FEATURE REPORT: ELECTRONIC HEALTH RECORDS ......ment Office and Client Services. The participants...

BY JERRY ZEIDENBERG

TORONTO – While other hospitalshave been implementing commer-cial electronic health record sys-tems, Sunnybrook Health Sciences

Centre has created its own health informa-tion system – called SunnyCare. It has donethis over the past few years, tying togetherbest-of-breed components from the privatesector and adding its own, home-grownsoftware to create a solution like nothing elseavailable in Canada.

“SunnyCare is a single, integrated work-flow solution,” said Sam Marafioti, Sunny-brook’s Vice President and Chief Informa-tion Officer. “In my 30 years in hospital IT,I’ve never seen anything as powerful.”

A key element of the system will be rolledout next year – it’s the clinical documenta-tion component that will extend electronic,

clinical charting to every healthcare profes-sional in the three-campus hospital.

That’s no small task, as there are currentlyover 6,500 clinicians and care-givers in theorganization, working in acute care, rehaband long-term care settings.

But already, SunnyCare is providing on-line documenting to nearly 3,500 physicians,

residents and allied health professionals inthe organization. The charting ranges fromconsult notes and admission order sets tomedication reconciliations and care plans toprogress notes and discharge summaries.

“Clinical documentation is a crucial com-ponent of the solution,” said Marafioti. “It’s

important for patients, physicians, staff alike.”While electronic charting systems are

available in other EHR platforms, Sunny-Care is extending the solution to each andevery care-giver in an integrated fashion. Inshort, everyone will be able to use the samesystem – that’s a real breakthrough, ashealthcare has traditionally operated in afragmented, siloed way.

“All forms have been re-designed to fitinto this single workflow,” said Marafioti. “It’sdesigned by clinicians, for clinicians. Sunny-Care gives them a single, integrated view.”

What’s more, Sunnybrook plans to makeSunnyCare available to other healthcare or-ganizations, just as it has offered them itspatient portal, called MyChart. The My-Chart portal is used in a variety of hospitalsacross Ontario, and in April, Sunnybrookannounced its first MyChart customer out-

Sunnybrook creates its own advanced EHR

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Sunnybrook has been using its expertise in clinical I.T. to devise a unique, Electronic Health Record system. The solution is enhancing team-work and leading to improved patient-care. Pictured (l to r): Katherine Vandenbussche, Clinical Documentation Project Team Leader; SamMarafioti, Vice President and CIO; and Laura Viola, Director of Sunnybrook’s Project Management Office and Client Service.

A key element of the system willbe rolled out next year – it’s theclinical documentation solution.

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Ottawa’s regional EHRThe Ottawa Hospital has been co-ordinating the creation of a re-gional, Epic-based ElectronicHealth Record, in conjunctionwith five other partners.Page 4

AI-based quality assuranceReal Time Medical has allied withGoogle to bring cloud-based, AIto the challenge of quality assur-ance and education in radiologyand other specialties. The systemwill increase quality in medicineand keep skills up-to-date.Page 6

More profitable clinicsMany medical clinics, strangelyenough, operate at a loss. But anew, web-based system that en-ables patients to schedule theirown appointments is allowingmore than two dozen clinicsacross Canada to lower theircosts and restore profits. 2

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FEATURE REPORT: ELECTRONIC HEALTH RECORDS — SEE PAGE 26

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 23, NO. 4 MAY 2018

DIAGNOSTICIMAGING

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side of Ontario – Fraser Health, in BritishColumbia.

SunnyCare is a web application plat-form developed at Sunnybrook and certi-fied by Canada Health Infoway as a juris-dictional class electronic medical recordsystem. “SunnyCare meets clinician needsby integrating information from highlyspecialized, departmental systems and pre-sents clinical workflows that are easy to useand can be accessed from desktop comput-ers and mobile devices,” commentedOliver Tsai, Director of IT at Sunnybrook.

While SunnyCare supports electronicdocumentation, most nurses are currentlycharting on paper – as they are in manyhealthcare organizations. The goal is toswitch everyone over to electronic docu-mentation, and to support best-practicedocumentation standards.

That will promote information sharingamong teams, and will reduce duplicationof effort for clinicians and patients.

Sunnybrook has partnered with OrionHealthcare to integrate its clinical docu-mentation engine into SunnyCare. Orion

has been working closely with the team atSunnybrook to customize its solution andintegrate it with SunnyCare workflows.

“Electronic documentation will allowus to capture information once, and toshare it, instead of asking patients the samequestions over and over again,” com-mented Katherine Vandenbussche, a regis-tered dietician at Sunnybrook and a Clini-cal Documentation Project Team Leader.

Not only will this save time and troublefor care-givers, but it will also provide abetter experience for patients. She notedthat patients sometimes get anxious ifthey’re asked to repeat the same informa-tion, such as names, addresses and birth-dates, to different clinicians. “Enabling allclinicians to document in SunnyCare willbetter align with how we work together asan inter-professional team to provide thebest care possible for our patients,” saidVandenbussche.

Sunnybrook is a leading-edge healthcareprovider with three different campuses inToronto – an uptown rehab hospital; a cen-tral site in mid-town Toronto, whichhouses a major trauma centre, cancer andcardiac care, research, a long-term facility,

and a host of other medical programs; anda downtown orthopedic hospital.

“Using the principles of user-centreddesign, the development team and clini-cians across Sunnybrook have invested agreat deal of time in the design of Sunny-Care’s clinical documentation workflowsto support best-practice standards for var-

ious clinician groups,” said Laura Viola,Director of Sunnybrook’s Project Manage-ment Office and Client Services.

The participants include nurses, physi-cians, occupational therapists, physiother-apists, and many others, she said.

Medical and everyday language incharting was a significant issue for work-flow. “What a doctor means when he orshe uses a term may have a completely dif-ferent meaning to a physiotherapist or oc-cupational therapist,” said Dr. Chris Hob-

son, Medical Director for Orion Health. Indeed, the design team started by

identifying 39 different patient care cate-gories where standardized terminologiescould support inter-professional teamdocumentation. This included service-re-lated information used in areas like cardi-ology and respiratory medicine, as well aspatient data and personal information –such as the name a person prefers to becalled by, and what kinds of supports heor she has at home.

The ClinDoc team at Sunnybrook is us-ing the standardized terminologies tostreamline over 1,000 different formsacross the interdisciplinary team, so thatclinicians all speak a common language.

To ensure effective and efficient docu-mentation workflows, where possible Sun-nyCare will use a template driven formatinstead of free-form notes. In many cases,check-boxes will be used, so that docu-menting can take place much faster thanbefore while adhering to agreed-to stan-dardized terminology.

As well, SunnyCare will pull data di-rectly from medical devices. As a first step,vitals monitors will be integrated to Sun-nyCare so related clinical documentationwill update automatically. This kind of de-vice integration ensures a comprehensive“one-stop-shop” for patient clinical infor-mation, saving time for all clinicians andimproving patient safety.

Moreover, SunnyCare clinical documen-tation will provide value across the inter-professional team. For example, embeddedclinical workflow will allow orders to flowto a nursing kardex and work list, and willprompt clinicians with appropriate assess-ments and templates for documentation.

This is a leading-edge feature and re-quired specialized, intelligent coding inSunnyCare, noted Marafioti. “Sunnybrookcan quickly and seamlessly embed work-flows to facilitate the clinician’s care deliv-ery process,” he said.

Standardized, electronic informationcan also be analyzed more effectively, givingthe hospital a greater ability to understandthe condition of patients before, during andafter hospital stays. This can be a powerfultool for improving service quality and forplanning enhancements for future services.

Ultimately, adding interprofessionalclinical documentation to SunnyCare’s ex-isting functions will lead to a single, share-able electronic record for each patient,rather than a mixture of paper and digitalnotes in departmental silos.

Through this project, Sunnybrook maybe achieving a first in Canada. No othermajor hospital has yet to create an elec-tronic health record that encompasses

CONTINUED FROM PAGE 1

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Address all correspondence to Canadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9 Canada. Telephone: (905) 709-2330.Fax: (905) 709-2258. Internet: www.canhealth.com. E-mail: [email protected]. Canadian Healthcare Technology will publish eight issues in 2018. 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. ©2018 by Canadian Healthcare Technology. Thecontent of Canadian Healthcare Technology is subject to copyright. Reproduction in whole or in part without prior written permission is strictly prohibited.Send all requests for permission to Jerry Zeidenberg, Publisher. Publications Mail Agreement No. 40018238. Return undeliverable Canadian addresses toCanadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9. E-mail: [email protected]. ISSN 1486-7133.

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

Volume 23, Number 4 May 2018

Contributing EditorsDr. Sunny MalhotraTwitter: @drsunnymalhotra

Dianne [email protected]

Richard Irving, [email protected]

Dianne [email protected]

Sunnybrook creates enterprise-wide system for clinical documentation

Over 1,000 different forms,across interdisciplinary teams,have been standardized to easecollaboration and workflow.

CONTINUED ON PAGE 4

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BY SHAFIQUE SHAMJI

Consider the care journeymany patients face as theynegotiate their way throughmultiple hospitals in thehealthcare system to be di-agnosed and treated.

A patient in a rural area, for example,might first go to the nearest hospital fortests and initial treatment. There would beregistration, care visits and scans per-formed. If there’s a need for specializedcare outside the scope of that facility, thenthe patient is referred to a specialist at alarger hospital for more treatment.

As the patient moves from one hospitalto the next, he or she might have to repeatbasic information multiple times or therecould be a lag between when diagnostic re-sults are transferred from one hospital tothe other. All of this is an extra burden onpatients at a time when they need to focuson their health.

Ontario is moving forward with a 10-point implementation plan for its DigitalHealth Strategy, aiming to enhance accessto health information and services,strengthen quality, effectiveness and ac-countability, and stimulate innovationand growth.

In step with the province, my goal atThe Ottawa Hospital is to harness technol-ogy to create a better patient experience.And I am very excited about a pivotal pro-ject underway involving five partner orga-nizations in eastern Ontario.

The Ottawa Hospital, The Ottawa Hos-pital Academic Family Health Team,Hawkesbury and District General Hospi-tal, Renfrew Victoria Hospital, St. FrancisMemorial Hospital in Barry’s Bay, Ont.,and the University of Ottawa Heart Insti-tute have come together as the Atlas Al-liance to implement a Health InformationSystem (HIS) by Epic, an industry leaderin electronic health record software.

When this digital hospital networklaunches in June 2019, there will be one in-tegrated electronic system to manage pa-tient information, chart across specialties,and manage research data and physiciandocumentation.

Epic provides a patient-centered plat-form, with an electronic health record thatis accessible regardless of where patientsreceive care. That means informed deci-

sions can be made with the most up-to-date information.

Through Epic’s MyChart, patients willbe able to view their lab or radiology re-sults using their mobile devices. They willhave access to education materials, pre-visit questionnaires, and post-visit sum-mary of care.

Patients will become active partners inmanaging their health.

The Epic HIS will improve the experi-ence of care, the work life of healthcare

providers, and the health of our popula-tions, and it will reduce costs. It will pro-vide: best-practice order sets; electronicdocumentation tools; care pathways; careprocess management; inter-provider com-munications; clinical decision supporttools; and performance measurement.

Recently, I met Lamia Almorsay, whohas the unique perspective of looking at thehealthcare system through the eyes of botha provider and a patient. Almorsay, who isa pharmacist, worked overseas for much of

her career in quality management, patientsafety and hospital administration.

When she was diagnosed with breastcancer, she started a year-long journey thatenabled her to look at the healthcare sys-tem through a patient’s eyes. The view wasquite different from the one she has had asa pharmacist.

“Many things could have been done in abetter, faster and safer way. I hated the re-dundancy of repeating myself to everyhealthcare provider who I consulted withor was referred to. This redundancy or rep-etition of information may result some-times in missing information, forgotteninformation or even misinterpretation ofinformation,” said Almorsay.

It’s stories like these that compelled thepartner hospitals to look for a better ap-proach for patients and staff alike.

The scope of the project is broad, thepace is fast, and the dynamic collabora-tion of analysts, developers, stakehold-ers, and trainers across six healthcarecentres is what will ensure we will reachour goal of implementation. Over the20-month project our analysts and train-ers will configure a system that involvesall workflows that support patient careand billing.

Interface developers and business in-telligence developers will manage deviceintegration and data conversion. Epicapplication managers and coordinatorsare working in concert with the analystsand the developers for each of the 29modules to support the development,testing and integration of the Epic sys-tem, the successful Go-Live and post-Go-Live support.

Stakeholders, including clinicians, radi-ologists, porters, clerks, and patient advo-cates, are providing input, reviewing mate-rial and making decisions when necessaryfor the build.

Trainers will be leading mandatorytraining for 18,000 end-users.

At Go-Live, we will empower staff todeliver 21st-century care using this 21st-century solution. And, we will enable pa-tients to navigate their care journey ef-fortlessly, so they can concentrate onwhat matters most – the quick return togood health.

Shafique Shamji is Executive Vice President,CIO, The Ottawa Hospital

The Epic team at The Ottawa Hospital. Planning for the implementation has been highly collaborative.

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

Shafique Shamji, Executive Vice President and Chief Information Officer; Michelle Leafloor, Program Director;Dr. Glen Geiger, Program Medical Lead; and Yvonne Wilson, Program Clinical Lead, at The Ottawa Hospital,believe the Epic Health Information System will harness technology to create a better patient experience.

standardized, electronic clinical docu-mentation for each and every health-care professional.

One of the first steps in creating asuccessful system of this sort is to gainthe acceptance and buy-in of every clini-cal group. Through a user centred designprocess, Sunnybrook has been asking allclinician groups to help design the newsolution, so that everyone has input intothe process and end result.

That’s meant regular, multi-depart-

mental meetings, guided by experts in de-sign and change management. As part ofthe process, Julie Waspe, a registered nurseand Clinical Informatics Specialist at Sun-nybrook, noted there’s an iterative processgoing on, where models are sent out toclinicians to look at and comment on.

“We’re sending out wireframe modelsthat show what the system is looking like,and we’re asking clinicians to comment onthem,” said Waspe. “Users get to play withand interact with wireframes of the solu-tion, which allows them to provide specificand detailed input about what their re-quirements are and how the clinical docu-mentation team can improve the solution.”

In this way, there is a constant flow ofinformation and communication amonggroups. And in the end, it becomes agroup project, where clinician groups

across the hospital have a say in the de-sign. While a detailed change manage-ment and training plan will be put inplace, user engagement and ownership of

the solution has proven to be a powerfulcomponent of SunnyCare adoption.

Users like being consulted about howSunnyCare clinical documentationshould work, and they see the potentialbenefits – the time savings and the abil-ity to quickly see what others have al-ready charted and build on it from aninter-professional perspective.

“It’s a big shift,” said Vandenbussche.“Many are moving from non-standardizedpaper notes to a standardized electronicdocument.” Nevertheless, the gains of thesystem appear to be outweighing any trep-idation from users. “People are getting ex-cited about it,” said Vandenbussche.

Sunnybrook systemCONTINUED FROM PAGE 2

It’s a big shift, as manyclinicians are moving frompaper to the shared,electronic charting system.

Six partners in Eastern Ontario join forces to implement Epic EHR

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BY JERRY ZEIDENBERG

eal Time Medical, of Mississauga,Ont., has announced a partner-ship with Google that not only

positions the Real Time Medicalplatform on the Google Cloud, but alsocreates a working partnership to createnew, AI-driven solutions for clinicians inCanada and worldwide.

Real Time Medical is the creator of apeer-review, quality and education systemfor radiologists and other clinicians. Thesolution checks the quality of the readingsdone by radiologists and other specialistsby sharing a portion of their work amonga group of peers on the Real Time Medicalnetwork.

Their identities, however, are anonymized,so there is no fear of embarrassment orrepercussion. If mistakes or “discrepan-cies” are found, the clinician is alerted sohe or she can modify reports and brush upon skills for the future.

“We’ve conducted seven radiologyquality audits across four provinces, forministries of health, hospital networks andphysician insurance organizations,” saidDr. Nadine Koff, a radiologist and Presi-dent of Real Time Medical. “We know thatperformance varies not only by individual,but also by exam type and sub-speciality.It’s for this reason that our system, unlikeso many others, provides for per user, persubspecialty, anonymized and individual-ized peer learning and review.”

Indeed, while a discrepancy rate of one totwo percent is considered normal, indepen-dent reviews have found the rate of discrep-ancies for some radiologists run as high as20 percent. Nevertheless, many hospitals andhealth regions still haven’t implementedquality assurance systems for their clinicians.

Those that have, say executives at RealTime Medical, haven’t always installed ef-fective systems. Ian Maynard, CEO of thecompany, says that some hospitals are usingpeer review systems that may check onlyone exam reading per day for a radiologist.

By contrast, Real Time Medical’s systemcan be set to check any number – even 100%of a particular exam type, if so desired.

“Many systems amount to nothingmore than an arbitrary one case per user,per day, regardless of the number of diag-noses generated,” said Maynard. “That’s re-ally nothing more than a “check the box”,we do peer review approach. Other systemshave users comment on a historical examwhile interpreting the current. Not only isthat approach objectively invalid becausethe historical report is not anonymized, butmore importantly, historical exams can be6 or 12 months old. The patient is beingrescanned for a reason, likely a worseningof symptoms. These solutions are behindthe times, and they fall far short of whatwe’re capable of as a country.”

Maynard noted that Real Time Med-ical’s technology, which is used in hospitalsand regions across Canada, offers a morethorough analysis of readings.

Moreover, the intelligence componentof its system can spot where clinicians mayneed extra help with readings – for exam-ple, discrepancies may be found more of-

ten when they’re reading head and neckCTs, or certain types of ultrasound scans.The system can alert them to this.

Real Time Medical’s alliance with Googleis one of the first instances of a Canadianhealth technology company putting its solu-tion on the Google Cloud. By doing so, itlowers the cost of using the system for hospi-tals and clinics, as they don’t have to acquiretheir own infrastructure – they simply makeuse of the computing power of the cloud.

Dr. Koff observed there are no issues ofsovereignty or privacy involved, as Googlehas a high-security data centre in Montreal.

The platform now available offersshared peer review and quality assurancefor radiologists and pathologists. Otherspecialities will be added in the future.

So, right now, hospitals and clinics thatjoin the system benefit from the expertiseof radiologists and pathologists outsidetheir own facilities. It’s a system of sharedexpertise that spots discrepancies andraises quality, no matter the size of the or-ganization that uses it.

“It doesn’t matter if you’re in a clinicwith five radiologists,” said Enzo Costanza,Vice President of Product Developmentand Implementation at Real Time Med-ical. “Our Canada-specific deployment al-lows for radiologists and pathologists inhospitals and independent healthcare fa-cilities throughout this country to connectand gain the benefits of large-scale, AI en-hanced peer review, regardless of their size,or number of practitioners.”

He added that, “Other systems are site-limited, or tied to site specific, EHR, RIS,PACS or voice reporting solutions and of-fer very little in terms of a critical mass ofpeers with the same subspecialties.”

On a cloud-based system, by contrast,users are connected to a far bigger commu-nity of peers. And they’re not constrainedby the type of PACS or EHR they are using.

The partnership with Google will allowReal Time Medical to draw on the expertisethat Google has in artificial intelligence –Google is a leader in AI and Deep Learning,and the company has established AI centresof excellence in Toronto and Montreal. It isalso a partner in the Vector Institute, an AIthink-tank and accelerator in Toronto.

At the same time, Real Time Medicalwill be helping Google develop its ownhealthcare applications. “They approachedus and since then things have progressedquickly from a partnership perspective,”commented Dr. Koff.

Indeed, in conjunction with Google,Real Time Medical plans to develop fourdifferent AI-driven applications. The firstof these was announced by the company atthe recent Healthcare Information Man-agement and Systems Society (HIMSS)conference, held in Las Vegas in March – itconsists of the ‘intelligent sampling’ app,which spots areas in which a particular ra-diologist may need to get up to speed.

As well, at HIMSS, the company an-nounced a powerful alliance with ClientOutlook, the maker of the eUnity viewer.The company’s next AI-powered solutionwill likely be announced at the Radiologi-cal Society of North America (RSNA) con-ference in November.

Many benefits to AICloudQA platform, for quality and peer learning

Below is a summary of howReal Time Medical’s innova-tive and award-winningAICloudQA platform willhelp clients lead peer learn-

ing and review initiatives to improvephysician skills and patient outcomes:

• Simultaneous prospective and retro-spective peer learning: It’s the first plat-form capable of simultaneous prospec-tive and retrospective peer learning andreview of current and historical studies.

• Highest granularity system for userand case specific continuous quality im-provement: Unlike systems restricted tonon-user specific, system-wide, ormodality-based sampling rates for allphysicians across their network regard-less of experience or skill level, the RTMsystem provides adjustable, user-specificsampling by study type and sub-spe-cialty. This provides high granularity,

high value, continuous quality improve-ment specific to each individual user andis responsive to their peer learning expe-rience and performance over time.

• All user peer review feedback: Be-cause AICloudQA integrates peer re-view into your processes and work-flows, it provides a continuous educa-tional opportunity. Specialists and med-ical learners benefit from performance-enhancing, ongoing, anonymized feed-back and acquisition of additionalknowledge through collaboration andAI assisted pattern recognition andlearning assistance.

• Minimal impact to workflow:AICloudQA uses standards-based mes-saging to communicate to your currentimage acquisition systems and presentsphysicians with a browser-based, re-quired actions worklist and diagnosticquality viewer.

• Best practices: The system meets andexceeds CAR, ACR, and Health QualityOntario guidelines for “ideal” and “bestpractice” peer review system characteris-tics, including workload balanced peer re-view. Additionally, AICloudQA provides

“on the fly” anonymized Peer Review inaccordance with best practices, wherebyneither the original specialist nor the re-viewer knows the other’s identity.

• Extensive analytics: Create customiz-able dashboards or select your ownmetrics to view and export a wide rangeof data.

• Patient critical results communica-tion: Unlike other systems, AICloudQAcloses the loop for critical results notifi-cation and management. It comes com-plete with automated monitoring of crit-ical findings, acknowledgements and re-quired escalation.

• Cloud-based: The solution removesthe need for concern over the acquisi-tion, cost and maintenance of your ownservers unless on-site solution deploy-ment is preferred.

• Offsets increased workload: This isthe first system on the market capableof providing clients with workloadbalanced peer review. The ability ofRTM’s solution to provide workloadbalanced peer learning, as well asdiagnostic workload balancing helps tooffset the increased work associatedwith peer learning while contributingto overall quality improvement.

Specialists and medicallearners benefit fromongoing, anonymizedfeedback and knowledge.

Real Time Medical launches AI-powered quality assurance solution

Real Time Medical’s leadership team: (l to r) Dr. David Koff, Dr. Nadine Koff, Ian Maynard, Enzo Costanza.

R

The AI component of the RealTime Medical system can spotwhere clinicians may need helpwith readings.


Toronto, Montreal and Edmontonhave all touted themselves asleading-edge developers ofhealthcare technology. Now, get

ready for Brampton to join the club. Thecity, located just north of Toronto, is hometo a rapidly growing cluster of medicaland life-sciences companies, educationalfacilities, and leading-edge hospitals andclinics. Brampton is about to build onthat, with a strategy that fast-tracks its de-velopment as a health-technology hub.

At the heart of Brampton’s healthcareexpertise is the giant William Osler HealthSystem – with three campuses and one ofCanada’s busiest Emergency Depart-ments. The hospital is now taking that ex-

pertise and allying with educational cen-tres and entrepreneurs to create new tech-nologies – to both improve medical out-comes and generate economic activity.

“Over the next year, we’re creating a fo-cus on innovation at Osler,” said Dr.Naveed Mohammed, Vice President ofMedical Affairs at the hospital. “We’ll betaking front-line companies and invitingthem to work with our clinicians. It willbe a bit like Dragon’s Den, with a numberof projects completing their validation atOsler, with complete support from thehospital.”

Already, the hospital has launched aresearch and innovation unit, headed byDr. Ronald Heslegrave. “We’ve now gotfour or five companies working with us,and we’re coordinating the developmentof an app for supporting palliative pa-tients in their homes,” said Dr. Hesle-grave. On the research side, the group isspearheading a large study of cardiac pa-tients; many more studies and innova-tion projects will be launched in thenear future.

A key component of the city’s health-care technology strategy revolves aroundthe Peel Memorial Centre for IntegratedHealth and Wellness, which opened last

year in downtown Brampton. The $500million hospital – part of the Osler net-work – is geared to a new model of health-care: disease prevention and wellnesspromotion. As well as restoring patientsto health, the centre is focused on preven-tive care for nearly 1.3 million people inthe Brampton catchment area. “The focusof the centre is unique in Ontario, andpossibly across Canada,” said MartinBohl, Sector Manager for Health and LifeSciences at the City of Brampton.

To this end, Brampton is taking a spe-cial interest in methods and technologiesthat prevent people from becoming ill inthe first place. City planners are alreadyenvisioning the creation of a “super-clus-ter” of innovative preventive health tech-nology companies surrounding the PeelMemorial Centre for Health and Well-ness. The aim is not only to serve the hos-pital next door, and the Brampton-areacommunity, but to export the new solu-tions worldwide.

Indeed, the local population travelsback and forth between Brampton andsouth Asia so readily that William OslerHealth System recently struck up a part-nership with the Apollo chain of hospi-tals and clinics in India, one of thelargest providers of healthcare servicesin the country. Not only are the partnerssharing medical expertise with eachother, but the stage is also set for thetransfer of new technologies, too. “We’recontributing to hospitals outside our bor-ders,” said Dr. Mohammed.

Brampton is geographically advantagedfor this role. It’s located 20 minutes fromPearson International Airport. It has ex-cellent links to downtown Toronto – it’sjust 30 minutes away by GO Train. And

Brampton sits at the centre of the Innova-tion Super Corridor.

Brampton already has a base of top-tiercorporations, including Medtronic Canada,Canon, Dynacare labs and surgical roboticsdeveloper MDA Corp. All told, there are800 health and life-sciences companies inthe Brampton region, employing more than12,000 people, with an average growth rateof 6% a year.

Other major players include TaroPharma, Loblaw, the owner of ShoppersDrug Mart, Stericycle, Sharpsmart Canada,and The Stevens Co., a national distributorof medical equipment. And CanadianBlood Services is based in the city, too.“CBS just invested $20 million to expandtheir labs here,” said Bohl. “They added 90new jobs.”

In addition to healthcare providers like

William Osler Health System, Bramptonis home to Peel Manor, a large seniors’ fa-cility, and the ErinoakKids Centre forTreatment and Development, a largeautism care and children’s disability careprovider. There are some 600 medical anddental clinics and facilities in the region,employing 12,000 workers in the life sci-ences. “There are amazing opportunitiesfor synergies here,” said Bohl.

Education and the development of tal-ent is another important building block inthe healthcare innovation strategy. Sheri-dan College’s largest campus is located inBrampton and specializes in appliedhealth and community studies. Moreover,Ryerson University – in partnership withSheridan College – has announced an ex-pansion to Brampton, where it plans tobuild a $150 million educational campus;it will focus on science, technology, engi-neering and math (STEM). The school,world-famous for its DMZ business incu-bator in downtown Toronto, aims to cre-ate a new accelerator at the Brampton site.Part of the plan is to connect student en-trepreneurs with area business peopleand clinicians to devise new medical appsand technologies.

Dr. Wendy Cukier, a professor of ITmanagement at Ryerson University andthe school’s former VP of Research andInnovation, notes that innovation thrivesmore readily “on the periphery” – not intraditional hospitals or universities indowntown centres, but in companies andinstitutions that are willing to take risksand break boundaries. “Breakthroughs of-ten come from unexpected places,” sheobserved. In this respect, she continued,Brampton, the William Osler Health Sys-tem, and entrepreneurs have a wonderfulopportunity to collaborate and createnew solutions.

Healthcare technology: A game-changer for Brampton and patient-careHealthcare providers, corporations and entrepreneurs are collaborating in Brampton to build an international health-tech hub.

MED-TECH INFRASTRUCTUREEDUCATIONAL SUPPLEMENT

“Over the next year, we’re creating afocus on innovation at Osler. We’ll betaking front-line companies andinviting them to work with ourclinicians. It will be a bit like Dragon’sDen, with a number of projectscompleting their validation at Osler.”

– Dr. Naveed Mohammed,VP, Medical Affairs

William Osler Health System

There are over 800 health-sector businesses and agencies, from doctors’ offices to global players in medicalresearch and devices, in the Brampton region.

An artist’s rendering of the health cluster, near the Peel Memorial Centre for Integrated Health and Wellness.

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WHITBY, ONT. – After imple-menting a web-based pa-tient portal in December2014, Ontario Shores Centre

for Mental Health Sciences conducted ayear-long survey to assess the benefits forpatients and healthcare providers.

The results showed significant benefitsin several areas. In particular, the studyfound that portal users were 67 percentmore likely to attend an appointment thannon-users. Provider productivity is signifi-cantly enhanced when patients keep andattend their appointments.

Moreover, portal users were nearly 30percent less likely to make requests for in-formation than non-users. Patients withaccess to their own medical informationcould find information themselves.

Researchers at Ontario Shores notedthat, “Treatment for mental illness has

shifted from focusing purely on treatmentof symptoms to focusing on personal recov-ery. Patient activation is an important com-ponent of the recovery journey. Patient por-tals have shown promise to increase activa-tion in primary and acute care settings.”

The study, titled “A Web-Based PatientPortal for Mental Health Care: BenefitsEvaluation”, was published in The Journalof Medical Internet Research.

Ontario Shores studied 461 patientswho made use of the portal in the one-yearperiod following its launch.

The objective of the survey was to con-duct a benefits evaluation of a Web-basedportal for patients undergoing treatmentfor serious or persistent mental illness inorder to examine the effects on:

• patient activation• recovery• productivity, and• administrative efficiencies.

Ontario Shores Centre for Mental HealthSciences is a 346-bed public teaching hospi-tal in Whitby, Ontario, that provides a widerange of assessment and treatment servicesto those living with complex and seriousmental illness.

By employing evidence-based ap-proaches that leverage clinical best prac-tices, innovative technology, and the latestadvances in research, Ontario Shores be-came the first HIMSS Davies EnterpriseAward recipient in Canada and the firstbehavioral health organization in theworld to achieve HIMSS EMRAM Stage 7.

The hospital is a user of the MEDITECHelectronic health record system, and alsoimplemented the company’s patient portal.

Ontario Shores is recognized as one ofthe world’s leading advocates for the “re-covery model” of mental health care,which is focused on restoring fuller func-tion and quality of life to those living withmental illness. Under this model, patientsare encouraged to become more activeparticipants in their own care and careplanning. Patient engagement, therefore, isconsidered an essential component of therecovery model of care.

All registered inpatients and outpa-tients at the tertiary level mental healthcare facility were offered the opportunityto enroll and utilize the patient portal.Those who chose to use the portal andthose who did not were designated as“users” and “nonusers,” respectively. Allpatients received usual treatment.

Users had Web-based access to viewparts of their electronic medical record,view upcoming appointments, and com-municate with their health care provider.Users could attend portal training or sup-port sessions led by either the engagementcoordinator or peer support specialists.

The MEDITECH portal provided thesepatients with:

• Secure, web-based access to key medicaldata, including lab results, medications,visit history, discharge instructions, andeducational materials

• A secure method to electronically com-municate with their caregivers

• The ability to view and request appoint-ments, renew their prescriptions, and up-date their demographic information

• Access via any web browser on any com-

Survey identifies the benefits of a patient portal in mental health

CONTINUED ON PAGE 10


© 2018 Cerner Corporation

Discover health care as it should beSince 1985, we’ve helped lead the charge in Canada, connecting health care and IT for a better future. And throughout our journey, we’ve gained insight. The insightto see value that can’t always be seen.

When it comes to providers, we value delivering intelligent solutions and services, like our flagship EHR platform Cerner Millennium®, that continue to improve the health and care of individuals and their communities – from day one.

For clients, we value smarter ways to do the everyday – communicating, coordinating and improving the efficiency of your workforce. Knowing that at the end of the day, every second saved is a life benefited.

And for patients, we value a brighter future – empowering them to get involved with their own well-being through patient-centered care tools. Because an engaged patient will always make a healthier person.

When it comes to health care, we’ve turned insights into wisdom. The wisdom to know that we’re never done learning, growing and sharing, side by side, with you. Because change is progress and health care is too important to stay the same.

Visit cerner.ca for more information


BY JERRY ZEIDENBERG

OAKVILLE, ONT. – Cloud DX, theaward-winning developer ofthe Vitaliti vital signs monitor-ing system, has teamed up with

Sheridan College in Oakville, Ont., to fur-ther develop the AI-powered solution.

Cloud DX, based in Kitchener, Ont., re-cently won an Epic Bold Innovator awardat the Qualcomm Tricorder XPRIZE com-petition, in California’s Silicon Valley. Itsadvanced technology is able to read morethan a dozen vital signs when worn by a pa-tient, and it processes the data in the cloudusing artificial intelligence to provide a di-agnosis on 19 different medical conditions.

“We’re now taking the technology andadding a mixed reality environment,” saidMagdin Stoica, a professor in Sheridan’sFaculty of Applied Science and Technol-ogy, and leader of a group of staff and stu-dents working on the project.

“The goal is to create a more efficientway of diagnosing patients,” he added.“Mixed reality is being used to replace thepaper chart.”

Dr. Ed Sykes, Director of Sheridan’s newCentre for Mobile Innovation, observed thatthe Sheridan team is applying augmentedreality, virtual reality and Deep Learning tothe Vitaliti platform, all in an effort to im-prove medical outcomes. The Centre forMobile Innovation, funded by the federalgovernment, is conducting several collabo-rative projects with industry partners. Thepartnership with Cloud DX is one of sixprojects currently under way at the school.

The Vitaliti technology – with sensorsthat attach to the chest and ears – is ideal

for remote monitoring. It can help main-tain the health of users in their own homes,and can also act as an early warning system,detecting the onset of serious conditionsbefore a patient would otherwise need torush to the hospital. In this way, the tech-nology could help reduce pressure onCanada’s overloaded ERs and hospitalwards, while improving medical outcomes.

In the same way, it’s also extremely use-ful for in-hospital monitoring – providingclinicians with comprehensive data aboutvital signs and predicting crashes. Vitaliti iscurrently being reviewed by HealthCanada for this purpose, and approvals areexpected this year.

Meanwhile, the team at Sheridan is de-vising advanced solutions using the Vitalitiplatform in three different areas.

First, it is creating a monitoring systemfor nursing stations. The super-sized com-puter screen enables nurses and otherclinicians to view their patients in theirbeds, with a summary of their vital signs,all at once.

The patients and data appear on “tiles”on the screen. The system provides real-time monitoring of vital signs, includingblood pressure, heart rate, oxygen andbody temperature. It also crunches thedata, and provides easy-to-read, colour-coded diagnoses and alerts that show whenthe patient may be running into trouble.

Physicians can agree or disagree withthe diagnosis and sign off or modify thesuggested treatment. They can write di-rectly onto the screen, which featureshandwriting recognition, and cross out adiagnosis they differ with, and add theirown conclusions and notes.

The system even detects patientcoughs, converts the sounds into a wave-form, and sends the data to the company’scloud for diagnosis. The AI in the cloudanalyzes the waveform, and sends back adiagnosis – such as pneumonia, tubercu-losis or influenza.

The diagnosis is weighted – for example,the Cloud DX system may decide that thewaveform indicates a 90 percent probabilityof pneumonia, but only a 15 percent possi-bility of influenza. The physician can agreewith the diagnosis or override it – simplyusing handwriting on the big monitor toadd his or her own diagnosis or notes.

The system is designed to save time forclinicians and to keep a closer eye on pa-tients. “There is a tremendous amount ofinformation being collected in hospitals,but the data can be overwhelming,” saidStoica. “Computers can analyze the data,24 hours a day, and never get tired.”

A second project is to make the data avail-able on mobile platforms, like tablet comput-ers. “If a nurse or doctor is having lunch inthe cafeteria, they can still monitor their pa-tients,” said Stoica. “They will be able to seethe same breakdown of data and alerts.

A third project is perhaps the most am-bitious. Using the Microsoft HoloLens, aheadset with glasses, clinicians can maketheir rounds, and chat with patients, whilesimultaneously receiving a feed with thepatient’s vital signs appearing in the head-set glasses.

This means physicians won’t need tobring special diagnostic equipment to thebedside, and they won’t need to check thedifferent logs made on monitors or in nurs-ing notes. It will all appear automatically ontheir glasses, as they look at the patient.

The goal, noted Stoica, is again to savetime and trouble for the physician, whileproviding real-time, accurate data.

Just like the nursing station monitoringboard, which provides suggested diagnosesbased on data-crunching done in thecloud, the HoloLens will also present a di-agnosis and possible treatment, again sav-ing time for the physician.

Right now, the HoloLens seems a bitheavy and unwieldy for a doctor to comfort-ably wear and make the rounds. But Stoicapointed out that the current set of glassesdates from 2015, and a newer, lighter modelis expected to be announced this year.

“It will probably be easy to flip them upand down,” said Stoica.

Cloud DX was co-founded by Dr. SonnyKohli, an ICU physician at the OakvilleTrafalgar Memorial Hospital, in Oakville,Ont. Dr. Kohli also serves as medical direc-tor of Cloud DX. He notes that, “In thenot-so-distant future, we believe that auto-mated, hands-free, mixed reality displayslike the Microsoft HoloLens will enabledoctors to quickly triage patients and de-cide on treatment options faster.

Cloud DX and Sheridan bring mixed reality to patient monitoring

Sheridan’s Magdin Stoica demonstrates the patient monitoring and display system for nursing stations.

puter or electronic device with Internetconnectivity

• The ability to show, print, and sharepertinent information with health careproviders at other facilities, in support ofmaintaining continuity of care.

Ontario Shores supports the Open-Notes movement, which advocates for pa-tient access to all personal health informa-tion. Using Meditech’s portal, OntarioShores makes reports available to patientswithin three days of entry, providing keyinformation from physicians, allied health,and outpatient clinicians.

Proxy users – patients’ substitute decisionmakers, legal guardians, or anyone else towhom a patient has provided consent – haveaccess to the same information as patients.

To promote use of the portal to patientsand staff, Ontario Shores organized train-ing facilitated by peer support specialistsand an engagement coordinator to repre-sent both perspectives – that of the patientand of the clinician.

Peer support specialists are staff mem-bers who have lived experience with men-tal health issues. They promote the portalto patients and conduct training sessions.

The engagement coordinator – an RN –was a temporary position funded by CanadaHealth Infoway (CHI) during the portal

launch. The coordinator promoted the por-tal’s benefits to both staff and patients.

Ontario Shores depended on the engage-ment coordinator to encourage enrollmentand noticed a drop-off when the temporaryposition ended. To increase enrollment andstrengthen the portal’s sustainability, On-tario Shores built clinician prompts into thedocumentation for admissions and treat-

ment reviews, encouraging providers to of-fer portal enrollment to patients.

Patient Activation and Recovery: Theconcept of patient activation refers to “apatient’s knowledge, skills, ability, andwillingness to manage his or her ownhealth and care,” and is an essential com-ponent of patient engagement. OntarioShores measures activation using the Men-tal Health Recovery Measure (MHRM), apatient self-reporting tool with eight dis-tinct domains:

• Overcoming Stuckness• Self-Empowerment• Learning and Self-Redefinition• Basic Functioning

• Overall Well-Being• New Potentials• Spirituality• Advocacy/Enrichment.

During the study, patient scores in thesedomains were monitored along with theircumulative score. The cumulative scorewas used to gauge patient activation, whileindividual domain scores were used to as-sess recovery.

The results showed that Ontario Shorespatients using the portal self-reported sig-nificantly higher scores for both activationand recovery than they self-reported be-fore using the portal.

Portal users’ total MHRM scores im-proved by over 16 percent. Users’ self-per-ceptions of recovery across all categoriesimproved significantly.

Portal users’ scores improved in sevenout of eight MHRM domains. Patients us-ing the portal indicated improvement innearly every category.

Ontario Shores is working withMeditech to move their patient self-assess-ment process online, enabling patients tocomplete their surveys via the portal. Ad-ditionally, they continue to examine vari-ous service delivery models that leveragetechnology to expand treatment optionsand reduce wait times using evidence-based virtual treatments, as a complementto their existing treatment.


Survey shows benefits of patient portal in mental health

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Ontario Shores supports theOpen Notes movement, whichadvocates for patient access toall personal information.

IT powered the teamwork that helped save Sarah’s life.

COLLABORATION ACROSS THE TEAM.

When Sarah became seriously ill, it was an IT platform that brought the right team of healthcare professionals together – primary and specialty care providers, IT & business administrators, health systems and payers, Sarah and her doctor. They were able to collaborate seamlessly with full access to her diagnostic data.

The result? Sarah got the life-saving care she needed in a timely, efficient,and affordable manner.

Connecting people and data. Anywhere.

© C

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ealth

, Inc

., 20

18.


BY JERRY ZEIDENBERG

TORONTO – Family physicians mayappear well-paid for their work, buttheir primary care clinics are often in

the red or struggling to hit break-even. Sosays Keith Chung, CEO of Veribook, which

has created a solution that’s currently beingused to improve the financial position ofdozens of clinics across Canada.

“Many clinics are in bad shape, andsome are even running at a loss,” saidChung. “Their costs are rising, and feeshave been reduced.”

One of the sore spots for primary careclinics is the cost of scheduling appoint-ments, as patients can tie up the reception-ist’s time with phone calls about new ap-pointments, changes and cancellations.

In the aggregate, scheduling an ap-pointment by phone costs between $1 and

$5 each. In total, they typically amount to25 percent of the cost of running a clinic.

And that’s where Veribook comes in,with its online appointment schedulingsystem that can quickly cut these costs by70 percent, says Chung.

At the two-site Magenta Health clinicsin Toronto, which have implemented Veri-book, patient adoption of the online sys-tem has reached 95 percent.

“That fixes the losses,” said Chung.As a result, the Magenta Health clinics

are in the black, and they actually runwithout dedicated receptionists. Staff atthe clinics take phone calls when neededand help assist patients over the phone, butthose calls are relatively few.

“Staff are doing much more value-added work,” said Chung. When they’re onthe phones, he noted, “They’re spendingmore time on follow-ups and referrals.”

For its work in re-engineering the clinics’workflow and producing cost-savings, Ma-genta Health was given a first-place awardin 2017 in the Canada Health Infoway Ima-geNation Leading Practice Challenge.

The award was also given in recognitionof the benefits for patients. By using the on-line system, patients can schedule appoint-ments at times that are most convenient.

“They don’t have to wait to call the clinicduring business hours,” commented BenShah, Director of Business Development forVeribook. “A parent may have a sick child at2 in the morning, and might be thinkingabout visiting an ER – where they’ll wait forthe next five hours to see a doctor.

“But the parent can log onto her localclinic’s scheduling system at 2 am, and seethat there’s an appointment available at 9am. It’s worth waiting for that.”

Shah, who is also a physician by train-ing, observed that most of the patients us-ing Veribook do so outside regular busi-ness hours.

Moreover, appointments can be madefrom any platform – desktop computer,tablet or smartphone.

And automated reminders are sent topatients, so they don’t forget about theirappointments.

Of course, online scheduling isn’t new formedical clinics. However, Veribook has ex-perience in online scheduling in many otherindustries and started applying its expertiseto physician clinics in 2014. What is new isthe intelligence it has brought to the process.

The system knows the work-habits andpreferences of the various doctors workingin a clinic. For example, some physicians liketo reserve time slots for urgent medical mat-ters, so the system will take this into account.Similarly, for pediatric appointments wherea nurse is needed, the online system will au-tomatically spread these appointments outthroughout the day to reduce delays.

The rules-based system can also be pro-grammed, for example, to intelligently in-clude catch up time, to minimize wait timesfor patients and to reduce physician stress.

It’s all customizable, said Chung. “Itmaps onto a physician’s organizationalworkflow,” he said. “A system shouldn’t beone size fits all.”

Added Shah: “Not every physician of-fers the same services, and different ser-vices can be available at different times.The system recognizes this.”

Online scheduling for clinics can reduce costs, restore profitability

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echnology can help us do amazing things. But ultimately it’s people who make or break it: by embracing technology – or giving it the cold shoulder. With healthcare technology demonstrating real impact on engaging patients, improving health and lowering costs, it’s worth the effort to hit it out of the park.

solutions that patients and clinicians love and use, and that deliver on their long-term promise.

The 5 essentials of health technology adoptionBY SHANNON MALOVEC, PRINCIPAL, PATIENT ENGAGEMENT, TELUS HEALTH

Patient engagement solutions show great promise to drive down health costs while improving health outcomes and patient experiences. To reach Shannon and the Patient Engagement team at TELUS Health, email [email protected]

Foster closer relationships between patients and providersPatients used to be the object of clinical care.

But it’s different now. We know that, as owners of our bodies, we not only have the most at stake, we can also have the most impact on our own health.

So when patients say that a technology helps build trust with their doctors, nurses and pharmacists, and that it makes them feel like valuable members of their own healthcare team, it’s a sign that better health outcomes are not far behind.

Because engagement is the most impactful element of any health solution, don’t miss the opportunity to bring patients and providers closer together, whether through collaboration, communication or co-monitoring.

Ensure ease of use and convenience for allIf technology is complicated, slow or hard to

use, people won’t use it: simple as that. Usability masters like Apple and Google have set the bar high with everyday technology. Why would patients or clinicians tolerate clunky healthcare tools?

Patients and clinicians need to feel that the technology makes their lives easier in some way.

communicate about a health problem or book an appointment? Then they’re in.

Every step of the way must be fast and intuitive, from enrolment to daily interaction through mobile anytime, anywhere access. So put patients and providers at the heart of the process by gathering input on tasks and usability. And consult, test, consult and test again to get the

For heart failure patients engaged in a home health monitoring program at B.C. Island Health:

- Emergency visits dropped by 82%- Hospital admissions dropped by 90%- Hospital stays were 98% shorter.

“The personal health record resulted in an increased sense of partnership with my health care provider.”

– Saskatchewan personal health record pilot program participant

Clinicians in two B.C. Health Authorities (Island and Interior) reported 100% satisfaction with the ease of use of their remote patient monitoring solution.

Provide complete, accurate, up-to-date informationIf the data‘s wrong, out-of-date, or it’s just

a narrow slice, patients won’t see the value of coming back.

For a complete patient picture, data must come from multiple sources like clinical systems, provincial assets, and patient-maintained data. To be accurate, all that data must be properly integrated. To be current, aggregation and integration must be constant.

When you can offer access to complete, accurate and up-to-date health information such as medications, current conditions, vaccinations records or lab results, both patients and providers see the same holistic healthcare picture. Everyone’s more informed and appointment time is better spent.

Offer extraordinary, valuable service

Give users a reason to keep coming back to your tool. Appointment reminders? Flu shot alerts? Online learning opportunities for managing a chronic condition? The ability to share your own health metrics with your care team? Always-current dashboards for providers to better understand their patient population as a whole?

Valuable extras can be the enticement people need to engage over the long term.

Ensure complete securityHealth information is highly personal, and

people rightly worry about it being used in ways they didn’t intend. If you let them worry, they won’t trust your system, and adoption will be low.

Systems that prove beyond a shadow of a doubt that health information is private and secure – and systems that make it easy for people to control access permission – are more likely to be accepted into everyday life and work.

It’s critical to take solutions through rigorous privacy and security assessments. You may need, for example, to let patients in mental health chat forums engage anonymously or allow patients and providers alike to treat sensitive information with discretion.

Adoption drives empowermentWith global research showing that less

engaged patients cost the health system between 8 and 21 percent more than engaged patients,1 it’s clear that engagement is the foundation of our bigger health goals: better outcomes at lower cost.

mind in all healthcare solution projects, you’ll see stronger adoption and healthier patient engagement.

1 Hibbard J H, Greene J, Overton V (2013) ‘Patients with lower activation associated with higher costs; delivery systems should know their patients’ “scores”.’ Health Affairs, 32, no (2013):

“Access to my results prior to a medical appointment means more value during the appointment.”

– Saskatchewan personal health record pilot program participant

Clinics using the EMR portal notice an increase in logins after sending out flu shot alerts or breast cancer screening awareness messages.


BY DIANNE CRAIG

t first glance, the four-foot tall ro-bot gesturing, talking and en-gaging visitors just inside thesouth entrance to HumberRiver Hospital appears to be a

simple greeter, placed there to welcomeand charm anyone who walks by. But Pep-per is so much more than that, and ‘his’potential use for many more applicationsin a hospital setting is seemingly endless.

Developed by Tokyo-based SoftBank Ro-botics, Pepper is the first humanoid robotthat can move naturally, avoid obstacles,identify sounds and recharge independently.

The robot reads emotions by analyzingvoice, facial expressions and vocabulary,and with its machine-learning capabilities,it can learn over time. Designed to projecta friendly, engaging ‘personality’, Pepper isideally suited for customer-facing, or inthe case of a hospital setting, visitor andpatient-facing roles.

It’s not surprising that Humber Riverwas the first hospital in North America toacquire Pepper, as it’s the continent’s firstdigital hospital. With that distinction, thereis naturally a focus to see how it will main-tain its leadership. “You always want to bedoing more,” said Barbara Collins, presi-dent and CEO of Humber River Hospital.

“We were looking for applications inhealthcare and setting a budget for artifi-cial intelligence. We already had a flat ro-bot that delivered supplies. Staff wonderedif we could ever have anything else,” shesaid, referring to the idea of having a dif-ferent, more humanoid robot.

They looked at available options andstarted talking with SoftBank about fivemonths ago. “Pepper was very affordableand had the most capabilities,” recalledCollins. “Patient-focused care is really im-portant to us. We needed one robot for the

kids, and we ended up with two Peppers,”she says, noting that one is in the lobby,and one is going to be dedicated to inter-acting with pediatric patients.

The Pepper dedicated to children mayaccompany them to the OR, to relieve anx-iety while helping to keep them calm, en-gaging them and playing games with them.

Currently, the hospital is looking atadapting Pepper for use in triage. “Peoplecome in, and may be nervous, or don’t knowwhy they are waiting. Pepper could remindthem about not eating or drinking before atest, show them how to fill out a form, andprovide information,” said Collins.

Another application for Pepper cur-rently under consideration at HumberRiver Hospital is to use him to assistAlzheimer’s patients. “Pepper can dance

and exercise – great for an adult withAlzheimer’s,” observed Collins. It couldalso give reminders, like, “Don’t forget totake your pills”.

Collins said SoftBank will ensure Pep-per evolves along with its technology. “Wehave five years of upgrades. They come tous automatically,” she said.

Pepper can respond to emotions andtakes commands, either verbally or throughits touch-screen tablet. Eventually, withevolving voice capabilities, Pepper may notneed the touch screen at all.

According to Bob Edwards, Director ofRetail for Humber River Hospital, cus-tomization of Pepper is an ongoing process.Both Collins and Edwards project there aremany potential applications for Pepper, andsay they are in the early stages of consider-ing new ways to customize the devices.

At the moment, Pepper’s ‘dedicated sto-ries’ are its key content. “If you ask it to tellyou a story it will tell you about the portalsof care at the hospital,” said Edwards. Thehospital is set up like an airport, so the ro-bot might say, ‘Go to Portal C for theBariatric Clinic’.

Pepper also provides information, likewhere other departments and units are lo-cated, such as the one for dialysis, andwhere the washrooms, gift shop, and foodcourt are.

The hospital’s second Pepper robot,dedicated to being with children, will beused frequently in the pre-op area. “Therobot there can entertain children beforeoperations. It will meet the child and fam-ily in the operating room, or even go downthe hall with them. It will entertain them,do a dance, take a selfie or play a virtual in-strument,” said Edwards. Under the ‘Dosomething fun’ selection, playing a virtualinstrument is one of the options.

The robot stretches out its arms in frontabout two feet apart, and the child can ac-tually play the invisible virtual keyboardsuspended between the robot’s hands byhitting the air anywhere in that space andhearing the corresponding notes played.Children observed playing this keyboardare delighted to hear the sounds.

Another valuable way the hospital’s sec-

ond Pepper, dedicated to children, is goingto be used, is to comfort kids who are inisolation. A robot companion is ideal in anisolation room where human visitors maypose a risk of infection, noted Collins.

Pepper is one of several robots, and ro-botics-related products and services, AItechnology and other offerings produced bySoftBank. The company currently offerstwo humanoid robotics platforms. In addi-tion to Pepper, they offer NAO, a muchsmaller robot used primarily in educationalsettings. Pepper was launched in October,2014 in Japan, and in the U.S. in 2016.

“When you’re thinking about robots,you’re thinking about the form factor, andhow it engages with people,” said SteveCarlin, Chief Strategy Officer for SoftBankRobotics America in San Francisco. Hefeels Pepper is particularly well-suited for ahospital environment. “Pepper is so invit-ing, engaging. It can interact with patients,allay fears, and provide companionship.”

One thing that sets Pepper apart is itscapacity for emotional recognition, so itcan adapt to the mood of the person en-gaging with it. “Pepper finds facial pointsand compares those points. For example, itsees the corners of your mouth go up, orgo down, and can tell if you are happy orsad,” says Carlin.

A lot of work went into ensuring thatPepper could engage well with people andhave relatable qualities. At first glance it is

clear the robot has a friendly, non-threat-ening appearance, an appealing, friendlyvoice and gentle movements. It also has anability to find common ground with peo-ple. For example, in response to a songchoice by a child interacting with Pepper atthe hospital, it says, “I love that tune!”

Carlin says the four foot-tall Pepper re-flects a decision to make it big enough, butnot imposing. Its facial features were de-signed to be human-like, but not too hu-man-like, because the brain can read thatas a little creepy. “You can’t fool the brain.The eyes are large and expressive, anime-like, and the arms are about communica-tion,” said Carlin.

Pepper has three cameras: 2 HD cam-eras and one 3D depth sensor – to “see”and interact with people. It also has 20 en-gines in its head, arms and back to controlprecise movements. A 10-inch touchscreentablet is used to convey information andencourage input.

There is one camera in the forehead, to‘see’ you, one in the mouth, to detect ob-stacles, and one in the right eye, similar toa Kinect X-Box sensor, to detect motion.The three cameras can be used in unison,to search for faces, for example, or to lockinto a face, said Carlin. SoftBank is cur-rently working to enhance the conversa-tional UX (user experience) with Pepper.“Every app is designed around being able tospeak to Pepper,” said Carlin. “We’ve beenworking with Google and other companieson a dialogue-flow chatbot.”

Humber River Hospital enhances patient-focused care with robots

Barbara Collins, president and CEO (at left), tries out the new Pepper robot with a group of patients.

A

TORONTO – Acumyn, a Toronto-based healthcare technology firmspun out of the University

Health Network, has announced the re-lease of AQUA Radiology, said to be theworld’s first clinic-wide automatedquality assurance (QA) software plat-form for diagnostic imaging devices.

AQUA Radiology is a platform thatallows clinics to standardize QAprocesses, automate regulatory tests,and access real-time data across all di-agnostic imaging devices, regardless ofmanufacturer or site location.

Available immediately, AQUA Radi-ology delivers a unified and time-savingsolution to manage compliance toAmerican College of Radiology (ACR)accreditation requirements and clinic-specific policies.

AQUA Radiology was developed incollaboration with world-class pilotsites at Rush University Medical Centerin Chicago, Princess Margaret CancerCenter in Toronto, and Life SavingImaging Technologies (LISIT), a Japan-based medical physics contractor.

“To develop a product alongside thetechnologists and operations managersthat will benefit most from its use isfundamental to the way we choose tocreate products at Acumyn,” said Dr.Daniel Letourneau, Chief TechnologyOfficer of Acumyn and himself a vet-eran of hospital and clinical environ-ments as a medical physicist. “Opti-mized for efficiency and accuracy, im-age-based QA tests can now be com-pleted in seconds, without compromis-ing any compliance requirements.”

The platform offers on-premise orcloud-based implementation options.AQUA Radiology is available as an an-nual subscription with four pricingtiers based on number of devices thesoftware monitors.

Its key features include:• Automated daily and annual image

performance tests for CT and MRI• Out-of-box policies that meet ACR ac-

creditation requirements for CT and MRI• Scalable software to allow expansion

to new departments and sites • Flexibility to add any modality


Pepper recognizes voice andfacial expressions. It can avoidobstacles, identify sounds andrecharge independently.

UHN spin-off creates software for DI

EDUCATIONAL SUPPLEMENT

Anjum M. Ahmed Global Director Imaging Information SystemsAGFA HealthCare

Augmented Intelligence and Machine Learningoffer outstanding potential to redesign the deliveryof healthcare around the world. In partnership withAgfa HealthCare three years ago, the Dubai HealthAuthority recognized the potential of MachineLearning Algorithms and Augmented Intelligence-enabled workflows in medical imaging. With astrategic goal of achieving workflow automationand fast access to diagnostic imaging results, anapproach to enable Augmented Intelligence inmedical imaging was devised to consider theapplication of Augmented Intelligence in Chest X-Ray screening.

WHAT IS AUGMENTED INTELLIGENCE?

Augmented Intelligence is the intersection ofmachine learning and advanced applications, whereclinical knowledge and medical data converge on asingle platform. The potential benefits ofAugmented Intelligence (AI) are realized when it isused in the context of workflows and systems thathealthcare practitioners operate and interact with.Unlike Artificial Intelligence, which tries to replicatehuman intelligence, Augmented Intelligence workswith and amplifies human intelligence.

Together, the Dubai Health Authority (DHA) and AgfaHealthCare created an innovative approach forvalidating AI-enabled medical imaging in theautomation of X-Ray screening for diseases liketuberculosis. The partners solidified the arrangementwith the signing of a Memorandum of Understanding(MoU) at the Arab Health Conference 2018.

The MoU has led to the first Augmented Intelligence(AI) validation in the United Arab Emirates based onChest X-Ray. This government/industry MoU willenable key benefits of Artificial Intelligence, and will

support the Dubai Health Authority’s goal ofincorporating the latest technological advancementsin the medical field for improved efficiencies andenhanced patient-centric care.

“We perform nearly 5,000 Chest X-Rays every dayacross the 20 Medical Fitness Centers in Dubai. Wewant to improve turnaround times, accommodatemore exams, increase volume and capacity andensure we spend more time in clinical review insteadof sorting out daily exam worklists. That’s where AIwill help us to be more productive, serve ourcommunities better and improve client satisfaction,”said Dr. Loai Osman Said, Specialist Radiologist,Medical Fitness Center, Dubai Health Authority.

ENTERPRISE IMAGING STRATEGY – BUILDING AN IMAGING DATA LAKE.

The DHA has 20 medical fitness centers across theemirate of Dubai for issuance and renewal of visas.

The DHA is currently validating the use of AItechnology with Agfa HealthCare and plans toimplement this technology across a few medicalfitness centers for continuing validation.Subsequently, the DHA will assess the feasibility ofexpanding this technology across all of its 20medical fitness centers. The total number of peoplewho visited the DHA-run medical fitness centresduring 2017 for new and renewal visas were2,126,066. A medical fitness test is a mandatoryrequirement for all expats in the UAE. It is requiredfor a residency, employment or education visa.

VALUE-BASED CARE

Value-based care is all about providing costeffective quality care and helping improveoutcomes. With this approach in mind, the DubaiHealth Authority and Agfa HealthCare beganexploring the use of AI technology across 20Medical Fitness Centers in Dubai, in 2015. Based oncurrent workflow gaps and the need to improve turn-

around times, it was decided to validate AI-enabledautomated Chest X-Ray screening workflow at themedical fitness centers.

The DHA provided Agfa HealthCare withanonymized Chest X-Ray samples, half of whichwere categorized as normal X-Rays, and remaininghalf with tuberculosis findings based on labconfirmation. Agfa HealthCare and VRVis Viennaanalyzed these anonymized X-Rays between 2015and 2016, and developed a workflow concept witha Machine Learning Algorithm.

After the development and lab testing phase, AgfaHealthCare and the Dubai Health Authority devisedan onsite validation framework to test the AIalgorithm for accuracy in Dubai. An onsite validationand testing workflow was designed to assureevidence was documented appropriately.

Two Radiologists were assigned by the DHA, duringthe Phase One onsite validation, to validate the AIAlgorithm-generated results and provide feedback.Upon completion of the Phase One onsite validationearly in January 2018, the AI Algorithm validationworkflow designed by Agfa HealthCare correctlyflagged tuberculosis findings with 90% accuracy,based on Chest X-Ray findings.

After completion of the Phase One onsite validation,the AI Algorithm was retrained and deployed againat one of the Medical Fitness Centers in Dubai. TheAl Algorithm’s sensitivity improved to 95% aftercompletion of Phase One onsite validation, and the

goal now is to further validate the AI Chest X-RayAlgorithm with input from DHA Radiologists.

“Based on the analysis of results so far, and howthe AI Algorithm is performing, we will be able tosignificantly improve our reporting workflows.Currently, due to high exam volumes, standardreports can take up to seven days before they getsigned off. With AI technology, cases that areflagged for a disease like tuberculosis would getfollowed up on the same day,” said Dr. ElTag M.Ibrahim Mudawi, Specialist Radiologist,MedicalFitness Center, Dubai Health Authority.

If you are interested in reading the completewhitepaper, please contact [email protected]

VALUE-BASED VALIDATION OF AIIN MEDICAL IMAGINGDubai Health Authority Achieves Successin the Validation of AI for Chest X-Ray Screening


BY JUSTIN FAIOLA

TORONTO – When a patient isadmitted to a hospital and ad-ministered medication, theydepend on their healthcareteam to order, prepare and ad-

minister the right medication in the cor-rect dosage exactly when they need it.

This process may seem straightforwardto the patient, but with close to half a mil-lion medication orders per year and mil-lions of doses dispensed, staff at The Hos-pital for Sick Children (SickKids) know theprocess is in fact quite complex.

Through a $30 million, multi-year,multi-project program called ProgramDose, SickKids is transforming its compli-cated, manual medication managementprocess into a modern, medication man-agement system. This new system leveragestechnology and the unique knowledge andskills of hospital staff to streamline phar-macy workflows and deliver safer, more ef-ficient, high-quality care.

“When we launched this transformationof our medication management process andtechnologies five years ago, it was the singlelargest investment in patient safety under-taken by SickKids,” said Marilyn Monk, Ex-ecutive Vice-President, Clinical Services andProgram Dose Executive Sponsor.

One of the key objectives of ProgramDose is to enhance patient safety by au-tomating pharmacy dispensing services.Automated dispensing cabinets (ADCs)were rolled out across SickKids to ensureall medications, including high-risk med-ications such as narcotics, could be se-curely stored and properly dispensed bynurses in patient care areas.

Similarly, Anesthesia Workstations(AWS) – systems designed for secure stor-age and point-of-care access to anesthesiamedications and supplies – were imple-mented in every operating room, makingSickKids one of the first paediatric hospi-tals in Canada to achieve this milestone.

The AWS and ADCs both comeequipped with a labelling system that im-proves patient safety by reducing medica-tion labelling errors, as well as barcodingtechnology to ensure that the right drug is

dispensed. The cornerstone of SickKids’ pharmacy

services transformation has been the re-cent construction of an 11,000 square-footsterile compounding clean room – a highlycontrolled environment that leverages anintegrated workflow where the latest tech-nology and aseptic techniques are com-bined to ensure the integrity of com-pounding products, such as chemotherapyand other IV medications.

“The opening of the clean room is oneof the most exciting milestones of thistransformative journey,” says JoshuaHamid, Pharmacist, SickKids. “Centraliz-

ing most of our medication preparationactivities in the clean room provides amore efficient workflow for staff and amuch safer practice for our patients.”

In the clean room, pharmacy staff use aBoxPicker, a high-density medication stor-age and retrieval system to manage inven-tory and barcode scanning to facilitatemore accurate selection of medications –the first of its kind in Canada to be imple-mented in a clean room.

In addition, a new IV workflow man-agement system also provides pharmacytechnicians with a “guided digital recipebook” to prepare parenteral compounds,

error-free, step-by-step. Using a combination of barcode verifi-

cation and gravimetric (weight-based)measure, technicians are able to ensure theright drug, concentration and correct vol-ume are selected.

Pharmacists are then able to verify thatall products are compounded accuratelythrough a remote verification feature thattakes advantage of an overhead camerathat records a picture of every compound-ing step. Each of these new features has in-creased efficiencies and reduces potentialcritical errors when compounding IVs andhazardous mixtures.

The clean room meets the latest Ontarioprovincial pharmacy regulatory standards,United States Pharmacopeia (USP) 797 and800, and the National Association of Phar-macy Regulatory Authorities standards thatspecify criteria for sterile compounding andsafe handling of chemotherapy and otherhazardous drugs.

While leveraging new technologies hasbeen crucial, other ingredients have con-tributed to the recipe that has made thismulti-year transformation of pharmacyservices a success.

LEAN methodologies, including ValueStream Mapping and optimization ap-proaches using Discrete Event Simulationwere used to redefine pharmacy dispens-ing workflows to further support the im-plementation of just-in-time delivery andreduce the amount of wasted medication.

These techniques have allowed SickKidsto reduce its pharmacy inventory by 15percent, while simultaneously increasingthe number of unique medications avail-able closer to or at point-of-care.

Pharmacy technicians are also nowspending on average 81 minutes less perday checking medication orders that havebeen modified and filled.

Another critical success factor to thistransformation was the establishment ofa program governance structure andframework to ensure the successful deliv-ery of the 17+ projects which made upProgram Dose.

“At SickKids, delivering the best, safestand most efficient patient care is at theheart of our values,” said IhtishamQureshi, Program Dose Director. “With astellar team and framework, we were con-sistently able to deliver our projects ontime, on budget and in a high quality way.Program Dose’s success is rooted in thededication and close collaboration be-tween our Pharmacy, Nursing, Anesthesia,IMT, Facilities Development, Plant Opera-tions and Process Improvement teams.”

“With the implementation of Epic, ournew hospital information system and bar-code medication administration in sum-mer 2018, SickKids will implement the fi-nal component needed to achieve closedloop medication management,” saidJimmy Fung, Director, Pharmacy. “To-gether, we are ensuring that our new med-ication management system supports thevery best care and outcomes for our pa-tients, enabled by state-of-the-art facilitiesand technology solutions.”

Interested in learning more about Pro-gram Dose and SickKids’ transformationof pharmacy services? Contact [email protected].

SickKids pharmacy automation transforms medication management

Justin Robillard, Registered Pharmacy Technician at SickKids, stands in front of a BoxPicker in the clean room.

Members of the SickKids Program Dose team at the official opening of the clean room in March.

Study leads to a dramatic drop in surgical site infections

MONTREAL – A pioneering teamfrom the infection preventionand control service, infectious

diseases unit, surgical teams and phar-macy have significantly impacted thehealthcare environment for surgical pa-tients at the McGill University HealthCentre (MUHC).

The team has slashed the number ofinfections by more than half in cardiacand transplant surgeries and they ex-pect to keep trending in that directionuntil the MUHC is positioned as aCanadian leader in limiting SSIs.

They are well on their way, and theyhave already begun to share their advanceswith institutions from across Canada.

Dr. Charles Frenette, Director of In-fection Control, MUHC adult sites, and

the four-person team is using a varietyof measures to battle surgical site infec-tions (SSIs), including long-term dataanalytics, a remodeling of surgical pro-

tocols, and a revision of surgical pro-phylaxis to achieve its goals.

SSIs are a by-product of surgery andthese infections can lead to complica-tions such as increased chances of mor-bidity, mortality, C. difficile infectionsand longer hospital stays.

The team is made up of Daniel Thi-ron, Pharmacist; Yveta Leharova, Re-search Coordinator, Infection Control;Connie Patterson, Infection Control Pro-fessional; Sylvie Carle, Associate Head ofPharmacy Education; and Dr. Frenette.

“There has been a substantial drop inSSIs, which has kept patients from unnec-essary stays and has saved the MUHC mil-lions of dollars. This benefits the patients,the hospital, and society, and is highly costeffective as the money can be used forother patients,” said Dr. Frenette. AniqueDecary from the MUHC also reached outto the Université de Montréal’s Daniel Th-iron, who worked as the pharmacist in-volved in improving prophylaxis.

Limiting SSIs in solid organ transplants

The team has already reducedthe number of infections bymore than half in cardiac andtransplant surgeries.



Just Discharged...Now What?For millions of aging Canadians, getting help in the community after being discharged from hospital can be a challenge. It is critical that patient care is transitioned and coordinated from the hospital into the community.

Orion Health’s Rhapsody® Integration Engine provides a critical link to connecting islands of information without the need to rip and replace legacy systems. Rhapsody provides instant accessto data to make the connections that are the foundation of integrated, holistic care. Our approach to healthcare data exchange is seen every day—inthousands of decision-making moments that add up to tremendous positive impacts on population health.

More coordinated care means fewer trips to the hospital, less burden on already stretched acute care resources, and ultimately better health outcomes.

When it comes to helping Canada’s healthcare providers share critical patient information within facilities, between organizations and across regions, Orion Health is here to support your next opportunity to make a difference in care delivery and a patient’s well-being.

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

Earlier this year, frontlinephysicians in Canada startedusing the Lumify ultrasoundsystem – a point-of-care ultra-sound solution technology

from Philips that consists of transducersthat can be plugged into Android smart-phones or tablets.

Users can download the Lumify appfrom the cloud into their Android de-vices, attach a transducer, and they’reready to go.

It’s extremely portable, as there’s mini-mal equipment to carry around. “All of theprocessing is done in the probes,” com-mented Sharon Mulvagh, a cardiologist atthe QE II Health Sciences Center, in Hali-fax. “This system is revolutionary in somany ways.”

Dr. Mulvagh has returned to Canadaafter a long and successful career at theMayo Clinic, in Rochester, Minn. Whilethere, she gained a great deal of experiencewith various forms of portable ultra-sound, as well as with traditional ultra-sound platforms.

She has been testing the Lumify systemin Halifax with both in-patients and am-bulatory patients in her clinics.

What’s especially striking about the Lu-mify technology, she said, is the quality ofits images. “The resolution is comparableto full-sized ultrasound,” said Dr. Mul-vagh. She has been using Lumify transduc-ers with an Android tablet, instead of aphone, to take advantage of the display ona larger but still portable screen, which themedical residents appreciate seeing duringbedside teaching sessions for point-of-careultrasound.

The system offers a number of probesand can be used for a wide array of exams.For her part, Dr. Mulvagh has been usinglow- and high-frequency probes, which areexcellent for cardiac, lung and vascularimaging, respectively.

Another breakthrough from Lumify,

she said, is its exceptional connectivity.“You can interface to any PACS, so there’sarchivability when you need it.” This issomething that hasn’t always been avail-able with previous types of point-of-careultrasound.

She noted that archiving isn’t alwaysneeded – if the point-of-care ultrasound isbeing used to augment the role of a stetho-scope for an initial exam, transferring thepictures to a PACS may not be required,just as stethoscope sounds wouldn’t betransferred to an archive.

However, if you’re conducting an examin the Emergency Department, you’d mostlikely want a record of the findings..

As well, if you’re examining a patientwith a complicated problem, and youwanted to share images with colleagues,you might also want to transfer them tothe hospital PACS.

And by using a tablet, Dr. Mulvagh iseasily able to type in notes about examsor access the records of patients – an-other feature that’s not so easily accom-plished using other forms of point-of-care ultrasound.

She observed that a system like Lumifyacts as an extension of the traditionalstethoscope. She emphasized the word “ex-tension” rather than replacement should

be used, as most doctors will defend theuse of the stethoscope – which is still a veryuseful device.

However, there are advantages to point-of-care ultrasound that stethoscopes can’toffer. For example, with ultrasound, you canactually visualize the pathology in a patient.

When patients are presenting with

problems like shortness of breath, you canuse point-of-care ultrasound to actuallysee if they have leaky valves, volume over-load or aortic stenosis. “You can gain somuch information,” said Dr. Mulvagh.“Seeing is believing.”

Moreover, using a low-cost – but high-quality – ultrasound system like Lumifyat the point of care, you can often screenout patients who might otherwise beroutinely sent for a formal echocardiog-raphy exam.

That could reduce the wait lists for echoexams in provinces like Nova Scotia, wherethe waits are quite long, she said. “You canimprove the quality of care, and efficiencyof delivery, by prioritizing access to thosewho will benefit the most from big-ticketimaging devices.”

A skilled sonographer can also deter-mine at the point-of-care which type ofexam would be most useful for the patient

as a next step– for example, whether a for-mal echo study is needed, or if a CT scanwould be more helpful.

Dr. Mulvagh noted that medical resi-dents she works with love point-of-care ul-trasound, but some of her colleagues aremore set in their traditional ways. She feelsthat education about the use and value ofhandheld ultrasound should begin inmedical schools.

Patients are also beneficiaries of thetechnology – through the quality of thediagnosis it provides, and also via patienteducation. “Patients are very impressed,”she said. “We can show them at the bed-side, say, that the walls of their hearts arethickened, and that’s why they need totake their meds. It really hits home withthem then.”

“And when we show them the colourDoppler flow on the Lumify, they’reknocked out.”

With Reacts, Lumify becomes an integrated tele-ultrasound solution

MONTREAL – The Philips Lu-mify portable ultrasoundsystem now includes vir-tual collaboration capabili-

ties, thanks to a partnership with Innov-ative Imaging Technologies (IIT), ofMontreal. The Philips Lumify solution,available in Canada, turns any compati-ble Android smart device or tablet into ahigh-resolution ultrasound system .

Integration of the Reacts technology,developed by Montreal-based IIT, nowenables live sharing of the Philips Lu-mify ultrasound stream, as well as thebi-directional sharing of audio, webcamvideo streaming and interactive virtualpointers.

That means a person at a remote lo-cation can launch a Reacts session andbegin a remote face-to-face conversationon their Lumify ultrasound system, thenflip the camera on their smart device toshow the ultrasound probe position andshare the Lumify ultrasound stream.

This results in both parties simultane-ously viewing the live ultrasound imageand probe positioning, while discussingand interacting through the Reacts plat-form. In this way, an expert sonographerat a distance can coach and educate theperson carrying out the exam. He or shecan even use virtual pointers to highlightareas of interest.

“Tele-ultrasound allows remote shar-ing of ultrasound videos or images be-tween parties who are in separate loca-tions. This is usually performed by com-bining a traditional ultrasound systemwith some form of videoconferencingsystem or software combined with acomputer and a video converter tobroadcast the ultrasound videos or im-ages,” said Dr. Yanick Beaulieu, CEO ofIIT and a creator of the Reacts platform.“Now, it’s all integrated into one solu-tion that fits into your pocket.”

“The intuitive, easy-to-use Lumifysystem, with the Reacts solution built

right in, makes it much easier to do tele-ultrasound,” said Dr. Beaulieu, who alsoworks as a cardiologist and critical carephysician in Montreal.

Dr. Beaulieu added that Lumify withReacts is ideal for real-time remote ul-

trasound education, supervision, andassistance.

Many doctors, he pointed out, wantto improve their ultrasound skills. “Butthere’s a bottleneck – they don’t want tospend every weekend traveling and goingto workshops to learn and practice.”

Using tele-ultrasound, however, they can communicate with a remoteexpert or colleague any day of the

week. “It’s anytime, anywhere training.” Other possible uses include:

• A professor can go on virtual ultra-sound rounds with students, helpingthem learn anatomy and probe position-ing quickly and efficiently, unrestrictedby location.

• A midwife in a remote location cancall upon an obstetrician who is milesaway to receive perspective and guid-ance, discussing the ultrasound exam asif they were in the same room.

• In acute care, Lumify with Reacts al-lows an emergency medical technician inan ambulance to stream the live ultra-sound exam and discuss a patient’s con-dition with an emergency departmentphysician, expediting appropriate caredelivery upon arrival.

The Reacts interactive collaborationplatform, integrated with the Philips Lu-mify mobile ultrasound system, is avail-able globally everywhere Lumify is sold,including Canada.

As Reacts is built right intothe system, clinicians canconduct ‘anywhere, anytime’ultrasound education.

Lumify turns Android tablets and phones into ultrasound systems

Clinicians plug a transducer into their Android tablets or phones to create a portable ultrasound system.

Using an Android tablet orphone, physicians can easilymake notes and call up recordsduring an ultrasound exam.


Grant yourself the opportunity to transform patient care

Joule is giving you the chance to take your idea to the next level with an innovation grant. The possibilities are endless.

Available grants include: Two $25,000 early-stage innovation grants One $80,000 and one $25,000 later-stage innovation grants One $25,000 social innovation grant Four $5,000 grants awarded to residents and medical students

Don’t delay, application deadline is June 1st 2018.

Visit joule.cma.ca/grants to apply today!

grantyourselfthe opportunity to transform patient care.

Visit joule.cma.ca/grants to apply today!

Joule is giving you the chance to take your idea to the next

level with an innovation grant. The possibilities are endless.

Available grants include:

$80,000 and one $25,000later-stage innovation grant

$5,000grants awarded to residents

and medical students

$25,000social innovation grant

$25,000

early-stage innovation grantsx2

x1

x1

x4Don’t delay, application deadline is June 1, 2018.

E D U C A T I O N A L S U P P L E M E N T

edical identityinformation is worthabout $50 on the street,

while a stolen social security orcredit card number only brings inabout $1, according to statisticscited by the Federal Bureau ofInvestigations. Couple the allure ofthis valuable information with thefact that the healthcare industryhas struggled to implement data-protection strategies.

What do you get? The kind ofvulnerability that cybercriminalslove to prey on. Not surprisingly,66 percent of organizations had experienced asecurity incident with 70 percent of theseorganizations reporting disruption to their ITsystems, according to a recent HIMSSCybersecurity Survey. What’s more, individualcyberattacks have affected as many as 78 million records.

Highly skilled threats. Perhaps most troubling:there’s not much relief in sight, as the frequencyand sophistication of attacks continue to escalate.“It is not simply the kind next door trying to hackinto healthcare systems anymore. It is someonewho is highly skilled or it is an organized effort,”said Lee Kim, JD, director of privacy and security atHIMSS. “So, our threats have def initely becomemore sophisticated and severe.”

In addition, according to an analysis of data fromthe Microsoft Security Intelligence Report from TimRains, director of security at Microsoft, ransomwarerepresents less risk than other types of malware.However, he points out that the rapid evolution ofransomware suggests that the risk could rise in thefuture. As a result, healthcare organizations mustup their security game.

The zero-trust strategy. Instead of taking a passiveapproach to data security – assuming an “it willnever happen to me” stance – healthcareorganizations must instead adopt a “zero trust”strategy. “We have grown so dependent on doingthings electronically, the ability to have ourcomputers up and running is almost akin tobreathing or having access to water. So,

organizations need to more proactively plan foraround-the-clock access to data,” Kim said.

They need to mount a more impenetrabledefense against cyberattacks. Healthcareorganizations should inspect everything frominternal and external networks to people toprocesses. In addition, it’s important to ensure thatbusiness associates, trading partners and otherthird parties are aligned with organizationalsecurity strategies. Even more important,organizations must mount a zealous offense –stopping cyberattacks before they hit.

“Healthcare organizations need to startimplementing strategic and tactical data protectionstrategies before an attack has a chance tomaterialize,” said Leslie Sistla, CISO, MicrosoftWorldwide Health. “Usually organizations don’tknow if they have an intruder on their network.They need to go on the offensive and understandwhat normal behavior looks like and start to lookfor suspicious behavior. They can start to look foranomalies such as suspicious messaging orsomeone who is logged in from a different mobiledevice or users accessing servers they don’tnormally access.”

To support these aggressive game plans,organizations must rely heavily on:

• Data encryption when data is in transit and at rest

• Increased user education and awareness • Tools that automate and enforce encryption

• Vigilant shutdown of shadow IT throughout the organization

• Management of encryption keys • Utilization of advanced analytics and

threat protection

The more you know, the better. According to arecent HIMSS Cybersecurity Survey, 51 percent ofsecurity incidents are identif ied by an organization’sinternal security team and 50 percent by an internalstaff member who is not part of the security team.As the f irst line of defense against cyberattacks,staff members need to be well informed when itcomes to data protection. But that isn’t happening.

In fact, HIMSS survey respondents did not express much confidence in their organization’sabilities to detect security incidents. Only a smallpercentage indicated that their organizations were highly prepared to detect zero day attacks(20.2 percent), negligent insider attacks (20.5percent), malicious insider attacks (21.5 percent)and advanced persistent threat analytics (27.6 percent).

The primacy of education. That’s why education isso important. “When it comes to the use of mobiledevices and data, staff members need to understandwhat is appropriate and not appropriate,” said CraigEidelman, a mobility specialist with Microsoft Healthand Life Sciences. “It’s important to ensure that allemployees understand just how critical security isbut still realize that they can leverage mobile deviceswhen they need to get critical information to takecare of patients.”

Download the full eBook for free at aka.ms/securityforhealthcare

Microsoft

M

Building rigor into cybersecurityA blueprint for healthcare organizations

”I love treating my patients, but not the paperwork.“

2017 Fujitsu Canada, Inc. All rights reserved. Fujitsu and the Fujitsu logo are registered trademarks of Fujitsu Ltd. All other trademarks are the property of their respective owners.17.0111.0114

ScanSnap: Versatile scanners for all needs in healthcare.

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BY DR . SUNNY VIKRUM MALHOTRA

Outpatient practices are oftenflooded with patients, but there areonly so many hours in a day to seethem, causing long patient wait-times and frustration. Increasingthe number of physicians or mid-

level employees often doesn’t work for financial rea-sons, because practices are already under pressure.

That’s why telemedicine use is on the rise. It’smaking vast strides toward increased efficiency, sophysicians and healthcare providers can see more pa-tients each day, and patients can receive more thor-ough, high-touch care.

Telemedicine takes many forms. It may mean“seeing” patients remotely over the Internet via videoconferencing, mostly checking in on patients withchronic diseases such as diabetes or seeing someoneexperiencing a common issue such as a cold, rash, orcough. What a relief for them not to have to leavehome when they’re feeling ill.

Or, it could mean applying innovations such asAugmedix (www.augmedix.com), a scalable, secureservice that uses smartglass technology to securelycapture physician/patient interactions and deploys aremote scribe to capture the outcomes of the visit inan electronic medical records (EMR) system. Physi-cians later review and sign-off on the notes.

Technologies such as these can reduce costs, clini-cal space, and overhead – all while improving the pa-

tient experience, ensuring service consistency, andallowing outpatient practices to treat more patients.

Documenting medical outcomes through smart-glass technologies and “escribes” is an especially

compelling use case for telemedicine. Remember thelast time you visited a physician? How muchtime did he or she spend interacting with thecomputer/EMR versus talking and interact-ing with you face-to-face?

When a physician turns away from apatient for computer time, it’s an unfulfill-ing experience for practitioners and pa-tients alike.

“The transition to the EMR for outpatient prac-tices has been difficult due to extensive, time-consum-ing data entry, and an inability to engage with patientsduring a visit,” says Pelu Tran, president and co-founder of Augmedix. “We enable healthcareproviders to interact with the patient and forget aboutthe computer because they can rely on a skilled scribewho is knowledgeable in medical terminology as apartner who completes EMR data entry for them.”

Although the use of EMRs can seem burdensomeat first, the issue of data entry and data utilization isvery important. In the near future, data will be used tointegrate diagnoses and at-home management as part

of a complete telemedicine network that bringscare into the patient’s home. Outpatient facili-

ties will be alleviated because they will nolonger be overburdened, and patients willbenefit from a far more swift, personalized,and engaging experience from the caregiver.Many telemedicine advances are trans-forming the healthcare landscape. Just

look at all the new ways that administra-tive details such as data entry into an EMR

are being replaced. Jobs can now be ac-complished by people with the ap-

propriate skill sets, allowingeveryone to do their bestwork, reducing overwork in outpatient facilities,and improving patientoutcomes.

VI

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Some physicians are using remote scribes to input the data.

How to stop hating your electronic medical record system

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

Patients and healthcare professionalsinvoke a Supreme Court of Canadadecision that stated, “access to awaiting list is not access to healthcare.”

What the new Canada-EU Trade Agreement means for hospitals BY DENIS CHAMBERLAND

Hospitals are now in thetrade business. On Sep-tember 21, 2017, theCanada-European Union

Comprehensive Economic and TradeAgreement (CETA) came into force(on a provisional basis, as it stillneeds to be approved by all memberof the European Union (EU)).

The agreement, which includes30 chapters of rules defining tradebetween Canada and the EU, regu-lates trade in goods and services,sets an investor-state dispute settle-ment system, impacts intellectualproperty rights for pharmaceuticaldrugs and sets rules for governmentprocurement.

CETA creates a free-trade zone al-lowing Canadian businesses guaran-teed access to a market of more than500 million consumers, includingaccess to EU government procure-ment which is valued at over CAD$3.3-trillion annually. The reverse isalso true: EU businesses now haveaccess to the Canadian market, andto the North American Free Trade(NAFTA) environment.

Unlike previous trade agreements,under Chapter 19 CETA opens upcompetition to the government pro-curement activities of the so-calledthird tier of government, such asmunicipalities, school boards, uni-versities and hospitals.

Now a hospital considering a spe-cific procurement needs to askwhether the procurement being con-templated is a “covered procure-ment” under CETA. Not all procure-ments are covered.

Various annexes to CETA set theprocurement value thresholds ofgoods, services and construction ser-vices applicable to a particular classof procuring entity (i.e., hospitals).The thresholds for procurement arevalued in special drawing rights(SDRs), which is an international re-serve asset created by the Interna-tional Monetary Fund based on acluster of currencies.

The SDRs are converted into localcurrency and the thresholds are ad-justed at regular intervals by GlobalAffairs Canada. The thresholds cur-rently applicable to hospitals are$237,700 for goods and services and$9.1 million for construction (note

that the thresholds vary as the con-version rate changes).

These are high thresholds whencompared to those set out in theCanadian Free Trade Agreement (tobe discussed in the next column).

Aside from the thresholds, CETA’sprocurement rules do not apply toeverything. Many exceptions andexemptions exist.

For example, under Article 19.2,on limited tendering, procurements

related to “theprotection ofpatents, copy-rights orother exclu-sive rights”are excepted,as are pro-curementsthat “wouldcause signifi-cant inconve-nience or sub-

stantial duplication of costs” for thehospital. It’s not enough to casuallyclaim an exception. The partyclaiming it must find a sound basisfor it, one that could withstand ahard-headed auditor’s gaze, as well

as the scrutiny of the courts. Under CETA, procuring entities

may also limit conditions for partici-pation in a procurement process.Such conditions can be imposedprovided the conditions are essentialto ensuring that a supplier has thelegal and financial capabilities andthe commercial and technical abili-ties to undertake the work.

As well, supplier registration sys-tems are allowed provided they arenot set up for the purpose of creat-ing unnecessary obstacles to partici-pation. Selective tendering andmulti-use lists are generally permis-sible, subject to some requirements.

Under CETA, procuring entitiesmust publish notices of intendedprocurement that must include pre-scribed detailed information, befree-of-charge, and subject to a sin-gle point of access. Procuring enti-ties are also encouraged to publish anotice of future procurement plansonce annually.

Where there is a challenge to aprocurement, under CETA theprocuring entity and the disap-pointed bidder are encouraged to re-

Denis Chamberland



V I E W P O I N T

Healthcare Denmark has released aWhite Paper about the Scandina-vian country’s approach to tele-

health and virtual healthcare, titled “Den-mark – a Telehealth Nation.” The full papercan be found at: http://healthcareden-mark.dk/media/1625194/HCD-Telehealth-white-paper-v1-single-0318.pdf

Like many other countries, Denmarkhas an ageing population and a growingnumber of chronic patients. More andmore people are in need of healthcare,which places an increasing strain on pub-lic finances. Telehealth solutions may helpthe healthcare system to meet this chal-lenge in a way that also improves the qual-ity of care.

Telehealth is not just about technology;it requires organisational change. It mayact as a catalyst for new routines and work-flows, which put the patient at the centreof treatment.

Instead of admitting the patient to thesystem, the system is deployed to the pa-tient. In general, patients are assigned amore active role in their own treatment:They learn more about their conditions,improve their self-care skills and are ableto influence their own health situations.

At the same time, telehealth solutionsreduce the number and length of hospital-isations, enhancing the financial viabilityof the healthcare system. Denmark hasbeen working strategically with telehealthfor years. At the core of these efforts are anumber of small and large-scale telehealthprojects carried out across the Danishhealthcare sector.

The most successful concepts are se-lected for further trials and development,preparing them for national dissemination.

TeleCare North: The TeleCare Northproject has implemented home monitor-ing to support patients suffering fromCOPD (chronic obstructive pulmonarydisease). The project has established newcross-sector roles and procedures to sup-port the region-wide implementation ofhome monitoring. This has paved the wayfor a new integrated care model, which al-lows the concept to be expanded to otherpatient groups.

Since 2013, approximately 1,400 COPDpatients in the North Denmark Region haveaccepted the offer of home monitoring.

Research shows that patients with se-vere COPD experienced improved qualityof life through the telehealth program, andthe number and length of hospitalizationswere reduced by 11% and 20% respec-tively. Building on the positive results forCOPD patients, the offer of home moni-toring will now be expanded to includeheart failure patients as well.

The Virtual Hospital: The virtual hos-pital concept allows patients to receivetreatment at home and enjoy the samequality of care as they would in hospital. Itsaves them the trouble of going to the hos-pital for control visits or treatment ses-sions, and frees up hospital resources at thesame time.

Bispebjerg Hospital in Copenhagenhas implemented a telehealth service forwound patients that has increased effi-ciency and patient satisfaction. Spe-cialised municipal home nurses are re-sponsible for the treatment, which is co-

ordinated by a wound healing centre atthe hospital.

The results of the project have inspireda nationwide telehealth solution for thetreatment of wounds. At Rigshospitalet inCopenhagen, the Chemo at Home projectuses a redesigned workflow to offer pa-

tients higher-quality treatment without in-creasing expenditure.

At Aarhus University Hospital, the De-partment of Obstetrics and Gynaecologyhas implemented a telehealth solution al-lowing women with pregnancy complica-tions to be monitored at home. The num-

ber of outpatient visits has been reduced,staff spend 75% less time on patient mon-itoring, and the number of inpatient daysfor women with pregnancy complicationshas been reduced by 44%.

Odense University Hospital has imple-

Denmark, a northern nation, offers lessons in remote and virtual care

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BY DIANNE DANIEL

Some call it the dreaded clipboard. You ar-rive at your initial appointment with amedical specialist and your first task is tofill out a series of intake forms. Often, youfind yourself sitting in a busy waiting area,relying on memory, and the tendency is to

rush or even skip over answers. You quietly think toyourself: ‘No one is going to look at this anyway.’

What if those same questions were emailed to youweeks in advance and you could take time filling themin from the comfort of home? What if, instead ofgeneric questions on paper, you were presented with acomputer tablet and the opportunity to click througha series of questions tailored specifically for you?Would you be inclined to provide better information?

Dr. Sean Wharton, internal medicine doctor andmedical director of the Wharton Medical Clinic insouthern Ontario, believes you would.

From the start, his multidisciplinary approach toweight and diabetes management has centred on effi-cient note-taking, including patient reported outcomes(PROs). Each visit to a Wharton clinic begins with adiscussion of personal goals and outcome objectives.

Some questions are carefully structured to pro-vide clear data points for future research, while oth-ers are based on collecting firsthand patient informa-tion – such as whether patients are able to bend to tieshoes or feel comfortable in their clothes.

When the clinic launched in 2008, PROs wereloosely captured by clinicians during patient visitsusing an electronic medical record (EMR). More re-cently, the clinic implemented an integrated PRO

platform, from InputHealth Systems Inc.,to collect patient intake data in a more con-sistent and usable manner.

“Before, patients often skipped over those ques-tions, questions we know are very valuable,” saidWharton Medical Clinic research coordinator Re-becca Christensen. “Now we’ve made it easier to cap-ture. We’re able to get deeper information about ourpatients and better understand what their goals andhopes for the program are.”

The new “visit one package” is sent to first-time

patients through a secure link prior to their visit. Inaddition to obtaining a comprehensive weight his-tory, it also includes open-ended questions intendedto capture personal experience. Once the forms arecompleted and returned, the clinic uses a natural lan-guage output option provided by InputHealth to cre-ate a visit-one note that serves as the starting pointfor the initial in-person appointment.

“We use it to create the majority of a visit-one notein a patient’s own words,” explained Christensen.“They don’t have to hand over these forms that they’recarrying around. They know it’s been received by us… it’s going directly into our EMR and we’re able tomake sure it’s held in the strictest of confidence.”

The new process is providing the foundation for amuch broader PRO strategy in the future. Dr. Whar-ton said the intent is to capture patient informationin an automated way at every visit, ultimately leadingto more accurate and complete note-taking and abetter measure of outcomes.

“If we can get better notes that we’re proud of,that relate to what happened in the actual visit andthe interpretation is accurate and we’re proud ofthem, then those things can be given to patients,” hesaid. “There’s less chance of litigation, there’s moreappropriateness and everybody is on the same page.That’s a very tall order.”

Dr. Puneet Seth, chief medical officer at In-putHealth, believes PROs are entering a renaissancestage. Whereas patient-reported data used to be seen asan added value, it’s now viewed as an “absolute neces-sity for the healthcare system moving forward,” he said.

Patient reported outcomes have been around formore than 40 years in the form of structured ways to

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Customized patient questionnaires can collect better and more thorough information.

Patient reported outcomes (PROs) beingdeployed to improve data collection

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Canadian hip and knee replacement patients invited to the PROM

Hip and knee replacementsurgeries will be amongthe first to benefit from acommon approach to col-

lecting and reporting patient-re-ported outcome measures or PROMs,following a coordinated effort led bythe Canadian Institute for Health In-formation (CIHI) to advance PROMsinformation across Canada.

Last fall, CIHI and the CanadianJoint Replacement Registry AdvisoryCommittee, comprised of representa-tives from the Canadian ArthroplastySociety and Canadian OrthopaedicAssociation, agreed on a standardminimum data set for obtaining pa-tient-reported outcomes, includingthe use of pre-surgery and post-surgery questionnaires to better gaugethe change in patient health status fol-lowing a hip or knee replacement.

The effort supports Canada’s pushfor value-based healthcare deliverybecause it provides more timely andaccurate PROMs data, which can beintegrated with costing data, patient-reported experience measures

(PREMs) and other clinical outcomemeasures to determine which inter-ventions are providing the best pa-tient outcomes for the lowest cost,said Greg Webster, director of Acuteand Ambulatory Care InformationServices (AACIS) at CIHI.

“CIHI’s focus is on advancing acommon approach to PROMs acrossCanada, as this is the most efficientway to provide the most valuable andcomparable data. We’re using provenPROMs tools rather than developingnew PROMs. The momentum forPROMs is increasing and CIHI isworking with others to align and ac-celerate progress,” explained Webster.

Hip and knee replacements are alogical starting point, he added, be-cause the clinical community is al-ready engaged in improving out-comes through the Canadian JointReplacement Registry, operated byCIHI in collaboration with theCanadian Orthopaedic Association.

Some orthopaedic surgeons arealready using PROMs like the Ox-ford Hip Score (OHS), Oxford Knee

Score(OKS) or WOMAC (WesternOntario and McMaster UniversitiesOsteoarthritis Index) to assess indi-vidual patients using brief standard-ized questionnaires focused on painand functioning.

The new standard minimum dataset uses the OHS & OKS and adds asmaller, more generic tool called the

EQ-5D-5L, designed to measure apatient’s general health and qualityof life characteristics.

The idea is that patients completethe brief questionnaires within eightto 10 weeks prior to surgery andthen provide follow-up informationone year after surgery – all of whichcan take place online using web,kiosks or tablets.

“You can then measure improve-

ments for those patients and do riskadjustments to see if similar patientsreceiving similar surgeries are expe-riencing similar improvements intheir pain and functioning,” saidWebster, adding that the move frompaper-based to digital data collectionis making it “faster and cheaper” toobtain standardized PROMs data.

In Ontario, for example, the Min-istry of Health and Long-Term Careis working with Cancer Care Ontarioto create an infrastructure to sup-port electronic data collection, frompatients receiving hip and knee re-placement surgeries.

The initiative involves adaptingkiosks and tablets to allow patientsto securely provide information in aclinical setting. Replacing paper withelectronic forms means the informa-tion can be quickly fed into elec-tronic medical records, allowing formore informed discussions betweensurgeons and their patients. ThePROMs data from this initiative willbe provided to CIHI and the Min-istry for analysis and reporting.

Hip and knee replacementswere a logical startingpoint, because of relatedwork occurring in this area.


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

collect information. What’s changed is theadvent of mobile technology and new waysto connect with patients electronically –leading to the concept of the electronicPRO or ePRO.

InputHealth’s philosophy is that patientengagement needs to be a bidirectional re-lationship. If you’re going to ask patients tolog into their computers or use their phonesevery day to report outcomes, they need tounderstand why they’re doing it and feelthat they are receiving something in return.

In other words, the more personal theconnection, the better the patient en-gagement.

When a family doctor refers a patient toa specialist, the sooner that specialist en-gages with the patient, the less apprehensivehe or she will be. Using an ePRO platform,a specialist can connect ahead of a first visit,send a brief introduction to his or her ser-vices, request patient information and let apatient know what to expect, for example.

“That small gesture of reaching out to aperson can be a very transformative patientexperience,” said Dr. Seth. “All of a sudden,you’ve developed this human connection.It’s coming directly from your clinicalprovider and if you have an automatedmeans for being able to do this, it can reallyprovide a win-win for all parties involved.”

The idea, he added, is to move away frompaper-locked pieces of information to a dig-ital approach. To do it effectively, however,requires good design. It’s not a matter oftaking an existing paper survey and au-tomating it, but designing an ePRO from thestart to take advantage of digital technology.

InputHealth’s platform is like a blankcanvas. Organizations use the software tobuild their own forms, incorporating de-pendency logic and branching trees tobuild intelligent forms tailored to patient-specific populations.

For example, if a patient responds thatthey are experiencing elbow pain, they willbe asked questions about where the pain isradiating on their arm, what makes it worse,what makes it better and whether it’s on theinside or outside. Similarly, a male patientwon’t be presented with questions about hismenstrual cycle and a female patient won’tbe asked about her prostate health.

Researcher Dr. Cheryl Forchuk, MentalHealth group leader at Lawson Health Re-search Institute in London, Ont., is investi-gating InputHealth’s ePRO platform as ameans to support communication be-tween care providers and clients in themental health field.

Based on the findings of an earlierstudy, which showed that usingsmartphones to facilitate online

communication resulted in a 30 percentreduction in outpatient visits, her group ispartnering with InputHealth to make thestrategy more personal.

“It’s very much a case of one size does-n’t fit all, so we’re trying to look at incor-porating differences for different sub-pop-ulations,” she said.

One group that didn’t respond well tothe smartphone study were seniors.Whereas younger patients preferred tex-ting, older patients wanted to use largerdevices, type less and have the opportunityfor face-to-face interactions.

Using InputHealth’s technology, re-searchers designed questionnaires forGoogle Chromebooks and enabled virtual

visits to take place. Feedback from thestudy indicated that once they were pre-sented with a more appropriate interface,elderly patients were willing to supplymore information.

The goal of the research is to alleviatebottlenecks in the mental health system bystrengthening community-based supportsand services. An ePRO approach provides ameans for patients to maintain communica-

tion with a care provider without the needto visit an outpatient clinic. Fewer visits arerequired, but the accessibility is greater.

Facilitating communication is key, sheadded. There are hundreds of smartphoneapps available for free that can monitormoods, for example, but only a handfulhave been evaluated. Patients who are atrisk for problems with mood and depres-sion who use such apps in isolation, with-

out an avenue to talk to somebody, mayend up at even greater risk.

“We know from some of our work withdepression that introspection without com-munication can actually increase depres-sion,” said Dr. Forchuk. “We want to moni-tor what’s going on, but do it in a way thatinvolves communication rather than doingit as a solitary activity or dealing with Dr.Google.”

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Engaging the communities of carefor over 8,000 patientsBy directly engaging with physicians, we have seen improvements in patient outcomes and reductions in costs that surpassed ourexpectations. This real‐time data collection allows eShift to supporthospitals, clinicians and patients quickly and effectively. Currently live in 5 LHINs, our Patient Care Pathways include:

• Palliative• Complex Pædiatrics• Complex Adult (COPD/CHF)• Stroke• Ortho Rehab Now live in Erie St. Claire LHIN

“Instrumental in enabling real-time data collection through eShift’s dashboard and access to virtuallythe entire health care team.”

—Laurie Gould, Chief Clinical and Transformation Officer for London Health Sciences Centre.

Improving patientquality of care

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show in May



BY MICHAEL GREEN

ecognize this? You make an appoint-ment to see your doctor. The day ar-rives, and you tell your boss and col-

leagues that you’ll be away from work forabout three hours. You travel to the doctor’s

office, spend some time in the waiting room,see the doctor, then travel back to work.

If your doctor is missing information,you may need to repeat a test or book a fol-low-up appointment. If you have a chroniccondition, you might experience this sev-eral times a year.

The time adds up. So does the lost pro-ductivity for your employer. Your health-care providers and our health system alsoexperience time and productivity losseswhen information is incomplete or un-available.

The solution? At least part of it is to

connect health information electronicallyso providers can access and share it. Ac-cording to a new pan-Canadian studycommissioned by Canada Health Infoway(Infoway), the growing use of connectedhealth information – the information ex-changed using interoperable electronichealth records (iEHRs) and complemen-tary solutions for sharing information be-tween providers and organizations – isproducing significant financial and time-saving benefits for patients, providers, ourhealth system and our economy.

Connected Health Information inCanada: A Benefits Evaluation Study, foundthat the greatest benefits are in four areas:

• Reduced duplication of diagnostic testing;• More effective use of inpatient settings;• More effective use of emergency

departments; and• More effective ambulatory (outpatient)

interactions.Using an established benefits evaluation

framework developed by Infoway, as wellas a standardized methodology for evalu-ating the national effects of digital health,the study estimated current benefits of:

• 18 million hours a year in time savingsfor patients (i.e., less time taken off workto go to appointments);

• 5.9 million hours a year in time savingsfor providers (i.e., freeing them up to seemore patients);

• $1 billion a year in health system value(i.e., money that can be reallocated forother health care priorities); and

• $189 million a year in economic pro-ductivity gains (i.e., through time NOTlost from missing work).

Sandra Wallace of Ottawa, Ontario, hasbeen saving time as a result of connectedhealth information. Her daughter, Cam-ryn, has a number of health challenges thatrequire frequent appointments.

“It’s fantastic to be able to sit in a clinicappointment now with the doctor and seeall the data and medications, everythingthat she’s on is right there in front of us.That’s just a fantastic change, it makeseverything flow so much quicker in ap-pointments today,” Wallace said.

Healthcare providers like Dr. Tunji Fa-toye of Winnipeg, Manitoba, couldn’t agreemore.

“Rather than waiting while a clerk callsaround to labs or other clinics or hospitalsto have information sent, I can now log onand confirm my patients’ health informa-tion with them right in the examinationroom,” he said.

“I can see what blood tests they haddone at another site without waiting forphone calls or faxes. I can confirm whichmedications a patient had filled withoutmaking another phone call to the phar-macy or interrupting a clinic nurse to con-firm the information.”

Added Dr. Fatoye: “You can’t imaginehow much time is saved on any given dayand how much more efficiently the clinicruns.”

Patients and providers, and by exten-sion, our health system and our economy,are experiencing these benefits because ofinvestments made by Infoway and theprovinces and territories in the founda-tional elements of an iEHR – patient and

Connected health information saves time and money for Canadians

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BY KATHERINE TUDOR

There is no shortage of Canadiannews headlines about hackers get-ting into government and health-care provider websites to gain ac-

cess to personal information and patienthealth information. These headlines are aconstant reminder of the stark reality thatcybercrime is not going anywhere.

You may think that cybercrime com-mitted to access private information onlycame along with the advent of the Inter-net. In fact, security incidents and privacybreaches are nothing new. Before the wide-spread use of the Internet, electronic med-ical records (EMRs) or other informationsystems, practice staff could snoop in pa-per charts and no one was the wiser.

Not to be dismayed, there are ways toprotect your practice and confidential pa-tient data from security incidents and pri-vacy breaches regardless of how you collectpatient information. With over 15,000physicians and nurse practitioners in On-tario using EMRs, there is more focus thanever on protecting patient data in elec-tronic systems.

The OntarioMD Privacy and SecurityTraining Module was developed to provideconvenient privacy and security trainingfor Ontario physicians and healthcare pro-fessionals who use EMRs. There are a fewgood tips for paper chart users as well,”said Sarah Hutchison, CEO, OntarioMD.

“It’s the most comprehensive onlineprivacy and security training for physi-cians and their staff available in Ontario,”she added. “It has been reviewed and en-dorsed by the College of Physicians andSurgeons of Ontario, the Canadian Med-ical Protective Association, the OntarioMedical Association and eHealth Ontario.

“No other privacy and security trainingmodule can provide attestation that youhave successfully completed the training toenable access to digital health assets.”

Under the Personal Health InformationProtection Act (PHIPA), physicians arehealth information custodians (HICs). AsHICs, physicians have an obligation toprotect Personal Health Information on anongoing basis. The OntarioMD Privacyand Security Training Module covers top-ics such as safeguarding personal informa-tion from security incidents leading to pri-vacy breaches, and how to comply withobligations under PHIPA.

The training is available to registeredusers of OntarioMD.ca. Physicians andnurses can become registered for the siteand get a username and password to accessthe training module.

Once you have a username and pass-word, you can simply log in and launch themodule. Physicians and nurses who areregistered users can sponsor any staff whocould benefit from the training.

The OntarioMD Privacy and SecurityTraining Module has been certified as aSelf-Learning Program by the College ofFamily Physicians of Canada for twoMainpro+ credits.

The training covers: • the importance of privacy and security,

and your legal and professional obligations• personal health information and own-

ership of medical records

• Ontario’s Electronic Health Record(EHR) systems and your obligations as auser of such systems

• consent and consent directives • ways to safeguard personal health infor-

mation• developing policies for acceptable use of

personal health data and EHR systems• system and network controls that must

be in place before you access EHR systems• how to manage relationships with elec-

tronic service providers• identifying and appropriately responding

to security incidents and privacy breaches

“Privacy and Security go hand in handwith any digital health solution” said familyphysician, Dr. Thérèse Hodgson. “Thecomprehensiveness of the OntarioMD Pri-vacy and Security Training Module allowedme to ensure that my staff would be well-educated in privacy and security.”

OntarioMD offers new training course for online privacy and security


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worldwide survey of 1,500 clini-cians, IT decision-makers and pa-

tients found that 72 percent be-lieve mobile devices are im-

proving the quality of patient care. Theyagree the technology gives clinicians ac-tionable intelligence at the bedside with

the effect of increasing time with patientsand reducing errors.

Zebra Technologies Corp., a marketleader in rugged mobile computers, barcodescanners and barcode printers, sponsoredthe survey, which was conducted in 2017.

The report, called The Future of Health-

care: 2022 Hospital Vision Study, offers aperspective from the front-line of patientcare. It also highlights the changes that clin-ical mobility is expected to have on globalhealth services within the next five years.

Zebra’s 2022 Hospital Vision Studyidentified the rising adoption of clinical

mobility – the use of mobile devices suchas handheld mobile computers, tablets,cordless barcode scanners and mobileprinters – in hospitals around the world.

According to survey respondents,nearly all hospitals estimate that mobiledevices will be used at the bedside bynurses (97 percent) and physicians (98percent) by 2022, but also increasingly byother members of the care team – such aspharmacists, lab technicians, radiologists,and patient transport professionals.

The study also highlighted how patientsperceive the rise of clinical mobility withnearly eight-in-ten survey respondentsfeeling positive about mobile tools beingused to improve their care.

Key findings: Clinical mobility is rapidlybecoming the global standard for patientcare: Zebra’s 2022 Hospital Vision Studyidentified the rising adoption of clinical mo-bile solutions across all disciplines by 2022.This growth includes areas where mobility isalready widely used (bedside nurses risingfrom 65 to 95 percent), as well as an increasein other areas such as pharmacist and phar-macy technicians (from 42 to 96 percent),lab technicians (from 52 to 96 percent), andICU nurses (from 38 to 93 percent).

The study highlights a reduction in pre-ventable errors as a key benefit. Surveyednursing managers and IT decision-makersexpect clinical mobility to reduce errors inareas including medication administration(61 percent) and specimen collection la-beling (52 percent).

Mobile technologies allow clinical staffto spend more time at a patient’s bedside:By 2022, 91 percent of nurses are expectedto access electronic health records (EHRs),medical and drug databases (92 percent),and lab diagnostic results (88 percent) us-ing a mobile device, reducing time thatmust be spent away from patients.

Communications are expected to im-prove due to rising clinical mobility adop-tion: Nearly seven-in-ten of surveyed nursemanagers credit clinical mobility with im-proving staff communication and collabo-ration, as well as the quality of patient care.

At the same time, 64 percent of sur-veyed IT decision-makers identify nurse-to-physician communications as a top areafor improvement.

Clinical mobility will be augmented withreal-time location information to stream-line workflows: Real-Time Location Sys-tems (RTLS) will be used to locate every-thing from equipment, supplies and phar-maceuticals to patients and staff. This visi-bility will allow administrators to improvebed availability, staff workflow, and safety.

Faster data streams, integrated throughhandheld mobile technologies, are expectedto improve detection and notification oflife-threatening conditions. By 2022, 98percent of surveyed IT decision-makers ex-pect predictive analytics and early notifica-tion for life- threatening conditions, such assepsis and hospital-acquired infection, willbe sent to clinicians’ mobile devices.

As well, patients are aware of the bene-fits of clinical mobility and becomingmore active participants in the delivery oftheir healthcare. The majority of surveyedpatients (77 percent) are pleased with clin-ician usage of mobile technologies to im-prove the quality of their care.

Improvement in quality expected from mobile technology at bedside

A


provider registries, laboratory and druginformation systems, diagnostic imagingrepositories, and clinical reports and im-munizations. As providers began usingthese systems, Infoway commissionedpan-Canadian benefits evaluation studiesto provide insights into the value for Cana-dians and our health system.

The findings for individual foundationalelements were significant, but we alwaysknew that the true value would be unlockedwhen these elements were connected andbeing used by vast numbers of providers.

That’s exactly what’s happening. Over thepast decade, there has been significantgrowth in the number of providers who areable to access connected health information.

As of January 2017, an estimated 301,000(more than half of the 500,000 estimatedpotential users) were accessing one or moresources (e.g., laboratory tests, diagnosticimaging) to retrieve patient information.

More than 162,000 of these providerswere actively accessing two or more clini-cal information sources. In addition, weknow that 85 percent of primary carephysicians report using electronic medicalrecords in 2017, enabling them to accessvarious systems right from their desktops.

Integration with other clinical systems,such as hospital information systems andpharmacy management systems, has alsohad a huge impact.

We believe the findings in our newstudy are likely conservative, due mainly tothe lack of available data to quantify valuein some areas. We also believe that thevalue of connected health information willincrease significantly as solutions are en-hanced with new features and functionali-ties, and as these solutions are more fullyintegrated into point-of-care systems andclinical practices.

The study estimates that, at full adop-tion, we could see benefits of:

• 76 million hours a year in time savingsfor patients (compared with 18 millioncurrently);

• 15 million hours a year in time savingsfor providers (compared with 5.9 millioncurrently);

• $3.9 billion a year in health system value(compared with $1 billion currently); and

• $732 million a year in economic pro-ductivity gains (compared with $189 mil-lion currently).

As Canada continues to transitionfrom creating the platform for digitizingand sharing patient information, to mak-ing the best use of connected health in-formation, our health system will be moreefficient, effective and sustainable, andpatients will have a better experience andbetter outcomes. Patients and providersare optimistic.

“The technology used in digital healthcan improve the care that patients receive,like wait times and quality of service,” saidMonique Boiteau on Laval, Quebec. “We aspatients feel that we are being looked after.”

Dr. Darcy Marciniuk of Saskatoon,Saskatchewan, agrees.

“We used to have many medical recordsin various doctors’ offices and otherhealthcare professionals, hospitals, institu-tions, and we’re starting to see a seamlessintegration of those records so that every-body involved in the care of a patient hasaccess and availability to that same infor-mation,” he said.

“It’s much more efficient. It breaksdown barriers and I think it’s going to im-prove patient care.”

Michael Green is President and CEO ofCanada Health Infoway. Connect with himon Twitter @MGreenonHealth.

has improved with liver infection ratesdropping 200 percent, thanks to new mea-sures that include a change of prophylaxis,better timing and using chlorhexidinewashes before the operation. Not one in-fection resulted from renal transplants in2016.

According to Dr. Frenette, cardiacsurgery used to tally almost 100 infectionsper year, with each infection adding$75,000 in hospital stays. That number hasbeen cut by half.

“We went from over 10 percent of pa-tients having infections to around fivepercent. But there’s still room to im-prove,” said Dr. Frenette. “We think wecan decrease by another two to three per-cent, which would be in line with the bestrates in the world.” The team creditsMUHC staff for helping make this ambi-tious plan a reality.

“It’s very important to have a team ofsurgeons who are open to feedback andrecommendations. We have been able toachieve this and it makes a big difference,”said Yveta, a trained nurse clinician who isone of the team’s Infection Control Con-sultants. “We collected, we analyzed andwe recommended – but if we do not re-ceive collaboration, then we will not makea difference.”

Yveta points to improvements intraining and educating young surgeonswho also happened to come of age dur-ing the timeline of their study, which be-gan in 2011. That added experiencetranslated into improved results insidethe operating room.

“I’m personally satisfied to make a dif-ference, to feel appreciated, and to see thatour work is being rewarded,” said InfectionControl’s Connie Patterson, who worksside-by-side with Yveta and Anique.


The true value of EMRs areunlocked when the elements areconnected and used by largenumbers of providers.

mented a telehealth service offering homesupport to families with pre-term babies.Instead of starting their new family lifewith a lengthy stay in unfamiliar hospitalsurroundings, the solution allows familiesto be discharged as soon as the baby is inno clinical danger.

Telepsychiatry: For patients with amental disorder, timely access to mentalhealth services is often of vital importance.Telepsychiatry can provide them withfaster and more flexible access to mentalhealthcare services, as well as the opportu-nity to be more directly engaged in theirown treatment.

The Region of Southern Denmark hasestablished a Centre for Telepsychiatryto empower patients and improve out-comes and service delivery through theuse of telehealth. The Internet Psychi-atric Clinic gives citizens with mild tomoderate depression or anxiety fast ac-cess to evidence-based treatment andguidance, without the need for a referralfrom their GP.

Based on the positive results, it has beendecided to implement the solution in allfive Danish regions. The Centre for Telepsy-chiatry has also implemented home-basedvideo consultations, providing easier accessto psychiatric care.

Home-based video consultations alsosupport joint decision making between

patients, mental healthcare providers andother healthcare professionals.

A national infrastructure for telehealthdata: Denmark’s implementation of large-scale telehealth solutions between 2011and 2015 has revealed that telehealth re-quires a new approach to data and datasharing. This has led to new initiatives anda sustained focus on standardisation andfurther development of the Danish health-care system’s IT infrastructure in order tosupport telehealth on a national level.

Denmark was the first country in theworld to adopt the Continua Health Al-

liance standard as the national standardfor telehealth devices. It is now the back-bone of a robust framework for imple-menting telehealth nationwide.

Compliance and prevention: Telehealthhas the potential to inspire and motivatecitizens to engage in their own health in anew way. It may increase their awareness ofrisk factors and facilitate close cooperationbetween patients, providers and profes-sionals of the healthcare system. At theMunicipality of Esbjerg, telehealth is usedto promote population health. Telehealth

and preventive services have been designedto motivate chronic patients to adopt ahealthy lifestyle and improve their compli-ance with treatment.

At the Municipality of Holstebro, astudy has documented how a telehealth so-lution supporting home blood pressuremeasurement has reduced the reportingbias normally associated with the detec-tion of hypertension. The study not onlyrevealed that many patients were beingtreated on the basis of an inaccurate diag-nosis. It also identified a number of citi-zens with undiagnosed hypertension.

Odense University Hospital is collabo-rating with the national health authoritieson a project that will make screening forcolorectal cancer more efficient. Since 2014,all Danish citizens between the ages of 50and 74 have been offered screening for col-orectal cancer – either a colonoscopy, whichis a highly accurate, but invasive procedure,or a stool test, which is non-invasive, butmuch less accurate.

A new “camera pill” technology allowscolonoscopy diagnostics to be carried outin the patient’s own home, significantly re-ducing the risk and discomfort associatedwith conventional screening methods.Some of Denmark’s most promising andsuccessful telehealth concepts are de-scribed in further detail in the full WhitePaper – along with the potential or docu-mented gains for the patients as well as thehealthcare system as a whole.


Healthcare Denmark offers lessons in remote and virtual care

solve their differences through consulta-tion. For the many cases where a pleasantchat won’t suffice, CETA states that theparties should appeal to a “designatedadministrative or judicial authority”.

To date no such administrative or ju-dicial authority has been set up, thoughwe understand there is the possibilitythat some provinces may establish a biddispute resolution procedure.

If the pattern of complaints thatemerged after the establishment of thebid-dispute resolution forum at the fed-eral level in the late 1990s is any indica-tion, we should expect hospital procure-

ment to loom larger in the future. It iswidely accepted that bid protest proce-dures make public procurement morerobust and increase value to taxpayers.

The new obligations – procedural,administrative and technical – which

CETA imposes on hospitals are gener-ally consistent with those flowing fromthe Canadian Free Trade Agreement(CFTA), but they are not similar in allrespects, and they are voluminous. No

effort was made here to provide a de-tailed or comprehensive overview.

So as hospitals bravely launch them-selves into the business of trade, caremust be taken to comply with both CETAand the CFTA, as well as the BroaderPublic Sector Procurement Directivewhich continues to apply to hospitals.

Denis Chamberland is a commerciallawyer with extensive procurement, tech-nology and trade law experience in thehealthcare sector in Canada and Europe.He works with many hospitals on a vari-ety of projects, including helping hospi-tals understand and implement the re-quirements of the new trade agreements.He can be reached at [email protected].

ChamberlandCONTINUED FROM PAGE 24

It is widely accepted that bidprotest procedures makeprocurement more robustand of increased value.

Infoway studyCONTINUED FROM PAGE 28

Study leads to adramatic drop in SSIs

Denmark was the first countryin the world to adopt theContinua Health Alliancestandard for telehealth.


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