FEATURE REPORT: DEVELOPMENTS IN TELEHEALTH – SEE …...receive a diagnosis of the tissue sample,...

BY JERRY ZEIDENBERG

ICHMOND HILL, ONT. – MackenzieHealth, a technologically advanced

hospital that has already achieveda HIMSS EMRAM Level 7 rank-

ing, the top tier, has taken another step for-ward in its “smart-hospital” strategy with thelaunch of a digital platform for pathology.

“We’re one of the earliest adopters of dig-ital pathology in Canada,” said Richard Tam,executive VP and chief administrative officerat Mackenzie Health. “This is going to leadto breakthroughs in timely diagnosis.”

Pathologists typically examine tissuesamples in cases of cancer and other seriousdiseases. The sooner the referring doctorsreceive a diagnosis of the tissue sample, thefaster they can start treating their patients.

Currently, in most hospitals, pathologycases are examined using glass slides and mi-

croscopes, by pathologists inside the hospi-tal. Often, they’re sent to outside patholo-gists when a second opinion is needed orwhen an in-house pathologist with the re-quired sub-speciality is not available.

Unfortunately, the process of sendingslides by courier and receiving a diagnosiscan take days or even weeks. It’s time-con-

suming to package up the slides, send themoff by taxi or courier, and wait for the pathol-ogists to finish their readings and reports.

However, the practice can be transformedby a digital platform – where the samples aredigitized by a special scanner and sent to theexperts via online networks. Once online,

the process of sending samples to a specialist– either in-house or at another hospital –and receiving a diagnosis can be reduced toa few hours.

“The digital pathology network is an en-abler of faster, more effective diagnosis andtreatment,” said Amir Soheili, program di-rector, Clinical Support Services, at Macken-zie Health.

“Glass slides can also get damaged orlost,” explained Soheili. And they can only besent to one site at a time, where they are ex-amined under a microscope by a singlepathologist at a time.

But when the samples are digitized, theycan be rapidly sent to several pathologists si-multaneously, who could be anywhere inOntario – or worldwide.

Not only is speed a factor, but so is the ac-curacy of the diagnosis. On this score, it helps

Mackenzie Health becomes a leader in digital pathology

CONTINUED ON PAGE 2

Dr. Clinton Campbell, a pathologist at Hamilton Health Sciences, is leading a one-year-long project to digitize slides and apply machinelearning to help doctors better detect tell-tale signs of disease. He and his colleagues are focusing on blood and marrow pathology slidesin this test, and applying machine learning technology to blood disorders like leukemia, lymphoma and myeloma. SEE STORY ON PAGE 4.

Hamilton Health Sciences adds AI to pathology

“This is going to lead tobreakthroughs in timelydiagnosis,” said Richard Tam.

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App for COVID-19 infoAn app called COVID AIKnowledgeEnable uses artificialintelligence to find the latestpeer-reviewed articles that answerthe questions of physicians,researchers and the public.Page 4

Virtual check-inNorthern Health, in BritishColumbia, has introduced aservice that allows patients toremotely check into labs andother services, so they canphysically show up minutesbefore the actual appointment.Page 6

Virtual nursingNurses are using smartphonesand innovative software tovirtually check up on groups ofpatients living in the community.The system enables one nurse toeffectively manage scores ofpatients. 0

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FEATURE REPORT: DEVELOPMENTS IN TELEHEALTH – SEE PAGE 18

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 25, NO. 7 OCTOBER 2020

T W E N T Y- F I V E Y E A R S

DIAGNOSTICIMAGING

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to have the help of “sub-specialists”, who aresometimes located at various hospitals orfacilities in the United States or Europe.

Sending glass slides to experts outsidethe hospital and obtaining reports can of-ten take weeks, said Soheili. But again, us-ing the digital network, the turnaroundtime can be reduced significantly.

In the near future, Mackenzie Health’sseven pathologists will also benefit fromthe addition of artificial intelligence (AI)software, which will spot areas of interestin the samples for the pathologists to note.The AI software will act like intelligent as-sistants, helping with the diagnosis.

The hospital has been working on theproject for two years in conjunction withits technology partner, Philips, which issupplying the technology solution.Mackenzie Health conducted a validationstudy over the last year, using about 1,000pathology cases, to ensure the technologymeets the standards of its doctors. Contin-uous validation and quality assurance willremain key elements within the MackenzieHealth Digital Pathology initiative, as the

hospital considers itself to be in the start-up phase of the project.

Overall, Mackenzie Health conducts ap-proximately 16,000 to 17,000 pathologycases each year. It expects that number todouble when it opens a second hospital, theCortellucci Vaughan Hospital, in 2021. (Theorganization recently received a $40 milliondonation from the Cortellucci family, whichowns construction and development com-panies and has been active in philanthropyin the Vaughan area, north of Toronto.)

The two-hospital system will be greatlyassisted, said Soheili, by the digital net-work, as attending physicians and patholo-gists will be able to share digitized imagesand reports from one site to the other.

When outside opinions are needed,Mackenzie Health now relies on patholo-gists at three or four outside hospitals. Thehospital will be inviting these pathologiststo join the digital network, to speed up ac-cess to patient pathology samples and thedelivery of reports.

As well, Mackenzie Health will be opento pathologists across Canada and interna-tionally who are willing to join the network.

“We’re hoping to be the catalyst for dig-

ital pathology in Ontario,” said Tam. Un-like radiology, which has been using com-puterized networks and tools for decades,digital pathology is just getting off theground in Canada.

Tam noted that Mackenzie Health isone of the first hospitals in Canada to havea full digital pathology platform consistingof scanners, workstations, software sys-tems and a high-performance network.

Some hospitals have pieces of digitalpathology systems, he said, but not allcomponents.

At the core of the system are specializedpieces of equipment, like high-resolution

and rapid-throughput digital scanners.Tam explained that each pathology slidecan take up a gigabyte of storage space,and a study may consist of 20 to 100 slidesor even more.

That requires high-capacity storage andfast-transfer of data on the network. Butit’s also helpful to have workflow tools forthe pathologists, to help them manage thereadings – something that’s part of thePhilips system. “It helps them share theworkload between members of a wholeteam,” said Tam.

Workflow software can intelligentlysplit the reading of exams among patholo-gists, and if one specialist is busy, can re-route the work to another. This results in amuch more efficient division of labour.

At Mackenzie Health, reports and radi-ology images are currently available to pa-tients themselves through an online appli-cation called MyChart; the digital imagesof pathology cases will be available to pa-tients through the same application in thenear future. That will allow patients tomore easily share information with otherphysicians and caregivers, as needed.

To help drive the digital pathology pro-gram forward, Mackenzie Health recentlyrecruited Dr. Andrew Evans as the newchief of Pathology and director of Labora-tory Medicine. Previously, Dr. Evans wasdivision director, Telepathology, at theUniversity Health Network in Toronto. Heis a leader in the application of new tech-nologies to the practice of pathology.

Tam noted that digital pathology alsohas benefits in lockdown situations – likethe one we recently witnessed withCOVID-19. For several months, hospitalssignificantly reduced the numbers ofhealthcare professionals working on-site,and reduced the flow of patients throughtheir doors, to protect workers and pa-tients from infection.

However, assisted by a high-perfor-mance digital network, pathologists will beeasily able to work from home, receivingstudies digitally and reporting online.

“When we have access to the data in thisway, we remove one of the barriers tocare,” said Tam.

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Address all correspondence to Canadian Healthcare Technology, 1118 Centre Street, Suite 204, 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 2020. 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. ©2020 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. Returnundeliverable Canadian addresses to Canadian Healthcare Technology, 1118 Centre Street, Suite 204, Thornhill ON L4J 7R9.E-mail: [email protected]. ISSN 1486-7133.

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

Volume 25, Number 7 October 2020

Contributing EditorsDr. Sunny MalhotraTwitter: @drsunnymalhotra

Dianne [email protected]

Dianne [email protected]

Dave [email protected]

CONTINUED FROM PAGE 1

Mackenzie Health becomes a Canadian leader in digital pathology

Tune in on Oct. 13 and Nov. 17 for a two-hour program that addresses important health care topics including virtual care and e-mental health.

Learn more about improving health outcomes for Canadians and creating a more sustainable health system for future generations — register today!

Join us for the Infoway Partnership: Fall Series virtual events!

infoway-inforoute.ca/partnership-fall-series | @Infoway

Dr. Andrew Evans Richard Tam Amir Soheili

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 O C T O B E R 2 0 2 0 h t t p : / / w w w . c a n h e a l t h . c o m

BY LISE DIEBEL

HAMILTON, ONT. – Dr. ClintonCampbell envisions a futurewhere pathologists work as in-formation specialists in sophis-

ticated computer labs with the world’smost current, relevant data at their finger-tips. Instead of diagnosing disease one slideat a time under a microscope, there wouldbe thousands of images to compare online.

Dr. Campbell is working to make thatvision possible by harnessing a type of ar-tificial intelligence (AI) known as machinelearning.

The first steps toward this high-tech fu-ture are taking place at Hamilton HealthSciences (HHS) right now, thanks to an in-novative pilot project exploring digitalpathology and AI. It’s among the first pro-jects of its kind in Canada, and could helpmodernize the way pathology is conductedaround the world.

“Pathologists currently use an old-fash-ioned light microscope to view sections ofhuman tissue, which is a 300-year-oldtechnology,” said Campbell, one of about100 pathologists in Canada who specializesexclusively in blood disorders, likeleukemia. Campbell is leading an HHSstudy into digital pathology and AI. He issupported by Drs. Catherine Ross andMonalisa Sur for this pilot.

Pathologists study tissue samples of dis-ease taken from patients during surgery, orin the case of blood, during a procedureknown as a bone marrow biopsy.

Samples are placed on glass slides forexamination under a microscope. Patholo-gists then look at minute features of cellsand tissue and extract information to bet-ter understand the disease. This, in turn,may lead to a diagnosis and the best treat-ment options for patients.

“The system we have currently workswell,” said Dr. Campbell. “But we can’tshare images of human tissues in real-timewith colleagues or do `virtual peer review’where multiple pathologists can examineslides together at the same time.”

Currently, when a pathologist at anotherhospital wants Dr. Campbell to view a setof slides and offer insights, the slides areshipped to him in thick cardboard folders.

“This is an inefficient process that leadsto delays in diagnosis. Imagine how muchbetter it would be if we could share theseslides digitally in real-time,” said Dr. Camp-bell. “It would allow for wider, faster con-sultation. And if you add AI into the mix,you’ve also got access to a vast amount ofknowledge that’s sorted through machinelearning to prioritize the very best infor-mation to help with your case.”

Machine learning, in the most basic

sense, is a type of AI that can automaticallylearn patterns from data, like pathologyimages, and then use this knowledge tomake useful predictions about the world.This means faster, better reports becausemachine learning will help extract themost important information, and thencompare this to tens, hundreds or eventhousands of other previously diagnosedsamples instantly.

“It’s kind of like having Google forpathology, with a team of virtual patholo-gists on standby in the cloud 24/7,” he says.“This could transform the way diagnosticmedicine is done.”

HHS is conducting a one-year pilotproject on digital pathology in partnershipwith Huron Digital Pathology in St. Ja-cobs, Ont.

Huron’s AI-based image search platformconnects pathologists to the expertise of

their colleagues worldwide, increasing thespeed and effectiveness of patient care.

HHS is using a scanner provided byHuron to collect and catalogue digital slideimages. The project started in May and isbased at HHS Juravinski Hospital andCancer Centre. The goal is to collect 3,000digital images from blood and bone mar-row pathology slides.

The partnership between HHS andHuron was made possible through the On-tario Bioscience Innovation Organization(OBIO), a not-for-profit organizationdedicated to advancing health technologyinnovation and commercialization. TheOBIO recently announced the launch ofthe first eight Early Adopter Health Net-work (EAHN) innovation projects, includ-ing the Huron-HHS partnership.

So why has it taken so long for pathol-ogy to dip its toes into the digital pool? Amajor hurdle has been image file size andprocessing. Hamid Tizhoosh heads the Lab-oratory for Knowledge Inference in MedicalImage Analysis (KIMIA Lab) at the Univer-sity of Waterloo. He helped Huron developits technology and has been working withHuron and Dr. Campbell to devise a systemthat loads images faster and more efficiently.

They are doing this by collecting onlythe small sections of pathology specimenimages that relate directly to the disease,rather than trying to load the entire image.Images are then processed with AI tools tomake a powerful image search engine.

“Huron and the KIMIA Lab piloted thisgroundbreaking technology, and we’renow expanding this into hematology withthe hope of improving it and applying it toblood disorders like leukemia, lymphomaand myeloma,” said Dr. Campbell.

Lise Diebel is a Public Relations Special-ist at Hamilton Health Sciences.

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

MISSISSAUGA, ONT. – As theCOVID-19 pandemiccontinues to sicken andkill people around theworld, questions con-

tinue to arise about the characteristics ofthe virus. For example, how do we avoidinfection, and what are the best practicesfor caring for those who have contractedthe disease. A new app, COVID AIKnowledgeEnable™, uses artificial intel-ligence to rapidly find the latest peer-re-viewed articles that answer the questionsof physicians, researchers and membersof the public.

To be sure, there is much to learnabout the novel coronavirus. “There arehundreds of new scientific findings inevery medical discipline, published everyday,” said Ian Maynard, CEO and co-founder of Real Time Medical Inc.,the developer of the app. “During thispandemic, you can multiply that by afactor of 10.”

Real Time Medical’s app makes triag-ing this information possible using AIand the collective insight of experienced

medical professionals around the world.COVID AIKnowledgeEnable is a clinical

decision support app and information lo-cation tool that allows users to engage inresearch and education by helping them tolocate trustworthy medical articles andother resources where such content is al-ready available on the internet. Signifi-cantly, the app includes ratings of articlesand commentary from healthcare profes-sionals to assist users in determining whichsources will be most helpful to them.

With the support of the National Re-search Council of Canada’s IndustrialResearch Assistance Program, Real TimeMedical has been working on the under-lying technology of AIKnowledgeEnablefor almost two years. When COVIDcame along, the company decided to ap-ply that technology to the informationclutter created by COVID.

“The app is specifically designed forboth healthcare professionals and thepublic to help them make better in-formed decisions for their patients, theirfamilies and themselves,” said Dr. DavidKoff, chairman and co-founder of Real

Time Medical. “Only trusted, peer re-viewed data sources are used.”

Dr. Koff explained that users benefitfrom seeing information directly fromthe original source. They also gain in-sights from comments or recommenda-

tions that doctors and researchers mayhave about a particular finding.”

“With a resurgence of COVID-19 in-fections in multiple jurisdictions inNorth America and around the world,and the advent of a new school year,people need a way to zero-in on themost valid scientific data and advice re-

quired to keep their families and patientssafe – and to cut confidently through theclutter of misinformation,” said Dr. Koff.

Clinicians and the public will also beable to use an updated version of COVIDAIKnowledgeEnable to research the latestdata on any medical symptom or ailmentthey choose – not just COVID-19.

RTM’s COVID AIKnowledgeEnablecombines AI-enabled search of multiple,trusted, peer-reviewed medical datasources with the collective intelligence ofdirect physician input to deliver themost relevant and current findings.

Overlaid with the latest federal healthguidelines, COVID AIKnowledgeEnableis an effective weapon in the global fightagainst COVID-19, arming healthcareprofessionals and the public alike withthe information they need to make theright decisions from trusted medicaldata sources such as the Centers for Dis-ease Control and Prevention, the NewEngland Journal of Medicine, theLancet, and others.

“Amid the race for a viable vaccine, it

AI-powered app quickly finds latest information about COVID-19

Microscope to machine: rethinking the practice of pathology with AI

Pathologist Dr. Clinton Campbell, left, works on the AI project with graduate student Youqing Mu.

CONTINUED ON PAGE 20

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 O C T O B E R 2 0 2 0

Transforming healthcare delivery across the

circle of care.

We are leveraging virtual care technology to keep Canadians and their care teams connected.

Discover our virtual care solutions. telushealth.com/virtualcare

BY ELAINE MITROPOULOS

HAMILTON, ONT. – St. Joseph’sHealthcare Hamilton has in-troduced a new method of pa-tient care to better meet the

needs of the community during theCOVID-19 pandemic and beyond: virtualcare for emergency department services.All it takes is a smartphone, tablet or com-puter to save a trip to the hospital.

“Emergency departments and urgentcare centres in Hamilton are still open forin-person visits, and are safe for thoseseeking care,” says Dr. Gregory Rutledge,chief of Emergency Medicine at St. Joe’s.“Virtual appointments, however, are anideal option for those who are hesitantabout coming to hospital, and who are ex-periencing urgent but non-life-threateninghealth concerns, are unable to obtaintimely access to a family physician, or donot have a family physician.”

By filling out a virtual appointment re-quest form on the hospital’s website, eligi-ble patients can book same-day virtual vis-its on a first-come, first-served basis. At theappointed time, patients connect with anemergency department physician througha secure video portal integrated withDovetale – St. Joe’s digital health informa-tion solution.

“Virtual visits are not intended forhigh-acuity patients who are experiencingreal emergencies, such as a heart attack orstroke,” Dr. Rutledge adds. “Patients in se-vere medical distress should always call911, and should not drive themselves tothe hospital.”

Likewise, if symptoms worsen whilewaiting for a virtual appointment, Dr. Rut-ledge advises visiting the emergency de-partment in person.

What to expect during a virtual ap-pointment: Through the video visits,

physicians provide extensive and safe pa-tient assessments and clinical recommen-dations for further treatment, includingreferrals to other care providers. Physi-cians can also prescribe new medicationbut cannot provide regular refills of med-ication already prescribed.

Patients 18 years of age or older, with avalid Ontario health card, can fill out theonline registration form to be scheduledfor a virtual appointment. Patients whoare successful in securing a same-day ap-pointment can expect to wait an average ofone hour before hearing back.

Patients can use the service if they haveaccess to the following: Computer or mo-bile device with video and microphone ca-pabilities; the Zoom application; Internetaccess; e-mail (to access appointment linkand reminders); a quiet, secure space toengage in a virtual visit.

While virtual care sessions are not

recorded, they are documented in a pa-tient’s electronic health record. Moreover,notes from the virtual visit are shared witha patient’s family physician through securefax within 24 hours from a visit.

A timely solution to providing care: Atthe onset of the COVID-19 pandemic, Dr.Rutledge says the hospital’s emergency de-partment saw a significant decline in visits.Physicians worried people with urgent is-sues needing a medical assessment werechoosing not to come to the hospital out offear of contracting the coronavirus.

“As St. Joe’s gradually reintroduces ser-vices and volumes at the hospital increase,having virtual options, including a virtualemergency department, helps to limit traf-fic in the hospital, while providing theright care to patients from the comfort oftheir own home or space,” he says.

Through the service, Dr. Rutledge’steam has provided virtual assessments to

patients with a range of health concerns,including head injuries, abdominal pain,back pain, and rashes.

Since launching in July, the service hasseen a steady increase of patients, with adedicated virtual emergency departmentphysician available to accommodate asmany as 45 patients a day. Dr. Rutledge ex-pects a greater volume of patients in the fall,when it is expected the flu season will coin-cide with a second wave of the pandemic.

“Now that we have the technology andprogram in place, we see the service ex-panding as people access virtual care to beappropriately directed to an assessmentcentre for testing, the hospital, or to stay athome and quarantine,” he adds

The future of virtual emergency visits:Dr. Rutledge says future plans to extendthe virtual service include issuing lab or-ders, as well as follow-up appointments toexpedite and ensure continuity of care.

“The ability to schedule follow-up ap-pointments to review how patients onhome care, intravenous therapy, or antibi-otics are feeling after discharge will offeran extra layer of assessment,” he says.

He also sees a place for virtual emergencyservices in treating patients in remote areas,as well as providing peer-to-peer support forhealth-care providers in communities thatcould benefit from additional resources.

“Throughout the pandemic, St. Joe’shas proven to be an innovator in virtualcare,” Dr. Rutledge says. “With good evi-dence to support patients have been happywith their virtual appointments duringCOVID-19, we will continue to find newways to deliver care to the community.”

To learn more about St. Joe’s virtualemergency visits program, see stjoes.ca/emergencyvirtualvisits.

Elaine Mitropoulos is a public affairs spe-cialist at St. Joseph’s Healthcare, Hamilton


BY ANNE SCOTT

PRINCE GEORGE, B.C. – In May2020, with the COVID pan-demic escalating, NorthernHealth searched for options toenable better physical distanc-

ing in common patient waiting areas.A Northern Health interdisciplinary

team representing Laboratory, MedicalImaging, and Information Managementand Information Technology (IMIT) in-vestigated solutions. The team was led byBjorn Butow, director, Clinical Informa-tion Systems, and Lisette Vienneau, re-gional director, Diagnostic Services.

After reviewing vendor offerings, theteam decided to implement the Net CheckIn solution by Innovative Computer Soft-ware, a company based in Minneapolis,Minnesota. Net Check In’s system is usedby more than 12 million people aroundthe world, in sectors that include retailand hospitality, education, automotiveand laboratories. It bills itself as the top“queue management solution” available.

In Northern Health, the service hasbeen branded as “NH Check In” and de-creases the number of patients in the re-gion’s hospital waiting rooms. Instead, itlets them safely wait in their cars,homes, or offices until just before theirappointments.

“Many patients are so eager to usethis service, especially during the pan-demic” says Butow. “They see real-timewait-time updates so they can better jug-gle their life, work and family withoutbeing tied up in our waiting rooms withother sick patients.”

Net Check In is hosted in Canada (us-ing AWS) and is a simple, cost-effectivesolution that met Northern Health’s clin-ical and IT requirements. It was quick toimplement and is easy to use for bothpatients and healthcare departments.

Patients can use the service throughan app (iOS or Android), or through theNorthern Health website.

They receive app notifications andcan sign up for text-based notifications.

Interestingly, Net Check In is used by

Canada’s two largest private labs – byLifeLabs at 380 locations, and by Dy-nacare at 200 locations.

“NH Check In not only helps to re-duce the COVID-19 risks to our patients,especially the most vulnerable, but also

reduces the risk to our front-line staffand healthcare providers,” said Vienneau.

It’s also a great tool for rural andnorthern patients, many of whom haveto travel long distances with family toget to their medical appointments.

“We have many patients who don’tlive near a Northern Health facility,” says

Sandi Watts, the project clinical lead.“It’s a very patient-centred service thatoffers a convenient way to check in forservices ahead of time, so they can betterplan their travel.”

Booked appointments can also be fac-tored into the wait times.

“Patient feedback so far has been re-ally positive and enthusiastic,” says KentForeman, the project’s technical lead. “It’sreduced the number of patient phone in-quiries and provides better service re-porting to Northern Health operations.”

The product launched at the end ofJuly for laboratory services in three pilotlocations in Northern BC: Prince Ru-pert, Terrace, and Dawson Creek.

Over the coming weeks and months,it will expand to support other locations– approximately 20 communities acrossnorthern BC – and other types of ser-vices and clinics.

Anne Scott is the Regional Manager ofCorporate and Program Communications,Northern Health.

Waiting rooms and COVID: New solution helps with physical distancing

St. Joseph’s Healthcare Hamilton launches virtual emergency visits


Virtual appointments are ideal for those who are hesitant about coming to the hospital for urgent care.

A path to building stronger healthcare systemsNow more than ever, we need to deliver care differently,and radical innovation can help us. Philips’ newly released

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BY JERRY ZEIDENBERG

LONDON, ONT. – Most virtual visitstoday involve patients talking todoctors over the phone or, in more

advanced scenarios, using Zoom orTeams for video visits. But a group of

eight physicians at iTelemed, in London,Ont., have extended the practice of vir-tual medicine by deploying instrumentsat the point-of-care.

They’re training visiting nurses, per-sonal support workers and other care-givers, located at the point-of-care, to use a

digital stethoscope, otoscope and dermas-cope, so that a remote doctor can conducta more comprehensive exam.

“In this way, we’re able to make virtualhouse calls,” said Dr. Keith Thompson, afamily doctor and chief medical officer atiTelemed, part of the Canada Telemedicine

Group. “It’s more than just the regularvideo encounter.”

The non-profit telehealth company hasbeen working on putting together theequipment that’s needed to conduct a reli-able remote exam for several years now.

Dr. Thompson said iTelemed has testedseveral peripherals, and now has a kit that’seffective. It can be taken on rounds by anurse, or shipped to a site when needed,where a trained healthcare worker can op-erate the peripherals after connecting alaptop computer to reach the doctor.

A key part of the system is the Agnessoftware platform, which runs on the doc-tor’s desktop computer and connects tothe remote computer and the peripherals.The Agnes software has been licensed fromAMD Global Telemedicine, a companythat has been in the telehealth business fordecades. It’s located in the Boston area.

In another innovation, iTelemed hasstarted conducting virtual visits in congre-gate living sites. In particular, the physi-cians at iTelemed are working with Partic-ipation House, which runs more than 60small facilities for continuing, complexcare patients in the London area.

Each facility has three or four individu-als with serious medical issues. Some pa-tients may be on mechanical ventilatorsand may also have physical and develop-mental disabilities such as COPD, heartfailure, asthma, epilepsy, schizophrenia,and other medical issues.

“They are medically the most challeng-ing part of the population to treat,” saidDr. Thompson.

He gave an example of a recent incidentin which a resident at a ParticipationHouse facility was having trouble breath-ing. To further test the concept of a remotevisit with the assistance of medical periph-erals, Dr. Emad Heinen conducted a vir-tual check-up on the patient.

With the help of an on-site care-giver,and the remote stethoscope, Dr. Heinendetermined that the patient was sufferingfrom pneumonia. “He could hear thecrackling in the lung,” said Dr. Thompson.

He could also prescribe antibiotics toget the patient started on the road to re-covery. For its part, iTelemed is workingwith a pharmacy that can accept digitalscripts and deliver prescriptions right tothe door of the patient.

In this instance, Dr. Heinen, Dr.Thompson and on-site staff had preventeda trip by the patient to the local ER – andhad obtained a diagnosis and treatmentplan quickly. “The staff were smiling,” hesaid. “They knew that without the virtualhouse-call, a trip to the hospital wouldhave been needed.”

Earlier this year, iTelemed announced apartnership with Fanshawe College inLondon. The collaboration will see Fan-shawe, a community college, train localnurses and personal support workers inthe use of the virtual care peripherals.

They’ll get training in how to set up andposition the digital stethoscope, otoscopeand dermascope. In this way, more care-givers will be able to assist iTelemed’s doc-tors at the point of care. Dr. Thompsonsaid that iTelemed is also looking into thepossibility of examining patients at nurs-ing homes using virtual technologies.

iTelemed expands scope, adding devices and reaching new patients



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BY DAVE WEBB

OSHAWA, ONT. – The “virtual ward”project at the Central East LocalHealth Integration Network (LHIN)

was pushed ahead of schedule by an un-likely force: the COVID-19 pandemic.

“It’s been an organizational goal forquite some time,” said Dr. Ilan Lenga, anephrologist and chief information officerfor Lakeridge Health, part of the CentralEast network. But COVID-19 was “a majorimpetus” to accelerate things.

The “virtual ward” is exactly that – nurses

can monitor the recovery of whole groups ofremote patients as if they were doingrounds. The difference is, the patients aren’tin the hospital.

Built on the Vivify remote-care platform,an app pushes questions to the patient’ssmartphone – the same questions a nurse

might ask on his or her rounds. Communitycare nurses monitor the results, communi-cate with patients to address issues, and con-sult with doctors to determine whether thepatient should return to the hospital.

There are several reasons to clear thebrick-and-mortar wards more quickly, saidDr. John Dickie, chief of surgery and sectionchief of thoracic surgery at Lakeridge. Thelonger patients stay in the hospital, the morelikely they are to be exposed to pathogens.And a likely second wave of COVID-19 infec-tions is looming ominously on the horizon.

Meanwhile, hospitals are trying to catchup with a five-month backlog of surgical pa-tients, whose operations were delayed due tothe pandemic. There are additional pres-sures to get them in and out of hospitalquickly, but with the best possible outcomes.

“Hospitals are looking for capacity,”said Cathy Slevin, senior manager of clini-cal care and home and community careprograms for the LHIN.

Once they are discharged, patients arefaced with a “white space”, those nerve-rat-tling weeks before the follow-up appoint-ment with a doctor. Patients may en-counter a serious problem while at home,and might need to see a medical profes-sional earlier. Or they may get the jittersand return to the hospital unnecessarily.

However, remote nurses can check onthem “virtually”, by using the Vivify plat-form. In this way, they can advise the pa-tient on what to do for serious problems -such as calling an ambulance or seeing thedoctor right away. If the problem is less ur-gent, the nurse can advise the patient onhow to handle things at home.

“Every day, (the virtual ward) is like anurse doing a bedside assessment,” Slevinsaid.

And that assessment can be done whilenurses are performing their other duties.Nurses have a “traffic light” dashboard todetermine what needs follow-up by phoneor video, and an escalation path for moreserious cases. Patients can be referred di-rectly to a doctor or team rather than wait-ing in the ER.

The first virtual ward cohort, launchedAugust 6, was composed of recoveringCOVID-19 patients. Congestive heart fail-ure (CHF) and chronic obstructive pul-monary disease (COPD) were schedulednext, followed by patients recovering fromthoracic surgery.

While the program is only taking tho-racic surgery patients at first, Lakeridge in-tends to extend it to all post-operative pa-tients, said Dr. Dickie. Orthopedic sur-geons are “very motivated” to be includedin the program, said Dr. Lenga.

Dr. Lenga said surgeons are “onboard-ing” community care nurses, trainingthem in the specific issues and escalationpaths related to their particular specialty.

In addition to bedside assessments,community care nurses are good at navi-gating available resources for patients inthe community, said Slevin. For example,if a patient is homebound and out of gro-ceries, they can connect the patient with acommunity organization that can help.

Leveraging existing technology madethe program very low-budget and quick toimplement, Slevin said. Patients don’t need

Tech allows community care nurses to make their rounds, even at a distance


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www.netcheckin.comCONTINUED ON PAGE 19

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Self-monitoring empowers patients and improves treatment outcomes in times of COVID-19.

Decentralized testing ensures therapeuticcontinuity with anticoagulated patients

SPONSORED CONTENT

emoving barriers for Canadian patientsso that they can better access diagnostictests has recently taken on heightenedimportance, especially in the COVID-19

pandemic. Proper diagnosis is theonly way to ensure that the right

choice of treatment regimen is made in a timelymanner, but how can we do this more effectively?

Point-of-care testing is emerging as a reliablemethod to improve health outcomes by bringing di-agnostic testing closer to the patient across the clini-cal spectrum, significantly accelerating diagnosiswhile increasing cost-effectiveness. The availabilityof quick and accurate medical information throughpoint-of-care testing has never been more crucial.

With COVID-19 putting extreme pressures on ourhealthcare system, there has been a marked increasein point-of-care diagnostic solutions combined withtelehealth. The increase can be attributed to attemptsto minimize potential virus exposure by taking pa-tients out of the institutional setting, thereby safe-guarding their health and that of healthcareproviders. When doing so, however, an importantbalance needs to be struck to maintain therapeuticcontinuity for patients, especially for those with con-ditions that require ongoing medical counselling tomanage health risks and adjustments to dosages.

Life changer for anticoagulated patientsPatients on anticoagulation treatment are a case inpoint. They account for 1% of the Canadian popula-tion (i.e. more than 350,000 Canadians), mostly 55and over, which is a group already at increasedCOVID-19 risk. Despite the introduction of new oralanticoagulants, warfarin continues to be the standardof care in the prevention and treatment of throm-boembolism. With some 100,000 Canadians cur-rently being treated with warfarin and requiring reg-ular diagnostic testing to evaluate proper dosage, theyare well-served with a small portable reading deviceto self-monitor coagulation from the comfort of theirown home, such as the CoaguChek® coagulometer.

Bob’s storyBob Ramsay is one such patient. After an aortic valvereplacement, Bob was placed on life-long anticoagu-lant therapy, which required him to undergo INR(International Normalized Ratio) testing at aToronto-based clinic twice a week. It was a burdenthat not only heightened his anxiety, but also ham-pered his passion to travel. When he heard aboutself-testing, he was immediately interested. It finallygave him the convenience and peace of mind hewanted. For patients like Bob, the advantages areclear. CoaguChek® enables them to take charge ofmonitoring their blood coagulation themselves andto participate actively in their treatment withouthaving to visit a hospital or clinic. All is needed is totake a drop of blood from a fingertip – a virtuallypainless step – and insert the test strip into the devicefor analysis. In just one minute, the system revealsthe coagulation result with an accuracy very compa-rable to that of a laboratory test.

This is in direct contrast to the impact of testingin a clinical setting, which contributes to absen-teeism at work, recurring parking costs, challengesfor people with reduced mobility, as well as manyother difficulties that threaten treatment adherence.These frequent visits also monopolize important

health system resources, requiring the work ofnurses, laboratory technicians and physicians foreach analysis, in addition to increasing the risk of ex-posure of more vulnerable patients to contagiousviruses in the hospital environment.

Decreasing the burden on the healthcare systemCoaguChek® offers reliable support for follow-upsby clinicians, providing patients with peace of mindwhile decreasing the burden on clinics and hospitals.Manufactured and distributed in Canada by RocheDiagnostics for the past 15 years, CoaguChek® is aneasy-to-use and effective fingerstick technology thathelps patients measure their own IRN from a singledrop of blood.

Each test takes no more than one minute, provid-ing nearly immediate results and adjustment in med-ication with minimal patient discomfort, all in thecomfort of their home. They are also able to interact

remotely on a regular basis with their physician – oreven their pharmacist – to share results and discussdose-adjustment guidelines.

The cost of the coagulometer, as well as that of teststrips, is reimbursed by most private insurers in Que-bec, the only province where such coverage is cur-rently offered. For patients covered by the Quebec’sPublic Prescription Drug Insurance Plan, the Régiede l’assurance maladie du Québec (RAMQ) coversthe costs of test strips. Although there is currently noprovincial coverage for CoaguChek® test strips out-side Quebec, clinicians and healthcare administratorshave an important role to play in sharing the benefitsof the CoaguChek® system and INR point-of-care(meter) testing with provincial government represen-tatives and other healthcare professionals. Increased

awareness among healthcare decision makers wouldgo a long way in making INR point-of-care testingmeters more accessible across the health system.

Better outcomes and lower risk of complicationsDr. Samer Makhaly, a resident physician and Hema-tology research co investigator at McGill University,provides additional insight on the benefits of Co-aguChek®.

“I have worked closely with many patients usingthe CoaguChek® device. With proper training, pa-tients find the device user-friendly, convenient andtime saving,” he explains. “With the help of ‘point-of-care’ technology, patients feel empowered and are ac-tively involved in their own care. This has reflectedpositively on multiple aspects, including patients’compliance, as well as the time in which they are intheir target INR range.”

Numerous studies have shown that patients whofrequently measure their INR them-selves have better treatment outcomesand a lower risk of complications.1, 2 Inaddition, the combination of warfarinand self-monitoring is a cost-effectivesolution for stroke prevention and of-fers equal or better efficacy than thenew class of oral anticoagulants.

Contributing to better results at the point-of-careThanks to innovative tools like Co-aguChek®, Roche Diagnostics is theworld leader in in vitro diagnostics,supplying a wide range of rapid, reli-able instruments and tests for diseasescreening and diagnosis in laborato-ries, at the point-of-care, and for pa-tient self-management. It delivers a

comprehensive range of rapid, cost-effective anduser-friendly diagnostic systems designed to measurea variety of clinically relevant parameters.

The CoaguChek® system is the leading profes-sional and patient PT/INR point-of-care testing me-ter in Canada providing accurate PT/INR valuesfrom a single drop of blood within one minute, en-abling immediate results and adjustment of medica-tion with minimal discomfort to the patient. It showshighly comparable results with the gold standard ref-erence method of the World Health Organization(WHO) and an excellent correlation to laboratoryanalyzers. The use of point-of-care testing (POCT)coagulation monitoring devices is recommended byCanadian health technology assessment agencies(HTAs) for professional use and for patient INR self-monitoring, when appropriate.

Tools like these show that a broader adoption inthe healthcare system of POC INR monitoring willprovide equitable access for all eligible patients tohigh quality anticoagulation management while ad-dressing the burden of increased costs associatedwith anticoagulation therapy.

For more information: coaguchek.ca and rochecanada.com

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1. Garcia-Alamino JM, “Self monitoring and self managementof OAT,” Cochrane Review 2010.

2. CADTH, “Guidance on the usage of POC,” CADTH Report 2014, Volume 3, Issue 1C

CoaguChek® enables patients to participate actively in their treatment withouthaving to visit a hospital or clinic.

INR testing anywhere and anytime with immediate results.

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BY DR . RASHAAD BHYAT

few months ago, I wrote an article forthis magazine in which I talkedabout the dramatic rise in the

adoption and implementation of basic vir-tual care as a result of the COVID-19 pan-

demic, and the challenges we will have toovercome to build on this success. WithCanadian Patient Safety Week coming upOctober 26-30, I want to talk about howvirtual care is contributing to patient safety.

Before the pandemic began, about 10 to20 percent of primary care visits in Canada

were conducted virtually – that is, by video,email, text messaging, secure messaging orphone. Within weeks of the onset of thepandemic, that had risen to about 60 per-cent, according to statistics tracked byCanada Health Infoway (Infoway).

I was among those clinicians who

adapted quickly. In just a few weeks, myfamily practice group went from seeing themajority of our patients in-person, to con-ducting most of our consultations virtually– largely by phone, with some video visits.

Patient safety was the main driver forthis pivot to virtual care. Everyone was onhigh alert to comply with stay-at-home di-rectives, observe physical distancing, andkeep people out of crowded clinics andwaiting rooms to reduce their risk of con-tracting the virus. There was also a concernthat the shortage of personal protectiveequipment was putting clinicians at risk.

There are a number of other ways thatvirtual care is contributing to patientsafety. Let me share an anecdote about oneof my patients who had just come out of avery serious neurosurgical procedurearound the time that COVID-19 hit.

The patient was recovering at home andexperiencing what turned out to be a sig-nificant post-opera-tive complication. Iwas able to schedulea video visit withthis patient to seewhat was going on.

As a result of see-ing the patient, andnot just hearing thepatient describe theproblem, I was ableto make a more ac-curate diagnosis thathelped the patient get the level of care thatwas needed at that time. I might not havemade the same diagnosis if we had had aphone visit or no contact at all.

Some patients might not realize thatthey can have a caregiver, family memberor friend with them when they have a vir-tual visit. Just as with an in-person visit,having another person there to ask ques-tions or hear the conversation, con-tributes to patient safety. The CanadianPatient Safety Institute is emphasizingthis aspect of virtual care during its Con-quer Silence campaign for Canadian Pa-tient Safety Week this year, and I think it’svery important.

As Canadians continue to cope with thepandemic, mental health is a concern thatcan also be a safety issue, especially if peo-ple in crisis are contemplating self-harm.Infoway is a major funding partner of thevirtual care service Crisis Text Line pow-ered by Kids Help Phone, which offersbilingual 24/7 support to young Canadiansvia texting, their preferred method ofcommunicating. Young people might notwant to go to a doctor or an emergencyroom or even make a phone call for help,so the texting service gives them a modernoption they’re comfortable with.

Last year alone, this service had almost134,000 texting conversations that pro-vided support or interventions that savedapproximately five young lives every day.Infoway recently partnered with a comple-mentary service in Quebec called Tel-je-unes. It offers virtual mental health servicesto young people via phone, text, email andchat, and demand has increased by at least30 percent since the pandemic began.

Dr. Rashaad Bhyat is clinician leader, ACCESS Health at Canada Health Infoway.

Virtual visits contribute to patient safety, giving patients more options


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The researchers foresee additional uses of the technology in long-term care facilities and rehab centres.

Jewish General tests Microsoft HoloLensand mixed reality for COVID control

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MONTREAL – To protect health-care workers against the risk ofexposure to COVID-19 frominfected patients, the JewishGeneral Hospital (JGH) is oneof the first medical institutions

in North America to experiment in real-time withmixed reality headsets to minimize direct contact be-tween staff and patients.

By using Microsoft HoloLens, an untetheredmixed-reality device with apps and solutions that en-hance collaboration, practitioners are better equippedto provide the best personalized care at a time whenphysical proximity presents an imminent danger.

“With a single person in the hospital room, wecan secure the information we need about a patient’scondition while minimizing the risk of the spread ofinfection,” explained Dr. Lawrence Rudski, Chief ofCardiology and Director of the Azrieli Heart Centreat the JGH, who is spearheading this trial. “WithHoloLens and the Dynamics 365 Remote Assist app,we are able to limit contact and enhance consultationat the same time.”

Dr. Rudski explained that a physician or otherhealthcare professional can safely enter a patient’sroom after donning PPE and a HoloLens. The devicecaptures a view of the patient and the room, while col-leagues view the images and consult from a safe localeelsewhere in the hospital. If necessary, additional re-sources and expertise can be brought to the bedside.

HoloLens uses cloud and artificial intelligence(AI) services, including Dynamics 365 Remote Assistand Microsoft Teams, to send a highly secure, livevideo-feed to a computer screen in a nearby room.This allows healthcare teams to see everything thedoctor treating COVID-19 patients can see, whilethey remain at a safe distance.

Those watching can interact with the individualwearing the HoloLens by uploading charts and X-rays into the field of view and even draw on orpoint out at eye-level a place on the patient’s bodywhere a procedure is to be performed or a treatment

administered. It also allows for dictation of voice-to-text and hand gestures to operate its internal com-puting capabilities so forms and charts may be com-pleted in real time.

HoloLens provides a comfortable and immersivemixed-reality experience that is preferable to smartphones or other devices because of its reliability, se-curity, and mixed media applications. It is alsohands-free, thus allowing the person who is with thepatient to perform a variety of tasks while remainingin constant contact with those outside.

Dr. Rudski said the hospital’s experience withHoloLens amid the first wave of COVID-19 proved thetremendous capability of the technology and will helpthe team be better prepared for a possible second wave.

“We are now looking into other areas to deploythis powerful technology and we are focusing on ad-dressing some challenges we identified in the first go-around,” he said. “These include lacking specialists inour affiliated nursing home and rehab hospital set-tings, pairing up doctors in these institutions tomake care more efficient, as well as having enoughtrained nurses in the ICU, should the number of pa-tients needing ventilators proliferate.

“We also expect that the experience we gain dur-ing these projects will refine how we will use theHoloLens in other non-COVID settings in the hospi-tal, in other sites, and even out to home care in thecommunity. As the HoloLens evolves, we will workwith Auger Groupe to incorporate these advance-ments and we will leverage them into our patientcare plans,” said Dr. Rudski.

“Having the privilege of helping the medical teamat the Jewish General Hospital to fight COVID-19 isan incredible opportunity for my team of mixed re-ality experts,” said Marcel Lafontaine, P.Eng, the CEOof Auger Groupe Conseil. Montreal-based AugerGroupe Conseil specializes in industrial process en-gineering and has expertise in improving the perfor-mance of organizations. “By working to integrate in-novative Microsoft tools to minimize the risk of con-tamination and optimize the treatment of patients,we are, together, advancing science.¨

Kevin Peesker, President of Microsoft Canada,said, “I am pleased to see the incredible work theJewish General Hospital and Auger Groupe Conseilis doing with Microsoft HoloLens and Dynamics 365Remote Assist to help keep patients and healthcareworkers safe.” Peesker added, “I’m heartened by theinnovative solutions that Canadian researchers andhealthcare providers are developing – at record speed– to help in addressing the pandemic. These innova-tions, made possible by the power of the cloud, willpositively impact the delivery of patient care far be-yond COVID-19.”

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s the first hospital in Quebec designated totreat coronavirus patients, we were com-

pelled to adapt our operations to the realityof a large number of highly infectious individualsneeding our care,” said Dr. Lawrence Rudski, Chiefof Cardiology at the Jewish General Hospital andChief Medical Information Officer for CIUSSS –West Central Montreal, the local health region.

“We rapidly identified those technologies thatcould help us navigate this crisis, with an eye onhow they would improve the care we provide ourpatients going forward,” he added. “We formed ateam of progressive leaders in the departments ofNursing, Critical Care, Surgery and Medicine todevelop protocols for use and to work withHoloLens. We are confident that HoloLens will bea valuable tool for facilitating remote consulta-tions between local physicians, nurses and spe-cialists anywhere within our network, but also

anywhere in the world for all manner of treat-ment scenarios.

“In the short term,” he continued, “it enhancesthe safety and security of our healthcare profes-sionals, while reducing our need for personal pro-tective equipment.”

The JGH has run a series of successfulHoloLens simulations involving COVID-19, pal-liative care and intensive care unit scenarios. Thedevice has also been used to provide wound careto a patient, guided by a nurse specialized in thearea. “The next step,” adds Dr. Rudski, “is to havestaff ready to use this technology across ourCIUSSS in time for the anticipated second waveof the pandemic. Subsequently, our plan is forour clinicians to use HoloLens headsets to consultwith colleagues within our CIUSSS and for us toprovide our own expert consultation to othersites throughout Quebec and beyond.

Technology helps JGH navigate COVID crisis

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This past spring, after most of theworld came to a standstill due tothe pandemic, many workplaces

began transitioning their employees to re-mote locations. For some, this meant set-ting up new ways of connecting with tech-nology, considering shared meeting plat-

forms that would be safe and secure, andensuring appropriate infrastructure was inplace to support home offices.

As businesses adapted to our new nor-mal, at North West Telepharmacy Solu-tions it was business as usual for over 100employees already working from inte-

grated remote offices across Canada.During this pandemic, multiple projects

continued and flourished. “A high priorityproject has been meeting the needs of ourcurrent clients to integrate CPOE andscanning services in one solution, Power-GridRx by Pipeline Rx. We did not miss a

beat since both our companies have beenpositioned to work securely anytime fromanywhere,” said Kevin McDonald, director,North West Telepharmacy.

PowerGridRx securely enables bothCPOE and scanning of written paper or-ders into a cloud-based solution for verifi-cation, review and follow up by pharma-cists and pharmacy technicians. Featuressuch as handover reports, interventions,and statistical capture make this a solid so-lution. Furthermore, the solution makestelepharmacy much more efficient, whichwill eventually decrease the cost of doingbusiness and make telepharmacy an evenmore attractive alternative for hospitalpharmacy support in off-hours.

Innovation and addressing market gapshas always been a priority for North WestTelepharmacy. Projects such as Canadianaccess to Penguin Innovations “Virtual

Cleanroom” and other pharmacy learningopportunities highlight this. Adapting tothe needs of clients was a natural step andevolution of the projects.

McDonald explained, “We now havetwo Canadian Council on Continuing Ed-ucation in Pharmacy (CCCEP) accreditedcourses – large modules in both sterile andnon-sterile compounding. Combiningthat with the virtual component, we arehoping learners will be able to practice andlearn without the need for using additionalPPE, which is in short supply. It also allowslearning from home.”

A real benefit to current clients duringthis pandemic has been the day-to-daypractice of pharmacy. Operations managerKelti Verhagen said, “We would normallyprovide last-minute sick coverage for ourclient sites, on average, once or twice permonth. At the start of the pandemic, wewere receiving requests for multiple shiftsper day. Filling these requests was a possi-bility because our staff are already set up towork from any location and we are morethan prepared to support hospitals for anypotential second wave of COVID-19.”

Business manager Sammu Dhaliwallhas been busier during the pandemic,with requests from hospitals in prepara-tion for the fall.

“There has been increased interest fromhospitals to understand how our team ofhospital-trained pharmacists could sup-port any capacity issues to be experiencedduring the second wave,” said Dhaliwall.“Since we have telepharmacy contractswith both Mohawk-Medbuy and Health-PRO Canada, hospitals can very easily‘turn on a switch’ to use our services. Wehave also introduced our Virtual Medica-tion Reconciliation on Discharge (VMRD)program allowing for virtual interviewswith patients just prior to leaving the hos-pital along with a virtual follow-up within72 hours in the patient’s home.”

Bringing new virtual pharmacy technologies into the hospital sector



BY NORM TOLLINSKY

new state-of-the-art cath lab equippedwith a Discovery IGS 730 angiographysystem from GE is the first step in a planto bring cardiac care at St. Michael’s

Hospital in Toronto into the 21st cen-tury. Part of the hospital’s Walter

and Maria Schroeder Brain and Heart Centre, the ul-tra-modern cath lab suite, or hybrid room, was com-missioned and operational in March just as COVID-19 put a halt to construction of the Centre’s otherplanned cardiac care facilities, including an echocar-diogram lab, a structural heart clinic, a dedicated re-covery room and three additional cath labs.

“A hybrid room is a room where you can do bothcatheter-based procedures and surgical procedures,”explained Dr. Neil Fam, director of interventional car-diology and head of the hospital’s cardiac cath labs. “Ifyou need it to do an open heart procedure or anythingelse surgical in nature… (in addition to or following)a catheter-based procedure, you can do it in the sameroom without having to move the patient to an OR.

“It’s where we will be doing a lot of our innovativestructural heart procedures, including mitral and tri-cuspid clips, valve replacements, transcatheter aorticvalve implantations (TAVIs) and other catheter-based procedures for treating congenital abnormali-ties such as atrial septal defects and patent foramenovales, or holes in the heart,” said Dr. Fam.

The suite’s advanced ventilation system and theaseptic attributes of the imaging device, which does-n’t sit over the top of the patient throughout a pro-cedure and can be moved away for post procedurecleaning, makes it ideal for treating patients with in-fectious diseases, so during the spring and early sum-mer it was primarily used for treating COVID-19 pa-tients with heart attacks.

The mobile, untethered Discovery IGS 730 imagingsystem is a key enabler of the room’s hybrid capability.

Unlike fixed floor or ceiling systems, it can bemoved aside and out of the way by pressing a buttonon a control panel, allowing multi-disciplinary teamsunobstructed access to patients.

“It allows for more flexibility about where the var-ious team members can be positioned around thepatient,” explained Dr. Fam. “It’s very mobile, so it al-lows for multiple different configurations of theroom. For the average catheter-based interventionthrough the groin up to the heart, we’re standing onthe right side of the patient. However, if we’re doinga different procedure where we need to go from thepatient’s head or neck, it allows us to configurethings to provide optimal access and make it er-gonomic for the procedure.

“The image detector is much larger and the huge56-inch monitor (on a mobile boom) has the capac-

ity for multiple inputs – whether that’s echo, angio,intravascular, or intracardiac imaging. It allows us toimport CT scan images and co-register them withthe X-ray fluoro images. You can have all of these dif-ferent inputs up on the screen at the same time,which gives you much more insight into what’s hap-pening with your patient.

“The superior imaging has allowed us to seethings better and make real-time decisions in a waythat we couldn’t before,” said Dr. Fam.

Earlier iterations of the Discovery IGS 730 wereintroduced to the market in 2014, but the imagingdevice with robotic C-arm has been continuouslyupgraded since then, said Carsten Stevenson, ad-vanced clinical specialist, GE Healthcare.

“The imaging chain is now AI-based and we’vemade significant progress in dose reduction, imagequality, system functionality and integration.”

For example, GE has developed software tools thatallow for the visualization of ultra-thin stents oncethey have been placed in an artery – something that’svery difficult to see using conventional imaging tech-nology, explained Stevenson.

“This is very important because when you finishdoing a coronary procedure and you’ve fixed the nar-rowing of the vessel, you want to make sure it hascorrectly expanded, that there’s no malappositionand that there’s no calcium around the vessel in-hibiting its expansion.”

According to Arlene Desousa, product marketingleader for the Discovery IGS 730, the unit at St. Mike’sis one of five currently installed in Canada with an-other six scheduled for deployment this year and next.

Once construction of additional facilities plannedfor the hospital’s Brain and Heart Centre is completedin 18 to 24 months, patients undergoing a structuralheart procedure will be able to recover in a new, co-lo-cated recovery room with dedicated staff, whereascurrently they are transferred to the hospital’s ICU.

The Centre’s structural heart clinic will be triplethe size of the space currently being used and will al-low for more virtual consults, teaching and research.

“We will be able to enroll patients in studies or tri-als all in the same place, whereas right now, half ofthe research staff is located off-site,” said Dr. Fam.

The hospital’s cardiology department boasts sev-eral other world-renowned practitioners in additionto Dr. Fam, including Dr. Chris Buller, Dr. John Gra-ham and Dr. Mark Peterson. According to Dr. Fam,the state-of-the-art facilities will also help to attractnew staff, including international fellows.

The price tag for the completed cath lab suite, in-cluding all of the equipment, was a reported $17.8million and funded by private donations from theSchroeder family and several other donors.

The room includes advanced ventilation and moveable, easy-to-clean equipment.

Hybrid cath lab at St. Michael’s Hospital isoptimized for catheter-based procedures

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GE Healthcare’s Discovery IGS 730 angiography system is a key component of St. Mike’s hybrid cath lab suite suitable for both catheter-based and surgical procedures. Unlike fixed floor or ceilingsystems, the IGS 730 can be moved aside and out of the way by pressing a button on a control panel.


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A hybrid room is a place where you can do minimally invasive catheter-based procedures and more open, surgical interventions.

BY ROBERT AMYOT, MD

Early into the coronavirus pandemic,Montreal-based MEDFAR Clinical So-lutions – the developer of a leading-edge EMR, in Quebec and now inBritish Columbia – shifted its focus tohelp its users get into COVID-19 re-

sponse mode. It was all-hands-on-deck, from collect-ing clinic requirements to fast-tracking product vali-dation with one goal in mind: enhancing the safetyand efficiency of delivering healthcare.

Overnight, MEDFAR helped many clinics adoptthe complete MYLE virtual care management solu-tion. All the features of the MYLE ecosystem weremade available to MYLE users, regardless of theirsubscription plans.

Now that the initial COVID-19 surge is behind us,how do we prepare for the second wave? We con-ducted interviews with leading healthcare decisionmakers, as we believe the second wave is no longer amatter of “if”, but “when”.

Identifying the most vulnerable patients: WithMYLE Analytics, a powerful data analysis feature,clinics can easily stratify their patients and prioritizefollow-up visits for groups with higher risk. “Withinthe first couple of weeks of the pandemic, we wereable to send each physician a list of their patients,categorized by their vulnerability codes, by their ageand so we actually had a way of reaching out to ourmost vulnerable patients,” said Dr. Mark Karanofsky,unit director of the Herzl Family Practice Centre ofthe Jewish General Hospital in Montreal.

For Xavier Arancibia, director of operations atGMF Santé-Médic, the problem was “how do we letour patients know we are still open?” He overcame thischallenge by identifying patients who had not visitedthe clinic for a long time with MYLE Analytics.

In addition, monitoring the clinic’s response tothe pandemic becomes possible with the MYLEecosystem. Dr. Karanofsky added: “MYLE Analyticsis also currently used to analyze data regarding howCOVID cases were followed at Herzl, which will pro-vide a lot of insights on our capabilities.”

Protecting patients: Minimizing physical contact

is key to avoiding the spread of the virus. But with-out the right tools, it is easier said than done.

“MYLE Patient Portal allows us to securely senddocuments to patients. [Otherwise] we’d be re-quired to set up a secure method of how toemail things and get documents to patients,whereas the Portal just closes that loop very,very quickly,” Dr. Karanofsky explained.

“We can add anything to the MYLE Pa-tient Portal. All these functionalities al-lowed us to return to full capacity. If wehadn’t had access to these functionalities, Ireally don’t know how we would have doneit,’’ says Arancibia.

Choosing a provider available 24/7: Withclinics forced to transform their operations

abruptly, expert, easy-to-reach support becomes adetermining success factor. “I personally feel that thesupport that MEDFAR has provided has been noth-ing short of spectacular. The users always have accessto support and that really makes it actually veryfunctional,” Dr. Karanofsky said.

The power of fully integrated virtual care: Asclinics adjust in real-time to the spread of the virus,they need the proper solutions and knowledge toquickly navigate their entire operation along thephysical-virtual spectrum.

Dr. Karanofsky asserted: “If I had to turn the clinicoff tomorrow, I could do it. I could even scale up myvirtual medicine instantly. And so, I think our abilityto respond to that, even though it was fast last time,I think we’d even be faster now.’’

What will “normal’’ look like post-COVID? Dur-ing the pandemic, clinicians quickly discovered that

the videoconferencing embedded in MYLEcould add new dimensions to the care they

provide. “How often can you get to see yourpatients where they live and their setup?Especially for the elderly patients, what’sthe home environment? And you can see alot of trip hazards that are an easy thing tofix,” observed Dr. Karanofsky.He added, “The goal is never to go back

to March 12. And our hope is that by us-ing the technology that we have, and ex-

panding on what it can do, to push theenvelope and really target at least

about 30 percent as remote.” Mr. Arancibia added, “We

need to change the way wedo things. Telemedicineshould play a role, like atriage, that would make

it the first line.”

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Analytics, document management and integrated video are all important for effective patient care.

With a second wave of COVID-19 on the horizon, how do we prepare?

Robert Amyot, MD, is a cardiologist and entrepre-neur. He serves as chief operating officerand chief medical officer at MEDFARClinical Solutions. He is also a boardmember of several organizations, including Royal College International.

With MYLE Analytics, for data analysis, clinics can stratify their patients and prioritize follow-up visits for groups with higher risk.

Connected Health technologies will improve the quality of careBY LAURIE LAFLEUR

AND SHIRLEY FENTON

Connected Health, which com-bines digital networks withwearable devices such as

smart watches, monitors and mobiletechnologies, has the potential todramatically improve the delivery ofremote care to patients at home andin the community. Connected healthdevices and networks are promotinghealthy behaviours, encouragingmedication adherence and easing themanagement of chronic conditions.

As of 2019, Connected Health wasin its infancy in Canada. However,the COVID-19 pandemic has pushedit into prominence and previousroadblocks are being removed atwarp speed.

The emergence of telepresence:Telepresence, the next evolution intelemedicine, leverages a variety of

connected health devices to fully im-merse remote physicians into thecare setting. One exciting example isCatalyst, a platform for real-timeclinical collaboration. It was recentlylaunched by Dr. Jeff Soble, cardiolo-gist and associate professor of Medi-cine at Rush University Hospital,and his team at ASCEND Health In-formation Technology, in Chicago.

Telepresence leverages a variety ofconnected technologies to allowphysicians to be virtually present inmany care settings as if they werethere. From providing integrated liveaudio and video of the room to al-low care providers to see, hear, andinteract with colleagues and patients.Supporting information is streameddirectly from physiologic monitors,procedural devices, and imagingmodalities to enable physicians toactively participate in the care ofcomplex patients and cases – with-

out leaving their home or office. Telepresence in action: Telepres-

ence has recently opened the doorfor physicians to closely monitor andcare for COVID-19 patients in ICUenvironments. With telepresence

technologies, physicians can see andhear their patients in real-time, com-municate with nurses, and closelymonitor vital signs and medicationdelivery. By enabling remote interac-tions, hospitals can gain access to a

larger pool of specialized intensiviststhat may not have otherwise beenavailable, while also reducing PPErequirements and the risks associ-ated with physical interactions.

Adding further value, the use oftelerobotics augments telepresencetechnologies, extending to physiciansthe ability to navigate and controltheir environment. Physicians canremotely control a robot equippedwith audio, video, and tactile sensorsallowing them to freely moveamongst and communicate with pa-tients and colleagues.

In more advanced use cases,telepresence can bring highly spe-cialized interventionalists and sur-geons from anywhere into the oper-ating room. In addition to a liveoverview of the OR itself, remotephysicians can view images and in-formation generated from ultra-

Shirley Fenton Laurie Lafleur

CONTINUED ON PAGE 23


V I E W P O I N T

TORONTO – The COVID-19 pan-demic has stressed some parts ofthe healthcare system to its limits,triggering an unprecedented

worker shortage. Many facilities wereshort-staffed when the virus struck, andstill are, making it difficult to provide ap-propriate care to patients.

“Healthcare facilities are dealing withstrained resources and IT that isn’t keepingup with demand,” said Raul Rupsingh,chief technology officer at BookJane, acloud-based staff optimization and com-munication health technology platform.“Time-consuming activities, like shiftscheduling, resource allocation, and com-munications are often being done manu-ally, and this process is made even morepainful when dealing with the unprece-dented circumstances we find ourselves in.”

Since the coronavirus pandemic began,BookJane’s technology has been adoptedby hospitals, long-term care and retire-ment facilities in Canada to quickly bringhealthcare professionals into action whenand where needed.

The proprietary BookJane J360 platformallows any healthcare facility in theprovince to immediately broadcast a servicerequest to healthcare professionals, basedon proximity, preferences and availability.

The requests appear directly on theplatform’s mobile app, available on An-droid and iOS, to ensure instant responsetime and acceptance of the request.

BookJane is working with the OntarioMedical Association (OMA) to get all On-tario physicians onto the mobile plat-form. Physicians can register and withinminutes can see where there is a need fortheir services.

“COVID-19 impacts everybody and weare proud to provide a solution to helpmeet the evolving needs of our healthcaresystem and frontline workers as they dealdirectly with this crisis,” said Curtis Khan,CEO and founder of BookJane. “In health-care, time is everything. And our systemwill save valuable time when Ontariansneed it most.”

BookJane is currently working withother caregiver associations to migratetheir memberships onto the platform sothat hospitals may be able to access onehub for a variety of staffing needs. Book-Jane’s J360 platform has delivered over 1million caregiver service hours to manyhealthcare clients across the province.

In particular, Ontario’s long-term carefacilities are currently on the frontlines ofCOVID-19 breakouts. With the decision torestrict healthcare staff from working atmultiple long-term facilities, an already in-demand work force was put under in-creased pressure.

Personal support workers and regis-tered nurses who haven’t fallen ill to thevirus themselves, are struggling to meetthe needs of residents, leaving seniors in aneven more vulnerable environment.

“Currently we are working with over700 healthcare facilities and providingthem access to the highly skilled workforcethey urgently require,” said Khan. “To curbthe effects of the pandemic, we must worktogether to provide the necessary supportto our frontline healthcare workers. Theadditional support exists and BookJane

connects this workforce to where they arerequired most.”

The BookJane platform matches eachfacility with access to its own pool of work-ers as well as agency staff, when needed.

BookJane runs on Amazon Web Ser-vices (AWS) and relies on the cloud

provider’s scaling capabilities to ensure itsupports the growing demand. In fact,with just the OMA work, traffic spikedfour-fold and BookJane did not experienceany service downtime.

With the help of AWS partner Onica – aRackspace company – BookJane was able

to architect a solution in the cloud thatgives it the flexibility it needs to scale-upand down with demand.

“To supply these hospitals and health-care facilities with emergency workers,clinicians, and nurses is deeply impactfulduring this crisis,” said Rupsingh.

Platform eases on-demand shift scheduling of healthcare professionals

TELEHEALTH

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BY DIANNE DANIEL

s ICUs in the U.K. surged to capacity at theheight of the COVID-19 pandemic, itquickly became evident that life-savingmedical intervention wasn’t the only

critical care required. Giving familiesand friends under lockdown a

chance to see their loved ones, and in some caseswhisper a final good-bye, was equally vital.

Thanks to the rapid response of a unique trans-Atlantic partnership, those face-to-face connectionsnot only happened, they flourished – virtually.

It started with a simple idea. Louise Rose, PhD,a Critical Care Nursing professor at the FlorenceNightingale Faculty of Nursing, Midwifery andPalliative Care, King’s College London, was observ-ing family members desperate to connect with iso-lated COVID patients while busy ICU staff had noway to facilitate calls other than through personalsmartphones.

Recalling her collaboration with Aetonix SystemsInc., a Canadian virtual care start-up she had beenworking with prior to moving to the U.K. in January,she immediately thought of the company’s aTouch-Away communication and information sharing plat-form as a possible solution.

She took her idea to Dr. Joel Meyer, a critical careconsultant at Guy’s and Thomas’ Hospitals in Lon-don. As it happened, Dr. Meyer had already been in-

vestigating secure virtual visits for the ICU and inlate March, they reached out to the Ottawa-basedcompany. Within days, the Life Lines ICU projectwas launched, a philanthropic endeavour to connectfamilies to their loved ones.

“Looking back on it, it was crazy,” said Dr. Rose.“We were working 16 hours a day and we were verylucky at that same time that things came together.”

Aetonix wasn’t set up to do business in the U.K.,but when founder and CEO Michel Paquet receivedthe call, he says he knew he needed to help.

The company connected with Amazon Web Ser-

vices to quickly scale-up its cloud-based environment overseas. Its teamthen configured a simple-to-use ICUcommunication care pathway, and byApril was onboarding hospitals ontoaTouchAway at a rate of 10 per week. The goal was to make it extremelysimple and efficient for busy ICUstaff to connect people, said Paquet.“It sounds easy, but when you hearDr. Meyer explain what an ICU lookslike in a rush like this, when they’reall loaded with PPE and gloves andmasks, and panic is hitting the roof,you don’t have time to install an app,sign in with an account and press afew buttons,” said Paquet. “It has tobe go, go, go!”

Life Lines is a unique partnership of clinicians,academics, companies and charities. Backed byKing’s College London, King’s Health Partners, theTrue Colours Trust, the Gatsby Charitable Founda-tion, British Telecom (BT), Google, Samsung andMobileIron, the initiative is now providing 4G-en-abled tablets to more than 170 ICUs within the UKNational Health Service (NHS).

Tablets are pre-loaded with the scaled downversion of aTouchAway to enable secure commu-nication between COVID patients and their lovedones, and each NHS organization is provided with

Ottawa-based Aetonix developed a device and platform keeping ICU patients in touch with their loved ones.

Canadian expertise in virtual care nowdeployed in hospitals across the UK

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nother Ontario-based virtualcare service that quicklyramped up in March when

COVID-19 cases were peaking isOntario Telemedicine Network(OTN), now part of the new OntarioHealth government agency. An earlyprovider of virtual care services,OTN has provided the opportunityfor either direct-to-patient or hostede-visits for many years.

Almost overnight, direct-to-pa-tient visits surged from 350 concur-rent events per day to 2,500 per day,said OTN vice-president Technologyand Services Sharon Baker, eventuallyleveling off at about 2,000 per day.

“We had prepared but we justhadn’t estimated how significantlyour volumes would increase andhow quickly that would happen,”said Baker. “We had to do some sig-nificant and quick adjustments toadd capacity in order to meet de-mand, but we were able to do that.”

According to OTN’s COVID up-date, 22,000 new account requestswere made between March 1 and theend of May, with 740,000 virtual visitsconducted. When hosted visits –where patients visit a medical siteclose to them to connect with a re-mote care provider – dropped off at

the height of the pandemic due tolockdown restrictions, direct-to pa-tient consults “went through theroof,” said Baker, prompting severalpartners to join together to launch theOntario Virtual Care Clinic (OVCC).

A collaboration between the On-tario Medical Association, Ontari-oMD, Ontario Ministry of Healthand Ontario Health, with fundingprovided by Canada Health Infoway,OVCC is staffed by roughly 200 li-censed Ontario physicians.

Novari Health of Kingston, Ont.,is providing the virtual waiting roomcapabilities through its eVisit virtualcare software system, and quicklycreated a COVID-19 Emergency Re-sponse Team to work with OTN todesign, build, test and deploy the vir-tual clinic.

In a statement, Novari Healthpresident John Sinclair said: “Neverin all my years have I witnessed ateam come together with such asense of purpose, drive and determi-nation to improve access to care …our team accomplished things in afew weeks that I previously wouldhave thought impossible.”

OVCC is designed to treat non-urgent health concerns such ascolds, cough, flu, allergies, women’s

health issues, chronic disease man-agement, pain, urinary tract infec-tions, rash and medication ques-tions. It is not intended to replaceregular care, but to allow access toprimary care physicians from thecomfort of home at a time wheneveryone is being extremely vigilantabout reducing public outings tostop the spread of coronavirus.

Patients who access the service atwww.seethedoctor.ca require an On-

tario health card, internet access,email address, mobile phone num-ber to receive text notifications, anda device with a camera and micro-phone. When they sign in, they entera virtual waiting room and are ad-vised on their estimated wait time tosee a physician.

The speed with which the virtualclinic launched is a direct result ofongoing work to advance virtualcare in Ontario. OTN had previouslyconducted five proof of concept pro-

jects across the province to evaluatevirtual visits between patients andproviders, including how to bill forvirtual visits.

In March, the province introducedtemporary virtual care billing codes,which apply to both telephone andvideo visits, and a more permanentpolicy change is being negotiated.

“It’s really about using integratedvirtual care as one of the modalities,based on clinical appropriateness,”said Baker, adding that the telephonestill has a role to play. “We’ve beensaying for years that the future ofhealthcare is virtual care, but the fu-ture arrived on about March 2.”

Not all care providers who signup with OTN are conducting virtualvisits. Baker said there’s a significantcohort that have embraced it for themajority of their patient visits whileothers are conducting sporadicvideo visits, and a small grouphaven’t held any. Meanwhile, OVCCcontinues to grow.

“COVID was the burning plat-form to force people to try it, be-cause what else was their option?Their option was not to have care,”said Baker, “and now that peoplehave seen the look and feel, I think itwill be very hard for us to go back.”


Ontario virtual care clinic sees demand ‘go through the roof ’

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Earlier this year, OntarioHealth used Amazon WebServices to quickly scale-upits virtual clinic.

T E L E H E A L T H

a digitally secure dashboard to enroltheir patients.

BT centrally manages tablet configura-tion and performance, tracking the tabletsremotely so they can be disabled if they leavethe hospital premises. Invited family mem-bers sign an end-user licence agreementwith Aetonix which states that their contactdetails will be permanently deleted when thepatient is removed from the platform.

In order to make ICU virtual visits asseamless as possible, Aetonix kept func-tionality to a bare minimum. When anICU staff member wants to initiate orschedule a call, they simply pick up thenext available tablet, search for their pa-tient in the dashboard and click on thefamily member listed.

Because the tablets were deployed atthe height of U.K.’s COVID surge, whenentire ICUs were devoted to treatingCOVID patients and some hospitals wereforced to set up multiple ICUs, there wasno time for training.

“We literally delivered tablets into theICU with a set of instructions as to how touse aTouchAway,” said Dr. Rose. Now thatshe has had time to conduct follow up, sheadded, the overriding message is “it’s soeasy to use.”

Not only do the virtual connections al-low for tough good-byes to be said, but forthose who recover, there are often virtualparties, pet visits and in one instance, evena successful marriage proposal.

“There’s always been a need to enable away for families to be present in the ICUwithout being physically there,” said Rose.The pandemic was the driving force toquickly ramp up secure ICU virtual visits,but now that they’re happening, the goal isto keep the option in place. “COVID hascalmed down somewhat in the U.K., butwhat we’re seeing now is that some centresare transitioning to using this as an ongo-ing family visiting platform,” she said.

Moving forward, Life Lines is workingwith Aetonix to develop a critical care re-covery pathway, possibly adding a diaryfunction so notes taken by clinical staffwhile an unresponsive patient is on a ven-tilator can be shared with family members.

“I’m a big believer that if we want tolearn from this crisis, it’s that virtual carereally needs to offer a complete service,”said Paquet. “That’s my vision and that’swhere we’re leading our team. How do weenable professionals and patients to beguided for their disease or condition sothat in the future if such a thing happens,it’s okay, we’re all organized?”

In addition to the work it is doing with

Life Lines across the ocean, Aetonix is alsoproviding multiple virtual care pathways tohealthcare providers in Canada. Each path-way developed includes assessment mater-ial, a workflow to guide the care team, pa-tients and other members of their circle ofcare on what actions will be taken when,and educational material to further theirunderstanding of the specific condition.

Pathways are currently available for

chronic obstructive pulmonary disease(COPD), diabetes and multiple conditioncare, as well as for staff screening forCOVID-19. A new initiative is also provid-ing a mechanical ventilation care pathwayto support patients and parents of youngchildren who need to use ventilationequipment at home. As Paquet explained,pathways can as simple or as complicatedas necessary, depending on the need.

Removing barriers to outstanding patient-centred healthcare, today and every day

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Bring leading clinical knowledge into your

any hardware aside from their existingsmartphones, although the COVID-19 pa-tients were also provided with an oximeter,which measures oxygen saturation througha non-invasive fingertip device.

Working with the Ontario TelemedicineNetwork (OTN), the region didn’t have togo through a request for proposals (RFP)process, as Plano, Texas-based VivifyHealth has been a vendor of record forOTN’s remote patient monitoring pro-grams since 2017.

Vivify’s Remote Patient Monitoring(RPM) platform boasts more than 90 clin-ical and engagement pathways. Users canmodify the content, or create their owncustom pathways.

In its 10-year history, Vivify claims arecord of 97 percent patient satisfaction,65 percent readmission reduction and 8.2xreturn on investment.


Tech allows nurses to make virtual rounds


T E L E H E A L T H

VANCOUVER – Having operatedfamily practices for over 20years, Dr. Essam Hamzawanted to address the prob-lems he was seeing as a physi-

cian in his practice. He took action and de-veloped a suite of technologies to help clin-icians better manage their costs and becomemore efficient, while providing a better pa-tient experience; he established CloudMDSoftware and Services to do this in 2018.

As CEO of CloudMD, Dr. Hamza over-sees a company which is digitizing deliveryof healthcare by providing patients accessto all points of care from their phone, tabletor desktop computer. The company offersSaaS-based health technology solutions tomedical clinics throughout Canada and hasdeveloped integrated solutions deliveringquality healthcare through a combinationof connected primary care clinics, telemed-icine, and artificial intelligence.

CloudMD currently provides service toa combined network of 376 clinics, over3,000 licensed practitioners and almostthree million patient charts through itstechnology components.

In this Q&A, we obtain Dr. Hamza’sviews as a physician and technological in-novator in the Canadian healthcare system.

CHT: With the emergence of COVID-19,virtual health has come to everyone’s at-tention, seemingly overnight. Why do youthink it has taken so long to reach themainstream?

Dr. Hamza: As a physician, I understandfirst-hand the pain of operating a practice.When physicians graduate, they are imme-diately thrown into the system, and are ex-

pected to know how to manage costs, howto operate a business profitably and so on.So, I can appreciate why physicians some-times resist new technologies and/or newways of doing things.

With the emergence of COVID-19,there has been a unique convergence ofthought and acceptance around virtualmedicine – patients, providers and govern-ment payers all saw the need and inherentvalue in this approach, and so adoptionand implementation occurred very quickly.

CHT: Do you think virtual medicine ishere to stay?

Dr. Hamza: Yes, no question, virtual medi-cine is here to stay for a host of reasons. Pa-tients have found telemedicine to be a con-venient and easy way to access physicians.GPs appreciate that 70 percent of the ser-vices they perform can be done virtually,so virtual medicine enables them to be ef-ficient, while still allowing them to see pa-tients when they absolutely need to.

Equally, governments are pleased whencitizens get better access to care and oper-ating costs are reduced. It’s a win-win-winscenario.

In addition, within practice manage-ment, we are seeing operational changesoccur with the emergence of “hybrid clin-ics” where clinicians switch seamlessly be-tween virtual patients and patients pre-senting in-person. This is a more efficientway to leverage clinical resources and Idon’t think you’ll see this model disappear.

Lastly, virtual care solutions can be eas-ily integrated into practices and serve as aplatform to bolster continuity of care, eas-ily managing patient transitions to special-

ists, mental health counselors or therapistsas well as pharmacists.

The patient is assured that everyone isbetter connected and all working from acommon set of records. This results in bet-ter patient outcomes, which is ultimatelywhere cost savings occur, not to mentionbetter patient engagement and satisfactionwith care.

CloudMD has been focused on this vi-sion of longitudinal care since its inception– our hope is that the widespread accep-tance and adoption of telemedicine willbring this into reality for everyone.

CHT: What changes, if any, do you see onthe horizon?

Dr. Hamza: At CloudMD, we’ve alwaystaken a patient-centric view of care, with akeen desire to support a patient’s journeyas they navigate through the healthcare

system. This was our rationale for develop-ing a fully integrated and secure platformunderpinned by an EMR system calledJUNO (originally based on OSCAR opensource code), an integrated billing system,and patient portal (to allow patients toschedule and manage appointments).

While governments allowed main-stream video-conferencing solutions to beused at the onset of COVID, I think youwill see them start to require the use of se-cure, health-grade solutions very soon.

As well, clinicians will re-examine someof the technologies they initially chose todeliver telemedicine, as in some cases theirexperiences have not been positive.

Third, I think the connection betweendelivery of physical and mental health ser-vices will become more intertwined.COVID-19 is putting significant strain onpeople throughout society, and with GPsbeing on the front line of healthcare deliv-ery, they’ll need a seamless, integrated andeasy way to help patients assess their situa-tions, and refer them to mental health pro-fessionals in their communities.

Lastly, it is imperative to affordably de-liver telemedicine services to remote sitesthroughout Canada (which are, in manycases, indigenous communities). The cur-rent practice whereby residents travel out-side communities to obtain health services– or having a clinician visit from outsidethe community – is simply fraught withtoo many gaps and risks, not to mentioncomplicated extensively by the impracticalaspects of self-quarantine. It is really im-portant governments work quickly to ad-dress the healthcare needs of these com-munities by leveraging proven telemedi-cine technologies.

Our recent acquisitions reflect the evo-lution of healthcare access we envision atCloudMD; please visit www.cloudmd.ca tolearn more.

Q&A with Dr. Essam Hamza: A take on the future of virtual care

Dr. Essam Hamza, CEO of CloudMD

is our hope that COVID AIKnowl-edgeEnable will provide users withan effective tool in managing thepandemic and getting on with ourlives,” said Maynard. “Controlling thevirus will be the key to re-igniting theglobal economy, while more effectiveinformation access and exchangehelps medical professionals, policy-makers and the public to make betterinformed decisions with the mostup-to-date and relevant data in oneintegrated platform.

Clinicians and the public canaccess the app via a small monthlysubscription fee of US$1.99 a monthfor the standard version and US$2.99a month for the medical professionalversion. A 14-day free trial is also available for all users. The webversion is available now athttps://app.aiknowledgeenable.com. Itwill be available on Google Play andApple stores on October 15.


AI-powered app findslatest COVID info


T E L E H E A L T H

BY EILEEN MCPHEE

Over 700 people gathered on-line for the e-Health 2020 Vir-tual PopUp Conference in Julyto connect and learn from

presentations like Mobilizing ArtificialIntelligence in the Real World, FillingMental Health Gaps with High-Tech, andVirtual Care.

In addition to the plenaries and panelpresentations, attendees shared more than2,500 messages through the conference app.In-app community discussions grew fromquestions such as “Is COVID-19 a catalystfor virtual care?” and “Change Management:how can patients and providers be bettersupported with a smoother transition?”.

Attendees connected online by creatingover 86 community board discussion top-ics based on shared language, region, andinterest in subjects like Virtual Care for Se-niors, Patient Engagement and PatientIdentification, Engaging Customers inDigital Health, and Indigenous Care, a fo-rum created to discuss digital and virtualhealth activities taking place in First Na-tions Communities across Canada.

The Indigenous Care forum was startedby Nancy Gabor, Virtual Care Strategist,Mustimuhw Information Solutions Inc.,asking: “What digital or virtual care inno-vations are emerging for indigenous com-munities in Canada as a result of COVID?What short- or long-term trends to you seeemerging?”

Attendees contributed examples of vir-tual health projects underway acrossCanada connecting people living in re-mote communities with healthcare andhealth services. Examples include:

• Heart patient Adamie Amamatuak, whowished to return home to Puvirnituq,Nunavuk after cardiomyopathy surgery atMcGill University Health Center (MUHC)– more than 1,600 kilometers away. Nursepractitioner Stéphanie Ben Hamronstepped in to provide distance educationto staff at the Innulitsivik Health Center sothey could care for Mr. Amamatuak (andhis new mechanical heart) where he feltmost comfortable – in his home.

• First Nations Virtual Doctor of the Dayprogram, a unique service for First Na-tions people in British Columbia and theirfamily members that enables people withlimited or no access to doctors to makevirtual appointments. The intent of theprogram is to enable more First Nationspeople and their family members to accessprimary healthcare closer to home. Theprogram includes doctors of Indigenousancestry, and all doctors are trained to fol-low the principles and practices of culturalsafety and humility.

• Mustimuhw Information Solutions(MIS), a BC-based organization workingwith industry leaders in virtual care to de-velop targeted solutions focused on Na-tions-based care models. These tools helpproviders stay in touch with clients andeach other to reduce avoidable travel,missed appointments and prevent exacer-bations that would require clients to travelfor care. MIS is working to empower FirstNations Health Centres to provide theirbest care, from anywhere. Learn moreabout MIS here.

“Canada’s First Nations have excellenthealthcare programs in their communitiesand knowledgeable, committed localhealthcare providers,” said Nancy Gabor,virtual care strategist, Mustimuhw Infor-mation Solutions (MIS). “However, geo-graphic distances and access to healthcare

resources can make it difficult or danger-ous for clients to meet with their providerswhen they need care.”

She added, “Telehealth can serve a vitalrole in First Nations communities allowingclients to reach out for care digitally, help-ing providers to connect with each other to

strengthen care teams, or enabling securetransmission of personal health informa-tion between clients and providers.

“MIS addresses these gaps by helpingNations-based providers and their clientscommunicate, share, and store informationover distances securely and seamlessly.”

e-Health 2020 showed progress in virtual care for First Nations communities

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COVID-19 has led to an unprecedentedsurge in the use of virtual care in On-tario. Virtual visits – by video, audio,

or telephone – allow patients and healthcareproviders to connect safely at a distance for

routine care, minimizing risk. Remote mon-itoring, meanwhile, lets care teams track theprogress of at-risk patients, such as thosewho may have tested positive for COVID-19but do not need hospitalization.

Ontario’s Ministry of Health has en-couraged providers to use virtual carewhenever possible during the pandemic.Demand has been high. Between late Feb-ruary and mid-July, OTN, the province’s

primary virtual care delivery partner and abusiness unit of Ontario Health, theprovincial agency overseeing care delivery,activated more than 20,000 new accounts.

Total direct-to-patient clinical video vis-its through the Ontario Virtual Care Pro-gram, or using OTN video technology, rosefrom 115,275 in March to 206,198 in June –and those numbers did not include servicesoffered outside the provincial platform, suchas telephone calls. Virtual care is an increas-ingly mainstream delivery channel, offeringbenefits that include convenience, high sat-isfaction, strong outcomes, and safety.

While the groundwork for virtual careexpansion in Ontario has been many yearsin the making, several models of care, testedthrough pilots, were quickly adapted, andimplemented, to assist in the COVID-19 re-sponse. That work has revealed additionalopportunities, all of which are under con-sideration as system leaders plan for thepossibility of another COVID-19 wave co-inciding with flu season. Among the areasfor potential virtual care expansion beyondprimary care: emergency services; electivesurgery support; mental health and addic-tions; and long-term care.

Emergency services: Virtual models ofcare in emergency departments can assistin assessment, allow providers to offer clin-ical advice, and direct patients to appropri-ate care settings, relieving pressure on hos-pitals. Patients seeking medical care or ad-vice and who may be considering a trip toan emergency department, for instance,could log on to a hospital webpage that in-cludes a live link to initiate a virtual visit.

They could then be triaged and pre-screened remotely, either by an actualnurse (using digital tools) or an artificialintelligence chatbot (using sophisticatedalgorithms). Next, they could be placed ina “virtual waiting room” to see a physicianor sent a scheduled time for a virtual visitvia text or email. If necessary, patientscould also be redirected to an in-personemergency department assessment.

In May, Ottawa-based CHEO becameCanada’s first pediatric hospital offering avirtual emergency department. Familiesare asked first to try to connect with theirprimary care physician or pediatrician, butif they are unable to, they can visitwww.cheo.on.ca, where, after completing aself-triage assessment to determine appro-priateness, they can book a same day videovisit with an emergency physician special-izing in pediatric care, avoiding the needfor an in-person hospital visit.

The Electronic Canadian Triage AcuityScale, or eCTAS, developed by Cancer CareOntario (now a business unit of OntarioHealth), is used in 115 Ontario hospitalemergency departments, primarily to helpfront-line nurses calculate an acuity scorebased on combinations of 169 different pre-senting complaints – such as chest pain, con-fusion or vomiting – and more than 400other variables, including pain level or fever.More than 90 per cent of emergency patientsin Ontario are currently triaged using eC-TAS, which also shares real-time data, in-cluding infection-control updates from Pub-lic Health Ontario. Research has demon-strated eCTAS improves triage consistencyand accuracy – and Ontario Health’s OTNand Cancer Care business units are exploring

Ontario ramped up virtual care, and is now exploring more options

T E L E H E A L T H

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ways it might be further leveraged in pre-hospital assessment.

Optimizing elective surgeries: As On-tario’s hospitals have begun to resumeelective surgeries temporarily postponedduring the initial COVID-19 wave, virtu-ally enabled models of care could poten-tially be expanded to streamline pre- andpost-surgical care while minimizing in-person contact to prevent additional out-breaks. Among the potential benefits: im-proved coordination of care, streamlinedpatient throughput, reduced length of hos-pital stays, minimized readmissions, and abetter overall patient experience.

Pre-operative care options include as-

sessment – pre-anesthetic consultations,among them – patient education and in-struction, and advance discharge planning.St. Joseph’s Health Care Hamilton, for one,has pioneered a virtual care model thatkeeps surgical teams connected to patientsand home care providers using telephone,video, and the hospital portal.

Surgical transitions solutions, used bycare providers including William Osler

Health System, University Health Networkand Scarborough Health Network, can im-prove patient engagement, support andmonitoring both before and after surgery,boosting outcomes and efficiency. (CurrentOntario vendors of record availablethrough Ontario Health include Seam-lessMD, Vivify Health and InTouch Health.)

Surgical process management tools(such as Novari ATC, available via standing

procurement through Thunder Bay Re-gional Health Centre), are currently beingused by 30 Ontario hospitals to organizeand manage surgical caseloads, in somecases across regions. More intensive re-mote patient monitoring (RPM) can alsoassist in earlier discharge and improvedpost-op care. Ontario Health (OTN), forexample, offers an RPM platform withprotocols to support post-acute care.

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sound, ECG, fluoroscopy, or scopeimaging and advise technologists andother physicians on how best totriage and treat patients in real-time.

When augmented with teleroboticsand other connected technologies,physicians are able to perform com-plex invasive procedures remotely –from routine appendectomies andhernia repairs to complex imageguided procedures such as cardiaccatheterization and spinal fusion.

This technology can greatly reducethe time and cost associated withmoving patients or providers whenspecialized consultation is required –something that may not be possiblewhen critical illness or injury is in-volved. In rural or lower-income com-munities in particular, where access tospecialized providers is limited, telep-resence can help close the gap to en-sure consistent and reliable access tohigh-quality care for all Canadians.

Learning more: McMaster Univer-sity and the National Institutes ofHealth Informatics Canada (NIHI)are offering a joint certificate in Con-nected Health and the Internet ofThings (IoT). In this 10-sessioncourse, participants will explore vari-ous Connected Health technologies,learn how they can be successfully in-tegrated and adopted into Canadianhealthcare settings, and understandthe unique privacy, security, and ethi-cal factors that must be considered.Register today: https://www.nihi.ca/in-dex.php?MenuItemID=594

Laurie Lafleur is a professor of HealthInformation Science and Health IT con-sultant. With 20 years of experience inthe MedTech industry Laurie has suc-cessfully stewarded healthcare organiza-tions of all sizes and profiles through dig-ital transformation strategy, procure-ment, and adoption. Shirley Fenton, along-time member of the University ofWaterloo, is the vice-president of the Na-tional Institutes of Health Informaticsand a co-founder of Waterloo MedTech.She has over 30 years of experience ininformation technology and business de-velopment and is passionate about stim-ulating innovation in health care.


Connected Healthtech will improve care


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