BY JERRY ZEIDENBERG

CALGARY – To improve the coordinationof patient-care among general practi-tioners, radiologists, surgeons and

other specialists, the Health Quality Councilof Alberta is calling for greater investment inelectronic communications networks.

That may sound paradoxical, as Alberta isoften cited as the Canadian province that has

invested most in electronic systems forhealthcare, and is a national leader in the useof electronic charting.

But the HQCA is calling in particular fornetworks that connect one doctor to an-other, so that each can inform the other ofwhat he or she is doing with patients.

Such networks would include electronicreferrals and notifications that messages havebeen received and dealt with. They would

also include alerting systems that convey ur-gent messages such as critical test results.

They differ from most of the regionalelectronic networks that have been createdso far, which upload patient data to centralrepositories and allow physicians to accessinformation at their discretion. The sys-tems being called for are much more proac-tive, and would replace the phone calls and

Stat! Better communication needed among physicians

CONTINUED ON PAGE 2

INSIDE:

Family TyzeAfter testing Tyze, a system thatenables families, friends and care-givers to communicate using acomputerized solution, Saint Eliz-abeth Health Care has acquiredthe company. We profile the solu-tion through its users.Page 4

Lending a hand to PSWsVHA Home Healthcare, based inToronto, is rolling out 1,000 Black-Berry devices to personal supportworkers across Ontario. A pilotshowed the smartphones andGoldCare software dramatically im-proved the efficiency of the home-care workers.Page 6

Reviewing your peersPeer review in radiology depart-ments is one of the most impor-tant developments occurring in di-agnostic imaging. It is expected toraise quality of reporting and pro-vide continuous education of rads.Page 8

Hackathon for healthHacking for Health, a weekend-long event that combined com-puter experts with medical clini-cians, was held at the downtown

MaRS facility in Toronto. The win-ning apps will be tested and re-fined at city hospitals.Page 4

The newly constructed Royal Victoria Hospital in Barrie, Ont., invested $70 million in state-of-the-art diagnostic technologies, includinga completely automated lab system. The solution provides continuous lab sample processing and analysis, enabling staff to focus on higher-value tasks. Pictured are hospital president and CEO, Janice Skot, and Dr. Russell Price, clinical director of lab medicine. SEE STORY ON PAGE 13.

Total lab automation at Barrie’s Royal Victoria

Making a difference where it really matters

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FEATURE REPORT: DEVELOPMENTS IN SURGICAL SYSTEMS – PAGE 10

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 19, NO. 2 MARCH 2014

LABORATORYTECHNOLOGY

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faxes that still predominate among doc-tors’ offices.

The HQCA report has caught the atten-tion of Alberta’s minister of health, FredHorne, who is demanding that provincialmedical organizations, including the Al-berta Medical Association, take note of thiscall for action on electronic networks thatlink physicians, as well as the report’s nineother recommendations. (For the full list,with details, see www.hqca.ca.)

“The minister has asked many of theorganizations for their plans to implementthe recommendations,” said Patricia Pel-ton, acting chief executive officer of theHQCA. “He wants to hear their planswithin the next few months.”

The HQCA attracted a good deal of pub-licity by focusing on the case of 31-year-oldGreg Price, who died three days after under-going surgery for testicular cancer in May2012. While this form of cancer has highrates of survival if caught early and treatedquickly, Mr. Price had to wait months forappointments with specialists (the first sur-geon he was referred to didn’t respond for93 days), received few call-backs for subse-quent appointments and tests when heneeded them, had to wait nearly three weeksfor an ‘urgent’ CT scan, and essentiallydropped through the cracks of the system.

As his father, David, said at a Calgarypress conference late last year, “Greg diedprematurely. We believe he died prematurelybecause of multiple gaps and failures in theso-called system of healthcare in Alberta.”

Problems with ‘continuity of care’ havedogged healthcare systems across Canadafor years, and the issue of communicationbreakdown was recently examined indepth by the Health Quality Council of Al-berta. The council produced a 92-page re-port last December that analyzed thedilemma in general, and focused on thecase of Greg Price in particular.

“We know that in any study of sentinelevents [unexpected events that lead to se-vere injury or the death of patients],communication breakdowns are alwaysamong the top factors,” said Dr. WardFlemons, author of the study and anHQCA medical advisor.

In addition to peer-to-peer networkslinking medical professionals, the HQCAis calling for the use of a patient portal thatallows patients not only to view theirhealth records and test results, but also letsthem see what has happened with referralsto specialists.

In this way, patients can keep tabs ontheir appointments and prod the system,when necessary.

“Gone are the days when a doctor can

manage his patient’s health completely,100 percent of the time,” said Dr. Flemons.“Patients often have five or six differentchronic conditions. Every member of theteam has to be active, and has to be moni-toring the same information – and thatteam includes the patient himself.”

As it happens, Alberta Health has beenworking on a patient portal for some time,and the plan is to go live with it this year.

In addition, the province will start test-ing e-referrals in 2014.

Dr. Flemons concedes there are manychallenges ahead when it comes to build-ing physician networks to improve thecontinuity of care. Firstly, it requires thatall physicians use computerized healthrecord systems. While the province is atthe top of the list when it comes to

physician usage of EMRs, not all doctorsin Alberta are fans of the systems. Thatmeans there will still be gaps in the pro-posed solution.

As well, a network that securely con-nects thousands of doctors to each other

would need to be devised. That, too, is amissing link.

“We agree, it’s going to be a consider-able project,” said Dr. Flemons. “But if youmake it easy for people to do the rightthings, they will do the right things.”

Some commentators in Alberta praisedthe HQCA report, but were skeptical of itsrecommendations ever coming to pass – orat least in the near future. In response, Dr.Flemons noted that families of patientswho have suffered from gaps in continuityof care, including the Price family, willpressure politicians and medical organiza-tions to keep their promises. For its part,the Price family has created a web site tohighlight the issue: See http://healthar-rows.ca. “The families are going to holdpeople accountable,” said Dr. Flemons.

CONTINUED FROM PAGE 1

Art DirectorWalter Caniparoliart@canhealth.com

Art AssistantJoanne Jubasjoanne@canhealth.com

CirculationMarla Singermarla@canhealth.com

Publisher & EditorJerry Zeidenbergjerryz@canhealth.com

Office ManagerNeil Zeidenbergneilz@canhealth.com

Address all correspondence to Canadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill, ON Canada L4J 7R9. Telephone: (905) 709-2330.Fax: (905) 709-2258. Internet: www.canhealth.com. E-mail: info2@canhealth.com. Canadian Healthcare Technology will publish eight issues in 2014. 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. ©2014 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: jerryz@canhealth.com. ISSN 1486-7133.

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

Volume 19, Number 2 March 2014

Contributing EditorsDr. Alan Brookstonealanbrookstone@shaw.ca

Dianne Danieldianne.daniel@cogeco.ca

Richard Irving, PhDrirving@schulich.yorku.ca

Rosie Lombardirosielombardi@hotmail.com

Andy Shawandy56@telus.net

Patricia Pelton Dr. Ward Flemons

Coordination of patient-care among physicians needs improvement

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 M A R C H 2 0 1 4 h t t p : / / w w w . c a n h e a l t h . c o m

Some of the recommendations of theHQCA report:

• That Alberta Health and Alberta HealthServices should strongly consider makingadditional investments in the provincialelectronic health record and e-referral sys-tem to standardize workflow processes forall specialized healthcare services. The im-proved communication would enable thefollowing functionality.

• Electronic referrals confirmed as ‘re-ceived’ by the service provider.

• Management of appointment schedul-ing including booking confirmation andpatient notification.

• Report generation and transmissionback to the referring provider.

• Confirmation that the patient has com-pleted a follow-up appointment with thereferring provider.

• Notification to the referring providerabout referrals that are incomplete, de-layed, or denied when submitted to theservice provider.

• Notification to the referring providerabout known or projected waiting timesfor tests, consultations, or procedures thatare outside specified limits.

• Notification to the referring providerand the patient about important processes(referral, appointment scheduling, patientnotification, appointment completion, pa-tient follow-up) that were not completedsuccessfully according to the scheduledcompletion time.

• A patient portal for viewing:• When the key steps in the referral, ap-

pointment time, and report generationprocess for specialist consultation, spe-cial diagnostic imaging studies, and pro-cedures have been successfully completed

and notifications when they have not.• Appropriate contact information for

patients when they detect a problem withthe special health service, referral, appoint-ment booking, or follow-up procedures.

• Lab results, DI reports, pathology re-ports, procedure findings, hospital dis-charge summaries, other diagnostic infor-mation (e.g., EKG, echocardiograms, pul-monary function tests).

When a reliable electronic referral sys-tem is developed and functioning, the netbenefit to Albertans will not be realizeduntil all healthcare providers are using the

system to manage the referral and follow-up processes for patients who require spe-cialized healthcare services.

Given that, Alberta Health will need towork with Alberta’s healthcare providers toensure that when the system is operationaland reliable, it becomes the only acceptedapproach for managing patients who re-quire these services.

• The College of Physicians & Surgeons ofAlberta and other relevant healthcare col-leges should amend their Standards ofPractice, and Alberta Health Servicesshould amend its policies and procedures,related to coordination and provision ofservices. In so doing, healthcare profes-sionals and clinics that provide specialistconsultation, advanced diagnostic imagingstudies, or semi-invasive and invasive pro-

cedures would confirm completion ofthose studies, services, or procedures andbe required to track critical process steps(transactions) between a referringprovider and a service provider such thatboth know and have documented in a pa-tient record that the following steps havebeen completed:

• A request for service has been sent andreceived.

• A specific appointment date and timefor the service has been made.

• The requesting provider and the patienthave been notified of the appointment de-tails (and the patient has accepted the ap-pointment).

• The report of findings has been success-fully sent to (and received by) the request-ing provider. This will only be possiblewhen there is a complete provider registrythat is continuously maintained and up-dated; this is particularly essential whenservice providers have a critically impor-tant result that needs to be communicatedurgently to the requesting provider who istherefore responsible for managing the re-sult for the patient.

• The Alberta Society of Radiologists(ASR) in collaboration with AlbertaHealth Services (AHS) and the College ofPhysicians & Surgeons of Alberta (CPSA)develop policy and procedures that wouldsupport radiologists to expedite the care ofa patient whom they find has a time-sensi-tive health condition by:

• Directly ordering the next logical DItest if one is required.

• Directly referring a patient who has atime-sensitive health condition to a clini-cal service when it is obvious the patientrequires that expertise.

Recommendations include additional investments in EHR

It’s recommended thatradiologists should be able todirectly refer patients to otherspecialists, in urgent cases.

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Network enables friends and families to connect and contribute to care

BY ANDY SHAW

The three-day Hacking HealthToronto event held at the city’sMaRS Centre late last fallsounded more to the uniniti-ated like a continuing medical

education course for pulmonary specialiststhan a high-energy collaborative for aspir-ing medtech innovators – all out to heal thehealthcare system’s many ills – matched upwith seasoned, willing-to-help mentors.

While more than a few angel investorsalso looked on, the “Hackathon” beganearly Friday evening with a pep-rally stylepitch session staged by the Hackathon’sMontreal-based organizers and their 27black-shirted volunteers. In quick succes-sion, some 42 groups of dedicated re-searchers, healthcare organizations, newbusiness start-ups, physicians, social work-ers, and other medtech creators of allstripes leapt to the stage to rapidly pitchtheir problem-solver in one-minute or less(drowned out by a behind-the-curtainsDJ’s music if they went longer) and spellout the kind of help they felt they needed todevelop their breakthrough further. From aMaRS centre auditorium full house of 406Hackathon participants, the on-stage inno-vators called for designers, programmers,healthcare practitioners, engineers, privacyexperts, marketers, data analysts, or evenpatients to step forward and help them out.

After all 42 ideas were pitched, the ex-pert mentors in the audience got to choosewhich innovators they were going to teamup with for the weekend.

And so, for much of the next 48 hoursand well into both nights, mentors and sup-plicants alike armed themselves with lap-tops, calculators, whiteboards, notepads,

etc., and collaborated away at circular tables.At each, the common goal was to come upwith a mock-up, model, or prototype thatwould not only solve a front-line healthcareproblem, but also be transformed into aworkable “demo” by Sunday noon, which ina two-minute on stage presentation wouldwin the hearts and minds of the sixHackathon judges. They, in turn, wouldthen dole out the coveted prizes offered bythe Hackathon’s impressive list of sponsors.

In all, 19 Hacking HealthToronto sponsors or partners par-ticipated by offering prizes, men-toring the Hackathon pitchers, andof course keeping an eye out forinnovations that might help theirown causes or organizations.

At least one mentor among thesponsors was there to also help the42 presenters woo the Hackathonjudges. In a MaRS Centre ante-room briefing, Ian Chalmers ofPivot Design Group, counselled:“Make sure you let the judges knowin your presentations that you arepractical. Explain how the idea isgoing to get funded. Is it a paid-forapp, or is it pay-per-use? Do you hope toget sponsorship from a hospital or agency,do you hope to get seed capital, and thatkind of thing.”

By late Sunday afternoon at theHackathon’s wind-up, a weary but still ea-ger MaRS Centre audience sat hushed tohear who had won what.

Among sponsor prizes, The Women’sCollege Highest Fruit Award went to threebidders for initial further development atthe hospital:

Alo: a seven-member team of indepen-dent engineers, a physiotherapist, a recent

med school grad, a website designer, and agadget-guy technician who pitched acloud-based solution to the problem oftransferring complex care patient infor-mation to multiple healthcare providers,and which also enables patients to updatetheir own medical histories.

Dignity Talk: a five-member team lead bya respiratory therapist who proposed aweb/mobile application called “Choose YourOwn Adventure” for planning your own and

more agreeable death. Their pitch pointedout: “Most people, when asked, say they’dprefer to die at home, free of pain and sur-rounded by loved-ones… (but) doctorsdon’t know what their dying patients actu-ally value at the end of their lives … By de-fault, many people die a highly medicalizeddeath in an ICU. Because of cultural barri-ers, patients are being denied the choice of acomfortable, dignified death.”

S.O.S: a five-member team, including aregistered nurse leader, a mobile app devel-oper, a third-year university biology student,a bio-medical engineer, and a medical doc-

tor with a doctorate, all connected with theBaycrest Centre for Learning, Research andInnovation in Long-Term Care – addressedthe problem of poor patient-condition datacapture during emergency transfers. Theiranswer: a fully automated system that con-stantly records the patient’s condition, thenconsequently prioritizes the urgency and theactions called for, and ends up generating acomplete report of what was done and why.

Women’s College will have these threeteams put through a human-de-sign workshop with their designexperts, clinicians, and patientsall helping out. Afterwards, eachteam will present their nowmore refined and workable ideato the hospital’s senior manage-ment. One will then be pickedfor a full, three-month trial atWomen’s College.The Beworks behaviouralchange prize went to BLU+, aseven-member team led by anorganizer and mentor who isalso a patient, assisted by a anart-and-design college grad, apharmacy student, a .NET de-

veloper, a marketer, a health informaticsspecialist, and digital user interface de-signer.

Their aim: to produce a “human main-tenance manual” containing nothing lessthan “a detailed interactive timeline ofthings you need to do to stay out of thehospital, from age zero to 100.”

Women’s College winner S.O.S. also gotthe nod as the best solution for clinical ap-plications; PatientFlow won again as best forhealth administration; and the best for con-sumer health and patient application wentto the My Baby and Me Passport pitch.

Combining health, tech and creativity at Hacking Health Toronto

BY DIANNE CRAIG

Let me know if there is anything Ican do.” Delivering the news of adevastating diagnosis to friendsand family usually elicits that

heartfelt response, along with the assump-tion there is little they really can do. Car-ing for a family member facing a seriousillness or a lifelong disability can bedaunting and isolating. Vancouver-basedTyze, which has a cloud-based personalhealthcare networking platform that en-ables families to build personal communi-ties of care, is on a mission to change that.

Donna Thomson’s 25-year old sonNicholas has severe cerebral palsy. Beforeshe started using a Tyze personal net-work, Thomson and her family in Ot-tawa used a variety of professional ser-vices, including night nursing to moni-tor her son’s severe sleep apnea, alongwith after-school helpers, her sister,neighbour, and mother.

She used a whiteboard and tried toconnect with everyone when Nicholaswas unstable and needed extra care. Someof the messages written on a medicalchart on his bed were not getting

through, for various reasons. This couldbe serious when changes in his medica-tions were missed by some friends orother helpers who didn’t see the messagesand assumed nothing had changed withhis needs and care. Also, when someonecouldn’t come in to help, Thomsonsometimes had no way of reaching every-one quickly to find a replacement.

“With Tyze, all the medications are ona file. If there’s a medication change,everyone (on the network) gets an email.If there are side effects in the seizuremedication, everyone gets an email andverifiers go out for appointments,” saysThomson. Also, she says, “if a task needsto be done, it goes on a task list, and peo-ple on the network can claim that task.”

Intended for use by family, friends, andin some cases, formal care providers, Tyzenetworks are designed to optimize andenhance the support and care they canprovide. Networks of enhanced care andsupport are closely tied to better healthoutcomes, improved experience of careand better cost efficiencies for the system– the three Triple Aim dimensions, aframework of ideals from the Institute forHealthcare Improvement (IHI).

Tyze Personal Networks are private so-cial platforms that consist of a shared cal-endar, messaging system, stories and up-dates wall, file sharing and storage. Net-works are set up to support individualsand families facing disability, chronic dis-ease, end-of-life care and aging-relatedchallenges like Alzheimer’s, fracture or re-

placement surgery or transitions betweenvarious care settings. The cloud-based so-lution is accessible on an affordablemonthly subscription, and some health-care providers also give Tyze to patientsand families. Tyze was recently acquiredby Saint Elizabeth Health Care, a not-for-

profit community care agency which hasbeen offering the networks to families.

Kerry Byrne, director of research atTyze, describes the networks as a “set oftools and functions developed to mobi-lize informational, emotional and practi-cal support.” While it is easy to see theimportance of having a personal networkfor quickly delivering status updates andarranging for help, it is the emotionalsupport that is just as valuable.

In fact, Tyze evolved in part fromfounder and CEO Vickie Cammack’s 20year focus on developing strategies toaddress isolation. Speaking on the com-pany’s YouTube channel, she notes howironic it is in our “hyper-connectedworld that we are collectively growingmore vulnerable to isolation,” and ob-serves “there is no independence with-out interdependence.”

According to results from five onlinesurveys, 88 percent of users reported thatTyze made it easier to share information,and 83 percent reported it was easier tocoordinate care.

Learn more about Tyze at Tyze.com andhttp://www.youtube.com/user/TyzeCommunity.

Tyze ties together families and caregivers.

The My Baby and Me Passport team produced a winning smartphone app.

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

BY JAY PARKES

Six-year-old Randy LeBlanc hasjust been rushed into the Emer-gency Department at Toronto’sHospital for Sick Children com-plaining of severe chest pain.

Randy, who lives in Orillia, Ontario, has acongenital heart defect. As a result of surgi-cal procedures performed at Royal VictoriaHospital in Barrie and a strict medicationregimen, Randy has been getting by prettywell – until now.

An experienced emergency physician isalready waiting for Randy when his ambu-lance arrives. Made aware of Randy’s con-dition by his parents, who accompanyhim, the physician immediately orders achest X-ray.

Using a Web Viewer, the physician’s col-league, a cardio-radiology specialist, is ableto quickly and easily access Randy’s previousmedical images, which are stored in elec-tronic format in a diagnostic imaging repos-itory at Royal Victoria as part of Randy’slongitudinal Electronic Health Record(EHR). By comparing these with the newexam just taken, the attending physician andradiologist are able to diagnose Randy’s sit-uation and initiate effective treatment.

Advancing the pan-Canadian EHR:The Web Viewer, the diagnostic imagingrepository, and the ability for an autho-rized physician or radiologist at SickKidsor any of Ontario’s 148 hospitals toquickly, easily and securely store, accessand share medical images online for anyOntario patient (e.g. X-rays, ultrasounds,MRIs, CTs), are all part of a larger initiativeby Canada Health Infoway and jurisdic-tions across Canada to implement a singleEHR for all Canadians.

Enabling clinicians to have a longitudi-nal view of diagnostic imaging (DI) history,regardless of where earlier images were ac-

quired, accelerates diagnosis and treatmentstart and enables the seamless delivery ofcare to patients who present outside theirlocal healthcare facility. It also reduces costto the health system and improves the pa-tient experience by reducing the need forduplicate exams and patient transfers.

For its part, Ontario has been imple-menting four such DI networks and associ-ated repositories (DI-r), where all medicalimages will be stored and accessible by allhospitals in the province. Three of the im-age network and repository solutions are al-ready fully deployed, including the South-western Ontario Digital Imaging Network(2009), the Hospital Diagnostic ImagingRepository Service (2010), formerly theToronto East Network, and the Northern &Eastern Ontario DI Network (2011).

GTA West project marks final phase:The fourth and final step toward sharingof medical images amongst Ontario’s hos-pitals is the Greater Toronto Area (GTA)West DI network project, a $50 million ini-tiative being orchestrated by the UniversityHealth Network on behalf of the GTAWest consortium. The project, which be-gan in 2010 and is already operational, wasexpected to be fully rolled-out by the endof summer, 2013.

“The GTA West DI network is the firstsuch solution in the country to be designedand implemented using open, industrystandards for the communication, storageand transmission of diagnostic images,”said Hitesh Seth, sector VP, consulting ser-vices at CGI Group, which is providing thedesign, implementation hosting and ongo-ing operation, as well as systems integra-tion and overall project management.

According to Seth, the standards-baseddesign facilitates the easy connection andsharing of images within GTA West, as wellas externally with other imaging reposito-ries. The resulting DI network and reposi-

tory will support 22 hospital corporationswith 38 sites across five Local Health Inte-gration Networks. It will serve patients liv-ing in the western parts of the GTA and inNorth Simcoe Muskoka, and will supportaccess by approximately 10,000 medicalprofessionals.

Right at home amongst early adopters:The team at SickKids is no stranger tofirsts and to being on the leading edgewhen it comes to adopting new imagingtechnology. The hospital was among thefirst to implement a Picture Archiving &Communications System (PACS), for ex-

ample, first to leverage an enterprise stor-age solution as a PACS backend, thus elim-inating the need for CDs to transportmedical images, and among the first to gofully digital from the get-go, implementingPACS and eliminating the use of film-based images across all departments, in-cluding the operating room.

In addition, clinicians at SickKids wereon board early when it came to sharingmedical images electronically with anotherfacility, in this case, Bloorview Hospital,which serves as a rehabilitation centre forpatients leaving SickKids.

“We were asked to be a pilot site for theGTA West DI network project because of thehospital’s history of leading the way inimaging innovation, and because of theunique requirements and challenges that acombined tertiary care and academic centrefocused on the care of children presents,” ex-plained Daniela Crivianu-Gaita, VP & CIO,information management and technologyportfolio, at the Hospital for Sick Children.

According to Crivianu-Gaita, it was feltthat a DI network solution designed tohandle all the challenges of a pediatric en-vironment would pretty much work any-where. For example, the hospital’s patients,ranging from newborns to 18-year-olds,often have chronic conditions and are seenregularly for many years. As a result, a sig-nificant amount of historical patientrecord information, including medical im-ages, must be quickly and easily accessibleto clinicians, and remain accessible for anextended period, so that it can be viewedin the context of the growth of the patient.

Pilot test confirms design: The pilot de-ployment at SickKids consisted mainly ofbuilding links between the SickKids datacentre and PACS system and the data cen-tre at CGI, where the imaging repositoryand other GTA West DI network compo-nents are hosted.

These links, which use the eHealth On-tario ONE Network connectivity back-bone, enable SickKids and Bloorview totransfer medical images to and from therepository. They also allow images and as-sociated radiology reports to be retrievedfrom other hospital PACS systems throughthe GTA West repository.

“This infrastructure was thoroughlytested to ensure different usage scenarioswere covered, and all the different possibleworkflows were simulated, to confirm thatthe connectivity and systems were workingas expected,” said Crivianu-Gaita.

SickKids helps develop an innovative, regional imaging repository

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GoldCare MobilityPlus and BlackBerrys help PSWs deliver care

At some point last fall FelisterMburu understood that hertypical workday as a PSW withVHA Home Healthcare, in

Toronto, would change dramatically.Mburu works in the East York region,which was part of a pilot project thatsaw the company deploy GoldCare Mo-bilityPlus on 20 BlackBerry 10 devices.

VHA is one of the first healthcarecompanies to implement a BB10 plat-form and, to date, has rolled out approx-imately 400 BlackBerry devices. Imple-mentation is scheduled to finish in April2014, by which time a total of 1,000 de-vices will be rolled out to all PSW staffacross Ontario.

GoldCare is a leading provider ofhealthcare information managementsoftware for community, residential andlong-term care organizations, as well as18 Children’s Treatment Centres acrossthe province.

GoldCare MobilityPlus lets you se-curely manage appointment, client andprogram information, and improve doc-

umentation, reporting and communica-tion from a smartphone platform. Thesolution increases communication andefficiency, decreases missed and unfilledvisits, improves compliance at the pointof care, reduces operating costs, and pro-motes care team and client collaboration.

“MobilityPlus improves the quality ofcare I’m able to give my clients andmakes the old way seem old-fashioned,”said Mburu. “You don’t have to keepcalling the office for addresses or mes-sages or ask someone to speak slower be-cause you can’t understand them. Whenyou’re driving, GPS takes you where youwant. There’s no confusion – you havethe apartment, the entry code, the street,the client, you have everything you want.I love it!”

Ben Kim is the MobilityPlus ProjectLead for VHA. Having moved from Pre-ferred Health Care Services, where hisresponsibilities included implementingthat company’s MobilityPlus solution,Kim joined VHA in 2012 and broughtwith him extensive industry experience

and familiarity with the GoldCaremHealth solution. He reported that PSWresponse to implementing MobilityPlusat VHA has been mostly positive.

“Personally, I believe MobilityPlusbenefits the field staff by empoweringthem. It provides a lot more informationto the field staff than previously,” saidKim. “Just like patient empowerment

through ensuring they’re informed oftheir condition and treatment choicesand options, PSW empowerment is prac-ticed through providing them with theirschedule information and client infor-mation. It gives them better control overtheir schedules, and better decision mak-ing on delivering care because they knowmore about their clients than before.”

VHA responded to staff apprehensiveof the implementation or those experienc-ing difficulty using the device by nomi-nating MobilityPlus champions, earlyadopters who engaged in training sessionsto support their co-workers in the field. Asone of these champions, PSW Paul Miole,who is part of the Toronto Central team,assists with training his colleagues to takeon the new system.

“Information can be immediatelysent to coordinators and supervisors forsolutions to client issues and events,”Miole explained. “Another great benefitis the ability to see the care plan visuallyon the device.”

VHA’s pilot evaluation reveals thatMobilityPlus has impacted a number ofkey performance indicators. Missed vis-its, client complaints and administrationare drastically reduced. Staff satisfactionhas improved because staff are more in-formed about clients and schedules, re-ceive a faster response from supervisorsand the office, and are better connectedwith co-workers.

Using the smartphone, ‘Youdon’t have to keep calling theoffice for addresses, or asksomeone to speak slower.’

Daniela Crivianu-Gaita, VP and CIO at SickKids.

Produced by Ontario’s CommunityCare Access Centres (CCAC),which coordinate care in commu-nities, thehealthline.ca is a website

that in one place provides access to currentinformation about a wide range of healthservices across the province.

The site informs people about the ser-vices available, and where and how theycan access them, whether for help at homeor in the community, for caregiver supportor financial support services, for trans-portation, or even for help finding shelter.

Full provincial implementation wascompleted on August 1, 2013, making the-healthline.ca available across all 14 LHINs.The result is a comprehensive informationand referral process that is accurate, com-plete and standardized.

Thehealthline.ca simplifies access to in-formation for Ontarians, whether patientor provider. It offers several intuitive searchoptions that make it easy for people, eventhose relatively unfamiliar with the Inter-net, to find the information they need.

“One of the things I really like to dowhen I have a patient in the office is toturn to the computer and bring up a webpage, a resource they can access at home,”said Dr. Jonathan Kerr, family physician,

Belleville, Ontario. “thehealthline.ca isquick and easy to use, and they can gohome with the website address and accessthe resources themselves.”

Thehealthline.ca contains approximately40,000 service records, and the site receivesmore than one million visits annually in theSouth West region alone. Users can searchby location and postal code, generating re-sults based on their specific location andservices nearest to them in increments offive km, 20 km and 40 km. Thehealthline.caalso includes a health library and news,events and job listings for each region.

By making reliable health informationaccessible, the site supports consumer em-powerment, self-management and inde-pendent community living. Locationsearching, mapping, detailed listings,videos and other special features help peo-ple access and understand the services theyneed, as close to home as possible. The siteis also a resource for family physicians andother health professionals, helping themconnect their patients to local services.

Launched in 2002 through an innova-tive partnership among health institutionsin London, thehealthline.ca quickly ex-panded across southwestern Ontario. In2011, CCACs selected thehealthline.ca asthe provincial online solution from anumber of alternatives for its collaborativebusiness model and innovative informa-tion platform.

Recognizing health information as apublic good, the CCACs, the Local HealthIntegration Networks (LHIN) and the-healthline.ca Information Network arecommitted to working in partnership to en-sure that data is collected only once, shared

freely and that thehealthline.ca integrateslocal information from reputable sources.

Key data partners include FindHelp In-formation Services, Community Informa-tion Centre of Ottawa, Information Nia-gara, Inform Hamilton, Community Con-nection, 211 North West (Lakehead Social

Planning Council), Halton InformationPartners, Community Information PartnersPeel, Community Information Centre Wa-terloo Region (Social Planning CouncilKitchener-Waterloo), Community Informa-tion Guelph, and Waterloo Social Planning.

The Ontario Association of Commu-

nity Care Access Centres (OACCAC) andthehealthline.ca Information Networkwork under an umbrella agreement inpartnership with CCACs to coordinateand support an integrated network of 14websites corresponding with LHIN bor-ders and the provincial gateway site.

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The site enables familyphysicians and caregivers toeffectively connect theirpatients to local services.

Website gives patients and caregivers an easy-to-use information source

F O C U S O N S O C I A L M E D I A

M A R C H 2 0 1 4 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 7

The health industry strives to deliver high-quality care and the best-possible outcomes for patients and citizens at lower costs. It’s a goal that health organizations, communities, partners, and Microsoft can all rally around.

Innovative, flexible, and cost-effective health solutions from Microsoft and its partners help connect people, processes, and information to help advance collaboration and enable health teams like yours to make more insightful decisions, faster. These solutions work in concert with your existing systems to help improve ef fciency and quality of care.

Learn more at www.microsoft.ca/health

Real impact for better health

Canadian Healthcare Technology’sAndy Shaw recently interviewed Dr.Jacques Lévesque, President, CanadianAssociation of Radiologists (CAR). Dr.Lévesque is a clinical professor of radi-ology at Laval University, and a prac-

tising radiologist at his own clinic in Quebec City.

CHT: Dr. Lévesque, is it fair to say that what’s top-of-mind for you these days is both how Canadian health-care systems can provide a better quality of patientcare and what radiologists can do to contribute to it?

Dr. Lévesque: That’s true, and so you probably alsoknow that CAR has for many years involved itselfwith quality assurance, especially in our associationthrough different types of guidelines for radiologists,and also for physicians who order medical imagingin Canada.

And what we are stressing now is less about the ra-diological exams themselves – we do those very well –but more about the appropriateness of that exam. Andwe’re pleased to see that this emphasis on appropriate-ness is emerging as a trend. We can see it, for instance,in the interest that is being expressed at the local hos-pital level, as well as more broadly and nationally.

CHT: Do you see any other encouraging trendsthese days in what radiologists can do to improvepatient care?

Dr. Lévesque: Yes, physician peer review. It’s startingto happen in more and more health jurisdictions inCanada right now [including Ontario which re-cently announced a province-wide peer review pro-gram]. Although many centres have practised peerreview in their facilities for some time, there is amovement towards broader programs in jurisdic-tions. There is a peer review pilot project going on inBC, for example, and in other jurisdictions are atvarious exploration levels.

CHT: In practical day-to-day terms, can you describehow peer review works?

Dr. Lévesque: There are different types of peer re-view – one method looks back on images and reportspreviously done, and another looks at images and re-ports at the time they are carried out.

The first practical challenge is how many exami-nations get reviewed. As a practitioner doing mam-mograms, chest X-rays, and other general radiologywork, I might make 50 examinations a day. Impossi-ble to have them all peer-reviewed, of course, but be-cause our examinations are now digital and we areconnected by PACS networks, we have the softwarethat can randomly select a set percentage of my ex-ams every day and send them off together with mydictated report to a colleague for his or her review.So, say, just as an example, it was 4 percent; thatwould mean two of my 50 examinations would besent off for a colleague to review.

CHT: So what happens then?

Dr. Lévesque: Well, the radiologists receiving thoseimages would normally send back one of three possi-ble responses: the first response would be to agree

with my assessment; the second could be a note I getback saying that something in my interpretation of theimage may be looked at differently; and finally theycould also say flatly that I have made a mistake, whichis possible, of course, because nobody is perfect.

So not only does peer review put greater safetyinto the healthcare system, it also is a whole otherway of providing continuous medical education. Be-cause it is such an elegant, double-benefit solution, Ithink peer review is going to have a huge impact inthe next 10 years.

CHT: What about the radiologists themselves? Couldthey be contributing to better care by making moreefforts to improve communications with patients?

Dr. Lévesque: That’s a very interesting question tome – because I believe a radiologist should be an in-tegral part of patient care. And when you think aboutit, there was a time when they were. Twenty years

ago, before the pendulum swung to digital images,we were all reading film. Physicians themselves weregoing into the X-ray department and looking atthem, and whenever they had a question they wouldcome to see us. They really had no other choice butto do that, and so our day-to-day contact back thenwith physicians was much better. But now with thedigital revolution upon us, the doctors can see theirpatients’ images and read our reports in the wards ortheir offices and as a result there is far less contact.That to me means radiologists should take the lead

and go on rounds and become an actual member ofthe care team again, to ensure their expertise is avail-able readily to other physicians and patients.

In my own case, I take advantage of 30 years ex-perience and write in my reports, often making sug-gestions about doing this and that, which we shouldconsider concerning a particular patient. That’s thekind of thing that can be discussed on rounds and it’sa very good way to make yourself as a radiologist in-tegral to the team. It’s time, in other words, that thependulum swings back the other way.

CHT: Just to be fair to that digital world, hasn’t ithelped in lowering radiation dosages that patientsare exposed to?

Dr. Lévesque: We agree fully that the digital worldhas brought many benefits to our profession and tothe care we provide patients. Lowering radiationdose is one of those benefits. Digitized detectors arefar more sensitive and so now we need less dose, of-ten as much as 50 percent less with the CT and X-raytechnology we have now.

But I think the real advances will come in the next10 years when every patient will have a digital recordof the doses they’ve received throughout their lifetime.

There was a pilot project going on at DalhousieUniversity that points to the future. If you have had atumour when you are very young and you are exam-ined frequently with CT scans, that won’t be forgottenwhen you are older. In the future, patients having acomplete cumulative dose record will be very helpfulto more effective and safer care for them.

CHT: Just one more question about the benefitsabout going digital: Do you think the portals that areemerging on the web where patients can see theirown examination images are contributing to a hap-pier healthcare customer?

Dr. Lévesque: Well, happier perhaps, but certainlyportals that give the patient access to their imagesand care information are also a great way to make thepatient more responsible. It is easier, with that kindof information available to you, to start building apersonal health record. We are just in the infancy, butI can see that there’s also so much more we can dowith these portals. They make it easier for hospitals,for instance, to do more out-patient follow up. Sothey can be a way of shifting more expensive health-care into the less-costly out-patient realm. But thereare issues that have to be resolved and privacy is a bigone. Right now in many jurisdictions, for example, ifI work in a private clinic I cannot access patientrecords in the hospital.

CHT: Finally, Dr. Lévesque, is there any one pointyou would like our readers to retain from this in-terview above all the others ?

Dr. Lévesque: I think the idea of physician peer reviewcan’t be over emphasized – because it’s not just a safe-guard against medical discrepancies. For radiologists,regular peer reviews are really more about constantprofessional development. If you go to a conferenceevery now and then you’ll probably retain 20% ofwhat you learned at best. But peer review allows youto learn on a daily basis and because the learning re-lates directly to the work you are actually doing, youwill retain infinitely more.

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Peer review improves quality and provides continuous education for diagnostic imaging specialists.

Peer review is on the radar screen as a keyissue for Canadian radiologists

“Because it is such an elegant, doublebenefit solution, I think peer review isgoing to have a huge impact in the next10 years,” says Dr. Levesque.

Dr. Jacques Lévesque, President, Canadian Association of Radiologists

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BY DOMINIC COVVEY

Heroism. We often hear thatword associated with a soldier,a police officer, or an ordinarycitizen giving his or her life to

save someone or to accomplish somethingof importance. Heroism means that therewas courageous behavior that achievedoutstanding effects or preserved noblequalities. Actually, it bothers me that hero-ism seems associated only with the risktaken when death or major injury is likely.

Interestingly, there are many synonymsfor heroism. There are the obvious oneslike bravery, courage and valor. But, thereis also a different dimension: backbone,spine, grit, spirit, mettle, chivalry or the

older term ‘moxie’.We honour heroismbecause we see it asevidence of the bestin humans.Is there heroism re-lated to eHealth? Myanswer an absoluteYES! Let’s think aboutthat for a minute.What if you areaware that there is an

activity going on that essentially wastestaxpayers’ money. I experienced an exam-ple of that long ago related to an agree-ment between a provincial governmentand a company. The deal was known to bebad, the uppity-ups recognized this, butthere were excuses for proceeding.

I knew of this deal and lacked the hero-ism to blow the whistle on it. Frankly, I wastold that if I did, it would end my ability towork with the government and exposing itwould do no good except embarrass peo-ple. In retrospect, I was simply a coward.There was an opportunity for heroismthere, in that I would’ve risked my career atleast for a number of years by outing thedumb thing and maybe saving a few mil-lion dollars of people’s hard earned money.

So, one kind of heroism is whistleblow-ing. If you unmask something that is injur-ing people and is wrong, you take the riskof losing your job and maybe even yourability to ever work again in your field ofchoice. In eHealth, we have seen many ex-amples of where the whistle needed to beblown. In some cases the malfeasance even-tually became known through othermeans, but those involved early on didnothing about it. No doubt, if they had,they would have suffered publicly and pri-vately. However, we needed them to do it,and that would have exhibited heroism.

What about a project that’s going awryand no one does anything about it? Let’ssay you take your observations of signifi-cant dislocations up the chain of com-mand and no one does anything about it?Need an example? Read my last article, inthe February edition of Canadian Health-care Technology, on the Obamacare web-site debacle! Why didn’t anyone speak up?That would’ve exhibited heroism andcould conceivably have saved possiblyhundreds of millions of dollars and graveinconvenience for many people who wantto get health insurance.

People tell me stories about how things

are going at their institutions. They feelthings are just not making sense or areproceeding inappropriately. Despite this,the project still goes go on and no one doesanything about it – notwithstanding thelikelihood the project will fail or gravelydisappoint. In this case, pointing out the

problems or trying to intervene might getyou kicked off the project team or get youlabeled as a malcontent. I would suggestthat speaking up and, if necessary, goingup the chain of command is an example ofheroism and we desperately need thatheroism in all our organizations.

Maybe we need an eHealth Silver Staror even a Medal of Honour for eHealthheroism. And we certainly need heroes!

Dominic Covvey is President, National Insti-tutes of Health Informatics, and an AdjunctProfessor at the University of Waterloo.

Courage in the face of danger: Heroism is required of eHealth pros

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

Dominic Covvey

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If you’re going to take steps to reduce surgicalwait times, isn’t it prudent to consult the peo-ple who are actually doing the waiting? Theprovince of Saskatchewan believes so. In 2010it launched the Saskatchewan Surgical Initia-tive (SSI), a four-year plan to transform the

surgical experience and provide all patients an op-portunity to have surgery within three months. In-volving patients in the process is one of the initia-tive’s critical success factors.

Up front, patients were responsible for identifyingwait times as a key concern, based on informationcoming out of Saskatchewan’s 2009 Patient First Re-view. As the transformation unfolds, they retainan integral role by serving as patient advisorson committees. They are also part of the solu-tion, using an on-line surgical directory to exer-cise a greater degree of control over their per-sonal surgical experiences.

“It’s been a fundamental shift in the way wethink of things,” says SSI executive directorTerry Blackmore. “Collaboration, a commonvision and having patients involved has reallymade us think a lot more about system im-provement from the perspective of a patient.”

In addition to patients, the SSI executivesponsorship group and guiding coalition con-sists of representatives from the SaskatchewanMinistry of Health, the health regions andfront-line providers. From the outset their tar-get of reducing wait times to three months wasaggressive.

“Is three months the right target? I don’tknow. It was a bit arbitrary, but our access andthe wait times are much improved from fouryears ago,” says Blackmore. “As we get closerand closer to the end, weeding out those ineffi-ciencies becomes more and more difficult be-cause we’re already almost there.”

In 2010, people were waiting 18 months totwo years for surgery and patients often askedto be added to a wait list “just in case” theyneeded surgery down the road.

“It was not uncommon for people to think,my knee’s kind of bugging me, I should reallygo see a specialist and put my name on a wait-ing list because it’s going to take two years to getsurgery and by then it will probably be reallybad,” explains Blackmore.

Now, the majority of patients are waitingthree months or less and the mindset hasshifted from one of doubt to one of trust. Pa-tients are added at the appropriate time as opposedto “just in case,” she says.

Saskatchewan’s success is based on a disciplined,lean methodology approach. Essentially the SSI isputting the surgical process under the microscope,identifying waste, looking for ways to eliminate itand introducing changes that add value. From atechnology perspective, the province’s surgical reg-istry – introduced in 2004 as a central data repositoryto collect and measure surgical data and wait times –has proven to be a key facilitator, enabling the initia-tive to further establish an on-line specialist direc-tory and launch a pooled referral system.

Anybody, members of the public included, canaccess the specialist directory and the health min-

istry has held awareness campaigns to publicize itsavailability. The directory indicates which sur-geons perform various specialties, and providesestimates of expected wait times. The goal is toarm the general public with information to makeinformed decisions.

“People are comfortable with using technologyand will poke around and search,” says Blackmore.“Maybe I live in Regina, but the surgeon in MooseJaw has a shorter wait time and it’s important tome to have the procedure done quickly. I can makethat choice.”

Pooled referrals is another change gaining accep-tance. When a patient opts to go with the next avail-able surgeon, a referral is sent to a central computer

system. From there the case is forwarded to the ap-propriate surgeon, who either accepts it or rejects it,stating why. If an appointment is scheduled, thespecialist ensures all preliminary testing is com-pleted in advance.

It’s about maximizing the value of that first visit,says Dr. Peter Barrett, SSI clinical lead and one of thefirst to use pooled referrals in his urology office. Tra-ditionally, it would take as many as three visits to aspecialist before all tests were completed and a deci-sion about surgery could be reached. Now, surgeonsare armed with the information they need from dayone, reducing the wait time for surgery and improv-ing access by freeing up two or more appointmentsto see new patients.

“At no point was the intent to take away choice,”he adds. “Even with pooling, patients are informedthat they can see any doctor they want as long as theyknow up front that they may have to wait longer.”

Other changes that are contributing to reducedwait times in Saskatchewan include more emphasison clinical pathways, implementation of standardsurgical checklists, better patient flow and dischargeplanning, and more training of operating-roomnurses to increase surgical capacity. In addition, avariations and appropriateness working group is ex-amining ways to further reduce times by standardiz-ing processes and flow, such as case carts for certainprocedures and best practice protocols.

Yet, the real game-changer, maintains Dr. Barrett,was the decision to put patient representa-tives on every committee. A mantra thatsums it up best is one he borrows fromAlaska’s South Central Foundation: “Noth-ing about me without me.”“Lots of places have a patient advisory com-mittee, but to me, that always ghetto-izedthem,” he says. “If you actually put them onevery committee, it’s amazing how itchanges the conversations.”One “Aha!” moment came when Dr. Barrettran a letter by the SSI’s executive sponsorgroup for approval. He was informing sur-geons about why internationally recognizedsurgical checklists were going to be manda-tory. “I can still remember this one patientlooking at me and saying, ‘You mean youdon’t do this now?’” he recalls.Report cards have a role: The changes in-troduced in Saskatchewan as part of theSSI are in line with the Canadian WaitTime Alliance’s (WTA’s) objective to putmore information about wait time perfor-mance in the public domain. One reasonfor issuing report cards is to show differentprovinces how they compare with eachother, as well as to give patients a betterunderstanding of how individual experi-ences fit into the big picture.“My strong sense is that patients don’t mindwaiting a reasonable length of time as longas they know they’re not lost in the system,that somebody is keeping an eye on things,that it’s safe to wait and there aren’t going tobe any screw ups,” says Dr. Chris Simpson,WTA chair and president-elect of the Cana-dian Medical Association.Dr. Simpson applauds the strong culturalcomponent to the work under way in

Saskatchewan, noting the province has a long historyof patient-centred reform and collaboration.

“Culture is what drives change,” he says. “The no-tion that we’re accountable for patient outcomes andaccountable for patient satisfaction as customers is acultural thing and maybe that’s where Saskatchewanis a little bit ahead of some of the other provinces.”

In its 2013 report card on wait times in Canada,the WTA iterated the best way to make sustainedreductions in wait times is to introduce changesaround how they are “mitigated, measured, moni-tored and managed.” Saskatchewan received an “A”for ongoing efforts to provide timely data that iscomprehensive, patient-friendly and helpful. It alsoearned recognition for having the strongest

Surgical waits now average only three months, down from 18 months to two years in 2010.

Patient participation improvessurgical wait times in Saskatchewan

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cataract wait time reporting and special-ist consultations.

Nadeem Esmail, director of Health Pol-icy Studies at the Fraser Institute questionswhether some of the strides made by theprovince will be sustainable over the longterm. He contends that in the absence ofhealth policy reforms like activity-basedfunding and other market-oriented strate-gies that have worked well in other coun-tries, Canadians will continue to waitlonger than average.

“The idea that we have to wait perme-ates Canadian thinking about healthcareand it’s nonsense,” says Esmail. “The coreproblem remains – we spend more, we waitlonger. We have to figure out how to spendless and wait less at the same time, and thesolution is clearly health policy reform.”

Activity-based funding creates incen-tive to increase the volume of surgeriesdelivered, shorten wait times and attractmore patients, he argues. In Stockholm,for example, total volume of activity in-creased by 11 percent while total costs fellby one percent as a result of activity-based funding.

“In Canada, all of a sudden the fear-mongers come out and says that’s the de-struction of medicare and universality,”says Esmail. “It’s an unfounded fear. Thereality is it works better for everyone.”

WTA’s Dr. Simpson welcomes the ideaof activity-based funding, noting thattentative strides are under way in On-tario. But he cautions against whole-scalechanges across the board. “I’m an incre-mental revolutionist,” he says. “You can’tupset the apple cart overnight and expecteverything to fall into place … There’s noshame in making mistakes. As long asyou’re doing it in small steps and incre-mentally, then you can learn from it andchange direction.”

The continuous improvement cul-ture in Saskatchewan takes a similarapproach. The idea is to start small,

ensure a particular improvement is solidand then expand it to the next hospital.Sometimes the change can be as simple asintroducing a daily phone call to ensurepatient transfers between hospitals gosmoothly.

One thing everyone agrees on is youcan’t fix the problem of surgical waittimes through increased funding. But youcan spend money more wisely, contendsDr. Barrett. The SSI budget for 2013-2014is $70.5 million. More than $60 million isdirected towards hospital costs related tohigher surgery volumes; $7.8 million isfor home care and post-operative rehabsupport; roughly $1.2 million is for im-proved assessment clinics and patientpathways; and, $4 million is for qualityand safety improvements.

Since 2007, the number of peoplewaiting longer than six months forsurgery in Saskatchewan has fallen 66percent, from 10,635 to 3,577. Pooled re-ferrals now exist for orthopedic sur-geons, neurosurgeons, general surgeons,urologists, cardiac and vascular sur-geons, obstetricians and gynecologists.And clinical pathways are in place for hipand knee, spine, bariatric, prostate andpelvic floor surgeries, with acute strokecare and lower extremity wound care un-der development.

Dr. Barrett is confident those improve-

ments will be sustainable over the longterm due to the culture of continuous im-provement now in place. By collecting, an-alyzing and reporting real-time data aboutwait times and surgeries, the province hasits pulse on the situation and is unlikely toslip back to where it once was.

As a representative of the WTA, Dr.Simpson agrees. “Any sort of slippagewe’ve seen in our report cards, I firmly be-

lieve has been because people have said,‘There. Mission accomplished.’ As soon asyou take your eye off the ball, it slips backto its former state.”

Another advantage in Saskatchewan,and a possible lesson to learn for otherprovinces, he adds, is the genuine sense ofcollective responsibility that exists be-tween the various groups, including pa-tients. Rather than a culture of blame,

there’s a sense of working together to solvea problem.

“I think they become better than thesum of their parts when they take thatcollective view,” says Dr. Simpson. “Whatthey’re doing isn’t revolutionary in andof itself. It’s just basically measuringthings well, reporting things well andthen being committed to a culture ofcontinuous improvement.”

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Automation improves surgical wait times at Capital District Health

The Centre for Imaging Tech-nology Commercialization(CIMTEC) was founded in2011 to accelerate the com-mercialization of medicalimaging and digital pathol-

ogy technologies. It works with researchers,start-ups and small and medium-sizedcompanies across Canada, providing a one-stop-shop of technology and business de-velopment services to help customers alongthe entire commercialization continuum.

“We find that many of our customerscome to us with limited knowledge of thecommercialization process and how to be-gin,” says Michael Waterston, business de-velopment director at CIMTEC, “or theysimply don’t have the in-house skills,knowledge or capacity to follow throughwith every step and nuance required tosuccessfully bring a product to market.”Adds Waterston, “CIMTEC can become avaluable part of each customer’s team byfilling their knowledge and capacity gaps.”

To work with CIMTEC, a medical imag-ing innovation must be past proof-of-con-cept with evidence that it works. From aregulatory standpoint, there is a significantdifference between a proof-of-concept andwhat’s required to sell a product for clinicaluse. CIMTEC’s team of engineers and spe-cialists draws upon its many years of indus-try experience to help customers develop

their hardware and software to commercialquality standards.

The key is to start the conversation withCIMTEC so they can understand the needsof your project and help tailor a commer-cialization plan for a specific product orcompany.

KalGene Pharmaceuticals, Inc.: KalGenePharmaceuticals, Inc.’s oncology programsare aimed at improving clinical out-comes through the use of personalizedmedicine, with a particular focus onbreast and other epithelial cancers.KalGene has established several inter-national research and development col-laborations and recently signed a multi-year collaborative agreement withCIMTEC for commercialization of itscompanion diagnostics and therapeu-tics program.

Dr. T. Nathan Yoganathan, presi-dent and CSO of KalGene Pharma-ceuticals, Inc. says, “We are pleased towork with CIMTEC to further ourmission of developing products that savelives and improve healthcare outcomes.Our collaboration with CIMTEC will en-able us to better advance our goal of de-veloping cancer diagnostic and treat-ments through the power of personalizedmedicines”.

Says Bart Sullivan, CEO of CIMTEC:“Our work with KalGene is a prime exam-

ple of the value CIMTEC brings to themedical imaging community. CIMTEC’sexpertise in digital pathology andKalGene’s strong background in biotech-nology has created a potent partnership tosupport KalGene’s development of an ad-vanced cancer diagnostic system.”

Perfint Healthcare: Because incidenceof liver cancer is particularly high in Asia

and sub-Saharan Africa, Perfint Healthcarein India was looking for an ultrasound-based solution to liver cancer treatment.Perfint came to CIMTEC by way of a pro-totype 3D ultrasound-guided focal livertumour ablation system being developedby CIMTEC in partnership with WesternUniversity’s Robarts Research Institutewith funds from the Ontario Institute for

Cancer Research (OICR). The prototypesystem showed very positive results duringtesting in the clinic of interventional radi-ologist, Dr. Nirmal Kakani at LondonHealth Sciences Centre.

The current phase of the project ispartly funded through the InternationalScience and Technology PartnershipsCanada (ISTP) program and the Depart-

ment of Biotechnology India.CIMTEC, Western University andClaron Technology Inc. are develop-ing hardware and novel softwaremodules and integrating them into animage-guided oncology therapy sys-tem for wide distribution abroad byPerfint Healthcare.“This collaborative project has thepotential to profoundly impact livercancer treatment in developing coun-tries such as India, North Asia andpart of Europe where access to CTand MR scanners is extremely lim-ited,” says Dr. Aaron Fenster, CIMTEC

Centre director and founding director ofthe Imaging Research Laboratories at Ro-barts Research Institute at Western’sSchulich School of Medicine & Dentistry.“The big advantage is that highly accurateablations can be performed in a proceduresuite, as opposed to a CT scanner, makingthem more accessible, faster and muchcheaper.”

CIMTEC assists with the commercialization of new technologies

BY LYNN MOLLOY

HALIFAX – Capital DistrictHealth Authority(CDHA), an academichealth district, is NovaScotia’s largest provider of

health services provincially. It has sevensurgical venues completing approxi-mately 34,000 surgeries per year. Its12,000 employees, physicians, learnersand volunteers care for a catchment areaof over 400,000 residents and providetertiary/quaternary care to the rest ofNova Scotia, the Maritimes and the At-lantic provinces.

In December 2012, CDHA, success-fully implemented Novari Surgical Ac-cess to approximately 130 surgeon’s of-fices. Novari is an off-the-shelf softwaresolution for e-booking, with the abilityto measure, monitor and manage pa-tients waiting for surgery. The softwarealso includes a module for integratingwith the pre-operative process – pre-ad-mission clinic. Physician offices nowhave up-to-date wait list information attheir fingertips and administrative assis-tants can easily wait list and book pa-tients for surgery.

In CDHA, there was much variationin processes from office to office with re-spect to surgical bookings, technologyand knowledge of internal hospital in-formation systems. About 60 percent ofthe surgical offices are located inside thehospital (on-site) and the remainder arelocated in the community (off-site). The

surgical booking process was totally pa-per-based prior to implementation andthe surgical booking offices were inun-dated with reams and reams of paper.

The process to wait list and book a pa-tient for surgery was twofold. The admin-istrative assistants submitted paperworkto the booking office so a patient couldbe placed on an elective wait list. The pa-tient was entered into Pathways Health-care Scheduling (PHS) and populated aprovincial wait list registry PAR-NS(Provincial Access Registry Nova Scotia).

When a date was identified forsurgery, the administrative assistantswould then update the paperwork andresend to the booking officer to get a pa-tient booked for surgery. The movementof paper between the surgeons’ office andthe booking office was heavy, with formsbeing lost, misplaced, misfiled and some-times sent to the wrong clinical area.

Offices located off-site relied on couri-ers and fax machines for submission ofnecessary information, while on-site of-fices would fax, hand deliver or place ininterdepartmental mail. This was simplynot manageable and needed to improvefor maximum use of resources and toprovide timely access to care.

Prior to implementation, training ses-sions were held for all users that wouldbe accessing Novari Surgical Access. Formany offices the learning curve wassteep, with the project team providingsupport as needed for a few weeks fol-lowing implementation. With many off-site offices, it was necessary to establish

Virtual Private Networks (VPNs) for theoffices to safely access the software in asecure protected environment.

The communication and coordina-tion of the Information Technology De-partment and our provincial informa-tion technology team (Health Informa-tion Technology Services Nova ScotiaHITS-NS) was invaluable in providingthis service.

Today, the process for data collectionis now timely (real-time data), efficient,accurate and reflective of the patients ex-perience, while providing the necessaryinformation required to make effectiveresource allocation decisions.

With the implementation of NovariSurgical Access, all surgeons’ offices in

CDHA have transitioned from a paper-based booking process to an electronicpaperless booking process, includingscanning the necessary documentationto book a surgical case and electronicallysending to the booking office with the e-booking request.

The surgeon’s office receives notifica-tion when a case has been successfullysent to the booking office, scheduled,cancelled completed and/or removedfrom the elective wait list. There is an in-

ternal messaging feature that allows thesurgeons office and the booking office tokeep abreast and updated of any changesto the operating room schedule.

This feature has greatly reduced thenumber of phone calls between the book-ing and surgeons offices. The system isalso interfaced with the hospital registra-tion system, greatly reducing the amountof duplicate data entry occurring. Thetransferring of patients from one office toanother is seamless and can be completedwith a few clicks of the mouse. Clinicalleads in the operating room now haveeasy access to view bookings as they ar-rive from the surgeons’ office allowingplanning and coordinating of equipmentto occur in a timely fashion and decreasecancellations associated with conflicts orunavailability of specialized equipment.

With the implementation of NovariSurgical Access, the accountability forplacing patients on the elective wait listand queuing for surgery is solely the re-sponsibility of the administrative assis-tants. The redundancy in the process be-tween the surgeons and booking officehas been removed and the data entry er-rors occurring with duplicate data entryis no longer an issue. Patients are beingplaced on the wait list in a more trans-parent prospective approach and themovement of paper between the surgeonand booking office has been eliminated.

Lynn Molloy is Manager, ORIS & Sur-gical Access (PAR-NS/Novari), Perioper-ative Services, at Capital District HealthAuthority in Halifax.

S U R G I C A L S Y S T E M S

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Physician offices now haveup-to-date wait list data, andappointments can be easilybooked by administrators.

Dr. T. Nathan Yoganathan, President of KalGene Pharmaceuticals.

BY JANICE M. SKOT

Anyone driving Ontario’s busyHighway 400 through Barrieover the past four years couldn’thelp but notice the construction

of the newly expanded Royal Victoria Re-gional Health Centre (RVH). The hospital,which serves the city of Barrie, SimcoeCounty and the District of Muskoka, dou-bled in size to one million square feet,adding 101 new inpatient beds, additionaloperating suites, a regional cancer centreand specialty programs not found else-where in the region.

One particularly noteworthy highlight ofthe expansion project is the $70 million weinvested in leading-edge clinical technologyand equipment. Among these investments,which also included the latest imagingequipment and ‘Smart OR’ technology, is afully automated medical laboratory system.

The hospital received a big boost re-cently when, as part of our expansionproject, RVH introduced one of the firstTotal Laboratory Automation (TLA) sys-tems in Canada. The system, consisting ofapproximately 10 analytical lab instru-ments directly connected to a 65-foot-long, L-shaped, dual-track conveyor, au-tomatically routes lab specimens to theappropriate analyzers, where the re-quested tests are performed, and allowstechnologists to monitor and verify testresults more efficiently – all without sam-ples being touched after loading.

The automated system became opera-tional at RVH in 2011 as part of a six-stagelaboratory renovation and laboratory staff,physicians and patients all enjoy signifi-cant benefits that include:

• Quality and Accuracy: Bar code infor-mation read from each vial by the auto-mated system ensures necessary tests areconducted and test results are properlymatched to the right patient

• Staff Safety: The system automaticallyremoves rubber stoppers on specimenvials, eliminating the risk of repetitive-mo-tion injuries to staff, who previously un-capped hundreds of vials daily

• Process Consistency: With automation,the delivery of samples to the analyzers ismuch more consistent and considerablyless time-consuming than the previousmanual approach

• Increased Capacity: Automation en-ables us to easily handle the increasing vol-ume of assessments arising from the healthcentre’s expansion, without having to hireadditional staff

• Continuous Flow: With specimens con-tinuously moving through the system,testing workload is smoother and overallturnaround time for producing results isfaster and more consistent

• Cost Avoidance: Increasing testing ca-pacity without adding staff avoids recruit-ing during a market shortage of experi-enced Medical Laboratory Technologists

• Cost Reduction: Increased capacity isallowing referred-out testing to be broughtback in-house, thereby reducing cost andturnaround time, while increasing processefficiency

According to Dr. Russell Price, RVH’schief of pathology and clinical director oflaboratory medicine, “Of the many notable

benefits of the automated system, the mostsignificant is that its continuous flow oper-ation provides the most efficient way ofdelivering the results physicians need forclinical decision-making. From a LEANprocess perspective, it eliminates muchnon-value-added activity, allowing staff to

focus on reviewing the quality of diagnos-tic information.”

Echoing Dr. Price’s sentiments, BarbaraLemay, RVH’s administrative director oflaboratory services, adds that, “Most im-portantly, by streamlining and improvingworkflow processes, core lab automation

enables us to provide lab results in atimely, and extremely safe and precisemanner for the treatment of our patients.”

Janice Skot has been the President and CEOof Royal Victoria Regional Health Centresince 2004.

Expansion at Barrie’s RVH features advanced lab automation technology

F O C U S O N L A B O R A T O R Y T E C H N O L O G Y

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BY THOMAS HOUGH CMC

Few firms at RSNA13, held last De-cember in Chicago, were showing adiagnostic imaging VNA. Most were

showing Enterprise-wide VNAs. Typically,enterprise-wide VNAs are appearing to be

a preferred solution due to the ability todeal with DICOM and Non-DICOM files,while being a single source for all contentrelated to patient health events.

In the case of an enterprise-wide VNA,part of its purpose is in taking the “A” outof the Diagnostic Imaging PACS. The en-

terprise-wide VNA is oriented toward col-lecting all forms of images, videos anddocuments within the healthcare enter-prise and providing storage for this con-tent. In addition, well-developed enter-prise-wide VNAs support electronic med-ical record (EMR) applications.

DICOM viewing applications are in theprocess of separating from the PACS to be-come an independent layer integrated be-tween the VNA and the EMR applicationin the healthcare infrastructure.

Firms such as, Carestream, Merge,Philips, General Electric, McKesson, Cal-gary Scientific, and Claron Technologies,along with a number of other firms, allprovide a viewing layer to facilitate clini-cians across the enterprise quick and effi-cient access, as needed, for patient healthevents. These viewing applications areclassified as zero footprint viewing appli-cations and provide access to images andother medical content via an agnostic webbrowser that supports HTML 5, so viewerscan operate within the shell of the webbrowser.

Historically, radiologists and clinicianswould meet in the Diagnostic Imaging de-partment to view advanced visualizations ofspecialized anatomical exams, including 3-D, colonoscopy, CT angiography, CT/MRperfusion or cardiac exams, to mentiononly a few.

What makes thezero footprint viewer“leading-edge’ is howusers are able to ac-cess patient healthrecord content. Stateof the art viewers em-ploy a current gener-ation browser thatsupports HTML 5.This can be found onany workstation in ahospital, a computer at a clinician’s home, ora wide variety of mobile applications such asiPhone, iPad, or Android phones or tablets.The use of HTML 5 for all image display andmanipulation being done on the server sidefacilitates two advantages. First, the Imageand PHI only reside on the display screenRAM. Thus, when you close the browser,there is no remaining PHI data to be found.Second, a single server does all the imagerenderings; from simple window level andmagnification to advanced visualization,thus access to this technology becomes cost-effective and provides access to all cliniciansacross the healthcare enterprise.

Now a query through a well-developedEMR portal permits clinicians to see a pa-tient’s longitudinal health record acrossany Enterprise-wide healthcare facilityand/or geographic region. With the VNAand viewing layer supporting and inte-grated into the EMR application, the needfor DI VNAs become diminished.

With the “A” taken out of PACS, as sug-gested above, and the viewing applicationbecoming a layer on top of any VNA, PACSas we have defined it in the past is now be-ing deconstructed to become only a part ofthe larger healthcare enterprise informa-tion infrastructure. Healthcare providerswho are seeking PACS replacements thatare not thinking in terms of this strategywill find themselves in a very expensiveplace with a difficult path forward. More-over, they won’t be keeping pace with peerswho travel this new path forward.

Thomas Hough is President and founder ofTrue North Consulting & Associates Inc. Thecompany is based in Mississauga, Ont.

Zero-footprint technology is changing the nature of image archiving

D I A G N O S T I C I M A G I N G

Thomas Hough

REGISTER NOW - Early bird deadline: April 4, 2014

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Canada’s Only Nationale-Health Conferenceand Trade Show

It is with pleasure that we invite you to e-Health 2014 in Vancouver from June 1 - June 4, 2014.

REGISTER NOW: Early bird deadline: April 4, 2014

CONFERENCE HIGHLIGHTS:• An excellent conference program filled with practical experience and lessons from

those on the ground• The largest and only national e-Health event and trade show in Canada• Unequalled social event and networking opportunities• Canadian Health Informatics Awards Gala: June 3

Plenary Session: Big Data is Here Today: Population Health, Personalized Medicine, & Life Sciences Convergence

Speaker: Frederick Lee, MD, MPH / Director of Clinical & Translational Informatics / Oracle Health Sciences

Closing Keynote Address Saving Lives and Health Care Dollars: Pharmacy’s Action Plan for Better Health Care

Speaker: Domenic Pilla, President & Chief Executive Officer, Shoppers Drug Mart

Vancouver Convention Centre

June 1 - 4, 2014

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© 2014 InterSystems Corporation. All rights reserved. InterSystems and InterSystems HealthShare are registered trademarks of InterSystems Corporation. 3-14 Ability2 CaHeTe

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to coordinate all patient care

We offer a platform for Strategic Interoperability.Our technology is essential if you want to makebreakthroughs in strategic initiatives such as coordinating care, managing population health, andengaging with patient and physician communities.

Add our HealthShare platform to your EMRs.InterSystems HealthShare® will give you the ability to link all your people, processes, and systems – and to aggregate, analyze, and share all patientdata. With HealthShare, your clinicians and admin-istrators will be able to make decisions based oncomplete records and insight from real-time analytics.

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S A V E T H E D A T E ! May 23-24, 2014

Venue: The Fairmont Hotel Vancouver

900 West Georgia Street, Vancouver, British Columbia

To register, please visit www.toshiba-medical.ca

Toshiba’s International CT Symposium “Functional CT Imaging – Moving Forward” will explore a wide range of clinical topics, from the

perspective of the radiologist, cardiologist, technologist and physicist. A faculty of internationally renowned speakers has been assembled

to provide an academic experience of the highest order, engaging participants in every element of modern CT imaging. The symposium will

take place at the Fairmont Hotel Vancouver, British Columbia. CE Accreditation: Conference attendees will be approved to earn category

‘A’ continuing education credits.

“Topics-at-a-Glance” include:• Single Energy Metal Artifact Reduction (SEMAR)

• Dose Reduction Technologies

• Cardiac Imaging

• The Radiographer’s Perspective

• The Focus of the Physicist

• Role of CT Scanning in MSK

• Initial Experience Using 160 Slice CT

• Radiation Dose Considerations

• Ultra Low Dose Chest CT

• Pediatric Imaging

• Organ Perfusion & Dual Energy in the Abdomen

• Neurological Imaging Using Volumetric CT

International CT Symposium 2014

May 23-24, 2014

Fairmont Hotel Vancouver

Functional CT Imaging - Moving Forward

Guest Speakers• Professor Alain Blum - CHU Nancy, France

• Dr. Russel Bull – Royal Bournemouth Hospital, UK

• Dr. Marcus Chen – NIH, USA

• Ms. Kate Clough - Bradford NHS, UK

• Dr. Cupido Daniels – Dalhousie University

• Dr. Bruce B. Forster - University of British Columbia

• Dr. Mark Kon - Bradford NHS, UK

• Dr. John Mayo – Vancouver General Hospital

• Dr. Narinder Paul – UHN, Toronto

• Dr. Daniel Podberesky – Cincinnati Children’s Hosp. Med. Ctr.

• Professor Patrik Rogalla – University of Toronto

• Dr. Donatella Tampieri – Montreal Neurological Institute

S A V E T H E D A T E !