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INSIDE:

How to use social media?A team at Sunnybrook Hospital isusing Twitter, YouTube and otherforms of social media to informpatients and the public. The sys-tems are also showing the hospitalwhat patients want.Page 4

A new home care EMRToronto-based VHA Home Health-Care, a provider of home care ser-vices, was using the Pixalere soft-ware system for wound care man-

agement. The two organizationshave worked together to producea complete EMR, which is now be-ing used by VHA’s team.Page 4

eReferral in AlbertaA test of an eReferral system in Al-berta, focused on a few specialties,has been so successful and popularwith physicians that it will begreatly expanded this year.Page 9

An Epic project at CHEOCHEO plans to fast-track its usageof the Epic information system.The system has proven its worth,and before the end of 2017, theplan is to have it up and running

throughout the hospital, includingemergency, inpatient care, themedical day unit, pharmacy, radiol-ogy and oncology.Page 6

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FEATURE REPORT: ELECTRONIC HEALTH RECORDS — SEE PAGE 14

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 21, NO. 4 MAY 2016

BY JERRY ZEIDENBERG

REGINA – eHealth Saskatchewan hasbegun activating a hybrid cloud, anintegrated mixture of private and

public cloud technologies. A high-powered private cloud will con-

solidate the data centres that are running inthe province’s 13 health districts, making thedelivery of computer services much more ef-ficient. At the same time, the enhanced abil-ities of the cloud will improve access to in-formation for authorized doctors, nursesand other clinicians.

Meanwhile, the province is also testingthe use of a public cloud, called the CitizenHealth Information Portal (CHIP). This

system allows patients to track a portion oftheir electronic health record and to up-load various kinds of information – suchas results from tests and encounters in clin-ics and labs.

“We’re working to achieve a balance be-tween the two clouds,” said Wilbour Crad-

dock, VP of Information Technology ateHealth Saskatchewan. “We’re providing aweb front-end that allows patients to updatetheir information and upload information

like blood glucose results, calorie intake, andother important data.”

CHIP also allows members of the publicto see the results of their lab tests, hospitalvisits, immunizations and pharmacy records,all in a secure manner.

The public cloud is currently a pilot pro-ject that will enrol about 1,000 patients andwill run for six to eight months. At thatpoint, eHealth Saskatchewan will conductan evaluation to see which features are mostused, what more is needed, and, generally,how it can be optimized.

In future, additional public clouds fromtop-tier vendors like Microsoft and Ama-zon could be tied to the system. eHealth

eHealth Saskatchewan revvs-up hybrid cloud

CONTINUED ON PAGE 2

Surgeons and interventional radiologists are now using interactive virtual reality (VR) to plan surgeries and procedures. The technology en-ables them to visualize the intricate anatomy of their patients before conducting operations, so there are fewer surprises during the actual pro-cedures. Clinicians at the Toronto General Hospital and the Hospital for Sick Children have been testing the technology. SEE STORY ON PAGE 8.

Virtual reality assists surgeons and radiologists

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eHealth Saskatchewan will create a balance between theprivate and public clouds.

MANAGEDEQUIPMENT

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Saskatchewan has worked with its keydata-centre vendor, EMC, to implementtechnology that will allow various systemsto be integrated in a secure manner.

“We were early into our thinking onthis, and built a data centre that supportsmodern healthcare users,” said David Di-mond, Chief Technology Officer forEMC’s Global Healthcare Business. “Thereis enormous growth of patient data andtoday, a hybrid approach is needed,” hesaid, noting the popularity of apps andnew kinds of devices that people are usingto track their health.

“Patients are using all types of devices,with apps on their iPhones and Android de-vices that are continuously updated, and thelocation of the data not necessarily known.But it can still be connected to our cloud.”

Saskatchewan is one of the first jurisdic-tions in Canada to deploy a private/publiccloud strategy to better manage its healthinformation.

While the public component of the sys-tem is still in the testing phase, the privateportion of the cloud is being rolled out in

full force. Earlier this year, eHealthSaskatchewan moved from the use of a sin-gle data centre to twin centres, one inRegina and the other in Saskatoon.

The twin data centres have full failoverabilities – if one is temporarily down, theother can take over and serve cliniciansand administrators across the province.“We can shut off one data centre and nevermiss a beat,” said Craddock.

Moreover, the new, private cloud is be-ing used to consolidate the computerizedapplications used in Saskatchewan’s 13health authorities, along with those of theMinistry of Health. The ministry’s solu-tions include birth and death registrations,vital statistics, and a health-card registry,along with others.

There are multiple benefits. In additionto the disaster management capabilities,the system centralizes the software solu-tions that are used by the 13 regionalhealth authorities. “They were all support-ing their own applications,” and runningseparate data centres, said Craddock.

So instead of multiple data centres,there will soon be just two. That meanshardware and software can be more easily

managed, with upgrades done at the sametime, instead of on different timelines atmany different locations.

The province-wide applications includethe Allscripts Sunrise electronic patientrecord and an EHR viewer from OrionHealth that allows clinicians acrossSaskatchewan to see the records. There are

also common applications used for regis-tration and pharmacy, as well as a Cernerradiology information system.

Most of the community physiciansacross the province are using QHR’s Ac-curo electronic medical record; it, too, willbe integrated into the private cloud, mak-ing the management of patient records forphysicians much more efficient.

An outlier is the province-wide PictureArchiving and Communication System(PACS), which is supplied and managed

separately by Philips. The company main-tains its own servers in the data centres,and runs the province-wide PACS on be-half of the health system.

An innovative feature of the eHealthSaskatchewan cloud is the inclusion of vir-tual desktops and ‘follow-me’ technologyfor clinicians. This means a doctor wholeaves a computer in one exam room orward can jump back to wherever he or shewas in the next system simply by swipingan ID card over a reader.

“They can return to their last session,wherever they are,” said Craddock.

This will save a lot of time and troublefor doctors when moving around a facility.It means that clinicians don’t have to carrya tablet around, as they can easily reach allthe information they need, wherever theyhappen to be.

Craddock’s team will be enabling 6,000desktops in this way over the next fewmonths; the uptake by clinicians will takeplace over the next year.

In all, the rollout of the hybrid cloudhas been the result of two years of hardwork and a substantial investment, Crad-dock said. The new data centres each have600 square feet of ‘heavy density’ comput-ing power, with 3,000 servers and terabytesof storage capacity.

“We’ve built a robust infrastructure,”said Craddock.

CONTINUED FROM PAGE 1

Art DirectorWalter [email protected]

Art AssistantJoanne [email protected]

CirculationMarla [email protected]

Publisher & EditorJerry [email protected]

Office ManagerNeil [email protected]

Address all correspondence to Canadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9 Canada. Telephone: (905) 709-2330.Fax: (905) 709-2258. Internet: www.canhealth.com. E-mail: [email protected]. Canadian Healthcare Technology will publish eight issues in 2016. Featureschedule and advertising kits available upon request. Canadian Healthcare Technology is sent free of charge to physicians and managers in hospitals, clinicsand nursing homes. All others: $67.80 per year ($60 + $7.80 HST). Registration number 899059430 RT. ©2016 by Canadian Healthcare Technology. Thecontent of Canadian Healthcare Technology is subject to copyright. Reproduction in whole or in part without prior written permission is strictly prohibited.Send all requests for permission to Jerry Zeidenberg, Publisher. Publications Mail Agreement No. 40018238. Return undeliverable Canadian addresses toCanadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9. E-mail: [email protected]. ISSN 1486-7133.

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

Volume 21, Number 4 May 2016

Contributing EditorsDr. Sunny MalhotraTwitter: @drsunnymalhotra

Dianne [email protected]

Richard Irving, [email protected]

Rosie [email protected]

Andy [email protected]

Saskatchewan’s hybrid cloud integrates public and private technologies

The private cloud willconsolidate the many systemsused in Saskatchewan’s 13health authorities.

THE JUNE/JULY EDITION of CanadianHealthcare Technology will containour annual directory of leading suppli-ers of health information technologyto the hospital, continuing care andclinic sectors. The directory is a popu-lar guide for managers in these organi-zations, as they look to see who is of-fering solutions in a variety of areas.The Resource Guide will be printed inthe June/July issue, and it will also bereplicated on the Canadian HealthcareTechnology website, where it will appearfor the next year. Visit our our websitefor a free listing. Company logos can beadded for a modest fee.

The June/July issue will also con-tain our regular coverage of topicalnews events – developments that arehaving an impact on the delivery ofhealthcare in Canada and around theworld. The articles include a look at aVancouver company that has createdan easy-to-use EMR. The company isquickly winning new customers.

Coming in June/July:Directory of suppliers

Allscripts Sunrise™ connects people, places and insights by integrating clinical and operational data across all care settings. This delivers a complete view of a patient’s health that follows them through each stage of care.

The Power to Transform Canadian Health Care.That’s the Power of Allscripts.

www.allscripts.com | @allscriptsCAN

A Canadian Innovation

Copyright © 2015 Allscripts Healthcare Solutions, Inc.

2 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y M A Y 2 0 1 6 h t t p : / / w w w . c a n h e a l t h . c o m

Health information has the power to change the quality of our lives, and we’re working hard to improve healthcare across generations. When clinicians have access to complete patient information from the entire care continuum, everyone benefits. Enhanced analysis. Increased insight. Informed decisions. And that adds up to a better quality of life for everyone.

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SOLUTIONS FOR: Healthcare Integration | Population Health Management | Electronic Health Records

For more information, please visit us at eHealth in booth #416 or e-mail [email protected]

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h t t p : / / w w w . c a n h e a l t h . c o m4 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y M A Y 2 0 1 6

TORONTO – How do you coordi-nate patient care among hun-dreds of healthcare providerswho work independently in com-

munities scattered across a province? Cre-ating an electronic health record systemhas been VHA Home HealthCare’s re-sponse to this challenge – and it is revolu-tionizing the way the organization’s nursesdeliver client care.

VHA staff and service providers deliverhealthcare and support services in homes,the community and long-term care facili-ties across Ontario. Its large records man-agement team processes the paper healthrecords produced by more than 800 nurs-ing and rehab service providers.

This paper-based system created gaps incare coordination, and limited the organi-zation’s ability to measure quality and pro-mote best practice. The solution – movingto an electronic health record (EHR) – notonly offered productivity gains withinrecords management, but also aligned withVHA’s commitment to continuous im-provement, client safety, and quality ofcare through accurate and complete clini-cal documentation.

“VHA places a strong emphasis ontechnology and its ability to improve theway we work,” says Drew Wesley, VHA’sDirector, Information Management andTechnology. “You see it in our strategicplan and in communications from ourleadership. The message has been clear andconsistent that technology is our future,and our service providers were ready toembrace the change.”

VHA’s EHR implementation team se-lected Pixalere as its technology partner,after piloting the company’s wound caremanagement system with a small group ofnurses for 10 months. “We have been fo-cused on improving wound care for over10 years,” says Pixalere’s CEO Ken Hends-

bee. “VHA purchased our healthcare ap-plication and they recognized that it couldbe modified for other uses within theirhealth services. We’re agile, so we wel-comed the opportunity to create an ex-panded, customized system.”

Over the course of 18 months, Pixaleredevelopers enhanced the tool to meetVHA’s internal procedures – expanding onthe existing features to incorporate VHA’srequired forms, including client assess-ments, medication management forms,pain assessments and physician orders.

“The evolution is ongoing, but our im-plementations have been successful be-cause of our agile collaboration, and con-tinuous review of current and future fea-ture development,” says Hendsbee.

VHA reviews Pixalere’s builds whilethey are being developed, and provides im-mediate feedback. The resulting EHR fea-tures enable VHA nurses to document theirfull range of client services through photos,free-form text, check boxes, and decisionsupport, to meet the organization’s accred-itation and other best practice standards.

“Pixalere has been a tremendous tech-nology partner,” says Wesley. “They havebeen very responsive and worked withour team to significantly expand andevolve their cloud-based platform into afully-functional, community-focusednursing EHR.”

VHA’s EHR implementation team alsoleveraged the knowledge of point-of-carestaff at all stages of the EHR’s develop-ment. “Our nurses have been very involvedin the design of the system so its interfaceis intuitive for them. They were also en-gaged in the selection of the mobile device– a laptop with detachable touchscreenand built-in SIM card,” says Kartini Mistry,Professional Practice Specialist, ClinicalInformatics, whose role on the team is toensure the EHR design promotes good use,

professional practice and quality care forthe client.

Over the course of the rollout, all VHAnurses received mandatory computer liter-acy training, an intensive five-hour work-shop on the application, and a one-houronline exercise to complete at home. “Theat-home exercise gave the nurses an op-portunity to practise using the system, andgave us the opportunity to provide feed-back where there were shortcomings. Wecould promote best practice right from thestart,” says Mistry.

The EHR is now used province-widewith all adult nursing clients. It is used tocapture client information in real time,and allows all nurses involved in a client’scircle of care to receive accurate data, makebetter care decisions, and allocate re-sources strategically.

“It has definitely improved accessibilityand consistency of our client data. Thingslike lost faxes or illegible charts have beeneliminated,” says Mistry.

Moreover, “The system pre-populatessome information from other IT systems,which ensures consistency, and there aremandatory areas for nurses to complete,enabling us to shape clinical practice,” addsMistry.

“It’s also exciting to see the documenta-tion process is proving to be faster thanwith paper once users get over the learningcurve.”

Having a mobile device with decision-support tools also encourages users to dotheir documentation right at the point-of-care. This allows VHA supervisors to dolive audits and provide immediate real-time feedback on performance.

Sunnybrook Hospital shines in its use of Twitter and other social mediaBY JERRY ZEIDENBERG

TORONTO – Sunnybrook Hos-pital now has the mostwatched YouTube channel ofany hospital in Canada, saysSivan Keren Young, the med-

ical centre’s chief of web and social me-dia. She added, “We couldn’t say thatwhen we first started,” as the organiza-tion had to learn how to use social me-dia effectively.

Keren Young spoke at the recent Mo-bile Health Summit, a two-day confer-ence that was organized by the StrategyInstitute.

Take a look at Sunnybrook Hospital’sYouTube channel and you see a broadarray of polished videos, and they’re re-freshed regularly with new ones offeringtips to patients and the community, aswell as news about the hospital’s medicaltriumphs and research breakthroughs.

A two-minute video about exercisefor babies, for example, has garneredover 665,000 views. One on the hospi-

tal’s recent breaking of the blood-brainbarrier has elicited over 43,000 views.

Meanwhile, Sunnybrook’s Twitter feedhas a whopping 29,000 followers. Peopleare cottoning on to the hospital’s menuof health tips and cutting-edge news.

Keren Young says it took a while tolearn how to use social media effectively.“Six years ago, Sunnybrook was likely totweet out a press release. But that’s bor-ing. Nobody wants to read that.”

Now, the tweets have punchy head-lines and colourful photos. And throughtrial and error, and by carefully monitor-ing reactions and comments, Sivan andher team have a good idea of what pa-tients and the public want to read.

“What are people interested in? You’vegot to listen first. See what the conversa-tion is about, and then add value.

“When you do have something im-portant to say, people will listen.”

And they’ll watch you on their com-puter screens and smartphones. Thatwas certainly the case when Sunnybrooklive-tweeted a heart surgery. “It got im-

mediate attention, as it was the first timeanyone had done this,” she said.

“It led to an increase of 5,500 Twitterfollowers in three days.” The hospital re-peated the exercise with a live cancersurgery.

It’s important to respond quickly tocomments, too. This kind of interactivitywith patients and the community willfoster a closer relationship. Look on thehospital’s Twitter site and you’ll see the

social media staff responding to ques-tions with polite and helpful commentsand suggestions.

Sunnybrook has learned how to be-come more effective, as a hospital,through its use of social media. It re-cently conducted a patient care survey

through Twitter as a way of finding outwhat patients like and dislike.

For example, when phoning patients,Sunnybrook used to have “unknownname” show on the phone’s ID screen, asa way of maintaining privacy. However,many patients were ignoring the calls, asthey didn’t know who was calling anddidn’t want to be bothered. As a result,they were missing appointments andcare instructions.

When asked whether they’d prefer theID to read “Sunnybrook Hospital”, over85 percent of the Twitter users who par-ticipated in the survey said yes. As a re-sult, the hospital changed its phone ID –presumably leading to higher patientsatisfaction and better care.

Accomplishing all this, however, tooktime, effort and an investment. KerenYoung joked that many people think be-cause you’re using the web, it’s all free.“It’s not,” she asserted. “Your investmentin people is large. And it has to tie intoyour corporate strategy. Nobody wouldsay that’s free.”

Pixalere’s wound care management software formed the core of a full-fledged electronic health record.

Sunnybrook’s two-minuteYouTube video about exercisefor babies has garnered over665,000 views.

Wound management system transformed into an EHR for home care

shaping tomorrow with you

For more information on Fujitsu scanners, please visit www.fujitsu.ca/scanning.


BY MAUREEN VAN DREUMEL

OTTAWA – When Allerject – acommonly prescribed epi-nephrine injector used forthe emergency treatmentof patients with severe al-

lergic reactions – was recalled in October2015, the Children’s Hospital of EasternOntario (CHEO) used its Epic health in-formation system to do several things notpossible before.

It could run a report of how manyAllerject scripts were written and notifyproviders; create a system alert to preventproviders from submitting future orders,with a link to the Health Canada recall no-tice online; and recommend a substitute.

This is just one example of how CHEOis using Epic to introduce key clinical im-provements across the hospital.

CHEO is fast-tracking its Epic imple-mentation to realize system-wide benefitslike this as soon as possible.

“Epic represents a fundamental changein how we communicate and how we de-liver care,” said Tammy DeGiovanni, Direc-tor of Ambulatory Care at CHEO. “It offerscontinuous quality improvement and that’show we’ve chosen to implement it.”

Before the end of 2017, CHEO will ex-pand its current use of Epic from ambula-tory care, admission/registration, and itsmain lab and genetics program throughoutthe hospital to include emergency, inpatientdocumentation and ordering, the medicalday unit, pharmacy, radiology and oncology.

CHEO is also leveraging the EpicHaiku/Canto apps to go mobile.

CHEO is the first Canadian hospital toachieve HIMSS EMRAM Stage 6 in ambu-

latory care and within the next two years,CHEO plans to be one of the first Cana-dian hospitals to achieve HIMSS Stage 7throughout its organization.

So far, CHEO has implemented Epicacross 44 services, including 80 separateclinics with more than 900 physiciansand staff.

Dr. Jim King, Medical Director of Infor-matics at CHEO, noted, “Most CHEOphysicians are already using Epic in outpa-tient clinics and, while there is a steeplearning curve and working with the sys-tem takes effort, they are eager to use Epicin all aspects of care.”

As its use spreads throughout the hospi-tal, clinicians are finding it easier to coordi-nate their care across multiple disciplines.

Epic is also helping CHEO meet thechanging expectations of a digital genera-tion. Patients and families expect seamlessaccess to personalized health informationand services, realized through one singleelectronic health record per patient. Forthose with complex medical historieswhose paper charts can number multiplevolumes, an EHR means their full story isat the fingertips of each member of theircare team and they no longer need to re-peat their story or wait for physical chartsto follow them from clinic to clinic.

It means real-time information sharingbetween clinics. “I think my favouritething about Epic is that the chart’s alwaysavailable,” said pediatric ENT specialist Dr.Matthew Bromwich. “That’s a gamechanger in that you can always make deci-sions, whether you’re on the floor or inclinic or in emergency, based on the mostup-to-date information.”

Starting in April 2016, CHEO also began

offering instant, ‘view-only’ access to EpicMyChart – a secure, online portal that givespatients, parents or legal guardians accessto parts of their medical record. MyChartalso provides the information they need tokeep on top of appointments, make deci-sions and be true partners in care.

CHEO also offers ‘interactive’ MyChartaccess in its diabetes, ENT and endocrinol-ogy clinics to allow two-way communica-tion between clinicians, patients and fami-lies. During the next two years, CHEO willgradually expand interactive MyChart ac-cess to other areas of the hospital.

CHEO was one of the first hospitals touse Epic, back in 1993, for patient schedul-ing, registration and hospital billing. It hasbeen an early innovator and investor inelectronic health records because it be-

lieves in the value information systemsbring to patients, the hospital and thehealth system as a whole.

“We chose Epic as our electronic healthrecord because it frees us up to focus onour passion, which is caring for kids, notsearching for information,” said AlexMunter, president and CEO of CHEO. “Itwill mean that all patient information is inone place and readily accessible as a patientmoves through the hospital.”

As CHEO physicians and staff becomeproficient with Epic, they’re seeing the im-pact of what it can do. “Epic provides uswith timely, evidence-based informationthat we are already using across the hospi-tal to identify trends, find issues and con-tinuously improve care,” said Mari Teitel-baum, vice-president of technology andchief information officer at CHEO. “It’salso helping us tackle challenges such as agrowing patient population, increasing pa-tient complexity and the need for more ef-ficient and effective care.”

Better data has enabled CHEO to morequickly and accurately track and assess thenature and quality of its care.

Since CHEO started implementing Epicin its outpatient clinics in October 2013,physicians and staff have seen 78,269 pa-tients and documented 421,196 clinical en-counters. This preliminary snapshot – madepossible through its use of Epic – revealsthat CHEO provides over 40 percent of itspatient care closer to home through phonecalls (33 percent), prescription refills, etc.About one-quarter of all outpatients nowreceive an after-visit summary documentingthe outcome of their clinic visit.

Staff and physicians across the hospitalare learning to use this data to analyze andstreamline their clinic workflows. Ortho-pedic physicians, for example, have usedEpic data to help revamp their schedules,smooth volumes and decrease appoint-ment time for families.

And Epic referral management has en-abled CHEO to track, measure, report on –and reduce – initial consult wait times fornew outpatients. Referrals are triagedwhen received and referring providers no-tified of patient referral status.

Maureen van Dreumel is a communicationsadvisor for strategic initiatives at the Chil-dren’s Hospital of Eastern Ontario.

Business systems analyst Jennifer Gillert works with Dr. James Jarvis as CHEO launches Epic in orthopedics.

CHEO expands use of Epic to improve safety, quality and outcomes


Open and flexible solution engages all stakeholders within

the health ecosystem

underway globally

Innovative 14,600,000people served in

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BY JERRY ZEIDENBERG

To the 3D printing that’s taking themedical world by storm, we cannow add another innovative, three-

dimensional technology – interactive vir-tual reality. Wearing special goggles and

manipulating instruments, clinicians canexamine diagnostic images that appear tofloat in space in front of them.

Not only can they view organs, like thebrain, heart and colon, but they can alsoturn them over, dissect them, and make allkinds of precise measurements – of blood

vessels, aneurysms, tumours, and other ar-eas of interest.

The technology is showing great poten-tial in a number of areas, including surgi-cal planning. When faced with a challeng-ing surgery or interventional procedure,such as closing off a ballooning aneurysm

in the brain of a patient, a clinician can use3D virtual reality to view the anatomy ofthe patient beforehand so there are no sur-prises when the actual operation is beingconducted.

A leader in the field of 3D virtual realityis EchoPixel, Inc., of Mountain View,Calif., in the heart of Silicon Valley.EchoPixel’s True 3D technology is the firstFDA approved virtual reality system formedical-image processing.

In addition to Stanford University, theCleveland Clinic and the University of Cal-ifornia, San Francisco, EchoPixel is nowtesting the technology in pilot projectswith the Hospital for Sick Children, inToronto, and the Toronto General Hospi-tal’s cardiac centre.

“Doctors can dissect tissue and takethings apart, all in 3D, on the screen infront of them using reconstructions of thepatient’s actual anatomy,” said SergioAguirre, chief technology officer andfounder of EchoPixel.

He explained the company’s technologyturns the data sets collected from CT andMRI scanners, as well as ultrasound de-vices, into three-dimensional images thatcan be manipulated in a far more realisticmanner than regular 3D reconstructions.

After all, traditional 3D constructionsare still displayed on two-dimensionalmonitors. In contrast, virtual reality im-ages appear to the eye as objects, just asthey would when the clinician is conduct-ing a procedure.

And using the True 3D system, clini-cians can probe, cut, push and pull at tis-sue and structures to see what happens, allin real-time. That gives them a better ideaof what to expect when they conduct theactual operations.

Using EchoPixel’s technology and tools,they’re able to better plan a surgery. “In thecase of an aneurysm,” said Aguirre, “youcan see how to approach the aneurysm,which structures need to be avoided, howmuch coil will be required to fill it, whatsize of coil is best, and the size of thecatheter that should be used.”

Aguirre noted this allows for more ac-curacy and better outcomes: “It reducesthe mistakes that are made. You don’t haveto take out and replace implants after-wards, for example, because the wrong sizewas used.”

For some clinicians, virtual reality plan-ning may be an alternative to creating 3Dprinted models, which can take days orweeks to produce. And with 3D printing,mistakes are sometimes made and theprocess begins over again.

“Our technology speeds up the surgicalplanning and the surgery itself,” said RonSchilling, PhD, the CEO of EchoPixel.“And it gives clinicians the confidence theyneed to do the surgery.”

For clinicians who like working with 3Dprinted models, EchoPixel’s technologycan also be used to help with the printing.Schilling said the software helps producemore accurate models, and it turns themout of the printer much faster.

That’s because a lot of the work in 3Dmedical printing involves the processing ofimages; EchoPixel’s True 3D performs thejob much more quickly than other soft-ware packages, Schilling said.

VR is tested for surgical planning at Sick Kids and Toronto General



BY GARY FOLKER

An e-referral pilot program in Al-berta has shown how doctors’ of-fices can become more efficientand also how they can collabo-

rate more effectively. To build on this suc-cess, the province now plans to expand thee-referral project beginning later this year.

As Dr. Allen Ausford, who is with theLynnwood Family Practice in Edmonton,puts it: “When more than two-thirds ofclinical users say that eReferral has im-proved the quality of care and continuityof care, that’s when you know you must bedoing something right.”

The eReferral pilot was launched in July2014 by Alberta Health Services (AHS)and Alberta Health. Powered by OrionHealth’s portal solution, called AlbertaNetcare, the eReferral pilot aimed to im-prove the coordination of patients transi-tioning across Alberta’s continuum of care.

The project started with three earlyadopter groups: lung cancer; breast cancer;

and the hip andknee joint replace-ment specialties. Through eReferral,the status and essen-tial documentationfrom referrals aredistributed to spe-cialists and referringhealthcare providersin a faster and moreconsistent manner.On average, special-

ist clinics receive 45 to 50 referral faxesevery single day. Some of these arrive late,many are sent to the wrong providers andoften times, the referral forms are simplyincomplete.

According to Jodi Glassford, Director ofClosed Loop Referral Management, eRe-ferral and Alberta Referral Pathways atAHS, “the biggest portion of one clerk’sjob every day is calling the referring doc-tors’ offices to get a copy of the ECG.”

Incomplete referral information notonly leads to frustration, but it also resultsin a number of issues that are resource-in-tensive and continue to burden the systemfinancially: increased referral volume;transition of care delays; and, ultimately,rising healthcare costs.

Dr. Ausford notes that most referralscontinue to be done via fax, “despite thefact we have a robust enterprise EMRwith integrated access to the provincialEHR Netcare.”

The eReferral project has standardized amethod of sending the informationneeded for a referral, eliminating the trou-blesome faxes.

“Most EMRs already have a patientsummary sheet with all the pertinent in-formation,” explains Dr. Ausford. “UsingNetcare, we can attach this summary sheetto the eReferral, which only takes a secondto do. Having access to the right patient in-formation helps us to make better care-plan decisions.”

The eReferral solution includes the op-tion for requesting advice rather than a fullconsult, as there are many times where thepatient doesn’t actually need an in-personmeeting with the specialist.

The entire process of completing an eRe-ferral request for service takes an average ofthree minutes. Early results have shownthat the eReferral solution fosters morecollaborative patient care while helping toreduce unnecessary visits, duplication oftests and administration time.

Since the pilot’s launch, a total of 4,008eReferrals have been submitted, with thebulk for breast cancer (2,484), hip andknee referrals (1,191) and lung cancer(333). The majority of clinical users (81percent) say that eReferral has increasedefficiency in the referral process, and an

overwhelming 87 percent of users believeit has improved transparency.

Gary Folker is the Executive Vice Presidentfor Orion Health North America. Formore information on Orion Health, visitwww.orionhealth.com

Alberta scores success with e-referral pilot program, now readies a bigger rollout

© 2016 Cerner Corporation

To learn more go to www.cerner.ca

Cerner’s health information technologies connect people, information and systems, putting information where it’s needed most.

Together with our clients, we are committed to improving the health of individuals and communities.

Working together for a healthier tomorrow today.

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Gary Folker


BY DENIS CHAMBERLAND

In Canada, hospitals are under tight fi-nancial constraints, and in someprovinces, they are required by law to

maintain balanced budgets. At the same time, the pressures to im-

prove patient care continue to drive upcosts.

Traditional purchase, rental and leasingarrangements for medical technology –such as MRIs, CT scanners and ultrasoundequipment – are increasingly uneconomi-cal and generally unsatisfactory, as equip-

ment rapidly becomes obsolete. Budgetsconstraints and technology obsolescenceare serious problems for most health sys-tems globally.

Managed equipment services (MES):MES addresses many of the challengesfaced by hospitals in relation to medical

equipment. MES involves the outsourcingof all aspects of a portfolio of medicalequipment to a third party that specializesin providing managed services.

The MES provider procures, installs,trains users, manages and maintains theportfolio of medical equipment for along-term, typically ranging from 15 to25 years.

The MES provider owns the equipmentfor the entire term and makes it availableto the hospital as an integral part of a man-aged service, which includes all of the nec-essary elements to support effective use ofthe equipment.

The portfolio of equipment is re-placed by the MES provider on a pre-dictable, pre-arranged basis, in accor-dance with terms set out in a comprehen-sive legal agreement. MES ensures thatpatients and clinicians always have accessto the highest standard of equipment,thereby reducing clinical risks and in-creasing productivity.

With MES in place, the availability ofin-scope medical equipment is never aproblem.

MES converts a traditional asset pur-chase deal into a services offering, markedby predictable annual service paymentsand no capital out-lay. Because of itssignificant marketpresence and narrowfocus on medicalequipment, the MESprovider provides amuch higher stan-dard of service at acost-effective price,often at much belowthe hospital’s exist-ing cost structure.

Today the outsourcing of non-coreactivities is a standard practice withmost larger organizations. It allows forboth a transfer of risks to a specialist or-ganization that is better positioned tomanage those risks, and for the hospitalto focus on its core role of providing ahigh standard of clinical services to pa-tients. The platform that MES creates isalso often a catalyst for other hospital-wide reforms.

Some of the benefits of MES include:• Allows hospital staff to focus entirely on

improved patient care;• Ongoing access to up-to-date medical

equipment – no technology obsolescence.Up-to-date equipment also improves pa-tient safety.

• Continuously well-maintained medicalequipment, with procedures that are ad-ministered more quickly.

• More rationale and predictable workingenvironment that facilitates long-termbudget planning.

Recent MES success story: Several MESarrangements have now been put in placein Canada. The most recent and perhapsthe most advanced is Mackenzie Health’sMES deal with Philips Healthcare, an-nounced in November 2015.

The deal, worth over $300 million over15 years, will provide Mackenzie Healthwith access to state-of-the art medicalequipment under a flexible, single pay-ment structure that allows for both lower

Managed equipment services gaining acceptance in Canadian hospitals

Denis Chamberland

are you dealing with:• Workflow Efficiency

• Infection Control Concerns

• Low Patient Satisfaction Ratings

are you struggling with:• Security of Software & Patient Information

• Items that Require Heavy Maintenance

• Wire Management Issues

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Medication Compartment

Curved EdgesDeflect Collision and Minimize Damage and Injury

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Task LightRecessed Under Monitor

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Recessed Scanner Pocket Stays Hidden Below Monitor

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costs and better cost management over theterm of the deal.

Philips will be accountable for the pro-curement, installation, systems integra-tion, maintenance and timely replace-ment of equipment in accordance with apre-defined investment plan and theterms of a robust legal agreement, whichis structured to ensure accountability,drive continuous improvement and pro-vide Mackenzie Health with ongoing ac-cess to Philips’ healthcare innovations.Solutions from outside vendors will alsobe part of the mix.

Some of these innovations focus on sys-tems interoperability, diagnostic imagingequipment utilization, radiology practicemanagement, and patient-centric design,among others.

“We want to expand the quality of carewe offer in our region, and MES’s flexiblepayment model makes that possible bymaking the cost of the procurement and

the maintenance of the equipment morepredictable and allowing us to better man-age annual costs,” says Terry Villella,Mackenzie Health’s Deputy Chief Finan-cial Officer, who was directly responsiblefor the MES procurement process.

A distinctive feature of MES is its‘multi-vendor’ nature. While contractuallyensuring that it will provide a pre-set per-centage of the equipment with the MESportfolio, Philips will also procure andtake full responsibility to manage and ser-vice equipment from other manufacturersduring the term, thereby ensuring clinicalchoice at Mackenzie Health.

The importance of advisors: Putting anMES arrangement in place tends to be acomplex undertaking because it involves awide range of expertise typically unavail-able within the hospital or the vendor or-ganizations. This makes extensive relianceon the advice on the vendors problematicgiven the differing financial interests.

As Ms. Villella observes, “Workingwith advisors who are highly specializedand knowledgeable about MES and thehospital sector greatly assisted the devel-opment of the RFP, the evaluationprocess and the final selection of the suc-cessful proponent.”

And she adds, “By structuring an effi-cient and effective approach to the negoti-ation process, the skills our advisorsbrought to the table ensured that ourhealthcare team has ongoing access to thebest medical technology available, on thebest terms available in the marketplace.”

Above all, the MES must be customizedto the hospital’s specific objectives andneeds if it is to be effective and achieve thevalue the hospital is hoping for.

Mackenzie Health was able to achievea wide range of highly advantageous ben-efits that are not typically available tohospitals. These include significant fi-nancial benefits, comprehensive risktransfers in several important areas, pro-ject delivery on time and in line with theoriginal business case, and a highly com-plex procurement process conducted

without a challenge or complaint fromany of the proponents.

Given the rapid pace of change in med-ical technology, hospitals can no longer bythemselves hope to keep up with what isrequired to improve clinical outcomes forpatients while at the same time meet the fi-nancial and other pressures that confrontthem daily. The managed equipment ser-vices model can be an important part of

the solution for many organizations, as it isat Mackenzie Health.

Part 2 in this series, which will be pub-lished in the June/July edition of CanadianHealthcare Technology magazine, will fo-cus on the ICAT (Information, Communi-cation, and Automated Technology) com-ponent of the project, which is intended totransform Mackenzie Health into a ‘Smart’hospital.

Denis Chamberland is a member of a multi-disciplinary advisory group that works withhealth systems in Canada on a wide range ofmanaged services projects, including MESand Managed ICAT Services (MIS). Thegroup worked with Mackenzie Health on thehospital’s MES project and was also fully en-gaged on all earlier successful CanadianMES transactions. He can be reached [email protected]

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The MES model enables thehospital to focus its efforts onbetter patient care, instead ofprocurement and maintenance.

BY DR . SUNNY MALHOTRA

Expecting parents are always very anx-ious about the health of their new in-fants, especially as the delivery datenears. They usually make a special ef-fort to find out about child-rearing andthe newest ways of improving that tra-

ditional process. They are also among the most likely to disregard

budgets and will be selfless in their personal fi-nances to sacrifice for their children. The concept offrequent infant surveillance with baby monitorsand real-time video equipment has allowed for im-provements in monitoring over the years to tracksleeping habits, breathing rate, skin temperature,blood oxygen, heart rate and Sudden Infant DeathSyndrome (SIDS).

Interestingly, a new generation of ‘smart nurseryproducts’ has recently emerged for staying connectedwith your child. These products are suitable for chil-dren from birth to 18 months and allow parents tomonitor real-time data, including the baby’s breath-ing, sleep activity, body position and skin tempera-ture with their smartphone or tablet.

Connected clothing has become a fundamentalfor the smart nursery. A smart baby monitor calledMimo is a real-time audio feed that allows you to lis-ten to your baby via machine-washable onesies and amonitoring device. Monitors are also used alongwith sensors that attach to your baby’s clothing withMonbaby Smart Baby Monitoring.

There are wearables that monitor temperature,heart rate, motion and positioning such as Sprout-ling Baby Monitoring and the Owlet. Alarm alertscan allow you as a parent to leave your child morecomfortably in the hands of grandparents, nanniesor the babysitter while helping you prevent diseasessuch as SIDS.

Sensors can be utilized for toddlers transition-

ing from a crib to beds, as smart lighting in thehallway can be automatically triggered outside thenursery. This is also helpful if your child gets theurge to wander at night, as it becomes harder to doit in the dark.

Sensors can be a great addition to your front andback door, kitchen cabinets, the front yard gate anddrawers to prevent toddlers from leaving the nurseryand exploring new areas without your knowledge.

There are sensors that can act as medication oractivity reminders. Security sensors can also let you

know when someone enters your child’s room.This can be done via Mother and 4Motion CookiesVersatile Sensors. Dropcam wireless video moni-toring cameras can assist you in monitoringyour child as part of a more manually inten-sive solution.

Creating an environment with optimallighting and music for routine stimulationhave been underutilized. The Belkin WemoLight Switch and “smart lightbulbs” allowyou to manage your child’s lights from any-

where in the world via a mobile app, and they helpsave energy by setting timers or turning on beforeyou need to enter the room.

This can also help when you sleep train yourchild during those initial sleepless nights as part ofa comprehensive sleep training plan. Monitoringthe temperature, humidity and light levels in yourchild’s room via mobile device has been an area ofdevelopment with climate control sensors such asWimoto.

There are smart play toys such as Kumki, whichare Bluetooth-enabled, and play music and tell sto-ries. These “white noises” can also help block out thesounds in the house that may wake your baby.

Smart devices include smart bottles, smartclothes, smart measuring devices and improvedwearables/video monitoring to keep mothers and fa-thers closer to their children. The development ofyour child is managed with intermittent weightmonitoring among other clinical indices noted byyour pediatrician.

There are ways to collect further information on amore regular basis with the use of “smart bottles”

to calculate the amount of milk intake as wellas “smart weight scales” such as Withings to

track your baby’s weight gain on a moreregular basis. This is a new form of actionable data toimprove parenting and diagnose problemssooner on the consumer level. It would begreat to see a layering app to connect all

these sensors and applications under one ap-plication to allow for a simpler user inter-

face. Parenting gadgets can help facilitatemen and women going back to work

sooner, if they choose to, or indifferent countries withshorter maternity leaves.Welcome to Nursery Ver-sion 2.0.

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Sensors help monitor babies and toddlers, giving parents a better understanding of their child’s health.

New parents can alleviate their stress using the latest generation of smart sensors

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

There are wearables that monitortemperature, heart rate, motion andpositioning, alerting parents whensomething seems to be wrong.

What does it take for doctors to change their working methods?BY JERRY ZEIDENBERG

What would it take forphysicians to alter theirtraditional working

methods and modernize? Threethings, says Farzad Mostashari:First, a personal reason – thechange must give doctors more in-dependence or more time with theirfamilies. Second, a financial reason– the change or technology shouldresult in more income. And third, aprofessional reason – the newmethod must result in better carefor their patients. Hit all three andphysicians are likely to adoptchange in a New York minute.

Mostashari spoke on this topic atHIMSS in Las Vegas in March.

During the hour-long talk, thehumorous and engaging former Na-

tional Coordinator for Health Infor-mation Technology at the U.S. De-partment of Health recounted atelling incident that occurred shortlyafter his government agency hadushered EMRs into many New Yorkdoctors’ offices.

On a visit with his boss to a smallpractice that had recently computer-ized, Mostashari asked the doctor ifshe liked the new EMR. “No,” shebluntly answered, “It slows medown.”

It was an embarrassing moment,receiving that kind of answer in thepresence of one’s boss. But itdemonstrated something toMostashari. The physician didn’t likethe system because it slowed herdown, which meant she couldn’t seeas many patients. Which in turnmeant she couldn’t bill as much.

So right away, the EMR failed onthe financial front. Instead of help-ing the doc, it hindered her. Changewasn’t going to happen.

As well, many physicians findthat EMRs are not easy to use. And

they’re not so sure they help theirpatients.

Mostashari observed that EMRsmust be constructed more intelli-gently. Not only must they be easierto use, they must also contain thewisdom and experience of real clin-icians. “EHRs on their own do

nothing to improve quality,” hesaid.

But if you tweak the systems toinclude smart alerts, you can im-prove outcomes. He talked about apilot project that reminded doctorsto give vaccines for pneumoniawhen they gave the elderly their flushots in the fall. “Four years later, 67percent of the elderly had receivedtheir pneumonia vaccine.” It was aterrific improvement.

Using simple alerts, you can eas-ily enhance the health of your pa-tients. You also make more money.And if the system is well-designed,it’s not hard to use, meaning youdon’t waste your time fighting withtechnology.

Again, you’ve got to hit all threefactors – personal, financial and pro-fessional to make change happen.

When EMRs include simplealerts, they can improvepatient health andphysician satisfaction.


V I E W P O I N T

BY JENNIFER MACGREGOR

As I visit with healthcare leadersacross Canada, one thing isclear: their focus on outcomes ispaying off. They’re improving

patient safety and efficiencies throughouttheir organizations with electronic healthrecords (EHRs) and other health informa-tion technologies.

Several clients using Allscripts solutionshave demonstrated outstanding clinicaland financial results. They’ve created valuewith their investments in technology in avariety of ways, including:

Simplify complex calculations for betteraccuracy and efficiency: At Alberta Chil-dren’s Hospital (ACH) in Calgary, intelli-gent order sets have helped clinicians with

complex calculationswhen ordering med-ications or intra-venous nutrients,which is also knownas Total ParenteralNutrition (TPN).Many of these areweight-based calcu-lations, which canvary widely in a pe-diatric environmentthat cares for 500-

gram premature newborns, 90-kilogramteenagers and everyone in between.

Order sets have simplified the TPN or-dering process. Once the clinician selectsthe appropriate birth weight and dose perday, the order set auto-calculates requiredadditives, run rate, vitamins, amino acidsand sodium dextrose.

ACH neonatologists send about 30 to40 TPN orders every day. Prior to the orderset it would take 5 to 10 minutes for eachbaby, but now it takes less than 30 secondsto order. This efficiency saves two or threehours every day, reducing the amount oftime by 90 percent and saving 700 to 1,000hours per year at ACH.

Successfully manage diabetic popula-tions: Diabetes is a substantial area of con-cern for healthcare organizations. Control-ling the disease by helping patients maintaincontrol of blood sugar levels reduces patientrisk and financial cost. Up to 40 percent ofAlberta Health Services Calgary Zone pa-tients admitted to some of the medicalwards have glucose intolerance or diabetes.

AHS initiated a pilot project to comparedifferent methods of controlling bloodsugars. Many physicians were using amethod known as Sliding Scale Insulin,which triggers variation in blood sugarlevels. The second method, known asBasal-Bolus, requires patients to take a reg-ular base dose of insulin every day, then in-termittent short-acting insulin is givenwith meals according to calculated need.

AHS built order sets that would en-courage clinicians to choose the Basal-Bo-lus method for more stability in bloodsugar levels. The pilot population showedpromising results. Patients with con-trolled, in-range blood sugars increasedfrom 38 percent to 66 percent. In thissmall group of diabetic patients, AHS wasable to reduce their average length of stayby two days.

Automate bed management for better

patient care: Regina Qu’Appelle HealthRegion (RQHR) is the largest healthcaredelivery system in southern Saskatchewanand faces the same occupancy manage-ment challenge as many other healthcareorganizations. Both hospitals in the systemhave very busy surgical and emergency ser-

vices with occupancy of core patient bedstypically at least 100 percent.

By automating bed management,RQHR is now able to assign new patientsto beds within 15 to 20 minutes, which isin the 90th percentile for similar sized hos-pitals. RQHR has also realized financial

benefits from automating bed manage-ment. For example, RQHR finds that pa-tients’ length of stay is typically 42 percentlonger if they are not placed on the appro-priate medical or surgical floor, costing theorganization $400,000 per year.

Four ways to create value with healthcare information technology

INFORMATION IS...

the future

© 2016 Iron Mountain Canada Operations ULC. All rights reserved

Your future success as a Health Information Manager depends on your ability to lead your organization through the ever-changing healthcare landscape. You need practical guidance and the right tools to navigate this new world of Health Information Management. We’re here to help.

Learn More at ironmountain.ca/healthcare

Jennifer MacGregor

CONTINUED ON PAGE 16


BY DIANNE DANIEL

When Dr. Denis Vincent showedup at an Edmonton Hackathonevent sponsored by HackingHealth in November 2013, hisidea was simple. He wanted tosolve the “humongous waste of

time” spent on negotiating patient referrals to special-ists by phone or fax. He also wanted to ensure no pa-tient suffered as a result of a lost or delayed referral.

A family doctor with a practice in Bonnie Doon, aneighbourhood in south-central Edmonton, Dr.Vincent believed it was possible to create a light, se-cure, web-based service to facilitate the exchange ofinformation between physicians and specialists,leveraging a subscription model. Over the course ofa weekend, and with the help of eight volunteers, hehammered out a prototype. Nearly three years laterand backed by a team of highly skilled IT industryveterans equally intent on solving the problem, thatinitial product is now gaining momentum as a viableelectronic referral (e-referral) solution.

“If we can get doctors to show leadership, and allpitch in a little, we can solve the referralproblem today,” says Dr. Vincent, not-ing that his business model is simply tobe self-sufficient and not rely on tax-payer money at all.

Called ezReferral, the software-as-a-service is accessed through any webbrowser and is hosted inCanada. It operates as acommunication hub, al-lowing important refer-ral information to be ex-changed between medical officesregardless of the electronic medicalrecord (EMR) used at either one.

An office without an EMR scans pa-per documents and attaches them tothe referral as PDFs. At a rudimentarylevel the goal is to replace phone andfax with a more reliable and efficientcommunication vehicle, but the servicealso features functionality aimed atmodernizing the entire health referralprocess, including the ability for patients to be in-cluded in the loop.

To use ezReferral, medical offices must sign up foran account and pay a modest fee – a vastly differentapproach from larger, government-funded efforts thatattempt to get all providers on one e-referral softwaresystem hosted by a health authority or local health in-tegration network (LHIN). The ezReferral service istypically accessed by medical office administratorswho login to manage referrals, which includes attach-ing letters and relevant patient information as well asrequesting appointments and tracking status.

When a specialist accepts a referral, the system no-tifies the requesting office as well as the patient. Pa-tients who have Internet access are sent a message witha secure link and PIN so they can access their own re-ferral information online and confirm their appoint-ments. Patients who do not have Internet access – es-timated at 10 percent and shrinking – are telephoned.

“It provides much better care to patients,” says Dr.Vincent. “They know when the letter’s been sent,when it’s accepted, when everything’s been booked.

They’re in the loop rather than sitting on the side-lines anxiously waiting and wondering if it fellthrough the cracks.”

Since launching in 2015, ezReferral is steadilygaining a user base in the Edmonton area, includingfamily doctors in the South Side Patient Care Net-work, cardiologists, gynecologists, psychiatrists andsurgeons. Becky Michalowski, operations manager atGateway Medical Clinic in South Edmonton wasamong the first to sign up.

“When we first started with ezReferral thereweren’t that many offices on board, but as we’vegrown it’s been instrumental,” says Michalowski,who handles referrals for the clinic’s five doctors.“Rather than sending over a fax and following upweeks later to make sure the referral didn’t get lost,with a click of a button you can follow the wholeprocess right there in front of you. It’s incredible.”

At first Michalowski worried the extra step of log-

ging into a separate service would prove cumber-some. But she soon realized how easily she could cutand paste between her office’s EMR and ezReferral.The dashboard interface is simple to follow, she adds,and will alert her to any changes in the status of a re-ferral, eliminating the guesswork.

“Once they’ve accepted the referral it goes to ‘wait-ing to book’ or ‘under review,’” she explains, notingthat a specialist can request additional information atany time, which she simply uploads to the referralrecord. “A little red envelope will come up next to it soyou know there’s been a change,” she says.

Michalowski estimates roughly half of the office’sreferrals are now completed through ezReferral, in-cluding obstetricians, gynecologists, dermatologists,rheumatologists, cardiologists and a few ear, nose andthroat specialists. Two groups she’s hoping to see jumpon board soon are urologists and orthopedic surgeons.

Since its launch, ezReferral continues to operate asa social enterprise; after expenses are covered, addi-tional revenue will be put back into further researchand development efforts. Its team of 20 developers is

largely made up of former telecom experts who arededicated to the cause and are well positioned to en-sure the system is secure and scalable.

“Every one of us knows someone who’s beenmessed up by the referral process,” says ezReferralgeneral manager Justin Hookins. “We just feel it’ssomething that needs to get done and we want tomake it happen.”

By keeping it simple – and maintaining a strongfocus on transmitting and tracking relevant informa-tion – ezReferral aims to be a speedier solution to thee-referral challenge than large-scale efforts that oftenget bogged down in efforts to integrate with EMRs orlose their funding due to budget cuts.

Dr. Vincent is hopeful the subscription servicemodel can complement e-referral efforts under wayat the provincial level in Alberta, like the first phaseof Netcare’s e-Referral, which was intended to targethip and knee joint replacement. Once a critical massof ezReferral users is reached in Edmonton, the ser-

vice will be launched in RedDeer and Calgary.“There’s skepticism. Peoplewho’ve been wrestling with thisfor a long time say ‘How can afamily doctor come up with anidea at a hackathon over a week-end?’” he says. “A lot of it isserendipitous. I’m not a brilliantgenius. A lot of things just fellinto place at the right time.”

Kingston, Ont.-basedNovari Health is an-other company seizing

an opportunity to tackleinefficiencies in the e-referralprocess. Its Novari eRequestplatform is a web-based, e-refer-ral management system that actslike an air traffic control centre,routing referrals directly frompoint A to B or managing themthrough a central intake pro-gram. The company focuses ex-clusively on access to care andhelping patients to navigate suc-cessfully through a healthcare

system. “Because Canada was late to the game, welooked at what other jurisdictions are doing in thearea of e-referral and lessons learned,” says NovariHealth president John Sinclair. “From that, we wereable to use the latest cloud-based technology from Mi-crosoft. We’ve created a next-generation e-referral sys-tem; we skipped the first generation altogether.”

Novari eRequest is a configurable platform builton the Microsoft technology stack and marketed toprovincial governments, health authorities orLHINs. In March, Novari Health announced that theCentral East LHIN in Ontario selected eRequest forits Centralized Electronic Referral & Routing Initia-tive (CERRI).

The goal is to provide a central point of accessthat will make referrals for multiple pathways acrossmultiple organizations and care sectors. CERRI isleveraging the experience of the Central Intake Pro-gram at Ontario’s Mississauga Halton LHIN, whichimplemented Novari eRequest in 2014.

The objective of a central intake model is to be acommon denominator for referrals, to “have that

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Solutions like ezReferral and Novari’s eRequest are reducing delays and keeping patients better informed.

Improved processes for e-referrals are gaining traction among physicians

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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

third party and neutral person who’s reallytrying to standardize the referral processand also the playing field, in terms of get-ting a patient to the right place based onwhat their care needs are,” explains NalaSriharan, manager of the Central IntakeProgram for Mississauga Halton.

When the program was created in 2013,it started with diabetes referrals and contin-ued to handle them manually. The focuswas placed on revamping processes instead.Multiple referral forms were replaced withone standard form, and all diabetes referralswere rerouted through central intake wherea clinician triages each case to determineacuity and decides which of 10 available di-abetes programs is most appropriate.

“We’re taking the guesswork out of thephysician’s office,” says Sriharan. Central-izing the process also enables the LHIN toidentify standards and room for improve-ment. For example, the region collectivelyagreed to standardize on three types ofbloodwork required to initiate a diabetesreferral. It is also working to set standardsaround how long it should take to processa referral marked urgent.

“Prior to central intake, every programwas doing their own thing. Now, becausewe’re that common denominator, we wereable to bring them together to work onthings together as a region,” she says.

Implementing Novari eRequest tookthose workflow gains a step further, remov-ing the inefficiencies associated with track-ing paper and e-mail referrals. At thispoint, physicians log into the web-basedapplication separately to submit a referral.Central intake then manages the referral ineRequest and forwards it to the appropriatediabetes program which also uses the ap-plication to book the patient appointment.

“We can see exactly where the referral issitting, what has happened to it and who’stouched it,” explains Sriharan, adding thatNovari Health is currently working onEMR integration to further streamline theprocess.

One benefit is that the software canbe configured to flag overdue refer-rals, alerting administrators to take

action. It’s those types of quality improve-ments that are helping to ensure patientsdon’t get lost in the system, says Sriharan.

“I think the model we have imple-mented and proven is that the referralprocess needs to be streamlined and thereneeds to be standardizing,” she says. “Ithink the most important aspect for any-one considering an e-referral strategy is tohave their processes in place first. Technol-ogy will create efficiency in terms of timeand gaps in communication, but yourprocess has to be efficient to begin with.”

The Mississauga Halton Central IntakeProgram also handles foot care, as well asaddictions and mental referrals. Foot-carereferrals were added to Novari eRequestlast year and addiction and mental healthe-referrals are expected to go live later thisyear. Sriharan believes the model is applic-able to any referral.

“You’re creating efficiencies in processes,you’re reducing the burden at the referringsource in terms of where to send the referral,and you’re also streamlining and standardiz-ing processes in terms of access,” she says,noting that no referral sits with the centralintake program for longer than one month.

Novari Health works with clients to de-

termine the routing rules and pathways foreach referral type, and any standardizedforms are embedded directly into eRequest.In addition to working on EMR integration– so that the e-referral application launchesfrom within the EMR – the company isworking to integrate with provincial clientand provider registries. The software canalso be configured to send and receive in-formation from existing patient portals.

“In Ontario, we’ve begun the work ofthat integration, to be able to integrate tothose e-health assets,” says Sinclair. “Ourcorporate philosophy is that the generalpractitioner, having invested in his or herEMR, that’s where they live and breathe ...To ask them to exit their EMR to go to athird-party solution to kick off a referral,for some that’s problematic.”

In Edmonton, Dr. Vincent believes that

philosophy is changing. “We do get resis-tance from people who say ‘I don’t like tobounce from one app to another.’ But youknow, young people have no problem withthat. They can bounce between 10 apps,”he says. “The old idea that one piece ofsoftware has to do everything is going out.The new approach is that you have veryspecific pieces of software that do their jobwell and you just use them concurrently.”

It’s the way we put it together that sets us apart!

Enterprise Imaging



Vancouver Island Health Authority, anorganization that oversees more than18,000 employees, has successfully de-

ployed Auto Shift Callout (ASC) from Vocan-tas. The new system improves the way IslandHealth contacts staff members to offer shifts,and it integrates easily with Kronos ESP.

Previously, keeping hospitals within theauthority fully staffed could be a tricky task.When a relief shift became available, sched-ulers would need to call all eligible employ-ees and offer them the shift – one by one.

These requirements, in place to ensurefairness and equal opportunity for Island

Health employees, were time consuming forschedulers. Occasionally, employees wouldnot be notified that they had been awardedthe shift until just hours before they neededto be at the hospital, or worse, the shift wouldnot be awarded at all – increasing risks to pa-tient safety due to insufficient staff.

Island Health deployed Vocantas’ AutoShift Callout (ASC) system to solve thisproblem. As soon as a shift is available inESP, the ASC system is automatically up-dated so that schedulers can launch a call-out to all eligible employees.

Shift-offer calls with Vocantas’ signa-ture cheery, professionally recorded, auto-mated voice can be launched to many em-ployees simultaneously, as well as in textand email format – dramatically reducingthe amount of time needed to inform em-ployees of an available shift.

The time-saving is so significant thatschedulers are offering not only reliefshifts, but advanced bookings to employeesthat are days and even weeks ahead of time.

After just one month in live production,the ASC system made more than 269,893phone calls, delivered 312,546 texts andsent 71,230 emails. During this same timeperiod, more than 10,790 relief shifts weresuccessfully awarded.

The ASC solution provides employeeswith a sophisticated web portal, where em-ployees can edit their contact informationand preferences, review and bid on avail-able shifts, and review shift offer histories.

Employees can access this portal fromany device that supports web browsing,enabling employees to log in anytime,anywhere.

Employee responses are automaticallysent back to ASC in real time; once the re-sponse window closes, ASC will automat-ically indicate that the shift is ready foraward.

Island Health improves staffing efficiency using automated solution

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Connect data and coordinate careacross settings: Fraser Health Authority isworking to make all relevant clinical infor-mation from multiple source systemsavailable at the point of care. The provin-cial health system is currently exchanginginformation across its continuum of carefrom acute to community settings.

One example of clinical benefits comesfrom the Fraser Health Psychosis Treat-ment Optimization Program (PTOP). Itstreatments often include Clozapine, whichaids clients with psychosis who have notpreviously responded well to other psy-chotropic drugs.

The interoperable clinical network en-abled PTOP pharmacists to review andmore effectively evaluate lab results for asmall group of patients receiving Clozap-ine. Technology enabled the Clozapineprogram to reduce hospitalization andemergency room visits by up to an 80 per-cent savings, or about $30,000 per patientand most importantly improves the livesof these patients.

By investing in adaptable technology onan open platform, these organizations areexcelling. They’re proving that technologycan help create value and drive success forthe entire healthcare industry.

Jennifer MacGregor is Managing Director,Canada, at Allscripts.

CONTINUED FROM PAGE 13

Four ways to create valuewith healthcare IT




BY DR. KARIM KESHAVJEE

There has been a lot of hype abouthow FHIR, HL7’s new interoper-ability darling, will revolutionizehealthcare. Indeed, FHIR has a lot

going for it. Easier to implement than HL7v3, FHIR comes with a lot of new tooling,lots of support and a ton of passion behindit. And sure enough, it is making great in-roads in the United States. Still, howeverpowerful FHIR is, its benefits are likely tostay firmly entrenched South of the border.

Why is that, you ask? It’s simple. Canadais not America. Our healthcare ecosystem isorganized and structured very differentlyfrom that of the Americans. And thatmakes all the difference.

As an example, the State of New Yorkhas run out of patience with its frag-mented health system and insurance in-dustry. So, they’ve taken matters into theirown hands and have started to manage thehealthcare system for the entire statethemselves. They’re analyzing data, mak-

ing policy decisionsbased on that analy-sis and allocating re-sources accordingly. To do that, they aregathering data fromall sources and com-bining them in theirown data warehouse.Ontario’s Ministry ofHealth won’t be do-ing that anytimesoon. And, while Al-

berta and some other provinces are movingin this direction, they have a long way to go.

The large managed care organizations inAmerica, like Kaiser Permanente andGeisinger, own all the assets for producinghealth outcomes. They own clinics and hos-pitals and they own the insurance risk thatis an inevitable part of healthcare in the US.

They manage hospitals, primary careclinics, specialty clinics and negotiate drugpricing with pharmacies. They can enableprimary care clinics, hospitals and pharma-cies to share data. They also get access to allthe lab results from every one of their pa-tients. They can and do analyze their owndata for improving patient care, settingpolicy, driving outcomes and cutting costs.

Their house is on FHIR! However, it isinteresting to note that both Kaiser andGeisinger got frustrated with the interop-erability merry-go-round and switched toa single-vendor system for their organiza-tions, letting the vendor figure out how toget key departmental systems working to-gether and getting on with the work of tak-ing care of patients.

Yes, they do use HL7 and FHIR. But thepoint is that they are moving away fromusing them as a ‘plug-and-play’ system.They have decided to govern and managehow the information will flow and theyhave outsourced interoperability to theprofessionals, so they can focus on theircore business - patient care.

Meanwhile, north of the border,Canada’s healthcare non-system is aloosely coupled set of fiefdoms that areforbidden from sharing data with eachother, other than through very stylized andhistoric document sharing arrangements.

Even then, timeliness and quality of in-formation are not characteristics thatspring to mind when speaking about exist-ing information sharing. Canada does nothave the legislative framework nor the reg-ulatory flexibility to allow a single organi-zation to combine and manage risk and

care coordination under one umbrella. Even in the one area where Canada

might be able to use FHIR - in the OntarioHealth Links programs that are trying tocoordinate care for complex patients acrossthe continuum of hospital, primary andhome care, most care coordination plans

are written on paper because the data shar-ing agreements are too complex to navigatein an inflexible regulatory regime.

Dr. Karim Keshavjee is a Family Physicianand CEO of InfoClin, a primary care infor-matics consultancy practice.

Why FHIR interoperability won’t be putting Canada on fire anytime soon

Dr. Karim Keshavjee

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BY ANANTH BALASUBRAMANIAN

Security and patient safety have alwaysbeen of the utmost importance in thehealthcare industry; however, cyber-

extortion is now on the rise. According toMcAfee Labs’ August 2015 Threats Report,ransomware in particular is spiking rapidly,growing 58 percent in the second quarterof 2015, compared with Q2 of 2014.

Yes, despite many hospitals being in-creasingly diligent in keeping up with thelatest endpoint security tools, such as anti-

malware, personal firewalls, file encryp-tion and more.

The fact that ransomware is on the risehas been evident in recent media. One re-cent high-profile attack includes Holly-wood’s Presbyterian Medical Center,which recently paid out $17,000 in bitcointo obtain a decryption key to recover itsstolen healthcare data. On the other end ofthe spectrum, The Ottawa Hospital was re-cently able to avoid paying ransomwarefees as a result of having proper data man-agement practices in place.

What sort of data management prac-tices should be considered to help protectagainst cyber-extortion?

Maintaining a secure, regularly-sched-uled backup (a.k.a. data copy) of your or-ganization’s laptop and desktop files is agood place to start. With data copy, yourlaptop and desktop files are preserved andcan easily be restored if a ransomware at-tack occurs. Without a secure data copy,your only option is to pay the criminal’sransom price and hope it’ll be enough toget your data back.

Experian predicts in its 2016 DataBreach Industry Forecast that sophisti-cated attackers in 2016 will continue to fo-cus on insurers and large hospital net-works where they have the opportunity forthe largest payoff. Also according to theforecast, more hackers will likely look toaccess data for extortion purposes or otherscams in 2016 as the value of paymentrecords decrease on the black market.

In fact, 38 percent of organizations arealready reporting that they’ve been tar-geted by cyber-extortion. Hospitals andother healthcare practices can avoid thisthreat by ensuring data is regularly and se-curely backed up.

Ransomware isn’t the only threat cur-rently facing the healthcare industry.Though we might traditionally think of acriminal remotely stealing and ransomingcritical health information before sellingit on the Internet, we must also consideranother vulnerability scenario – like aphysician’s laptop being left unattended.

In fact, lost and stolen devices accountfor 45 percent of all breaches, according toVerizon’s health information data breach re-port. This was the case in 2015 when a lap-top was stolen from aphysician’s car at TheMedical College ofWisconsin in Mil-waukee. Even thoughThe Medical Collegehas firm policies inplace prohibiting thedownloading of pa-tient information toportable media, thatpolicy had been bro-ken by the physicianand information pertaining to one patientwas indeed stored on the laptop.

Given physicians are often on the go andit’s sometimes necessary that certain pa-tients be treated at multiple facilities, collab-oration and information sharing is a largepart of today’s healthcare ecosystem. Assuch, it is critical that physicians can accessand organize healthcare data quickly andeasily. If The Medical College of Wisconsinhad a solution in place that offered remotedata wipe capabilities, for example, they mayhave been able to avoid a breach of data.

Plus, geolocation features that use anendpoint IP address on the last connectioncan provide location details such as thecountry, state, city and even street of themissing device. This helps ensure thatstolen property can be retrieved quickly.

Whether threats come in the form ofcyber-extortion or more traditional thiev-ery, endpoint data backups help ensurecritical files stored on laptops and desktopsare preserved and can easily be restored ifan attack occurs.

Endpoint data backups should be seenas a type of insurance in the event that allof your other security tools have failed.Prevention is always better than cure, andprotecting your data before it is stolen orquarantined helps prevent serious conse-quences for your credibility, patient safetyand legal liability.

Ananth Balasubramanian is General Man-ager of the Healthcare Business Unit atCommvault.

Want safe, healthy data? Prevention and protection are the keys

Friday, June 17th, 2016 7:30am - 5:00pm

TARGET AUDIENCEThis conference is intended for an audience of

professionals and students in Healthcare (Radiologists,

Physicians, Technologists, Industry Representatives),

Health Informatics (PACS managers, DI managers,

IT professionals, CIO/CTO’s), and engineering and

computer sciences.

LEARNING OBJECTIVESThe Medical Imaging Informatics and Teleradiology practical course addresses issues

arising from the growing penetration of computers in medicine and the need to understand

the new technologies necessary to acquire, process, store, and exchange medical images.

This annual conference brings together experienced speakers to cover challenging topics in

the field of medical imaging informatics and provides a unique opportunity to approach the

experts and find answers to questions and issues.

• Talking together: standards in medical imaging

• Communication of images: network, security

• Technology of the future and impact on imaging workflow

• Radiation control and monitoring

More InformationNATALIE PARK

CHSE Coordinator

P: 905-525-9140 ext. [email protected]

Registration [email protected]

P: 905-525-9140 ext. 22671 F: 905-572-7099

www.fhs.mcmaster.ca/conted

REGISTER ONLINE: http://fhs.mcmaster.ca/conted/register.html

facebook.com/mcmaster.conted twitter.com/mcmasterchse ca.linkedin.com/in/mcmasterchse

Medical Imaging Informatics and Teleradiology Conference11th

Annual NEWVENUE!L I U N A STATION360 James Street North Hamil ton, Ontar io , Canada


Ananth Balasubramanian

Support the Evolution of Health Care

Intelligent Health Pavilion™

In partnership with the Intelligent Health Association (IHA), HealthAchieve will be featuring a technology destination on the show floor highlighting integrated technologies in a hospital and iHome setting, as well as a wearable technology exhibit.

Exhibitors: Showcase your products and services.

Visitors: A must-see attraction! Get real-time demonstrations of the latest technologies revolutionizing health care.

Contact: Isabella Wai at 416-205-1354 or 800 598 8002 ext 1354, [email protected]

Experience the Evolution in Action at HealthAchieveOne of the largest and most prestigious health care conferences and exhibitions in North America is returning to Toronto this November 7, 8 & 9! With a complex and ever-changing health care system, embracing evolution is the only way to change it for the better. HealthAchieve continues to inspire ideas and innovation by providing global health care and business leaders with an unparalleled opportunity to learn from each other, share their ideas, and evolve their perspectives at a conference that evolves right along with them.

HealthAchieve 2016November 7–9, Metro Toronto Convention Centre healthachieve.com

Since its inception in 1875, Toshiba has worked to improve the quality of life for all people. The company’s technology has delivered on this mission with medical innovations that are Made for Life — made to improve the lives of patients, clinicians and administrators. We at Toshiba aim to maximize the quality, safety, and efficiency of medical care, supporting clinical practice with reliable quality products and innovative, cutting-edge technologies. The high image resolution and superior operability of our medical systems creates new clinical value - while our advanced applications, supported by highly reliable technologies, open the door to the next stage of medical care with some of the most powerful and patient-friendly systems available. Toshiba: A Focused Perspective in Diagnostic Imaging

Leading innovation with compassion and

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ULTRASOUND CT MRI X-RAY SERVICES

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