferers saw their acute care needs drop dramatically in just one month.
“Deloitte and Touche did a follow-up study on the project and concluded that for every (New Zealand) dollar spent on the system, it saved 1.47 dollars.” says Graham.

Smith says future efforts to integrate CDMI with other Alberta healthcare initiatives will increase its value even further. Links between the CDMI and the province-wide Alberta Wellnet will be set up to pull in both pharmaceutical and laboratory information. Also, ties with an Alberta Medical Association project now under way connects the CDMI with the rollout of a standard electronic medical record for physician’s offices.

But to start with, when the CDMI is scheduled to go live with its first phase early this spring, Sierra Systems will have technically integrated four CHR outpatient clinics and the five disease-specific chronic care programs designated as top priority by the CHR including programs for diabetes and hypertension patients.

But like climbing in the Rockies, the biggest challenge in implementing the CDMI is not the equipment needed to scale the heights, but the humans using it, says Don Newsham, a Sierra Systems partner.

“Making sure that everyone understands what data is being gathered, how it is going to be used, and how to use the clinical guidelines in the system, that’s the biggest part of the change management and training we are responsible for.

“So we have worked very closely with a doctor and a nurse from Orion who know both the Orion tools and the needs of chronic disease management intimately.”

It’s an oversimplification, but what the CHR chronic disease caregivers learn in their training in essence is how to use the Web-based Concerto portal to access their applications and patient information. Then, how to employ the database smarts of the Soprano workflow software to better manage their care giving.

“When you combine all this with the other EHR projects we have going on in conjunction with the CDMI, I don’t think there is anything else like it in the country,” concludes CHR director Smith.

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Computerized integration of medical devices a leading trend at Medica

By Andy Shaw

The call was from Jerusalem. Seemed odd that what I thought was a Canadian company would be calling me from there. But given the international state of technology these days, and the fact that I had earlier e-mailed over 50 Canadian participants heading for Medica 2003, the world’s largest annual medical technology trade show – I thought it was simply an enterprising Canadian company rep being diligent about getting back to me while he had a spare minute or two on the road.

“Hello, Andy this is Josh from Q-Core (didn’t sound familiar) and we’d like to set up an appointment with you on Medica’s opening day, on Wednesday, at our stand in Hall 6,” announced the upbeat voice from the other side of the planet. “We have some new technology we’re unveiling at Medica that we think you and Canadian Healthcare Technology readers would be interested in.”

Q-Core has designed and brought to market a remarkable digital drug delivery infusion pump that is wearable. It thereby promises to help the cost-saving shift from in-patient care to ambulatory care happen sooner.

Included among the pint-sized pump’s advanced electronics are an algorithm-driven electromagnetic flow control that delivers dosages with unprecedented precision.

A simple USB connection from the pump to a computer can download all the information connected with a patient’s intake of the pump’s drug payload. It can also be monitored remotely via a cell phone – meaning a nursing station or physician can get real-time feedback from a remote patient’s belt-born pump even while the patient sleeps, ambles out for the groceries, or takes a head-over-heels spin on a midway ride (the pump is not affected by gravity nor the position of the patient).

“We can also give it infrared and Bluetooth capability. So I think we’re nicely ahead of the curve. We’re just waiting for wireless and other infrastructure to become a reality back at the hospital,” says Ori Gal, chief financial and business development officer for Q-Core Ltd.

So I had kept the appointment, and when the four-day Medica show and conference ended on the Saturday, I concluded: that pump from that company in that hall stood for much of what Medica 2003 was all about. In short, the benefits of electronic integration are clearly on more and more designers’ and buyers’ minds.

Q-Core was making its first appearance at the 35-year-old show, helping to raise the number of exhibitors at Medica to a record of nearly 4,000. They filled not only Q-Core’s Hall 6 to the rafters, but all 17 halls of the sprawling Messe Duesseldorf fairgrounds. Another record breaking 132,000 visitors made their way around either on foot or by constantly circulating mini-buses. While not quite spilling out into the nearby Rhine River, the record breaking attendance at Medica has prompted the fairgrounds’ owners to build an 18th exhibition hall. It will be ready in time to handle the even larger multitudes expected at Medica 2004 in November this year.

By that time, a trend that emerged last year should be even more prominent: everyone, from recent start-ups like Q-Core on up at Medica was talking cost savings. No doubt, partly because the German government – and other European Union member states soon to follow – have given cost savings tremendous impetus by changing the way they fund acute care. No longer does the government re-imburse hospitals by the length of patient stays, nor by the sum of services rendered to each patient, but simply by “diagnostic groups”.

In effect, the government has said you take out an appendix, you get so many Euros, no more or no less, and no matter how long the patient stays in hospital. Same for hundreds of other surgeries, diseases, and ailments. Fixed price healthcare – and suddenly, there’s tremendous interest in any technology that will shorten patient stays so that hospitals can reap the most from that flat fee.

The German government has also passed a law that should be similarly transforming for medical information technology.

“They’ve said that by 2006 everyone living in Germany will carry a health card with a chip in it,” said Dr. Berthold Wein, a Medica 2003 exhibitor and radiologist at the Aachen university hospital. “The government purposely did not make clear just how much of a patient record that smart card will hold, nor how it will be integrated into the healthcare system. They don’t know how. They’ve left it up to us in healthcare to define and make work. So we’re starting to scramble now.”

No doubt, therefore, that Halls 16 and 17, which are almost entirely devoted to medical IT, will be bursting at the seams this year. Messe Duesseldorf’s permanent representative in Canada, Toronto-based Stefan Egge, is planning to take advantage of that burgeoning interest in medical IT.

“We’ve had our two Canadian pavilions that house most of the Canadian exhibitors in other halls,” says Egge. “But I think this year we’re going to realize a long-held ambition and also have a significant Canadian presence in the IT part of Medica.”

Egge and others are hoping that new IT emphasis will help remove the tunnel vision many potential Medica exhibitors have about their markets – that the United States is the only one worth focusing on and that you can only tap it by going to American shows.

“It’s clear by coming to Medica that there’s a tremendous potential market for assistive devices, for example, in Europe and the rest of the world,” said Dayle Ann Levine at Medica 2003. Levine is administrator and technology transfer officer for the Ontario Rehabilitation Technology Consortium and she added, “Besides, there were American people that I could never get hold of back home, but who showed up here at Medica and were readily available.”

The kind of people most Canadian companies at Medica hope are available to them are potential distributors for a product or service that, quite often, is sufficiently new to be unknown outside North America. Medica organizers pride themselves on their ability to attract decision makers who can make deals for something new on the spot or shortly thereafter. Their exhibitor surveys regularly confirm a high level of satisfaction with the “quality” of visitors to exhibitors’ booths.

One such happy customer at Medica 2003 was a first-time Canadian exhibitor, McCarthy Consultant Services Inc., based in Newmarket, Ont.
“We’re in the business of consulting exporters on regulatory matters,” said president David McCarthy. “We’d never been to Medica before, yet we’re leaving here with three or four contracts in hand.”

In large part, Levine and McCarthy can thank Ontario Exports Inc. (OEI), the export development agency of the Government of Ontario, and particularly Laura Vasarais, its behind-the-scenes major domo at Medica. Vasarais is the OEI’s area director for northern Europe and a veteran of the show. She orchestrates display space, on-site services, and other support for two OEI clusters of Ontario firms in two halls, making it easy and affordable for organizations like Levine’s and McCarthy’s to attend.

“Medica is a great venue for them to introduce new products, get a feel for market trends, and make new contacts who can help them expand their exports,” says Vasarais.

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RSNA is key conference for monitoring new radiological technologies

By Jerry Zeidenberg

CHICAGO – Never mind the Bulls, Blackhawks or Bears. The biggest show in Chicago, at least in late November and early December, is the week-long RSNA convention.

Short for the Radiological Society of North America, the RSNA regularly attracts nearly 60,000 attendees – of which 40 percent are radiologists and other physicians – to its annual gathering at Chicago’s McCormick Centre.

There were many fascinating developments at the RSNA’s 2003 event. Advances were announced in multi-slice CT, 3-dimensional imaging, integration of PACS with cardiology and other departments, computer assisted diagnosis (CAD), voice commanded systems, and direct radiography (DR). Moreover, several leading vendors announced business moves that are expected to result in new technologies and to change the balance of power in the medical imaging industry.

Below, we summarize a few of these developments.

Computed tomography (CT): There was considerable discussion of the emergence of ever-more powerful, multi-slice CT scanners. For its part, Philips announced a 40-slice CT – a machine that captures 40 slices with each gantry rotation. That’s a dramatic improvement over the single-slice, two- and four-slice scanners that are typically used in Canadian and U.S. healthcare centers.

The Philips device, dubbed Brilliance, is under final development in Israel (several years ago, Philips purchased Israeli-based Elscint, a leader in CT), and is scheduled for shipment in December 2004. One is already in use in Israel, where it provides data to hospital radiologists; further beta shipments will be made to luminary sites later this year.

At a meeting with the press at the RSNA, Philips vice president for global CT marketing, Jim Fulton, noted that a 16-slice version of the device will also be released, likely at the end of the first quarter of 2004. The 16-slice Brilliance is already in beta testing at several sites, including MetroHealth Medical Center in Cleveland.

Fulton observed that the 40-slice unit, along with the 16-slice version, will produce marked improvements in CT image resolution. In particular, these high horsepower machines are capable of imaging moving organs, such as the heart and lungs, without blurring. In pediatric cases, there will be less need to sedate patients.

Fulton said the 16-slice Brilliance will sell for approx. US$1.1 million, while the 40-slice model will cost US$1.5 million.

MetroHealth in Cleveland, which competes directly with the renowned Cleveland Clinic to provide the best medical care for patients, has been testing the 16-slice version of the Brilliance CT. Dr. Anthony Minotti, chairman of radiology at MetroHealth, said the ability to take quick, full body scans means patients need not be moved around a hospital for different types of imaging. “Our trauma patients used to require multiple scans for different parts of the body,” said Dr. Minotti. “Now, we use the CT to produce one set of data. It can be used for all purposes.

He added that patients have commented on the reduction in time needed to complete an exam, especially those who have a long history with CT scanning, such as cancer patients. He quipped that the longest part of the procedure has become the prep, and not the CT scan itself.

MetroHealth plans to upgrade to the 40-slice Brilliance, which can perform a whole-body scan in 15 seconds. “It will provide us with even better resolution,” said Dr. Minotti. He noted that it will also be used for new applications. “We’ll use it to assess for stroke and to conduct CT angiography,” among others, he said.

“We’ll be able to do pulmonary scans in 4 seconds, and cardiac scans in 8 seconds, with negligible artifacts.”

Picture Archiving and Communication Systems (PACS): There’s lots of activity in this category – one vendor estimated that 72 companies were hawking PACS at the show. Of note: there’s a big push by South Korean PACS vendors to market their wares in North America, with several Korean companies exhibiting at the RSNA.

According to industry observers, South Korean technology companies got into the PACS business quite early, and have implemented their systems in many of the country’s big hospitals. Using this experience, they’re making a bid to transfer their expertise to North America.

One such example is Infinitt of Seoul, which is distributing its PACS technology through SmartPACS, a systems integrator based in Irvington, New Jersey.

Asserting that most of the larger hospitals in the United States and Canada have installed a PACS, Infinitt is focusing on mid-sized and smaller hospitals, along with radiological clinics, said SmartPACS president David Parker.
Using a hosted solution, Parker said Infinitt/SmartPACS can get a PACS up and running in a medical center within 60 days. The cost of the solution, he said, is relatively low – essentially, it amounts to the price a hospital would otherwise pay for its film and chemistry. In exchange, it obtains a PACS with all of its benefits – soft copy reading, immediate access to images by radiologists and other physicians, no lost images, and reduced need for storage of films.

Parker said Infinitt has close to 300 PACS installations worldwide, with 121 in South Korea, 75 in Japan and 30 in Spain. It has installed 35 in the United States.

SmartPACS intends to expand to Canada, with offices in Montreal, Toronto and Vancouver.

Korean firm Marotech was also exhibiting at the RSNA, through its California-based subsidiary, Marotech USA, Inc. It, too, is planning a foray into Canada.

Agfa, Inc: The international PACS developer and Canadian market leader demonstrated the integration of its PACS with a variety of hospital departments that make substantial use of images – cardiology, orthopedics, and others.

On the cardiology front, Agfa announced a strategic alliance with Heartlab, Inc., one of the leaders in cardiac image management. Together, the companies will create integrated solutions for managing images and records in radiology and cardiology departments – which are said to be the two most “image-intensive” departments of a hospital.

Heartlab’s technology combines management of angiography, cardiac ultrasound and intravascular ultrasound with non-image data, such as waveforms and clinical reports. Using the Heartlab software, all of these can be made part of the patient’s clinical record.

“We expect this OEM relationship with Heartlab to accelerate the adoption of Agfa’s Impax for Cardiology solution, and to be a core element of our enterprise growth strategy,” said Agfa Healthcare’s general manager, Philippe Houssiau.

Agfa has also worked to integrate Radiological Information Systems (RIS) with PACS, so that a text report will simultaneously pop up on a monitor when a radiologist calls up previous images for a patient.

3D imaging: A hot topic at the RSNA. On this front, Agfa announced that it will incorporate Voxar’s 3D software into its Impax line. Instead of customers spending time and effort to weave a third-party 3D solution into their PACS, it will come already integrated as part of the Impax system.

3D capabilities are becoming increasingly important, as imaging devices – like multi-slice CTs – now produce much larger data sets. By re-constructing these data sets into 3D images, radiologists often obtain a better view than ever before.

Three-dimensional imaging also leads the way to more minimally invasive procedures – such as CT angiography and virtual colonoscopies. These CT-based techniques are welcomed by many patients, who fear probes of their bodies with catheters. They also show promise of a reduction in medical mishaps – such as punctured organs and blood vessels.

As a work in progress, Agfa demonstrated a technology called Web1000 ES, a new approach to web-enabled results distribution. It’s an IHE-compatible application that is said to provide remote, rapid, secure, clinical review from virtually any location.

For example, it will extend web-based results distribution to cardiology, enabling MPEG support for viewing multi-frame cardiology, such as cath lab movies and echocardiograms.

In addition to creating a single system for radiology and cardiology, Impax Web 1000 ES will integrate with any electronic patient record product. It means that EPR users from any department can use the web to access images and data from one point of access.

“We’re aiming at greater integration of information to create enterprise-wide solutions,” said Lenny Reznik, Agfa’s senior marketing manager, based in Greenville, S.C.

Kodak: Another vendor with plenty of PACS news to talk about at the RSNA show. Earlier in November, the company announced a drive to again become a top-tier provider of healthcare information systems. It used the RSNA as a forum to discuss its strategy.

Kodak was once at the forefront of the PACS marketplace, but in recent years, lost its momentum. Fueled by recent acquisitions and strategic moves, it may very well regain its footing in the PACS sector.

Chief among these developments was the November 2003 acquisition of Algotec Systems Ltd. of Tel Aviv, Israel, a leading-edge developer of PACS technology. Algotec, for example, was the first company to receive FDA clearance in the U.S. for a Web-based PACS viewer.

Kodak also announced that it will accelerate the development of healthcare information products through a double-digit percentage increase in R&D spending. As well, it has established a worldwide headquarters for its Healthcare Information Systems operation in Rochester, N.Y., within Kodak’s Health Imaging Group.

The company estimates the worldwide PACS market is currently worth US$1 billion, with annual growth of 15 percent to 20 percent.

It estimates that its own Health Imaging Group, which had 2002 revenues of US$2.2 billion, will expand by 7 percent to 9 percent annually from 2002 to 2006. The Health Imaging Group, in addition to PACS and RIS systems, includes computed radiography (CR), digital radiography (DR) laser imagers, mammography and x-ray film systems, dental imaging products and various service offerings.

At the RSNA, the company demonstrated its new System 5 PACS, which includes 3D processing and a patent-pending device that improves the speed of diagnosis for all types of MR imaging. System 5 is a direct result of Kodak’s alliance with Algotec, a relationship that stretches back into 2002.

Kodak also announced a new archive management system called VIParchive, which it acquired through the purchase of technology from Front Porch Digital Inc., also in 2003. Part of the trend towards PACS integration with other hospital departments, VIParchive extends Kodak’s portfolio beyond radiology and into the healthcare information technology market.

According to the company, by using the technology, IT managers can leverage shared storage systems across multiple applications ranging from radiology, cardiology, purchasing, inventory, payroll and other departments.

Kodak also demonstrated new features that will be added to its RIS 2010 radiology information system in 2004, including the ability to support wireless PDA-based dictation. Kodak showed an integrated PACS/RIS solution that will available in the U.S. for the first time this year, now that it has shown success with the product in Europe and Australia.

Misys: This is certainly a company to watch, especially with its recent acquisition of Per-Se’s electronic health record division. It now offers solutions across the enterprise, including PACS, RIS, pharmacy, lab, financials and data warehousing. It even has a practice management system for small to medium-sized doctors’ offices that integrates with the Misys EMR.

Interestingly, Misys is now among the top five largest healthcare IT companies in the United States. It had revenues of US$467 million and a profit of $75 million in the year ending May 2003. Headquartered in Raleigh, N.C., it has approximately 2,500 employees.

At the RSNA, it demonstrated its PACS Integration Module (PIM), which is said to integrate the Misys Radiology Information System (RIS) with nearly any PACS solution. It does this without a PACS broker, offers DICOM services and supports IHE (Integrating the Healthcare Enterprise) guidelines.

According to Misys, most RIS only receive and transmit HL7 messages. The Misys PIM, by contrast, will transmit and receive HL7 messages and DICOM messages.

This reduces the error rate in records and the need to manually check or re-enter data into records. It results in greater processing speed and higher accuracy for patient records in the radiology department, and ultimately, in the hospital information system.

GE Medical: If they had an award for largest booth at the RSNA, GE would have won hands down. GE Medical’s PR staff were even armed with maps to find their way from one part of the pavilion to another.

The company showcased developments in many leading-edge areas. These included:

• The application of Computer Aided Detection (CAD) to GE’s digital X-ray system, to assess chest images for 87 characteristics of lung cancer.

• GE’s new, multi-slice CT scanner, the 16 slice LightSpeed Pro16. Equipped with Xtream technology, the system enables physicians to view images in real-time.

• The OpenSpeed MRI system, using GE’s new Excite platform.

• VoiceScan, a new ultrasound technology that provides voice-activated control of system functions. By talking into a wireless headset, physicians and sonographers can interact with the Logiq 9 scanner and have it perform more than 150 actions.

Also on the ultrasound front, GE launched Speckle Reduction Imaging technology to improve image resolution. Ultrasound images, by nature, feature a granular appearance, which is referred to as “speckle”.

This artifact can sometimes obscure the underlying anatomy, such as vessel borders and tissue boundaries.

• The new Advantage Workstation application, AutoBone, which allows clinicians to remove the bone structure from diagnostic images in just one click. AutoBone software provides automated bone removal imaging from CT angiography studies for the abdomen and lower extremities. With a keystroke, bony structures can be removed and then restored to create the transparent roadmap.

“Clinicians have the flexibility to see as much or as little of the transparent bone as they like, and save hours of manual segmentation,” said Jennifer Dible, general manager, Advantage Workstation at GE Medical.

• When it comes to training, GE announced TIP Virtual Assist – essentially the extension of its training program to broadband, enabling sessions to be transmitted directly to a customer’s workstation.

Live, interactive sessions can now be conducted from remote locations, hundreds or even thousands of miles away.

Standard on most new GE imaging systems, TVA provides live, virtual training from instructors. GE’s trainers are able to deliver guidance or share control of the customer’s console for demonstration and training on software issues. Rather than replacing onsite applications training, TVA is said to augment face-to-face learning opportunities.

Digital radiography: Digital radiography has been making quiet, gradual progress in hospitals – slower than originally expected, perhaps, because of the perceived high costs of the technology.

However, its prospects for the long term look good, as prices come down, its capabilities continue to improve, and hospital executives are won over to the economics of investing in DR.

“70 percent of the imaging done in a radiology department is still the common X-ray,” noted Peter Black, president of BCL X-ray of Toronto, and a systems integrator and reseller for Swissray, a leading producer of DR technology. “Hospital emergency rooms are often backed up with patients waiting for x-rays. You can remove this bottleneck with DR, because you can do x-rays three times faster with digital radiography than with traditional film technology.”

That’s because the time needed to physically load and carry x-ray films, process them, and transport them to radiology reading rooms is eliminated by DR, which handles each step instantly and electronically.

According to Black, in many cases, it makes more sense for hospitals to invest in DR than in new generation Computed Tomography (CT) systems, simply because of the demand for standard x-ray exams.

Canadian firm Imaging Dynamics Corp. (IDC) of Calgary exhibited also at the RSNA, launching its new generation of Direct Radiography systems. A minnow in the world of whale-like imaging technology companies, IDC also announced sales to several hospitals in the United States.

Its booth, like that of Swissray, was buzzing with visitors, as physicians and hospital administrators investigate the technology.

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Hosted application solution takes root in the long-term care sector

By Issie Rabinovitch, PhD

I’ve been following Internet developments for a decade, and yet, it came as a surprise to me when I learned of how influential it has lately become in bringing IT services to the long term-care sector.

Long-term care is widely thought of as a low-tech sector. Few would argue that this reputation is undeserved. However, things are changing quickly and the agent of change is a new kind of business software provider, with a new and largely unfamiliar acronym: IBSP or Internet Business Service Provider.

Instead of requiring users to purchase and maintain their software applications on in-house servers, IBSPs offer off-site, hosted solutions. Customers use the Internet to tap into the software.

This pay-as-you-go method means little or no upfront costs for software and hardware acquisition, and none of the hassles of upgrading or troubleshooting. The IBSP looks after all of this.

Moreover, the applications are designed from the ground up to run in a Web browser, over the Internet. The familiar browser format is easier for users to learn than applications with a traditional Windows interface. The menus are simpler, the navigation is straightforward, and best of all for some users: there are no double clicks. Training time is greatly reduced.

The time needed to get up and running is also much shorter. In addition to one or more computers, all that’s really required is an Internet connection.

I recently spoke with Mike Wessinger, founder and CEO of Wescom, a technology company based in Mississauga, Ontario and specializing in long-term care. Through pointclickcare.com they have an IBSP offering (financial and clinical) that is used by one-third of Ontario’s long-term care providers. They have customers in other Canadian provinces and are growing rapidly in the United States.

In 1999 Mr. Wessinger and his brother, the chief technical officer of the company, came to the conclusion that the traditional software model didn’t work. They heard of the strides being made by IBSPs such as upshot.com and salesforce.com and thought that the new model made sense for the long term care market. In Fall 2000 they released the first version of their service for the Canadian market and in Fall 2002 they had a US release. Their market share has grown dramatically.

The major attraction of their service, according to Mr. Wessinger, is that there is no big cheque required up-front. Contracts are on a monthly basis and customers are free to cancel at any time. The retention rate is very high because the service meets the needs of most companies that use it.

The service appeals to companies of all sizes. Wescom’s smallest client is a 20-bed facility while the largest has 9,000 beds spread over many locations. The cost of using the service is simply a multiple of the number of residence days. This means that smaller companies are not penalized, as is invariably the case in the traditional software model.

I asked about training, security, and Internet bandwidth requirements and received reassuring answers in all cases.

Training is typically accomplished online, with no trainers on site. The trainers interact with users over the Internet and the phone in numerous short sessions. This is the approach that has been found to work best.

Security has been addressed in several ways. The hardware running the application and storing the data sits at an IBM data centre where it receives the same level of protection accorded brokerages and banks. Users connect to the service via a browser using SSL 128-bit encryption.

Although the applications perform better with a broadband Internet-connection, some remote sites get by with dialup. The applications are not bandwidth-intensive, by design. Bandwidth isn’t used while inputting, only when the page of data is submitted.

I concluded my interview with Mr. Wessinger by asking about immediate plans for upgrades.

The next release of the application will be a multi-site edition. Currently, a large nursing home chain might have dozens of different deployments. In the next version of the service there will be a single database for the enterprise.

Next, I spoke to Dale Mills, VP Information Services of Retirement Residences Real Estate Investment Trust, the company that owns Central Park Lodges, Canada’s biggest provider of long-term care services to seniors. They are also pointclickcare.com’s biggest customer, with 9,000 total beds.

Mr. Mills’ company already had an elaborate IT infrastructure when they started evaluating the service in summer 2001. The implementation was begun in September 2001 and completed by April 2002 after extensive testing, training, and changes.

The first components to be implemented were admin billing and trust accounts. They have two people in account receivable in their Cambridge and Toronto offices. In each home it is usually the office manager that inputs the data.

Before moving over to Wescom’s service, Central Park Lodges experienced the usual difficulties in maintaining their previous vendors’ software and keeping everyone up-to-date in a distributed environment.

There was a lack of consistency in doing trust accounts, among other issues. In an ISBP environment, all users in a company experience the identical software environment.

Mr. Mills confirmed several things I heard from Mr. Wessinger. Yes, the service does work with a dialup connection. He has two homes that are getting by with that since broadband isn’t available, but he expressed a strong preference for fast connections.

Mr. Mills measures the quality of software by ease of use. Wescom’s offering gets high marks since, in his experience, since April 2002, he has found that it requires little support.

 

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