Inside the February 2004 print
edition of Canadian Healthcare Technology:
Feature Report: Developments in diagnostic imaging
its e-Health network province-wide
After several years of pilot tests, Alberta
announced that its now rolling out an electronic health
record system to care providers across the province.
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.
Computerized integration a leading trend
A report from the worlds largest annual
medical technology trade show, featuring nearly
4,000 exhibitors and 132,000 visitors.
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.
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.
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 its 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.
Its 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,
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. Infoways 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. Its
absolutely incredible. Weve had a huge amount of political
will from the Minister (Gary Mar) to move forward. Hes
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 wouldnt 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. Theyve all identified information technology
as a cornerstone for moving forward.
Herron explained that consolidation of Albertas
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 were 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
Its 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.
Theyll also be able to fine-tune
the doses by monitoring drug and lab information. By seeing the
patients 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 theyre clear and legible to both patient and pharmacist.
As well, instructions for taking the medication can be printed
out for the patients 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. Its 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
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 provinces 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, its imperative that
they use the healthcare information network. By accessing and
sharing information, its 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 Albertas 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. Well 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 users unique ID number
determines the level of access to information. For example, a
pharmacists 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
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.
Calgary Health Region creates a leading-edge chronic care
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 whats
believed to be the worlds first regional chronic disease
Chronic care is the most challenging
because it cuts across so many healthcare stovepipes, says
CHRs 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 Edmontons
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 Regions 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 its 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
In order to do that, Sargious says theres
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 cant speak
to each other as regularly. So they need a system that allows
them to share common data sets.
Precisely the CDMIs aim.
Security of the CDMI and the confidentiality
of its patient information will be assured by force of Albertas
Health Information Act. Only healthcare providers involved in
a patients 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 youre 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 Orions
Senior Vice President, Graham is a former client of Orions
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 physicians 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
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, thats
the biggest part of the change management and training we are
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.
Its 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
dont think there is anything else like it in the country,
concludes CHR director Smith.
Computerized integration of medical devices a leading trend
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 worlds 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
Hello, Andy this is Josh from Q-Core (didnt sound
familiar) and wed like to set up an appointment with you
on Medicas 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 were 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 pumps 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 patients intake of
the pumps 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 patients 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 were nicely ahead of the curve. Were 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
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-Cores 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, theres 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.
Theyve 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 dont
know how. Theyve left it up to us in healthcare to define
and make work. So were 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 Duesseldorfs permanent representative in Canada,
Toronto-based Stefan Egge, is planning to take advantage of that
burgeoning interest in medical IT.
Weve had our two Canadian pavilions that house most
of the Canadian exhibitors in other halls, says Egge. But
I think this year were going to realize a long-held ambition
and also have a significant Canadian presence in the IT part
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
Its clear by coming to Medica that theres 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,
Were in the business of consulting exporters on regulatory
matters, said president David McCarthy. Wed
never been to Medica before, yet were 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 OEIs 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 Levines and McCarthys 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.
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 Chicagos McCormick Centre.
There were many fascinating developments at
the RSNAs 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. Thats 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
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.
Well use it to assess for stroke and to conduct CT
angiography, among others, he said.
Well be able to do pulmonary scans
in 4 seconds, and cardiac scans in 8 seconds, with negligible
Picture Archiving and Communication Systems
(PACS): Theres lots of activity
in this category one vendor estimated that 72 companies
were hawking PACS at the show. Of note: theres 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 countrys
big hospitals. Using this experience, theyre 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,
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.
Heartlabs 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 patients clinical record.
We expect this OEM relationship with
Heartlab to accelerate the adoption of Agfas Impax for
Cardiology solution, and to be a core element of our enterprise
growth strategy, said Agfa Healthcares general manager,
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 Voxars 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. Its an IHE-compatible application that is
said to provide remote, rapid, secure, clinical review from virtually
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.
Were aiming at greater integration
of information to create enterprise-wide solutions, said
Lenny Reznik, Agfas senior marketing manager, based in
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 Kodaks
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
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 Kodaks 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 Kodaks 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.
is certainly a company to watch, especially with its recent acquisition
of Per-Ses 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
GE Medical: If
they had an award for largest booth at the RSNA, GE would have
won hands down. GE Medicals 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 GEs digital X-ray system, to assess chest images
for 87 characteristics of lung cancer.
GEs 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 GEs
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 customers 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. GEs trainers
are able to deliver guidance or share control of the customers
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
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.
Thats 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
Hosted application solution takes root in the long-term care
By Issie Rabinovitch, PhD
Ive 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 thats
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 Ontarios 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 didnt 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.
Wescoms 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
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 isnt 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, Canadas biggest
provider of long-term care services to seniors. They are also
pointclickcare.coms biggest customer, with 9,000 total
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
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 Wescoms 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 isnt available, but he expressed a strong preference
for fast connections.
Mr. Mills measures the quality of software
by ease of use. Wescoms offering gets high marks since,
in his experience, since April 2002, he has found that it requires