Newfoundland hospital improves care by combining PACS with teleradiology

By Jerry Zeidenberg

GANDER, Nfld. – The James Paton Memorial Hospital in Gander has scored a technological coup by installing the first Picture Archiving and Communication System (PACS) in Newfoundland. PACS technology makes use of computers and electronic networks to store and transmit diagnostic images.

At the same time, the centre has also launched an ambitious teleradiology network that will connect three rural hospitals to the medical centre, dramatically speeding up access to medical specialists for doctors and patients in the outlying areas.

In May, the 92-bed James Paton hospital announced the installation of a $1 million Agfa IMPAX system, along with a computed radiography (CR) system for capturing routine X-rays in digital form instead of using photographic film.

The reduced need for film, chemicals and storage space for records will result in annual savings of $150,000.

As well, the PACS and teleradiology system are expected to greatly improve medical care for the public by enabling radiologists and other specialists to analyze diagnostic images more quickly. The rural hospitals will be able to send X-ray images and ultrasound files to Gander for quick, expert opinions.

“We’re leading the way for the province,” commented Dr. Clayton Hann, chief of radiology at the James Paton Memorial Hospital.

Dr. Hann explained that two of three outlying hospitals – Brookfield Bonnews Health Care Centre in Brookfield, and Notre Dame Memorial Health Care Centre in Twillingate – are 90 minutes away by car. When doctors at these smaller hospitals need an expert opinion about an X-ray, they typically send the films by courier to Gander. However, because of the time needed to physically transport the films and get them into the hands of radiologists, they can wait hours for a reply.

The process is even longer from Fogo Island, which relies on ferry transport to Gander. “In the spring, depending on ice conditions, the ferry can be out of service,” noted Dr. Hann. “It can be days before we get the films.”

In contrast, by scanning the X-ray films and sending the images over the telephone wires, specialists in Gander can be accessed in minutes. “In the case of a broken bone, if there are questions about how to treat it, one of the rural hospitals can beam images to one of our orthopedic surgeons,” said Dr. Hann. “In a few minutes, the orthopedic specialist could be giving advice to the remote doctor.”

In addition to X-rays, all three remote sites have recently acquired new ultrasound machines, and will be able to send images directly through the teleradiology network for analysis by specialists in Gander.

Dr. Hann said that in the future, if funding is available, the teleradiology system could be extended to other rural hospitals across the region. This could save patients car trips of four or five hours, when they need to consult a specialist in Gander. Instead, their diagnostic images could be sent via the teleradiology network, and the Gander-based specialist could quickly call back with an opinion.

Inside the James Paton Memorial Hospital, the PACS will be connected to workstations in the radiology department and also to the ER, OR, coronary intensive care units, and to orthopedic clinics. Physicians will be able to electronically retrieve digital X-ray images, along with pictures produced by ultrasound, nuclear medicine, and digital fluoroscopy. Later this year, the hospital intends to acquire a spiral CT machine, as well.

Dr. Hann said that mammography will continue to use film, because the digital technology for this specialty – which requires greater resolution than routine X-rays – hasn’t yet been perfected in a commercial format.

The James Paton Memorial Hospital serves a population of 53,000 in primary care and 120,000 for specialty areas such as orthopedics and ophthalmology.

David Lewis, CEO of the Central East Health Care Institution Board, said the teleradiology application “is the next logical step in regionalization.

“The first step is to eliminate duplication. Now we have to enhance services to patients in rural Newfoundland,” he said. “This system gives the rural hospital access to specialists, and adds to the comfort level of rural GPs because they can have a radiologist look at an image and get back with an accurate diagnosis. Consequently, patients get better healthcare.”

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Mount Sinai Hospital evaluates Palm Pilots in critical care

TORONTO– Mount Sinai Hospital and 3Com Canada Inc. have entered into an agreement to study the effectiveness of Palm computer devices in a Critical Care Unit. This is said to be the first study of its kind to systematically evaluate the benefits of palm computers as a medical tool.

“Handheld computing technology offers enormous potential for facilitating medical care management, but this has not been formally studied,” says Dr. Stephen Lapinsky, principle investigator for the research project. “We propose to evaluate Palm computer devices in the Critical Care Unit and develop a formal research study to assess the benefits of this technology in the critical care setting.”

As part of the agreement, 3Com is providing Mount Sinai Hospital with 17 Palm IIIx and technical support for the duration of the study.

“Palm computing devices offer new and exciting ways to gather and exchange information quickly and accurately within a hospital environment. We are excited to work in partnership with Mount Sinai Hospital to extend the reach of Palm technology and to help improve efficiencies within a Critical Care setting,” said Michael Moskowitz, National Sales and Marketing Manager, 3Com Canada, Palm Computing Division.

Critical Care is a good area for technology research projects because it is the highest cost area of the hospital, said Dr. Tom Stewart, director, critical care unit, Mount Sinai Hospital and assistant professor of medicine and anesthesia at the University of Toronto. He added that CCUs face increasing demands due to an aging population.

“We envision that these type of devices, along with some minor advances, will enable our team to be more efficient at patient care, teaching and research in an era of limited resources,” explained Lapinsky.

The research group will work with 3Com to identify the needed advances and the necessary information to be exchanged between the Critical Care team members. The Palm computer project will consist of two phases:

• A six-month period during which time members of the Critical Care Unit will provide feedback on their experiences with the technology and suggest ways that the information exchange and storage can be improved.

• A formal evaluation period that will assess various roles for the technology related to improving patient care and efficiency. The criteria for assessing the Palm computers include simplicity of use; perceived benefits over current practices; measurable benefits; novel use of the technology; and enhancement of patient care, teaching and/or research.

The Critical Care program at Mount Sinai Hospital is said to be a popular Critical Care training program at the University of Toronto, attracting a large number of residents and fellows of high calibre. The program has an established and growing research reputation, under the direction of Dr. Tom Stewart.

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Open source software used to create low-cost clinical applications

By Andy Shaw

“The basic idea behind open source is very simple. When programmers on the Internet can read, distribute, and modify the source for a piece of software, it evolves. People improve it, people adapt it, people fix bugs. And this can happen at a speed that, if one is used to the slow pace of conventional software development, seems astonishing.”

– The Open Source Page
(http://www.opensource.org/intro.html)

There can’t be a much more public, open source of information than a street sign. It’s there for all the world to see who pass it by. And true to its nature, Minoru Development Corp. (www.minoru-development.com) took its name from a Vancouver street sign.

But it’s Hamilton, Ont., where this unusual firm specializing in the development of “open source” information systems for healthcare is making its mark. Working with HappIN, the non-profit Hamilton Area Public and Private Information Network, Minoru is using available-to-everybody source code to develop a number of new applications for HappIN’s community health network.

The HappIN network already provides its member hospitals and community care givers with e-mail, Web access and online discussion forums. But Minoru is leading the development of new modules for the network including a clinical management system, a Web-based physician-pharmacist consultation system, and a geriatric patient index.

Now in various stages of development and clinical trials, these projects hold the promise of revolutionizing the deployment, integration, and especially the cost of community health information systems everywhere.

“In our last project the total software cost was $200,” says Joseph Dal Molin, a principal and co-founder of Minoru. “That’s because we are using open source tools like Linux as a base and it’s free to everyone.”

As many will know, Linux is a Unix-type operating system for computers that was created by Linus Torvalds with the assistance of developers around the world who contributed their innovations via the Internet. Long a favourite with computer hobbyists, Torvalds has now taken Linux into the corporate world. There, even the likes of the mighty Microsoft Corp. are beginning to give it nervous attention as competition both for their operating systems and applications. (And with good reason. Use of Linux is rapidly growing. For example, the Apache web servers used by the majority of Internet service providers around the world run on Linux code.)

“We’ve really taken application development and turned it on its ear for the healthcare market,” says Dal Molin, who earned his health information stripes running the former Digital Equipment Corp.’s health systems business in Canada. “If there was one thing I observed in working in the healthcare environment, it was that the propagation of information systems was not really as fast as it could have been.”

That was partly because, Dal Molin concluded, the healthcare environment is not a competitive one. “It’s an altruistic industry. But the irony is there is so much development working going on in various places, and yet so little of it is being shared. That’s why open source code makes such good sense for healthcare. If anything is developed on an open-source model, it can be shared via the Internet with everyone else.”

Dal Molin points out that open source development is not entirely new to healthcare. For example, he says, there’s been a complete suite of open source, hospital information systems available publicly for a number of years. It was developed for U.S. veteran hospitals. But what is new is that Dal Molin and Brian Bray, Minoru’s president, have developed a business model for their company and for their clients that encourages sharing and rapid development of inexpensive systems.

“With proprietary software you make money on your investment by selling and reselling the original product,” says Dal Molin. “You try to extract as much as you can from your investment. But in open source development we make our money by continuing to improve the product. We keep looking for projects that will fund additional development of the base code. So you are adding value as you go. It’s very dynamic.”

Dal Molin says on the current Hamilton-based projects, more than 200 on-line software developers are voluntarily contributing to the development of their code. Their payoff, of course, is that they get to use what they helped develop for free.

“I think the concept is marvelous,” says Dr. David Chan, a member of HappIN’s widely representative Board of Directors. Chan is a family practice physician and medical director at Stonechurch Health Centre. He also teaches at McMaster University. “The great thing about it is that open source software is constantly evolving. And we need that in healthcare. The questions we asked of our patients five or 10 years ago are not the same as we ask now. Nor will they be same in another five or 10 years. So, you’re never all kept at the same level, nor stuck with the same proprietary vendor.”

Dr. Chan is currently asking questions of the clinical management committee he supervises for HappIN. With Minoru’s help, it is designing a minimum data set for the geriatric information-sharing project. “So if a senior patient is referred to one of our day hospitals, the staff there can find out what happened when the patient had a stroke at St. Peter’s Hospital.”
Chan is also keen on the project now in clinical trial stage that links six family doctors with three pharmacies. “Potentially it will enable pharmacies to play a more important role. They can do a more enhanced medication profile and send it with a keystroke over HappIN’s secure dial-in network to the physician and then discuss it between them. The doctor will now have better information because the pharmacists will be aware of not only of the patient’s prescribed medication, but also whatever vitamins or herbal remedies the patient is taking. So pharmacists can become more like consultants.”

As consultants to HappIN and its application projects, Minoru and Bray bring sterling development credentials. President Bray is a former Microsoft project manager who is largely credited the development of the Microsoft Mail product.

Later, as a healthcare systems architect he designed an electronic medical record system now used by hospitals worldwide. Dal Molin, while at Digital, helped develop the McMaster University Medical Centre’s clinical repository.

That reputation helped land Minoru’s second major contract since starting up the company last fall. Minoru will do the front-end consulting in the Hamilton area for the Ontario government’s primary-care network projects.

In the past, proprietary vendors could always point to the absence of support provided by open source developers. But with Minoru active in the field and a legion of online programmers constantly making the applications more robust and sharing the results, support is much less a concern.

So a hospital does not have to rip out applications it has invested in to joint the open source movement.

The corporate world is also getting the open source message. Apple recently opened the server version of its QuickTime streaming technology to all takers. And even Microsoft is making rumblings of making much of its code public.

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Royal Ottawa Hospital to run program for telehealth technicians

By Jerry Zeidenberg

OTTAWA – The Royal Ottawa Hospital has announced that in September, it will become the site for a year-long program to train telehealth technicians. The development appears to confirm that demand for “distance medicine” solutions is growing, as urban hospitals seek to assist physicians and patients in surrounding areas via computerized networks.

What’s often missing from the equation is a pool of well-trained technicians who are able to install and maintain telehealth systems and computer networks in general.

To alleviate the shortage, the ROH has entered an agreement with Novatech Computer Careers of Kingston, Ont., a privately run school that has been accredited to deliver the telehealth technology courses by the Ontario government.

For its part, Novatech has taught computer education for six years and launched its first telehealth training-program a year ago. It’s said to be the only program producing telehealth technicians in Canada, and the courses cover a wide variety of skills.

“The students have six hours of lectures and labs every day, five days a week,” commented Rick Lawless, president and founder of Novatech. “They obtain Microsoft and Novell certification, and gain expertise in personal computers, telecommunications, telephony, cable technologies and computer security.”

He noted that students also learn about medical technologies. “They have training in medical software and hardware,” said Lawless. “It’s a hands-on program. By the end of it, they’re able to take a bucket of parts and put a PC together, or a remote stethoscope.”

Admittedly, it’s an intensive curriculum, and Novatech will be screening applicants to make sure they’re committed. “One of the most important things a student can do is to show up every day,” said Lawless, adding that a great deal of motivation and drive is also required to complete the assignments. Students don’t need a background in computer technology, but they must be eager to learn.

There’s a serious financial commitment at stake, too. Tuition is $13,500 for the program. But Lawless says that similar community college programs offering Microsoft and Novell certification cost as much as $19,000.

Moreover, Lawless asserts that it’s a worthwhile investment, since 95 percent of graduates from the school have found jobs. Companies hiring the students include Nortel Networks, Newbridge and Corel.

Over the last two years, the school has graduated about 200 students, and currently employs 25 instructors.

At the Royal Ottawa Hospital, the organizers are expecting about 30 full-time students to enroll. They’ll be split into two classes.

Lawless expects that some of the students will be recently laid-off healthcare workers who are re-training themselves for jobs in high demand – computer technicians, with special expertise in telehealth. Other applicants might simply wish to change the direction of their careers.

According to Lawless, the small class size – typically eight to 10 students – is a big boost to learning. He observes that university computer classes often contain as many as 150 students. “Students there are lucky to talk to their professors once a year,” said Lawless, himself a graduate of the University of Guelph’s public administration program, and in computer science from Pennsylvania State University.

By contrast, he said that Novatech’s students spend much more time with their instructors, who have all had actual field experience with companies such as Compaq Computer Corp., Rogers Cablesystems, and others.

For more information about Novatech Computer Careers, including the scope of the curriculum, readers can visit its web site at www.novatech.on.ca or call the school at 613-384-7959.

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