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Inside the February 2007 print
edition of Canadian Healthcare Technology:
Feature Report: Developments in diagnostic
imaging
Sick Kids creates fast-access system for documents
The Hospital for Sick Children has devised a
method of digitizing all paper documents generated by care-givers
within 48 hours, giving doctors and nurses fast access to
information.
New medical imaging technologies abound at RSNA
Chicago is often referred to as America’s Second
City, but when it comes to diagnostic imaging, this town is top of
the heap and A-number one. (Sorry, New York.)
READ THE STORY
ONLINE
eHealth Collaboratory
The eHealth Collaboratory is now open for
business. With management and staff now in place, the organization
is ready to help healthcare providers and vendors test the
interoperability of their solutions, and determine if they meet
national standards.
Physician productivity
Vancouver Coastal Health has launched PC Central, a web portal that
consolidates the support resources that physicians need. Designed
specifically for the region’s GPs, PC Central offers decision
support tools, referral information and forms, and more.
READ THE STORY
ONLINE
Appropriate DI
Dr. Robert Miller, president of the Canadian Association of
Radiologists, asserts that the volume of diagnostic imaging exams
ordered by physicians could be reduced by 10 percent. It will
require more appropriate requisitioning of tests.
UHN acquires top-tier CTs
Toronto’s University Health Network has purchased three of Toshiba’s
newest CT scanners, machines capable of imaging the heart or brain
in a single rotation.
PLUS news stories, analysis, and features and more.
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Document imaging system consolidates paper charts and e-records
By Jerry Zeidenberg
TORONTO – The Hospital for Sick Children has found a way of making
almost all patient information quickly available on computers –
including documents that are created originally on paper – thereby
allowing several doctors, nurses and other clinicians to view charts at
the same time, wherever they are in the facility and whenever they
require information.
The system has made it much easier for care-givers to access the
information they need, leading to faster communication among healthcare
professionals, patients and their families. It also allows clinical
decisions to be made more quickly, with more data to draw upon.
“The children we’re treating are usually seen by more than one
care-giver during a visit. They can be seen by a cardiologist, a
neurologist, a nurse, physiotherapist and a dietician,” commented Dr.
John Edmonds, clinical director of medical informatics. “That complexity
makes it difficult to handle cases with a paper chart. Each clinic will
be waiting for the chart, and if the records are on paper, moving them
around becomes very difficult.”
Since 2004, however, the hospital has been scanning all paper records
that are produced by non-computerized departments, along with paper
documents that enter the hospital from other medical centres to become
part of a patient’s chart.
Using a solution from Microdea Inc., of Richmond Hill, Ont., a
centralized office in the hospital scans all documents (as TIFFs) within
48 hours, and automatically routes them into the appropriate folders in
Electronic Patient Charts.
The documents are bar-coded so the indexing is done fast and accurately
– for example, documents are directed into tabs or folders for lab,
medications, diagnostic images, surgeries, etc., as specified by the
barcode. Some 15,000 to 17,000 documents are scanned each day.
The solution, called the Electronic Patient Chart (EPC), runs on
Microsoft SQL Server and now includes all paper records generated since
the year 2000. Using EPC, any number of authorized doctors, nurses and
clinicians can access a patient’s records in seconds.
If a care-giver or researcher needs older charts, they can still be
pulled from paper archives.
The hospital also runs an extensive Electronic Health Record system
using technology from Eclipsys. In addition, it operates some 40 other
electronic systems for departments such as lab, radiology and the
operating rooms. Patient information, in each case, is entered directly
into computerized records, resulting in accurate, paperless charts.
However, as Dr. Edmonds points out, some parts of the organization still
haven’t adopted these solutions and continue to generate paper records.
Moreover, patients often enter the hospital with paper documents from
outside labs, hospitals and clinics – meaning that paper is still a big
part of the health record.
As a result, the hospital is running its Electronic Patient Chart in
parallel with its other electronic solutions. The data collected by
these systems is, in many cases, fed into the EPC using interfaces,
creating a consolidated patient chart.
The EPC has produced multiple benefits. First and foremost, care-givers
can access the documents they need, simultaneously and as soon as they
need them.
This has proved especially useful in the emergency department. Patients
who arrive there have, in many cases, been treated at the Hospital for
Sick Children for a pre-existing condition and have charts at the
facility. “The emergency physicians no longer make phone calls for
patient records, or wait for them to be delivered,” said Dr. Edmonds.
“They can access the charts right away.”
He noted that EPC has also made a big difference for coders. “They can
do their coding on the EPC, using digitized documents, instead of
shuffling through piles of paper.”
And physicians and residents on rounds are thrilled with the system,
because they can quickly call up a variety of documents when checking on
patients.
Debi Senger, director of health records, observed that patients and
their families have also benefited, as they often call in to check for
details about their medications or other information. Nurses, in the
past, used to scramble to find paper charts, and patients would have to
wait. Now, nurses can quickly call up patient records on a nearby
workstation and answer questions immediately. “You don’t have to tell
them, ‘I’ll call you back’,” said Senger.
What’s more, the system has put an end to the phenomenon known as
‘shadow charts’, where nurses keep copies of important documents on the
ward, so they’ll be quickly accessible when needed. During a visit to
the Hospital for Sick Children, one of the ward nurses told us that
shadow charts are no longer necessary, since everything is instantly
available on the EPC.
Senger said the EPC system has become so popular among care-givers at
the hospital that the project leaders had to increase staffing in the
scanning centre. “It was originally set up as a Monday to Friday
operation,” said Senger. “But we soon had to add staff on weekends,
because the ER wanted records to be available immediately.”
The EPC also offers far greater security than paper records, noted Ana
Andreasian, technology director for Sick Kids. Once paper charts are
delivered to a department, she observed, there’s no way of telling who
has looked at them.
By contrast, there is an audit trail with the Electronic Patient Chart –
the system identifies the user, the reason for accessing the record (for
example, clinical or research), and the time of usage.
One of the latest security features added to the EPC is a ‘lock-box’
function. This allows patients, if they choose to do so, to specify that
certain parts of their records be inaccessible.
Andreasian said the EPC also saves space and reduces costs. It currently
requires a good deal of in-house and off-site storage-space to maintain
paper records – indeed, 1,200 linear feet are needed each year.
Additional costs are rung up when records are pulled and transported.
She said paper records are to be destroyed shortly after they are
scanned. That’s not happening right now, but will start soon, once the
hospital implements a second data centre for large-scale back-up and
redundancy.
Dollar figures on how much the EPC cost weren’t available, but Dr.
Edmonds said the Hospital for Sick Children annually invests 5 percent
to 6 percent of its operating budget in I.T., much more than the
national average. (Canadian Healthcare Technology’s 2005-2006 I.T.
survey found the average I.T. investment for hospitals was 2.5 percent
of the operating budget.)
Dr. Edmonds said the solution has been attracting attention from other
hospitals, and Sick Kids has hosted several site visits from
organizations looking for ways to improve their document management.
“We’ve had a lot of interest in this system,” he said.
New medical imaging technologies abound at RSNA
By Jerry Zeidenberg
Chicago is often referred to as America’s Second City, but when it comes
to diagnostic imaging, this town is top of the heap and A-number one.
(Sorry, New York.)
That’s because Chicago’s cavernous McCormick Place is the site of the
week-long RSNA conference, held each year after the American
Thanksgiving weekend.
Billed as the world’s largest medical conference, the Radiological
Society of North America’s annual educational meeting and trade show
attracts more than 60,000 delegates – including a large contingent of
radiologists, DI managers and hospital executives from Canada.
Some of the technological highlights of RSNA 2006 included:
MRI: Philips produced an MR that can be upgraded from 1.5T to 3T,
when a hospital or clinic is ready, without changing the magnet. As
Philips Medical Systems’ vice president of marketing John Desch
explained, “Normally, a limitation of MR is that a customer will install
a 1.5T magnet, but in three years, they may want to upgrade to 3T. Using
our solution, you start with a 1.5T, and later you can put in new coils
and you’ve got a 3T MR. It can save customers $1 million.”
Traditionally, installing a new magnet has not only been costly, but it
was also disruptive and often required the use of cranes and forklifts.
However, the new technology eliminates the need to bring in a new
magnet, resulting in minimal downtime during the transition from 1.5T to
3T, the company said.
For its part, Siemens announced an MR scanner with a moving table that
slides the patient through the magnet – much like a patient passes
through a helical CT machine. The technique, according to Siemens,
results in faster scans, higher resolution and the potential for new
types of studies. “This will do to the MR market what spiral CT did for
computed tomography,” ventured a Siemens spokesperson, stationed at the
company’s pavilion.
Meanwhile, GE Healthcare announced that it has now shipped 10,000 MR
magnets worldwide. Of those, 300 are 3T systems, and the company
expected to ship 55 more 3Ts by the end of 2006. In terms of emerging
applications, by far the greatest growth is being experienced in MR for
breast imaging. “For MR breast imaging, the number of procedures grew by
51 percent [in 2005],” commented Vicki Hanson, an MR marketing manager
based in Waukesha, Wisc. She added that interventional MR procedures
increased by 48 percent in that period, and cardiac MR exams grew by 36
percent.
Image-Guided Therapy: GE Healthcare demonstrated a system that
combines MR guidance with ultrasound ablation. It is currently being
used as an effective surgical technique for the removal of uterine
fibroids – essentially reducing a three-month recovery process to a few
days. “It dramatically lowers the length of stay for the hospital, and
transforms a procedure that previously required a 12-week recovery
period into day surgery,” said Peter Robertson, general manager of GE
Healthcare of Mississauga, Ont. “If she wants to, a woman can go back to
work in two days.” Robertson pointed out that the procedure has important
economic repercussions for patients and their families, healthcare
facilities and governments – not only are patients discharged from
hospital beds earlier, they’re also back to being productive members of
society much more quickly.
Significantly, the technology is showing great promise for oncology, and
is being further developed for ablation of prostate, breast, liver, bone
and brain tumours. Robertson explained that ultrasound waves, when used
at high frequencies, can heat and denature cancerous tissue at the focal
point while leaving surrounding structures intact. Exact positioning,
and checking the results, is completed with the simultaneous use of MR
imaging.
Enterprise IT Solutions: Agfa HealthCare continued to demonstrate
its transformation from what was traditionally viewed as a
radiology-centric PACS provider to a full-scale healthcare informatics
player. This was highlighted with their display of an Enterprise
Scheduling offering (iPlan), which can reside on top of any existing
application to extend functionality, Impax MPI, and the upcoming launch
of their Orbis platform in North America, scheduled for mid-late 2008.
The Orbis platform, widely used in Europe, will deliver HIS/CIS/LIS/
pharmacy/and enterprise management applications and related services –
effectively extending Agfa HealthCare’s reach from radiology to the
entire healthcare continuum. Additionally, Agfa HealthCare is also
ramping up their professional services offerings with the launch of a
Canadian healthcare consulting arm.
At the same time, Agfa showed a technology that’s capable of pulling
together electronic medical records from remote repositories – creating
a virtual electronic record, on an as-needed basis. This ‘federated’
model implements EMPI technology and single sign-on – meaning users need
only log-on once to access a variety of systems. Agfa is offering the
solution through a partnership with Medseek; it’s now being used by
several Canadian hospitals.
Teleradiology: Kodak demonstrated, as a work-in-progress, its
CareStream PACS system using ‘workflow grid computing’. The technology
connects imaging centers and hospitals region-wide, nationally or
internationally – producing a synchronized worklist that can be tackled
by any of the radiologists who are available. That could solve many
problems in countries such as Canada, which face shortages of
radiologists in many regions – especially rural districts. What’s more,
the system uses dynamic streaming technology, which means that in areas
with low-bandwidth, radiologists can start viewing the first images in a
study while the others are being transmitted. “You can set up a pool of
radiologists to do readings from a global worklist,” commented Ulf
Andersson, worldwide general manager of PACS and 3D applications.
“Radiologists with extra time or capacity can read the exams and create
reports. Naturally, you can also create a compensation structure for
them.”
It should be noted that in January 2007, Kodak announced a plan to sell
its healthcare division to Toronto-based Onex Corp., for US$2.35
billion. In a webcast, Onex managing director Robert Le Blanc and Kodak
Health Group president Kevin Hobert both noted the division will be
renamed in the future, but will continue with its current strategy and
product offerings. Le Blanc said there will be increased investments in
research and development.
Digital Mammography: Several companies have devised CR solutions
for mammography, but in Canada, only Christie Group with its Fuji
technology have so far been approved by Health Canada. Christie
announced that it has now installed CR mammo at St. Martha’s Hospital,
in Antigonish, N.S., and Credit Valley Imaging Associates clinic, in
Mississauga, Ont. For its part, Konica Minolta demonstrated its CR mammo
system, which it claims has the highest resolution. Konica Minolta’s
Regius PureView Mammography System, with 25 micron resolution compared
with 50 microns for many other CR mammo systems, is currently being used
in pilot studies at the University of Chicago Hospitals.
Digital Radiography (DR): Canada’s Imaging Dynamics Corp. released a new
DR system and unveiled a DR mammography prototype. The Calgary-based
outfit, which bills itself as the fastest-growing company in the medical
imaging world, took the wraps off a fixed-table DR system with a single
detector. Called the XM series, it’s designed as a more affordable fixed
table option to the company’s X2200, which uses a dual-detector system.
IDC also provided a ‘first-look’ at a prototype digital mammo system
that uses an optically coupled detector to create high-resolution images
at a relatively low price.
For its part, Kodak showcased a flexible DR system, the DirectView DR
9500, which boasts a ceiling-mounted U-arm containing both a tube and
detector. The system can be easily moved around a patient, instead of
requiring the technologist to move the patient into position. As such,
it’s said to be an excellent solution for general radiography, enabling
a wide variety of exams to be taken quickly, with high resolution and
fast throughput.
Computed Radiography: Agfa showed off a Computed Radiography
suite that offers resolution just below that of DR, at approximately
half the cost of conventional DR. Alternatively, the system takes
traditional CR-quality images using 50 percent of the X-ray dose of
standard CR. “That’s especially important in pediatric imaging, where
you want to make sure you’ve got the lowest dose,” said Mike Labelle,
Agfa’s CR/DR product manager. According to the company, Agfa is now
entering the modality market, in the sense that it’s installing whole
rooms rather than pieces of equipment. The new CR solution is appealing
to cash-strapped hospitals that would rather open two CR rooms at the
cost of one DR room – with near DR quality. Rooms can be outfitted with
both DR and CR technology – the CR can act as a backup in case of DR
failure, and also provides a portable option for taking images of
patients at the bedside.
Computed Tomography: Toshiba was the talk of the CT town with its
foray into 256-slice CT imaging. At the RSNA, Toshiba announced it will
install its first U.S. beta site 256-slice CT scanner at the Johns
Hopkins University School of Medicine and its Heart Institute, in
February 2007.
The system will be at Hopkins for a limited period of time to acquire
data for further product development. The 256-slice scanner is designed
to image the brain or heart in a single rotation.
During the RSNA, Toshiba announced a large implementation of DI systems
at Toronto’s University Health Network, including three high-end
Aquilion CT scanners. (See our coverage in this issue.) Two of the
machines will be installed at the UHN’s Peter Munk Cardiac Centre; a
third Aquilion will be applied to stroke and neural imaging at the
Toronto Western Hospital, also part of the UHN.
Just as cardiac imaging is pumping up the MR marketplace, so too is it a
hot application in CT. GE Healthcare is claiming a breakthrough in this
area with its Snapshot Pulse technology for CT cardiac imaging, a system
that reduces the X-ray dose by 70 percent or more while maintaining
image quality. Brian Duchinsky, GE’s global CT manager, explained that
the system uses ECG to synchronize the X-rays with the resting stage of
the heartbeat – thereby acquiring the clearest images while using far
less radiation. “One clinician attained an 83 percent reduction in
dose,” said Duchinsky.
For its part, Siemens demonstrated its ‘Webspace’ applications for CT,
which enable physicians to view and manipulate 3D reconstructions of
large CT datasets on any kind of computer, at any location – home,
office or operating room. The systems solve a problem facing physicians
today – while CT exams now generate hundreds or thousands of images,
which are most useful in 3D form, it usually takes a high-powered
workstation to handle the volumetric data.
However, the new Siemens solution, like just a few others on the market,
does all of the processing on a central server. As a result,
radiologists, surgeons and other physicians can access the 3D images on
virtually any computer – they no longer require access to a high-powered
workstation. Industry observers say this leading-edge, thin-client
solution will catch on, as it makes it possible for physicians to work
with 3D studies wherever they may be. A radiologist on-call at home can
review the most sophisticated CT exams on his home computer; a
radiologist waiting for a workstation in the DI department can use a
regular desktop PC to continue his readings; or a surgeon in the
operating room can review 3D reconstructions of a trauma patient who has
just had a CT exam and is being wheeled to the OR.
PACS/RIS: Many of the PACS vendors were touting integration, and
showed how a variety of modalities could be viewed on a single
workstation. Laurie Rogers, general manager of IT for GE Healthcare
Canada, stressed this as an important development for radiologists, as
many rads are currently forced to hike to different workstations to view
CT, MR, ultrasound or other types of images. New workstations from GE
Healthcare allow a single log-in to gain access to a variety of
modalities, 3D reconstructions, RIS and voice recognition-based
dictation.
GE Healthcare highlighted its adoption of IHE profiles into its PACS
solutions. Rogers noted the company currently provides eight of the most
important IHE profiles as part of its Centricity solution, including
scheduled workflow (SW), patient reconciliation (PR), and consistent
presentation of images (CPI, so images will look the same on different
workstations.) Also available are key image notes (KIN), PICS and XDS.
Kodak demonstrated advanced 3D capabilities, including vessel tracking
and measurement, automated bone removal for clearer images of organs,
and in an upcoming release, image fusion and volume matching – enabling
accurate comparisons of images generated by different modalities. “Our
3D systems are something of a well-kept secret,” commented Mike Jackman,
Kodak’s general manager, healthcare information solutions.
Another little-known facet of Kodak’s imaging business: its worldwide
development team for RIS is based in Canada – in Prince Edward Island.
“We’ve had a great team of software developers there for about six
years,” said Jackman.
Philips emphasized a big push on the integration front, with the close
coupling of its various solutions into the iSite system.
“We’re using iSite as our delivery platform,” said Matt Long, vice
president of healthcare informatics for Philips, noting iSite’s
strengths as a fast, web-based solution with wide-ranging functions.
Long commented that Philips is focusing on clinical solutions that are
‘close to the patient’. “We do better with active patient data at the
clinical layer,” said Long. “We’re concentrating on DI and monitoring
solutions, essentially the capture, review and diagnosis of clinical
information.”
In Canada, Philips recently won the bidding to supply a province-wide
PACS and RIS solution to Saskatchewan; at press time, contract details
were still being worked out.
On another front, Agfa highlighted a central archiving solution -–
capable of housing not only diagnostic images, but all healthcare data
for a region. “The Impax Data Centre solution emerged from our work in
the United Kingdom, where Agfa is involved in two of the five regional
PACS projects,” said Jason Knox, marketing manager for Agfa Canada. The
company recently won major contracts to build data centres for the
Quebec City and Sherbrooke regions of Quebec and the Toronto East
Network in Ontario.
While most large hospitals have now implemented PACS, or have made a
purchasing decision, many smaller hospitals in Canada still haven’t
acquired the technology. Neither have independent imaging centres.
McKesson is addressing this segment of the DI sector with a PACS
solution that uses a portion of the company’s Horizon PACS. It includes
multiple patient ID, cross-location communication and reporting, and
workflow tools.
“A piece of PACS technology is needed with the right pricing,” said
George Kovacs, senior product marketing manager. “Rural hospitals also
need minimal disruption – they can’t afford to be down. We’ve designed a
disruption-free cycle for them.”
Productivity: In an interview with Canadian Healthcare
Technology, Philips’ vice president of healthcare marketing, John Desch,
noted the company is working hard to deliver productivity solutions to
radiology departments – and to caregivers in general.
Chief among these productivity solutions is the automation of many
procedures – reducing the amount of work needed to conduct an exam, and
making things faster and easier for patients and caregivers.
As an example, Desch pointed to the company’s ‘SmartExam’ solution for
magnetic resonance imaging. “It’s a set of built-in protocols, and with
one button you can do a whole procedure,” said Desch. “It minimizes the
time for both the patient and the MR operator.”
Ultrasound: On the topic of simplifying exams in this way,
Philips also demonstrated ‘onboard protocol optimization’ for
ultrasound. Pat Venters, an ultrasound specialist with Philips,
explained that during hospital ultrasound exams, operators typically
take numerous views, which requires a great deal of keyboarding. Using a
new workflow enhancer, “any number of views can be included in a
protocol, and a button can bring up a list of different protocols,” said
Venters. In this way, much of the exam can be automated.
She noted that a recent test of the solution at Duke University,
researchers found a 30 percent time-savings on exams. “They saved 400
keystrokes on a carotid exam,” said Venters. “The solution makes
ultrasound exams faster, and it also provides consistency in a
hospital.”
Portable ultrasound developer SonoSite, Inc., announced wireless
capabilities for its systems, and pointed to a successful implementation
at the University Health Network, in Toronto, where a single sonographer
can provide ER exams at three different sites, shuttling from one to
another by car, and beaming the images to the PACS wirelessly.
Once in the PACS, the exams can be read and interpreted by radiologists
and other physicians throughout the hospital system. Sonosite also
announced upgrades to its MicroMaxx hand-carried ultrasound system,
including a high-frequency transducer that’s said to be ideal for
pediatric and neonatal studies, line placement and nerve visualization.
Zonare Inc., which last year released a breakthrough technology that
conducts ultrasound exams up to 10 times faster than conventional
systems, announced several software additions to its systems at the RSNA.
The new advances include Compound Harmonics, Virtual Apex Array, Auto-Dop
Trace and IQ Scan. The software upgrades are available for ZONARE’s
z.one ultrasound system, which it calls the world’s first Convertible
Ultrasound system. The cart-based system can be easily converted to a
premium, portable sonography unit.
eHealth Collaboratory ready to work with care providers, IT vendors
TORONTO – “The eHealth Collaboratory is open for
business,” says Kees Schuller, executive director of the new
organization. “We have a great team, a solid architecture, and we’ve
proven our initial concept.”
The eHealth Collaboratory was created to provide conformance testing
services for pan-Canadian standards based applications and
implementations, as well as offering procurement assistance to
jurisdictions making decisions around electronic health record (eHR)
applications.
Launched in May 2006, the eHealth Collaboratory received initial funding
from Canada Health Infoway, and is incubated at the University Health
Network’s Centre for Global eHealth Innovation, in Toronto.
Schuller joined the Collaboratory team as executive lead in June, 2006.
Among several of his high-profile roles in the IT business sector in the
past, Schuller was the founding general manager of Sapient Canada, a
provider of business and technology consulting services.
At the eHealth Collaboratory, he has led efforts to study what is
happening in the field of IT conformance testing both nationally and
internationally, and has directed team-building and the development of
work processes.
“Once the whole team was in place, things moved quickly,” said Schuller.
The team now includes Brian Leung as the technical lead, Joanne
Hohenadel as operations lead, Anjum Chagpar as the usability lead and
Allie Grassie as the stakeholder engagement manager, as well as
additional technical and operational staff.
The initial service offerings of the Collaboratory are focused on
recently released Infoway “stable for use” HL7 Version 3 based standards
– Client Registry, Provider Registry, and the pharmacy specification
CeRX.
What the Collaboratory quickly found is that conformance testing
involves far more than HL7 message specification validation.
Each Canadian jurisdiction is implementing the specifications somewhat
differently, based on their business requirements and workflows. For
example, some messages are optional, and some that are mandatory
contravene current legislation in certain jurisdictions. For these
reasons the Collaboratory is developing its architecture to be flexible.
What the Collaboratory is building is a plug-and-play stubbed version of
the pan-Canadian interoperable Electronic Health Record, one standard at
a time.
“Currently, we are gearing up to test the CeRX standard,” said Schuller.
“That requires the automated testing tool, known as the ‘harness’, to be
able to test drug information, hospital information, and point of
service or pharmacy systems.
“Each of these is created as a ‘stub’ or ‘simulation’ within our harness
architecture,” he continued. “When we need to test a system, we can
remove the stub, and place in the real system. We then run the test data
and catalogue of a particular jurisdiction.”
The same methodology is used for the Client and Provider Registry, and
will be used for further standards, as released. While the Collaboratory
considers interoperability and functionality to be the core of their
operations, it can offer far more, including usability testing, in
partnership with the usability team here at the Centre for Global
eHealth Innovation.
The premiere facilities and access to clinical staff ensure that it will
have the most robust usability assessments available.
Additional services in the area of procurement will be key for
hospitals, Local Health Integration Networks and jurisdictions looking
to invest in a manner that is in line with the overall eHealth vision.
“As more vendors are tested, our procurement service offering will
grow,” said Schuller. “Initially, we can offer testing to short-listed
prospects, but eventually, a buyer can come into the Collaboratory
website and review those vendors who have passed conformance testing, or
other testing.”
Allie Grassie, previously the Secretariat for HL7 Canada, has been
meeting with vendors from across Canada and beyond. “We know that
vendors are looking for ways to assure clients that their products will
interoperate seamlessly with other applications and implementations, in
order to generate further sales,” she said. “They also want to reduce
the cost and time of development. We can help them to do that.”
The Collaboratory is working diligently to ensure that its processes are
fair and unbiased, a key success factor for engaging the vendor
community, said Grassie. It is also reaching out to the jurisdictions,
promoting the value proposition of a faster, more effective,
interoperable eHR implementation, with better clinician uptake, and
removing the fear and uncertainty surrounding purchasing decisions.
The eHealth Collaboratory is currently engaged in initial conversations
with a number of jurisdictions, as well as partnership talks with other
conformance groups and technology providers.
Further information for vendors, jurisdictions and interested parties
can be found at
www.ehealthcollaboratory.ca.
PC Central web portal designed for Vancouver’s family physicians
By Jerry Zeidenberg
VANCOUVER – Too often, family doctors are slowed down
by the search for the right reference book or web site. They’re hindered
by the hunt for the proper referral form, or the paperwork needed for
reporting information to their provincial ministry of health.
Now, Vancouver Coastal Health is aiming to eliminate these frustrating
searches – and the delays that go along with them – by creating a web
portal called PC Central that aggregates many resources on one site. The
regional health authority hopes to speed-up patient care and workflow by
making commonly used resources available to general practitioners in a
few keystrokes.
The pilot site was launched last fall with 19 family doctors
participating; the plan called for an expansion to 100 GPs by January,
and to 500 by the end of 2007. The project has been funded by a $250,000
contribution from Vancouver Coastal Health’s Primary Care IT Strategy,
with additional investments planned for the future.
“So far, two things on PC Central have been especially helpful to me,”
said Dr. Patricia Mirwaldt, director of Student Health Services at the
University of British Columbia and physician leader of the PC Central
project. “First, the clinical reference tools have been really useful,”
said Dr. Mirwaldt. “Also, the access to referral forms right on the web
site has saved a lot of time and trouble.”
She noted that a number of high-quality clinical databases have been
integrated into the site, enabling family doctors to quickly find
answers to their questions – including queries about obscure diseases or
conditions and how to treat them. As an example, she cites the case of a
student whose lab test results indicated a bacterial strain that Dr.
Mirwaldt was not familiar with.
Instead of spending a lot of time searching for references, or sending
the student to a specialist, she used a clinical database on PC Central
and discovered that the mysterious bacteria could be treated with
antibiotics. “Within two minutes I was phoning the patient and arranging
appropriate follow-up and medication,” said Dr. Mirwaldt. “In the past,
this process would have taken me days, while I called TB Control and
Infectious Disease to find out what to do. As a result of PC Central, my
day was calmer and I was more confident.”
Dr. Mirwaldt explained that PC Central currently consolidates a number
of ‘public access’ databases, including the College of Physicians and
Surgeons Library. There have been discussions to add commercially
available resources, like UpToDate Online, as part of the future
development of the site.
Quick access to referral forms on PC Central has also made the working
day easier for physicians. The portal has been designed specifically for
Vancouver Coastal Health’s family doctors, and provides links for local
hospital departments, labs, X-ray centres and independent clinics, along
with specialized facilities to which GPs would most commonly refer their
patients
It also contains access to the referral forms needed for each, and
alerts doctors about other information they should know about – such as
paperwork that must accompany the patient, how the patient should
prepare for the appointment, how the physician should fill out the
requisition, and the hours of the clinic.
“I recently needed to get one of my patients into an eating disorder
program,” said Dr. Mirwaldt. “I was able to find a local clinic and went
directly into its web site, right from PC Central. I found out what they
needed, the referral forms, and how to get in touch with them.” She
noted that many different types of local or regional facilities are
listed on the site, such as detox centres for addictions – and more are
to be added, as PC Central is undergoing continuous development.
There are additional resources on the site that assist doctors with
workflow, including quick access to provincial and national guidelines
for treating various conditions. For example, the provincial guidelines
answer questions about treating asthma and diabetes, or the fitness of
seniors to drive. As the provincial website is constantly updated,
physicians obtain the latest information each time they click the links.
National guidelines are also available, such as whether CT or MR is
better for diagnosing a specific condition. In this case, the guidelines
are supplied by the Canadian Association of Radiologists.
As well, the forms for reporting adverse drug reactions are right at
hand. “We know that adverse drug reactions are underreported,” said Dr.
Mirwaldt. “This makes it much easier for primary care physicians – using
this tool, the data goes right to Health Canada.”
The site automates reporting the incidence of certain diseases to
provincial authorities. “In British Columbia, for example, clymidia must
be reported,” said Dr. Mirwaldt. “We can do it easily through PC
Central.”
The portal is also helpful for patient education, with patient handouts
that can be printed and given out to reinforce the issues discussed
during the clinical encounter. Moreover, the handouts often direct the
patients to web sites that are considered sources of ‘trusted
information’ for further education. “Patients often get their
information from web sites that are badly written and offer poor quality
information,” said Dr. Mirwaldt, citing clinical depression as one
example of a condition with web sites of questionable quality. “We’re
pointing them to trusted sources, with high quality information. They’re
not provided by drug companies, or by people who have had a bad
experience [and have an axe to grind].” Finally, the site has a news
section that keeps GPs updated about local developments, such as the
opening of new clinics or facilities.
PC Central is led by a committee consisting of eight physicians,
including Dr. Mirwaldt, along with two staff members.
One of the physician members came on board as a ‘technological Luddite’,
and was initially skeptical of the value of the web-based solution. “He
has brought up some very helpful ideas,” said Dr. Mirwaldt, who added
that the doctor is now a full-fledged supporter of PC Central. “He’s a
believer,” she said
According to Vancouver Coastal Health, more than a dozen physicians and
medical office assistants spent over a year identifying useful content
and links to be featured on PC Central. It now has more than 750 content
items available, with additional resources planned for the future. In a
press release issued by Vancouver Coastal Health, Vancouver physician
Rainer Borkenhagen said: “PC Central is like a medically oriented,
locally resourced, primary-care Google. It provides valuable information
about programs in the community and in hospitals. It also makes it
easier for me to download the appropriate forms for these programs.”
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