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Inside the May 2002 print edition of
Canadian Healthcare Technology:


Feature Report: Internet trends and healthcare


New view of medical problems at Calgary facility

The University of Calgary recently launched several medical-technology R&D projects – all with an information technology component – that are unique not just in Canada, but on the world stage as well.

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Centre for global e-health innovation launched in Toronto

Occasionally, sudden progress in the healthcare IT world can make your head spin. It recently happened for the Toronto-based University Health Network, whose eHealth Innovation program is directed by Dr. Alex Jadad.

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GE expands EMR strategy

GE Medical has further extended its reach into the electronic medical record marketplace with the acquisition of MedicaLogic, a leading developer. GE plans to offer an EMR for use in hospitals, doctors’ offices and community care.

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Hamilton projects funded

The federal government is providing $2 million to a pair of medical IT projects in Hamilton. Compete II will use EMRs and communication systems for disease management, while a surgical centre will develop the use of tele-robotic operations.

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Security concerns

In the wake of terrorist attacks and political upheavals, increasing attention is being paid to the security of computerized systems. Solutions include biometrics and outsourced management.


Healthcare via the net

Hospitals are developing a wide variety of Web-based solutions to keep up with the rapidly growing demand for information from both patients and clinicians. Canadian doctors are also devising Internet-based solutions to extend their reach outside the country.


PLUS news stories, analysis, and features and more.

 

Calgary is a magnet for top-tier, medical-technology R&D projects

CALGARY – The University of Calgary recently launched several medical-technology R&D projects – all with an information technology component – that are unique not just in Canada, but on the world stage as well.

“The projects are all prime examples of innovation at work and will help position Western Canada at the forefront of emerging technology in the health and life sciences arena,” said Stephen Owen, federal secretary of state for Western Economic Diversification. The federal agency has chipped-in $4.95 million for three of the most recent projects, which consist of the following.

• a $25 million program to create neurosurgical robots, devices that will improve the accuracy of procedures and quality of outcomes in brain operations;

• a $6 million ‘virtual reality’ centre, using high-powered computers, that will enable researchers to step inside three-dimensional representations of pharmaceuticals, biochemical molecules, and the human body itself. The facility will assist in the development of new drugs and other medical research. It will also provide the processing power for the Canadian Bioinformatics Resource (CBR) in Alberta, a computer network that allows researchers to access a variety of biotechnology and biomedical databases.

• The construction of a MRI scanner with a magnetic field strength of 9.4 Tesla, compared with the 1.5 Tesla machines that are typically used in hospitals today for clinical work. The new, $6 million system will be the most powerful MRI in Canada, and among just a few in the world in this class. It will be used for animal-based medical research and development.

When it comes to the first project, the neurorobotic device, researchers at the university have signed a $6 million contract with MacDonald Dettwiler & Associates Ltd. to help develop the technology. MacDonald Dettwiler is the company that designed and constructed the Canadarm, which has been used in the U.S. space program and the international space station.

In this case, MD engineers will assist in the creation of the ‘neuroarm’. The robotic system will actually consist of two robotic arms, each with at least six degrees of freedom, and a third arm equipped with two cameras to provide 3D, stereoscopic views. When used in the operating room, a surgeon will control the robot at a workstation. According to the university, the system will even relay the sense of touch to the physician at the control board.

Robots are able to provide better accuracy when it comes to sensitive procedures, such as implanting electrodes in the brain to treat Parkinson’s disease, drilling holes or making incisions to remove degenerative discs from the spine.

“This one-of-a-kind technology will allow neurosurgeons to perform, as never before, highly intricate surgical procedures on the human brain and spinal cord,” said Dr. Garnette Sutherland, professor and chief of neurosurgery at the university. “The system will provide us with unprecedented accuracy and dexterity.”

The technology will also be coupled with an intra-operative MRI system, enabling surgeons to image the interior of the brain as they work.

Partners in the project include MacDonald-Dettwiler subsidiary MD Robotics of Toronto, Western Economic Diversification Canada, the Seaman family of Calgary, the National Research Council and IMRIS Inc., of Winnipeg.

While robotics have been applied to other surgical specialties, such as cardiac bypass procedures and orthopedic surgery, this may be the world’s first robotic system specifically designed for brain operations.

The virtual reality centre – officially called the Sun Centre of Excellence for Visual Genomics, is an unusual setup. It’s essentially a cube that researchers can walk into, with images of molecules, organs and other structures displayed on its 8’ x 8’ walls. Wearing special goggles, the researchers see these images in 3D.

As project leader Dr. Christoph Sensen told reporters, “It’s like being inside a television and playing with the little people.” Researchers can also use handheld controls to rotate the images and zoom-in on them.

The benefit of the system? It allows scientists to visualize the shape, size and inter-relations of structures, instead of looking at rows and columns of numbers on paper – such as the codes for the human genome project.

Dr. Sensen, a professor of biochemistry and molecular biology at the university, said the device could also be used for medical education, enabling students to learn about anatomy and physiology without the need for cadavers. The centre could also be used to conduct medical experiments, reducing the need for lab animals.

Sun Microsystems of Canada is the key corporate partner in the project. It contributed $1 million worth of equipment, including a Sun Fire 6800 server, disk arrays for storage, along with tape library systems. It’s all linked by Alberta’s fibre-optic-based SuperNet to the University of Alberta in Edmonton and the University of Lethbridge.

The virtual reality room is itself called the CAVE (short for CAVE automatic virtual environment.) It was designed by Fakespace Systems of Kitchener, Ont. There are virtual reality rooms at other universities and private-sector companies, but this one at the University of Calgary is said to be one of the most advanced.

The third major project, a high-powered MRI scanner, will be created by two, newly announced facilities at the University of Calgary – the Experimental Imaging Centre and the Institute for Biodiagnostics.

The 9.4T MRI system will be used for imaging animals, and researchers say the technology will provide ‘near-cellular resolution’. They will use the system to track the course of diseases such as stroke, multiple sclerosis, arthritis and cancer, examining changes in detail and answering important clinical questions.

“The powerful technologies in this new center will accelerate our ability to take basic scientific discoveries from the laboratory into the clinic, and ultimately provide better diagnosis and treatments for our patients,” said Dr. Alastair Buchan, director of the Experimental Imaging Centre.

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Centre for global e-health innovation launched in Toronto

By Andy Shaw

Occasionally, sudden progress in the healthcare IT world can make your head spin. It recently happened for the Toronto-based University Health Network, whose eHealth Innovation program is directed by Dr. Alex Jadad.

In February, Dr. Jadad was keeping his fingers crossed that the Canada Foundation for Innovation (CFI) would provide a grant to help build a state-of-the-art centre for his growing research team. The hoped-for funding did indeed come through, and within a week of winning a $2.2 million CFI grant, the ebullient Dr. Jadad and his 20 scientists, researchers, consultants, and collaborators were showing guests around their new, 15,000 square feet of renovated UHN space. It was an open house for the “Centre for Global eHealth Innovation.”

For its part, the UHN has matched the CFI grant and together with other donors, they have given the flagship Centre a $5 million launch – and a unique global mandate: Innovate, not just for us, but for the world.

“The Centre’s mission is really an extension of UHN’s vision statement, and that is to develop exemplary patient-care with global impact,” said Dr. Jadad.

Consequently, the centrepiece of the eHealth Centre’s research facilities will be a state-of-the art “usability lab” where care delivery environments anywhere on earth can be emulated and new technologies tested.

“There’s so many things we can do with informatics,” said Tom Closson, chief executive officer of the UHN. “Now with this Centre, we can take them beyond vague concepts and actually test them out. That will put UHN and Canada on the leading-edge of medical informatics development around the world.

“So, having this Centre should lead to a transformation of not only how we provide healthcare, but also how we do research, and how we educate people,” continued Closson. “This is the centre of the future for healthcare, I’m convinced. So it is a very exciting development.”

What has also been exciting for both Closson and Dr. Jadad has been landing Dr. Gunther Eysenbach as the Centre’s first Senior Scientist.

A world-renowned expert on consumer use of medical-related, Internet information, Dr. Eysenbach built his reputation with research at the University of Heidelberg in Germany. Three major U.S. universities were trying to lure him to their campuses, but he came to Toronto instead.

“I came because the possibilities here at the Centre are endless,” said Dr. Eysenbach.

The Centre’s floor plans reveal that it will have office space and research facilities for at least eight more senior scientists.

“It will be a kind of mission control centre for innovators here,” says Dr. Jadad. “We’ll help accelerate the initiatives of people whose research is dedicated to improving patient care through information and communication technologies.”

Initiatives already under way at the eHealth Global Innovation Centre include four studies: on how 1,000 patients attending UHN clinics are making use of the Internet; on the impact of interactive stories told via a website dedicated to colorectal screening; on “coaches” used to help under-served cancer patients find helpful Internet information; and on the management of arthritis patients through an Internet-based patient communication centre.

The thousands of square feet still unoccupied at the eHealth Global Innovation Centre suggest that these efforts are just the start of a long list. Like his current projects, Dr. Jadad expects the space to be filled by increasing numbers of researchers – whose industrial partners, academic institutions, and governments collaborate to provide funding and resources.

Indeed, the eHealth Global Innovation Centre itself is an example of such collaboration. At its launch, the list of backers included the CFI, UHN, the Ontario Innovation Trust, the Canadian Cancer Society, Sun Microsystems of Canada, and the University of Toronto.

Among the facilities they’re supporting are: the “movie set” usability lab, as Dr. Jadad terms it; an observation deck where prospective researchers can learn how to make use of the Centre; a telehealth connection to 40 northern Ontario hospitals; two 30-seat classrooms for e-learning experiments, links to over 400 homes whose occupants have agreed to be part of Centre research, and soon to come, a supercomputer with the capacity to record, store, and distribute images in real-time of anything the Centre ever does.

There’s one other thing the Centre will also do in its bid to model better healthcare for the world – take advantage of its own environment. As the eHealth Global Innovation Centre’s website (www.uhnres.utoronto.ca/ehealth) points out, Toronto is home to people from 150 countries who speak 75 languages.

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GE Medical further develops electronic medical record with acquisition

MILWAUKEE, WIS. – As part of an expansion into the wider marketplace for electronic medical records, GE Medical Systems has acquired MedicaLogic, a leading U.S. developer of electronic systems for outpatient care. GE Medical paid US$35.25 million in cash.

The offering from MedicaLogic enables GE to further develop its electronic medical record technology, called Centricity Enterprise, to reach beyond hospitals and into outpatient care settings.

According to the company, the combined technology means that healthcare providers will ultimately be able to create a single electronic record for a patients’ entire medical experience – from the time of hospital admission to the last outpatient follow-up appointment.

Moreover, the entire clinical history of the patient will be accessible to clinicians everywhere during the care process, whether they are in the general practitioner’s office or the operating room of a hospital.

“It’s a strategically important acquisition for us,” said Greg Lucier, president and CEO of GE Medical Systems Information Technologies. “Our expansion into the ambulatory setting is a ‘first’ for GE, and because more patients experience care in this setting than any other in healthcare, it’s really an opportunity for us to make a major transformation in the healthcare industry.”

For its part, MedicaLogic of Hillsboro, Oregon, has 1,100 employees and claims to have installed electronic medical record systems in hundreds of hospitals, clinics and medical practices. Prominent hospitals using MedicaLogic’s software include Baylor Health Care System, in Dallas; New York University Medical Center; Yale New Haven Health System; and Wake Forest University Baptist Medical Center, in Winston-Salem, N.C.

According to GE Medical’s Lucier, “With MedicaLogic’s market penetration and acclaimed product, GE will provide the industry’s most comprehensive clinical solution as we develop a fully integrated electronic medical record that’s accessible wherever and whenever clinicians need it.”

As patients enter the outpatient setting, their historical information will be integrated into a single electronic record that moves with them even into the hospital setting, so clinicians can make timely decisions wherever they provide care and decision-making for patients.

Lucier said the acquisition of MedicaLogic creates a first-time opportunity for GE to connect entire healthcare communities together, including “integrated delivery networks”, through open industry standards coupled with clinically-focused integration and implementation teams.

GE Medical already provides an integrated inpatient clinical information system for labour and delivery, critical care, perioperative care, emergency department, med-surg, cardiology, and radiology. It claims to have invested more than $1.5 billion in technologies to help hospitals better manage clinical workflow.

“Our focus has been to transform clinical workflow for inpatient care areas through a paperless environment,” said Dr. Vik Kheterpal, vice president of Clinical Information Systems at GE. “Now by coupling the MedicaLogic offering with Centricity Enterprise, GE can offer healthcare providers an integrated, longitudinal record that enables them to create an environment that’s focused on satisfying two key objectives in healthcare today – enhanced productivity and patient safety.”

MedicaLogic says that its out-patient systems are used by more than 16,000 clinicians in the United States, and claims that its premier solution, Logician, is the most widely used ambulatory-care electronic medical record today.

“Healthcare providers will benefit from the synergies created by the transaction,” said Dr. Mark Leavitt, chairman of MedicaLogic. “Our EMR solutions for ambulatory care will complement GE’s broad and growing suite of clinical information solutions.”

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CHIPP funding to support Compete II and tele-robotics projects

By Neil Zeidenberg

HAMILTON – Two innovative medical IT projects based in Hamilton have received funding through a federal government agency. In March, Canadian Heritage minister Sheila Copps presented $2 million in CHIPP funding to managers of the Compete II and the Surgical Support Network projects.

CHIPP, the Canadian Health Info-structure Partnership Program, has been investing its kitty of $80 million into telehealth and electronic patient record projects across Canada, using a shared-cost formula.

Compete II – led by the Centre for Evaluation of Medicines, at St. Joseph Healthcare – is a sophisticated information and communications network linking diabetes patients with their family physicians, specialists, nurses and pharmacists.

It permits secure transmission of electronic health records (EHR), drug information and lab tests to support the self-management of diabetics. The overall goal is to determine whether providing customized disease information through electronic communication and phone technologies can improve the health of patients.

“Compete II will assist both electronic medical records and paper-based practices by using automated phone and data-fax technology to better integrate care amongst providers, and bring patients directly into the information and monitoring loop,” said Dr. Anne Holbrook, lead investigator of the project.

The project will establish one of the first electronic medical-record networks for family physicians in Canada, as well as the first emergency health record for patients in Ontario. As many as 100 family physicians in three cities, representing up to 10,000 Ontario diabetics, will collaborate to pilot the Diabetes Tracker and Core Data Set (a.k.a. summary health record).

The Tracker allows providers to follow their patient’s individual risk factors, and the Core Data Set assists physicians in building an electronic health record that can communicate with clinicians in any practice, regardless of the software used.

The project will also evaluate a telephone reminder system that responds only to the intended recipient. Using voice-authenticated technology, patients are notified of upcoming appointments, lab tests, monitoring information and medication refills.

“It seems deceptively simple, but the switch from paper-based to electronic healthcare will be one of the major health innovations of the century. It will drastically alter the way primary and secondary care are delivered, hopefully for the better,” said Dr. Holbrook.

The use of electronic devices will also lead to better legibility with regard to prescriptions, thereby reducing the risk of medical errors. If successful, the model can be modified for other diseases and finally establish a direct link between best medical practices and individual patients.

Also awarded funding was the Surgical Support Network at the Centre for Minimal Access Surgery (CMAS). It will conduct a telerobotics initiative that will assess the use of telehealth linkages for the purpose of telementoring – supporting surgeons in remote parts of the country.

“We want to be able to support surgeons in remote areas who wish to perform more complex procedures, but who need expert help,” said Dr. Mehran Anvari, the Centre’s founding director.

The Telerobotics initiative encompasses both tele-assistance, in which the mentoring surgeon provides assistance through the robot to the surgeon at the remote site, and tele-surgery, where the mentoring surgeon actually performs the surgery using the robot, with the remote site surgeon assisting the procedure.

Immediate benefits to patients and doctors include: improving the skills of local surgeons and teaching them the latest techniques, expanding the number of procedures done in remote parts of the country, and retaining surgeons in rural areas by providing access to continuing education.

CMAS has already mentored 36 doctors across Canada over the past three years. “We are working on telerobotics – that is operating a robot from a distance – to help assist surgeons in a wide variety of surgery. It’s an alternative to actually sending an expert to them. This option offers an expert to actually assist the surgeon in place, or even do part of the procedure if necessary, using robotics at a long distance. And so far, that is unique in Canada.”

The funding, which was matched by St. Joseph’s Healthcare, will go towards the purchase of telecommunications links. The telerobot itself – the only prototype of its kind in the world – will be rented. The prototype is a three-armed robot. One arm operates a camera, and the other two arms control surgical instruments and are used to perform endoscopic procedures. The robotic system – built by Computer Motion in Santa Barbara, Calif. – translates the surgeon’s natural hand, wrist and finger movements, permitting specialists in urban hospitals to perform complete procedures on patients in remote locations.

CMAS will connect to three partner sites: North Bay General Hospital, Complexe hospitalier de la Sagamie in Chicoutimi, and Stanton Regional Health Board in Yellowknife.

Phase one of the project will be completed by late December 2002, with the evaluation completed by March 2003. Phase two would then see six to eight robotic surgery sites established in centres across the country.

“We are very excited by this project,” said Dr. Anvari. “These methods could revolutionize surgical care in remote and rural regions of Canada. Also, it boosts the Centre’s leadership role and allows us to grow.”

 

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