Inside the Nov./Dec. 2000 print edition
Canadian Healthcare Technology:
Feature Report: Healthcare, the Internet and intranets
Hospital for Sick Children joins Starbright World
The Hospital for Sick Children has become the first Canadian medical
centre to join Starbright World, a U.S. organization that uses a variety of online
computer technologies to enhance the health and spirits of youngsters who are battling
Widespread usage of the Internet in hospitals has not yet occured
Hospitals are stymied by funding shortages, concerned about security
and standards for exchanging data.
PACs implemented at Quebec hospital in just nine weeks
Centre Hospitalier Pierre-Boucher, in Longueuil, Quebec, has created a
filmless radiology department in a matter of just nine weeks. That compares
with the months or years taken to install similar systems in other hospitals.
The rise of MDS in long-term care
Canadians have recently surged to the forefront when it comes to
developing computerized systems for the long-term care sector. Recent advances include a
system that combines the best of MDS.
Medical device challenges
By July 2001, manufacturers of medical devices will have to meet
rigorous quality standards when selling in Canada. The vendors are faced with other
regulatory and pricing pressures, as well.
ASP for Saskatchewan
Healthcare centres throughout Saskatchewan, and First Nations reserves,
have struck a $2.5 million deal with MediSolution Ltd., of Montreal, and AIM Inc., to
obtain a range of healthcare software products over the Internet using ASP technology.
The use of a laboratory information system, coupled with
re-engineering, has enabled St. Marys Hospital in Montreal to attain a 77 percent
increase in throughput. The hospital has become a model site for others seeking to
implement an LIS.
PLUS news stories, analysis, and features and more.
Torontos Hospital for Sick Children to join Starbright World network
By Neil Zeidenberg
TORONTO For most kids, being cooped up in a hospital bed is a
tough pill to swallow. Hours go by with little to do the high point of the day
might be having a blood-sample taken.
But a U.S.-based initiative that raises the spirits of hospital-bound
kids is attempting to change that. And its coming to Canada.
Starbright World a computerized network that connects children
in hospitals across North America was officially launched at the Hospital for Sick
Children (HSC), in Toronto, in September. Headed by Hollywood producer Steven Spielberg,
Starbright World is backed by members of the entertainment, computer and
The network offers videoconferencing, private and secure access to
almost 600 web sites, 150 games and activities, chat rooms, bulletin boards, e-mail and
The Find A Friend program lets children search for other
kids with similar interests, hobbies and illnesses. They can even search specifically for
a certain age range.
The feature encourages kids to communicate and socialize with each
A study conducted at the Mount Sinai Medical Center in New York found
that children experienced less pain and anxiety while engaged in Starbright World than
when engaged in other recreational activities.
Interactive CD-ROM games are available on a variety of topics like
diabetes, cystic fibrosis and sickle cell anemia. Kids can also access information on
common medical procedures ranging from bone marrow aspirations to radiology procedures.
The information is explained in a way that can be understood by a younger audience.
A program called Videos With Attitude addresses solutions to the
difficulties faced by young people with serious illnesses. Topics include Back to School,
an instructional video that prepares kids for re-entering their curriculum, Plastic Eggs
or Something!?, a video that helps young patients get through life in a hospital
environment, and What am I Chopped Liver?, a video that helps young patients
communicate with their doctor. Videos are free to teens with serious or chronic illness
and their families. For all others, a donation of $25 for each is requested.
Starbright Hospital Pals is designed to reduce anxiety and the need for
anesthesia in pre-school children undergoing radiation therapy (RT). During treatment,
childrens character Barney narrates stories, providing a distraction and
companionship so that young patients stay calm and still for the procedure.
Overall, the Starbright network addresses the issues that accompany
serious illness the pain, fear, loneliness and depression that can be as damaging
as the sickness itself.
We are thrilled to be the first hospital in Canada to offer the
Starbright program to hospitalized children, said Dr. Brian Shaw, chief of community
and mental health services at HSC. Since many of these children are in isolated
environments, it will enable them to interact and share experiences with other children
facing similar challenges.
The Starbright partners include Dell Canada, Global One and the Garth
Brooks Touch em All Foundation. Additional money for the program was raised through
Dell Canada has donated a total of 17 Optiplex GX110/L personal
computers to be used with the high-speed network connections donated by Global One, a
telecommunications company created from the merging of Deutsche Telekom, France Telecom
and Sprint. Sprint is the exclusive telecommunications sponsor for Starbright World,
supplying the network infrastructure.
Dell Canada is proud to partner with a program recognized for its
exceptional use of technology that benefits seriously ill children in such a meaningful
way, said Lawrence Pentland, president of Dell Canada. As personal computers
improve how we communicate, we believe that they will help bring these children together
and enhance their lives.
The Garth Brooks Touch em All Foundation a non-profit
organization founded in January of 1999 includes over 130 major league baseball
players who donate money to childrens charities based on their on-field performance.
Participants donate anywhere from $100 for a strikeout up to $1,000 for every home run
Starbright World in the United States has attracted many high profile
leaders. In addition to Steven Spielberg, it is co-chaired by General H. Norman
Schwarzkopf. Other corporate and foundation sponsors include The Troy Aikman Foundation,
and Turner Entertainment Network.
For more information on Starbright, you can visit their Web site at www.starbright.org
Widespread usage of the Internet in hospitals has not yet occurred
By Andy Shaw
Never have Canadians expected more of their healthcare system. And
never has there been more technology available to help providers deliver care to
Canadians. Its also fair to add, says Irene Podolak, that never have healthcare
providers expected more of technology. She should know. Podolak is a Toronto-based partner
of Deloitte & Touche who heads up the consulting firms Health Solutions
Practice. Its her job to spot, monitor, study, and advise on healthcare technology
It is the Internet that is raising expectations on both
sides, notes Podolak. Healthcare consumers, because of their growing
involvement with the Internet, are expecting more and better health information to be made
available to them. And healthcare providers, because of their Internet experience at home,
are asking themselves more and more: Why cant I get similar access to the
information I need at work?
In short, both patients and providers alike want better access to
decision making information. Yet Canadian hospitals have, so far, not turned to Internet
to help them.
Thats the conclusion Podolak draws from a Deloitte & Touche
study of the strategic forces impacting the Canadian healthcare system. Podolak conducted
the study in 1999, with the help of contributor Pat Jeselon, along with John Wegener of
St. Michaels Hospital in Toronto.
Access to the Internet in hospitals is still generally very
limited, says Podolak. People in management tend to have it, but otherwise the
percentage of staff with Internet access is quite small. They have internal networks for
e-mail. But otherwise theres not a lot of Internet connection outside of hospital
To reach beyond their walls and connect with other healthcare
institutions in their region, the Deloitte & Touche study reveals, hospitals by and
large have gone to protected networks, or extranets, in one form or another.
But they cost money and the lack of money so far has been a real
inhibitor of making regional networks happen, says Podolak. She cites Ontario
tight-fistedness as a classic example.
The impetus was there. The Ontario health services restructuring
commission had closed down hospitals, merged others, and acknowledged that to manage
patients effectively at different service encounter points this change imposed, the
providers that were left would have to be linked. Yet the government wouldnt fund
the IT side of making that happen, she says.
Nor do hospitals themselves have the wherewithal these days to make
those links or take much advantage of other innovative technologies, adds Podolak.
Most are in a deficit position. Y2K ate up tons of money and hospitals simply
cant find the capital.
Yet the Deloitte & Touche study revealed there is good news out
there. Projects aimed at better, cheaper, more easily accessed information abound across
Among the most hopeful are those exploiting the low costs and
universality of the Internet. In Alberta, for example, money from the provincial heritage
fund that taps oil and gas profits is helping to fuel a trial in Red Deer.
There, 15 family physicians are linked by an always-on Internet
connection to a secure web page maintained by Infoward Inc. (www.infoward.com) in Edmonton. From a stand-alone
Pentium PC, the physicians are presented with a desktop developed by another Alberta
company, Clinicare Corp., headquartered in Calgary. Its CLINT Desktop technology is
essentially a knowledge organizer that supports clinical decisions.
It is a huge resource library that keeps guidelines, research,
literature searches, and everything else up-to-date that a practicing physician might want
to consult to answer clinical questions, explains Dr. Neil Bell. That means
the doctors office does not have to try to duplicate the labour, and keep its
references all up to date.
And the doctor can get what he or she is looking for in a minute or
two. Because the access is always on, the doctor doesnt have to dial up and sign in
every time they need new information. That is a huge advantage alone.
Dr. Bell is a practicing physician but also works for the departments
of family medicine and public health at the University of Alberta, where he is an
associate professor responsible for research. Bell says he wrote-up the Red Deer
experiment as a research project while studying at Harvard University. Then he found
Alberta Heritage Foundation funding for it when he returned home.
We had seven or eight doctors originally signed up for the
project in Red Deer, but when others heard about it they wanted get on board too,
says Bell. And so far they are all reporting that they are very happy with the
system. Down the road, well do some research to see if it really does change how
well they manage their patients and whether it improves outcomes. But right now, so far so
Good enough, in fact, that similar projects using the Clint Desktop
were announced in July that will see physicians in Cumberland, B.C., Brandon, Man., and
Markham, Ont., also putting it to the test.
If such Internet-based knowledge is the alternative to the forbidding
costs of building and extending private networks, then all users must have the confidence
that the Internet can be made secure. At Mainsource Software Corp. in Ottawa, theyre
doing just that for all forms of medical information using metadata tag
With it, hospitals can create secure web portals for detailed clinical
information and via the Internet pass medical records safely far beyond their walls to
physicians, other healthcare institutions, and even patients alike.
A patients record can be a complex collection of data,
including text, as well as the sound of the heart, say, and the image of an x-ray,
explains Dr. Christopher Skinner, a practicing neurologist and Mainsources
vice-president of product development. But we can represent those different data
with a metadata tag. Then distribute those tags like a URL. So you can click on the tag
icon no matter where you are. Meanwhile, the data is not out on the Internet but sitting
safely encrypted in a repository somewhere else in the province or even country.
Such a system exists already for the Department of National Defence.
It means a serviceman can go from one military base to another have a complete
medical record follow him, says Dr. Skinner. He might have his blood pressure
checked at one base, or an electrocardiogram done at another.
The results will remain as an encrypted data object where they were
created but the tags will replicate themselves on other servers. So you can access the
data from everywhere yet dont have to have an Oracle or SQL database at every
location. Thats a really different paradigm.
For physicians, this flexibility means patient records are available in
the office, at the bedside or even at home. For the patients, their complete medical
records can be just a few keystrokes or mouse clicks away. For hospitals, clinical data
can now be integrated with other hospital systems or with other hospitals and clinics. As
Skinner points out, the tag technology will also defer to third-party security systems
that require a security certificate to authorize the export of data. Also, Mainsource
products create an audit trail, recording every data transaction and every viewing of
data. This makes them compliant with impending privacy legislation in both Canada and the
We have metastasized into the United States and now have a sales
force there, says Skinner.
Thats not surprising to Deloitte & Touches Podolak.
In the United States you are definitely seeing an increasing use
of the Internet to share electronic health records, says Podolak.
But so far we dont seem very inclined to go that route in
Canada. Weve been moving down the path of creating large infrastructures with
extranets. But the bottom line is they are very expensive. The Internet offers another
solution that is very affordable.
PACS implemented at Quebec hospital in just nine weeks
LONGUEUIL, QUE. Centre Hospitalier Pierre-Boucher, in Longueuil,
Quebec, has created a filmless radiology department in a matter of just nine
weeks. That compares with the months or years taken to install similar systems in other
The 327-bed medical centre now obtains images, transmits and stores
them using computerized technology and networks, complete with workflow techniques that
improve the way radiologists operate by automatically calling up and transmitting images
and patient records.
The modalities that have gone filmless are x-ray, ultrasound, digital
fluoroscopy and nuclear medicine. Images are all digitally recorded, viewed on a monitor,
transmitted to different areas of the hospital for consultation, and archived, eliminating
traditional film-based, picture-handling.
The fact that we were able to take Pierre-Boucher filmless so
quickly is an example of excellent project planning and implementation at every level of
the organization, said Julian Sale, vice president, medical imaging, for Agfa Inc.,
of Toronto, the vendor that installed the picture archiving and communication system
This was the fastest PACS implementation of its size anywhere by
any vendor, asserted Sale.
The speedy implementation was accomplished through a teamwork approach that involved
several departments radiology, information technology and administration, along
with the vendor.
Before getting Agfas IMPAX system up and running, patient
diagnosis and treatment at the hospital used traditional film-based imaging. Delays in
diagnosis often occurred as patients waited for images to be processed and transmitted
from radiology to their primary-care physicians.
With IMPAX, healthcare providers can now access images and radiology
reports remotely, reducing the amount of time patients spend anxiously waiting for medical
results and diagnoses.
Having an IMPAX system means that we are able to offer our patients state-of-the-art
diagnostic capabilities already being used in hospitals across North America, said
Donald Martineau, radiology manager at Centre Hospitalier Pierre-Boucher. We
couldnt be more pleased.
Traditionally, coordinating patient paperwork and images was a
time-intensive and cumbersome process, requiring the physical transfer of films and
documents from one department to another. The electronic transfer of radiology images and
data across multiple departments eliminates waiting time for doctors and patients.
In addition to improving patient care, Pierre-Boucher has eliminated
the cost of film and film processing. Pierre-Boucher performs 100,000 radiology exams each
year and estimates the IMPAX investment will pay for itself within five years, a direct
result of decreasing costs associated with film handling and archiving.
Pierre-Boucher represents the first full installation of an IMPAX
system in Quebec. At present, very few Quebec hospitals are equipped with this type of
diagnostic imaging capability, a situation it is anticipated the Quebec government aims to
rectify by subsidizing future installations.
After 18 years of operation our radiology equipment was becoming
obsolete, and so it became our mission to provide our patients and staff with the best
possible solution, in the fastest time, with the least amount of disruption said
Albertans provide new, computerized tools for long-term care sector
By Jerry Zeidenberg
Canadians have recently surged to the forefront when it comes to
developing computerized systems for the long-term care sector. Chief among them have been
John Hirdes a professor at the University of Waterloo and Paul Beaulne an
adjunct professor in Rehabilitation Medicine, at the University of Alberta.
John Hirdes is the director of the Canadian Collaborating Centre for
interRAI, which is based at the Providence Centre in Scarborough, Ont.
Hirdes and his colleagues have been developing the Minimum Data Set
(MDS) 2.0 tools for various types of long-term care centres such as nursing homes,
chronic care hospitals, and mental health centres.
Currently, Hirdes has been refining these assessment tools
essentially report cards that enable care-givers to make constant improvements
through a $1.67 million research project thats funded by the federal government. His
team is working with continuing care centres in four Ontario cities.
Overall, MDS 2.0 is an international project, with roots in the United
States. The effort under way since the mid-1980s has established methods of
assessing patients in long-term care and improving their care through continuous
monitoring. Its a form of quality control something that first made its
mark in industries like steel and automobiles, and is now being applied to enhance the
workings of the healthcare sector.
Briefly, proponents of MDS say that if you cannot measure something,
you cannot improve it. Therefore, in a sector where, previously, very little was measured,
the MDS researchers around the world have created dozens of quality indicators and care
They score residents on such things as cognitive abilities, memory,
depression determining the level of independence or care the client needs. A
battery of physical attributes is assessed, such as mobility, the history or danger of
falls, pressure ulcers and incontinence.
Over the past decade and a half, however, most of the development of
MDS has focused on creating separate sets of tools for the various long-term care sectors
such as nursing homes, psychiatric hospitals, and home care.
Paul Beaulne, a researcher in Alberta has produced a breakthrough by
integrating many of the assessment categories into a single system. Called CCNDI (short
for Continuing Care Needs Determination Instrument), the package enables long-term care
clients of all types to be assessed through a single point of entry in a healthcare system
(such as the Continuing Care Access Centres in Ontario).
The CCNDI allows for the easy transfer of the records to various
healthcare service settings, when clients are transferred from health care program to
another. We pulled together all of the best MDS tools, and put them into a single
assessment system, said Paul Beaulne, the lead researcher of the Alberta-backed
Beaulne is also director of the RAI Research Network in Edmonton, and
president of MED e-care Healthcare Solutions Inc., of Toronto. The RAI Research Network is
a research and consulting organization specializing in the long-term care sector. His
company, MED e-care, is now commercializing the CCNDI system, along with other MDS tools,
and is installing it in continuing care settings such as home care, community care and
long term care centres.
MED e-care has systems up and running in over 120 sites. (There is
still work to be done, however, as there are some 2,300 long-term care organizations
across Canada.) Through the use of 250 data elements in 20 different domains, CCNDI allows
care-givers to determine what sort of environment a new client needs such as
home-care, community care or a nursing home.
It also provides the means for continuous quality control. After
three months, you can make another assessment to see if improvements have been made,
Moreover, CCNDI is portable. A persons information can be
transferred to any type of organization thats familiar with MDS. Previously, a new
assessment would typically be made when a client moved from one form of care to another.
Now, thats no longer necessary.
It should be noted that functional assessments are a major undertaking.
These assessment require the involvement of a multi-disciplinary team of care
providers to determine the best setting in which to provide care, notes Beaulne.
Why do it again when a patient moves from home care to a nursing home?
Using CCNDI, the assessment can move from the point of entry, to home
care, nursing homes, assisted living, chronic care hospitals, psychiatric centres
or any other. Along the way, the various institutions can add other MDS tools and data to
the patient record.
Earlier this year, in July, the Canadian Health Information Institute
(CIHI) announced that it was endorsing CCNDI, contingent upon successful provincial
pilots. Already, CCNDI has passed muster in its Alberta pilots, and is being rolled out
province-wide. Its now being tested by Saskatchewan in Saskatoon and Regina.
Beaulne said that interRAI the non-profit organization that
develops and licences MDS tools worldwide has signed an agreement with CIHI to
participate with the province of Alberta in implementing the CCNDI. As a result,
Albertas creation is likely to be adopted by long-term care providers around the
Beaulne stressed that CCNDI was a large project that involved many
people. Alberta Health and Wellness invested some $1.2 million, and another $1.3 million
in staff time was donated at 56 different long-term care facilities in 12 health regions
across the province.
The amount of data collected was daunting 4,000 assessments were
completed on continuing care clients, and in each case, some 800 items were tracked. In
addition the project collected 250,000 records of staff time data in order to develop the
56 group- Continuing Care Classification System (CCCS) to determine funding levels for
continuing care in Alberta.
All of this was distilled resulting in the tools deemed most
necessary to make an initial assessment of a long-term care client. Beaulne noted that Dr.
Hirdes provided enormous resources for us. He also acknowledged the work and
help of Dr. Brant Fries of the Centre for Health Policy and Management at the University
of Michigan and Dr. John Morris at the Hebrew Research Centre in Boston, two other key
developers of MDS tools.