Newfoundland creates ‘pay-for-itself’ health network

By Andy Shaw

A unique, “Benefits Driven Business Case” has given the Newfoundland and Labrador Centre for Health Information (NLCHI) the ammunition to seek approximately $10 million in government money to implement the first two phases of an integrated health information network (HIN) for the province. The business case, developed by a consortium led by SmartHealth of Winnipeg, proposes rather unusually that the initiative be funded from within existing health ministry funds. As such, it may become a model for HIN development everywhere.

“In putting the business case together, we went through an exhaustive consultative process with over 1,000 healthcare people and what we identified were opportunities that could be taken advantage of in eight phases,” explained Brian Eckhardt, SmartHealth’s project leader for the Newfoundland project. “And what the department of health and community services was looking for, given the financial situation in the province, was a way of implementing a HIN without increasing budgets.”

As a result, the business case is built on the premise that the savings created by implementing one phase of the plan will finance the next phase. So the eight key points of the business plan, says Eckhardt, were ranked partly by asking: Where can IT best reduce healthcare spending, and where can it be done the fastest?

The top-ranked answers were the development of a “unique personal identifier” followed by a “personal medication dispensing history” for each Newfoundland resident.

“The personal identifier, or new health card number, is really the lynch-pin for everything else in Newfoundland,” says Eckhardt. “They do have a health card number there now for everyone, but it has some issues connected with it. It has demographic data inside the numbers, for example. So you can tell from the numbers where people live and whether they are male or female, their age, and what letters their last name starts with. Also, the health-card registry needs a lot of cleaning up. So if we fix those two things, they will produce huge benefits right away.”

Eckhardt says the consultative process set up by the NLCHI also pointed to great support for and potential savings from a dispensing history. “Studies show just about everywhere that if an individual’s medication history is available on-line to pharmacists and physicians, it greatly reduces the number of bad drug interactions and all the costs associated with them.”

“The provincial government is in the due diligence part of looking at these first two phases and we should hear within a month or two” says Steve O’Reilly, the NLCHI’s director of product development. O’Reilly adds that the recent federal announcement of increased funds for provincial healthcare may slow the decision-making process somewhat, but it makes him even more optimistic the project will eventually get the go-ahead. Once approved, implementing the first two phases of the plan will take about two years.

“We’ve built in some very specific measureables for each phase,” says Eckhardt. “That means the government health people will know how much has been saved in the first two phases and we can then ask them: Do you want to proceed with phases three and four?”

In all, the eight phases of the implementation/business plan are:

1. Unique Personal Identifier

2. Personal Medical Dispensing History

3. Personal Diagnostic Service History

4. Diagnostic Service Requester Decision Support – takes an individual’s diagnostic history interactive so healthcare providers can go over test results and record new information on-line
5. Personal Medication Regimen – takes the medication history and makes it interactive so that physicians can place orders on the system and change patient’s drug regimens

6. Personal Health Information Profile – forms the beginnings of an electronic health record incorporating diagnostic and dispensing histories, allergies, chronic problems, etc., and made accessible eventually province-wide.

7. Physician Practice Pattern Profiling – allows physicians to see how their practices compare to aggregate data on other physicians’ medication and diagnostic patterns

8. Clinician Decision Support Tools – provides access by healthcare decision-makers to knowledge databases of current clinical practices and experiences.

The NLCHI business plan estimates that implementing the first two personal identifier and medication history phases, while costing about $10 million to set up, will save Newfoundland’s healthcare system $1.2 million and $4.1 million respectively each year.

When fully implemented over a five-year stretch, the project will have met its costs and will be saving the government over $6 million a year to boot.

If that happens, a number of individuals and groups will be up for kudos. They include Sister Elizabeth Davis, the CEO of the Health Care Corporation of St. John’s, under which the NLCHI currently operates. It was Sister Elizabeth who was instrumental in developing the notion of a HIN as part of Newfoundland’s 1993 Health System Task Force.

It in turn spawned the NLCHI in 1996. With the mandate to “link hospitals long term care facilities, doctors, pharmacists, and health and community services within each health region”, the NLCHI fostered a healthcare IT strategic plan prepared by the consulting firm, KPMG, in early 1998.

By October of 1998, the NLCHI had its Benefits Driven Business Case in hand from SmartHealth. The Manitoba-based firm had won a three-way race to be the implementers of the IT strategy.

Through the efforts of Newfoundland’s non-profit Operation ONLINE (Opportunities for Newfoundland and Labrador in the New Economy), SmartHealth teamed with three local suppliers.

Jane Keller and Associates used 15 years experience with provincial healthcare providers to facilitate the consultation process.

Zeddcomm Inc. of St. John’s, most widely known for its contribution to micro-gravity experiments aboard the Space Shuttle, also has experience in developing computer systems and products for Newfoundland’s pharmacists and nurses, among others.

While, xwave solutions, the largest IT firm in Newfoundland and the fourth-ranked Canadian owned IT firm in the country, already operates a large number of healthcare systems in the province, including ones for the Department of Health and Community Services.

O’Reilly also credits the NLCHI’s own widely representative steering committee for shaping and seeing the SmartHealth, pay-for-it-as-you-go business case through to the government approval stage.

Readers can find a condensed version of the NLCHI’s Benefits Driven Business Case at the www.nlchi.nf.ca/HIN/BDBC.htm web site.

BACK TO TOP OF PAGE

Hospital for Sick Children acquires $4.2 million supercomputer

By Jerry Zeidenberg

TORONTO – The Hospital for Sick Children has acquired the world’s largest computer dedicated to biotechnology and health research in a public-sector institution. “This will put us at the leading-edge of bioinformatics,” declared Mike Strofolino, president of the HSC, at a press conference. “It will put us on a platform with just one or two other [institutions] in the world.”

The Silicon Graphics Origin 2000 computer is roughly the size of four-and-a-half kitchen refrigerators, and requires a 10-ton air conditioner to keep it cool in a special data-processing room. The acquisition of the $4.2 million machine was made possible by a $1.4 million donation from Silicon Graphics Canada, as well as an undisclosed amount from a donor who wished to remain anonymous.

The device will be used chiefly by the hospital’s bioinformatics team, which is headed by Dr. Jamie Cuticchia, a specialist in the use of computers to solve genetic problems. The affable and eloquent Dr. Cuticchia was recruited to the hospital about two years ago from the Johns Hopkins University School of Medicine.

At Sick Kids, he leads a team of scientists who are pioneering the use of computers to manipulate the huge amounts of information generated by the analysis of chromosomes, genes and DNA.

Dr. Cuticchia said that in 1999 alone, more biological data will be produced by scientists than in all previous years combined. He noted that powerful computers are needed to track and make sense of all this information.

The SGI supercomputer, he asserted, will be a big help: “Computations that used to take three months to perform will take less than a day, due to the supercomputer.”

The SGI Origin 2000 runs at a speed of 32 gigaFLOPS, and is equipped with 16 gigabytes of RAM and a terabyte of disk storage. Dr. Cuticchia estimated that it operates 100 to 500 times faster than a Pentium III desktop computer.

The computer will be accessible to researchers around the globe via the World Wide Web, but those at the Hospital for Sick Children will have top priority, followed by scientists from the University of Toronto.

“Our scientists here at HSC are literally champing at the bit to release their algorithms on this new behemoth,” said Dr. Cuticchia.

Bioinformatics researchers at the Hospital for Sick Children are focused on several projects:

• Developing algorithms to search DNA sequences for ‘overlaps’.

• Examining human DNA for similarities with other organisms.

• Integrating the genetic information housed in 70 different databases around the world into one giant database.

• 3D analysis and modeling of the ‘folding’ structure of DNA and proteins.

• Development of new algorithms to find genes and understand their function.

The research is expected to advance the theoretical understanding of genetics, but may also have some practical spin-offs. For example, better knowledge of DNA and proteins may lead to the development of more effective drugs, while the ability to compare gene sequences could improve the diagnosis of various diseases.

Said Dave Wharry, president of Silicon Graphics Canada: “Having two young children myself, I understand our parental promise to ensure our children’s safety and well being from disease. I can’t think of another project that will derive such a direct benefit from this supercomputer’s technical power, accuracy, speed and enhanced success rate.”

Silicon Graphics is working with the hospital to develop algorithms for the supercomputer. The machine consists of 64 processors working in parallel.

At the announcement, Jim Wilson, Ontario’s Minister of Energy, Science and Technology, noted that the establishment of the supercomputing centre at the HSC meshes nicely with the province’s strategy for biotechnology. Announced late last year, the strategy seeks to transform Ontario into one of the top six jurisdictions for biotech around the globe.

The bioinformatics program at the HSC is part of the hospital’s Centre for Applied Genomics, which officially opened in July 1998. In addition to bioinformatics, the Centre encompasses research activities in DNA sequencing and synthesis, gene and chromosome mapping, and gene identification.

BACK TO TOP OF PAGE

Computerized system has been tailored to suit emergency rooms

By Jerry Zeidenberg

TORONTO – While many hospitals have installed sophisticated, clinical information systems, few of them have computerized their emergency departments. “Only about 2 percent of the EDs in the United States have automated,” says Mark Clifford, president of Nine Rivers Technology, based in Raleigh, N.C. He estimates that Canadian emergency rooms are in the same boat. “Most of them are operating with paper, separate from the rest of the hospital.”

According to Clifford, that’s because the helter-skelter workings of an emergency department are much different than other areas of a hospital, and the major vendors of clinical information systems haven’t created unique systems for them. “In an ED, it can be utter chaos,” he said. “If someone is brought in with chest pain or trauma, you must drop everything else and deal with it.”

However, after two years of development, Nine Rivers Technology has started marketing a software solution tailored especially to the needs of EDs. Since November 1998, the 200-person company has sold 10 of its systems – called CurrentCare ER – in the United States and it’s in negotiations for 70 more.

In March, Clifford was in Toronto demonstrating the software to several hospitals.

Armed with a computerized system, said Clifford, an emergency department can dramatically reduce the time and effort spent on searches for paper charts – and eliminate the problem of paper charts that have been lost. As well, ED managers and clinicians can produce longitudinal records for patients. By knowing the previous history and experiences of patients, they can also develop ‘bonds’ with them, improving patient satisfaction levels.

What’s more, a computerized system creates more detailed records, helping with both billing and planning, and can quickly spot bottlenecks that block patient-flow in an emergency department. Indeed, a graphically oriented screen in the CurrentCare ER program even shows the layout of a department, complete with representations of beds and the patients waiting for services.

“You can see if the lab, or radiology, or individual doctors are holding up the whole department,” commented Clifford, asserting that the software can cut an hour off a patient’s visit to an ED.

CurrentCare ER runs on Microsoft NT using the SQL Server database. The system is set up as web screens, and is ready and able to run on an intranet. “If you have six or eight hospitals in a region, you can share information quite easily,” said Clifford.

As well as operating on workstations, the software can run on ‘thin client’ systems using wireless connections to the server. At a Florida hospital, the emergency department is using Sharp Jupiter-class handheld computers with infrared transmission to the server.

Barbara Alexander, business development manager for Microsoft Canada, noted that because it’s a mission-critical application, CurrentCare ER runs on twin servers. In the off-chance that one server fails, the other can take over.

“That way, your system is never down,” she said. “It also makes it possible to do routine maintenance on one server by switching the application to the other.”

The software can be connected to the hospital pharmacy, laboratory information systems (LIS) and to radiology information systems (RIS), enabling physicians and nurses in the ED to quickly obtain various charts, test results and diagnostic images. As well, the system offers electronic order entry.

According to the company, the software is HL-7 compliant; Clifford said Nine Rivers Technology, which is a system integrator, performs custom integration to tie the ED package to hospital systems previously installed by other vendors.

Using a pen-based, point-and-click technique, a nurse or doctor can quickly note vital signs and symptoms, make a diagnosis and enter orders.

Various alarms can sound to remind a physician or nurse to check on a patient, and the software automatically flags symptoms and vital signs that are abnormal.

There’s an extensive sketch library, as well, that can be used to graphically note the location of a problem. This can be done by drawing on the sketch with a pen.

Audit trails are also built-in. The identity of the person creating or revising a record is logged, and any revisions will include the previous information, as well.

Nine Rivers Technology has a web site at www.nrt.com

BACK TO TOP OF PAGE

Wireless systems improve point-of-care computing for doctors and nurses

By Andy Shaw

Hospitals, with their large size, to-and-fro staff, and intense need for clinical information on-the-spot, are perfectly suited to wireless information systems. Caregivers equipped with hand-held or cart-born wireless devices can attend to their priorities wherever they go. They can shift from room to room untethered and still get instantly online. Nurses, for example, don’t have to return to a nursing station, to input or check patient information. They can do it wirelessly from the bedside. Indeed, almost anywhere they are in the hospital, wireless-toting staff can tap into the hospital information systems in real-time.

While it may take weeks or months to set up a wired local area network (LAN) and days to modify it, a wireless LAN can be set up in hours and modified in minutes.

Most importantly, wireless LAN networks facilitate unmatched levels of integrated and paperless patient care. Using hand-held wireless devices as they do their rounds, nurses and physicians can retrieve treatment histories right in the patients’ rooms. And, as nurses enter the patient’s vital signs or other data on their hand-helds, they are instantly alerted if the figures fall outside that patient’s norms. On a full-blown wireless system, mobile caregivers needing other resources such as lab results, care plans, and clinical protocols can pull them quite literally out of thin air while on the move.

From the new patient’s point of view, a wireless environment means their hospitalization is more likely to be comfortable, thorough and short. Upon admission, staff can enter the patient’s personal and assessment information straight from the patient’s gurney or bed and the information is instantly available to all departments. As the patient moves through the care process, their identification is scanned at every new location. This eliminates most patient transfer errors since all clinical departments have access to a patient’s whereabouts at all times. Finally, at the end of their stay, patients can be discharged wirelessly right from their rooms.

Wireless systems are also making the hospital pharmacy more safe and secure. Drug wholesalers are now packaging their wares with bar-coded dosage forms. So the wireless nurse, before medicating the patient, first scans the unit dose bar code on the drug container. Next, the nurse scans the patient’s identification tag as well as her or his own. In an eye blink, the wireless system checks to see if that particular medication and dosage have been approved for that patient at that time. With their wireless access to the hospital’s drug databases, nurses can also check on interaction dangers with drugs taken earlier – before they pass the new pill to the patient. And that whole process of who administered what medication to whom and when is instantly documented and stored.

(Such documentation of patient encounters is so systematic and complete that some insurance companies have lowered their malpractice premiums for physicians who use computerized medical record systems.)

All this sounds wonderful, you might say. But how are wireless systems actually working out in practice?

Well, so far so good at the West Park Hospital in Toronto, for one, where Autros Hospital Systems Inc. has installed its wireless Point of Care Medication Management System and had it up and running since last fall. Autros is one of the first wireless systems in Canada to automate the management of medication. It employs bar coding and wireless RF communications to link physicians, nursing teams, and hospital pharmacists with the patient at the point of care.
Here’s how. When a patient is admitted to West Park, he or she receives a bar-coded wrist bracelet. Whenever the bracelet is scanned, the bar coding identifies the patient to the hospital’s information system. When a physician or nurse uses the Autros touch-screen tablet at bedside, a flicker of its infra-red light swept over the bar code gives the care-giver instant access to the patient’s medical record. Immediately on-screen appear any drug allergies the patient may have and their current prescription record.

“I thought it would take a long time to learn how to use it, but it didn’t,” says RN Dina Olalvar, a West Park staff nurse. “We had one day of training. And once you know how to use the system, it’s very fast.”

To order new medication, the physician can simply select it from an on-screen database displayed on the hand-held tablet. This immediately places the order in the hospital’s information system and zips it to the pharmacy.

At this point, the system has already ensured a significant saving and provided a new patient safeguard. By placing the order electronically, Autros eliminates the 6 percent prescription error rate that most hospitals experience due to misinterpretation of written prescriptions.

“With the Autros system, the doctors are directly entering their orders into the computer,” says Marcy Frank, the pharmacy project manager at West Park. “That means we no longer have an issue with the legibility or interpretation of orders.”

In independent testing at the North Carolina Medical Center, researchers found that hospital use of bar code technology resulted in a 30 percent decrease in the wrong drugs being administered. The number of times patients got drugs at the wrong time dropped 43 percent. They also found a 52 percent decrease in doses being inadvertently omitted.

The bar coding can produce these dramatic increases in efficiency and patient safety partly because the Autros dispensing carts are dispatched to the floors with the right dosage on board, for the right patient at the right time. Also, every time a bin in the narcotic drawer of that cart is accessed, the system automatically records the staff member’s name plus the date and time. The result is zero discrepancies in the narcotics inventory.

At West Park, Anne-Marie Malek, the vice president of programs, says Autros thus gives the hospital unprecedented control. “We have excellent and complete understanding of exactly what our medication delivery performance is at West Park.”

Of course, a wireless LAN can support more than clinical applications. The Autros system’s backbone also supports inventory and supplies management, asset tracking and file management applications that can improve the hospital’s bottom line.

“The financial impact of Autros is quite significant from two perspectives,” says Barry Monaghan, West Park’s president and CEO. “One is an absolute cost reduction. And the other is the leverage you get from the technology. Staff efficiency goes up and you have available to you decision support and management systems that give you a new handle on who’s doing what for whom and why.”

In future, wireless medical technology seems bound to take these efficiencies beyond hospital walls. Two wireless and networking giants, Motorola and Cisco Systems, are working together to create a wireless system based on the Internet Protocol (IP). Currently, most wireless systems such as the Autros system at West Park are based on proprietary protocols. So, only the owners of the protocols or companies designated by them can develop complementary hardware and software. But the IP protocol is an open standard, meaning anyone is free to use it to develop whatever products they like.

For the medical community, such a developmental free-or-all could generate some IP-based products that would be very attractive. Think of it. Physicians could be heading to the hospital dictating care instructions as they went. Through a wireless link to the Internet, their instructions would be recorded and attached to their patients’ medical record as voice mail files. Another possibility – wireless heart monitors that transmit 24 hours a day. They would send a constant stream of patient data via the Internet to a caregiver’s ever-watchful computer.

Though these developments may be several years away, the bet here is that wireless technology will soon move to the center of modern health care.

BACK TO TOP OF PAGE

HOME - CURRENT ISSUE - ABOUT US - SUBSCRIBE - ADVERTISE - ARCHIVES - CONTACT US - EVENTS - LINKS