BY ROSIE LOMBARDI P atients often fall through the cracks of our current paper-based referral sys- tem, which requires a great deal of phoning, faxing, and follow-up between family doctors and specialists. Different re- gions are trying to automate referrals, but Alberta is the first jurisdiction in Canada to roll out a province-wide e-referral portal. The leading-edge solution is built on top of its existing Netcare provincial EHR sys- tem, which already has 46,000 healthcare providers in its network. The project not only automates referrals, but it also introduces new features to im- prove access, such as real-time tracking and transmission of medical data. It also provides transparency about the process to patients. Launched in July 2014, the first phase of the roll-out automates referrals for three critical areas: hip and knee arthroplasty, breast cancer, and lung cancer. “We plan to evaluate the project after a full year of im- plementation and will harvest the lessons learned this summer. We will then decide where the eReferral capability best fits within the AHS IT roadmap,” says Allison Bichel, executive director of access for Al- berta Health Services (AHS). The system works like many familiar travel sites, explains Bichel. GPs can logon Alberta rolls out first wave of provincial eReferral system CONTINUED ON PAGE 2 Ontario Shores Centre for Mental Health Sciences, in Whitby, Ont., last fall became the first Canadian healthcare facility to achieve Level 7 on the HIMSS Analytics EMRAM scale. It’s also the first mental health hospital worldwide to accomplish this feat. The advanced, elec- tronic systems enable Ontario Shores to function without paper; they also improve patient safety and medical outcomes. See page 7. Happiness is reaching HIMSS Level 7 PHOTO: COURTESY ONTARIO SHORES INSIDE: Smart and interoperable A new system that links various health record solutions across Fraser Health has built-in intelli- gence. It uses semantic harmoniza- tion technology to recognize terms with the same meanings. Page 4 Effective housekeeping The combination of innovative Oculys software and BlackBerry phones is enabling the Chatham- Kent Health Alliance to track how room cleaning is progressing after discharges. The solution means patients waiting for a bed can be transferred more quickly. Page 6 Info governance When Quebec City healthcare providers decided to share an elec- tronic records system to improve patient care, they also worked out a strategy for paper records. Page 10 CAMH’s big bang theory When implementing a new and improved electronic health record system, Toronto’s Centre for Addic- tion and Mental Health opted to roll out a complete solution all at once. This approach is known as the ‘big bang’, and the well-orga- nized team at CAMH did it on time and under-budget. Page 4 Publications Mail Agreement #40018238 FEATURE REPORT: ELECTRONIC HEALTH RECORDS — SEE PAGE 16 CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 20, NO. 4 MAY 2015 GE Healthcare Technology for healthier lives DOCUMENT MANAGEMENT PAGE 14
Transcript
BY ROSIE LOMBARDI
Patients often fall through the cracks ofour current paper-based referral sys-tem, which requires a great deal of
phoning, faxing, and follow-up betweenfamily doctors and specialists. Different re-gions are trying to automate referrals, butAlberta is the first jurisdiction in Canada toroll out a province-wide e-referral portal.
The leading-edge solution is built on top
of its existing Netcare provincial EHR sys-tem, which already has 46,000 healthcareproviders in its network.
The project not only automates referrals,but it also introduces new features to im-prove access, such as real-time tracking andtransmission of medical data. It also providestransparency about the process to patients.
Launched in July 2014, the first phase ofthe roll-out automates referrals for threecritical areas: hip and knee arthroplasty,
breast cancer, and lung cancer. “We plan toevaluate the project after a full year of im-plementation and will harvest the lessonslearned this summer. We will then decidewhere the eReferral capability best fitswithin the AHS IT roadmap,” says AllisonBichel, executive director of access for Al-berta Health Services (AHS).
The system works like many familiartravel sites, explains Bichel. GPs can logon
Alberta rolls out first wave of provincial eReferral system
CONTINUED ON PAGE 2
Ontario Shores Centre for Mental Health Sciences, in Whitby, Ont., last fall became the first Canadian healthcare facility to achieve Level7 on the HIMSS Analytics EMRAM scale. It’s also the first mental health hospital worldwide to accomplish this feat. The advanced, elec-tronic systems enable Ontario Shores to function without paper; they also improve patient safety and medical outcomes. See page 7.
Happiness is reaching HIMSS Level 7
PHO
TO:
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URT
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ON
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O S
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INSIDE:
Smart and interoperableA new system that links varioushealth record solutions acrossFraser Health has built-in intelli-gence. It uses semantic harmoniza-tion technology to recognize termswith the same meanings.Page 4
Effective housekeepingThe combination of innovativeOculys software and BlackBerryphones is enabling the Chatham-Kent Health Alliance to track howroom cleaning is progressing afterdischarges. The solution meanspatients waiting for a bed can betransferred more quickly. Page 6
Info governanceWhen Quebec City healthcareproviders decided to share an elec-tronic records system to improvepatient care, they also worked outa strategy for paper records.Page 10
CAMH’s big bang theoryWhen implementing a new andimproved electronic health recordsystem, Toronto’s Centre for Addic-tion and Mental Health opted toroll out a complete solution all atonce. This approach is known as
the ‘big bang’, and the well-orga-nized team at CAMH did it on timeand under-budget. Page 4
Pub
lication
s Mail A
greem
ent #
40018238
FEATURE REPORT: ELECTRONIC HEALTH RECORDS — SEE PAGE 16
CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 20, NO. 4 MAY 2015
GE Healthcare
Technology for healthier lives
DOCUMENTMANAGEMENT
PAGE 14
to the e-referral portal via Netcare toconduct searches for specialists by geo-graphic area, next available appointment,or by name.
Once selected, the system offers a stan-dard form to capture the minimum dataset required to complete a referral. Labwork and other information can be di-rectly attached from Netcare or othersources. “We designed the eReferral formso it shouldn’t take more than three min-utes to complete,” says Bichel.
GPs can track the referral through thesystem, much like they would track aFedEx package, as the eReferral proceedsfrom appointment to visit to consult letter.This enables them to close the loop andensure the referral is completed. “Our end-goal is to also allow patients to track it too,but we haven’t launched that feature yet inthis first phase,” notes Bichel.
Responsibility for confirming an eRe-ferral booking is up to the patient and spe-cialist, not the GP, as another importantgoal is to reduce the administrative burdenon the referring physician. “Family doctors
are frequently stuck in the middle doing alot of admin work back and forth betweenthe two. We did some policy work to estab-lish roles and responsibilities in these com-munications. GPs can still use the systemto stay on top of things without necessarilyhandling the booking.”
About 1,100 eReferrals have beenprocessed through the system thus far, andthe project team is still evaluating prelimi-nary results. “About 650 were for breastcancer, and the rest were for arthroplastyand lung cancer,” says Bichel. “We had ac-tually expected the arthroplasty categoryto come first because there are typicallymore of these referrals than others. It’sprobably due to the fact that there are sev-eral major breast health centres across Al-berta and there’s a very specific referralbase for them.”
This unexpected finding highlights oneof the chicken-and-egg challenges to up-take of the system. A breast health centreprocesses many cancer referrals in thecourse of a month, so it’s worthwhile usingthe new eReferral system. But family doc-tors may only need to do one or twoarthroplasty eReferrals per month, and
they’re still doing other types of referralsvia fax because they aren’t in the eReferralsystem yet.
“Primary care providers are sayingthey’re more likely to use the system oncemore types of referrals are available,” saysBichel. “But we need a sufficient criticalmass of eReferrals from them to furtherdevelop the system.”
Another issue is that family doctors areunhappy about having to exit their EMR
systems to logon to another system to doa referral. “We have no choice – we haveto use a separate eReferral system tobridge all the different EMR systems inthe province. To tackle this, we’re lookingat enhancing the system by allowing themto attach a PDF file from an EMR andsend it over to Netcare instead of filling ina form.”
In preparation for future developmentof the eReferral system, Bichel says there’sa sister program underway called AlbertaReferral Pathways, which is working ondeveloping clinical content standards fornew types of eReferrals. “There are 13 dif-ferent tumor groups in the cancer world;we’ve only tackled two of them. So thatcould be our focus for the next wave ofdevelopment.”
Both GPs and specialists need to nego-tiate who does what in deciding the stan-dards for these new eReferral types. “Weneed to clean up these processes beforewe automate anything. Referral standardsdon’t exist now. To triage an eReferral,specialists need information from GPs.But what constitutes a minimum dataset? Specialists may say they need X in-formation, while GPs may respond thatthey don’t have time to provide thatmuch information.”
Having the right information on an e-referral can increase productivity and de-crease risk substantially, says Dr. Bill O’-Connor, an orthopedic surgeon and VPof clinical consulting at Orion Health, asoftware company that provides the tech-nology that links all the systems that useNetcare.
“When I think back to the mistakes Imade when I was practicing, it was typi-cally because we were missing importantinformation. The more information physi-cians have when they’re seeing the patient,the better the results will be.”
But it would be a mistake to view eRe-ferral systems as a temporary stop-gapmeasure until the nirvana of perfectly inte-grated health systems materializes in thefuture, adds O’Connor.
“There are certain things that EMRs areterrible at doing. eReferral is one of them.You don’t do your banking on your e-mailsystem – you use specific banking soft-ware. It’s the same thing for this.”
O’Connor says Orion is making stridesin minimizing logging on and off betweensystems. “When we set it up, what we do ismake many launches possible from withinthe EMR. We try to make the set-up as ef-ficient as possible, but the reality is – andpeople are starting to catch on – they’renever going to be able to do everythingthey need to do in an EMR. They’re goingto have to use other systems as well.”
CONTINUED FROM PAGE 1
Alberta first jurisdiction in Canada with provincial e-referral portal
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N E W S A N D T R E N D S
BY ROSIE LOMBARDI
Most hospitals opt for anincremental approach toimplementing EHR sys-tems, often out of fear ofjoining the line-up of
horror stories in the media about big ITproject failures. But if the right elementsare in place, the big bang approach – im-plementing everything all at once – canwork. Toronto’s Centre for Addiction andMental Health (CAMH), an organizationwith over 3,000 staff, successfully went livein May, 2014 with its new EHR and datawarehouse system with virtually no hic-cups – and under budget.
“Over the course of the four-year pe-riod from procurement to implementa-tion, our budget was about $50 million,and we even came in slightly under by $1million on completion,” says TraceyMacArthur, CAMH’s CIO.
Although big bang implementations arenot common in Canada, several U.S. hospi-tals have successfully used this approach inrecent years, and CAMH’s team carefullystudied these models, says MacArthur. “Itreally needs an all-hands-on-deck ap-proach. But even with that, I believe thereare some constraints on the size of the or-ganization that can do big bang. I’m notsure a very large organization could man-age all the logistics.”
MacArthur says project leaders weighedseveral factors in making the decision to gowith the big bang approach. Cost was a bigfactor. “We would not need to support twodifferent systems at the same time, or incurall of the interfacing and other technicalcosts of supporting two systems, or thecosts of a long-term project team being inplace – almost 60 percent of the project’scosts were labour costs.”
But cost wasn’t the only consideration.CAMH’s clinicians were eager to movefrom a paper-based system to an EHR.
Mental health patient records require evenmore documentation than medical ones,and clinicians were frustrated with dealingwith reams of paper files and the inabilityto pinpoint relevant information quickly.
“One of the huge advantages of the pro-ject was streamlining and standardizingour clinical documentation. We went fromabout 700 types of assessment forms tounder 200. Our clinicians put a great dealof effort in completing that work in ad-vance of the technical system implementa-tion, so they were really ready to move for-ward,” says MacArthur, adding thatCAMH has been contacted by mentalhealth institutions internationally to shareits innovations in standardizing assess-ment forms.
This pre-implementation work was alsogood preparation for the collaborative ef-fort needed for the technical implementa-tion. “The main ingredient for a big bangimplementation that we found is that theclinicians really need to be prepared for theintensive training and work.”
CAMH’s project team chose the CernerMillennium EHR platform for implemen-tation because it offered an all-encompass-ing solution that would span CAMH’semergency department, inpatient and out-patient clinics. In addition, the vendor wasinterested in gaining more expertise inmental health systems.
“We’ve been developing dynamic docu-mentation to capture data in areas wherethere are a number of contributors to ahealth record,” said Jim Shave, president ofCerner Canada. “The CAMH projecthelped us advance that system.”
Cerner staff worked in conjunctionwith CAMH staff on the project, butMacArthur says most of the implementa-tion team was comprised of in-house staff.“Over the course of the 20 months for thetechnical implementation, about 150 clin-icians were involved in design, testing orcoaching their peers at various points in
the project. We also had a dedicated pro-ject team of about 100 people, mostlycomprised of CAMH staff, but we also hadsome people from Cerner and Deloitte. ”
The team also implemented a separatedata warehouse in parallel, so staff wouldbe able to start using and analyzing the dataimmediately. “We take all the data out ofCerner, as well as other systems, and we putit in the data warehouse to aggregate it andgenerate reporting with Microsoft BusinessIntelligence. Our decision was to centralizeall of reporting into our iManage tool,which is a single portal for all reporting, beit clinical, HR, or financial data.”
MacArthur says there have been almostno technical hiccups since the system wasimplemented last year. “Our biggest chal-lenges were around the management of thelogistics on the critical go-live date. Wewere fortunate to receive support fromother Cerner hospitals in the Toronto area.You really need just-in-time training withthe big bang approach so the learning is
still fresh, so most of it was completed inthe six weeks prior to the go-live date.”
However, the team has had to tweaksome of the documentation templatessince the implementation. “It was hard toanticipate precisely how much of our clini-cal documentation should be contained indiscrete data fields versus free-form narra-tive documentation. We may have erred toomuch on one side or the other in our datacapture, so we’ve been fine-tuning that.”
With electronic data, clinicians can nowsee patterns and correlations they couldn’tbefore. For example, there are links be-tween physical and mental health, but clin-icians didn’t have hard data to crunch todetermine how to improve care. “In thepast, medical histories were noted incharts, but because we’re capturing that in-formation now as very discrete data ele-ments, we’re able to generate alerts tophysicians. The system is showing us thatover 90 percent of our patients are coming
Fraser Health deploys Allscripts’ dbMotion to integrate clinical systemsBY ROSIE LOMBARDI
Integrating separate and complexclinical information systems in alarge health authority is like workingwith a giant Rubik’s cube – but it can
be done. Fraser Health, which has 23,000staff servicing 1.7 million people in theGreater Vancouver area, is successfully im-plementing a commercial off- the- shelfhealth information exchange (HIE) solu-tion to unify clinical information fromhospital, community health, primaryhealth care and provincial systems.
But now that the HIE solution is inplace, the work to link all the systems isfar from done. “Health information ex-change is a continuous journey,” explainsPhilip Barker, VP of informatics and an-alytics at Fraser Health.
From the starting point in 2012, thegoal of the Unifying Clinical Informa-tion project was to implement a HIEthat would allow Fraser Health to ex-change information between all its clini-
cal systems, says Barker. “We wanted allrelevant information to be available tosupport clinical decision-making at thepoint of care, with no additional sign-ons or patient searches, while also mini-mizing clicking and keying to get thatinformation.”
To accomplish this, Fraser Health se-lected Allscripts’ dbMotion, a HIE solu-tion, to interconnect its Meditech sys-tems running in 12 major hospitals,Civica Paris in community health, Intra-health EMRs in primary care, and vari-ous provincial systems.
“We wanted an interoperable, inte-grated solution as opposed to overlaying aclinical system on top of other clinical sys-tems. The difference is that it changes howyou use a clinical information system. db-Motion makes your home clinical systemvery intelligent because it presents infor-mation in context, in the moment, fromall other clinical sources. You don’t have todrill down or hunt for information.”
dbMotion’s HIE technology also of-
fers some highly useful intelligence fea-tures, adds Barker. “It does semantic har-monization across systems, which meansit recognizes similar medical terms. Forexample, if a patient has ‘peanut allergy’in one system and ‘walnut allergy’ in an-other, and presents them in a meaning-
ful way. We thought this feature was par-ticularly unique.”
Another critical feature is the abilityto place an agent on clinicians’ desktopto notify them when new clinical infor-mation on that patient is available. “It’s atab that floats across the desktop to at-tract attention when there’s relevant newinformation they haven’t seen yet.”
dbMotion also offers a feature that en-
ables Fraser Health’s HIE to share datawith other health authorities. “It puts it ina clinical data repository that then can beused to exchange information with otherhealth authorities or provincial e-Healthprojects. It’s very important for us to beable to exchange our information, as theboundary between Fraser Health, and say,the Vancouver Coastal Health is porousand patients move between them.”
The HIE was implemented in 2013,and the project team has begun the longjourney to interconnect various systemsto create a unified healthcare ecosystem.
At the core of the HIE is establishing apatient’s identity with certainty, as this isneeded to identify and track all the patientrecords flowing from one system into an-other, says Barker. “We worked closelywith the Ministry of Health to leverage itsclient registry – the provincial electronicmaster patient index – so we could use itto identify and adjudicate client identitybetween our systems. The challenge of pa-
The solution providessemantic harmonizationacross systems, andrecognizes similar terms.
Project leaders: Karen Martin, Dr. John Strauss, Pakizah Kozak, Tracey MacArthur and Cathy Surphlis Foks.
CAMH implements new EHR system using the ‘big bang’ approach
CONTINUED ON PAGE 22
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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 M A Y 2 0 1 5 h t t p : / / w w w . c a n h e a l t h . c o m
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In 2014, Chatham-Kent Health Al-liance (CKHA) implemented a pa-tient flow dashboard tool to improvepatient outcomes and increase orga-nizational efficiency. The tool, devel-
oped by Oculys Health Informatics, quicklyhelped the organization have a real-timevisual picture of the needs of patients in theEmergency Department (ED) waiting to beadmitted while also providing an indica-tion of bed capacity at a glance.
With the needs of patients visible acrossthe organization, the staff responded – andwith impressive results. “Before, there wasa push to hurry and get people out of theEmerge, but now, we can pull them up tous,” explained Marguerite Miller, unit clin-ical aide at CKHA.
Visibility combined with accountabilitystarted to shift the culture and in less thansix months, CKHA’s performance acceler-ated. As one of Ontario’s 74 Pay for Perfor-mance hospitals, CKHA moved from 17thfor total length of stay for admitted pa-tients and 14th for time to inpatient bedrespectively up to 6th place for both.
More impressive is that the organiza-tion reduced its total number of beds inoperation from 265 to 216 within the sametimeframe, allowing it to solidify its finan-cial position, improve length of stay andreduce unnecessary wait times for patients.
While the results were both impressiveand rewarding, there was something elsehappening. Interestingly, the organizationnoted that performance started to plateauat about the six month mark.
In a constrained environment, hospitalscannot afford to let performance idle. It’swell documented that the longer a patientwaits in an ED stretcher to be admitted,
the faster they deteriorate. This lapse intime has a negative impact on the patient’soutcome and the productivity of the EDand receiving inpatient units.
So, what else could be done to ensureeffective patient flow continues across de-partments? What other barriers to receiv-ing appropriate and timely care exist?
“We knew that one of our process im-provement opportunities was to improvethe communication, notification and effi-ciency through which housekeeping couldprioritize and organize the bed cleaningrequirements on any given day,” said SarahPadfield, chief operating officer at CKHA.
In almost every hospital today, beds areat a premium – bed capacity at CKHA av-
erages 92 percent. With the prevalence ofinfectious diseases, there is also the need tounderstand the patient environment andbe vigilant in appropriate and effectivecleaning practices within the hospital.
The balance between turning beds overquickly and doing it properly is somethingthe organization holds in high regard.
In fact, CKHA’s ability to go outbreak-free in 2014 is largely attributed to house-keeping’s role as part of the care team.While it’s understood that housekeeping isa key to the equation; their work is not welldocumented and they did not have effec-tive tools to communicate and allocate re-sources to best support emerging needsacross the organization.
And then a light went on. If Oculys de-livers real-time visibility of admission needsand bed capacity, could it be expanded tomake the role of housekeeping visible too?
“Because of our culture of innovation,success in working collaboratively with atechnology partner and most importantlythe leadership and willingness of ourhousekeeping team, we said why not putBlackBerry smartphones in the hands ofhousekeepers and let’s see what improve-ments we can make,” noted Padfield.
Adopting concepts used by hotels,Oculys, working in collaboration withCKHA staff, created a tool to automateworkflow and track housekeeping tasks.This new solution, supported by the existingpatient flow module, creates communica-tion channels that reach across all disciplinesand units. The real-time data and organiza-tional view helps streamline decision-mak-ing and resources, which ultimately deliversconsistent and timely responses by house-keeping staff throughout the hospital.
The process begins in the inpatient unit,when nursing staff identify a patient dis-charge through Oculys Performance. Then,a task is sent electronically for housekeep-ing staff to accept on their new BlackBerryZ30s (and because it’s integrated with theregular Oculys tool, isolation protocols areknown prior to entering the room too.)
Once they do, the tool helps track howthe room cleaning is progressing and upontask completion, the system immediatelynotifies admitting that the patient waitingfor that bed can be transferred.
“The Oculys Performance solution withthe new housekeeping component sup-ports real-time efficiency. Our goal is todistill the complexity of the hospital into asimple solution that is easily adopted andimplemented,” says Franck Hivert, OculysHealth Informatics president and CEO.“We worked closely with the CKHA teamto solve a problem that would deliver mea-surable results and improve performance.”
The housekeeping solution can also beused to support ongoing patient careneeds, such as assigning tasks to supportspills or urgent requests across the facility.Over time, the Oculys solution should alle-viate the ‘air traffic’ syndrome the manage-ment team faces in trying to manage mul-tiple and competing priorities.
“This project has created a real sense ofpride within our team because it show-cases that we are a progressive group whocan see the benefits that technology willbring to our work,” says Carrie Sophonow,housekeeping manager, CKHA. “Oncefully implemented, we know we’ll see in-creased efficiencies and we expect, new op-portunities for our team to make a positiveimpact for patients at CKHA.”
While CKHA is in the pilot phase of thisnew initiative, it is already providingpromising opportunities to improvehousekeeping processes, including reduc-ing a lot of wasted time and energy in lo-cating staff, duplicating communicationsand prioritizing and assigning tasks. Byimplementing this new Oculys solutionand deploying it on BlackBerry smart-phones, CKHA aims to further improvepatient care while also reaffirming the roleof housekeeping as a critical part of thecare team within the hospital.
N E W S A N D T R E N D S
CKHA housekeeping’s Carrie Sophonow, Jesse Kelly and Amy Zamboulis, with Oculys’ Charlie Farkas.
Housekeeping staff improve time to inpatient beds with BlackBerrys
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N E W S A N D T R E N D S
BY SHERNETTE MUCCUTH HENRY
WHITBY, ONT. – Ontario ShoresCentre for Mental HealthSciences (Ontario Shores)recently became the first
hospital in Canada – and the first mentalhealth hospital in the world – to achieve theprestigious HIMSS EMRAM Stage 7 award.The announcement was made last fall.
Offered by the Healthcare Informationand Management Systems Society(HIMSS), the Stage 7 award signifies at-tainment of the highest level on the Elec-tronic Medical Records Adoption Model(EMRAM). It scores hospitals in theHIMSS Analytics Database on theirprogress in completing 8 stages (0-7), withthe goal of reaching Stage 7 – the pinnacleof an environment which is truly paperless.
“Our electronic medical record systemimproves the delivery and quality of carethat we provide and standardizes clinicaldocumentation in an environment that isefficient, secure and collaborative,” saidKarim Mamdani, president and CEO atOntario Shores. Mamdani is part of theleadership team, comprising the board ofdirectors and senior management, whichguided and supported the implementation.
The progression to Stage 7 took sevenyears, and required significant invest-ments in time and resources, with a gover-nance structure firmly in place to monitordeliverables.
“We employed a change managementframework which included full participa-tion from the areas involved, significantcommunication including relevant educa-tion and training at all levels,” explainedSanaz Riahi, director, professional practiceand clinical information.
The results were well worth the effort,with the Stage 7 designation indicating thatdocumented patient information is beingused to determine the best diagnosis andtreatment at all times. “It is important thatwe are getting the value out of the data col-lected. We use the data to make decisionsthat are based on facts to enhance how wepractice and in turn help our patients,” saidDr. Ilan Fischler, geriatric psychiatrist andmedical director, clinical informatics.
One such example is the electronic ad-mission assessment used at Ontario Shores.Used when a person is admitted to the hos-pital, there are certain mandatory fieldswhich must be completed and which willthen guide treatment. If the person beingassessed has a history of smoking, for in-stance, the system will automatically popu-late with next steps, which may include therecommendation of appropriate nicotinereplacement therapy.
Similarly, if a physician notes that a per-son will be receiving antipsychotic medica-tion, the system will automatically populatewith a recommendation to closely monitorfor potential metabolic side effects.
One of the challenges in mental healthis that antipsychotic medication may resultin increased weight gain, obesity and anincreased risk for diabetes. It is importantwhen these medications are prescribedthat they are accompanied by the appro-priate monitoring.
An electronic record system means thatonce this medication is ordered by the
physician, the system automatically gener-ates suggestions for such additional moni-toring. This greatly reduces any errorswhich may occur and enables clinical teamsto proactively address any emerging issuesand prevent metabolic complications.
“Since this system of monitoring has
been instituted at Ontario Shores, adherencewith the ideal recommended metabolic pro-tocols has doubled,” said Dr. Fischler.
The electronic system also facilitates thesharing of clinical information in a man-ner that supports the use of patient data toimprove performance and transform clin-
ical practices to one that is evidenced-based, ensuring that patients and familiesare recipients of recovery-oriented care.
Shernette Muccuth Henry is a Communica-tions Officer with Ontario Shores Centre forMental Health Sciences.
Ontario Shores becomes world-leading user of electronic medical records
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h t t p : / / w w w . c a n h e a l t h . c o m M A Y 2 0 1 5 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y 7
N E W S A N D T R E N D S
BY JERRY ZEIDENBERG
The Barrie and Community FamilyHealth Team, in Barrie, Ont., isone of the first primary care
groups in the province to roll-out a com-puterized web portal, enabling patients
and their care-givers to communicatewith clinicians and check on their med-ical records.
The system is certainly in line with thetrend towards empowering patients by giv-ing them ready access to their information.But it’s far more than that – it’s being
tested to see if it can, as the pundits pre-dict, reduce overall health-system costsand also improve medical outcomes.
“It has to show health improvement,and also a cost improvement,” said Dr.Brent Elsey, medical lead for the Barrie andCommunity Family Health Team, and a
project director for the portal, which isknown as MyHe@lthLinked.
The portal started signing on patientsand clinicians in March, and Dr. Elsey saysthat a data management group will crunchthe numbers after six months to obtaininitial results.
After issuing an RFP for the project, theteam selected a portal and patient healthrecord system from McKesson’s Relay-Health. For its part, RelayHealth has sup-plied the technology for a patient portal inNova Scotia, and recently won contracts inThunder Bay and Cobourg, Ont.
In Barrie, the first priority is to sign-onpatients with complex, chronic conditions.According to the Ontario government,these patients comprise only 5 percent ofthe population, but account for 66 percentof the health spending in the province.
If the portal can help keep these pa-tients healthy and out of emergencyrooms, it would contribute mightily tocontrolling runaway healthcare costs. Andin doing so, it would improve the qualityof life for the patients and their families.
As Dr. Elsey observes, the portal shouldbe able to accomplish these goals by givingpatients or their care-givers faster access tophysicians and other clinicians, includingnurses and nurse practitioners.
“It’s easy to foresee cases where patientsdon’t end up in the ER because they couldcontact us,” he said. “For example, becausethey got an antibiotic, they didn’t get sickand end up in the hospital.”
Proponents of secure messaging be-tween clinicians and patients, a phenome-non called eVisits, say that closer commu-nication will lead to better care-plans andimproved adherence, as many patientssimply won’t come in for an office visit.
For some, it’s too much trouble, whileothers will simply give up if they’re kept onhold when trying to book an appointmentby telephone.
But a quick message to the doctor orcare-team can do wonders. The patient canfind out if a weight gain is serious, ifbreathlessness or a cough needs immediateattention, or if a medication requires anadjustment.
“Often, patients simply want advice on acare-plan, such as what they should do whenthey’re on vacation,” says Dr. Elsey. “We canhandle this through messaging, instead ofrequiring them to come into the office.”
Of course, in many cases an in-personappointment is best, and the portal assistson this front, too. Using the online system,patients can cancel or re-book appoint-ments, find out about how to prepare foran appointment, or ask about changing acare plan.
In Nova Scotia, which has been usingRelayHealth for several years, the provincefound that secure communications haveenabled doctors to handle more patientencounters, both virtual and in-person, ac-cording to a recent benefits study.
Moreover, by handling smaller mattersvia electronic messaging, more time isavailable to spend with patients in the of-fice with more complex issues to discuss.
And although a fear among somephysicians is that they will be overloadedby patient messages, the experience inNova Scotia showed that most patients are
High-needs patients to benefit from new portal in Barrie, Ontario
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Visit www.imprivata.com/vdiwhitepaper to learn more.
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N E W S A N D T R E N D S
careful about not overtaxing their doctorswith questions.
“And if there are patients who do sendtoo many messages,” said Dr. Elsey, “we canalways tell them that they will have to comeinto the office with any further questions.”
Remuneration is also a key issue, andmany physicians will wonder how they willbe paid for the work they do online. Forsalaried physicians working with a roster ofpatients, it’s not a worry, as they’re paid a setamount. eVisits tend to make their practicesmore efficient, and promise to keep patientshealthier – which are powerful incentivesfor deploying a patient portal.
But those working on a fee-for-servicemodel are asking for compensation – ei-ther a lump sum or a fee for each eVisit.Provinces using patient portals, and otherforms of telemedicine, have been experi-menting with different payment models.
In a second phase of the MyHe@lth-Linked project, the Barrie team will startfeeding lab and diagnostic imaging test re-sults into the secure, patient records in the
portal. Patients will also gain access toother parts of their records, such as aller-gies and medications.
This will allow the more proactive pa-tients to really take charge of their ownhealth, modifying their behavior toachieve better results. For example, diabet-ics can monitor their results over time toensure better eating or exercise habits.
But Dr. Elsey notes that care will be takenwhen sending information to the patientportal. “We know if we have an anxious pa-tient, that he or she shouldn’t have the in-formation without an explanation,” he said.
On the other hand, there are many pa-tients who are perfectly able to interprettheir own lab results, along with other in-formation. “When the tests are normal,there is no problem in giving them the re-sults. If they’re abnormal results, we stillmay attach a note for the patient to call us.”
As Dr. Elsey says, for certain patients,access to the information can encourageself-management.
MyHe@lthLinked is a project set up bythe Barrie and Community Family HealthTeam as part of Healthlinks, a program theprovince launched to encourage commu-nity initiatives for the care of high-needspatients.
And while the initial thrust will be to re-cruit complex, chronic care patients, Dr.Elsey says that in the long run, he’d like tosee the portal made available to all patients.
When interviewed at the beginning ofMarch, Dr. Elsey said the project was aim-ing to enlist at least 10 providers and about100 patients by the end of the month. Butwith excitement growing about MyHe@lth-Linked, he anticipated the figures would bemore like 20 clinicians coming aboard inthe first month.
By the end of the year, he predicts that1,800 patients will be using the system,along with 100 clinicians, including doc-tors, nurses and nurse practitioners.
In the Barrie area, most of the physi-cians use QHR’s Accuro electronic medical
record, and RelayHealth has integrated thesystem with this EMR. “We need to make iteasy to use for the physicians,” said DavidMosher, Director of RelayHealth atMcKesson Canada. “We’ve configured it sothat it launches right from their EMRs, sothey don’t have to start a new application.”
MyHe@lthLinked is also easy to use forpatients, who can connect and share infor-mation with those they choose by using
their web browsers. “It’s like LinkedIn,”said Mosher. “You make a connection withanother person, and then it allows you toshare data with them. Family members canalso be authorized to book appointmentsor contact care providers.”
He notes that MyHe@lthLinked hasstrong security tools, and has gonethrough a privacy and security assessment.Patients are able to specify just how much
information they’d like to share with eachmember of the care team, and they canalso check to see who has viewed the data.
“The patient can go in at any time, andcan see who has looked at his or herrecord,” said Mosher.
The MyHe@lthLinked portal waslaunched with funding from Canada HealthInfoway, and the support of the provincial
E-visits can make practices runmore efficiently, and enablepatients to stay in close touchwith their caregivers.
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D O C U M E N T M A N A G E M E N T
BY ANDREA BACQUÉ
The healthcare sector has embracedelectronic records as the foundationfor sharing information and deliv-
ering quality patient care. The businessand clinical benefits of an electronic envi-
ronment are clearly recognized, but, ashealthcare providers are discovering, thetransition from paper to electronic is oftenmore difficult than anticipated.
In order to accelerate EMR adoptionand reduce the reliance on paper, health-care providers must come to terms with
two fundamental concepts: • embracing a hybrid environment in
which paper and digital records coexist,and
• addressing the shortcomings of legacypaper record systems, including people,processes and technology.
In managing a major transition of thisnature, leveraging a proven model or bestpractice approach is often recommended,independent of industry.
Does such a model exist in Canada? Itappears to, in at least one instance. InQuébec City, Iron Mountain has outfittedan EMR operation to cover over 130 mil-lion patient files for several hospitals in thearea. To assist other healthcare providersacross the country in their digitizationjourney, best practice principles andlessons learned from this example will beexplored.
Hospitals and clinics in the Québec Cityarea were aligned into four groups andcombined their purchasing. Collectively,they had selected a single Electronic Med-ical Record system, as they had sharedgoals of improvingpatient care throughdigital access to pa-tient records whileaddressing workforceand cost reductionobjectives.
They knew theone-time back-fileconversion would bemassive, and al-though the intentwas to run their ownday-forward operation, they did not havethe experience or expertise to set it up.
Adding to the issues and urgency for ac-tion was the fact that they collectively wererunning out of physical storage space forthe paper records. The customer selectedIron Mountain to address the complete so-lution, including establishing both onsiteand offsite EMR conversion centres. Theybelieved that we could provide the services
required and that we had the resources andcommitment to deliver the best value.
Establishing a framework for gover-nance: As a first step in the EMR transi-tion, it is important to have senior leader-ship sponsorship around a framework forgovernance, particularly around the poli-cies for Information.
Lifecycle Management (ILM). IGpolicies and practices are critical to thesuccess of a wider IG strategy and shouldinclude foundational ILM policies tomanage the processes for storage, reten-tion, and disposition of medical andbusiness records. These policies shouldalso address special records managementissues, such as formal hold orders andany applicable legal and regulatory re-quirements.
Getting organized for governance:Once the need for enterprise-wide Infor-mation Governance (IG) is established, itis important to understand how to get or-ganized to make it happen.
In order to maintain oversight andmeasure progress against your IG strategy,it’s critical to establish a multi-discipli-nary steering committee. The committee
Information governance should be addressed in transition to EMRs
Andrea Bacqué
Healthcare providers must cometo terms with a hybridenvironment, consisting of bothpaper and electronic records.
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provides direction and oversight, sponsor-ship for resources and funding, and alsooffers leadership to engender organiza-tional solidarity.
A steering committee is central to gov-ernance decision making, and requiresbroad representation across departmentsand functions, such as physician and nurs-ing leaders, the CFO, CIO, CMIO, IT,HIM, informatics, legal, finance, compli-ance, and risk. In Québec City, the steeringcommittee acted as the go-to, cross-func-tional group responsible for goal setting,approving and enforcing policies, andmeasuring results.
Developing an imaging strategy: Thesteering committee is also responsible fordeveloping the imaging strategy.
To do this, they need to identify and un-derstand the process by which health in-formation is created, received and pre-served for business and regulatory compli-ance purposes. Defining the informationthat comprises the “record of care” is partof any imaging strategy and the imagingstrategy should look to define a triggerevent or impetus for initiating digitization.
For example, in Québec City it wasagreed that the patient’s newly scheduledhospital appointment would be the opti-mum trigger event to initiate the go forwarddigitization processing of the patient’s med-ical record within a 48 hour period.
In addition, the integrity of the recordmust be considered, and appropriateprocesses developed to ensure complianceand an effective physical to digital medicalarchive transition.
Retention and privacy: Establishing re-tention and privacy policies is a funda-mental aspect of developing an effectiveEMR adoption strategy.
These policies must include specific cri-teria that define how long patient informa-tion must be retained and document de-tailed precautions on how to protect pa-tients’ privacy. More importantly, thesepolicies must be enforced. Enforcing these
policies means periodic movement of thefiles – whether for transfer or destructionpurposes. In a hybrid environment that in-cludes both paper and digital files, whichmeans the process must be managed rigor-ously to avoid a potential data breach. Forthis reason, it is critical to maintain a se-cure chain-of-custody across the lifecycleof a record, including imaging, storage,archival and retrieval.
This chain-of-custody safeguard shouldapply to anyone within the organization,as well as any third party partners involvedwith the process.
Aligning with strategic organizationalpriorities: And lastly, like any major initia-tive, the importance of communicating theend-game benefits cannot be overstated.The message should be driven by seniorleadership, via the Steering Committee,and reinforce that the transition to anEMR is a priority – not just because it’smandated, but because there are clearbusiness benefits to be gained by the pa-tient and the healthcare provider. From a
business perspective, clarifying the benefitsto the various stakeholders is critical togaining initial and ongoing support forany EMR adoption initiative.
From a management perspective, iden-tifying and reinforcing the clinical and op-erational benefits is the key to maintainingmotivation over the duration of the adop-tion period.
Providers that achieve success will be
those that take a comprehensive approachto balancing paper and digital records anddevelop a holistic document managementsolution executed against a clear strategywith defined governance oversight.
This requires reengineering old work-flows to address the impact a hybrid realityhas on people, processes and technologies.By winding down your paper processesand developing a comprehensive solution,
you’ll not only accelerate your transition toan EMR. In addition, you will morequickly realize increased patient through-put, shortened revenue cycles and im-proved operational efficiencies that drivevalue to the healthcare system and, mostimportantly, improve patient care.
Andrea Bacqué is Canadian Solutions Leaderfor Iron Mountain. She is based in Ottawa.
D O C U M E N T M A N A G E M E N T
As a first step in the EMRtransition, it is important tohave senior leaders create aframework for governance.
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BY JOSHUA LUI , MD
Afew weeks ago I had the pleasure ofparticipating in an Alumni Panel forthis year’s Next 36 Selection Weekend.Together with fellow Next 36/NextFounders alumni Jaclyn Ling, MichaelHelander and Jessica Ching, we talked
about our experiences in the program and buildingour companies. (Side note: they are all working onvery interesting things, and worth checking out).
Near the end of the Q&A, one of the finalistsasked:
What is the most important thing you learnedfrom this experience?
Without hesitation, for me it was focus.I have come to believe focus is incredibly impor-
tant, not just for startups, but for pursuing anythingmeaningful in life.
The basic truth is that it’s hard enough to do onething very well. It therefore follows that it’s impossi-ble to do many things well.
From a startup point of view, this meant putting100 percent of our energy into increasingly feweritems, across all facets of our company, SeamlessMD.We moved from providing a solution for any medicalcondition to focusing exclusively on surgery. We dra-matically reduced the number of metrics we focuson. And so on.
Today, we relentlessly say no to anything that does
not move the dial on the few items that matter. Thisis important because most opportunities you en-counter will be distractions.
Sometimes distractions are less obvious. For ex-ample, coffee meetings with kind, well-intentioned
people but no obvious relevance; networking eventsin your industry, or product features that only onecustomer is asking for.
A good barometer for whether an event was adistraction was whether you regretted it after. Overtime, you will gather enough data points to knowwhat is and isn’t a distraction for you.
Your time is valuable – don’t let any-one tell you otherwise. It’s okay to sayno – if you’re saying yes more often
than no, it might be worth re-thinking whether youare focused enough.
And this goes beyond startups, at least for me. Iam much happier focusing my time on close familyand friends who matter the most to me. They deserve100 percent of my attention.
The one exception I do make is around givingback and helping others. I never consider that a dis-traction, even if it is irrelevant to items I’m supposedto focus on. I will quickly say no to a coffee meetingabout help I don’t want, but I will happily take coffeewith someone who really needs help.
The most successful people I know arealso the most generous with their
time. I want to believe that isn’t acoincidence. When I consider some of the in-sanely busy people who give metime when they have no reason to, Ican’t help but feel grateful, and want
to pay it forward. It’s also very re-warding to see other people you’ve
helped do well.Otherwise, I’m going tokeep my head down andfocus on the few thingsthat matter. And I expectthat list to get shorter, but more ambitious,with time.
VI
EW
PO
IN
T
The truth is that it’s hard enough to do one thing very well, let alone many.
Entrepreneur finds the key to success in business: the ability to focus
Dr. Joshua Liu is CEO of SeamlessMD, ofToronto, a computerized system thathelps patients prepare for their opera-tions before surgery and assists inmonitoring their recovery afterwards.See www.seamless.md
The most successful people I know arealso the most generous with their time.I want to believe that isn’t just acoincidence.
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How everyone else gets stuff done in document managementBY GREG BELL
Imagine you’re a visual artist withthe dream job – designingposters for your favourite band.
You sketch out a few ideas in yournotebook, take photos of them withyour iPad, and share them with yourteam across the country.
Soon you’re all looking at thesame sketches on a virtual table. Oneof your colleagues in Nova Scotiafinds photos from a shared albumand starts positioning them overyour sketches. Your friend on thetrain in Vancouver sees the photosand adds comments using hersmartphone.
You draw a few changes usingyour tablet, and the whole teamagrees they look great. In minutesyou’ve collaboratively taken an ideato a refined draft, and shared it withthe band – and they love the poster.
In many industries, one of thebiggest challenges facing teams look-ing for collaborative document man-agement solutions is picking from thehundreds of incredible tools available.
A plethora of fast, affordable andelegant software allows musicians towork in virtual recording studios,
photographers to show their footage,and project managers to share plansand deadlines.
Meanwhile, conversations inhealthcare circles are often aboutfrustrations over getting seeminglysimple things done, like sharing ur-gent patient information from oneclinic to another.
The mid-2000s saw a significantshift towards secure cloud-basedtechnology. With the non-healthcareworld using tools like Box, Dropbox,and Google Drive for years to sharework instantly, there is an expecta-tion that business teams have accessto the latest version of documents,and can work from and search com-mon resources.
Even traditional email-on-a-com-puter has been left behind, as mo-bile collaboration apps are im-proved. Google and Microsoft havebeen in headlines lately for makinghighly polished apps for their com-petitor’s smartphones, includingGoogle Docs and Spreadsheets, Of-fice, and Outlook.
Slack, an online and mobile toolfor messaging and collaboration, re-cently boasted themselves as thefastest-growing workplace software
ever. Teams with these tools savetime, avoid errors and redundancies,and can work from anywhere.
What can healthcare learn fromthis innovation, so that clinicians,clinic managers, and patients can en-joy the same benefits? A few lessonsto guide us:
• Cloud-based tools are ready forhealth information. With the rightsafeguards, it can be safer to keepyour files on the cloud than in alocked filing cabinet behind your
clinic desk. Billion-dollar companiesnow rely on cloud-based documentsolutions – in many circumstancesthe security will meet health dataregulations.
• Even for clinics with electronicdocuments, huge cost savings cancome from moving low-level secu-rity applications to software-as-a-service companies. No more needfor that server in the closet with all
of your patient documentation.• Simple doesn’t mean stupid:
document management tools that doone thing well are often best. Mobileand web-based apps, rather thanenormous desktop software, are ele-gant, usable, and get out of the wayof the people using them.
• Better teamwork really doesmean better productivity: strong de-mand for the ability to cut throughnoise and work together efficientlyhas resulted in new tools for com-munication and collaboration.
Tools like Medeo allow for secure,mobile patient-provider videocon-ference, with shared records of careand exchanged messages and files onthe cloud.
Sookasa now offers HIPAA-com-pliant encryption for tools such asDropbox and Salesforce, and thepopular Box document manager hasbegun partnerships with healthtechnology systems for secure,synced collaboration in hospitalsand clinics.
Greg Bell is Director, Software Devel-opment, at QHR Technologies. Thecompany is based in Kelowna, BC,with offices in Vancouver and Toronto.
Web tools for teamworkare becoming secure, andhealthcare providers arestarting to use them.
V I E W P O I N T
BY MICHAEL MURPHY
At the intersection of technologyand healthcare, there is a uniqueopportunity to collaborativelytransform the healthcare system,
strengthen provider relationships and im-prove patient outcomes. Mobile health –or mHealth – promises powerful benefitsfor the healthcare industry through theadoption of mobile devices, downloadablehealth apps and flex-work policies. Ulti-mately, mHealth enables the end-user –whether it is a clinician, physician or ad-ministrator – to work seamlessly acrossmultiple devices with absolutely no re-strictions in location and time.
There are significant benefits to em-bracing mobile technologies in healthcare,including:
• Instant access to information forhealthcare providers – Access to patient
data is a criticalcomponent to pro-viding quality care.With mobile work-stations and tablets,healthcare providersare no longer lim-ited to capturingand accessing dataat monolithic sta-tions. One exampleof an organizationthat has imple-
mented a mobile platform is HamiltonHealth Sciences (HHS). Through mobiletechnology, HHS care providers can in-stantly access information, allowing physi-cians to diagnose patients from any loca-tion, on any device. If a physician is offsiteand an issue with a patient arises, thephysician is able to review the patient’scharts and medication remotely, from asmartphone, laptop or tablet and enter anote for the clinician to follow up on.
• Significant cost reduction – Advance-ments in mobile technology are extendinghealthcare beyond the hospital environ-ment and into the home. When a clinicianvisits a patient’s home to provide an as-sessment, it saves a trip to a hospital for thepatient or senior who may have limitedmobility and alleviates the financial bur-den on the healthcare system. In fact,Home Care Ontario (www.homecareon-tario.ca) states that the average cost of apatient in a hospital bed for a day is $842while a home care clinician can provide anin house checkup at $42 per day, a signifi-cant savings on the healthcare systemwhen totalled per day and per patient.
• Lower wait times – Some hospital in-frastructures take anywhere from 30 sec-onds to four minutes for a care provider tolog into a patient session. By using mHealthtechnology, there is an improvement in pa-tient wait times as doctors are able to keeptheir sessions open from room to room,eliminating the session login time. If a clin-ician is working with roughly 40 patientsper day, and each session requires four min-utes, this results in a time savings of nearlytwo hours each day. Multiply that numberby the number of care providers working ina hospital on any given day and the timesavings becomes significant.
• Revolutionizing patient care through
Mobile Clinical Computing – Having torely on stationary machines for informa-tion can delay patient care, especially asphysicians are known to service numeroushospitals and may not always be on site.Stationary PCs or workstations on wheelsuse anonymous access logins which can
pose significant security threats as anyonecan potentially login and view patientdata. As a result, hospitals are now startingto transition to Mobile Clinical Comput-ing (MCC). This innovation allows clini-cians to transfer the “cart on wheels” expe-rience to a single tablet or mobile device,
providing secure and instant access to in-formation right at the patient’s bedside.
Michael Murphy is the VP and countrymanager of Citrix Canada, a company thatenables mobile work styles, allowing peopleto work and collaborate from anywhere.
From hospital to home, there are benefits to mobile clinical computing
Michael Murphy
A portal that providessecure exchangeof information
Easily implemented, web-based connectivityamong patients and alltheir healthcare providers
For a demo visitwww.relayhealth.ca/demo
www.mckesson.ca
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FE
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BY DIANNE DANIEL
Leaving your family physician’s office af-ter a medical appointment can be a jug-gling act. Depending on the nature ofyour visit, you could be armed with arequisition for blood work, a script formedication, instructions for a test like
endoscopy or ultrasound, perhaps even an appoint-ment card for a specialist.
But what if you left empty handed? What if youreceived an e-mail instead, alerting you to check youron-line care portal for important information? Whatif you could simply show up at a lab or pharmacyand all of your information was waiting there on-line? Wouldn’t that be easier?
The Group Health Centre (GHC) in Sault Ste.Marie, Ontario, believes so. In 2010, the multi-spe-ciality, multi-disciplinary ambulatory care facilitymade a decision to rethink its electronic medicalrecord (EMR) strategy, engaging consultants, look-ing at European models and visiting leading-edge fa-cilities across the U.S. for input.
In the end it decided on a complete refresh, re-placing an aging product with the EpicCare Ambula-tory EMR from Epic Systems Corp., implementing avirtual desktop infrastructure with zero footprintclients, and essentially laying the groundwork for apaperless patient experience for the more than70,000 people it serves.
“The model we went with is: if the banks can doit, why can’t we?” says Ralph Barker, GHC vice-pres-ident, information services, and CIO. “We’ve reallyenabled and delivered true Bring-Your-Own-Device,anytime, anywhere.”
The new EMR strategy was rolled out in 2014 andincludes Imprivata single-sign-on technology, en-abling users to ‘tap’ into secure sessions with a proxim-ity badge. The solution connects 600 concurrent users,ranging from general practitioners (GPs) and special-ists to nurse practitioners and administrators, as well aslab and pharmacy professionals. It supports 850 activedevices, including desktops and tablet PCs, and enablesleading-edge functionality like e-prescribing.
“We bought a very advanced rocket ship and we’relearning how to fly,” says Barker, who credits thestrong commitment of the information servicesgroup and the Epic project team, including the threephysician champions who participated, for the pro-ject’s success, which was funded in part by CanadaHealth Infoway.
The switch to EpicCare had to occur in a “bigbang” fashion, he adds, noting that the group’s exist-ing EMR vendor was ending support for a productthat had been in use since 1997. “As complex as itwas, the team delivered the project on time, on bud-get and in scope,” he says.
Remarkably, GHC has a 98 percent penetrationrate for its new virtual desktop infrastructure (VDI)strategy, with only 10 dedicated PCs left in the entireorganization. One reason for the overwhelming adop-tion is that users were given the freedom to customizetheir desktops, just as they would a standalone PC.
In terms of minimizing workflow changes, GHCengaged physicians by delivering all functionalitywithin the EMR. It eliminated the need to leave a pa-tient record and then log into a separate portal toview lab results or prescribe medications.
“To me, that’s the wrong approach and our physi-
cians agreed,” says Barker. “They don’t want to worklike that. They want it all presented in one applica-tion, which is the EMR.”
Since implementing EpicCare, a typical patientvisit at GHC might look like this: A patient arrivesand is marked ‘present’ in the EMR, triggering an au-tomatic check with the Ontario Ministry of Health toensure a valid health card. In the exam room, a nursetaps into EpicCare with a proximity card, locates thecorrect patient record, and opens the session by mea-suring and recording vital signs, for example. Thephysician enters the room, taps into EpicCare andmaintains the same patient session started by thenurse, but accesses it through his or her authenticatedenvironment, with more functionality available.
“The interface actually adapts to their workflow,”explains Barker. “So when the nurse secures the sessioncoming out of the exam room, it locks it. The physiciancomes in, taps in, and the session re-enables in his nav-igator … It’s become an enormous efficiency gain for
the physicians and nurses.”Following the visit, if blood-work is required, patients sim-
ply show up at a lab; if pills are
prescribed, they go to any local pharmacy. All neces-sary information is accessed on-line and lab results areentered, so they can be trended.
Dr. Russell Tull is a GHC family physician with afull-time practice. As one of the physician champi-ons who took part in Epic Physician Builder coursesto facilitate his knowledge of EpicCare, he’s been us-ing the EMR in a live manner for more than one year.“Epic is a very powerful EMR, thus at times it can bea bit daunting with all of its features,” he says. “… Butonce these are understood, the benefits are limitless.”
Some of the features Dr. Tull uses regularly includethe medication-medication interaction checking andmedication-disease interaction checking. He is justbeginning to use the product’s artificial intelligence
capabilities to ensure “all screening procedures are inplace and all appropriate monitoring is being done forcurrent problems or treatments – all automatically.”
Most importantly, use of the MyCare patient por-tal available through EpicCare is changing the way heinteracts with patients. “Patients can book appoint-ments, see and add to their medical histories, printoff or request refills on their meds, print immuniza-tion records for their kids, see growth charts, andmost importantly, message the office with a non-ur-gent message directly, avoiding being met with a busysignal,” he describes.
Another group of Ontario caregivers benefittingfrom a unified EMR strategy are the 62 communityhealth centres (CHCs), 10 aboriginal health accesscentres and 10 nurse practitioner-led centres operat-ing within the Association of Ontario Health Centres(AOHC). Each centre is governed by a board ofclients, community members, health providers andcommunity leaders; their over-arching goal is to en-sure access to health services to those who encountera diverse range of racial, cultural, linguistic, physical,social, economic, legal and geographic barriers,which often contribute to the risk of developinghealth problems.
To date, AOHC has successfully migrated 4,100health providers, more than 1.2 million clients andmore than 61.8 billion client records to NightingaleOn Demand (NOD), a cloud-based EMR solutionprovided by Nightingale Informatix Corp. The mile-stone is “bittersweet,” says AOHC CEO Adrianna Tet-ley, because six remaining francophone centres are
still waiting for access to a bilingual version ofthe EMR, expected to be delivered later this year.“It’s absolutely happening, it’s just taking a lotlonger,” says Tetley. The delay is resulting from amid-stream decision to provide the francophone
centres with a newer version of Nightingale’s EMRwhich will not only support the French language,
but will also offer a much more intuitive platform fordelivering patient-centred care, she explains.
AOHC’s decision to move to a cloud-based EMRwas made at a time when “cloud” was equivalent to“application service provider.” Instead of havingmultiple servers in multiple sites running multipleinstances of an EMR, AOHC made a deliberate deci-sion to select a common platform, managing onecontract with a single vendor.
“We wanted everyone to be on a common EMR sowe could collect the data and tell the story about theefficiency and effectiveness of the work that we do,”says Tetley.
AOHC is roughly four years into a 10-year enter-prise licence with Nightingale. The product is used bymultiple members of inter-professional teams, en-abling client records to be shared among nurses,physicians, nurse practitioners, social workers, dieti-tians, health promoters and community health devel-opers. Because funding for the EMR project is pro-vided through eHealth Ontario, any improvements orcustomizations made to NOD are available to otherusers within the province as well, explains Tetley.
One advantage to adopting a cloud model is thatenhancements to the EMR can be quickly rolled outto 4,000 users at once. Which is why AOHC is first inline to pilot many government-led efforts, such asthe Ontario Laboratories Information System(OLIS), a province-wide, integrated repository oftests and results, and ConnectingGTA, the sharing of
Physicians are using highly advanced solutions to connect with peers and patients.
Rocketing interest in programs that linkdoctors to hospitals, labs and patients
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information between five local health inte-gration networks (LHINs) within theGreater Toronto Area.
“We’re seen as a leader in connecting tothe rest of the system,” says Tetley. “We verymuch looked at the blueprint of eHealthand made sure everything we did wasaligned with the information managementblueprint for Canada and Ontario.”
Another benefit is that the EMR is sup-ported by a common data warehouse, en-abling AOHC to apply analytics, includingmeaningful use data supplied by Ontari-oMD to measure who is using the EMRand how, and accountability indicators tocompare CHC performance between sec-tors and peer groups. “If you’re a down-town, urban CHC and you’re the only onein your LHIN, you can find your compar-ative group with similar populations inOttawa or Toronto and see how you aredoing against your peers,” explains Tetley.
Interestingly, AOHC has collected datato show that it is significantly above averagewhen it comes to screening for two of thethree cancer indicators set out as bench-marks by Cancer Care Ontario, despite thefact that its clients are usually more com-plex. “We say EMR is really important forclinical use, but telling our story, it’s thenon-operating reporting analytics (NORA)strategy that actually becomes our gem be-cause it’s where you can mine the informa-tion … to inform our funders and our de-cision makers,” says Tetley.
Fundamentally, every AOHC memberis able to make its own decision as towhether or not to use Nightingale On De-mand. Tetley credits the association’s on-going support, in part, to a robust gover-nance structure that ensures people are in-volved in decision-making.
A similar, cohesive structure is alsoproving valuable on Canada’s west coast,where primary caregivers on Vancouver Is-land are now benefitting from a commone-notification platform, despite the factthat they use disparate EMRs. Recently, theVancouver Island Health Authority (IslandHealth) introduced electronic notification,alerting family physicians when their pa-tients are either admitted or discharged asinpatients in all 13 hospitals across the au-thority, as a direct result of feedback so-licited from division members.
In the initial pilot project, administeredfrom July to September 2014, 42 GPs re-ceived real-time notification of inpa-
tient admission, discharge and death fromtwo Island Health hospitals. Those GPs us-ing EMRs received notification alerts di-rectly within their EMR; those without,were notified via Excelleris Launchpad, asolution already in place to deliver lab anddiagnostic imaging results across the island.
“We knew it would be good,” says ValStevens, Island Health’s director of accessand transitions, referring to the pilot’s suc-cess. “We couldn’t see that anyone would-n’t want to get one.”
The alerts are automatically generatedfrom the admission, discharge, transfer(ADT) portion of Island Health’s Cernerhospital information system, using HL7standards. No clinical information is pro-vided; the alert states that the physician hasbeen identified as the primary care providerand that more information can be viewedin PowerChart, the Cerner EMR used byhospitals throughout Island Health.
One change required at Island Health’send is that front line admitting staff are be-ing asked to change the way they ask pa-tients for the names of their family physi-cians. “We really wanted to make sure wewere capturing accurate information inthe record,” says Stevens. “Because it’s soimportant to have the right name in ourclinical system, we wanted our clerks tosay, ‘Who is your family doctor?’ instead of
‘Is Dr. Smith still your family doctor?’ Thiswas a real opportunity for us to improveour processes right from the beginning ofthe patient’s stay in hospital.”
Overall, 96 percent of the physicians in-volved in the pilot reported that e-notifica-tion is an asset to their practice.
Now that Island Health is extending e-notification to include all hospitals and allfamily practice physicians, approximately
750 active GPs are being alerted about pa-tient admissions, discharges and deaths inhospital. The next step, says Stevens, willbe to define the follow-up “human-to-hu-man” piece.
“We don’t know what it will look likeyet, but now that we have notification inplace, we can move forward with thatmore human-to-human discharge andtransition planning that needs to occur.”
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E L E C T R O N I C H E A L T H R E C O R D S
BY ANDY SHAW
TORONTO – Security expert PatrickMalcolm ended a day-long CyberRisk National Conference recentlywith a riveting “Getting into the
Mind of a Cyber Criminal” talk. It was a
wake-up call, not only for the 80 or so at-tendees, and others online, who monitoredthe Ontario Hospital Association confer-ence, held earlier this year.
It was also an alarm bell for anyone whobelieves there’s strong protection envelopingelectronic health records and their networks.
No way, scoffs the visionary Malcolm,known for stirring audiences with “startlinginsights and brutal honesty”. Claims Mal-colm: “My average time for breaking into aclient’s computer system, even with the mostsophisticated security, is about 78 minutes.”
Malcolm, an ‘ethical hacker-for-hire’,
operates NetRunner Inc. His clients in-clude the security conscious likes of theCanadian Armed Forces, various policeforces, and major businesses. Malcolmshows even these seemingly uber-securegiants how they can fall prey to what hecalls the “criminally versatile” hacker.
Malcolm’s benign hacking underlinesthe point that electronic health recordkeeping is still a risky business.
And few understand risk better than in-surance people like David Hallstrom ofCNA Insurance, a Chicago.-based firmwith over a million clients world wide. Theamusing Hallstrom has been underwritingtechnology risk insurance for 17 years.
“We live in a world where everyone isconnected,” Hallstrom reminded all in hisconference opening presentation. “Justlook at Facebook for example. There arenow 1.35 billion Facebook users registeredworld wide with 17 million of those inCanada, half the country. And soon in thecoming “internet of things” everything inyour house will be connected, includingtoothbrushes, no kidding. They are on themarket today and can send information onyour brushing techniques via the internetto your dentist.”
In other words, the opportunities for thecriminally versatile hacker who wants yourinformation have grown exponentially. Howmuch hacking, then, is actually going on?
“Not everyone insures for cyber risk, sowe don’t know everything that is going onout there, but we do know what actuallygets reported to insurance companies asclaims,” explains Hallstrom. “Of the re-ported breaches in 2014, about 34 percentwere from hacking events, about 19 percentwere interventions by employees (often thecase in hospitals) and about 15 percentstemmed from a lost or stolen computingdevice such as a laptop or cell phone.”
So what’s being done here in Canada toprevent such breaches and to build or per-haps re-build confidence in electronichealth records?
On that score, Brian Beamish, Ontario’sindependent information privacy com-missioner had some instructive insightsfor conference attendees.
“The challenge with making health in-formation secure is that it has a dual na-ture,” observes Beamish. “Because it is suchpersonal and sensitive information itneeds strong privacy protection and yet itmust also be quickly available to healthprofessionals to provide care.”
What’s more, patients fear having theirrecords hacked, adds Beamish: “We knowfrom studies that people may withhold in-formation from healthcare providers ornot provide accurate information tothem.” The net result can be a devastatingcollapse of trust in the whole electronichealthcare system.
The conference then turned to what canbe done about cyber threats with a “Learningfrom Each Other” discussion panel. ChadMarson, another certified ethical hacker, inhis case for the banking and financial sector,led the discussion off with a nod to the needfor meaningful collaboration.
“We’re in a very competitive industry,”says Marson who is a senior OperationalRisk Officer for the BMO Financial Group,“but you’ll never see an ad that says our
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E L E C T R O N I C H E A L T H R E C O R D S
bank’s security is better than anotherbank’s. We never compete on security.”
Marson has lived cyber collaboration aschair of the his industry’s collective Criti-cal Incident Response Team day, whichbrings together financial industry leadersto share common threats and work outwhat they should all do about them.
Says Marson: “Our industry advantage,of course, is that we have recourse. If creditcards are compromised, we can cancelthem. But you can’t cancel or bring back aperson’s medical information. That’s whywe calculate that a person’s medical infor-mation is worth five to 10 times as much astheir credit card is.”
Panel member Janet Money knowsabout breaches in cyber walls through herwork as a privacy and access associate atThe Hospital for Sick Children, in Toronto.
“Of the 13 breaches we have had in 10years of Ontario’s privacy act, seven ofthem involved information technology;”says Money. “Five of those were the hospi-tal’s doing; four of them were existing sys-tems issues like lack of encryption; three of
the seven were rogue employees; and onlyone breach could be considered malicious.”
In that notorious breach, hackersdemonstrated their versatility at making il-licit cash by feeding information abouthospital newborns to sellers of registerededucational savings plans.
“But do these numbers show a trend orare they just a blip?” Money asked the con-ference and then answered: “With just onemalicious incident over a decade, I wouldargue that it is not a trend; but it is some-thing we should be concerned about.”
Fellow panel member Marson thinksthe concern over cyber security in health-care, whatever its level of seriousness,should be focused on people, not technol-ogy, to stem information leaks: “Peoplework hard at security, I know, but unfortu-nately they can be your easiest point ofcompromise.
“So your people have to be very aware ofwhat kind of hacking they might be subjectto and be trained on how to deal with it.”
For Ontario privacy commissionerBrian Beamish, the answer to the threat ofthe criminally versatile is for healthcare or-ganizations to build a “culture of privacy”:“That requires a commitment from thetop, which think is already there in mosthealthcare organizations, but it also in-volves generating solid policy as well asclear-cut procedures and making sure theydon’t sit on a shelf.”
Cyber risk insurance man David Hall-strom agrees: “Too often we have seen CIOseven who don’t know what to do with se-curity threats. So you definitely need a se-curity policy that makes clear to absolutelyeveryone in your organization: this is howyou can use data; this is how our organiza-tion protects it; and you have to agree tofollow these guidelines; and if you don’tyou will no longer be an employee here.”
Cyber security guru, Patrick Malcolmhowever, calls for more drastic measures.
“The enemy, the hackers, have all the
advantages because we are not treating ourdata as we should, and so they will outpaceus,” predicts Malcolm “So you need tothink of your patient data as a toxic chem-ical. That means that just like handlingtoxic chemicals, you need to know exactlywhat you are doing when you move thedata, know exactly what you are doingwhen you store it, and know exactly whatyou are doing when you access it.”
And be aware too of the criminally ver-satile, whom Malcolm emulates daily in hisconsulting work.
As an example, he told of a cyber at-tack he launched on a willing client withsupposedly rock-solid security. Hetricked a pub waitress into thinking theUSB key he handed her had been left be-hind by an employee of the client com-pany upstairs and would she mind giving
it to the next employee who came in –and she did.
The USB key was not what it appeared tobe, however. The moment the unsuspectingemployee plugged it in, his computerthought it was a keyboard, which comput-ers never check for viruses nor malware.
“Once that happened,” reported Mal-colm, “I was able to hack their entire sys-tem in just under 44 minutes.”
Data breaches can lead to adevastating collapse of trust inthe whole electronic healthrecords system.
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E L E C T R O N I C H E A L T H R E C O R D S
BY DAVE WEBB
There’s no question technologybrings incredible improvementsinto the healthcare process. Butthose applications that enhancepatient outcomes come with a
cost in terms of time and convenience forclinicians.
Because the security and privacy of pa-tient records, scheduling, medication or-ders and the dozens of other applicationsin a clinical environment is so crucial, doc-tors, nurses and other clinicians spend alot of their time logging into (and out of)secure applications – perhaps as many as70 times during an eight-hour shift.
“In our previous processes, physicianswould walk into an office in the morning,and they’d typically (be working with) acouple of exam rooms and their officesand the nurses’ stations,” says Joe Cruise,IT director with Group Health Centre(GHC), which serves 70,000 residents inthe Sault Ste. Marie and Algoma districtsin Northern Ontario.
“The preparation time in the morningwas often as much as 20 minutes to spendtime in each exam room, prepping the sta-tion, getting the logins in place to ulti-mately get access to the medical recordsapplication.”
As well, clinicians would sometimeshave to go through several levels of au-thentication to access the application, eachwith their own credentials, Cruise says.
GHC is hardly a laggard in terms ofhealthcare technology adoption – the cen-tre introduced electronic medical records(EMR) in 1997, making it one of the firstorganizations to adopt the technology –
but Cruise and chief information officerRalph Barker saw an opportunity to fur-ther streamline processes. It involved a“forklift” cutover, replacing the entire ITinfrastructure with a new system built onthree components.
A virtual desktop infrastructure (VDI)solution from VMware Inc. consolidatesdesktop images on a central server and dis-tributes them to zero client devices in examrooms, at nurses’ stations, in offices, etc.
Clinicians can move from room toroom and bring up their desktops exactlyas they’d left them. The interfaces for aphysician and a nurse, for example, areconsiderably different; this customizationand portability means clinicians don’t haveto hunt for the appropriate interface whenthey move to a new screen.
Software from Epic Systems Corp. pro-vides the EMR and practice managementbackend. But there was still the issue of lo-gin time from machine to machine.
Single sign-on technology from Impri-vata Inc. helped pull the two together andmake the clinicians’ journey from stationto station seamless. Simply tapping an ac-cess card on a reader on the VDI zero clientverifies the user’s identity, and calls up theappropriate interface.
By Cruise’s estimate, that morningsetup time goes from 20 minutes per roomto less than four seconds each time theclinician logs in.
Clay Ritchey, chief marketing officer of12-year-old Imprivata, says that VDI tech-nology is gaining more traction in health-care than many other industries, partly be-cause privacy and regulatory compliance
issues are a barrier to the adoption ofcloud technologies. VDI offers similarbenefits to those of a cloud infrastructurein an on-premise environment.
He says 65 percent of healthcare organi-zations in the U.S. will have moved to someVDI infrastructure in the next 24 months.
But even so, with the average cliniciandealing with more than 40 applications,and logging into them 10 to 12 times anhour, a password sign-in time of 30 to 60seconds costs staff as much as 45 minutes aday, Ritchey says.
Single sign-on technology gives a user apersistent login, verified by a tap card orbiometric identification through, for ex-ample, a fingerprint reader. Single sign-onalso integrates the VDI infrastructure andthe applications, allowing staff to instantlyreturn to the interface they were most re-cently using.
“Single sign-on is required to unlockthe power of (the healthcare organiza-tion’s) VDI investments,” Ritchey says.
It has made for a very different pictureat GHC.
“When a nurse arrives, she literally tapsa card, which authenticates her through tothe medical records application, which isthe primary app they need,” Cruise says.It’s configured with the interface the nurseneeds; after reviewing and entering vitalsigns, the nurse taps the reader to securethe screen and walks away.
When the physician walks into theroom, he or she taps a card on the reader,which authenticates the doctor and bringsup the doctor’s preferred EMR interface.
“It’s a two-to-three-second pop, and thescreen is there, and he’s able to go immedi-ately to work with the patient,” says Cruise.“He sees the input from the nurse, but heis working under his own desktop layout.”
One-tap login to applications saves clinicians up to 45 minutes a day
65% of healthcare organizationsin the U.S. will have moved tosome form of VDI infrastructurein the next 24 months.
Ministry of Health and eHealth Ontario. Patients seem very anxious to connect
with physicians on-line. As Dr. Elseynoted, of the first 10 patients he invited
onto the system, nine immediately agreed.“One opted out,” said Dr. Elsey, “becausehe didn’t have a computer.”
Evidently, patients and their care-giverslike the ability to message clinicians. Theyalso like accessing their own medical records.
Mosher notes that, “85 percent of pa-tients say that having access to their healthrecords makes them more aware of theirhealth issues.”
In the end, this helps both patients andthe medical system. For example, he men-tions medication compliance. “We knowthat compliance is only 50 percent. Manypatients don’t know why they’re takingtheir pills, so they stop. But if they can senda quick message to their doctors, to findout if everything is happening the way itshould, they’re more likely to keep takingtheir meds.”
In future, said Dr. Elsey, the portal willlikely be opened to other organizationswith a stake in the patient’s care. He saiddiscussions have already started with thelocal Community Care Access Centre,which coordinates home care with Emer-gency Medical Services.
“We can see this as a great benefit toparamedics, who could access the patient’srecord when giving care,” said Dr. Elsey.Paramedics could see, for example, the med-ication record instead of relying on the rec-ollections of the patient’s family or friends.
Dr. Elsey is quick to point out, however,that analysis needs to be done to prove theworth of the system, especially to justify anongoing investment.
The data management group, he says,will be collecting information about emer-gency department visits and hospital re-ad-missions, to see if they have fallen with useof the portal. They will also look at metricslike follow-up visits to GPs after dischargefrom hospital, to see if they have improved.
He is optimistic that MyHe@lthLinkedwill deliver on its promise. “This will be anenabling piece of technology,” said Dr.Elsey. “In the end, it will help us deliverbetter care.”
CONTINUED FROM PAGE 9
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in with medical diagnoses, which is morethan we expected.”
CAMH’s systems are now connected toa number of external entities, including itslocal family health team, the Ontario LabInformation System, the regional healthrecord project, ConnectingGTA, and oth-
ers. “We’ve been a viewing site only untilnow, but in the coming year, we’ll be con-tributing data to ConnectingGTA. Andnow that our discharge summaries areelectronic, we can send them to any GPwithin 24 hours.”
With a wealth of data to slice and dice,CAMH can see where there are gaps. “Be-cause we can now report more accuratelyon our patient population, we’re startingto see where we’re not doing a good job of
collecting complete data on our patientsand where we need to focus more effort.For example, getting a complete picture ofhow patients are arriving to us and captur-ing the referral sources, so that we’ll knowwhich organizations are most importantfor us to collaborate with.”
CAMH will continue to build up its sys-tems in the coming years, says MacArthur.“We’re planning to expand our analyticsplatform so we can drive more quality-of-
care advances. And we’ll be focusing on in-tegrating research with clinical care, andimplementing our clinical-trial function-ality in the future. For example, we’re in-volved in collaboration with Trillium andSick Kids called the Medical Psychiatry Al-liance that will look at news ways of inte-grating mental and physical health care.”
Shave says CAMH’s success with its bigbang implementation is already inspiringother Canadian hospitals to follow suit.“The next major implementation we’redoing is at a community hospital in Corn-wall that’s also opted for a big bang imple-mentation to reduce costs.”
Big bang implementations have alreadybeen making a big comeback in the U.S. inrecent years, and there are good reasons forthis, says Shave. “It’s really hard to take anincremental approach with a partly auto-mated system while parts of the system arestill based on paper. That piecemeal ap-proach to automation introduces brokenworkflows and inconvenient or really diffi-cult workarounds. Those horror stories inthe media occurred in the past when thetechnologies and processes weren’t sophis-ticated enough for big IT projects. Themarket wasn’t ready for that level of col-laboration and coordination. But all theseelements have evolved today.”
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tient identity is very significant andyou need to have eyes wide open toensure your data is clean and there aregood identity mechanisms in place.”
Using the provincial registry’sironclad identity mechanisms mini-mizes the repetitive sign-ons anddrudgery that can frustrate HIEusers, he adds. “The registry ensuresit’s the right patient. That minimizesclicking and data entry because youdon’t have to hunt for patients orpick them from a list.”
One interconnection of the Unify-ing Clinical Information project hasbeen completed thus far. “We’ve im-plemented the dbMotion solution tothe point where the Paris system,which is our community health ser-vice delivery system for mentalhealth, substance abuse and homecare, can view information from ourhospitals’ Meditech systems.”
The team is currently working onthe reverse flow – to make Paris dataavailable to Meditech systems – andalso integration with the provincial labinformation system (PLIS) to makepublic and private sector lab resultsavailable to all Paris and Meditechusers simultaneously. “This is allscheduled to go live in June 2015.”
Decisions about the sequence ofsystems to link-up and roll-out aremade by a clinical working group. “Wehave plans to integrate the next largeclinical system, which is Intrahealth,used by our primary care providers,”said Barker. “And we’re going to beintegrating our HIE with otherprovincial repositories such as Phar-manet, which will make pharmaceuti-cal information much more readilyavailable to our clinicians.”
Thanks to a secure region-wide patient portal powered by InterSystemsHealthShare® and Hixny, Marla and her entire family feels a whole lot better.
During a hospitalization, Marla and her husband had access to a complete online medical record spanning the entire care community. No one had to worry that crucial information might be lost or forgotten. It was all right there, accessed with a Web browser.
What does the family know now about patient engagement? It means peace of mind.
To learn more about Hixny and HealthShare, InterSystems’ health informatics platform, visit InterSystems.com/Patient2W
A HealthShare Success Story: Hixny
“Patient engagement?”We just feel better.
Better Care. Connected Care. HealthShare.
Toshiba’s International CT Symposium “Computed Tomography at the Heart of Integrated Diagnostic Imaging” will explore a wide range of clinical topics, from the perspective of the radiologist, cardiologist, technologist and physicist. A faculty of internationally renowned speakers has been assembled to provide an academic experience of the highest order, engaging participants in every element of modern CT imaging. This accredited academic event will take place at the Fairmont Queen Elizabeth, Montreal, Canada and McGill University.
“Topics-at-a-Glance”: Session A (June 12, 2015)
• Neuro Intervention Treatment of Acute Stroke and/or AVM
(Arterio-Venous Malformation)
• Neuro Imaging with Perfusion Analysis and Interpretation
• Patient treatment and care management post neurological event
• Acute Stroke Imaging
• Live Streaming of Neuro Intervention Treatment of AVM
(Arterio-Venous Malformation)
Venue: McGill UniversityMontreal Neurological Institute and HospitalMontreal, Quebec
S A V E T H E D A T E ! June 12-13, 2015
For additional information, please visit www.Toshiba-Medical.ca
International CT Symposium 2015
June 12-13, 2015Fairmont The Queen Elizabeth (Montreal)
COMPUTED TOMOGRAPHY AT THE HEART OF INTEGRATED DIAGNOSTIC IMAGING
“Topics-at-a-Glance”: Sessions B & C (June 13, 2015)
• AIDR Enhanced Imaging
• 4D MSK Imaging - Movement Analysis
• Advanced Vascular Imaging
• The Next Step in Cardiovascular Evaluation
• Subtraction Versus Dual Energy - The New Debate
• Single Energy Metal Artifact Reduction using Helical CT and/or Volume CT
• Volume, Volumetric or Helical CT - from a Technical Perspective
• Contrast versus Spatial Resolution in Neuro Imaging
• Dose Reduction Technologies
• Volume CT Imaging in Cardiothoracic Diagnosis
• Fusion Imaging – Integrated Diagnostics
Venue: Fairmont The Queen Elizabeth900 Rene Levesque Boulevard WestMontreal, Quebec
