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Inside the March 2006 print
edition of Canadian Healthcare Technology:
Feature Report: Wireless and mobile solutions
PEI announces $13 million investment in provincial EMR
Prince Edward Island is building a $13 million
system that will standardize and connect electronic medical records
in all seven of the province’s acute-care hospitals and a mental
health facility.
Calgary clinic offers Western Canada’s first open MRI
MYK Imaging, a private-sector clinic in Calgary,
has launched Western Canada’s first open MRI service. The scanner
makes it much easier to image claustrophobic patients, children and
people who are obese.
READ THE STORY
ONLINE
BlackBerry helps ICU staff
Trillium Health’s ICU doctors, nurses and
healthcare professionals have deployed wireless BlackBerry devices
to improve communication among them. Physicians can be more easily
reached, and can respond to events in a more systematic manner.
IT at new Toronto hospitals
Bridgepoint Health and the Humber River Regional
Hospital recently received the go-ahead from the provincial
government to build new facilities. They’re planning different
approaches to the acquisition of IT solutions.
READ THE STORY
ONLINE
Interview: Capital Health
Reporter Andy Shaw converses with Sheila
Weatherill, CEO of Capital Health, in Edmonton, and the
organization’s CIO, Donna Strating. The executives talk about their
approach to technological change.
Referral system for rehab
There’s a new way for facilities in Eastern
Ontario to send rehab referrals to each other and for community
physicians to access rehab specialists. They can now do it online,
using the Rehabilitation Integrated Transition Tracking System.
PLUS news stories, analysis, and features and more.
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PEI announces $13 million investment in provincial EMR
By Jerry Zeidenberg
CHARLOTTETOWN – Prince Edward Island is building a $13 million system
that will standardize and connect electronic medical records in all
seven of the province’s acute-care hospitals and a mental health
facility.
The province will implement computerized solutions from Cerner Corp. for
a host of applications, including admissions, discharge and transfer (ADT),
lab, pharmacy, ordering and scheduling, and emergency rooms.
Through quick access to medical records in hospitals across the
province, the systems are expected to reduce paperwork and the
duplication of tests, and to improve patient safety.
Funding for the project is being split three ways: the participating
hospitals are contributing about $2.6 million, and the province of PEI
and Canada Health Infoway are each chipping in approximately $5 million.
Not only is it a large-scale IT project, but it’s scheduled to be
completed in just 15 months – a very fast implementation for an effort
of this size. “A key measurement of a project’s success or failure is
whether it takes too long to put in place, and one of our requirements
was a solid methodology for getting the system up and running quickly,”
said Calvin Joudrie, director of the iEHR/CIS project for Prince Edward
Island.
Indeed, one of the main reasons the province selected Cerner as a
partner was the company’s implementation strategy, as well as the
quality and features of the clinical systems and, naturally, competitive
pricing.
The effort with Cerner involves ‘co-building’ of some 22 modules to
create the system, using a team of 24 individuals from PEI who are
dedicated to the project, along with over 60 others from the province
who are acting in support functions, as well as personnel from Cerner.
For its part, Cerner is committed to reach various targets at certain
dates, with financial rewards for hitting each of those milestones.
Not only will solutions be accessible within hospitals, but a high speed
network is already in place that will enable medical professionals in
one location to access electronic records that have originated at
another site. Electronic health records will be housed in a central
repository, with a backup system in case the central warehouse ever
fails.
Phase one of the project will start with the island’s two largest
hospitals, the Queen Elizabeth Hospital in Charlottetown and the Prince
County Hospital, in Summerside. Work is expected to be completed at the
two sites by March 2007.
Systems at the other five hospitals are slated for completion in May
2007, with work ending at the mental health facility at the end of June
2007.
While Cerner is supplying the bulk of the new clinical systems, Joudrie
noted the province will maintain its current Radiological Information
Systems (RIS) from IDX and its Agfa Picture Archiving and Communication
System (PACS).
Using these systems, Prince Edward Island is part of Maritime PACS
network that enables clinicians in PEI, New Brunswick and Nova Scotia –
and to some degree, Newfoundland – to share all diagnostic images.
The imaging system has worked well for the partners. “The sharing of
information from the PACS is spectacular,” said Joudrie. “Any hospital
can access any image, from any other hospital.”
These radiology systems are to be integrated with Prince Edward Island’s
new clinical systems. So will other solutions that are found to be the
best choice for particular applications. To make this kind of
integration possible, said Joudrie, an access layer is being designed
into the iEHR/CIS project to ensure that alternative solutions will be
able to interface with the system.
The new system will also support wireless solutions, as well as various
PDA (handheld computers) and tablet PCs with handwriting-to-text
conversion. “This is a great attraction for people with low to average
keyboarding skills,” said Joudrie. “We’re giving them tools so that they
can make the jump to computers as easily as possible.”
He noted that there are also change management personnel on the project
team, in recognition of the ‘people issues’ that must be worked through
when implementing technology and changing the way that staff members do
their work.
In the future, the province intends to provide referring physicians with
connections to the hospital systems. For now, it’s testing this type of
connectivity by linking four community health centres with the hospital
systems.
The physicians will have access to lab and radiology results, and will
be able to schedule appointments, in some cases.
“This can save a lot of time,” said Joudrie. “Instead of the doctor’s
secretary calling and getting busy signals, and calling back again, the
physicians themselves will be able to book many appointments using
quick, electronic systems.”
Joudrie explained that the province is starting the
physician-to-hospital connectivity as a pilot project so that it can
test the level of integration that’s needed. It’s not yet known whether
a ‘portal’ into the hospital system is sufficient, or whether full
integration with the physician office systems used by some doctors is
required.
Integration is also planned with PEI’s Drug Information System, which is
connecting retail pharmacies and doctors’ offices. By bringing this data
into the hospitals, physicians there will have even more information
about the patients they encounter. “They can get a really good picture
of the meds people are on,” said Joudrie.
According to a release from the Prince Edward Island government,
“Providing health care professionals with the ability to access medical
records electronically means patients will no longer have to take their
charts with them to the hospital. This will also eliminate the need to
copy and transfer paper versions of medical records between health
facilities, which, in turn, will reduce the risk of error and improve
the safety and security of medical records. The EHR will also help
prevent the occurrence of duplicate medical tests, reduce the risk of
drug reactions in patients and eliminate the need for patients to
repeatedly answer the same series of questions when receiving
treatment.”
Speaking on behalf of the Canada Health Infoway, which aims to improve
the delivery of healthcare in Canada through the use of electronic
solutions, CEO and president Richard Alvarez said: “PEI will be one of
the first jurisdictions in Canada to have a complete provincial
electronic health record, which will enable improved quality of care.”
Calgary clinic offers Western Canada’s first open MRI
By Jerry Zeidenberg
CALGARY – A private-sector clinic has launched Western Canada’s first
‘open’ MRI scanner, a machine that makes it much easier to image
claustrophobic patients, children, and people who are obese. As with
other for-profit clinics, MYK Imaging is charging for exams – in this
case, $695 per study.
But unlike other private centers offering MRIs, MYK Imaging soon hopes
to obtain funding for patients through the local health authority or
possibly the provincial government.
“We strongly believe in universal access for everyone, and we don’t want
to charge patients,” said Dr. Deepak Kaura, medical director of MYK
Imaging and a radiologist who also works at the Alberta Children’s
Hospital. “We’re in discussions about obtaining funding through the
region or the government.”
Dr. Kaura believes his centre, which consists of three clinics and
currently performs 125,000 exams each year, has an excellent chance of
qualifying for the funding, since there are no other open MRIs in
Western Canada. As such, his company is offering a valuable service to
patients.
“It’s something that’s not available in the public system,” he observed.
He noted that there are some patients who simply won’t go into the
noisy, closed-tunnel MRI systems that are typically found in hospital
radiology departments. Moreover, many children won’t sit still in the
standard systems, but do very well with their parents sitting next to
them in an open MRI.
Some elderly patients fall into this category, as well.
And often enough, patients are too big or heavy to fit into the tunnel
of a traditional MRI – a phenomenon that has led some major vendors to
start producing extra-wide MRIs for patients of larger girth.
The open machine, however, can accommodate all of these patients. Dr.
Kaura added that among U.S. patients who have experienced an MRI exam in
both an open system and a tunnel-based machine, the vast majority prefer
the open systems when given the choice.
“I feel guilty about charging,” said Dr. Kaura, “but we’re trying to
give people another option.” He explained that without the availability
of an open system, many Calgary-area patients wouldn’t get an MRI scan
at all.
Offering the service, however, is costing MYK Imaging a fair chunk of
cash. Indeed, the MRI and new Picture Archiving and Communication System
(PACS) the three-site clinic has installed required an investment of
approximately $3 million.
Dr. Kaura’s MYK Imaging has installed a state-of-the-art open MRI
scanner from Hitachi. He explained that thanks to recent advances in
open MRI technology, the system compares favourably with closed tunnel
systems. “There’s been a revolution in the open MR marketplace,” he
said, explaining that in the past, the open systems used to require 40
percent more time to conduct a patient exam.
For its part, Hitachi reduced that figure to 20 percent in the machine
that’s currently installed at MYK Imaging. But an even newer
breakthrough has resulted in coils that completely level the playing
field, enabling the open MRI to perform exams in the same amount of time
as the closed bore systems. MYK Imaging has this technology on order;
its new equipment is expected at any time.
There have also been breakthroughs in terms of image quality. In the
past, open MRIs – which have lower field strengths than tunnel-based
systems – haven’t been able to differentiate between fat and fluid as
well as the bigger machines. “The 1.5 Tesla machines have always been
able to do this,” said Dr. Kaura, referring to the standard systems
found in hospitals.
Now, however, the 0.3 Tesla open system used in his private clinic can
make fine distinctions between fat and water – something that’s
important for determining pathology. “Hitachi has improved the hardware
dramatically,” said Dr. Kaura. “The field is much more uniform.”
On the image management side, MYK Imaging has implemented a web-enabled
PACS from Fuji – rendering it the first multi-site clinic in Western
Canada to use a PACS.
Coupled with an advanced RIS from Unicus Data Systems, of Calgary, the
clinic’s image management system is improving workflow for its 10
radiologists as well as referring physicians. Using an automated
dictation/transcription service, radiologists can read reports, send
them online to a transcription service, and receive an alert for
sign-off when they’re returned.
Reports can then be automatically routed to referring physicians via fax
server and as an electronic report, although Dr. Kaura stressed that
radiologists always call the referring doctors when there’s an
abnormality or medical complication.
The local physicians can also connect to the MYK Imaging system to view
images in the PACS; this feature is already experiencing significant
uptake from referring physicians. “There are 20 to 30 doctors using it
at any given time,” said Dr. Kaura.
He noted that four of the clinic’s 10 radiologists are pediatric
specialists, and that MYK Imaging runs Western Canada’s first and only
pediatric radiology centre that’s outside of a hospital – a service
called Kids Imaging and Diagnostic Specialists (KIDS). “It’s the first
in this part of the country, and possibly in all of Canada,” said Dr.
Kaura.
And while MYK Imaging plans to run its open MRI eight hours a day, it
intends to offer researchers access to the machine for the other 16
hours. “We’ll make it available to them at minimum cost,” said Dr. Kaura.
He explained that many radiologists, including himself, are also
academicians who want to conduct leading-edge research. However,
“there’s a paucity of time for research studies,” a problem compounded
by the province’s drive to reduce wait lists by increasing the clinical
use of available hospital MRI scanners. There’s already interest brewing
from university and hospital researchers, as well as from the National
Research Council of Canada. More information about MYK Imaging and its
open MRI service is available on the web:
www.openmriofcanada.com.
Wireless BlackBerry transforms communication at Trillium’s ICU
By Andy Shaw
Critical care physician and medical informatics
consultant Dr. Chris O’Connor certainly makes you think. That’s an
intended pun connected with Dr. O’Connor’s initiatives taken under the
banner of the THINK project at Trillium Health Centre, in Mississauga,
west of Toronto.
THINK – Transforming Healthcare into Integrated Networks of Knowledge –
is a concerted effort by the hospital to enhance its care by freeing up
the flow of information.
At a recent Insight Information Co. conference on the state of the
wireless art in healthcare, Dr. O’Connor made attendees think about what
wireless email can do to free that flow – and why that’s needed.
“I don’t think we’re much different from other hospitals, but I went
around Trillium on various floors and looked at how, in 2005, we
communicated as clinical teams,” Dr. O’Connor told the conference as he
put up slides capturing what he saw. “And as you can see, here’s how we
do a lot of it. When a patient develops a need, the nurse writes it down
on pieces of paper like this. In our ICU, incidentally, the preferred
medium of communication was a note on a paper towel. And then they wait
until the doctor physically comes around and finds the note before any
action is taken.”
Dr. O’Connor went on to say that he found it “absolutely remarkable”
that this paper-based system, and all its potential inefficiencies,
would be the norm in the age of the internet and electronic
communications.
Nor did he think much more of the one electronic effort to improve
communication that is also a norm in hospitals – paging.
“Physicians dislike getting paged because it’s very disruptive,” said
Dr. O’Connor. “And it turns out nurses and other members of the
healthcare team like it even less because doctors tend to ignore their
pages. So they have to page doctors multiple times. Or they wait to page
until a patient is very, very sick. Either way, it’s not good for
anybody.”
Neither was his secondary research any more encouraging.
“Communication between patient and care-givers is at the heart of what
we do, but there is virtually nothing written on communication in the
medical literature,” said Dr. O’Connor. “Paging, for example, is
something the medical community does all day long, yet I found only
three articles on paging.”
But what set Dr. O’Connor on his mission to improve communication more
than anything else, he said, was a potentially fatal clinical mistake he
made himself.
“A patient feeding tube was put into the lung of an ICU patient instead
of the stomach and I didn’t notice it on the X-ray I was reviewing,” he
said. “It’s a simple task and I had read thousands of such X-rays.
Missing the error was inexcusable. The patient received two feeds into
the lung and could have died. Luckily, he didn’t.”
The incident triggered some serious self-examination.
“I asked myself, Why did that happen? And I remembered that while I was
reading the X-ray, I was surrounded by a scrum of nurses, all tapping me
on the shoulder and telling me things like: the patient’s family is at
bed 62; the guy in bed 50’s blood pressure is a little high; and the
person in bed 36 has not passed much urine in the past couple of hours.
“And that led me to the realization that e-mail would be perfectly
suited to this. It’s very good for short, little communications. So, why
don’t we incorporate it into the care process,” concluded Dr. O’Connor.
Thus began a pilot project that led to a six-month trial and
subsequently a full-blown deployment in the Trillium ICU of a BlackBerry
wireless handheld e-mail system. It has wiped out intrusive shoulder
tapping, reduced paging dramatically, and been a hit with physicians and
nurses alike.
“It’s the first such system in the world, so far as we know,” said Dr.
O’Connor. “We began by just giving the BlackBerrys to the ICU’s four
physicians. The nurses had to log into their desktops to send their
messages to the doctors. But that actually worked. It was a stunning
success right from the start. It significantly de-fragmented the care
process and improved the response time to messages.”
Dr. O’Connor said that the first order he ever responded to on his
BlackBerry is indelibly etched in his mind.
“The nurse sent me a message suggesting that a certain patient needed
more anti-hypertension medicine. That seemed reasonable, so I touched
the Reply button and typed ‘Yes, go ahead.’ then hit the Send button and
it was done. Done in less time that it would usually take me to even
find a phone to answer a page. It took my breath away.”
Contributions of equipment and support from BlackBerry-maker, Research
in Motion (RIM), and six months of free air time from Rogers paved the
way for a full blown trial. BlackBerrys were also then made available to
every shift of the ICU’s 20 nurses, as well as selected dieticians,
physiotherapists, and other staff. Without retreating to a desktop, they
all could now “tap the shoulder” of the physician by thumbing a message
on their BlackBerrys, no matter where they or the doctors were – and
without being disruptive.
“We’ve been getting 40 to 50 such a messages a day, but they don’t
interrupt. You can deal with them in those little cracks of free time
that show up between caring for patients,” said Dr. O’Connor. “It’s an
extremely cool thing.”
And more beneficial things than even anticipated.
“Just things that we didn’t expect, like the staff going off on a coffee
break. If they’ve forgotten to hand something off, for example, they are
now sending a message from the cafeteria. Most staff are very
conscientious so they like to be able to stay in touch,” said Dr.
O’Connor. “They can also stay in touch with their families by e-mail
(the BlackBerrys are not used as cell phones), so it helps them come
into work even if there are some difficulties at home.”
Having such a useful device in hand, however, has not contributed to any
pilfering and consequent loss of privacy. The BlackBerrys are signed
for, picked up, and returned at the beginning and end of each shift. In
more than six months of pilot and trial testing at Trillium, no
BlackBerry has gone missing. And if one ever were to, its contents can
be removed remotely. In the meantime, the messaging between caregivers
is all logged and kept on a Microsoft Outlook account for each
BlackBerry. That information will eventually find its way, said Dr.
O’Connor, to every Trillium patient’s permanent electronic record.
As to drawbacks to the system, O’Connor said he’s been hard pressed to
find any, although he anticipated some.
“We’ve not had change-management or intensive training needs, for
instance. That’s partly because it was not imposed upon us. It was our
own ICU’s initiative. RF (radio frequency) interference has not been an
issue even in the ICU. Costs for running the system over cell net as we
have in the trial would be about $17,000, minimal against our $20
million dollar ICU budget.
“But even those costs can be reduced to near zero if you run it over a
Wi-Fi local area network as we intend to. I thought keystroke error
might be a big issue, because you can be typing important numbers in the
messages, but the physician gets to see those numbers before replying,
so there’s a built-in check and we’ve had no keystroke errors so far.
“The system does mean there is less face-to-face time (or
face-to-shoulder time) with the physicians, to be sure, but reducing
communication to a short message makes one think about what’s truly
important. Nursing resistance was minimal even at the start. About 75
percent accepted it right away and within a couple of months all of them
were on board. Everybody likes it.”
Two state-of-the-art Toronto hospitals take
differing approaches to IT
By Andy Shaw
Just before the turn of the New Year, the Ontario
Ministry of Health gave the go-ahead to the planners of two
state-of-the-art, 700-bed hospitals to better serve the mushrooming pop-
ulation of the Greater Toronto Area.
Though they will be new in many ways – including new bricks-and-mortar
and the latest in medical technology – they both have historic roots.
Humber River Regional Hospital and Bridgepoint Health (formerly
Riverdale Hospital) both serve regions adjacent to rivers – the Humber
and the Don – that once bracketed what was then a much lesser Toronto
area. It was on those rivers emptying into Lake Ontario that natives and
explorers of old voyaged and gave meaning to the town’s “meeting place”
name.
Today, the builders of both Toronto hospitals are promising new “models
of care” that will reach beyond hospital walls and into their respective
communities. But there, the similarities end.
Humber River in north-west Toronto will move to a new site that will be
home to a regional hospital dedicated to acute care.
Bridgepoint Health is staying put in its vantage point by the east end
of the Gerrard Street Bridge, which spans the Don Valley. It will modify
and expand its existing campus and its roles as a provider of care for
complex diseases and as a rehabilitator.
Different too will be their respective approaches to adopting technology
– especially information technology. CIO Peter Wegener says Humber River
will be taking what he feels is an exciting and challenging “clean
slate” approach to adopting new IT. His counterpart, CIO Steve Banyai,
says Bridgepoint will be going with what they’ve got, building on their
recently developed and unique web portal platform as a foundation.
“Given how technologies are both developing rapidly and converging, we
want to develop a flexible, interoperable IT infrastructure that will be
plug-and-play. So that we’re not ever caught by a technology going
obsolete on us,” says Wegener.
“To do that, we’re going to take what you might call a visionary
approach to creating that infrastructure and rely very heavily on the
experts in the industry to help us develop a view of what that
infrastructure should look like.”
Across town, Banyai knows what the new Bridgepoint’s infrastructure
looks like now.
“I’ve had the advantage of being the industry consultant who developed
the strategic vision for the hospital’s infrastructure before I moved
over and became CIO. So I got to implement my own plan,” explains Banyai.
That plan strategically positioned Bridgepoint neither as an early
adopter nor a laggard when it comes to technology uptake.
“We purposely did not put ourselves on the bleeding edge,” says Banyai.
“We took the view instead that technology should be an enabler of both
our care and business process and not the other way around.”
In that view, he shares some process-come-first common ground with
Humber River and Wegener.
“Before we make any decisions about technology, we’re developing models
of the types of patient care we want to deliver,” says Wegener. “Then we
will go look for the technologies that can help us deliver that care in
the most efficient and safe way.”
Wegener adds that he and Humber River Regional will not go looking for
those technologies from only the traditional “big boys” among medical
technology suppliers.
“If they have a technology that provides a particular service better
than any other, then we would certainly welcome any niche provider in
the industry into our partnership.”
Wegener feels Humber River has the flexibility to choose the very best
partners in the building of the new facility, thanks to the Alternative
Financing and Procurement (AFP) that will pay for the project. AFP, a
policy announced by the Ontario government in 2004, allows construction
work to be financed and carried out by private sector builders, who
assume the financial risks of finishing the project on time and on
budget. The completed facilities, however, remain publicly owned and
controlled.
When the new facilities at Bridgepoint Health are complete, their
information technology will be underpinned by an old Bridgepoint partner
– Novell and its open enterprise software. “When I first got here, I
looked at what Novell had in place and said, ‘Hmmm, this isn’t up to
what Microsoft, for example, is doing as an industry standard,’ so I did
a full review. But I discovered that Novell really did have the modern
products we needed to deliver on our strategic plan. As a result, we
maintained our relationship.”
With his updated Novell software, Cisco Systems networking, and HP
hardware all up to speed, Banyai went on to add to them a system
integrating suite called Novell exteNd, which gives users the keys to
Bridgepoint’s wide-stance portal.
“What exteNd does for us is give us enterprise-wide single sign-on and
identity management,” says Banyai. “So that to put technology in front
of our users all they need is only one user name and one password. With
them, they can get to all their data and all their applications with a
couple of keystrokes or clicks. It gives them fast, secure, seamless,
and transparent access to everything they work with.”
With that ease of access in place, Banyai could then build a
multi-faceted portal that embraces a range of specialized views.
“We’ve built an executive portal or view, for example, where senior
management can see at a glance how things are performing in real time.
“If you are the chief financial officer you want to know what we’ve been
spending money on; if you are the VP of operations you want to know what
our occupancy rate is. We’ve also created a clinical view, an
administrative view, and next on our list is a physician’s view and then
a remote view.”
And all those views can all be seen from any kind of workstation or
web-accessing device, current or future.
The future of the technology employed at both the new Bridgepoint and
Humber River hospitals is not without its challenges, albeit different
ones.
For Bridgepoint Health and Steve Banyai, the immediate challenge is to
step away this time from its leading-edge avoidance and, beginning in
September, integrate a beta version of MediTech’s new Human Resources
module.
“We’ll be the first site in Canada to install and beta test it,” says
Banyai.
With that module proven and in place, however, Banyai feels
Bridgepoint’s portal-based infrastructure will be ready to take on a
larger challenge. Bridgepoint Health intends to become, for complex
disease sufferers and those in need of rehabilitation, the country’s
first “smart” hospital to care for them.
For Humber River Regional Hospital and Peter Wegener, the hurdles yet to
be overcome in their clean slate approach are both mental and
logistical.
“There are so many good technologies out there now, I’m just worried
about not getting to see them all,” says Wegener. “Before we decide, I
want to see the best in not just what will help us build our electronic
health record and other clinical services, but also what will give us
the best view of things like our financial information, of what will
automate our building maintenance best, of everything. That’s the real
challenge of the visioning exercise we’ll be going through soon for the
new hospital.”
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