Inside the March 2011 print
edition of Canadian Healthcare Technology:
Feature report: Wireless and mobile solutions
UHN, GE to launch centre for digital pathology
GE Healthcare will open its first global centre of excellence in
digital pathology in Toronto, in conjunction with the University
Health Network and HTX, a health technology commercialization agency
that’s funded by the Ontario government.
New generation of wireless devices suit the workflow of
Is wireless, that favourite subject of small pilot projects in
healthcare for the last decade or so, finally ready for the big
leagues? Well, some of the biggest players in the mobile health game
certainly think so.
READ THE STORY
Microsoft in healthcare
The software titan has targeted ‘chronic condition management’ as an
area of great importance, one in which its technological solutions
can both reduce costs to the health system and improve outcomes for
READ THE STORY
Assessing the impact of electronic systems in healthcare
As a follow up to his last column on Electronic Health Record
adoption in Ontario, Richard Irving comments on a recent article in
the Archives of Internal Medicine, Jan 24, 2011, by Romano and
Stafford, entitled Electronic Health Records and Clinical Decision
READ THE STORY
A joint EHR strategy
By combining their IT efforts, three hospital organizations in
southern Ontario will be able to accomplish more and offer a greater
range of computerized services to clinicians. Efficiencies and
cost-savings are also in the plan.
VON Canada has completed a two-year project with IBM to evaluate its
methods and systems and to begin updating them. One of the projects
includes a test of smartphones for visiting nurses.
Cancer care kiosks
The cancer care centre at Southlake Regional Health, in Newmarket,
Ont., has implemented Canadian-designed kiosks that speed up service
for patients and improve satisfaction levels. They also integrate
with hospital and provincial information systems.
PLUS news stories, analysis, and features and more.
UHN, GE to launch centre for digital pathology
By Jerry Zeidenberg
TORONTO – GE Healthcare will open its first global centre of excellence
in digital pathology in Toronto, in conjunction with the University
Health Network and HTX, a health technology commercialization agency
that’s funded by the Ontario government.
“The centre in Toronto will play a central role in the transformation of
the 125-year-old practice of pathologists using slides,” commented GE
Healthcare’s Canadian general manager, Peter Robertson, speaking to a
room full of partners, clinicians and dignitaries at the Toronto General
He explained that pathologists, for the most part, still make their
diagnoses using slides and microscopes – a slow and laborious process.
The new centre will develop and test a new generation of digital slide
scanners, workstations and workflow software that’s designed to improve
the speed and quality of diagnosis, and to enhance patient safety.
GE Healthcare and its digital pathology joint venture, Omnyx of
Pittsburgh, Penn., will invest $7.75 million, while the Ontario
government-backed Health Technology Exchange (HTX) is kicking in a $2.25
Robertson said discussions are under way with other partners who are
expected to furnish another $7.2 million for a total of $17.2 million
over the next three years.
In the last two to three years, experts have noted that digital
pathology is verging on the brink of a revolution. Technological
breakthroughs have been made – such as rapid and accurate scanning of
slides – that are expected to change the nature of pathology in the way
that PACS has already transformed the practice of radiology.
Where once radiologists relied on film and light-boxes, they now
routinely make use of computerized workstations with instant access to
images, digital tools for analyzing studies, and electronic sharing of
pictures and data with colleagues. These benefits are expected to be
disseminated throughout the discipline of pathology, where pathologists
currently wait for slides to be delivered – often from hundreds of miles
away – before manually slipping them under their microscope lenses and
Dr. Sylvia Asa, pathologist-in-chief at the University Health Network,
observed that when using these traditional methods, pathologists must
sometimes wait days for the slides to arrive – many rural hospitals
don’t have pathologists or pathological sub-specialists on staff, and
must send slides to the UHN or other large centres for diagnosis. This
means that patients, in turn, must wait days for results and for their
treatments to start.
To counter these delays, the UHN has been running a project with 21
hospitals across Ontario whereby the hospitals can digitize their slides
and send them electronically to pathologists at the three hospital
network – Toronto General, Toronto Western and Princess Margaret
Moreover, the UHN is conducting a scientific study with the Timmins
hospital, along with nine hospitals that surround it, to validate
whether the results of digital slides and readings are on par with
traditional techniques using glass slides and microscopes.
Dr. Andrew Evans, a pathologist at the UHN who was one of the first to
advocate the use of digital technologies, pointed out that there has
been some resistance by pathologists to make use of computerized
methods. In the past, the scans of slides have not always been of the
quality needed to make definitive diagnoses – and pathologists have
balked at using them to make decisions that can have significant
consequences, such as telling a patient that he or she has cancer. But
in recent years, the technologies for scanning have vastly improved, as
have the technologies for organizing and manipulating images on screen
and collaborating with colleagues.
In particular, GE Healthcare and Omnyx have devised a two-camera system
for taking fast, high-resolution scans of slides. The first camera scans
the slide while the second is used to focus – ensuring that the image
that is gathered is sharp, bright and clear.
Dr. Evans and Dr. Asa are confident the trials with Timmins will
demonstrate that digital slides can be as good as standard slides. Once
this is systematically demonstrated, pathologists are likely to switch
to digital tools.
“Once they’re convinced that what they see on screen is the same as what
they see on the slides, they’ll start using computers to make their
diagnoses,” said Dr. Evans. He noted that they’ll want to see results
from a large-scale study involving thousands of cases – and that’s
what’s being conducted with Timmins and nine other hospitals.
Of course, numerous other technologies are involved, such as workflow
tools that will link studies to patient records, call up previous slides
from the same patient, help analyze the image that appears on screen,
share digital slides with other pathologists and clinicians, and so
In addition to GE Healthcare, other corporate leaders in the field
include Philips and Siemens, along with a host of smaller, specialized
What’s more, a variety of Canadian hospitals are developing expertise in
digital pathology. In December, the federal government awarded funding
of $13.3 million to the Centre for Imaging Technology commercialization
and Research, a collaboration between Sunnybrook Research Institute,
part of the Sunnybrook Health Sciences Centre, and the University of
The venture is aimed at helping researchers and small companies
commercialize medical imaging and digital pathology innovations in
The UHN centre is the first project to be supported by HTX under the
Ontario Flagship Program, which is designed to attract multinationals to
establish advanced R&D facilities in the province.
John Soloninka, president and CEO of HTX, noted that GE Healthcare and
Omnyx could have established a digital pathology centre of excellence
anywhere in the world, but chose Ontario because of its high level of
medical imaging expertise.
As a means of leveraging the province’s human capital in medical
technologies and creating companies that will generate jobs and products
to sell around the world, HTX and the government of Ontario have
identified two missing pieces. “The first is increased financing for
early-stage companies, and the second is multinational companies that
will invest in R&D in Ontario,” said Soloninka. “This collaboration will
address both.” Commented Soloninka: “The new centre will create an
outstanding platform to generate new companies.”
New generation of wireless devices suit the workflow
of healthcare professionals
By Andy Shaw
Is wireless, that favourite subject of small pilot projects in
healthcare for the last decade or so, finally ready for the big leagues?
Well, some of the biggest players in the mobile health game certainly
think so. “What we have seen recently is an explosion of wireless and
hand-held applications,” said Gord Stein, the business segment
vice-president at Rogers Communications Inc., as he helped open the
annual eHealthAchieve conference organized by the Ontario Hospital
Association (OHA) late last year in Toronto. “And they have exploded
first of all in response to the drive towards more personalized medicine
for the patients, but also to the enormous pressure there is now in the
healthcare system to both improve service and provide greater
Mobile applications have also ‘exploded’ because the duds have
“We have the wireless technology we need for mobile health here right
now. And it works,” said Bruce Ross, the president of IBM Canada Ltd.
Ross was one of three heavyweights on an opening morning eHealthAchieve
panel that included Don Morrison, the chief operating officer for
Research in Motion (RIM) and Rob Devitt, the president and CEO of
Toronto East General Hospital.
Morrison cited some International Data Corporation (IDC) statistics
supporting the notion that better clinical collaboration is a vision of
caregivers all connected to each other with cell phones, pagers, nurse
alerts and wireless tablets. As he put up another IDC-based slide, COO
Morrison commented on a critical component of digital collaboration:
“It’s showing that 80 percent of doctors in Canada will be using some
form of mobile technology by 2012.”
And that’s because even traditionally skeptical MDs see the logic of
mobile healthcare’s greatest benefit: In hand, they’ll have what they
need to know when they need to know it, unlike ever before.
“Doctors and other caregivers will be on the receiving end of a system
that aggregates data from all sorts of systems and then renders the data
in a way that allows them to do their jobs faster and better,” said
Morrison. “Ten years ago I might have been giving a presentation like
this and saying, ‘This is what the future holds’ – but that future is
now. Whether you are talking (wireless) software or hardware today we
have what it takes. It is just a matter of putting them together, and
that is what IBM is so good at doing.”
And what earlier adopter Toronto East General hospital, with IBM’s help,
has been so good at implementing.
“What we did first, and I strongly advise others to do the same, is to
start small –but think big,” said hospital CEO Devitt. “We started with
a small wireless device, the Vocera communicator, that simply hangs
around your neck on a lanyard.”
Devitt went on to say that because of the sophisticated and rock-solid,
secure, wireless technology the little Vocera offers, Toronto East
General went on to implement wireless in a big way.
“We knew that if you gave employees something less sophisticated like a
single purpose alarm, they would carry it for about two months and then
it would end up in their lockers,” said Devitt. “But the Vocera has so
many other functions that we soon saw the greater quality of care and
safety, as well as the financial returns it brings, so we went big with
IBM started the project by installing 300 wireless access points that
provide hospital-wide coverage, despite what Devitt described as a
“clunker of an old building full of nooks and crannies.” But he proudly
points out that Toronto East General now has wireless coverage even in
its stairwells and elevators.
“We stepped back at that point when we saw the bigger possibilities and
decided to go hospital-wide with it, and not just in one department,”
said Devitt. “And even with that, what was to be an 18-month project
came in two months early and was on budget.”
What that budget bought were 1,500 Vocera communicators for 3,000 users
who immediately began experiencing a slew of benefits.
“A nurse, for instance, can just double click the Vocera, and a ‘Code
White’ goes out to the whole building. So every security officer in the
place is instantly alerted and because of the device’s tracking
capability, they know exactly where the nurse is,” said Devitt.
He further explained that the Vocera has also been hooked into the
hospital’s nurse call system.
“How many at this conference have seen the situation where a patient
pushes the button and the light flashes at the nursing station, but the
nurse is not there?” asked Devitt. “So you have an angry patient and a
frustrated staff member who missed the call. Now the patient pushes the
button and the nurse gets the call no matter where the nurse is.”
Not a surprise then when the results of Toronto East General patient
surveys came in showing their satisfaction with the hospital’s care have
gone way up.
“We’ve had a number of other metrics on the Vocera. Our average time for
a porter to respond successfully to a call has dropped from 45 minutes
to 19 minutes,” said Devitt. ‘We’ve also applied wireless to our
electrocardiograms and made the results available on an electronic
chart. So our turnaround time for an interpretation has dropped from
four days in our days of the paper chart – to one day today. And we
estimate that we’ve saved $20,000 a year as a result of that one
Those impressive wireless results also caused Devitt and the hospital’s
powers-that-be to rethink their electronic medical record (EMR) strategy
in a big way.
“We originally thought our EMR system would be a wired one, but now
we’ve decided to make it completely wireless,” said Devitt.
As a result, Devitt and the hospital are working with IBM, RIM and their
EMR provider to integrate all their mobile devices and wirelessly access
their Cerner clinical systems.
“To have our nurses be able to both read and enter vital signs on the
same device – that is our immediate goal,” said Devitt. “It’s another
example of thinking big but starting small.”
Meanwhile across town, Mount Sinai Hospital has gone big having started
small with Apple’s iPhone. As reported in the June/July 2010 issue of
this magazine, Mount Sinai’s innovative VitalHub system is putting
virtually all the hospital’s clinical applications and many of its
administrative ones on the iPhone. That means that doctors, for example,
can get up to speed on all their patients’ status before conducting
“Typically, when a physician sees it, they love it, and want it,” says
Neil Closner, a Mount Sinai vice president who is now also CEO of the
hospital’s VitalHub spinoff company.
“But some may already be on some sort of BlackBerry plan, so they might
wait until their contract for that runs out.”
That delayed demand is a bit of a blessing in disguise, as it turns out.
“We’ve deployed over 200 iPhones, but one of our challenges has been a
shortage of iPhones because of their sheer popularity,” says Closner.
Nonetheless, the clinically equipped VitalHub iPhones have made their
way into two major departments at Mount Sinai: General Internal Medicine
and Surgery. As well, there are a number of beta deployments in selected
Nor has the iPhone shortage deterred the now very entrepreneurial
VitalHub from selling its system to others.
“We have preliminary agreements to roll out VitalHub at three other
Canadian hospitals and we are having talks with a number of U.S.
providers,” says CEO Closner.
That iPhone shortage, coupled with the explosion of new wireless gear
mentioned at the outset, also have Closner and VitalHub thinking about
“The device manufacturers have really stepped up their game, in terms of
making more and more devices available that are applicable to medicine,”
says Closner. “We started out with a focus on Apple and we still have
that focus, but we are also very optimistic about some others. RIM’s
newer devices like the Playbook have certainly come a long way.
And we are also keeping our eye on Android to see how it plays out. So
we are evaluating what our next platform will be.”
Microsoft targets chronic conditions to improve
Dr. Bill Crounse is a medical doctor and senior director of worldwide
health for Microsoft Corp. But he didn’t start out in the direction of
Bill Gates at all, even though they lived in the same neck of the woods.
Bill Crounse first came to public attention as a television news anchor
in Seattle – before making a dramatic career switch via medical school
in Ohio to a family practitioner and later to hospital administrator
work in Seattle. Since joining Microsoft a decade ago, Dr. Crounse has
globe-trotted to more countries than he can remember – and has come back
convinced that chronic disease is the healthcare world’s number-one
challenge. Canadian Healthcare Technology’s Andy Shaw recently spoke
with Dr. Crounse.
CHT: Dr. Crounse, you speak of “chronic condition management”
rather than chronic disease management. Why is that?
Dr. Crounse: Well, it’s because there are a lot of risk factors
related to chronic disease that you want to manage, but which are not
really diseases. As a family doctor, for example, I might want to help
you manage your fitness level, or your diet, or your weight problem.
It’s also an important indication of how Microsoft and others have
broadened their view of chronic disease management. It’s a view that
instead of focusing only on patients and diseases, embraces people. When
we think of chronic disease we think of patients. When we think of
chronic conditions we think more about the needs of people, all people.
CHT: So in your global travels what have you seen out there in
terms of technology that’s helping advance this broader chronic
condition management approach?
Dr. Crounse: First of all, it’s probably worth talking about what
the technology is attempting to do or improve. Certainly everything we
are trying to do with healthcare technology at Microsoft, and other
innovations in health and healthcare is to answer: How do we improve the
quality of care, while at the same time drive down costs, and also make
health information and care services more accessible?
And the starting gate for the answer is the
electronic record, be it an EMR or an EHR or a consumer’s own personal
health record (PHR), and their related technologies. So, on electronic
record usage, what I see out there is that generally both in Canada and
here in the U.S. we are lagging behind most of Europe and the likes of
some Asian countries. I’m also seeing very good work around eHealth
solutions in New Zealand, and especially Australia. And in the United
States, if you look at the large managed care organizations, there’s no
records and eHealth initiatives are groups such as Kaiser Permanente and
GroupHealth here in Seattle. They are virtually paperless.
CHT: How have they managed to excel?
Dr. Crounse: It’s because the business model for organizations
like Kaiser in the United States is perfectly aligned to support eHealth
initiatives. The physicians are employed by the organization which
serves as the provider as well as the payer or insurer of care. It is
the best milieu for technologies to play out to everyone’s advantage.
GroupHealth here, for instance, has about 75 percent of its population
online and they’ve been able to move about 30 percent of the usual
demand for primary care services that it was experiencing in its actual
clinics and move it online, so patients and consumers don’t even have to
leave home in order to interact with health professionals. People can go
online, and access their complete medical record, manage their
prescriptions as well as their benefits, make appointments, participate
in web conferences, email their doctors, and expect to get a timely
reply to their email questions. It’s a great way to get the information
and certain kinds of medical services that consumers are seeking to
manage a lot of their minor ailments and chronic condition concerns.
In the United States, that model works fabulously
well within the managed care system, but it quickly falls apart when you
take it outside of those organizations because you lose that wonderful
alignment of business incentives. Canada is very different from the U.S.
but shares some commonalities, and there are things we can learn and
apply from organizations like GroupHealth and Kaiser. For example, at
the macro level, provinces both govern the provision of care and act as
the insurer, therefore it is in the province’s financial interest to
move care into more cost-effective paradigms, reduce duplication and
improve quality. Helping people prevent illness and stay healthy has a
positive impact on the health of citizens, improves productivity as a
nation, and helps control spending. The Canadian model is not misaligned
from a business model perspective, but more can be done to manage health
like a system and align incentives across the various stakeholders.
CHT: And yet you say a country like Australia has managed somehow
to get to the forefront of chronic condition management. How did the
Aussies do it?
Dr. Crounse: Australia has done fabulous work which I can tell
you a bit about in a moment. But at the outset they recognized that even
when you get the electronic-record-in-place, the game is not over. The
electronic record by itself won’t get you where you want to go. It’s
what you do next that really addresses the big healthcare issues of
quality, costs, and access. It’s how well you apply the digital
information in your electronic records, how well you search or mine that
data, and how well you use contemporary information/communication
technology to improve lines of communication and collaboration among
care teams and the people they care for, in the clinic, hospital or even
the patient’s own home – these are the real measures of success.
I recently spent a few weeks in Australia and we did
a big campaign going city to city talking about a new paradigm in
chronic care and technologies that link patients and consumers with
clinical care teams via technology. You can look up what’s been done
down under on our Microsoft Australia site (http://www.microsoft.com/australia/health/chronic-care).
It’s full of case studies on solutions for chronic care, such as
prevention and self-management, coordinating and integrating care, care
decision support and enabling care team collaboration and communication
that are built on such products as SharePoint, Microsoft CRM for patient
relationship management, SQL server, BizTalk server, and key performance
indicator technologies. Many of the solutions are available in Canada.
CHT: So what could that all do for better
chronic condition or disease management in Canada?
Dr. Crounse: First off, you can arm your community-care health
workers with mobile technology, be it smartphones like the new Windows
Phone 7 that I just picked up, or with tablet devices. They allow nurses
and other clinicians to visit clientele in their own homes and
immediately connect back to their caregiver agencies so that everyone is
on the same page. Australia, some home-care initiatives in Europe, and
the Ontario Association of Community Care are early adopters of our
unified communications or what we now call Microsoft Lync technologies.
We also have worked with the National Health Service and the Torbay Care
Trust [in the south of England] to arm community matrons who go out and
care for the elderly in their homes.
CHT: Speaking of results, no doubt what you and Microsoft are
developing is being influenced by President Obama’s healthcare reform
drive, which includes supporting the spread of technologies and
equipment that can demonstrate “meaningful use.”
Dr. Crounse: I am sure you’ll agree that not much could be more
meaningful in “meaningful use” than enabling patients or consumers and
their doctors or other caregivers to share information. That is what our
HealthVault solution is about, which puts in consumers’ hands a vehicle
for sharing health information securely with their providers, or anyone
else they want to share it with. HealthVault is also now available in
Germany where it is known as Assignio, and also in the United Kingdom.
Of course, we are working hard with our Canadian partner, Telus, to
bring their version of the solution to Canadians – Telus health space,
powered by Microsoft HealthVault.
In my opinion, services such as HealthVault are part
of a beautiful new model of health information – one that is patient or
consumer driven, not healthcare system driven. But it is going to take
businesses that can scale services to global levels with a rich system
of partners who can look at the long haul and invest for years and years
to really help transform the healthcare industry. That’s where Microsoft
comes in. We have a pretty good track record of transforming industries,
CHT: Well, now that we are talking about the future, what have
you got in the Microsoft top hat that could be transformational?
Dr. Crounse: They are not just ours, of course, but cloud-based
services hold enormous potential. We can see, for instance, that large
public hospital systems that have already invested heavily in their own
data centres might create a “community cloud” service to offer highly
scalable, more manageable and less expensive ICT solutions for use by
other hospitals, clinics, and doctors offices, as well as by local
social service agencies.
Assessing the impact of electronic systems in
By Richard Irving, PhD
As a follow up to my last column on Electronic Health Record adoption in
Ontario, I will comment on a recent article in the Archives of Internal
Medicine, Jan 24, 2011, by Romano and Stafford, entitled Electronic
Health Records and Clinical Decision Support Systems.
Romano and Stafford analyzed physician survey data on over 250,000
ambulatory patient visits and found that only 1 of 20 quality-of-care
indicators showed quality was greater in EHR versus non-EHR visits. For
clinical decision support systems, again only 1 in 20 indicators showed
better performance. For the rest of the indicators there were no other
significant quality differences.
What can we conclude from this? Certainly some may conclude that EHRs
are a waste of time and money if they can show no improvement in quality
of care. I believe that conclusion is likely to be premature on a number
First, I might raise the issue of whether or not the quality-of-care
indicators used actually measure those aspects of care likely to be
impacted by an EHR or CDS? In other words are the quality of care
indicators too narrow? For example, would all medication errors appear
in this data? Or would time saved by clinical care givers be recorded?
Second, I wonder if an analogy can be drawn between EHR adoption in
healthcare and computerization in industry generally. In the early
1990s, Paul Strassmann, a senior IT executive and consultant,
demonstrated that there was no relation overall between the amount
invested in computers and productivity gains across industries or even
However, detailed analysis showed that organizations which were
well-managed tended to show positive gains from IT investment and those
which were poorly managed tended to show losses from investments in IT.
Overall, their IT investments tended to cancel each other out! One
wonders if the same might be happening here. In other words, are some
clinical organizations adopting EHRs but not changing their behaviors to
take advantage of them?
A third quibble is that the conclusions are based on survey data and do
not include any direct observation of EHR use. While survey data is
valuable, direct observation can provide a level of depth and context
that is not available with a survey. It would be helpful if a study of
20-50 sites could be done using direct observation. If these studies
could be conducted over a period of several months or perhaps even a
year or two so much the better.
Finally, the focus on quality-of-care indicators may be misplaced. If
there are few or no differences in quality-of-care, at least these
systems are doing no harm. But what about efficiency and effectiveness?
Quality-of-care is an important aspect of healthcare but it is only one
aspect. Are scarce clinical resources being used more effectively? Is
the time taken to manage not only patients, but also the paperwork
overhead reduced? Is coordination between caregivers better? Can the
level of administrative staffing be reduced?
Before one can reach any general conclusions about the usefulness of
EHRs, the preceding questions must be answered in some fashion.
Richard Irving, PhD, is an associate professor of management science
at the Schulich School of Business, York University, Toronto.