november/december 2016 edition – full issue

BY JERRY ZEIDENBERG

BRAMPTON, ONT. – It has been almosta year-and-a-half since WilliamOsler Health System launched thefirst-ever, Managed Equipment Ser-

vices (MES) deal for a Canadian hospital. Asthe pioneer in this area, the agreement wassomething of an experiment, but it has pro-duced solid benefits for Osler, one of thecountry’s largest community hospitals.

“We’ve replaced about 30 pieces of diag-nostic imaging equipment in the past year,”commented Joanne Flewwelling, ExecutiveVice President, Clinical Services and ChiefNursing Executive at Osler. “The agreementhas allowed us to stay on the leading edge ofclinical advances.”

Osler went live with the MES agreement,

in partnership with Siemens Canada, inJune 2015. Since then, others have followed.The new Humber River Hospital inToronto, which opened in October 2015,implemented an MES with GE Healthcare,and Mackenzie Health announced an MES

deal with Philips for its upcoming Macken-zie Health Vaughan site, as well as its exist-ing facility.

Flewwelling observes that Osler was on theverge of refreshing dozens of pieces of imag-ing equipment when it awarded the MEScontract to Siemens Canada. The hospital’s

Brampton Civic site had opened as a brandnew facility in 2007, with equipment that wasdue for a refresh after eight to 10 years.

The DI and cardiology systems at Osler’sother site, Etobicoke General, just outsideToronto, was also ready for an update.

“It was going to create a cash-flow issueall at once,” says Flewwelling. “A lot of equip-ment was going to reach the end of life at thesame time.”

In addition, in early 2017, Osler would beopening a brand-new outpatient hospital –the new Peel Memorial Centre for IntegratedHealth and Wellness – which would requireall new equipment.

So after issuing an RFP and going throughthe evaluations, Osler signed a 15-year con-tract with Siemens to replace and maintain

Osler shows benefits of managed equipment agreement

CONTINUED ON PAGE 2

MyChart, a Personal Health Record system developed by the Sunnybrook Health Sciences Centre, is gaining momentum and now has 140,000users. In addition to Sunnybrook’s patients, MyChart is available to patients, families and clinicians at many other hospitals. In future, the sys-tem may be used by facilities outside Canada. Pictured are Sunnybrook team leaders Sarina Cheng and Sam Marafioti. SEE STORY ON PAGE 10.

MyChart PHR serves growing number of patients

PHO

TO:

DO

UG

NIC

HO

LSO

N,

SUN

NY

BRO

OK

HEA

LTH

SC

IEN

CES

The deal helped alleviate a cash-flow crunch, and provides Oslerwith the appropriate equipment.

INSIDE:

Newfoundland’s EHRNewfoundland and Labrador areleading the way to a fully con-nected provincial EHR. By April, theprovince plans to have all four ofits regional authorities feedingdata into a central repository. Page 4

The power of analyticsA team at the University of OntarioInstitute of Technology has beendeveloping the Artemis analyticssystem. It anticipates problems en-

countered by infants in NICUs, andsaves lives. Now the team is ex-panding the scope of Artemis.Page 6

EMR for mental healthPsychiatrist and computer scientistDr. David Gotlib found that tradi-tional EMRs didn’t suit the needsof mental health professionals. Heproduced KoNote, which is opti-mized for charting free-form notesand logging numbers.Page 4

ImagineNation hits 5 yearsInfoway’s ImagineNation Chal-lenges program is now five yearsold. We look at some of the pro-gram’s successes, which include

improvements in prescription dis-pensing and tracking, and an appthat helps expectant parents navi-gate pregnancy.Page 8

Pub

lication

s Mail A

greem

ent #

40018238

FEATURE REPORT: INNOVATIVE HEALTHCARE PROVIDERS – SEE PAGE 16

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 21, NO. 8 NOVEMBER/DECEMBER 2016

INFOWAYAWARDS

PAGE 8

190 pieces of imaging equipment through-out the hospital.

It meant the organization could re-place its aging equipment without takinga major hit on capital resources – instead,the costs would be spread over the next15 years.

At the same time, it would receive ongo-ing equipment replacements and servicingover the life of the agreement for all threeof its hospitals – the Brampton Civic, Eto-bicoke General and Peel Memorial sites.

And with Siemens, it felt it had a part-ner with deep experience in medical imag-ing and managed equipment agreements,which it has conducted in Europe andaround the world.

“We wanted someone with global expe-rience in MES,” says Flewwelling. “We didhave a relationship with Siemens in thepast, but when it came to choosing a part-ner, we had a robust RFP process. We hada fairness advisor, too, as we didn’t wantothers to feel excluded.”

Perhaps the greatest success story todate has been the replacement of an aging

MR machine at the Etobicoke site with astate-of-the-art 1.5T scanner.

“It was a seamless transition,” says Joe-Anne McCue, Director of Diagnostic Imag-ing and Laboratory, noting the newSiemens machine was installed and quicklymade operational in November 2015. Whilethe old scanner was removed, and beforethe new one was up-and-running, Siemenssupplied a portable scanner at the site.

As a result, nearly all patients couldhave their exams done on schedule at theEtobicoke site. “Only one patient couldn’tbe accommodated, and that patient wastransferred to another Osler site,” saysFlewwelling. “It was a real testament to theproject management skills of the partners.”

Of course, other modalities that havebeen replaced have ensured the hospital isstate-of-the-art in additional areas, too, in-cluding Computed Tomography.

A key part of the MES agreement is thatnot all of the equipment is to be suppliedby Siemens.

“It was important for the stakeholdersto have this assurance,” says Flewwelling.“They wanted to know they would be get-ting leading-edge equipment.”

For example, Osler is switching fromCR to DR in its portable X-ray devices, andhas opted for Carestream as the vendor.Similarly, it is replacing its general purposeultrasound systems across the three hospi-tals, and has chosen Philips as the pre-ferred supplier.

However, in many areas, Osler will beopting for Siemens equipment. “We knowthat Siemens is a leader in the market forMRI and CT,” says McCue.

Osler is currently focusing on a majorrefresh of systems at its Brampton Civicsite, where $50 million to $60 millionworth of equipment is nearing its end of

life. This will be followed by a major in-vestment in DI and cardiology equipmentat the new Peel Memorial, in 2017, and byongoing upgrades at Etobicoke General.

The team at Osler has focused on diag-nostic imaging and cardiology equipmentin its MES with Siemens – unlike otherhospitals, which have created blanketagreements for all types of equipment, in-cluding surgical rooms, environmentalsystems and various types of software.

“We purposely limited it to DI and car-diology,” says Dr. Joseph Fairbrother, Osler’sChief of Diagnostic Imaging and the archi-tect of the MES strategy. He said that if toomany areas are included in an MES, theproject can become difficult to manage,with too many competing priorities.

“In some regions, MES hasn’t workedwell,” says Dr. Fairbrother. He and mem-bers of the team examined the experiencesof hospitals that have implemented MESagreements in the U.S. and U.K.

By maintaining a focus on DI and car-diology, Dr. Fairbrother believes the OslerMES has produced a manageable and ef-fective strategy. It is delivering state-of-the-art equipment, with the features andcapabilities that are needed.

It is also bringing the appropriateequipment into the hospital, at the righttime, resulting in additional cost-savings.

“We’re not procurement experts, we’reimaging experts,” he notes. “Now, we’vegot people shopping the market for us, andthey are experts.”

That’s proven to be a huge time-saverfor Dr. Fairbrother and his colleagues.

“We were spending too much time ad-vocating for equipment,” observes Dr.David Kelton, Site Chief of DiagnosticImaging at Osler’s Brampton Civic Hospi-tal and specialist in Interventional Radiol-ogy. That included researching equipment,attending meetings and making pitches forvarious types of technologies.

And with so many modalities involvedin modern-day patient care – MRIs, CTs,ultrasound, general and portable X-ray,angiography and others – Dr. Kelton saysthat kind of advocacy “just isn’t possibleanymore.”

The MES has been a huge advantageon this front, says Dr. Kelton. “It frees upyour time, and allows you to focus onclinical care.”

In particular, this year Osler launched anew stroke program, called Code Stroke,and it opened a new vascular program –the Endovascular Therapeutics Program –before that.

By reducing the time spent on equip-ment procurement, physicians at Oslerhave had more time to develop and fine-tune these programs for patients.

CONTINUED FROM PAGE 1

Art DirectorWalter [email protected]

Art AssistantJoanne [email protected]

CirculationMarla [email protected]

Publisher & EditorJerry [email protected]

Office ManagerNeil [email protected]

Address all correspondence to Canadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9 Canada. Telephone: (905) 709-2330.Fax: (905) 709-2258. Internet: www.canhealth.com. E-mail: [email protected]. Canadian Healthcare Technology will publish eight issues in 2016. Featureschedule and advertising kits available upon request. Canadian Healthcare Technology is sent free of charge to physicians and managers in hospitals, clinicsand nursing homes. All others: $67.80 per year ($60 + $7.80 HST). Registration number 899059430 RT. ©2016 by Canadian Healthcare Technology. Thecontent of Canadian Healthcare Technology is subject to copyright. Reproduction in whole or in part without prior written permission is strictly prohibited.Send all requests for permission to Jerry Zeidenberg, Publisher. Publications Mail Agreement No. 40018238. Return undeliverable Canadian addresses toCanadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9. E-mail: [email protected]. ISSN 1486-7133.

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION TECHNOLOGY IN HEALTHCARE

Volume 21, Number 8 Nov/Dec 2016

Contributing EditorsDr. Sunny MalhotraTwitter: @drsunnymalhotra

Dianne [email protected]

Richard Irving, [email protected]

Rosie [email protected]

Andy [email protected]

William Osler’s Flewwelling, Kelton and McCue.

William Osler Health System shows benefits of first-ever MES deal

Register now. Reserve your place. Go to algonquincollege.com/digitalhealth

Effectively Leverage and Use IT in Healthcare EnvironmentsThe Algonquin College Digital Health Graduate Certificate program delivers the proven benefits of integrating management, healthcare, and technological skills.

Put technology to work. Stay current for safer patient care.

60of the program is offered online.

%

Learn while staying in your current healthcare environment.

2 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y N O V E M B E R / D E C E M B E R 2 0 1 6 h t t p : / / w w w . c a n h e a l t h . c o m

In the ever-changing world of health care,

Allscripts can help you master the future.

Our solutions improve care and operations

across your organisation — to take you as

far as you want to go. We put precision

and power in your hands.

Drive the health care of tomorrow.

LEAD THE

CHANGE TO SMARTER CARE

allscripts.com

LEA

CHA

AD THE

ANGE TO

O

CHA

SMACAR

ANGE TO

TERARRE

O

R

In the eve

Allscripts c

Our solutio

-changing world ofr

can help you maste

e aove carons impr

e,f health car

e.er the futur

nd operations

k

oss youacr

far as you

and powe

Drive the

ganisation — tour or

upewant to go. W

er in your hands.

e of tomhealth car

o take you as

noisicerpt

.oww.morr

allscripts.c

com

N E W S A N D T R E N D S

BY JERRY ZEIDENBERG

By April, Newfoundland andLabrador will have 100% of itscommunity pharmacies con-nected and delivering data into

HEALTHe NL, its provincial electronichealth record. Moreover, it will have allfour of the province’s health authoritiesfeeding various types of data into therecord by next summer.

That means healthcare professionalsacross the province – from St. John’s in theeast to Labrador City in the northwest –will have access to critical patient informa-tion in a matter of seconds.

These developments are just some ofthe latest in Newfoundland and Labrador’sjourney to the province-wide, electronichealth record, a goal it calls, “One Patient,One Record.”

“In the next 12-18 months, we will haveone of the most comprehensive provincialEHRs in the country,” says Gillian Sweeney,VP of Clinical Information Systems andQuality at the Newfoundland and LabradorCentre for Health Information, the leadagency for implementing the system.

On tap for the near future: e-referrals,e-prescribing and a patient portal. “We arescoping them out,” says Sweeney.

The province has already achieved agreat deal. Sweeney outlined the progressthat’s been made and the plans for the fu-ture in a recent webinar, titled “The HolyGrail of Healthcare: One Patient, OneRecord.” (It can be accessed at:http://web.orionhealth.com/holy-grail-of-healthcare-registration.html)

Of course, the investments in HEALTHeNL have been made to enhance patient care.By providing accurate clinical information,

clinicians will be able to make faster andbetter decisions about patient treatmentsand care plans. Almost one-third of New-foundland and Labrador’s 6,500 healthcareprofessionals have signed onto the system,and more are expected as the capabilities ofthe solution quickly grow.

Currently, there are six sources of infor-mation that feed into the clinical datarepository, which has been built for theprovince by Orion Health. It is at the heartof Healthe NL, along with the viewer,which was also supplied by Orion Health.The six sources of data include:

• Client Registry• Pharmacy Network• Provider Registry• Community health (such as

immunizations)• Hospital Meditech systems (includes lab

results, DI reports, encounter notes, etc.)• PACS (for diagnostic images)

“We were the first in the country to in-troduce a client registry,” observes Sweeney,noting the solution accurately identifiespatients and links data between systems. “Itprovides real-time authentication at thepoint of care.”

The province was also one of the first inCanada to have a PACS repository; about99 percent of the imaging in Newfound-land and Labrador is digital, and 55 mil-lion studies are stored in the provincialPACS each year.

Meditech is used at hospitals in each ofthe four Regional Health Authorities, butdifferent versions have been implemented.That has created an integration challenge,but the NLCHI intends to have them all con-nected to HEALTHe NL by next summer.

Pharmacies have proven to be a very im-portant source of data. Of the province’s

202 pharmacies, 136 are now feeding datainto HEALTHe NL, and the goal is to havethem all in the system by April.

On another front, the NLCHI has alsolaunched a physician EMR project, whichis designed to link physician systems toHEALTHe NL. EMRs for doctors in theprovince are supplied by Telus Health.Sweeney said co-leaders in the project arethe Department of Health and Commu-nity Services and the Newfoundland andLabrador Medical Association.

“Partnerships with vendors, profes-sional associationsand RHAs have allbeen critical to get-ting the project offthe ground.”The EMR programis known as eDOC-SNL, and the firstphase of integrationwith the EHR in-cludes the client andprovider registries,laboratory results,

diagnostic imaging and clinical docu-ments. The plan calls for a November 2016rollout of this initial phase.

For its part, HEALTHe NL is currentlyexperiencing robust usage, with 260,000transactions per month being exchanged be-tween the four RHAs and the client registry.

Sweeney notes that constantly checkingand maintaining the integrity of data is acrucial function. As far back as 2002, theprovince created a registry integrity unit toensure data quality and accuracy. In onesix-month period in 2016, the unit re-solved 11,000 tasks to maintain the accu-racy of information – which goes to showhow important this activity really is.

NLCHI is continually tracking how clin-icians are using HEALTHe NL. Interestingly,the major users are nurses. Indeed, fully 75percent of the users are nurses, followed byphysicians (10 percent), pharmacists (8 per-cent), licensed practical nurses (4 percent)and nurse practitioners (3 percent).

To date, the system has been usedmostly to obtain DI reports (41 percent)and medication profiles (23 percent). Sig-nificantly, the volume of requests for med-ication data has recently overtaken DI re-ports, Sweeney notes.

The addition of many community phar-macies this year has helped drive up the re-quests for medication profile information,as more patient information was available.

As one nurse told the NLCHI, “I havebeen using HEALTHe NL for the list ofmedications on a daily basis and printingthem for the physicians. It really helps tohave access to this information in the ER.”

Access to lab reports (14 percent) wasnext, followed by clinical documentation(7 percent) and immunization records (3percent).

Health professionals have benefitedhugely from the availability of DI reports,as in the past, these reports were often sentout by mail. Now, they are available to clin-icians as soon as radiologists have enteredtheir reports.

Of the 6,500 healthcare professionals inthe province, 2,007 are currently usingHEALTHe NL. Of them, 623 are considered‘active users’, those who have logged on atleast three times in the last three months.

Sweeney expects to see usage jumpnext year when all four RHAs are con-nected and more hospital information isavailable. “That’s when we will see evengreater benefits.”

Physician-created KoNote makes it easy to chart notes and numbersBY JERRY ZEIDENBERG

TORONTO – Dr. David Gotlibhas worked with plenty ofEMRs in his career as a psy-chiatrist, but was never verypleased with them. “They

were all too structured,” he says. “They’rebasically glorified spreadsheets with aWindows front-end.”

This was especially evident in hisarea, psychiatry and mental health. “Ican work much faster using paper thanan EMR,” he says.

That’s because mental health chart-ing is so dependent on notes and nar-rative. “The traditional EMR isn’t sogood at organizing narrative informa-tion,” he observes.

At the same time, psychiatry and so-cial services records, in general, require agreat deal of counting and numeric in-formation to track the performance of apatient. Unfortunately, most EMRs donot help doctors and nurses with thischallenge, either.

So Dr. Gotlib decided to create a pro-gram that could do a better job. Luckily,he has a background in computer sci-

ence – in fact, he did a degree in com-puter science before becoming a physi-cian, and was well acquainted with theins and outs of software.

With the help of a talented program-mer, in 2014 he launched a system calledKoNote. (See http://www.konote.ca/)

The solution helps mental health pro-fessionals with both charting and count-ing. In fact, the program reminds users tocount various things in the notes, and willautomatically generate graphs showinghow the patient is doing in different areas.

“The progress note prompts you tofill in a number,” says Dr. Gotlib.

It’s also designed for group work, andshows the notes that others have enteredand the reasons why treatment changeswere made. “It’s designed to be multi-dis-ciplinary, and it can be used for in-pa-tients and out-patients,” says Dr. Gotlib.

Doctors, nurses and social workers atSt. Joseph’s Health Centre, Toronto, useda prototype of the system on a psychiatricinpatient unit for three years with muchsuccess. “It’s the compass that aids us tomap our care,” one nurse told Dr. Gotlib.

The users like it, said Dr. Gotlib, be-cause KoNote “guides you to chart in a

way that you treat people. It also takes lesstime to chart electronically than on paper.”

And it’s easy to use. Dr. Gotlib saysthe “most technophobic person as theGriffin Centre liked it the most.”

When you look at the KoNote system,you immediately notice that it has aspare, elegant appearance. That’s inten-

tional. One of theproblems with tra-ditional EMRs, saysDr. Gotlib, is thatthey’re over-engi-neered and clut-tered: “Many doc-tors hate EMRs be-cause they’re toobig, with too manythings they don’tneed.”In contrast, KoNote

has a simple interface. “It’s designed formy grandmother to use,” he quips.

It also makes use of a different designphilosophy. Dr. Gotlib says he was in-spired by the work of Dr. LawrenceWeed, creator of the “problem-orientedmedical record”. Instead of highlightingthe sources of patient information, such

as diagnostic images, prescriptions,physician notes, Dr. Weed’s record fo-cuses on a well-defined list of the indi-vidual’s problems.

(Dr. Weed was also the progenitor ofthe SOAP method of medical charting –subjective, objective, assessment and plan.)

When it comes to the problem-ori-ented record, Dr. Gotlib says he differsfrom Weed in two respects.

First, KoNote is flexible and allows youto determine how much structure youwant. For mental health, this is impor-tant, says Dr. Gotlib. “You really want tomaintain a level of uncertainty until youare sure about what you’re dealing with.”

Second, the system is multi-discipli-nary and can be used by a wide range ofhealthcare professionals – from doctorsand nurses to social workers and com-munity care workers. By having every-one chart in a unified way, and docu-menting what is relevant to patient-care,more accurate diagnoses and more effec-tive treatments can be made.

“You don’t want to see car-loads ofdocuments,” says Dr. Gotlib. “And youdon’t want to have to reconstruct every-thing in your head.”

Newfoundland and Labrador on the verge of a province-wide EHR

Dr David Gotlib

Gillian Sweeney

h t t p : / / w w w . c a n h e a l t h . c o m4 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y N O V E M B E R / D E C E M B E R 2 0 1 6

WorkForce DS-86065 ppm/130 ipm 80 Pg ADF





Built-in WiFi

Freedom of Choice

Specifications subject to change without notice. EPSON and WorkForce are registered trademarks and EPSON Exceed Your Vision is a registered logomark of Seiko Epson Corporation. Copyright 2016 Epson America, Inc.

Epson® document scanners can bring an entirely new level of efficiency to your business:

• Choose from 19 different models

• Compatible with over 70 software packages

• Simple setup and easy networking

• Built-in cloud integration

• Models with speeds up to 65ppm

From travel-friendly portables to workgroup and departmental solutions, there’s an Epson documentscanner that’s ideal for every need.

See all your Epson document scanner choices at epson.ca/docscan


BY DR. CAROLYN MCGREGOR

OSHAWA, ONT. – In summer 2016,we were excited to announce anew $3 million project to de-velop a market-ready version of

Artemis to be used at bedside by clinicians.This will initially be deployed at our newpartner hospital Southlake RegionalHealth Centre in Newmarket, Ont., withsupport from my long-time research part-ner IBM Canada.

Dr. Dave Williams, Southlake’s Presi-dent and CEO, is leading the Health Ecos-phere Innovation Pipeline Project(HEIPP), a great initiative to enableSouthlake to be a hub for demonstratinghealth technology innovation. My researchat the University of Ontario Institute ofTechnology (UOIT) is part of HEIPP,along with research partners at York Uni-versity and the University Health Network.

We first deployed Artemis in 2009 as apilot research study to demonstrate howdata collected by medical devices in hospi-tal neonatal intensive care units (NICU)can be harnessed and utilized for new ap-proaches to providing care to fragile pre-mature and newborn infants.

Traditional healthcare involves humanbeings taking the vital readings of patientsintermittently over long intervals. Artemistakes a ‘big data’ approach by applyingtechnology to constantly measure a widerange of vitals. We wanted to showthrough Artemis that it was technicallypossible to do this.

Artemis can take 500 electrocardio-grams readings a second, along with mea-sures every second for heart rate, respira-tory rate, blood-oxygen saturation and

blood pressure metrics. With this en-hanced data available for each patient,there is great potential to improve clinicalpractice and outcomes.

Our clinical research study exploredwhat we could see in these very fast patientsignals, particularly about infants beingimpacted by an infection.

Clinically, Artemis was able to seechanges in the variability of heart rate toconfirm a change in health status. However,because we were able to easily look at othermedical information concurrently, we dis-covered a way to classify different health-status changes based on both the variabili-ties of heart rate and breathing rate, with-out any other clinical information.

We have reported on how we can seepotentially different health status changesfor infants who went on to be diagnosedwith infection, compared to those whowere receiving certain drugs at the timesuch as morphine, as both situations canlead to changes in heart rate.

Artemis has supported research stu-dents in the NICUs of The Hospital forSick Children in Toronto, Ontario; Womenand Infants Hospital in Providence, RhodeIsland; and The Children’s Hospital of Fu-dan University in Shanghai, China. Ourinitial clinical research has detected pat-terns for conditions that infants in theNICU can develop, such as:

• Apnoea of prematurity (pauses inbreathing due to prematurity)

• Retinopathy of prematurity (eye dam-age from premature birth)

• Anemia of prematurity (often fromblood loss for medical tests)

We have also been able to demonstratethe potential of new approaches to exam-

ining the way the brain is developing basedon sleep patterns, assessing pain in theseinfants and assessing the impact of drugsthey receive as part of their care.

We have also demonstrated how we canmonitor NICU ‘graduates’ after they movehome using Artemis Cloud to provideHealth Analytics as a Service to people in anon-hospital environment. I have partner-ships with Toronto-based AlayaCare towork on new approaches to home-basedmonitoring funded through a researchgrant with Ontario Centres of Excellence.

I have been collaborating in researchwith IFTech Inventing Future TechnologyInc., a tech start-up in Durham Regionthat invented the ARAIG (As Real As ItGets) haptic garment. I have also been col-

laborating in research endeavours withsomeone trained in military/police tacticaloperations teams.

The ARAIG haptic garment allows play-ers to feel what is happening in the gamewhile they play. We believe there is greatpotential to learn more about the brain’sdevelopment during tactical training topotentially help prevent the onset of Post-Traumatic Stress Disorder. These findingscould eventually be integrated with train-ing for other first responders.

The University of Ontario Institute of Tech-nology’s Dr. Carolyn McGregor is theCanada Research Chair in Health Informat-ics and a Professor with the university’s Fac-ulty of Business and Information Technology.

Better data collection and analysis needed to combat opioids epidemicBY JERRY ZEIDENBERG

How do you solve a prob-lem like the overuse ofopioids? We know this isa serious issue – a recentseries of articles by the

Globe and Mail newspaper points outthat Canada is the world’s second-largestper capita consumer of opioids. The re-sults are deadly. Between 2009 and 2014,no fewer than 655 Canadians died fromfentanyl overdoses. And that’s just onetype of opioid.

Once they’re hooked, many addictsstart doctor shopping. They seek contin-uing highs from their drug, instead ofrealizing they’re addicts and that theyneed treatment. They obtain multipleprescriptions and fill them at differentpharmacies.

In some cases, desperate patientsmake high-quality copies of the scriptsto pass to multiple pharmacies.

So what to do about this? How do wefind out which patients are abusing thesystem? In theory, prescribing patternsare already being tracked, as pharmaciesare required to submit reports whenthey write prescriptions for opioids.

Trouble is, across Canada, the reportstend to be on paper.

“The paper goes into a drawer for daysor weeks, and by the time they’re filed,the patient has collected five or 10 pre-scriptions,” observes Greg Horne, Health-care Lead for SAS Canada, in Toronto.“There’s too much of a time lag.”

That contrasts with the situation inthe United States, where most states arenow collecting opioid prescribing infor-mation through electronic networks,comments Jen Dunham, Principal Solu-tions Architect with SAS Institute Inc., inWashington, D.C.

That’s allowing state health authori-ties to monitor prescribing patterns on adaily basis. In at least one state, Okla-homa, the data monitoring and collec-tion for opioids is being done in real-time, at the ‘point-of-sale’.

Canada will soon start to rectify theproblem, notes Horne, with the launchof a national e-prescribing network. Thesystem will connect doctors and phar-macies, and will make use of electronicprescriptions. “The patient never gets aprescription in his hand,” says Horne.

The national e-prescribing program isbeing implemented under the auspices

of Canada Health Infoway, and is calledPrescribeIT. It’s expected to start in 2017in Alberta and Ontario, and will be thenbe rolled out to other provinces.

By connecting doctors, pharmacistsand health authorities, the system will beable to monitor the number of prescrip-tions that physicians are writing and thatpatients are filling.

PrescribeIT is also expected to helpwith adherence – physicians will be able

to tell if patients have filled their pre-scriptions. If not, they can find out why.

When it comes to the opioids epi-demic, it will speed the collection of datathat’s needed to find out who is receiv-ing too many pills.

And as Horne notes, with the use ofanalytics, PrescribeIT will also enableauthorities to detect “atypical prescrib-ing patterns”.

“You will be able to see which doctors

are pushing out a lot of business topharmacies,” says Horne. Similarly, it’smuch easier to spot errant pharmacists,those who are dispensing unusually highvolumes of opioids.

Dunham observes that with the helpof analytics, the same techniques used indetecting fraud or financial crime can beapplied to opioids. “You can spot thepill-mill pharmacists,” she says.

Horne notes that the opioids epi-demic hasn’t been handled effectively todate. While governments have crackeddown on the use and sale of some drugs,effectively delisting them from provincialformularies, this technique has onlyspurred the use of other opioids.

“You simply create a new black mar-ket by doing that,” he says. “People trygetting the drugs somewhere else, orthey turn to other opioids.”

That observation is supported by theevidence. In 2012, the year OxyContinwas delisted from provincial drug plans,18.3 million opioid prescriptions weredispensed in Canada. Last year, that fig-ure jumped 18.6 per cent to 21.7 mil-lion, according to IMS Health, a health-care information services company.

Dr. Carolyn McGregor and her team have been deploying Artemis to help infants in neonatal intensive care.

The Artemis Project: Pushing new frontiers in healthcare analytics

Analytics enable experts tospot ‘atypical’ prescribingand dispensing amongphysicians, pharmacists

CONTINUED ON PAGE 19


Canadians might have to think long andhard to determine the last time theysaw an X-ray image printed on film. Ittook time and a lot of hard work, butfor thousands of healthcare providers,the efforts to move from paper to dig-

ital were well worth it. Across Canada today, healthcare providers are in-

stantly and securely retrieving digital health infor-mation such as diagnostic images, lab test results anddrug information to make informed care decisions,leading to improved outcomes.

With foundational elements in place, Infoway rec-ognized an opportunity to further promote innova-tion and in 2011, the organization launched the In-foway ImagineNation Challenge series, in a bid to in-spire, provoke, and promote innovation in healthand healthcare, and to foster a community of inno-vators in Canada.

“There are very talented people in Canada, and wewanted to encourage them to innovate to advancedigital health,” said Fraser Ratchford, a Group Pro-gram Director at Canada Health Infoway who leadsthe Challenge series. “Friendly competition to sparkinnovation through Challenges was a relatively newconcept at the time, but it didn’t take long for Cana-dians to embrace it.”

Five years and a total of 11 Challenges have cre-ated an innovation momentum that is still goingstrong. Thousands of participants have stepped up,contributing ideas, measuring use, and describingthe impact digital health has had in Canada. Theirexperiences weave a story of a country of innovatorswho are determined to use technology to improvethe health of Canadians. So far, they have loggedmore than 74 million uses of digital health, alwayswith an eye to improving patient outcomes.

“Thousands have participated since the Chal-lenges were launched in 2011. For example, theIdeas Challenge, our first one, drew submissionsfrom Canadian clinicians, patients and researchersfrom across the country,” said Ratchford. “I thinkthat’s reflective of the talent, imagination, and pas-sion we share for improving care through digitalhealth innovation.”

That initial Ideas Challenge asked Canadians forbold new ideas to transform healthcare – how wouldthey enhance access to services, improve quality ofcare delivery or make the system more efficient?

Submissions were received from across Canada,including one from the Niagara Region PublicHealth Unit, who submitted an idea for an app tohelp expectant parents navigate pregnancy. Theywanted to place useful information about the variousstages of fetal development at the fingertips of ex-pectant parents and provide them with the ability tolog progress. The idea won the Canada’s Choiceaward, and since then, it has been developed anddownloaded more than 17,000 times.

The Data Impact Challenge is another example ofone of Infoway’s successful Challenges. The goal herewas for participants to demonstrate the knowledgethat can be uncovered by analyzing the data stored indigital health systems.

“The information is already there, in digital for-mat,” said Ratchford. “It’s more important than everto analyze the information that we collect to informhealth policy and practice.”

One such example is the submission by the

MOXXI (Medical Office of the XXIst Century)-McGill team, which reported on the number of pre-scriptions that are written each year, but for a vari-ety of reasons, are never dispensed, or picked up bythe patient. Having this information informs med-ication management practice and policy. Influenc-ing practice and policy to improve outcomes for pa-tients has always been a central tenet to the InfowayChallenges.

Similarly, the Patient Impact Challenge, held in2013, reinforced the fact that an overwhelming num-ber of patients want access to digital health tools andcapabilities for themselves.

Patients like Cheryl-Anne from Beaconsfield,

Quebec, summed up the value of what many Cana-dians want in her submission to the Patient ImpactChallenge: improved communication with theircare providers.

According to her submission, “Access to my spe-cialist through email has helped me tremendously inbeing fully engaged as a patient.”

In fact, the availability of digital health tools forCanadians has doubled in the last two years, prompt-ing Infoway to launch the Engaged Patient Chal-lenge, its latest, which recently ended.

Entrants were asked to describe what being anempowered patient means to them and why it’s im-portant. Judges will choose the best five submissionsand invite their authors to Toronto to participate inactivities during Digital Health Week, which is heldevery November to raise awareness of the value andbenefits of digital health, and the role it plays in sup-porting healthier Canadians and families.

As part of Digital Health Week (November 14-20), the Better Health Together community of morethan 40 healthcare organizations, along with patientpartners, is coming together to help shape a future ofhealthier Canadians through innovative digitalhealth solutions. Anyone can join the conversationthroughout the week via #ThinkDigitalHealth.

As for future Challenges, Ratchford says, “We’reproud of what our community of innovators has ac-complished in five years, and we’re looking forwardto what is yet to come.”

About ImagineNation Challenges: The ImagineNationChallenges seek to inspire, provoke, and promote inno-vation in health and healthcare and foster a commu-nity of innovators in Canada. While each ImagineNa-tion Challenge is different, they all share the same ulti-mate goal: to improve the quality of care and the pa-tient experience. Since 2011, the ImagineNation Chal-lenges’ has run 11 Challenges, with 469 entries fromover 410 individuals/organizations participating na-tion-wide. The community of Challenge participantshas answered healthcare questions, adopted and spreadthe use of new technologies and put their best ideas for-ward in 11 different Challenges.

IN

FO

WA

Y

AW

AR

DS

Thousands have participated since the Challenges were launched in 2011.

Infoway ImagineNation Challenges celebratefive years of digital health innovation

A team from Sunnybrook Health Sciences, in Toronto, was one of the winners of Infoway’s ImagineNation Challenges.

ImagineNation Challenges by the Numbers:

Five years of ImagineNation Challenges.................

469 entries representing over 410 organizations in 11 Challenges

.................Over 200 judges contributed to reviewing and scoring Challenge

.................More than 74 million uses of digital health solutions

.................$2.3 million in awards distributed

.................Over 1000 clinicians, health professionals, academics and

Canadians submitted ideas or cast votes in the Ideas Challenge.................

Over 3.6 million log-ins to the Outcomes Challenge.................

More than 120 stories submitted in the Patient, Career and Business Impact Challenges

.................The Accelerate Challenge helped push teams to reach 20,000 users

.................30 million social media impressions in the Public Health Social

Media Challenge, with an additional 80,000 social engagements.................

Teams in the e-Connect Impact Challenge exceeded 71 million uses of digital solutions

.................Over 50 responses were received in the Data Impact Challenges,

answering pressing healthcare questions


shaping tomorrow with you

For more information on Fujitsu scanners, please visit www.fujitsu.ca/scanning.


BY ANDY SHAW

TORONTO – Now over 10 years in themaking, Sunnybrook Health Sci-ences Centre’s MyChart Personal

Health Record Service (PHR) is now gain-ing the momentum its innovators

dreamed of – this year, eight new membersites will go live, with eager patients join-ing not just from Sunnybrook but alsofrom many other healthcare providers. Aswell, MyChart is experiencing a sharp in-crease in use by doctors.

“I’m thrilled by MyChart’s growth, but I

had hoped this would have happened a lotsooner,” says Sarina Cheng, Sunnybrook’sDirector of Health Records and the vision-ary Director of the MyChart Program.“Twenty years ago, I was inspired person-ally because I had a very sick daughter withKawasaki disease (since fully recovered).

“It was a rare and unknown diseasethen, so I kept pushing for more informa-tion. But clinicians weren’t talking to meand I realized then that the patient was notreally part of the healthcare equation.Luckily, many years later joining Sunny-brook Hospital, I met the right CIO at theright time who agreed that what we had todo was to empower the patient and givethem a voice in the circle of care”.

Today, patients who sign up for My-Chart can assure themselves of a continu-ity of care from all who care for them – bethey physicians, physiotherapists, pharma-cists, or family and friends. In other words,they can share their health records withanyone they choose.

As the first patients used MyChart andthey found both what was useful and notso, its developers listened and added newempowering tools to its make-up. Most re-cently in 2012, for example, Sunnybrookadded MyChart mobile so patients couldquicken their access through any smart-phone, iPad, or tablet.

In 2013, Sunnybrook partnered with theCanadian MedicAlert Foundation, so thatany MyChart patients wearing MedicAlertdevices could provide paramedics or otherfirst responders with immediate access totheir critical personal health information.

That same year, Sunnybrook also part-nered with their Family Practice HealthTeam so patients could speedily book andsee appointments with their family physi-cians, as they do with other hospital ap-pointments, all in one place.

And most recently, in 2014, MyChartadded a tool with the mental health com-munity in mind, called the ‘Mood Tracker’.Developed in partnership with Sunny-brook’s Psychiatry leadership, the MoodTracker allows patients to record their feel-ings throughout the day and it can visuallyillustrate to doctors a patient’s mentalhealth status over periods of time.

“It’s clear that the patients and clini-cians behind these additions to MyChartare the innovators; they truly understandthe importance of the patient voice,” saysSam Marafioti, Sunnybrook’s CIO and VPof Corporate Strategy and Development.“So they are the drivers in MyChart’s de-velopment now.

“We, as technical support, of courseembrace Ontario’s PHIPA legislation (Per-sonal Health Information Protection Act)that underpins the movement to a morepatient-centred healthcare system, butquite frankly, it is patients and clinicians inMyChart’s case that are driving this mo-mentum now.”

Today, MyChart has 140,000 users andthe numbers are steadily growing. About90 percent are patients and 10 percent doc-tors or family members.

With MyChart, users stay connected toall their personal health records. They canshare them with not only individual physi-cians but with multiple healthcare teamsfrom multiple hospitals and healthcareservices within and outside of the country.

In addition to mental health monitor-ing tools, they can use MyChart’s shareabledaily logs and diaries with nurses, doctors,family or friends who can make their owncontributions to the record.

They can also help patients to monitor

Sunnybrook’s MyChart PHR has 140,000 users in Canada and abroad

....................................................................................................................................................One Platform - For better Decision Support

DynamineTM and DynaboardTM powered by

Delivering Tomorrow’s Healthcare Analytics TodayA division of MediSolution

Local: 1(905) 673-4100 ext. 66212Toll Free: 1(800) 668-7530 ext. 66212

[email protected]

Admission Source

10 20 30 40 50 600

Clinic

Day Procedure

Direct

Emergency

Ad

mis

sion

Sou

rce

Typ

e

Admission Source

Nursing Home

Home

Other

Retirement Home

Acute Care

Patient Count

Average 6.4

LOS

0.0

1.0

2.0

3.0

4.05.0

8.0

10.0

9.0

7.0

6.0

Enterprise Business Intelligence��

Infection Control & Antimicrobial Surveillance��

Nursing and Allied Health Workload��!�� !�� "��# ��$��%��

&��!�� '��(��

BedManagerTM (Patient Flow / Bed Management)

2014-Apr

2014-May

2014-Jun

2014-Jul

2014-Aug

2014-Sep

2014-Oct

2014-Nov

2014-Dec

2015-Jan

2015-Feb

2015-Mar

16

16

16

16

16

16

16

16

16

16

16

16

$ 136,784

$ 136,784

$ 136,784

$ 136,784

$ 136,784

$ 136,784

$ 136,784

$ 136,784

$ 136,784

$ 136,784

$ 136,784

$ 136,784

17

17

19

18

10

16

$ 145,333

$ 162,431

$ 153,882

$ 65,490

$ 136,784

$ 145,333

$ 8,549

$ 25,647

$ 17,098

-$ 51,294

$ 0

$ 8,549

$ 8,549

$ 8,549

$ 8,549

$ 8,549

$ 8,549

$ 8,549

$ 8,549

$ 8,549

$ 8,549

$ 8,549

$ 8,549

$ 8,549

Month MCH

Forecast

Cases

Forecasted

Revenue

Actual

Cases

Actual

Revenue

Variance Hospital

Rate

Summary 193 $ 1,641,408 97 $ 809,253

h t t p : / / w w w . c a n h e a l t h . c o m1 0 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y N O V E M B E R / D E C E M B E R 2 0 1 6

symptoms and support treatment for sleepdifficulties, high blood pressure, diet, weightloss, cancer and other serious diseases, aswell as watch their overall health status.

“All that information is available, seam-lessly, to everyone the patient permits to seeit. That’s what makes MyChart unique,”observes Marafioti.

Of course, there were lessons to belearned when the system was first launchedin 2006: “We entertained the idea that pa-tients and physicians would be equal par-ticipants at the same time, and so, registertogether,” says Cheng. “But we learnedquickly that was not the right model.

“As soon as we went live, we were gettingcalls from both sides but especially fromclinicians saying, ‘Well this doesn’t work forme. Or that sure doesn’t work for me.’”

What Cheng and Marafioti both real-ized was the big challenge of implementingMyChart effectively for physicians was nottechnical, but human.

“It was the challenge of change manage-ment,” says Marafioti. “The best examplehas to do with time-stamping of when testresults could be released to MyChart sub-scribers. ‘You mean you want patients tohave information before I get it?’ was atypical response. So we worked with thedoctors and now almost all of that resis-tance has gone away.”

Adds Cheng: “Its to the point now, thatthe only results participating physicianshold back are cancer pathology results, so

the physician can review them first beforediscussing them with the patient. Andthat’s understandable.”

Moreover, in the early MyChart days,physicians at Sunnybrook saw it as athreat. But as more and more patientscome forward through MyChart to presentthemselves with better knowledge andmore relevant data about their conditions,doctors now see the advantages of per-sonal health records and have increasinglystarted to embrace them.

“We have a gastroenterologist, for ex-ample, who now makes so much use ofMyChart he says he runs half his practiceon it,” says Marafioti. “And that kind of re-alization on the part of physicians has beenthe tipping point for MyChart. So now weare seeing very real collaboration with pa-tients happening more and more.”

Even back in a 2014 survey, 91 percentof 70 physicians using MyChart reportedthey believed their patients’ access to My-Chart improved the patient experience.

More specifically, they replied that itsupports collaborative disease trackingand better medication compliance, re-duces adverse drug events, and eliminatesduplication of lab work and other tests.

Perhaps most importantly, physicians rec-ognize that personal health records like My-Chart help them focus on actually deliveringcare, and not on retrieving information.

That success has not gone unnoticed.MyChart’s participating partners now in-clude Mount Sinai Hospital, MackenzieHealth, MedicAlert Canada, Lifelabs(CML), Toronto EMS, Michael Garron

Hospital, William Osler Health System,Headwaters Health Care Centre, Universityof Ottawa Heart Institute, The OttawaHospital, Central CCAC, Baycrest Hospital,and most recently St. Michael’s Hospital.

On the immediate horizon, as MyChartextends its network beyond hospital walls,is a plan to have family doctors come intothe fold, as well as other allied health pro-fessionals and community services.

In order to subscribe at mychart.ca, youneed to be or have been a patient at Sun-nybrook or one of the participating part-ners above. The good news is that unlikesome other PHR systems, MyChart is free.

And if Sunnybrook has its way, MyChartmight one day soon be available to all On-tarians and perhaps others far beyond.

“Well, first of all, you don’t have to be aCanadian citizen or resident here, only a

patient, so we are already international inthat respect. MyChart can be accessednow from 160 countries worldwide,”points out Marafioti.

Closer to home, the hope also is that My-Chart becomes endorsed as the recom-mended PHR for the province by eHealthOntario, the provincial government’s agencythat’s facilitating the spread of a standard-ized electronic health record system.


Physicians, along with patients,are using MyChart, as it helpscreate better collaborationbetween doctors and patients.

Head for the top of the line: the DR 600 high performance digital X-ray room. With high productivity, innovative features and ZeroForce Technology, the fully

experience of patients and operators alike, even in busy imaging environments. At its heart lies the ‘gold standard’ MUSICA image processing software, offering consistently reliable, high-quality image visualization. The bottom line is, the DR 600 takes Agfa HealthCare’s latest technologies and puts them to use to help you provide top-of-the-line imaging and delivery of patient care!

Find out more, visit agfahealthcare.com

LOOKING FOR SPEED, PRECISION AND COMFORT?

h t t p : / / w w w . c a n h e a l t h . c o m N O V E M B E R / D E C E M B E R 2 0 1 6 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y 1 1


BY KATHERINE TUDOR

Communication between hospitals andcommunity-based family physiciansused to be a challenge in Ontario.

Physicians often had no idea that a patientwas in the hospital until days or weeks later.

This lack of integration between hospi-tal information systems and primary careelectronic medical records (EMRs) meantthat family physicians could not follow upwith patients after their hospitalization asquickly as possible for any necessary conti-nuity of care.

Now, thanks to OntarioMD’s eNotifica-tions, physicians receive real-time elec-tronic messages in their electronic medicalrecord (EMR) systems whenever their pa-tients are discharged from a hospital emer-gency department or are admitted or dis-charged from an in-patient unit.

eNotifications flow securely throughOntarioMD’s Hospital Report Manager(HRM), the provincial electronic reportsolution. eNotifications not only let physi-cians know that their patients were in thehospital, but also signal the imminent elec-tronic arrival of hospital reports to EMRs– discharge summaries and other medicalrecord and diagnostic imaging reports –which include important, up-to-date in-formation about the care the patient re-ceived in the hospital.

Over 6,500 family physicians use HRMand 3,500 of them have adopted the eNo-tifications feature. In a recent survey, 75percent of these physicians reported thateNotifications allow for follow-up with pa-tients sooner after their hospital visits.

“My practice has been receiving eNoti-fications and it’s been a positive experi-ence. I followed up with one of my patientsshortly after I received an emergency de-partment discharge eNotification and thepatient was blown away that I was able tofollow-up with him so quickly,” says Dr.David Kaplan, a family doctor.

eNotifications support Health Links, anOntario Ministry of Health and Long-Term Care initiative to provide more coor-dinated, efficient and effective care for pa-tients with complex conditions in 69 com-munities across Ontario.

Complex care patients, who representfive per cent of Ontario patients, spendmore time in hospitals and in emergencydepartments than other patients and ac-count for two-thirds of health care costs.

Letting family physicians know aboutthese events has been critical to coordinat-ing timely follow-up care and reducing thepotential for unnecessary hospital read-missions for these patients.

eNotifications include a Health Linkspatient identifier and the patient’s Com-munity Care Access Centre. This informa-tion is very useful in coordinating carewith Community Care Access Centres af-ter hospital stays. Physicians are able to beproactive instead of reactive when they arenotified about their patients’ hospital visitsbecause they have the necessary informa-tion they need to support timely decisionsin the management of their patients.

eNotifications have been recognized fortheir contribution to the Health Links ob-jective of better coordinated and effectivecare in the patient’s community and have re-sulted in eNotifications being identified as aLeading Practice by Accreditation Canada.

eNotifications have also been recog-nized for their value in transforming pri-mary care and improving follow-up carefor patients in Ontario with finalist statusfor the Information Technology Associa-tion of Canada’s 2016 Ingenious Awards.

eNotifications are expanding to physi-cians and nurse practitioners across On-tario and the number of users is growingevery day. The only requirements forphysicians or nurse practitioners to receiveeNotifications are the access and use of anOntarioMD-certified EMR and a connec-tion to HRM. There is little change to thephysician’s workflow and no need foradded training.

Katherine Tudor is Director of Communicationsand Marketing at OntarioMD, in Toronto.

eNotifications mean faster follow-up for Ontario patients after hospital stays



BY DIANNE DANIEL

LONDON, ONT. – Every day, morethan 400 cancer patients receivetreatment through the London Re-gional Cancer Program (LRCP)

and its partners throughout southwesternOntario. Up until recently, they were anisolated group – not literally, but becausethe system used to manage, track and ad-judicate their comprehensive cancer careplans was standalone.

Following the successful implementa-tion and rollout of Cerner PowerChartOncology, that’s no longer the case. Cancerpatients are now integrated with LondonHealth Sciences Centre’s hospital informa-tion system, meaning their complex med-ication record and information related totheir cancer journey is available for anytreating clinician to see in one comprehen-sive health record.

“Our paradigm was that the cancer pro-gram had to be part of the overall hospitalinformation system,” says Neil Johnson,vice-president, Cancer Care and CorporateStrategy, LHSC. “We’re plugging into thatand making it work from a cancer perspec-tive, as opposed to using a cancer systemand hoping the hospital can connect.”

The decision to move to Cerner Power-Chart Oncology was driven by a steeringcommittee made up primarily of clini-cians, and including a cancer patient andthe parent of a child with cancer.

After evaluating the software exten-sively, they decided it provided several ben-efits over Cancer Care Ontario’s (CCO’s)Oncology Patient Information System(OPIS). Though ‘tested, tried and true,’ andused in the LRCP’s adult oncology pro-gram for more than a decade, OPIS is asiloed system, forcing clinicians to rely ontwo systems when treating cancer patients.

“When an adult patient came into ourchemotherapy suite, their chemo was en-tered in one system (OPIS) but if theyneeded other medications associated withtheir chemo, those were entered into thehospital information system,” explainsGlen Kearns, LHSC CIO and integratedvice-president, Diagnostic Services. “Wewere entering drug information into twodifferent systems in order to serve the pa-tient, so we didn’t have cross-checking toensure a drug ordered in one system was-n’t in conflict with the dose or volume ofanother drug.” Lack of an integrated ap-proach often created delays in workflow,he added.

LHSC, along with St. Joseph’s HealthCare London, is a long-time user of theCerner PowerChart electronic medicalrecord, as well as computerized physicianorder entry (CPOE) and barcode medica-tion administration at bedside.

The ability to integrate its adult and pe-diatric cancer programs into that environ-ment, which encompasses 11 hospitals, is ahuge benefit, says Kearns.

For example, if a cancer patient under-goes surgery at an ancillary hospital siteand receives follow-up care there as op-posed to LHSC, the treating surgeon willhave access to the integrated care plan, in-cluding a complete medication profile.Similarly, if a cancer patient shows up attheir local emergency department, doctors

will know exactly where they are in theirtreatment plan without having to wait forinformation to be faxed.

As part of its PowerChart Oncology im-plementation, the LRCP built approxi-mately 800 highly detailed electronic on-cology order sets, aligned with best evi-

dence. An important feature is the elec-tronic claims link which automaticallysubmits treatment plan information toCCO, which in turn authorizes payment.

“All of our funding for operations inour chemotherapy suites is predicated onthat, so if we don’t have good information

going to the funder, the program doesn’tget paid,” says Johnson.

Bob Knust, Cerner’s oncology solutionresults manager, calls the order sets “verycomplex, multi-phase power plans” thatintegrate pharmacy, imaging, laboratory

HOW CAN YOU PREPARE FOR

THE FUTURE OF HEALTHCARE?

You start today with the right partner,

the right tools and the right insight.

Evident. A leading solution for hospitals combines Thrive, our HIS/CIS solution offering

seamless integration across the continuum of care and LikeMind, our unique

support model featuring a dedicated team of experts and a promise of partnership.

877-418-2210 evidenthealth.ca

Committed to helping improve the quality of healthcare for the people you serve.

Cancer treatment data is no longer isolated in the London region



BY DR . SUNNY MALHOTRA

Audiology, which involves the testingand treatment of poor hearing, is anexpensive field. That has made it atarget for new technologies that offercheaper solutions and excellent re-sults. Entrepreneurs, including physi-

cian-innovators, have been leveraging the power ofmodern technology to reimagine how audiology ser-vices can be delivered.

Before 2014, 60 youngsters a year were flown fromIqaluit to Ottawa to have their hearing tested at theChildren’s Hospital of Eastern Ontario. This is be-cause Iqaluit, like many rural communities or devel-oping countries, have limited access to specialty careand equipment.

Dr. Matt Bromwich, co-founder of ClearwaterClinical, decided to bring audiology testing to thekids instead of the kids to the test. As a result, Shoe-box Audiometry, the first clinically validated au-diometer that runs on an iPad was born.

The solution is comprised of a tablet, softwareand calibrated headphones. This technology can beused to administer a full diagnostic hearing test andcan be deployed anywhere in the world. From remotecommunities across Canada to developing countries,this validated audiometer on an iPad is changinghow hearing health is managed.

Shoebox Audiometry offers two testing methods,manual and automated. In manual mode, a system

functions like a traditional audiometer and is con-trolled by the tester, most likely an audiologist or anENT physician.

Automated mode utilizes gamification, where pa-tients virtually test themselves using pre-set configu-rations; dragging and dropping an image on the

screen based on whether or not they hear atone presented at various frequencies.

Traditional audiometer testing can becost prohibitive, due to expensive $10,000sound chambers. Similarly, Video Towers,which can cost anywhere from $65,000 to$100,000, have minimal portability and

limited availability. They are used for documentationof an endoscopic procedure.

But Dr. Bromwich realized that he carriedaround an HD recording device every day. Con-necting the endoscope to a smartphone could repli-cate a video tower that could be carried in a lab coatpocket.

Used with a companion app called Modica, it se-curely captures photos and video of procedures di-rectly on a mobile device.

Through the app the video can easily be sharedwith other specialists for consulting, with residents forteaching, and even with patients to help them under-

stand their diagnosis. The app automatically backsthe images up to a HIPAA-compliant storage

service then deletes the file from the phone.These are security and patient privacy mea-sures that cannot be achieved by using thedefault camera that comes standard withyour iPhone.Bringing technology to the consumer to

overcome geographical barriers is a majorsource of disruption, irrespective of the

medical field. This is an example of ENTdisruption being brought to the

masses. Developing productswith Health Canada and

FDA clearance to safelyempower patients repre-sents the new age of digitalhealth.

VI

EW

PO

IN

T

Shoebox Audiometry is the first clinically validated audiometer that runs on an iPad.

Re-imagining audiology and endoscopy:new technologies are re-inventing ENT care

Dr. Sunny Malhotra is a US trained cardiologistworking at AdvantageCare Physicians. He is anentrepreneur and health technologyinvestor. He is the winner of Bestin Healthcare - Notable YoungProfessional 2014 and thenational Governor General’sCaring Canadian Award 2015.Twitter: @drsunnymalhotra

Traditional audiometer testing can beexpensive, due to the equipment that isused. Shoebox Audiometry changes thisby using an iPad.

Information security is really a human problem

R E B O O T I N G e H E A L T H

BY DOMINIC COVVEY

Once upon a time in the1970s, members of the Kr-ever Commission, charged

with assessing the status of the pro-tection of health information, de-cided to see data facilities firsthand.

Although much information atthe time was paper-based, the com-puterization of records was becom-ing commonplace. We have alreadyseen what happened at the govern-ment data centre – see my last articlein the October issue of CHT.

In that instance, it was clear thatstaff adherence to security proce-dures left a lot to be desired! It wastoo easy to engage in a little bloody-mindedness to show that fancy soft-ware was not the ultimate protectionmechanism for records. But, here isanother story illustrating yet anotherhuman issue.

We’ll de-identify this story. A ma-jor medical department at an acade-mic medical centre, which saw about100,000 patients a year, had its (in-dependent) computer system in thebasement of the hospital.

One good thing was that there wasno sign saying “Computer Room”.However, the door to the computerroom was always unlocked and any-one could walk in. Further, that roomwas on a heavily-traveled corridor.

This open wound in the securityof the institution resulted in a visitbeing made to the hospital SecurityOffice. The Chief of Security was in-formed and requested to do some-thing about the matter. Months later,when the Commission wished tovisit computer facilities, this seemedto be a natural one that would bringthe issue of security into bas-relief.Pause here to guess what happened.

A small group of Commissionstaff went to the computer roomand, lo and behold, the door was stillunlocked. So, in we went. We sym-bolically removed several disk packs,briefly walked out into the corridor,and then, avoiding a felony charge,returned the packs to the room.

As a last step, we symbolicallykicked the computer to demonstratethat we could have, if we wanted,simply destroyed it. We all then left,heads bobbling with dismay. That

was one demo that succeeded!But, of course, you can also guess

the sequel to the story: after our littlevisit, the Security Office was again in-formed and told what we did. Weekslater, the door was still unlocked.

This, yet again, illustrates the de-pendence of security on humans,their policies, their actions (or lackthereof) and their belief that securityis so important that it deserves their

attention anddedication.Years later, Ihad set up aconsultingcompany thatprovided IT-related ser-vices. We wereengaged bythe CEO atthe Hospitalfor Sick Chil-

dren to perform a review of theirsystems and personnel. This was acarefully designed and executedprocess to determine technical ca-pabilities, personnel competenceand performance, and, of course,

the status of computer security. We formalized this process and

called it an “Information SystemsAudit”. The audits were modeled onmanagement audits. They were car-ried out by three carefully-selectedreviewers, according to a docu-mented protocol. Of course, we dealtwith matters like those just men-tioned and all the other things sur-rounding computerization.

Security was a key aspect of theaudit and it was almost alwaysfound to be deficient. Sometimes,simple matters, like having a signand directions to the computerroom were remarkable.

Other times it was a lack of phys-ical security, such as locks on doors.In some instances it was the locationof the computers in a place wherethey would be flooded in a storm orby failed plumbing.

Lack of fire protection, backup fa-cilities, inappropriate removable-me-dia storage, and many other factorswere also often found. The last timewe performed one of these auditswas at least 20 years ago, so writing

Dominic Covvey



V I E W P O I N T

The System Coordinated Access(SCA) program is leading an ex-citing initiative to remove ineffi-ciencies and barriers to care by

creating a secure, system-wide electronicreferral (eReferral) process that will allowinformation to flow across the continuumof care in Waterloo Wellington.

In order to realize this vision, the SCAprogram needed to find a partner thatcould not only design and implement thetechnological platform, but who also hadan understanding of the local health careenvironment and the ability to use thisknowledge to build out a solution thatsupports the diverse and complex needs ofthe system. The SCA program is funded bythe Waterloo Wellington Local Health In-tegration Network (WWLHIN).

In a collaborative effort, the SCA pro-gram, the Waterloo Wellington Commu-nity Care Access Centre (WWCCAC) andthe WWLHIN set out to secure an eRe-

ferral solution us-ing a new approachto procurement. “We felt we needed anew and differentprocess to find theright partner, a part-ner that would workwith us to build asystem that is sus-tainable and whowould be able to in-troduce innovation

as the solution scales,” says Sharon Baker,Director of Innovation Procurement. “Weare creating something to achieve certainoutcomes, and it’s something that is goingto evolve as both technology and thehealthcare system changes.”

Based on these unique needs, the evalu-ation team opted to use an innovationprocurement process to find a vendor thatmet the menu of qualifications. Theseprocesses were identified and promoted bythe Ministry of Government and Con-sumer Services (MGCS) through the Inno-vation Procurement Initiative under theOntarioBuys program.

OntarioBuys makes investments to sup-port innovation, facilitate and acceleratethe adoption of integrated supply chain,back-office leading practices and opera-tional excellence by driving collaborationand improving supply chain processes inOntario’s broader public sector (BPS).

The pre-procurement phase includedearly market engagement to assess marketinterest and capacity to respond to a Re-quest for Proposals (RFP), and to seek ven-dor input on the vision and process.

These included Market Sounding inwhich the team used a document postedopenly on MERX with background andspecific questions designed to gauge inter-est and seek feedback on the proposed ap-proach, followed by in-person market en-gagement events.

Members of the evaluation team, whichincluded representation from the SCA pro-gram, WWCCAC, WWLHIN, Langs, physi-cian community, Community Support Ser-vices and other system leaders across the re-gion, partnered with Communitech (the in-novation hub in Waterloo Wellington) andthe Information Technology Association of

Canada (ITAC) Health committee to designtwo days of facilitated engagement withlarge and small vendors (including startups).

This helped the evaluation team to bet-ter understand the market and create in-terest in the plan to design a regional eRe-ferral system. One of the key things raised

by the vendors at these sessions was thelikelihood that a consortium would be re-quired to address all elements of the RFP.

For the RFP, the evaluation team optednot to use the traditional approach of pro-viding a long list of functional requirementsand specifications. Instead, proponents

were asked to describe how their solutionswould help achieve the SCA program’s out-comes and high level requirements.

An evaluation tool was used to assessthe vendors’ capacity for innovation andalso to provide insight into the potential fit

New approach to procurement finds vendors for e-referral solutions

© 2016 Cerner Corporation

To learn more go to www.cerner.ca

Cerner’s health information technologies connect people, information and systems, putting information where it’s needed most.

Together with our clients, we are committed to improving the health of individuals and communities.

Working together for a healthier tomorrow today.

Sharon Baker



BY DIANNE DANIEL

When you’re managing capacityin a hospital setting, yesterday’snews isn’t going to solve to-day’s problems. What’s neededis a real-time picture based ontrusted data – a daunting task

for healthcare organizations. An even bigger challengeis turning that data into an accurate prediction ofwhat’s to come.

“In healthcare, we’ve been pretty good at analyz-ing historical trends. What we haven’t been necessar-ily good at is proactive planning,” says Sarah Pad-field, chief operating officer at Chatham-Kent HealthAlliance (CKHA), a 200+ bed community hospitaloperating two campuses in southwestern Ontario.

“We know what happened in the last six monthsand, yes, that is important. But when you’re trying tomanage beds on a day-to-day basis, what you wantto figure out is what’s coming at you today and inthe next couple of days, as opposed to what hap-pened yesterday.”

To provide that real-time snapshot into hospitalutilization, CKHA engaged the services of Waterloo,Ont.-based Oculys Health Informatics,a company focused on developingpractical, operational visibility solu-tions for healthcare professionals.

The company’s core product, OculysPerformance, is a mobile tool that dis-plays operational data from disparateinformation systems in a simple for-mat, providing information such as bedavailability and patient flow. After aone-time implementation fee to es-tablish key data points, the service isoffered at an affordable monthly sub-scription fee.

Padfield calls the visualizationtool a “real-time utilization dash-board” configured specifically forCKHA. Hospital staff access itthrough either a BlackBerry 10smartphone or desktop, there arescreens at every nursing station andit is also widely deployed through aweb-based link so users can access itfrom anywhere. At a glance they can see how longeach patient has waited and what’s happening withbed availability – for example, making adjustments tooptimize capacity and reduce wait-times on the fly.

CKHA’s initial goal was to positively influence thetime from when an ER patient is admitted to hospi-tal to when they are actually moved into a bed.“When we started we were averaging well over 14 to15 hours. Now we’re consistently under eight hours,”says Padfield. It has since expanded the tool to in-clude housekeeping, enabling housekeepers andporters to prioritize cleaning and maintain up-to-date bed availability status.

Though the end result is a simple-to-understandview, the engineering behind the Oculys solution iscomplex. Formed in 2011 and known for developinga real-time emergency department wait clock in con-junction with St. Mary’s General Hospital in Kitch-ener, Ont., the company also works closely with aca-demics at the University of Waterloo.

The algorithm that drives its real-time utilization

tool is now garnering attention from California’sStanford University, says Oculys president and CEOFranck Hivert, and the company is adept at leverag-ing the expertise of data scientists.

But its real focus is on the end-users, the hospitalclinicians and managers.

“The reason we’ve been successful is because wehave worked with users in understanding what infor-mation they need to make better decisions (and ex-tracting it), instead of getting the data first and see-ing what analysis we can run on it,” says Hivert.“We’re not the tool they’re going to use to analyze thelast six months of data. Our philosophy is: Let us giveyou the information right now, today, so you can dosomething about it.”

CKHA is one of five hospitals that make up theErie St. Clair local health integration network(LHIN), all of which will be using Oculys Perfor-mance once Leamington District Memorial Hospitalgoes live with its implementation this fall.

The deployments, created with the help of Oculys,mean there will soon be a LHIN-wide real-time uti-lization view – a real achievement. Phase One is cur-rently being rolled out and will provide as many as 20LHIN employees with a snapshot of activity across

the whole region, an “unprecedented” development,according to Hivert.

“We are presenting to the LHIN a consolidatedview of exactly what’s happening so they can makebetter decisions,” he says. “That’s something onlyfour years ago was deemed to be impossible withoutan investment of millions of dollars.”

The tool will be key to helping the LHIN managesurge capacity across the region, particularly in theevent of an emergency. It will also provide informa-tion about operating room schedules and patientwait times, information that can be shared betweenhospitals to assist in managing daily capacity.

“When we started working with hospitals and toldthem we would be extracting information from theirfeeds to come into a regional view, the biggest con-cern was that we didn’t want to miss things,” says ErieSt. Clair LHIN health system manager Rashoo Brar.“Technology is an enabler, but sometimes it can be ahurdle, too.”

To ensure data integrity, the LHIN performed rig-

orous validation and testing of components, sendingthe data back to each hospital for further testing. Theresult is a high level of trust in the data presented bythe tool. And if there’s any discrepancy, it’s checkedright away, she says.

Padfield anticipates the regional tool – referred toas Oculys Performance LHINView – will help to re-duce bottlenecks in healthcare delivery and result inbetter system planning. In a proposed phase two im-plementation, the LHIN is considering adding aCommunity Care Access Centre link, as well, so thatdecision makers will know how many patients arewaiting for rehabilitation or long-term care beds, aswell as what services and beds are available.

“We have other systems we can use to go back andlook at our admissions and census to do historicalanalysis. This is giving us a real-time snapshot,” saysPadfield. “We didn’t build it to look at using it as abig, data analytics tool. We looked at it as a way tomanage behaviour and performance in real-time.”

According to a list of top healthcare analyticstrends for 2016, compiled by Perficient Inc. of St.Louis, Mo., achieving actionable data-driven insightsis in the top five.

The other four include: aligning clinical, qualityand financial analytics to enablevalue-based care; integrating clin-ical and claims data to enable pop-ulation health management in-sight; leveraging cross-continuumdata analysis for improved patientcare and outcomes; and, growingenterprise intelligence to measureand improve patient and organiza-tional health.

Ontario’s Hamilton Health Sci-ences (HHS), with its Inte-grated Decision Support (IDS)data store, is working towardsall five. Hosted in HHS’s part-ner environment, the centralrepository currently containsinformation related toroughly 37 million encoun-ters for 6.5 million uniquepatients. It is managed by ateam of 15 IT profession-als, including support an-

alysts, business intelligence analysts, content ex-perts, quality assurance experts and a user experi-ence analyst.

The SQL-based repository collects data from sixLHINs in southwestern Ontario: Erie St. Clair,South West, Waterloo Wellington, Hamilton Nia-gara Haldimand Brant, Toronto Central and Missis-sauga Halton.

Every day, the team applies reporting and analyticstools from Microsoft, as well as data visualization toolslike Tableau, to deliver visibility into the full patientjourney. It starts with patients identified through On-tario’s Health Links initiative as having multiple, com-plex conditions – the top 5 percent of patients who ac-count for two-thirds of healthcare costs.

“Because we have all of this data, and it’s linked,we can really get the visibility of those patients to seehow many ER visits they’ve had, the admissionsthey’ve had, the reasons for the admissions, and howmany readmissions they are having,” explains WendyGerrie, HHS director, Regional Integrated Decision

FE

AT

UR

E

RE

PO

RT

Predictive analytics and population data are helping hospitals plan days and weeks in advance.

Regions consolidate patient data to improvemanagement of hospital resources

ILLU

STRA

TIO

N:

LIN

DA

WEI

SS


I N N O V A T I V E H E A L T H C A R E P R O V I D E R S

Support Services. “It’s very beneficial to seewhat has happened in the past and then touse predictive modeling to determine whatwe think might happen in the future.”

The view into the longitudinal patientrecord also supports the transition fromvolume-based funding to value-basedfunding, she adds. HHS is currently in-volved in a pilot project to examine an in-tegrated funding model for congestiveheart failure (CHF) and chronic obstruc-tive pulmonary disease (COPD) patients.“A group of hospitals and CCACs putmoney into a virtual pot and we are havingthe dollars follow the patients in this bun-dled payment pilot to see how that works,”says Gerrie. “You really can’t do that untilyou can follow the patient.”

Each LHIN pays an annual fee to HHSto belong to IDS, essentially to cover costs.Information is exchanged through a secureportal and users only have access to thetype of information available to thembased on credentials and in accordancewith privacy legislation.

In addition to a number of fill-in-the-blank report templates related to popularqueries, which are returned in minutes,users can also leverage the knowledge ofthe HHS team to ask more specific ques-tions with reports generally taking two tothree days to complete.

One exciting development, says Gerrie, isthe ability to apply the information storedin IDS to examine population health. Cen-sus data, including postal code and socioe-conomic indicators, is included in the pa-tient files, meaning it’s possible to group pa-tients according to where they live and lookfor trends that might help to identify whatshe calls “rising risks,” people who are at riskof developing one of the 54 chronic condi-tions identified through Health Links.

“Right now we’ve exhausted the analy-sis we can do on the top 5 percent of ourusers,” she says. “Can we get to that nextlarge pocket and prevent them from be-coming that 5 percent? IDS is allowing usto get to that next step faster.”

Earlier this year, HHS announced acollaborative research initiative withIBM that will see a healthcare inno-

vation hub created in downtown Hamil-ton. Under the partnership, IBM is provid-ing access to its Watson cognitive and ana-lytics software while HHS offers practicalindustry expertise and serves as a real-world test environment.

As Gerrie explains, the partnership willbe instrumental in helping HHS to tapinto unstructured data. While the struc-tured, multi-LHIN IDS repository spansoutward and provides visibility into databeyond a hospital’s four walls, HHS alsomaintains an internal repository that in-cludes hospital-specific information re-lated to diagnosis and procedures, includ-ing unstructured pieces of data such asclinical notes or electronic feeds from dig-ital equipment. Watson is intended tomine that data in new ways, she says.

According to a news release announcingthe IBM partnership, one project will ex-plore adding a mobile component to“HHS’s early warning system, which elec-tronically monitors a patient’s vital signsfor subtle changes indicative of a worsen-ing condition or pending medical event.”Lilian Vasilic, HHS manager, BI Solutionsand Products, anticipates that the combi-

nation of Watson’s analytical capabilitiesand HHS’s rich data set will remove thelimitations of IDS’s SQL environment.

“What we have is not well suited for to-tally unknown analytics,” says Vasilic. “Wecan do visualizations and descriptive ana-lytics … but we’ve realized the relationaldatabase world is not really suited forplugging in a million lines of data and let-ting you data mine.”

IDS is already crossing the continuumof care by storing hospital data (acute in-patient, rehabilitation, complex continu-ing care, ER visits, same day surgery, men-tal health) as well as CCAC and commu-nity health centre data. Primary care datais missing, but pilot projects are underway. In the end, the goal is to provide alongitudinal view of patient outcomes andto try to “standardize the way all organiza-

tions are looking at transactions in thehealthcare system,” says Vasilic.

“This type of information really can beused to influence changes in policy,” addsGerrie. “You can look at the full picture fora patient and ask, ‘Why is my readmissionrate so high when I look at it across thespectrum of the six LHINs?’ We can start toadd that quality and value piece to the dis-cussion and factor it into policy.”

INFORMATION IS...

the future

© 2016 Iron Mountain Canada Operations ULC. All rights reserved

Your future success as a Health Information Manager depends on your ability to lead your organization through the ever-changing healthcare landscape. You need practical guidance and the right tools to navigate this new world of Health Information Management. We’re here to help.

Learn More at ironmountain.ca/healthcare


I N N O V A T I V E H E A L T H C A R E P R O V I D E R S

BY WAQAAS AL-SIDDIQ

Physicians at Rockyview General Hos-pital in Calgary are working withRedwood City, California-based

Biotricity Inc. to develop the next gener-ation of smart, wearable and medically

relevant biometric remote monitoringsolutions.

Building upon and moving beyond thesimple exercise, heart rate and activity track-ing monitors currently available, Biotricity’ssolution will also incorporate Heart RateVariability (HRV) monitoring, a well-re-

searched physiological monitoring tool. HRV monitoring has demonstrated the

ability to track the changing balance be-tween sickness and wellness in multiple dis-ease processes through diagnosis, treatmentand rehabilitation, including cardiac is-chemia and failure, sepsis, diabetes, as well

as cerebrovascular and neurological illness. A healthy person’s heart rate varies con-

tinuously from minute to minute through-out the day and night, and over longertime periods in response to both environ-mental and internal factors. As diseasetakes hold, measurable changes in thatcontinuous variability develop as an indi-vidual’s physiology responds to variousstresses placed upon it, and as that individ-ual becomes less active and less capable ofeffective rest.

Then, as treatment is administered, thatbeat-to-beat variability returns towardsnormal as both the internal environmentimproves and as the individual is able toresume normal activities and schedules.

This simple observation makes heartrate variability monitoring an ideal way totrack both sickness and wellness, which isparticularly effective when combined withother sorts of activity tracking.

Although Heart Rate Variability moni-toring has a well-researched history of suc-cess in monitoring and tracking sicknessand treatment in myriad of disease states,the utility of Heart Rate Variability moni-toring as a clinical tool has long been ham-pered by a variety of impediments includ-ing inconvenience, restricted connectivityand limited computing power.

The Biotricity device has been designedto address all those challenges simultane-ously, by using a small, convenient to wearand technologically sophisticated high-fi-delity (1000 Hz) heart rate tracker capableof providing true instantaneous inter-beatinterval derived heart rate informationcoupled with robust connectivity.

This combination of solutions will im-mediately transform the health-basedwearable technology milieu, equipping thehealthcare consumer and provider bothwith the next generation in smart data.

Currently, physicians at the RockyviewGeneral Hospital are engaged in develop-ing what has been called a “crystal ball witha pulse”, collecting long-term heart ratedata from healthy volunteers and criticallyill patients in the hospital’s Intensive CareUnit, in order to identify the best mannerin which to process and display the datathat Heart Rate Variability provides.

The intent of this preliminary work is toproduce an optimally designed, full moni-toring and data display package combinedwith the pre-existing cardiac rhythm evalu-ation capabilities already included in theBiotricity “Bioflux” monitor. The use ofdata from both healthy and critically ill vol-unteers will accelerate the development ofdisease and treatment specific algorithmsin conjunction with A.I. capabilities.

Once the development of that monitor-ing and display solution has been finalized,physicians at the Rockyview General Hospi-tal will initiate follow-up investigations uti-lizing Biotricity’s next-generation wellnessmonitor to optimize the recovery of majorsurgical and post-cardiac event patients.

Waqaas Al-Siddiq is CEO and Founderof Biotricty Inc., a healthcare technologycompany dedicated to delivering innovative,medically relevant biometric monitoring so-lutions. For additional information, visitwww.biotricity.com or email the author [email protected].

Next generation testing of wearables under way at Rockyview General

HOSPITALHOSPITAL

STAT-TransportAutomated management system for

transport of patients between facilities

> Less need to use ambulance> Global reduction of transportation> Quick return on investment

Improve your inter-facility transport

TransportEmergency

TECHNOLOGIES

Christie Technologies develops, integrates and supports health information solutions. Our innovative products are designed to assess and improve the management and performance of heathcare facilities across Canada.

For more information, visit our website at www.christieinnomed.com


between the SCA program team and thevendor teams.

The top two vendors emerging after thefirst five steps of evaluation were invited toparticipate in a design phase as the finalevaluation step. The design phase involvedthree collaborative sessions over a three-week period between each vendor and theevaluation team.

During this time, the vendors wereasked to simulate a rapid-prototyping de-sign exercise and develop a solutionmock-up. This turned out to be extremelyvaluable to the overall evaluation and re-ally allowed the evaluation team to seehow ideas on paper and in presentationstranslated into real life products and de-livery styles.

The process resulted in the selection ofan Ontario-based consortium of ThinkResearch, CognisantMD, and the Centrefor Effective Practice (CEP) to lead the de-sign and deployment of a ground-breakingeReferral platform for the WaterlooWellington community.

“Rather than using a traditional pro-curement approach to find a technologysolution, we used an innovation partner-ship approach to procure a partnershipwith a supplier to design and develop an

innovative solution that meets our needs,”says Baker. “By entering into a phased con-tract, we are establishing what we thinkwill be an exciting long-term collaborativerelationship with Think Research Groupand their partners.”

As part of the System Coordinated Ac-cess (SCA) program, this partnership ofvendors will work with family physicians,

specialists, community service providers,patients and family caregivers across theregion to build a technological ecosystemthat will enable faster links between pa-tients and healthcare providers and createa more seamless experience when movingfrom one part of the system to another.

“By using new and innovative ap-proaches, you create the opportunity for

new and innovative solutions,” says LoriMoran, SCA Program Manager. “A largepart of the success of this procurement is aproduct of the RFP evaluation team’s in-credible hard work and commitment toupholding the integrity and fairness of atruly innovative procurement process thatproduced results that we feel checked allthe boxes we set out to achieve”.

In some cases, addicts resort to streetdrugs, which networks like PrescribeIT arenot able to monitor.

Analytics, however, can still be used tocombat the misuse of street drugs.

“You can monitor where the overdosesare occurring,” says Horne. “That tells youwhere the street drugs are being used.”With the help of police and health profes-sionals, you are then able to find out whois bringing the drugs into the communityand distributing them illicitly.

“It’s similar to monitoring flu out-breaks,” says Dunham.

Of course, the key to reducing overdosesand drug deaths will be eliminating the im-

proper prescribing of opioids to beginwith, so that patients do not get hooked.

Physicians who were once taught thatopioids were a first-line therapy for pain

are now being instructed to screen theirpatients as a way of determining whomight become addicted. They are also be-ing trained to deploy other therapies be-fore prescribing opioids, if possible.

And patients who are found to be high-

volume users of opioids, through the useof analytics, can be directed into othertherapies – such as alternative drugs thatare less lethal.

Education and training of physicians isan important factor. Dunham recently co-authored a White Paper called ‘Data andAnalytics to Combat the Opioid Epidemic’.In it, she notes that U.S. doctors typicallyreceived only nine hours of education de-voted to pain management in medicalschool. In Canada, it’s double that. How-ever, Canadian veterinarians receive an av-erage of 87 hours of training in pain man-agement.

Clearly, there is a lot of work to be done.With treatments for addicts, too, we

need more data and better analytics, saysDunham. “We don’t do a good job oftracking treatments. We need more data todetermine the best outcomes, based onthe evidence.”

Overall, to reduce addiction and tragicdeaths, we will need better strategies formonitoring the misuse of opioids. We willalso need more information about thebest treatments for pain and for opioidaddictions. “It’s possible to collect betterdata, but it still has to be interpreted,” saysDunham.

Pointing to the U.S. experience, Dunhamsays that combatting the opioid epidemicrequires the use of tools like data surveil-lance and analytics. But the strategies mustbe put in place by public policies and legis-lation. “It all hinges on legislative changesand funding,” comments Dunham.

and scheduling information so that every-thing from prescribed drugs to blood testresults to follow-up appointments is avail-able in one integrated view.

“They don’t have to build it fromground zero. They can say this is the dis-ease, this is the treatment for it,” saysKnust.

Some of the biggest benefits followingimplementation of an integrated systemare showing up in the pediatric oncologyprogram, which was largely paper-based.

By automating the flow of informationbetween pediatric oncologists, the labora-tory and pharmacy – so that informationpasses seamlessly to each stakeholder inreal-time – LRCP has shaved as much as 25percent off of the amount of time a childand his or her family has to spend at hos-pital to receive chemotherapy.

“Now, because we’re capturing all ofthis information, the system is visuallytracking the workflow of the different or-ders so that as a patient is at LHSC fortheir outpatient visit to receive theirchemo ... we can start to see bottlenecksand gaps,” says Kearns. “It is absolutely im-proving overall patient care because the in-formation is now comprehensively avail-able at the point of care.”

In addition to operational benefits inthe clinic setting, where patients are seenmore quickly, the system also provides en-hanced safety.

Quality assurances are built into Pow-erChart Oncology to not only ensure or-der sets are executed correctly, but thatthey are accurate to start with. Similarly, ifa patient’s bloodwork indicates a changein blood count and their chemotherapy isdelayed by a day, the system automaticallyadjusts the treatment plan and workflow,

reducing the likelihood of errors or fur-ther delays. As an added benefit, becausecancer data is now comprehensively avail-able in a single system, LHSC academic re-searchers are starting to aggregate infor-mation across different patient types,gleaning valuable insights from pre-deter-mined reports produced by the Cerner sys-tem. “They’re able to get a different pictureof both individual patients, but even moreimportantly, some of the outcomes and re-sults from groups of patients,” says Kearns.

Moving forward, the LRCP is meetingwith each of its cancer disease teams to

identify opportunities for “tweaking andtinkering” the integrated system to furtheroptimize patient care. Appointmentscheduling on the adult oncology side isone area that requires improvement; theprogram is also investigating how to minedata in the system to better identify poten-tial candidates for clinical trials.

“How can we get at that data to find outthe kinds of patients we have coming inour door who might qualify for a clinicaltrial that we’re doing?” says Johnson.“That’s good for them. It’s good for sci-ence. It’s good for the whole organization.”


Cancer data is no longer isolated in the London region


New approach to procurement finds vendors for e-referral solutions


authoritatively about the status of mat-ters like this isn’t possible.

Human nature, being what it isthough, wouldn’t lead to a fatal arrhyth-mia if these things still happened. Totest this, you can snoop around and dis-cover security weaknesses, if any, in yourorganization.

Let’s call this a Personal Audit. Yourmission, should you accept it, is to comeup with a list of questions that youshould consider. Here are only a fewseeds to your own thinking:

• Is it possible to find the computerroom or the location of any storage me-dia? Worst case, is there a sign indicatingtheir location?

• Are computer facilities and mediastorage facilities locked, accessible onlythrough card or equivalent keys, and isaccess recorded electronically and peri-odically reviewed?

• Is there documented and published

policy regarding who can enter securefacilities, and do staff who use the com-puter facilities have pass cards (or theequivalent) that they carry all the time?

• Have the information system staffbeen trained in security and given writ-ten policies and procedures for access tofacilities and access to information? Arestaff reviewed regarding this?

• Are there documented policies andprocedures related to records access? Are

all personnel imbued with this knowl-edge and the penalties for violations?

• Are computer and media storage fa-cilities protected from fire and flooding,as well as electrical faults or failure? Arethere fire extinguishing facilities?

• Are firewalls in place to prevent illicitremote access and monitor attempts?

Are logs regularly reviewed?• Is there a person whose primary re-

sponsibility is security? Is this personfully competent, having been educatedand trained in security procedures?

A full list of these questions wouldgo on for several pages, as they did inour security audits. Certainly it wouldbe worthy of your time to make the listmore comprehensive. Maybe, in fact, anational organization should provide adetailed security protocol that is stan-dard for all healthcare institutions, andaudit results tracked and reported bothprovincially and nationally.

Yet again, it becomes clear, that thefrontline of security is properly trainedpeople, operating in a disciplined man-ner, and willing to be heroic for the sakeof the privacy of those we care for. Thatsounds like what our soldiers do, doesn’tit? Here is where we all can be heroes!

Dominic Covvey is President, NationalInstitute of Health Informatics, and anAdjunct Professor at the University ofWaterloo.

Dominic CovveyCONTINUED FROM PAGE 14

It is clear that the frontline ofsecurity is properly trainedpeople, solicitous of theprivacy of patients.

Canadian veterinarians receivefar more training in painmanagement than do Canadianphysicians in medical school.

Better data collection needed to combat opioids epidemic


Continuing our LegacyToshiba Canada Medical Systems

Thousands of minds and millions of hours over a century of time have built a legacy of innovation that continues to evolve as we do. From our collaboratively rich research and development past, we advance towards a bright future of technological innovation that is “Made for Life.”

Toshiba Canada Medical Systems continues to serve the Canadian healthcare community as its own organization reporting directly into Toshiba Medical Systems Corporation (TMSC). This provides close ties to our research, engineering and product specialists, enabling the

needs of our customers.

www.toshiba-medical.ca

©Toshiba Canada Medical Systems Limited 2016. ULTRASOUND CT MRI X-RAY SERVICES

To learn more about us, visit our booth at RSNA 2016 | North - Hall B: 7334

november/december 2016 edition – full issue

Documents

Transcript of november/december 2016 edition – full issue