Hospital for Sick Children develops telehealth system for home care

TORONTO – There’s been much theoretical discussion of late about using videoconferencing and other telehealth technologies to monitor chronic-care patients – and those recovering from acute illnesses – right in their own homes.

The technology would, so the argument goes, reduce the financial strain on hospitals by sending some patients home earlier while still allowing doctors and nurses to keep close tabs on them. It would also lower the pressure on home-care agencies, since nurses would need to make fewer visits to home-bound patients.

What’s more, many patients would rather recover in the comfort of their own homes, rather than in a hospital environment.

Now, the Hospital for Sick Children is showing how it can be done with a six-month pilot project that’s using telehealth technology to monitor 60 discharged patients with heart or lung-related diseases. The test will determine whether the technology is effective, and if patients actually like it.

The organizers of the project appear to be betting that their efforts will receive thumbs up on both counts.

“It’s not only world-class, but a first in the world,” said Dr. Robert Filler at a news conference. “There is no home care program as extensive or as thought-out.”

The TeleHomeCare Project links audio-visual and medical monitoring equipment from the patients’ home to a nurse at a 24-hour monitoring centre in the hospital, using an ordinary telephone line. A video camera lets the patient and his or her parent see, hear and talk with specially trained nurses at the HSC Bell Home Tele-Monitoring Centre.

A special device lets physicians and nurses periodically check the patient’s vital signs, such as heart rate, blood pressure and breathing rate, and record these in an electronic patient record.

Parents are taught how to set up the equipment and operate it while their children are still at the hospital. Once their kids are back home, the parents work with nurses at the HSC Bell Home Tele-Monitoring Centre to conduct the remote telehealth check-ups.

Children who may be candidates for the pilot program are being identified by clinical teams from the following departments: cardiology and cardiovascular surgery, respiratory medicine, general pediatrics, otolaryngology (ears, nose and throat) and the critical care unit.

If the family and physician agree, and the child meets the criteria for the program, he or she is then able to participate.

Dr. Filler noted that initially the project will monitor patients who have heart or lung-related diseases of a semi-acute nature. Children who need to be monitored more than once every four hours won’t be candidates.

The Tele-HomeCare Project has been funded by a research grant from the federal Health InfoStructure Support Program. The HSC Bell Home Tele-Monitoring Centre was established through a substantial donation from Bell Canada.

Other partners who have participated and made donations in kind to the project include:

• Toronto Community Care Access Centre, which assisted in the service development and will provide the community health and personal support services.

• Tecknowledge Healthcare Systems Inc., of Dartmouth, N.S., which provided technical and development expertise in designing the service.

• Home Care Evaluation and Research Centre at the University of Toronto, which is assisting in the evaluation of the project.

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Consultants recommend SmartHealth be disbanded

By Jerry Zeidenberg

WINNIPEG – A review of information technology projects in Manitoba has concluded that SmartHealth – a plan to electronically connect all care-givers in the province – has been a poorly managed effort that delivered a low return on investment. The report also contends that SmartHealth didn’t keep up with new technologies such as the Internet.

What’s more, according to the Deloitte & Touche study, SmartHealth delivered $15 million worth of approved work under an agreement with the government, but conducted another $14 million to $18 million of work without government approval.

Contending that little of the project will be of lasting value, the Deloitte & Touche consultants recommended the government pull the plug on SmartHealth and write-off the roughly $30 million to $35 million that was invested.

“Based on our evaluation, it appears that little of the work delivered to date on this initiative will be useful for a contemporary health information network,” the report concluded. (The study, “Information Technology, Major Initiatives Review,” can be found at www.gov.mb.ca/finance/dtfeb3rp.pdf)

SmartHealth was launched in 1995 as a five-year project to electronically link hospitals, pharmacies, doctors and other caregivers across the province. Innovative and ambitious for the time, the project had a five-year budget of up to $100 million.

The organizers claimed they could save the province $200 million per year in health costs by providing physicians with quicker access to patient information, pharmaceutical data and diagnostic tests. By wiring up doctors to labs and clinics, the SmartHealth managers argued that doctors would reduce the number of new tests they ordered, since they could quickly obtain a patient’s latest results on-line.

They’d also be able to call up longitudinal patient records to obtain detailed information that the patient might have forgotten, or couldn’t provide if unconscious in an emergency room. Evidence-based outcomes would point doctors and nurses across the province toward the most effective treatments.

Moreover, the SmartHealth team believed they could cut down on double and triple doctoring, the habit of some patients to visit several doctors to collect multiple prescriptions. Doctors and pharmacists would be able to call up the patient’s electronic patient record and quickly see a history of prescriptions obtained by the patient.

SmartHealth was created as a unit of the Royal Bank of Canada. A majority of the company was later sold to EDS Canada, a subsidiary of the giant U.S. systems integrator that was originally started by entrepreneur and political figure Ross Perot. The company was to work closely with the Ministry of Health to build the province-wide health information network.

But Deloitte & Touche say that SmartHealth ran into problems.

On the government side, the Executive Director position had been unfilled for three years, resulting in a lack of direction and focus within the project.

And while the project began with a clear vision, changes in health information technology and the emergence of Regional Health Authorities in Manitoba required constant revision of the network. This did not occur on a regular basis.

According to the report, “The health sector is dynamic and ever changing. In order to meet its objectives, any health information network needs to adjust and adapt to changing needs. It appears that the initiative did not have this approach.

“For this reason, the HIN needed a risk management process, with periodic reviews and a flexible adjustment process.”

Deloitte & Touche criticized SmartHealth for creating network components without a strategy for how they would be connected and fit into the health system on the whole.

For example, the DPIN pharmaceutical network was given kudos as a working system that offers information about prescriptions filled in retail pharmacies. However, it was criticized for being a custom software project that would have to be modified to work with the commercial software for electronic patient records used in other parts of the health system.

Similarly, the consultants questioned whether the partially completed Diagnostic Services Information Network (DSIN) will easily connect with other systems.

At the time of writing, no decisions had been made about the future of the project or the SmartHealth company in Manitoba. A phone call from Canadian Healthcare Technology to SmartHealth, asking for comment, was left unreturned.

In the review, Deloitte & Touche did recommend that the government redefine its health information needs and re-start an initiative. Manitoba is one of the few Canadian provinces that have updated privacy laws to address the issues that concern usage of computer records in healthcare. As a result, the province is poised to continue development of the HIN if and when the government chooses to do so.

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Newfoundland pioneers satellite-based telehealth for hospitals, ambulances

By Jerry Zeidenberg

ST. JOHN’S – Newfoundland has created yet another innovative project that involves the use of wireless technologies in healthcare.

This month, the province will power-up the Integrated Emergency Medicine Network (IEMN), a pilot program that uses satellite technology to connect emergency-rooms in nine far-flung hospitals and nursing clinics. The system provides doctors and nurses with videoconferencing, enabling them to engage in real-time consultations about patients in remote locations.

“It gives hospitals access to specialists located in other centres, and could mean that patients won’t have to be transferred as often,” said Keith Sheppard, project manager of the Integrated Emergency Medicine Network, and president of Collaborative Network Technologies Inc. (On the web at www.colabnet.nf.ca)

Furthermore, in what might be a first of its kind test in Canada, the network is tying in four traditional ambulances and one air ambulance. By outfitting the ambulances with MSAT satellite technology, paramedics can send and receive voice and data, including ECG, blood pressure, and other information.

“In Newfoundland, there’s often a tremendous number of kilometres travelled by ambulances before they get to hospitals,” said Sheppard. He explained that the new system enables paramedics to prepare emergency-room doctors and nurses about the condition of patients before reaching the medical centre.

The project involves hospitals and nursing clinics in the following locations: St. John’s; Goose Bay; Nain; Forteau; Twillingate; Port Aux Basques; Gander; Cornerbrook; St. Anthony.

The test system is a joint effort between several organizations, including: Collaborative Network Technologies Inc. of Newfoundland, Futureworks Inc. of Newfoundland, Memorial University of Newfoundland – TETRA, Telesat Canada, Industry Canada (Communications Research Centre) and QTECH Hybrid Systems of Ottawa.

Funding is being provided by Operation Online Inc., CANARIE Inc., the European Space Agency, the Canadian Space Agency and Health Canada.

An earth station is in operation at each of the nine hospitals and nursing centres. Signals are beamed up to a Telesat Anik satellite and back down again.

On the mobile side, the ambulances make use of MSAT technology, and won’t use videoconferencing at the moment because of bandwidth considerations.

The IEMN is an expansion of an earlier project, the Remote Community Services Telecentres (RCST). The RCST involved the same partners, who established satellite-based videoconferencing systems at six different centres.

The purpose was to develop telecentres in rural communities that could be used for telehealth, telelearning, business communications and high-speed Internet access.

Not only has the system been used for telemedicine, it’s also been used by doctors for education and training.

On another front, Newfoundland is forging ahead with its Wireless Homecare Project, which will use cellular-based technologies to connect visiting nurses with their offices, and with hospitals, while they are checking on patients in their homes.

The pilot project will test devices such as smart phones, palm computers and wireless notebook systems. It will also implement a variety of leading-edge software tools such as Java and Jini from Sun Microsystems, and the EPOC operating system from Symbian.

Sheppard is also manager for the Wireless Homecare Project. Another Newfoundland firm called Computers and Communications Ltd. is taking part, along with Siemens Business Services. Siemens will provide expertise in the development and deployment of healthcare applications, and play the lead role in the commercialization of the completed product.

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Who ya gonna call? SOGIQUE are Canada’s call centre experts

By Andy Shaw

You know you’re gonna call Ghostbusters if your house has just been haunted. And you also know that 911 is the number to call in an outright emergency. But if you’ve just come home from work and your child has developed a mild fever and you’re not quite sure what to do about it – Who are you going to call for a quick yet informed answer?

Or you’ve just been told by your doctor that you have a serious illness but not much else – Where are you going to turn for more enlightenment? Or if, in the middle of the night, you think you might be having an adverse reaction to a new drug you’ve just started taking – What are you going to do?

Well, in Quebec the answer is easy. You call your local community health information and social services centre (CLSC). Within a few minutes, at any time of day or night, you’ll be connected to a nurse specially trained and equipped to handle medical and especially health queries from the public.

At his or her fingertips are about 4,000 computerized pages of reliable health information organized into 400 different protocols, which the nurse can call up on a simple 486-powered workstation from a Microsoft Access 8 database. Operational for the past five years, this health information service is available in 147 CLSC centres throughout Quebec’s 18 health regions.

And something like it could be coming to a call centre near you.

“It’s something we’ve developed expertise in, so our commercial arm is marketing our Health-Info product around the world,” says Daniel Jacques, project director for Société de gestion informatique SOGIQUE inc., a not-for-profit company based at the Jeffrey Hale Hospital in Quebec City.

The bilingual Health-Info software and the training and annual upgrading that SOGIQUE provides with it are now part of call centres in Matheson, Cornwall, London, and the Ottawa-Carleton region in Ontario. Negotiations are under way for its use in Toronto and Vancouver. Elsewhere, modified versions of Health-Info are handling calls in Belgium, Brazil, France, Switzerland, and the United States.

“But it is the rest of Canada that we are really focusing on now. We can see a need for it in every province,” adds Jacques.

Asked about its origins, Jacques explains that the Quebec ministry of health set SOGIQUE up in 1986 to handle a specific problem. “At that time, there were private companies going around selling systems that were not quite working together the way they should. So we were set up to act as a kind of ombudsman and to integrate those systems.”

Since its inception, SOGIQUE has developed 27 software applications that integrate information and systems in primary healthcare, public health, mental health, and hospital services. Over 100 Quebec hospitals, for example, use a SOGIQUE-designed application that tracks their blood supplies from donor to patient.

“A lot of our products are very customized, so we are only taking a few of them to a broader market – ones like Health-Info that can be used elsewhere without much modification. In Brazil, for example, they are using Health-Info for a centralized health information call centre service for the entire country.” says Jacques.

“Our own labour board here in Quebec is also using Health-Info as the knowledge base for its intervention plan with injured workers,” says Jacques. “When people call in they can get advice and be referred, for example, to a good physiotherapist or a good psychologist. As a result, people are getting back to work more quickly and the board estimates that’s resulting in savings of about $15,000 to $20,000 per injured worker.”

Also among its more impressive accomplishments, SOGIQUE has also built a province-wide health information intranet. Currently, over 30,000 health care professionals are communicating on the intranet using Lotus Notes and soon, says Jacques, that count will rise to 60,000.

“We’re one of the world’s biggest users of the Lotus Notes application. The province picked it because we felt it was the most secure information sharing system,” says Jacques.

This extensive network helps keep Quebec’s medical and health information services decentralized. “It is usually less expensive to take a centralized approach when it comes to call centres (as Brazil has done), but when they are decentralized, people at the call centres have a better knowledge of the local resources, so it is easier to maintain good information,” says Jacques.

Taking the decentralized approach also keeps per unit costs down. The Info-Health package, including three-days of training, and annual updates can be had from SOGIQUE for about $5,000.

Depending on the size of the surrounding population, there may be as few as five Health-Info workstations and nurses operating them in a CLSC the size of Abitibi’s. Or as many as 25 in Montreal’s.

For all CLSCs, Jacques says incoming calls peak just after 5:00 p.m. when people get home from work. And they continue to be heavy until about 10:00 p.m. Overnight, when local CLSCs are closed, calls to it are automatically re-routed to regional call centres, which are kept up and running around-the-clock and ready for just about anything.

“Health-Info first of all works as a telephone triage system,” explains Jacques. “The system helps the nurse determine whether the call is an emergency. If it is, the nurse can immediately pass it on for a 911 response. Or the caller can be referred to a local walk-in clinic or to a physician.

“But over the five years we have compiled a lot of statistics with the system, and we’ve found that 70 percent of the calls we get do not require medical attention. Most people are simply looking for information, quite often out of anxiety.

“We have found that a lot of our calls are about children, so we are constantly expanding health information about kids in our database” says Jacques. “The information we put in is all scientifically reviewed by our council of experts in various fields. So that has helped doctors accept the system.”

Future developments include changing the Health-Info interface to a Web browser to increase its ease of use. A drug interaction protocol is also being added. And a revised marketing plan is aimed low, not high.

“We’ve tried to go in at the high levels of health ministries, but that ends up often with more studies being done. We’ve found we’re better off going in and seeing real people at the operational level who simply want better tools to do their job,” says Jacques.

To see how SOGIQUE’s Health-Info software works, visit the SOGIQUE Web site at www.SOGIQUE.gouv.qc.ca

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