newfoundland launches provincial telepathology net

BY STEPHEN SELZNICK

AND STEPHEN HENDERSON

An intellectual property infringementlawsuit in the United States, pittingone radiology service provider

against another, may have important impli-cations for hospitals, clinics and otherhealthcare providers across North America.When Virtual Radiologic (vRad), owner ofNighthawk Radiology Services, sued Tan-dem Radiology for alleged patent infringe-ment, the company also named two users of

Tandem Radiology’s services – Direct Radi-ology and Imaging Advantage.

The latter two are physician-owned radi-ology reading services. From a legal perspec-

tive, this puts pressure on healthcareproviders that acquire technological goodsand services to ensure their suppliers are not

infringing on the patents of others – lestthey be drawn into lawsuits themselves. Assuch, it’s important to build protectionsfrom intellectual property disputes when en-tering into agreements that involve techno-logical solutions.

This particular lawsuit was settled in Sep-tember 2014 without admission of liability,with Tandem agreeing to wind down usageof the technology platform in question. Thesuit was originally filed about a year earlier,in September 2013, in an Arizona court.

Protecting your organization from patent infringement

CONTINUED ON PAGE 2

Newfoundland and Labrador, in partnership with GE Healthcare, are launching Canada’s first province-wide telepathology system that’sHealth Canada approved. The solution modernizes the practice of pathology, enabling experts to quickly assess images and to confer with col-leagues while examining digitized slides. The system is expected to provide faster, higher quality care for patients. SEE STORY ON PAGE 4.

Newfoundland launches provincial telepathology net

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Innovation for the disabledOttawa’s Saint-Vincent Hospital,part of Bruyère Continuing Care, isshowing that modifications of sim-ple technologies can dramaticallyimprove the lives of seriously dis-abled patients.Page 6

Why privacy mattersRecent losses of patient data,through the theft of computersand improper access to electronicrecords, are having serious reper-cussions. Hospital employees havelost their jobs, while irate patientshave launched class action lawsuitsagainst clinics and hospitals. Page 7

Boosting your EMRAM scoreHospitals across Canada are scram-bling to increase their EMRAMscores. Significant improvements inpatient outcomes are registered,experts say, when Level 6 is attained.8

Portable sensorsInnovators are creating a new gen-eration of low-cost sensors thatare improving the health of peoplein developing nations, along withthose in Canada. In future, these

devices, which can attach tosmartphones, will become parts ofhousehold medicine cabinets. Page 20

Making a difference where it really matters

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40018238

FEATURE REPORT: INNOVATIVE HEALTHCARE PROVIDERS – SEE PAGE 18

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 19, NO. 8 NOVEMBER/DECEMBER 2014

SPECIAL REPORT:

IMAGINGPAGE 14

Healthcare providers shouldensure that their suppliers arenot infringing on patents.

We are fortunate to live in an agemarked by rapid technological innovationin the diagnosis and treatment of injuryand disease. We have all come to expectthat the healthcare system offer leadingedge and cost effective diagnostic tools andsolutions. This stokes a highly competitivemarketplace for systems and equipment,the cost of which makes up a substantialportion of a hospital’s or infrastructureservice supplier’s capital budget. Adminis-trators in turn must ask their suppliers notonly to tender top quality product, but thatthey do so at best available pricing.

Administrators are prudent to ask com-peting suppliers to bid for the privilege ofsupplying their product and systems offer-ing. The expectation is that a modicum ofcomparative shopping will bring to lightthe best overall value.

This is a challenge when dealing withthe purchase of advanced systems andequipment. Hospital and infrastructure ad-ministrators must be mindful to compareapples to apples, and in doing so minimizethe risk of proprietary rights infringement.

It goes without saying that being drawninto a proprietary rights lawsuit will erodeany price based cost savings. As well, sincemuch of the funding for these systems andequipment purchases is sourced from gov-ernment or patron donations, administra-tors must be sensitive to their moral andethical obligations to respect the intellec-tual property rights of others.

The intellectual property rights of a so-lution provider comprise a bundle ofrights including patent rights which wediscuss in this article.

A patent is a statutory monopoly. In ex-change for public disclosure of how tomake and use the invention so that otherscan further innovate an even better tech-nological solution, inventors are accordeda time limited monopoly (currently, inCanada, 20 years from the earliest prioritydate) to exploit their invention to the ex-clusion of others.

Unlike rights that arise at common law,patent rights only exist under statute if ap-plied for and granted, and then only inthose countries in which the patent is actu-ally registered. For example, a U.S. patentdoes not grant a monopoly over the inven-

tion in Canada, where the invention may befree for all to use if a corresponding Cana-dian patent has not been issued.

Infringement occurs when someone in-terferes with the full enjoyment of thosemonopoly rights. Infringement, inten-tional or otherwise, may arise in a numberof ways including constructing an inven-

tion under patent, using it, selling it, im-porting it or even selling or using a prod-uct made via a patented process.

It is “use” which hospitals and infra-structure providers should be particularlyconcerned with. In addition, hospitals andinfrastructure providers may expose them-selves to claims for inducing patent in-fringement if suggesting specifications, orsystems or equipment design in the ten-dering process. In some circumstances,this may also lead to a claim against the

hospital or infrastructure administrator inhis or her own personal capacity.

Any person who infringes a patent is li-able to the patent owner and its licenseesfor damages sustained after the patent is is-sued, as well as reasonable compensationfor any infringement occurring before thepatent issues but after publication of thepatent application. In certain circum-stances, patent infringement exposes theinfringer to an order to deliver over anddestroy the infringing product, an ac-counting for the value extracted from orprofit made by the infringer, punitive ormultiple damages, and the enforcementcosts of the patent owner.

In an infringement lawsuit, a hospitalor infrastructure service provider may alsobe ordered not to use the allegedly infring-ing product or system pending the out-come of the patent case which may takeseveral years to resolve.

While such situations represent a worstcase scenario, patent infringement shouldbe a front-of-mind concern for hospitaland infrastructure administrators. Hereare nine important considerations to keepin mind when purchasing health care tech-nology and systems to assist in limiting therisk of patent infringement:

• When drafting a request for proposal(RFP), set stringent parameters which al-low bids to be evaluated properly againsteach other.

• An RFP should require vendors to iden-tify the patents that they own or thirdparty patents that they in-license for useor, alternatively, to confirm that theirequipment and systems do not infringe onany existing patent and require no licensefrom current patent holders.

• Prospective vendors should also be re-quired to confirm that the patents they iden-tify, and all related in-licenses, are in full forceand in good standing in the territories inwhich the equipment or systems will be used,and for the intended purposes for which theequipment and systems will be used.

• Where an assessment is made that aparticular in-licensed third party patent iscritical, administrators need to considerrequesting a cut-through or other non-disturbance acknowledgement from the li-censor of that technology. This allows forthe continued use of the licensed thirdparty patent in the event that the vendorloses the right to do so directly.

• Prospective vendors should also dis-close any adverse patent claims or allega-tions. If there are claims or allegations out-standing, the vendor should provide a legalopinion as to their likelihood of success (anon-infringement opinion).

• In big ticket purchases consider request-

CONTINUED FROM PAGE 1

Lawsuit takes aim at two users of allegedly patent-infringing service

Art DirectorWalter [email protected]

Art AssistantJoanne [email protected]

CirculationMarla [email protected]

Publisher & EditorJerry [email protected]

Office ManagerNeil [email protected]

Address all correspondence to Canadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9 Canada. Telephone: (905) 709-2330.Fax: (905) 709-2258. Internet: www.canhealth.com. E-mail: [email protected]. Canadian Healthcare Technology will publish eight issues in 2014. Featureschedule and advertising kits available upon request. Canadian Healthcare Technology is sent free of charge to physicians and managers in hospitals, clinicsand nursing homes. All others: $67.80 per year ($60 + $7.80 HST). Registration number 899059430 RT. ©2014 by Canadian Healthcare Technology. Thecontent of Canadian Healthcare Technology is subject to copyright. Reproduction in whole or in part without prior written permission is strictly prohibited.Send all requests for permission to Jerry Zeidenberg, Publisher. Publications Mail Agreement No. 40018238. Return undeliverable Canadian addresses toCanadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9. E-mail: [email protected]. ISSN 1486-7133.

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

Volume 19, Number 8 Nov/Dec 2014

Contributing EditorsDr. Alan [email protected]

Dianne [email protected]

Richard Irving, [email protected]

Rosie [email protected]

Andy [email protected]

Under Canadian law, inventorsare given 20 years to exploittheir inventions to the exclusionof others.

DiaShareTM is the only patented, multi-ology capable, workload balancing, peer review and clinical productivity solution. It offers clients the broadest functional range in any platform of its kind.

THE ONLY PATENTEDMULTIOLOGYWORKFLOW AND PEER REVIEW PLATFORM

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shaping tomorrow with you

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BY JERRY ZEIDENBERG

ST. JOHN’S, N.L. – A province-widenetwork for telepathology, saidto be the first in the countrythat’s Health Canada-approved,is about to be launched by New-

foundland and Labrador. The $2.5 mil-lion project will help improve the diagno-sis of cancer and other diseases for pa-tients throughout the province by elec-tronically connecting hospitals to expertsat Eastern Health, in St. John’s, and ulti-mately, to other specialists in Toronto andWinnipeg.

Pathologists are in short supply inNewfoundland and across Canada, espe-cially in rural areas. Often, hospitals mustprepare slides and send them by courierfor an interpretation by pathologists inlarger centres, like St. John’s. That can be aslow process.

However, by using the telepathologysystem, hospitals in Newfoundland andLabrador will be able to digitize the tissuesamples and electronically send the imagessecurely across the telehealth network forinterpretation, a system that will providefaster results.

Not only are pathologists hard to comeby, but sub-specialist pathologists are evenmore so. Generalists/community patholo-gists tend to consult with sub-specialists,especially on difficult cases, and rely ontheir expertise before reaching a diagnosis.

“We’ve got pathologists throughout theprovince, but often you need a sub-spe-cialist,” said Mike Barron, CEO of theNewfoundland and Labrador Centre forHealth Information. “If there isn’t theright sub-specialist available in a hospital,

they’ll soon be able to connect with one inSt. John’s.”

He added that the network, in this way,“will improve the quality of care and pa-tient safety.”

Barron noted the 2009 Cameron In-quiry recommended that alternative meth-ods of providing pathology services be in-vestigated in Newfoundland, after 383

women received incorrect diagnoses ofbreast cancer. Of these, 117 required achange to their treatment programs.

The new digital pathology network is, inpart, an answer to this recommendation.

Several other Canadian provinces haveexperienced incidents of incorrect diag-noses of cancer, and are also taking steps toimprove the quality of pathology services.

The platform was developed by Omnyx,

a joint venture of GE Healthcare and theUniversity of Pittsburgh Medical Center.Based in Pittsburgh, Penn., Omnyx hasbeen pioneering the development oftelepathology scanners, workstations, net-works and workflow software.

In recent years GE and Omnyx part-nered with the University Health Network(UHN) Laboratory Medicine Program, in

Toronto, to test and validate the Omnyxdigital pathology system, in a project thatlinked UHN’s pathologists with a hospitalsite in Northern Ontario.

Newfoundland and Labrador is invest-ing $1.1 million in the first phase of thenew project, which will see equipmentinstalled at four different sites: the JamesPaton Memorial Regional Health Centrein Gander; the Central Newfoundland

Regional Health Centre in Grand Falls-Windsor; Western Memorial RegionalHospital in Corner Brook; and theCharles S. Curtis Memorial Hospital inSt. Anthony.

An additional $1.4 million is being in-vested by Canada Health Infoway. The firstphase will see these centres connected toEastern Health, in St. John’s. A later phasewill connect the hospitals with patholo-gists in Ontario and Manitoba – part of apan-Canadian telepathology project that’sbeing spearheaded by Infoway.

Barron observed that once the system isup and running, it could also be used forobtaining second opinions. “Pathology isnot an exact science, and it helps to get sec-ond opinions for a diagnosis,” he said.

GE Healthcare through Omnyx has de-vised scanners, display stations, softwareand transmission technologies that to-gether produce a solution that could trans-form the delivery of pathology services, al-lowing pathologists to digitally view andrapidly share slide images with colleagues,regardless of locations.

To further enhance accuracy and speedof diagnosis for pathology, GE Healthcareand Omnyx have partnered with RealTime Medical, also of Mississauga, Ont.Real Time Medical has developed work-flow software that allows pathologists tocollaborate; it automatically alerts col-leagues to new cases to review, tracks re-view progress and enables pathologists toreport results through the network.

“It enables collaboration between spe-cialists, allowing them to improve thequality of the diagnosis. It extends thereach of their skill sets,” said Ian Maynard,CEO of Real Time Medical.

And when slide images are sent topathologists for interpretations, if one isbusy, the case is automatically rolled overto another pathologist. That ensures thereis never a delay to have a case read.

“The turnaround time for a diagnosisin remote regions can be days or evenweeks when you’re shipping slides byFedex,” commented Mike Clarke, GeneralManager of GE Healthcare IT Canada. “Byeliminating need for shipping and trans-portation, we are making pathology slidesimmediately available for the consultingpathologist to read.”

Clarke said, “Our workflow software issecond to none, the scanner is easy to use,and the compression and streaming tech-nology is one of our breakthroughs.”

He observed that pathology files can bequite large, up to 10 times larger than radi-ology files, and compression and efficientstreaming is needed for files to be movedacross the network more efficiently. “Com-pression reduces network impact withoutcompromising the pathologists’ viewingexperience,” said Clarke.

What’s more, he said, the solutionis one of the few that’s Health Canadaapproved.

Clarke noted that Newfoundland andLabrador is not only one of the first juris-dictions in Canada to create a telepathol-ogy network, it’s also a North Americanground-breaker in the transformation ofpathology – a field that is ripe for techno-logical modernization. “It’s great to seeNewfoundland leading the way.”

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

Network for telepathology set to launch in Newfoundland and Labrador

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BY CECILIA L I

VANCOUVER – Patients with inheritedbleeding and inherited red bloodcell disorders such as hemophilia

now have access to improved care and sup-port, thanks to a newly launched tool.

The Inherited Coagulopathy and He-moglobinopathy Information Portal(iCHIP) is the first web-based, secure ap-plication in North America which allowspatients to directly enter his/her health in-formation into the system. Inheritedbleeding and inherited red blood cell dis-orders are rare, chronic and life-threaten-ing conditions that are costly and complexto treat. Patients with genetic blood disor-ders are treated with blood products andmay need frequent transfusions in boththe hospital and home setting.

iCHIP is unique in that it empowerspatients with inherited bleeding and redcell disorders to take ownership of theirown care.

The mother of a B.C. hemophilia pa-tient, Carmen Langdon, told reportersduring a recent launch event of iCHIP atBC Children’s Hospital that the technologyalso reduces some of the unnecessary bur-dens. “We live in a rural area and in thepast, we had no idea when the productswould arrive at our local hospital, so wewere making multiple trips before wecould pick up the products. Now, iCHIPsends me a notification and we know ex-actly when the products arrive – no morewasting time and back and forth on trips.”

In the past, coagulopathy patientstransfusing blood factor products at homewould record their usage manually orthrough an older system that was cumber-some to use; their home infusions wouldthen be assessed by their doctor at theirnext visit. Clinicians, in turn, would usemany non-integrated data systems torecord and monitor patient treatment andcare, which made it difficult to track longterm patient care and obtain an accurateunderstanding of product utilization.

iCHIP is comprised of two inter-con-nected modules – a Patient Home Module(PHM) and a Clinical Module. The PHMenables patients to directly enter theirhome infusion product usage and relatedtreatment details into the system fromhome. A real-time link with the ClinicalModule then enables clinicians to providetimely clinical care. An alert system is builtin to notify program clinical staff if a pa-tient enters a potentially serious bleed intothe PHM. Messages will also be automati-cally sent if product use for the patient isoutside the appropriate range.

The PHM offers other features to helpsimplify life for patients, such as the abilityto generate and print various types of per-sonal treatment protocols and reportswhich they can share with their primarycare providers, or carry with them whentraveling for emergency situations. Anotherhandy feature for patients is the system no-tification function that informs patientswhen their product is ready for pickup.

iCHIP was developed by the BC Provin-cial Blood Coordinating Office (PBCO), aprogram of the Provincial Health ServicesAuthority (PHSA), in collaboration withthe BC Inherited Bleeding and Red Cell

Disorders (IBRCD) Program cliniciansand patients.

“With the launch of iCHIP we are ex-pecting a tremendous impact on patientcare,” said Dr John Wu, Pediatric MedicalDirector, IBRCD program “From a system-wide perspective, with patient care being

provided in a more timely manner, it willreduce the acute episodes or crises that pa-tients may run into if some of their signsand symptoms are not captured earlier on”.

The Inherited Bleeding and Red CellDisorder Program was implemented in2012 to help establish and maintain na-

tional standards of care, ensure patientshave access to proper resources and ensurequality and accountability. The develop-ment of iCHIP was a key component of theIBRCD program, with a goal of providingIBRCD Program patients and clinicians a

iCHIP system is a North American first for blood disorder patients

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ANDREA MACLEAN

OTTAWA – A team at Bruyère’sSaint-Vincent Hospital isadapting conventional tech-nology to help severely dis-abled patients communicate

and maintain some independence.By customizing a variety of technolo-

gies, Assistive Technologist Bocar Ndiayeand volunteer Yih Lerh Huang have foundsimple solutions to complex communica-tion challenges. Today, approximately 50 ofthe 336 patients at Saint-Vincent Hospital,which operates the province’s largestComplex Continuing Care program, areusing open source software and hardwareand everyday objects (such as headbands),to remain connected to family and friends.

“Unfortunately, many of our patientshave lost the ability to use their hands andtheir voices in a traditional sense. We cre-ate the opportunity to communicate whennothing else is available,” said Bocar Ndi-aye. “By working closely with our patientsand their families we can customize solu-tions for them.”

Using mainstream technology andtools, Bocar and Yih Lerh are able to helpbring the outside world in for patients whootherwise would be unable to communi-cate. Small and simple tasks such as chang-ing the channel on the television or adjust-ing the volume on the radio allow patientsto enjoy little pleasures and have a betterquality of life.

“If the patient wants to control the TVor make a phone call, but physically isn’table to do it, we use different types of sen-sors – touch sensors or light sensors – thatwe customize for that patient who has lim-

ited hand or head movement,” said Ndiaye.The devices are attached to the patients

using hair bands. Some of the wiring isalso protected by cases for glasses. Ndiayeand Huang work on a shoestring budget,but have been able to custom-tailor de-vices for dozens of patients.

For seven years, Molly Knox has been apatient at Saint-Vincent Hospital. WithBocar’s help and that of his team,she now just has to move herhead to control her iPad, mean-ing now she can watch Netflixand Skype with her friends andfamily around the world. On herhead – making this all possible –is a simple, everyday headbandthat has been customized to en-able her to control the computer.

“It’s made a big difference,”she said. “I can go anywhere onGoogle. I can talk to friends.”

“I am so proud of the passionand commitment of this smallbut mighty team of employeesand volunteers,” said presidentand CEO, Bernie Blais. “If thereis something Bruyère can do tohelp our patients – we will.”

Combining dedicated high-cost health-care devices with low cost hobbyist partssuch as capacitive touch sensors, infra-red(IR) light sensors and gyroscopes, andworking closely with a wheelchair techni-cian, occupational therapists and speechlanguage pathologists, Bruyère affords pa-tients’ life-changing projects on a shoe-string budget.

“This team works hard and developssolutions that change lives,” says Mr. Blais.“We picture a day when the team has phil-

anthropic support so even more lives willbe transformed.”

Saint-Vincent Hospital ALS patient,Howard Hunter, uses the Tobii eye-track-ing software on his computer. This highlyspecialized and technical software re-sponds to his eye movements and the clickof a special button. Hunter is wheelchairbound and has limited mobility in his

hands and arms. His daughter Annie saidit’s made all the difference in his life.

“Having the computer really allows himto be like everybody else, to use his com-puter,” she said. “They get him up and allyou need to do is set up the computer. Youturn on one button and he’s able to use theInternet as anybody else would. There’snothing he can’t do on this computer withinfra-red eye-tracking software. It’s defi-nitely amazing and he enjoys it a lot.”

The future of this team’s initiatives and

ideas is endless as technology advances.Ndiaye and Huang are currently research-ing ways to help patients who cannot moveor communicate. There are undoubtedlyopportunities to adapt Bruyère’s simplesolutions more widely to other patients.Ndiaye said they wanted to adapt a specialgame that allows a person to elevate orlower a ball using their minds.

“What we’re trying to research isif there is any way we could in-terface it with a smartphone ortablet as well,” he said.The team recently received inter-national recognition as they wereasked to present their cus-tomized patient communicationdevices at the esteemed ISAACInternational conference in Lis-bon, Portugal this past July. Thisis a key conference for Augmen-tative and Alternative Communi-cation, which brings together ex-perts from around the world.Augmentative and AlternativeCommunication (AAC) de-scribes the methods that makecommunication easier for peoplewho find it hard to communicate

by speech. It includes many differentmethods, such as electronic talking aids,computers, books and boards with pic-tures or letters, and sign language. AACcan help people to understand what is saidto them as well as to say and write whatthey want. Clients have mostly acquiredconditions such as Multiple Sclerosis,Amyotrophic Lateral Sclerosis (ALS), Mus-cular Dystrophy, traumatic head injury,spinal cord injury, stroke and other neuro-logic disorders.

Andrea MacLean is Communications Managerwith Bruyère Continuing Care, in Ottawa.


Bruyère’s Saint-Vincent innovation helps disabled patients communicate

Enabling patients to accomplish everyday tasks gives them great pleasure.

data management tool that can be used toimprove health outcomes through betterand more timely patient care, as well as tofacilitate optimal use of blood products.

To ensure iCHIP met the needs of pa-tients and clinicians, stakeholders were en-gaged throughout the application develop-ment process. A Plan-Do-Study-Act ap-proach was used to gather requirementsand develop prototypes, which were thenrefined based on user feedback.

iCHIP is a three-tier web applicationbuilt using the latest technologies includ-ing Java Server Faces, Ajax, and Web Ser-vices, with strict adherence to BC privacylaws and security requirements. iCHIPcontains highly sensitive patient informa-tion, and as such, strong security controlsare in place to protect against inappropri-ate and unauthorized access.

Cecilia Li, RN, BSN, EMBA (Health Care)is the Provincial Director, BC ProvincialBlood Coordinating Office. For more infor-mation on iCHIP and the Provincial BloodCoordinating Office, visit www.pbco.ca.


iCHIP application forblood disorders



BY JERRY ZEIDENBERG

Despite years of lecturing by pri-vacy commissioners across thecountry, healthcare workers con-tinue to lose portable computers

or USB keys containing patient healthrecords. Even more disturbing are the con-tinuing reports of hospital employees whoimproperly access the records of patients.

What’s strange about this latter phe-nom is that most of the employees caught‘snooping’ in this way are found throughregular or random audits. Employeesknow such audits are being conducted, yetthey continue to peer into records theyknow they shouldn’t be viewing.

One recent example: In October, AlbertaHealth Services notified the public that anemployee of the Alberta Children’s Hospital,in Calgary, improperly viewed the records of247 patients. The person in question, whono longer works at the hospital, accessed therecords over a 14 month period.

The audit showed that he or she – theidentity of the person wasn’t made public– may have looked at the patient histories,contacts, birth dates, and other informa-tion through two separate databases, Net-care and Clinibase. The breach was discov-ered through a regular audit of the elec-tronic charts.

The matter is now being investigated bythe province’s Office of the Informationand Privacy Commissioner. If charged, theemployee faces a fine of up to $50,000.

Vickie Kaminski, the president andCEO of Alberta Health Services, apolo-gized for the breach and emphasized thatAHS takes the privacy of patient informa-tion seriously. She also said the organiza-tion “will take appropriate action reducethe chance of this happening again,” butdidn’t specify what steps will be taken.

Meanwhile, in Newfoundland, a formernurse was fined for inappropriately access-ing the records of patients. In October,Colleen Stamp was fined $1,000 by aprovincial court for accessing personalhealth records – without an appropriatereason – 18 times over a 12-month period.

Stamp, previously known as ColleenWeeks, was a nurse working in the emer-gency department at Eastern Health, theprovince’s largest healthcare organization.Her activity in the electronic record systemwas also discovered through an audit.

The province’s Privacy Commissioner,Ed Ring, said the fine reinforces the mes-sage that health professionals shouldn’tmisuse their ability to view the records ofpatients. It should remind healthcareworkers there are significant consequencesfor such actions.

And in September, Donna Colbourne, aformer accounting clerk at WesternMemorial Regional Hospital, in CornerBrook, was fined $5,000 after improperlyviewing personal health records on 75 dif-ferent occasions.

It’s not just patients and healthcare pro-fessionals who are implicated in breaches ofhealth records. Naturally, the hospitals andclinics whose records are lost or snoopedinto suffer a hit when it comes to ‘public im-age’. But they’re also on the hook financially.

The theft of a laptop computer contain-ing the health information of 620,000 Al-

bertans has spurred an $11 million classaction lawsuit against Medicentres, a chainof clinics that employed a consultant wholost the computer. Ironically, the consul-tant was a specialist in information tech-nology – a person who might be expectedto place a premium on data security.

In Ontario, an even larger class actionhas been filed against the Rouge ValleyHealth System, in Scarborough. The orga-nization faces a $412 million suit, an ac-tion launched after two hospital employeessold the personal information of 8,300new mothers to a RESP company.

There are significant penalties involvedin cases of health record breaches, alongwith the loss of public confidence. As such,hospitals and other organizations saythey’re stepping up their efforts to becomemore vigilant. Still, it will be important totake real steps to make improvements.

Privacy breaches have implications for patients, staff and providers

Cerner clients understand that health care is changing. They are equipped to meet the challenges this new environment poses. That’s why so many Cerner clients have reached HIMSS Analytics’ EMR Adoption ModelSM stage 6 – like North York General Hospital – and 7.

Visit us at cerner.ca to see how, together, we can make health care all that it should be.

© 2014 Cerner Corporation

Improving health care

together


In March 2013, Niagara Health Sys-tem’s (NHS) St. Catharines Siteopened its doors, marking a majormilestone in Ontario’s largest hos-pital integration. St. Catharines isthe largest of six NHS sites, span-

ning nearly one million square feet. Though integration and coordination

had dramatically improved since themerger in 2000, opportunities to furtherstreamline care, improve performanceand patient satisfaction remained, in-cluding frustratingly long wait-times inthe Emergency departments.

The hospital leadership had under-gone a process to identify barriers to op-timal performance, and they includedcommunication breakdowns and poorprocesses. The different hospital sites, de-partments and functions operated as si-los, and a focus on enhanced coordina-tion was needed.

Over the course of 2013, leadershipundertook a number of steps to improvepatient flow and wait times. A corner-stone of this effort was to adopt one sys-tem to improve communications andworkflow across the hospital sites.

In summer 2013, NHS selected Con-nexall as its integrated technology solu-tion. Connexall enables nurses, physicians,porters, housekeeping, coordinators andother staff, and patients to stay continu-ously connected through simple wirelessdevices. The technology has been imple-mented in over 1,000 organizations glob-ally, demonstrating a reliable track record.

Making the NHS adoption more am-bitious was the fact that it was the firsthealth system anywhere to deploy Con-nexall enterprise-wide – that is, using this

one solution to enable instant communi-cations between multiple functions, de-partments and hospital sites in a region.

“We didn’t just want to improve flow inone part of the hospital or in one location– our goal was to put tools in the hands ofstaff in all our sites in order to integratecare pathways across the region,” says An-gela Zangari, NHS Executive Vice Presi-dent of Finance and Operations. “We feltconfident moving forward with Connex-all, and were inspired by the potential toimprove our performance.”

Since November 2013, the NHS andConnexall developer, GlobeStar Systems,have rolled out five integrated applica-tions, specifically designed for NHS’unique clinical needs and physical spaces:

• A Patient Queuing solution in our cen-tral registration and ambulatory care areaswhich has sped up patient registration andeliminated the need for ill patients to standin line.

• A Portering solution that automatesporter requests, reducing the time nursesand others spend coordinating patienttransfers, enabling staff to better managetheir work, and making the patient journeywithin the hospital faster and smoother.

• A Housekeeping solution. Everyone onthe team can see the bed status everywherein the hospital at all times. Housekeepingstaff are notified immediately to have thevacant room cleaned so we can get the nextpatient into a bed much more quickly.

• A Telemetry solution. Clinicians receivereal-time alarms about medical eventssuch as changes in vital signs through theirhandheld devices.

• The Nurse Call Notification solution al-lows patients to directly reach a nurse via a

handheld device. This enhances the nurse’smobility and allows the patient to receiveassistance by way of direct interaction withthe nurse.

The results in under a year have beenstriking.

By compressing the steps in the clini-cal flow, different sites have been able tomove patients from the ER and throughthe hospital much faster. ER wait timesfor patients at the St. Catharines andWelland sites have gone down dramati-cally with Connexall. The 90th percentile

wait time for high acuity patients at theSt. Catharines site was reduced by 44%from September 2013 to August 2014.

In the past it could take nursing on av-erage over 55 minutes for patients to beready for imaging and transporting. Wewere able to get the average time down tobelow 25 minutes within four months ofimplementation.

Ms. Zangari says of the improve-ments, “once we were able to measurewhat was really going on, inter-profes-sional relationships and job satisfactionimproved. By making information trans-parent and giving staff greater controlover their work, everyone is now able toplan ahead rather than playing catch up.”

And we are seeing tangible improve-ments in the patient experience. For ex-ample, patients on crutches, women in

labour, and frail seniors used to have tostand in line to get registered for an ap-pointment. Patients now get a ticketupon arrival and can take a seat untiltheir number comes up.

“Patients find the experience muchmore satisfying and they get to their ap-pointments on time,” says Ms. Zangari.“Productivity has definitely gone up, aswell. We have the same number of em-ployees getting more accomplished in thesame amount of time.”

The methodical implementation ofConnexall was as important a componentto the success as the technology itself.From day one the cross-functional teams– including nurses, porters, housekeepingstaff, registration, Diagnostic Imaging,Lab, Biomedical and ICT – had direct in-put into the design and implementation.

For example, it was critical that theEVS/Portering team and nurses led thedevelopment of the nursing solutions, astheir teamwork is crucial to Patient Flow.ER and inpatient nurses now have thesame information about where each pa-tient is in the hospital and who is attend-ing to them at any given time, whichhelps with care coordination.

Physicians have also observed that pa-tient transfers between ER, diagnosticservices and inpatient units are muchmore seamless with Connexall.

Super-users from different depart-ments have a critical ongoing role, sup-porting new staff to use the system, andidentifying adjustments that need to bemade as needs change over time.

One of the workflow innovations thatthe NHS team is developing will be toperform tasks concurrently that used tobe done sequentially. For example,bed/room cleaning will be concurrentwith patient placement, movement andtransfer of accountability.

Hospitals tend to only get the patientready for transfer once a room has beencleaned. At NHS, viewing these activitiessimultaneously ensures that the patientarrives as the room clean process is com-pleted, saving precious time.

Another critical success factor washaving members of the Connexall teampartnering with the NHS ICT team towork with internal stakeholders to un-derstand business needs and develop arobust and sustainable system.

Having the technical experts fromConnexall on the ground, workinghands-on with hospital staff enabled usto design a solution that is tailor-madefor our population, services, geographyand facilities at each site.

Staff and managers are already thinkingof ways to further harness this solution toimprove how they do their work, such asusing the queuing system in the ED.

Dr. Suzanne Johnston, NHS President,notes “being first in Canada with a com-prehensive solution is impressive from atechnology perspective, but even more sofrom the perspective of creating the bestpossible patient experience. The Connex-all implementation is much more than anIM-IT project, it has promoted signifi-cant cross-functional operational team-work. It is really part of a cultural changethat’s underway at NHS.”


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Niagara Health System is the first healthcare organizationanywhere to deploy Connexallenterprise-wide.


BY FRASER EDWARD

In June, the CATAAlliance MobileHealth Advisory Board published asummary report from its MobileHealth Roundtable event, which was

held in Ottawa.“The inaugural mobile health round-

table was a first step in building awarenessof mobile health in Canada,” said JohnReid, President & CEO, CATAAlliance.“We are thrilled with the response and ex-cited to have brought together some 70stakeholders from government, hospitals,healthcare, industry, start-ups, academia,consultancies and the not-for-profit sec-tor,” Reid added.

At the event, six broad themes wereidentified as requirements to enablemHealth in Canada:

• Personal health information. Canadi-ans want to be “enabled participants” intheir own health and wellness. To achievethis, patients need greater access to theirhealth information via provincial personalhealth records, patient portals, etc. Sec-ondly, greater interoperability or a commondata set is required to facilitate greater ex-change of data. Thirdly, health professionalsrequire systems to manage, share and re-spond to the anticipated volume of healthdata generated by mHealth solutions.

• Reimbursement models. To simulateadoption and integrate mHealth as part ofstandard care practices, mHealth needs tobe supported within physician and institu-tional payment models. A combination ofintroducing mobile, virtual and remotecare options into billing code nomencla-ture and a continued move towards an out-come based payment models is required.

• Gap between innovation and adoption.To close this gap, healthcare institutionsneed to drive a shift in emphasis from per-petual trials to mass adoption. While theyard stick must be on quantifiable results,flexibility in funding models and innova-tion in procurement processes would allowinnovation to enter the healthcare system.

• Education and awareness. To achievemass adoption, the value of mHealth in-novation needs to be showcased acrossCanada. Canadians, administrators andmedical practitioners need support ma-terials to help them select and safely usemHealth solutions. Particular focus onprivacy and security concerns should beemphasized.

• Mobile health app certification. Withover 100,000 health apps available today,helping consumers and clinicians to iden-tify solutions that are both safe and clini-cally effective is important. Attendees pro-posed an industry-led certification ‘seal ofapproval’ system to achieve this.

• mHealth champions. Physicians, phar-macists and other health professionals arerequired to build trust in mHealth solutionsefficacy for Canadians. They will do this ifarmed with appropriate data and evidenceof real outcomes. As always, definitive resultsare the most powerful enabler for adoption.

With significant announcements aboutApple’s Health Kit and Samsung’s Sim-band, and an abundance of wearable de-vices and smart watches hitting the shelves,it is definitely time to enable mHealth tolive up to its promise in Canada.

While this is not an easy journey, onething is certain – we need to make room inour healthcare system to make mobile inno-vations part of the mainstream. I see no otherway to achieve the one thing our system hasalways lacked – a truly engaged and enabledpatient. That’s the power of mHealth.

After all, mobile health (mHealth) inno-vations promise to have a measurable im-pact on health outcomes while at the sametime facilitating new efficiencies inCanada’s healthcare systems. Understand-ing the opportunities and challenges to finda way forward is an important task, one that

was taken up by the Canadian AdvancedTechnology Alliance (CATAAlliance) andits Mobile Health Advisory Board(www.CATA.ca/communities/mhab/).

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TORONTO – As an entrepreneurwith a start-up company, you’reconfident you’ve got a great tech-nology and the potential to be-

come the next Facebook. All you need iscash, so you approach venture capitalists.

Often, the meeting doesn’t go well, de-spite your world-beating technology. Whydoes your pitch fall on deaf ears, and whatdoes it take to attract an investment from avencap company?

“I’m amazed at how many people dopresentations to us and haven’t researchedwhat we’re invested in,” said Scott Requadt,a partner with Clarus Ventures, of Cam-bridge, Mass. “They have a far betterchance of getting money if we have a part-ner who has worked in a related area. A lotdepends on finding the right person.”

Requadt was a panellist at the annualBloom Burton Healthcare Investor Confer-ence, held in Toronto in June. The two-dayevent attracts healthcare entrepreneurs andfast-growing companies in need of invest-ment, as well as venture capitalists, angelinvestors, lawyers and business consultants.

It is hosted by Brian Bloom, president,and Jolyon Burton, CEO. For its part,Bloom Burton offers an array of financialand consulting services to start-up and ex-panding healthcare technology companies,including direct investments and raisingcapital and financing with partners.

On the topic of what it takes to draw aninvestment from a vencap company, Re-quadt added that entrepreneurs must bepersistent and persuasive. “You need theability to turn one from a skeptic into anadvocate,” he said. “We’re data driven, andwe don’t want generalities.”

As well, he cautioned entrepreneurs:“Don’t bluff about what you don’t know,because we’ll figure it out. Be honest.”

Another panellist, Scott Weiner, a part-ner with Pappas Ventures of Durham,N.C., noted the importance of honesty andintegrity in gaining an investment. It’s notjust your technology and the know-how ofyour management team that the vencapcompany is evaluating. They’re also assess-

ing you and your colleagues on a personalbasis. “We get to know companies for overa year before we invest in them,” saidWeiner. “It’s like a marriage.”

To much merriment, he added that, “Amarriage in the U.S. lasts seven years –that’s about the time we hold a company.”

Weiner gave an example of the impor-tance that personality plays in an invest-ment. “A vaccines company pitched us lastweek, and at one point, their CEO dis-missed our questions as simplistic andunimportant. “Well, forget it, there’s noway we’re going to invest in that company.”

Healthcare conference shows entrepreneurs how to find investors

healthcare sector is one that has evolvedover time, with little system-wide design.As a result it contains many barriers –physician reimbursement models, regula-tory framework, budgetary constraints,procurement processes, information silosand privacy concerns, to name a few.

All of these factors add up to preservingthe status quo and hinder necessary change.

Every week, I read about an excitingmHealth application, device or accessorythat is brimming with promise. At facevalue they each present undeniable possi-bilities for improvement.

They all have a clear use-case, com-pelling patient benefits and a quantifi-able return on investment. So, with allthis innovation, where is the mHealthmomentum? The fact is, unless we havestructural change in our system, this in-novation, although interesting, will re-main irrelevant.

Fraser Edward is a Director at Telus Health,based in Guelph, Ont. He is also a member ofCATAAlliance Mobile Health Advisory Board.He can be reached on Twitter @FraserEdward


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M E D I C A L I M A G I N G

BY JERRY ZEIDENBERG

TORONTO – An advanced form ofmammography at the Joint De-partment of Medical Imaging isenabling radiologists to spotbreast lesions with more accu-

racy than ever before. That’s giving women abetter chance to fight breast cancer at anearly stage, when the success rates are muchhigher. It has also strengthened the Joint De-partment’s position as one of Canada’s lead-ers in the field of mammography.

“We’re here to bring innovation to ourpatients so that we can improve theirlives,” said Dr. Lawrence White, Radiolo-gist in Chief of the JDMI, which is madeup of the multi-site University Health Net-work, Mount Sinai Hospital, and Women’sCollege Hospital.

In particular, the organization has imple-mented three Selenia Dimensions tomosyn-thesis imaging suites, from Hologic, whichtake X-ray pictures of the breast and quicklyreconstruct the images in three-dimensions.(Hologic is distributed in Canada byChristie InnoMed Inc.)

3D imaging gives the organization’s 10breast imaging radiologists a better look atthe breast tissue than standard digital X-ray images – just as three-dimensional CTimages can provide a better view of certainbody structures than traditional, two-di-mensional X-rays.

But just to make sure they’ve got all thebases covered, UHN added new “C-View”software in May that enables the tomosyn-thesis machines to produce two-dimen-sional scans at the same time as the 3D im-ages are being taken.

That means the radiologists can scourboth the 2D and 3D images for tell-talesigns of cancer, without subjecting patients

to two sets of exams and the additional X-rays they would require.

“We’re reducing the radiation dose by 50percent, and at the same time, catching sig-nificantly more tumours,” said Dr. PavelCrystal, Divisional Head, Breast Imaging, atthe Joint Department of Medical Imaging.

The combined 2D/3D breast imagingtechnology is the first implementation ofits kind in Canada.

The Hologic Selenia Dimensions imag-ing suites were originally installed a fewyears ago. One of the machines wasrecently upgraded with the C-Viewsolution, a change that involvedboth software and hardware. Theinvestment was well worth it.

“We’ve had cases where we sawcancer, when we wouldn’t havewith standard mammography,”commented Dr. Rachel Fleming, abreast radiologist with the JDMI.

“There have been dozens ofthese cases,” added Dr. Crystal.

There are proven benefits to to-mosynthesis, Dr. Crystal said, re-ferring to studies showing thetechnology enables radiologists tocatch 33 percent more tumoursthan by using standard film screen or dig-ital X-ray mammography.

That’s tremendously important, as theearlier you can identify a tumour, the bet-ter the chances of treating it and keepingthe patient alive. So when it comes to to-mosynthesis, the JDMI physicians agreethe technology is the way of the future.

Indeed, radiologists and hospital man-agers from across Canada and around theworld visit the UHN to find out moreabout how tomosynthesis is implementedin clinical practice and how to use thistechnology to increase their cancer detec-

tion rate. One such example is an educa-tion course on tomosynthesis taught byDr. Supriya Kulkarni, Radiologist, JDMI,at the University of Toronto’s AdvancedImaging and Education Centre. This is theonly course of its kind in Canada.

Dr. Fleming also pointed out that to-mosynthesis reduces the call-back rate –the numbers of women who must returnfor another X-ray exam because some-thing wasn’t clear on the original image.Typically, 5-10 percent of women are

called back after undergoing a standardmammogram. “Tomosynthesis reducesthis recall rate by 15 percent,” she said.

Paul Cornacchione, Clinical Director,JDMI, noted this not only reduces anxietyin the women, who are frightened whenthey have to return for another X-ray, butit also improves patient flow at the hospi-tal. “It allows more throughput,” saidCornacchione. “You don’t need to takemore views.”

Dr. Fleming observed that tomosynthe-sis files are quite large, and reading a to-mosynthesis exam takes longer than a stan-

dard mammogram. “It takes double thetime, and maybe a little more,” she said.

Nevertheless, the additional time andeffort translates into identifying approxi-mately 33 percent more tumours than everbefore, sooner rather than later. “It’s wellworth the investment,” said Dr. Fleming.

The JDMI has 10 mammography ma-chines across its sites and aims to install to-mosynthesis upgrades on their mammounits at Women’s College and Mount SinaiHospitals in the near future; currently, the

three Hologic tomosynthesis suitesare all located at the Princess Mar-garet Cancer Centre.The JDMI conducted a total of58,785 mammography exams in2013/2014, of which 17,484 wereperformed at the Princess Margarethospital.The department’s 10 breast imagingradiologists are all skilled in interpret-ing both 2D and 3D images. In addi-tion to these highly specialized physi-cians, the organization also employs20 technologists in mammography.While the JDMI has surged to theforefront of mammography inCanada through the use of tomosyn-

thesis, it has a long history of leadership inthis area. “We went digital long ago,” com-mented Catherine Wang, executive directorof the JDMI.

“We had the first DR breast implementa-tion in all of North America, and we werethe first organization in Canada to be com-pletely digital for mammography.”

That leadership continues, said Dr.White, as the department has committeditself to pioneering personalized medicine– the application of genetic information,specific to an individual, to the treatmentof cancer and other diseases.

Trailblazers use tomosynthesis to improve the diagnosis of breast cancer

CT scanner at NYGH reduces wait times, improves outcomes

Medical imaging patients atNorth York General Hospital, abusy community academic

hospital located in Toronto, is the firstmedical centre in Ontario to implementSiemens’ SOMATOM Definition FlashCT scanner with Stellar Detector andEdge Technology.

Thanks to the system’s innovationsin CT technology, the hospital’s med-ical imaging team is better able to sat-isfy its own high standards of imagingquality while caring for a large numberof patients.

Each year the hospital sees more than200,000 medical imaging patients andperforms up to 30,000 CT scans. “Wecurrently have one of the lowest waittimes for procedures in the city, andwith the addition of the new SiemensSOMATOM Definition Flash CT scan-ner, we expect to further reduce thosetimes,” said Dr. Enoch Lai, radiologist atNorth York General Hospital.

The new CT scanner uses flash speedto capture even the smallest anatomicaldetails with up to 50 percent lower radi-ation and contrast dose using Siemens’unique Dual Source Dual Energy mode

to improve diagnosis and optimize treat-ment choices for patients.

The versatility of this CT scannermakes it ideal for disease screening anddiagnosis in a range of clinical applica-tions, including cardiology, neurologyand oncology.

Another patient benefit is the reducedneed for invasive diagnostic proceduresfor cardiac and stroke patients. Siemens’new scanner is capable of imaging thecoronary arteries, motion-free, in lessthan one to two cardiac cycles.

The pulmonary and coronary arteriesand the entire aorta can be imaged injust one scan. Now, instead of an inva-sive cardiac catheterization, patients canundergo a non-invasive diagnostic con-trast CT scan to diagnose cardiac prob-lems.

The trendsetting technology of thisinnovative SOMATOM Definition Flashcan facilitate 256 slices with 0.5 mmthickness per rotation for high-resolu-tion imaging, compared to the currentCT standard of 64 images per rotationand a scan thickness of 0.625mm.

“This technology allows us to handlemore complex exams, which means our

patients can book all of their scan ap-pointments at North York General with-out having to travel to different hospi-tals,” he said.

“The design of the scanner can alsoaccommodate larger or very tall patientswithout compromising speed and diag-nostic certainty. This enables the imag-

ing team to support the needs of all pa-tients in our community.”

The SOMATOM Definition Flashprovides fast coverage – the patient canbe scanned from chest to pelvis in as lit-tle as 1.5 seconds. Sharper images andreduced motion blur leads to clearer im-ages and more accurate diagnoses.

“It also means our patients don’t need

to hold their breath, as is necessary witholder machines, which makes the wholeexperience much more comfortable andless intimidating. This is particularlyideal for claustrophobic or anxious pa-tients,” said Dr. Lai.

As a result, there is shorter prep timeneeded with the patient, and the need torepeat exams is reduced. In addition toagitated or anxious patients, the newsystem also helps in the case of criticallyill patients, who have trouble holdingtheir breath, and with children who mayhave difficulty limiting their motionduring a scan.

These advances mean patients spendless time inside the scanners, givingthem a better overall experience and al-lowing the medical imaging team to seemore patients.

Jim Graziadei, Senior Vice President,Healthcare at Siemens Canada, sharesDr. Lai’s enthusiasm: “Siemens’ uniqueand innovative technology delivers anoutstanding return on investment withsuperior image quality, the lowest doseand outstanding workflow. The systemprovides both exceptional patient careand improved outcomes.”

Breast radiologists and technologists at the JDMI, downtown Toronto.

Dr. Enoch Lai, radiologist and CT Director at NYGH.

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BY VICKI FORDE

We’ve all been to hospitalsand heard the constantsounds of beeps and tones –which hospital nurses hear

all day long. Ventilators, infusion pumpsand blood pressure monitors are just someof the several hundred alarms per patientper day, which are causing alarm fatigue.

These are the beeps, rings and tonesthat come from different monitors and de-vices attached to patients. The alarms maybe real or false, but these life critical alarmscannot be ignored.

Over time, hospital caregivers becomedesensitized and overwhelmed by thenoises – a dangerous situation, as a pa-tient’s life could be at risk.

In the United States, The Joint Com-mission, which accredits U.S. hospitals andother healthcare organizations, has issueda sentinel event alert to hospitals about theneed to reduce “alarm fatigue” related toalarms set off by monitoring devices. Thisterm refers to situations in which clini-cians ignore or turn off the alarms thatthey find irrelevant or annoying.

Factors that contribute to alarm-relatedsentinel events include:

• Alarm fatigue – the most common con-tributing factor

• Alarm settings that are not customized tothe individual patient or patient population

• Inadequate staff training on the properuse and functioning of the equipment

• Inadequate staffing to support or re-spond to alarm signals

• Alarm conditions and settings that arenot integrated with other medical devices

• Equipment malfunctions and failures Since 2007, ECRI Institute has reported

on the dangers related to alarm systems. Inits annually published “Top 10 HealthTechnology Hazards” list, clinical alarmconditions consistently appear as the firstor second most critical hazard, reflectingboth the frequency and serious conse-quences of alarm-related problems.

In addition, the U.S. Food and DrugAdministration’s (FDA) Manufacturer andUser Facility Device Experience (MAUDE)database reveals that 566 alarm-related pa-tient deaths were reported between Janu-ary 2005 and June 2010, a figure that isconsidered by industry experts to under-represent the actual number of incidents.

Alarm fatigue also occurs when a truelife-threatening event is lost in a cacoph-ony of noise because of the multitude ofdevices with competing alarm signals, alltrying to capture someone’s attention,without clarity around what that someoneis supposed to do. It is compounded by in-consistent alarm system functions (alert-ing, providing information, suggesting ac-tion, directing action, or taking action) orinconsistent alarm system characteristics(information provided, integration, degreeof processing, prioritization).

Patients also experience alarm fatigue,as they are unable to rest with the multi-tude of alarm tones going off within theirroom.

Direct messaging and calls to staff havepractically eliminated the need for over-head paging and noise. Implementing aquiet, healing environment has proven to

result in healthier and happier patients.Alarm fatigue is a system failure that

results from technology driving processesrather than processes driving technology.Austco Communication Systems, aworldwide provider of IP Nurse Call So-lutions, uses mobile communication to

eliminate the need for alarms to bebroadcasted throughout the hospitalfloor or unit.

For example, when a patient presses thenurse call button for assistance, a notifica-tion is automatically sent to the assignednurse/caregiver’s mobile device. The noti-

fication includes the call location and typeof call allowing staff to respond to the callquickly and efficiently.

Vicki Forde is a Marketing and Communi-cations Specialist for Austco Communica-tions, North America. www.austco.com

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BY DR . JOSHUA LIU, BSC, MD

Most people who have worked inthe Canadian healthcare sys-tem have undoubtedly sharedthe same ‘eureka’ moments onthe impact digital health couldhave on improving patient

care while reducing costs.The transition from paper documents to Electronic

Medical Records and Computerized Physician OrderEntry (CPOE) were seen as significant milestones formany health care organizations, although even someof our “leading” organizations today still lag behind inthis regard. Sometimes it feels as if our health care sys-tem is waiting for everyone to catch up before takingadvantage of new digital health solutions.

All the while, three key trends in the past few yearshave created an unprecedented opportunity to radi-cally improve healthcare delivery:

• The explosion of mobile, wireless and wearabletechnologies

• The transition from fee-for-service to value-basedhealthcare

• The decreased barrier to entry for startup compa-nies and increasing private investments in healthcareinnovation

From improved patient-self management usingmobile health (mHealth) applications to remote pa-tient monitoring using wireless technologies, thereare a growing number of digital health solutions thatcan support high quality care at scale for our grow-ing population.

While the U.S. has unique healthcare problems ofits own, they are certainly ahead of Canada in devel-

oping, testing and adopting digital health innova-tions. When you compare the Canadian digitalhealth landscape to the American one, it’s almost asif Canada is in an entirely different universe.

So why is this concerning?There is growing evidence that many of our

costs and adverse outcomes are preventable. Butthe old way of requiring a healthcare professional

to do everything is simply not scalable, and we’remissing an opportunity to deliver safer, more effi-cient care at scale.

Upon reflection, there are several factors con-tributing to the limited adoption of digitalhealth solutions in Canadian healthcare.

Fragmented system: In Canada, the way inwhich hospitals are governed ranges from a sin-gle health authority in Alberta to multiplehealth authorities in Ontario, al-though it can be confusing as to

how much authority these organizations actuallyhave. In contrast, most hospitals in the U.S. are partof a hospital system or network, often owned andoperated by a central organization.

Fragmented system = low diffusion of innovation.With most Canadian hospitals operating indepen-dently, even if an innovation is proven and adoptedat one hospital, there is no inherent framework or in-centive structure for such an innovation to spread toother hospitals.

Conversely, the successful adoption of an innova-tion at one hospital in a large U.S. hospital system(which can be as large as 100 hospitals) is often usedas a case study for the rest of the hospitals in the sys-tem to also adopt the innovation. This is becausesuch systems are owned by a central body, which hasthe authority and incentive to scale successful inno-

vations to its other hospitals.Fragmented policies on personal health

data: Related to Canada’s fragmentedsystem are our fragmented policies onhow we collect, store and disclose per-sonal health information. Not only canthese laws vary from province to

province, hospitals within a singleprovince often have varying policies of

their own.Both within and across provinces,

we need a more unified set ofguidelines and methods ofapproval. Healthcare organi-zations and companies bothwaste time and money everytime an innovation’s privacy

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We should look more closely at the U.S. experience and follow their lead.

The digital dilemmain Canadian healthcare

Dr. Joshua Liu is co-founder and CEOof SeamlessMD, a Toronto-based com-pany that has produced a computer-ized, wireless solution for trackingand supporting pre-op and post-oppatients. For more information,see: www.seamless.md

When you compare the Canadian digitalhealth landscape to the American one,it’s almost as if Canada is in an entirelydifferent universe.

How to reward excellence among healthcare professionals?

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

BY DOMINIC COVVEY

Excellence. We say we strive forexcellence, that we focus ourstudents on excellence or that

we expect excellence. But what doesexcellence mean in the field ofeHealth?

What is excellence?The dictionary tells us that ex-

cellence is the quality of being out-standing or extremely good. Excel-lence is a state of extreme merit, astate of superiority where one hasexcelled.

I guess one question is: can werecognize excellence when we see it?I think that seeing excellence re-quires a ‘lens’ and a filter. The lensamplifies what is classed as ex-tremely good and the filter attenu-ates or eliminates the dross or unim-portant details.

In order to recognize excellence,we need unambiguous criteria. Each

of us must learn and internalizethese criteria to tune our perceptionto recognize true excellence in our-selves and others.

How do we recognize excellence?As a society, we feel the need to

recognize good work. There are a va-riety of awards that purportedlyidentify individuals and their work asbeing good. Some fields have awardsthat are widely accepted as indicativeof one’s achievement of the pinnacleof performance. The Nobel Prizeserves this purpose. Everyone recog-nizes a Nobel Prize winner as havingachieved the state of excellence. Inmathematics, the Fields Medal doesthe same thing. Computer Sciencehas the Turing Award and someother disciplines have prestigious in-dicators. All of these sing out thegreatness of their recipients.

Excellence is not only recognizedin matters of intellect, but also inmatters of action. The Congressional

Medal of Honor in the U.S. recog-nizes that a soldier has distinguishedhim/herself conspicuously by gal-lantry and intrepidity at the risk ofhis/her life, above and beyond thecall of duty. The key words in this

case are theconcepts of therisk taken andthe idea of be-ing above andbeyond duty.This award isoften bestowedposthumously,consequently.So we havesome defini-tions of excel-

lence both for intellect and for action.What are the criteria for

excellence?Awards like these set a very

high bar. Are there other levels of excellence?

A while ago, a friend and I dis-cussed writing an article on excel-lence in eHealth. The article in handis intended to be a start on that. Weweren’t thinking of excellence at theNobel and Medal of Honor levels,but rather of a more day-to-day levelof excellence, yet one that would beremarkable and worthy of celebra-tion. What would that level of excel-lence look like in our field?

Consider some of the followingpossibilities as potential indicators ofa performance that would be widelyacclaimed as being excellent:

• Achieving a degree, diploma, cer-tificate or other formal credential“with distinction”. This means thatone achieves all of the endpointsexpected, but goes that extra kilo-meter to differentiate oneself fromthe crowd.

• Developing and or implementinga system that goes beyond user satis-



Dominic Covvey


V I E W P O I N T

As healthcare systems continue todemand simultaneous improve-ments in both client outcomesand organizational productivity,

the use of technology to deliver and man-age client care has become a fundamentalbusiness element.

In the community care setting, the shiftto electronic point-of-care solutions isparticularly evident as providers increas-ingly place mobile devices in the hands ofclinicians and aides to facilitate effectivecare and quickly create required documen-tation of services. Recently, the quality ofcommunity care services has been furtheradvanced by mobile technology solutions.Mobile solutions have advanced to notonly collect data, but to instantaneouslyuse the data to improve operational andclient outcomes.

Michael Wons, President & CEO ofCellTrak Technologies, a leading mobile so-lution innovator in healthcare, was asked toexplain how mobile solutions can improveoutcomes for client and operations.

“In an environment where patient careand improvement is front and centre, andwhere provider agencies are going paper-less, CellTrak has worked with the indus-try to develop easy to use new features.Alert driven management, care coordina-tion and outcome management are thethree major components in a successfulmobile implementation.”

Alert Driven Management: Alert Dri-ven Management sends targeted, action-able alerts via email and text to agency of-fices, providing real-time insight into theimportant details of any visit. Operational,clinical and system alerts deliver intelli-gence from the field which the agency canimmediately act upon to ensure optimalcare delivery and resource management.

Types of alerts include: employee un-derperformance details, workforce sched-uling challenges, travel time and mileagereduction opportunities, staff safety issues,and device and data security.

Care Coordination: Care Coordinationsolutions enable home care providers todispatch the right person at the right timefor needed care. By leveraging the inte-grated GPS features of the solution, anagency can more efficiently match eachclient’s care requirements with the skill setsof available staff. When care managementteams are able to rapidly deploy the near-est field staff members with needed skillsto deliver vital care, when and where it isneeded, clients and payers alike will bene-fit from improved outcomes.

Outcome Management: The third fea-ture of mobile platforms is the OutcomeManagement solution. This feature en-ables agencies to better manage client carethrough access to real-time data. Informa-tion gathered in a uniform manner andshared among the members of a multi-dis-ciplinary care team provides a comprehen-sive and continuously updated view ofeach client’s condition and supports deci-sions to adjust care plans and/or escalateinterventions.

Real-time data contributes to bettercare coordination, improved planning forfuture care and reduction of unnecessaryhospital admissions. By focusing staff re-sources on the interventions that will

yield the greatest results, Outcome Man-agement improves client wellbeing, im-proves operating results and elevatespayer satisfaction.

Sharon S. Harder, President of C3 Advi-sors, LLC, a company which specializes inproviding operational, financial and hu-

man resources assistance to post-acute andcommunity care providers throughout theUnited States and Canada, was asked howto optimize a technology investment.

“Addressing a business’s pain points andopportunities for productivity improve-ment through the introduction of new

technology requires a careful review ofprocesses and procedures to ensure they arealigned with the new system’s functionality.

“Neglecting this important step in theimplementation process almost certainlyguarantees that old problems will simplybe replaced by new ones.”

How to maximize the effectiveness of a community care organization

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N O V E M B E R / D E C E M B E R 2 0 1 4 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y 1 7h t t p : / / w w w . c a n h e a l t h . c o m

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2015 could be a breakthrough yearin Canada as a handful ofhospitals prepare to be the

first in the country to reach Stage 7 on the ElectronicMedical Record Adoption Model (EMRAM), abenchmarking scale developed by HIMSS Analytics,a subsidiary of the U.S.-based Healthcare Informa-tion and Management Systems Society (HIMSS).

Others anticipate a quantum leap from Stage 3 to6 following successful implementation of computer-ized physician order entry (CPOE), often consideredone of the major stumbling blocks to obtaininghigher EMRAM scores.

In fact, improving scores is now high on the hos-pital IT agenda across the country, says Jim Shave,president, Cerner Canada, a supplier of healthcareinformation technology systems.

“I can think of several instances over the last yearwhere we have been asked to sit down withclients and help them map out what it takes toreach HIMSS 6 or 7, and where they stand to-day,” says Shave. “There’s a recognition thatyou’re doing good things as you climb up thisadoption scale.”

The EMRAM is an eight-step process de-signed to help acute-care healthcare organiza-tions track their progress as they move forwardwith electronic medical record adoption strate-gies. Each stage depicts a certain level of func-tionality and deployment, and organizationscannot move up a step until all criteria in thestage are met.

Compare American scores to Canadianscores and one of the first notable findings isthat the largest portion of U.S. hospitals are atStages 3 to 5, whereas most Canadian hospi-tals fall somewhere between 1 and 3. Canada isalso still awaiting its first Stage 7 result, whileroughly 3 percent of U.S. hospitals are alreadythere, with another 15 percent close behind.And, the number of U.S. hospitals meetingcriteria for Stages 5, 6 and 7 has been steadilyrising since 2011 while Canada’s growth re-mains relatively flat.

At first glance it appears Canada is laggingbehind. But what do EMRAM scores actuallysay about the ongoing journey towards the dig-ital hospital of the future?

John Hoyt, executive vice-president, HIMSSAnalytics, would argue there’s room for Cana-dian governments – provincial or federal – totake a more active role in pushing things along usingincentives. He attributes the recent spurt in U.S.achievement to the American Recovery and Rein-vestment Act (ARRA) program, which outlines a setof “meaningful use” criteria which organizationsmust meet in order to receive government funds.

“Our argument is we think the stimulus programhas worked,” he says.

But in Canada, the push towards automation hasless to do with incentives, competition and scoringand more to do with measuring outcomes and shar-ing. That often makes it difficult to apply the U.S.-developed EMRAM as a benchmark to gauge overallprogress, comments Don Newsham, CEO ofCOACH, Canada’s Health Informatics Association.

“Here in Canada, we need a broader and moreCanadian-focused set of adoption and maturity mod-els to really understand how we’re making progress,”

says Newsham. “We’re very supportive of hospitalsmoving in the direction of higher EMRAM scores …but the importance is the linkage, integration andconnectivity to all other components in healthcare.”

In February 2013, COACH published a white pa-per entitled Canadian EMR Adoption and MaturityModel: A Multi-Jurisdiction Collaborative and Com-mon EMR Adoption & Maturity Model. The reportgathered input from B.C., Ontario, Manitoba and Al-berta to propose a uniquely Canadian maturitymodel that divides measurements into three areas:functionality, breadth and outcomes. It also exam-ines integrated care and population impact, two pri-orities as Canada moves towards “personalized, pa-tient-led, participatory healthcare,” says Newsham.

“It’s not about getting to a certain level, it’s aboutusing technology to the greatest ability and opportu-nity you have available to you,” says Newsham. “EM-

RAM simply provides a measuring stick to helpdemonstrate where you are on that journey, but theimportance is the journey. Does a hospital say, ‘I’mStage 7; I’m done’? Absolutely not. Because the use ofdigital solutions and the opportunities to use tech-nology to the benefit of patient and provider areever-changing.”

According to HIMSS Analytics data, the five hos-pitals in Canada successfully demonstrating Stage 6functionality are: South Okanagan Hospital in B.C.,and North York General Hospital, Markham Stouf-fville Hospital, St. Michael’s Hospital and OntarioShores Centre for Mental Health Sciences in Ontario.

When North York General Hospital (NYGH)learned it had achieved Stage 6 back in 2011, thenews was “a pleasant surprise,” says Chief MedicalInformation Officer Dr. Jeremy Theal. “Our focuswas never the HIMSS Analytics scale. We embarked

on our e-Care project in 2007 to improve the qualityand safety of patient care; the EMRAM was not aspecific goal.”

Fast forward to today and NYGH now anticipatesachieving Stage 7 during its 2014-2018 eHealthstrategic planning period. The biggest difference isthat Stage 1-6 functionality only needs to be demon-strated in one clinical unit, whereas Stage 7 function-ality must be demonstrated hospital-wide, with dataexchange taking place outside of the four walls of thehospital, as well.

Stage 7 functionality also encompasses a longitu-dinal electronic medication administration record(eMAR), so that all medications are discretely docu-mented in the eMAR, including those given by ananesthesiologist during surgery. In addition, it entailsuse of business intelligence systems that actively ex-

tract and analyze data to inform decisionsand improve systems.Though the spirit of HIMSS 7 is a‘paperless’ hospital, Dr. Theal prefersto keep the focus on patient out-comes versus degree of automation.He’s also a firm believer that strongsystem design based on clinician in-put, workflow analysis, evidence-based principles and well-structureddata is the real differentiator, regard-less of the EMRAM stage. “I try to shift the conversation awayfrom words like automation and pa-perless and switch it more to deci-sions and outcomes, because I thinkthat’s where the real value is,” he says,noting that the emphasis at NYGH isalways placed on quality and safetyfirst. “Although we are happy to be atStage 6, there are some limitations inthe model because it doesn’t really fo-cus on patient outcomes, which iswhere we prefer to evaluate and im-prove on our performance.”University Health Network in Torontois also building its EMR adoptionstrategy around patient outcomes. In2011, senior Vice-President and CIOLydia Lee outlined the hospital’s goalof achieving Stage 6 on the EMRAMscorecard. After more than two yearsof planning and due diligence, UHN isready to move forward with a transfor-

mation project to replace a myriad of best of breedsystems with one enterprise-wide system. The pri-mary driver behind the hospital’s ambitious plan isbetter documenting and tracking of outcomes, andthat relies on better tools for discrete data capture.

“For us, the Holy Grail is being able to have infor-mation captured about our patients and the way wetreat our patients, and then tie that to good outcomeinformation so we can always understand what weneed to do to continuously improve,” explains Lee.

UHN currently scores near 4.75 on the EMRAMbenchmark. Although there are pockets of technol-ogy in use throughout the hospital that match thefunctionality laid out for higher EMRAM stages, it’snot yet pervasive or comprehensive enough toachieve a Stage 6 or 7 score, and won’t be until thetransformation project takes places, she adds.

“One of the challenges is that the project to rip

While Canadian hospitals currently score low, they may fare better with an upcoming HIMSS model.

Hospitals are seeking to improve theirEMRAM scores with new clinical systems

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out and replace your system is very expen-sive,” says Lee, noting that it’s much harderfor Canadian hospitals to make a financialcase. “I don’t have that stimulus fundingout there for me to grab. I have to makemy case truly on clinical outcomes andwhat’s in it for the hospital in terms of im-proving efficiencies.”

There is literature to suggest a correla-tion between better outcomes and pro-gression up the HIMSS scale. What’s inter-esting to note, says Hoyt, is that the “bigpayoff” comes at Stage 7 when all of thecriteria are met. There are small, incre-mental improvements from Stages 1-5, butthe more notable improvements start atStage 6 and increase exponentially at 7.

“So the message is, it takes the whole kitand caboodle to begin to drive quality, safetyand efficiency improvements,” he says.

But that doesn’t mean Canada is under-performing or under-achieving simply be-cause the majority of its hospitals are scor-ing in Stages 1-3. Many Canadian hospitalsalready have CPOE and Closed Loop Med-ication Management systems in place; yet,they can’t score higher on the EMRAMscale because they haven’t tackled nursingor clinical documentation. As soon as theydo, they will jump from Stage 2 to 6.

“Our advice is this is the typical mannerin which a hospital progresses up thesestages, but it’s not everybody,” says Hoyt.

Stage 4 in particular stands out as a ma-jor stumbling block in Canada. Accordingto Cerner’s Shave, the major hurdle isthroughput. Implementing CPOE intro-duces workflow changes that have a ten-dency to slow things down and it oftentakes as long as six months before im-provements can be measured. “Despitebetter quality, better safety and better out-comes, at the end of the day they’re notgetting the throughput they’re accustomedto,” he notes.

When UHN adopted CPOE nearly adecade ago, it changed the entire practicedynamic, says Lee. Prior to CPOE, doctorsissued verbal orders, nurses took note,placed the order at pharmacy and then ad-ministered it. Now, physicians place elec-tronic orders that go directly to pharmacyfor verification.

HIMSS Analytics recently intro-duced a Continuity of CareMaturity Model, now in pilotstages and slated for launch

early next year. Intended as a roadmap tohelp hospitals reach the goal of a “true in-terconnected healthcare delivery model,”it’s expected to be the guideline for whatcomes next, after EMRAM Stage 7.

Beyond EMR adoption, the Continuityof Care model examines interoperability,information exchange, care co-ordination,patient engagement and analytics – all ofwhich are top priorities in Canada – andCanadian hospitals are poised to score bet-ter than their U.S. counterparts, says Hoyt.“We’re too competitive (in the U.S.) andwe’re paying a price for it,” he says.

Once published, Hoyt expects Canadato score well on the Continuity of Caremodel, particularly in those provinces thathave established regional health authori-ties and laid the ground work for integrat-ing regional care, primary care, home careand community care.

One example of collaboration is theConnectingGTA project in Ontario, an ef-

fort between the Ministry of Health andLong-Term Care, eHealth Ontario, CanadaHealth Infoway, UHN and the five LocalHealth Integration Networks in theGreater Toronto Area. The project will en-able 700 service providers to securely sharepatient health information so that patientsreceive more co-ordinated care.

Another is Island Health’s One Record,One Patient, One Plan for Health and Care

strategy in B.C., based on an integratedelectronic health record strategy and anenterprise system from Cerner. As part ofits alliance with Cerner, the health author-ity is looking to integrate lab results, pre-scription history, information from com-munity care clinics, medical images, nota-tions and other relevant health informa-tion into a shared digital file.

“When you want to address maturity of

use and how well you are using the digitalhealth solutions that are in place today, ittakes a broader perspective of maturitymodels to do that kind of measurement,”notes COACH’s Newsham. “I’ve alwayssaid we will really have arrived at the levelof strong adoption and use when patientdemand is the driving factor for the use ofdigital solutions. I believe we are right atthe cusp of that.”



BY DR. MARK ANSERMINO

VANCOUVER – We’re on theverge of a wave of new solu-tions in global healthcare thatwill be the result of innova-tions in three key areas: tech-

nical, social, and business innovation. These segments overlap, but the most

influential innovation is likely to be inbusiness. We need business models thatwill ensure healthcare can be affordable foreveryone, everywhere. Innovation at scalewill bring about the democratization ofhealthcare, enabling all people to accessthe care they need.

Predictive healthcare: Innovative mod-els of delivery are required for healthcareto be affordable and accessible – even indeveloped countries such as Canada. Bysupporting and embracing new modelsthat are being pioneered in the developingworld, such as mobile health (mHealth),we can ensure a sustainable healthcare sys-tem for our children.

Technology innovation will enable us tobuild affordable mHealth applications thatwill deliver the power of predictive health-care. The key is to provide lifesaving inter-ventions before a patient’s condition be-comes critical.

Technology solutions can overcome thecurrent barriers to accessing healthcareservices that include diagnosis, triage,transportation and treatment. In many re-mote and low-resource areas, mHealthapps and sensors will enable communityhealth workers with limited training tomake sophisticated lifesaving decisions.

Mobile impact: Virtually everyone,everywhere has a mobile device that could

be used to deliver mHealth solutions. We arealready seeing a major impact on the deliv-ery of global health services and programsupport with text messages and electroniceducational materials. This needs to be ex-tended and enhanced to include diagnosisand treatment of a wide range of clinicalconditions. This can be done with wide-spread use of mobile medical sensors.

A medical sensor is an electronicmedical device that is able to mea-sure one or multiple specific physi-cal properties of your body. Thiscould include temperature, bloodpressure, blood oxygen level (oxy-gen saturation), activity level, sleepquality and duration and airwayflow, for example.

These sensors are routinely usedduring anesthesia and critical carein hospitals in high-income coun-tries. Mobile health devices equippedwith smart sensors can be used tobridge the gap in the availability ofclinical experts, ensuring that pa-tients who live hours, or even days, awayfrom healthcare can receive timely lifesav-ing interventions.

Global health: As an anesthesiologist, Ihave seen that innovative sensor technology– such as pulse oximetry – has supportedimprovements in the safety of children inmy hospital. This technology could alsohave a tremendous impact on a global scale.

In low-resource areas, many clinics –even hospitals – don’t have pulse oxime-ters. If they were available in every operat-ing theatre and every emergency room,thousands of lives would be saved. Mil-lions more could be saved if pulse oxime-ters were provided to frontline healthcare

workers around the world. The problem isthat they’re too expensive.

In the developing world, detecting riskcan be a lifesaver: it provides precious timeto ensure the required intervention can begiven. For example, we have pioneered theuse of oxygen saturation as a tool for iden-tifying women and children at risk of life-

threatening complications of diseases suchas pre-eclampsia (high blood pressure inpregnancy) and pneumonia.

In recent research, we have clearlydemonstrated that the measurement ofoxygen saturation will identify 20 percentmore women at risk of developing thecomplications of pre-eclampsia when usedin addition to other clinical signs andsymptoms. We are currently testing this in-tervention in a rigorous randomized trialwith over 20,000 women in four low- tomiddle-income countries supportedthrough the Bill & Melinda Gates Founda-tion and the Sensor Project. (See www.the-sensorproject.org)

The pulse oximeter sensor is easy to use:a SpO2 reading of less than 90 percentmeans the person is sick enough to requiremedical attention. That means communityhealth workers, with minimal training, willbe able to administer medications and referwomen and children to clinics or hospitals.

Healthcare at home: For people inCanada, a pulse oximeter couldalert them to the need to call theirdoctor or go to the ER. This wouldwork well for everyone, especiallypeople in rural or remote areas. Inthese instances, it could providecritical medical data to physiciansin clinics or hospitals that arethousands of kilometres away. In the near future, I believe thatevery Canadian household willhave a blood pressure cuff, apulse oximeter and a thermome-ter – perhaps even an ECG orother vital signs monitors – intheir medicine cabinet. All ofthese sophisticated medical de-

vices will be inexpensive sensors that pluginto a smartphone or other mobile device,and are powered by apps.

The potential for these app-devices istremendous. It is the foundation for indi-vidual predictive healthcare, which is thehealthcare model of the future.

J. Mark Ansermino, MBBCh, MSc (info),FFA, FRCPC is an Associate Professor in theUniversity of British Columbia’s Depart-ment of Anesthesiology, Pharmacology andTherapeutics; a pediatric anesthesiologist atBC Children’s Hospital; and the Chief Med-ical Officer at LionsGate Technologies Inc.(LGTmedical) in Vancouver.

Innovation for the developing world leads to cost-effective solutions

Virtual patient visits, via video and telehealth 2.0, provide benefitsBY MICHAEL SMIT

Canada has seen significant effortsin telehealth, most notably per-haps with OTN and BC Tele-

health. These, and other solutions acrossthe country and around the world,might be deemed “telehealth 1.0”. Thecharacteristics of these solutions includeexpensive hardware, fixed endpoint solu-tions (telehealth locations), fat clientsoftware architecture, and more oftenthan not, costs that far exceed returns.

Our Canadian catalyst for innovationmight be the charge to “Telehealth 2.0”,where we seek solutions that do notcarry these characteristics or limitations.Another consideration is the ubiquity ofpersonal and mobile computing.

We have an aging population, withouta doubt. What we also have is a learningpopulation. Canadians of all ages are ex-ceptionally well connected and adept withtechnology that permeates their lives.

With that connectedness and level ofsavvy, Canadians are seeking support fortheir health online, without expert guid-ance as to what is appropriate or not.More so than any other sector, it is ab-solutely necessary for the human factorto be a part of virtual healthcare.

One to one care from a practitioner isimperative to be able to properly inter-pret the signs of the human body, mind,and spirit. So the catalyst for connectedhealthcare might be to ensure we aremeeting Canadians with the solutionthey require to fit their lives.

Access to care, and the lack thereof, isand will continue to be a catalyst. As thebreadth of specialization continues to ex-pand, smaller communities, the elderly,infirm, and young families will continueto find it harder to gain access to the fullcircle of care that is available to the flexi-ble, mobile, urban population.

Virtual practitioner visits can go a longway to solving this issue. We have heardof significant gains in health managementfrom elderly communities on VancouverIsland who now have greater access totheir nephrologists and gastroenterolo-gists, allowing for more timely and mean-ingful follow-ups and checkups.

And this is where online doctors’ vis-its start to introduce a world of poten-tial. What we’ve observed is that anepisodic, single visit online between apatient and doctor has benefits mostlylimited to that specific consult. But, aswe have observed, when patients anddoctors continue to maintain parts of

their relationship through Medeo’s soft-ware, the value of each resulting interac-tion becomes that much stronger.

The continuous record of any notes,activities and care plans related to theconsultation are securely stored on thepatient’s file. These notes and details be-come accessible to any other practition-ers that are introduced to work on thispatient’s chief complaint. Any updates to

the file become instantly available to theentire circle of care working on the case.

Consider that every secure medicalvisit conducted virtually can be automat-ically codified and attached to the patientrecord, and even to an aggregate view ofother criteria such as disease state. Thepotential for a greater understanding ofclinical pathways and outcome measure-ment is tremendous. Unfortunately adeeper dive into that potential would ex-haust this article’s word count.

Perhaps most interesting, is that when

the tool of care is creating the record ofcare, the patient always has immediateand secure access to his or her care plan,through any connected device includingthe smartphone in their pocket.

Adherence instructions in a digitalworld are never subject to being mis-placed or thrown out, as is often the casewith paper notes. And practitioners canseamlessly and quickly create new virtualappointments with their rostered pa-tients once they observe any milestonesor progress indicators in the patient’sonline file.

Certainly, not all types of care can behandled or managed through a secureonline visit. Thought leaders in telemed-icine suggest the figure to be between 20percent and 50 percent of today’s pri-mary care. Anecdotally, at Medeo wehave been told of a ten-year dermatolog-ical issue being referred from a GP to aspecialist and resolved within four hoursthrough secure video consults, as op-posed to many months of waiting forthat referral where geography and clinicwait times are constraints.

Michael Smit is the COO of Medeo,Canada’s leading direct to patient virtualcare solution provider.

Leaders in telemedicinesuggest that 20 to 50 percentof patients could benefitfrom online doctor visits.

The use of innovative medical sensors can save lives around the world.



BY AHMAD ZBIB, MD

Oct 11, 2020. It’s 5:45 am. Myalarm goes off and I wish itdidn’t. It has been harder towake up despite my going to

bed earlier than usual. I reach out for myphone to upload the data from my Air-SyncPillow 3000, which I purchased twoweeks ago as recommended by Dr. Johns.

Today is the day I send my two-week logfile to Dr. Johns to help him make his finaldiagnosis. Alas, I look at my sleep patterndata and it confirms how I feel – it indi-cates restless sleep activity. I’m really notlooking forward to being diagnosed withsleep apnea, but at least I know there issomething I can do about it. I put my feetdown and that recognizable voice on myphone asks, ‘Would you like me to turn onyour coffee machine?’ How can I say nothis question?

I put my slippers on and walk to theshower as I hear the coffee maker grind thebeans and start perking away. At about thesame time, my shower radio turns on,playing oldies from the last decade.

Technology is finding its way into ourlives. The smarter our phones and their ac-cessories get, the more indispensable theybecome. And if you are like me, technologybecomes an indispensable extension ofyour body.

Nowadays, there seems to be quite theinterest in ‘wearables’. Wearables areminiature electronic devices that are wornunder, with or on top of clothing, usuallyfor the purpose of capturing objectivemeasures such as steps taken, body tem-perature, heart rate and much more.

Most recently, a new category hasemerged: the ‘ingestibles’, miniature elec-tronic devices and as the name indicates,they are ingested. Once inside the body, theycan capture information and relay it back toexternal devices. Such devices include Pro-teus Digital Health’s pill-embedded sensors,which track medication adherence.

Be it wearables, ingestibles or a new cat-egory that will likely emerge by the timeyou are reading this, these technologicaladvances are already shaping the wayhealthcare is being delivered. Although theimpact is more visible amongst the earlyadopters of both patient and healthcareprovider groups, it is only a matter of timebefore the rest follow suit.

These gadgets will also have an impact onthe way we train our future medical/clinicalprofessionals. Earlier this year, UC IrvineSchool of Medicine announced that theywill be implementing Google Glass as partof their curriculum and that is just the be-ginning. Google is currently projecting tosell over 21 million units of Google Glass in2018 and healthcare is expected to get a fairshare of the pie. Also, virtual reality acces-sories such as the Oculus Rift are already be-ing used to train surgeons and to practicebefore sensitive procedures.

A digital health geek like me can go onand on talking about the different kinds ofdevices in the market, but let’s get serious.The multi-billion dollar question here is:why should we care?

If you are an executive at any health-care organization and this is not on yourradar, I’ve got advice for you: it should!

Consumers and patients are adoptingwearables – including watches and otherdevices – that are giving them a tremen-dous amount of information. Combinedwith the information they can find on theweb, they will have more challengingquestions for your doctors, nurses and

other clinicians. What’s more, other or-ganizations will start to incorporate thedata from wearables into electronichealth records – if you’re not aware ofwhat others are doing, you risk becomingobsolete!

We often hear of doctors and nurses

building apps by leveraging the help ofentrepreneurs and business incubators,and many of their offerings are actuallyquite useful. It’s important to stay on topof new developments, so that your ser-vices remain relevant.

The wearables revolution is coming: Are you ready to try it on for size?



ing a freedom to operate opinion (FTO).An FTO provides independent legal con-firmation that the intellectual propertyrights encompassed by the supplier’s prod-uct are valid, and as to the scope of accept-able use that will not expose the hospital orservice provider to an unacceptable risk ofpatent infringement.

• Consider your insurance options. Doesyour organization’s insurance coverage in-clude coverage for errors and omissionsand potential liability for intellectual prop-erty rights infringement. If it does, whatare the parameters of that coverage andwhat back-up support do you need from

your prospective suppliers. Also, is yourcoverage enough, taking into considera-tion that you might expose your organiza-tion’s budget to infringement claims andhave to replace the offending equipmentor system?

• Prospective vendors should provide aminimum threshold of errors and omis-sions and intellectual property right in-fringement insurance, and your organiza-tion be identified as a named insured onthat policy. Remember that the cost of de-fending a patent infringement lawsuit willvery quickly eat into the overall insurancepolicy coverage available to you.

• A fulsome indemnity obligation from theprospective vendor should also be a baselineRFP requirement. However, recognize thelimitations of indemnities. While they are a

good adjunct to other protective measures,they are not a panacea. Indemnificationclauses are merely contractual so the scopeof protection they provide is dependent ontheir drafting and the financial status of theindemnifier at the time the indemnity is

called upon. Recent history has shown usthat even blue chip corporations can be ren-dered insolvent in challenging economictimes, leaving other companies in their sup-ply chain to shoulder burdens previously the

subject of indemnification clauses. In ap-propriate circumstances, consider support-ing indemnity obligations from third partyvendors with performance bonds or thirdparty guarantees (including guarantees ofperformance from parent companies).

Recognize that being drawn into apatent infringement lawsuit is an expensiveand time consuming endeavour. Any awardof costs you might receive will likely notfully compensate you for the cost in time,money and disruption in operations thatyou will have incurred, and you will havelost the opportunity to use the equipmentor systems while the lawsuit is pending. Aswell, litigation imposes discovery obliga-tions upon you that will result in your hav-ing to catalogue and produce all your elec-tronic communications and records thatmay be relevant to the action. This is an ex-pensive process in time and money.

Your staff will be taken away from theirregular duties for long periods of time andnumerous considerations will have to beassessed, including how this discoveryprocess will impact your privacy obliga-tions to patients or customers. It is not un-common to find yourself in expensive andtime consuming interlocutory proceedingsjust to settle these matters.

Stephen Selznick and Stephen Hendersonare lawyers with the firm of Cassels, Brock &Blackwell LLP, in Toronto.

My advice is simple: • Stay up to date: Reading this publica-

tion is a great start. That being said, this isnot enough. Start by devoting time daily tocatch up on the latest and greatest from theworld of digital health, mHealth and wear-ables. The simplest way is to follow key in-fluencers on social media outlets such asTwitter and LinkedIn. On Twitter, start bysearching the following hashtags: #digital-health, #mhealth, #wearables and #hc-smca. On LinkedIn, join relevant groupssuch as Paul Sonnier’s Digital HealthGroup. Another way to stay up to date is byattending meet-ups and conferences –there are many to be found in all majorcities around the year.

• Experiment (fail, early and fast): the bestway to learn something is to get involved. Ifyou happen to be in town when the Hack-ing Health group is hosting an event, join a

group and I promise, you won’t regret it.Another way to learn is to engage with agroup of early adopters. Learn from theirobservations, as this is often an indicationof what the general population will be in-terested in three to five years later.

• Think ecosystem. Gone are the days oflocked-down systems. Almost every wear-able device on the market place has an API(Application Program Interface). Leverage

some of these APIs to provide connectivityto your own systems – where it makessense, of course. Do not ignore privacy andsecurity requirements, but at the sametime, do not let privacy and security be thebarriers to progress.

Ahmad Zbib, MD, is Director, DigitalHealth and Innovation at the Heart andStroke Foundation of Canada.


The wearables revolution is coming: Are you ready for it?

Lawsuit takes aimCONTINUED FROM PAGE 2

Will your insurance cover yourcosts if you need to replaceequipment, pending theoutcome of an IP lawsuit?

and security standards need to be re-ap-proved at a new organization.

What’s acceptable in one hospitalshould be acceptable in every other hospi-tal. And these requirements must be clearand publicly available.

Healthcare’s tendency to build in-house: Because internally developed tech-nology takes longer to deploy and oftenstays within healthcare organizations, it isdifficult for healthcare organizations to at-tract the most talented software developersand designers who want to build quicklyand impact the global population. In con-

trast, health technology companies providethe most talented software developers theopportunity to build products that can im-pact patients and providers at a large scale.

In most cases, healthcare organizationsshould not be building digital health solu-tions in-house. They should focus on whatthey do best – delivering high quality med-ical care. What they should do is partnerwith technology companies who havegreater technical talent and experience,and work together to solve these problems.

Passive approach to value-based healthcare: No one changes unless they areforced, and we have created a limited senseof urgency in Canadian healthcare. Unfor-tunately, our current funding models arenot quite conducive to digital health adop-tion. Although we are beginning to tiefunding to quality, the vast majority ofhealthcare delivery is still funded based onvolume, leaving little incentive for health-care organizations to adopt digital healthtechnologies that improve coordination ofcare and patient outcomes.

In contrast, the U.S. has been muchmore prolific in terms of investing in, test-ing and adopting new digital health solu-tions, mostly due to the more aggressivepay for performance guidelines in Presi-dent Obama’s Affordable Care Act – for ex-ample, readmission penalties – therebyforcing providers to deliver higher qualitycare at a lower cost.

True, some parts of the Affordable CareAct are controversial and may ultimately beflawed, but you don’t know what policieswill or won’t work unless you try.

Personally, I’d rather be part of a systemthat’s a leader in trying to make value-based care work, instead of waiting and re-acting to what works in other countries. In-stead, our current funding model inCanada is out of date, and it’s killing ourability to innovate.


Dilemma in healthcare and the American experience

faction and achieves “client delight”. Asystem so efficient and easy to use thatno one can afford not to use it. I knowof a few examples of this, like the workof Dr. William Stead at Vanderbilt Uni-versity on his ICU system. Products likethis tend to generate user demand in-stead of requiring interventions toachieve user adoption.

• Delivering a capability or a conceptthat is paradigm-changing. Somethinglike this doesn’t just change the rules ofthe game; it changes the game itself.Think of the impact of VisiCalc in intro-ducing the concept of spreadsheets, or ofsocial media and the effect they have hadon our society, or of the Internet itselfand search engines. These have changedthe game in how we live, conduct busi-ness or interact socially. Outcomes ofthis genre are rare, but we need to strivefor that kind of impact in eHealth.

• Capabilities that change how wework. Moving to computerization andnetworking dramatically reduced the in-terminable time people spent makingphone calls to the laboratory and theanswering of the phone by the lab staff.Order entry and results reporting is achange at this level.

• Work that improves our satisfactionwith our jobs and our roles. Making ourwork life easier, introducing a degree ofpleasure into it and removing distur-bances seem like worthy effects. Ar-guably, this is achieved from time totime, but it’s antithesis, systems thatfrustrate, irritate, interrupt, devalue andconfuse people seem more common.

• Other valued effects. There probablyalso needs to be a category for a wholebox of other effects. For example, solu-tions that reduce errors or risk, mini-

mize forgetting, or enable teams to workas a unit, achieve something important,as well. Excellence can take many forms.What are your suggestions?

When NIHI was considering awardsfor excellence, several other criteria werebrought to bear, for example, that thework had international ramifications.For work like this we recognized Dr.Roger Côté for SNOMED. In the case ofDr. Brian Haynes, it was his and hisgroup’s remarkable work on developingevidence, particularly as to the efficiency

and effectiveness of eHealth that de-served recognition.

Can there be day-to-day excellence?Not everyone can rise to that level,

perhaps. Is there the possibility of defin-ing “personal excellence” similar to “per-sonal best” achieved by athletes? I wouldargue that this is a worthy goal for each ofus. We may not rise to the level of the fewpercent who receive public accolades.However, personal excellence may have aformula. It might start with fully grasp-ing, in all its complexity, depth, breadth,whatever the challenge is we face.

It would then expect us to becomefully capable as individuals, to workwith the proper tools, to define valuedobjectives, to develop comprehensiveplans, to obtain needed approvals, to getadequate budgets, to work tirelessly toaddress the challenge, to evaluate whatwe create and to communicate with allthose involved and affected. It wouldcap the application of fierce dedication,total commitment, and the pursuit ofneeded outcomes like they really matter!

Excellence involves risk and going be-yond simple duty! Let’s put our stake inexcellence!

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

Perhaps we should track‘personal best’ performancesin healthcare, as we do withathletes.


Dominic CovveyCONTINUED FROM PAGE 16

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