Toronto’s 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 it’s 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 telecommunications industry.

The network offers videoconferencing, private and secure access to almost 600 web sites, 150 games and activities, chat rooms, bulletin boards, e-mail and instant messaging.

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 other.

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 hospital fundraising.

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 children’s charities based on their on-field performance. Participants donate anywhere from $100 for a strikeout up to $1,000 for every home run they hit.

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

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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. It’s 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 firm’s Health Solutions Practice. It’s her job to spot, monitor, study, and advise on healthcare technology trends.

“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 can’t 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.

That’s 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. Michael’s 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 there’s not a lot of Internet connection outside of hospital walls.”

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 wouldn’t 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 can’t 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 the country.

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 doctor’s 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 doesn’t 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, we’ll 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.”

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, they’re doing just that for all forms of medical information using “metadata tag” technology.

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 patient’s 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 Mainsource’s 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 don’t have to have an Oracle or SQL database at every location. That’s 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 United States.

“We have metastasized into the United States and now have a sales force there,” says Skinner.
That’s not surprising to Deloitte & Touche’s 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 don’t seem very inclined to go that route in Canada. We’ve 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.”

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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 hospitals.

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 (PACS).

“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 Agfa’s 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 couldn’t 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 Martineau.

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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 that’s 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. It’s a form of quality control – something that first made it’s 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 classifications.

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 project.

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,” said Beaulne.

Moreover, CCNDI is portable. A person’s information can be transferred to any type of organization that’s familiar with MDS. Previously, a new assessment would typically be made when a client moved from one form of care to another. Now, that’s 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. It’s 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, Alberta’s creation is likely to be adopted by long-term care providers around the globe.

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.

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