FEATURE REPORT: WIRELESS AND MOBILE SOLUTIONS – PAGE 12 Publications Mail Agreement #40018238

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 21, NO. 3 APRIL 2016 INSIDE:

REPORT ON LONG-TERM CARE PAGE 6

Telehealth in Montreal The advanced Reacts telehealth platform has been selected by a team at McGill University Health Centre to deliver improved remote care to ventilated patients in the community. Page 4

Managing heart failure It’s believed that up to 60 percent of heart failure patients could be supported at home and kept from returning to hospital with better remote management. The Medly PHOTO: COURTESY OF HAMILTON HEALTH SCIENCES HEALTH PHOTO: COURTESY OF HAMILTON

app has been designed for this purpose, and more. IBM brings Watson Health to Hamilton Page 4 It’s the first major deployment of Watson Health in Canada, and research & development projects using its machine intelligence are ready for SoapBox for healthcare take-off. Pictured at the launch event are: Ontario’s chief health innovation strategist, Bill Charnetski; Hamilton mayor Fred Eisenberger; pres- Saint Elizabeth Health Care, the ident and CEO of Hamilton Health Sciences, Rob MacIsaac; and Dino Trevisani, president of IBM Canada. SEE STORY ON PAGE 5. home care specialist, has imple- mented an innovative solution that solicits ideas for improvement from employees and determines which ones are most useful. Quebec hospitals to standardize on Cristal-Net EHR Page 6 BY JERRY ZEIDENBERG It came as a shock to many in the e-health As well, “many of the hospitals still don’t Secure texting industry, who assumed the move would dis- have an electronic medical record, and Clinicians are finding that texting is uebec is steaming ahead with its plan place the commercial systems being used in Cristal-Net will be used as the EMR in often the most convenient way of to install an electronic health record, many of Quebec’s hospitals – including those facilities,” said Louis-Jacques messaging their peers. But texting Qnamed Cristal-Net, in every hospital some very new solutions with state-of-the- Lalonde, Assistant-Director of Informa- may include patient information, across the province. art software. tion Technology at the CHU de Québec- and colleagues may not respond in The computerized system is already used However, far from ripping-and-replacing Université Laval. extensively by the CHU de Québec-Univer- the clinical solutions that are already in- He explained that Cristal-Net has numer- sité Laval, which in early 2000 co-developed ous modules, including lab, pharmacy, Cristal-Net in conjunction with the CHU de Existing, commercial EHR Kardex, integration with the QHR (Quebec Grenoble in France. In October 2015, the Health Record), oncology, and the ability to CHU de Québec-Université Laval obtained systems that are working well integrate with PACS and RIS. the complete rights to the system and is now will remain in place. “It has a lot of capabilities,” said Mr. the sole owner and developer. Lalonde. It’s also user-friendly: “To create Health Minister Gaetan Barrette, who has stalled, the plan is to keep what’s working Cristal-Net, we worked closely with the clin- publicly voiced his frustration with the in- well, but to use Cristal-Net as a powerful in- icians, with doctors, pharmacists and nurses, a timely fashion. A solution from ability of the patchwork of electronic tegration tool to view and complete the to make the system useful to them.” PointClickCare is being used to records used in Quebec hospitals and clinics clinical data for the patient. It will tie to- He pointed out, however, that it doesn’t solve both challenges, providing to inter-connect, announced the plan to gether existing systems that previously have each and every capability – for exam- secure texts with follow-ups. standardize on Cristal-Net last December. couldn’t communicate. CONTINUED ON PAGE 2 Page 6 Quebec hospitals moving to install Cristal-Net EMR province-wide

CONTINUED FROM PAGE 1 just programmers and designers, but con- training and supporting the users of Communications Manager at CHU de tent experts like nursing and pharmacy Cristal-Net across the province, local hos- Québec-Université Laval. ple, hospitals will still need to acquire experts. This way, they will be better able pitals and healthcare organizations will Each of these provincial organizations imaging systems from outside suppliers. to converse with clinicians, to explain the maintain their own IT departments and will be able to grant permissions to clini- Other features that are add-ons include system to them and, conversely, to carry will stay in control of their systems. cians to use Cristal-Net, and will be able to order sets and closed-loop medication back their ideas and needs to the develop- Some hospitals are, of course, ahead of control how much of the patient record management. ment team. various care-givers can see. They will also “We’re leaving that to outside vendors,” While the plan is to have Cristal-Net be able to provide access to community said Mr. Lalonde. up-and-running in all Quebec hospitals by The Quebec City team produces physicians and clinicians, if they wish. However, he noted that alerts and flags 2019, there is a good deal of preliminary a major upgrade of Cristal-Net Mr. Lalonde, a software engineer by from these systems will be integrated with work that first must be done. Mr. Lalonde each year, and smaller updates background, joined the Cristal-Net team Cristal-Net, so that all clinicians will be said that his team is creating a check-list in 2010. He has helped bring commercial able to see important patient informa- for all hospitals, to determine what their are made each month. software development techniques, like fast, tion. “The idea is that you should never current capabilities and needs are when it agile production, into the organization. have to leave Cristal-Net to do your work comes to electronic records. others, and installations of Cristal-Net will The team now creates one major up- if you don’t need an access to a specific Organizations will need governance begin this year. “Everyone has already grade of Cristal-Net each year, with a clinical system.” committees and groups to establish the started, and some have more to do than smaller update each month. “That way, the A team at the CHU de Québec-Uni- best workflows and standards. As an ex- others,” said Mr. Lalonde. “But by 2019, changes are gradual, and the users have less versité Laval is in charge of implement- ample, to promote interoperability within everyone will be using it. trouble adapting,” said Mr. Lalonde. The ing Cristal-Net in hospitals across the hospitals, regions and across the “It is going to happen very fast.” continual updates, moreover, help ensure province. It’s currently a group of 26, province, common terminologies are The agenda for implementation is being the system is staying current with state-of- which will soon nearly double to 50. needed – for medications, tests, diagnoses created by a committee that reports to the the-art technologies. “Our team of 26 was serving the CHUQ and treatments. Minister of Health. The task has been It also goes through rigorous testing. hospitals, but the game has changed now. As well, training will occur, to get the made easier by the sweeping healthcare re- “In the last two years, we added more than We need more people to give quality ser- users ready for Cristal-Net. “We’re going to form that took place in Quebec in April 8,000 automated tests that are running vices to the new users of Cristal-Net,” train the trainers,” said Mr. Lalonde. “They 2015, when 182 health organizations were each day to make sure Cristal-Net is bug- said Mr. Lalonde. in turn will train their clinicians.” consolidated into 34. “It makes it easier to free” he said. The new staff members will include not While the team in Quebec City will be communicate,” said Pascale St-Pierre, a He said the system has all of the latest technological features – it is fully web-en- abled, and authorized individuals can use it remotely, from anywhere when it’s re- quired in their job. It also has innovative abilities when it comes to integrating a wide variety of clin- ical information systems, and presenting the relevant data to clinicians. Mr. Lalonde said that many commer- cial, clinical systems are not “open”, and it has proven difficult for hospitals to con- nect them together using their own re- sources. But Cristal-Net, he said, has powerful tools for integrating to existing systems. The plan is to use Cristal-Net first to connect systems and departments within hospitals and to make the data easily view- able and usable to clinicians. Next, Cristal-Net will be used to con- nect hospitals and health organizations across the province, so that clinicians in Chicoutimi, for example, can see what happened when their patients were treated in Montreal or Quebec City. Cristal-Net can do this, said Mr. Lalonde, without the need for centralized repositories that collect and house data. Instead, the system pulls what it needs from existing repositories. “We don’t want to duplicate information,” said Mr. Lalonde. “We’re able to use the informa- tion that’s already stored.” Other provinces that have had trouble connecting their own clinical systems will be watching Quebec closely, no doubt, to see what can be learned.

Publisher & Editor Contributing Editors Art Director CANADA’S MAGAZINE FOR MANAGERS AND USERS Jerry Zeidenberg Dr. Sunny Malhotra Walter Caniparoli OF INFORMATION TECHNOLOGY IN HEALTHCARE [email protected] Twitter: @drsunnymalhotra [email protected] Volume 21, Number 3 April 2016 Office Manager Dianne Daniel Art Assistant [email protected] Neil Zeidenberg Joanne Jubas Address all correspondence to Canadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9 Canada. Telephone: (905) 709-2330. [email protected] Richard Irving, PhD [email protected] Fax: (905) 709-2258. Internet: www.canhealth.com. E-mail: [email protected]. Canadian Healthcare Technology will publish eight issues in 2016. Feature [email protected] schedule and advertising kits available upon request. Canadian Healthcare Technology is sent free of charge to physicians and managers in hospitals, clinics Circulation Rosie Lombardi and nursing homes. All others: $67.80 per year ($60 + $7.80 HST). Registration number 899059430 RT. ©2016 by Canadian Healthcare Technology. The Marla Singer [email protected] content of Canadian Healthcare Technology is subject to copyright. Reproduction in whole or in part without prior written permission is strictly prohibited. [email protected] Send all requests for permission to Jerry Zeidenberg, Publisher. Publications Mail Agreement No. 40018238. Return undeliverable Canadian addresses to Andy Shaw Canadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9. E-mail: [email protected]. ISSN 1486-7133. [email protected]

2 CANADIAN HEALTHCARE TECHNOLOGY APRIL 2016 http://www.canhealth.com

NEWS AND TRENDS Medly app shows success in monitoring health of heart failure patients

BY JERRY ZEIDENBERG and compliance with the program was very high. ORONTO – The Centre for One patient even went to Florida for Global eHealth Innovation is four of the six months and still took his on the verge of releasing a new measurements and uploaded them. version of its Medly app that In the trial, many of the patients can monitor patients with two learned to modify their own diets and ex- orT more chronic conditions. Medly was ercise. Some learned, for example, not to first designed and released for heart fail- drink too much water, as it is not healthy ure patients. for heart failure patients. However, the system was designed as a Overall, said Seto, the patients experi- general platform, and a single Medly app enced improvements in quality of life and will soon be able to support patients with self-care. BNP fell significantly, and LVEF multiple chronic conditions, including levels increased by notable amounts as chronic obstructive pulmonary disease, found through a sub-group analysis. diabetes, hypertension, and chronic kid- BNP is a substance secreted from the ney disease. ventricles or lower chambers of the heart “We know that over 50 percent of peo- in response to changes in pressure that oc- ple who are 65 and older have two or more cur when heart failure develops and wors- chronic conditions,” said Emily Seto, an as- ens. The level of BNP in the blood in- sistant professor at the University of creases when heart failure symptoms Toronto, who chaired the Mobile Health worsen, and decreases when the heart fail- Summit in January. The conference was ure condition is stable. held in Toronto and was organized by the Left ventricular ejection fraction Seto: Finding funding models and managing workflow is the hard part of implementing remote monitoring. Strategy Institute. (LVEF) is the measurement of how much Seto works closely with the Centre for blood is being pumped out of the left ven- of cardiologists, it’s unlikely that physicians Nurses that did participate in a field Global eHealth, and described some of the tricle of the heart (the main pumping will be ready and able to field these alerts trial of Medly in the community found, in work being done there on monitoring chamber) with each contraction. and make call-backs in the future. addition, that it was difficult to get in chronic care patients through the use of Seto said that one reason the clinical That’s because the plan is expand the touch with patient’s physician when addi- apps to improve outcomes and to reduce trial was successful was that it had the use of Medly to thousands of patients, and tional advice was required. “Physicians costs and pressure on acute-care hospitals. backing of a clinical champion. Dr. to other hospitals. In fact, a remote moni- were often off duty, or busy with other pa- Patients using the apps typically take Heather Ross, who heads the heart failure toring program using Medly will be tients,” said Seto. readings of various vital signs; in some in- launched as standard of care to UHN heart Seto and her colleagues are working on stances, such as when they step on a Blue- failure patients in Spring 2016. An analo- solutions to these problems. In the near fu- tooth weight-scale in the morning, the It’s believed that up to 60 gous remote monitoring program will also ture, the remote monitoring system may data is automatically uploaded via Blue- percent of heart failure patients be launched this year to UHN chronic kid- be more useful for patients tied to hospital tooth to the patient’s smartphone. Data could be kept out of hospital ney disease patients. cardiac clinics, especially those whose clin- from the smartphone is then uploaded to “We envision a shift to nurse practition- icians are salaried. servers. with better management. ers supervising the alerts,” said Seto. Nurse Still, the continually falling cost of med- In the randomized controlled trial, practitioners will in some cases be able to ical equipment and phones makes remote alerts about abnormal readings were sent clinic, is a proponent of the Medly app and handle the alerts on their own. They will management of chronic care patients eas- directly to the patient’s cardiologist via e- its benefits for patients and the hospital. also know when to escalate the problem to ily affordable. mail. The message included the patient’s By keeping closer tabs on HF patients at a physician. Moreover, new sensors are being devel- phone number, so the physician could home, Dr. Ross and the creators of Medly The Centre for Global eHealth Innova- oped that will make remote monitoring simply click on the phone number to believe they can keep them out of hospital. tion is now testing new ways of expanding even more effective. Seto described a quickly get in touch. Indeed, the most common reason for the use of telemetry, apps and smartphones bandaid-like sensor that can be placed on “We didn’t want them to have to open hospitalization in Canada and the United into the community. It is in partnership the chest to take ECG readings. A head- the electronic patient record to start States is heart failure. There are 500,000 with Paramed, a visiting nurse and com- band that can monitor EEG waves is also searching additional clinical information HF patients in Canada, and about 5 mil- munity healthcare company, and CellTrak, being tested. and for phone numbers,” said Seto. lion in the U.S. which devises software for visiting nurses. But Seto said that when it comes to A six-month randomized controlled Moreover, up to 60 percent of the hos- However, it has proven harder to recruit apps and remote monitoring, technology trial of the Medly app that involved 100 pitalizations are preventable, with better patients in the community than at the is the easy part. “Implementation of the patients was a major success. The patients patient management, said Seto. UHN’s hospital clinic. As well, nurses are technology including finding funding were all enrolled in the University Health While the clinical trial, with its 50 clinic not currently able to bill for their ‘telephone models and managing workflow is the Network’s (UHN’s) heart function clinic, patients, sent alerts right to the smartphones visits’ which is a barrier to implementation. hard part,” she said.

Reacts deployed by MUHC to improve the lives of ventilation-assisted

ONTREAL – Reacts has been se- forts, the McGill University Health Cen- bile devices to interact with patients and file transfers – such as respirator data. lected by the McGill University tre (MUHC) decided to replace their old caregivers, regardless of location. They “The Reacts platform is easy to use, MHealth Centre’s National Pro- telehealth platform with Reacts, a versa- can propose virtual home visits, organize secure and focuses on collaboration, su- gram for Home Ventilatory Assistance tile technological solution providing collaborative sessions between healthcare pervision, education and remote assis- (NPHVA), to enhance its overall tele- unique interactivity. tance,” says its founder, Dr. Yanick health services and improve remote sup- “Reacts allows us to provide innova- Beaulieu. “It therefore meets the NPHVA port for its home-based ventilation-as- tive remote support and care for patients The Reacts telehealth team’s many needs, and more impor- sisted clientele. in the comfort of their own homes, no platform makes use of new tantly brings healthcare professionals The NPHVA team is composed of ul- matter where they are,” says Lyne Noel, technologies and runs on a and their patients closer together.” tra-specialized professionals who sup- Coordinator of Respiratory Services, The NPHVA team introduced Reacts port patients and their families in their Adult Sites, MUHC. “With this digital variety of devices. to its service delivery model in January home settings, while complementing video collaboration platform, we can re- of 2016. Implementation at the provin- various local and regional healthcare ally make a difference in the quality of professionals, provide remote training to cial level will continue throughout 2016. professionals through a range of clinical, life of patients and their families.” patients and providers, all thanks to a va- For more information about the Reacts technical and training services. With Reacts, the NPHVA’s profession- riety of features such as audio-video ex- telehealth platform, see: In order to optimize the team’s ef- als can use their own computers or mo- changes, remote auscultation, and secure https://www.iitreacts.com/

4 CANADIAN HEALTHCARE TECHNOLOGY APRIL 2016 http://www.canhealth.com NEWS AND TRENDS IBM brings Watson to Canada in partnership with Hamilton Health Sciences

BY JERRY ZEIDENBERG ing, super-computing, and many other spur the development of spin-off compa- duce start-ups, but to see them grow to 10, technologies. nies and will act as a business incubator. 100 and 1,000 employees. AMILTON, ONT. – Hamilton Researchers from nearby Mohawk Col- The province of Ontario is involved in the Barry Burk, IBM Canada’s vice president Health Sciences and IBM lege and McMaster University will also be centre through its chief health innovation of health, noted the new centre in Hamilton Canada are partnering to participating in the project and will bring strategist, Bill Charnetski, who helped bro- will be the first in Canada “where we’ve de- launch a healthcare innovation their own expertise and interests. ker the deal and make the project happen. ployed Watson for human healthcare in a centreH in the downtown core of the city – a The innovation centre is designed to Charnetski said the goal is not only to pro- meaningful way.” move that will help with Hamilton’s trans- formation from Steel City into a high-tech hub. Teams from both organizations will soon move into what used to be a Stelco office building that’s located in the down- town core. “We’re re-inventing Hamilton through healthcare,” said Dino Trevisani, president of IBM Canada, who is himself originally from Hamilton. “We’re going to make this a centre of excellence in Canada and for the world.” Trevisani spoke at a well-at- tended event, held at Hamilton Health Sci- ences, to publicize the announcement. Significantly, researchers at the new col- laboration centre will be the first in Canada to make extensive use of IBM’s Watson ar- tificial intelligence software for healthcare. Watson gained instant fame in 2011 when it trounced the reigning Jeopardy champion, Ken Jennings, in two televised matches. At that time, Watson required 10 racks of computers that filled a room; today, Watson software requires only a single server that’s the size of the vegetable drawer in your refrigerator. And because of stream- lined software, it runs 24x faster than before. That, in itself, is an indication of how quickly computer technology is advancing. Hamilton Health Sciences, for its part, is a powerhouse in health technology and has pioneered, among other things, advanced applications in region-wide, patient deci- sion support and a predictive analytics sys- tem called HEWS. This latter solution gathers data from patient monitors and medical devices and provides early warning of when a patient is running into trouble. It’s these two applications that will be the starting points for the teams from HHS and IBM. They will further develop the systems, both for use at Hamilton Health Sciences and for commercialization in Canada and around the world. IT’S ALL WITHIN YOUR REACH… “With the integrated data system, six LHINs are already feeding data into the so- lution,” said Mark Farrow, HHS’s vice president of information technology and CIO. “We can see how patients are using the healthcare system. Now, we can take it to the next level using Watson.” The system could be a boon to man- A gateway to integrated care agers and planners, enabling them to bet- ter match the resources that are needed at With the Agfa HealthCare Portal, hospitals can offer care providers, referring healthcare facilities with real-time demand physicians and patients “anywhere, anytime” access to the patient’s health from patients. Similarly, the intelligence of Watson information, even from different sources. Taking the knowledge and experience will be tied to the early warning system, it has built up with proven solutions that share images and other data, further improving the predictive capabili- Agfa HealthCare is now extending it beyond the hospital walls, to eventually ties of the solution. The president and CEO of Hamilton integrate all players in healthcare delivery. Health Sciences, Rob MacIsaac, noted the To À nd out more, visit www.agfahealthcare.com. new centre will be both a physical and vir- tual work space. Through the web and teleconferencing, patients, start-up busi- nesses and R&D staff at large corporations can all interact with technology developers at the downtown facility in Hamilton. In addition to IBM’s Watson Health, the team in Hamilton will also have ac- cess to IBM’s expertise in cloud comput- http://www.canhealth.com APRIL 2016 CANADIAN HEALTHCARE TECHNOLOGY 5 REPORT ON LTC PointClickCare Secure Conversations ensures clinicians receive messages or more than 15 years, Toronto- healthcare professionals to create their send pictures to the EHR via the software, based Responsive Health Man- own protected messaging network. Re- a particularly useful benefit for when a agement Inc. has sought ways sponsive has been using PointClickCare nurse is describing a wound for treatment. to advance resident care and electronic health record (EHR) technology “Responsive staff can see a record of staff operations through inte- since 1995. text communications from beginning to Fgration of healthcare technology and mo- Secure Conversations helps about 100 end,” said Godoy. “This reduces errors and bile solutions. staff members and clinicians at Mill potential miscommunication between Last year, the organization was faced Creek Care Centre securely communicate clinicians. We are seeing fewer errors on with the challenge of ensuring secure, time-sensitive messages regarding labora- orders, fewer missed orders and staff is timely staff text-message communication tory results, medical histories, practi- able to address the health concerns of resi- between nurses and physicians in one of tioner on-call notifications and resident- dents in a more timely fashion.” its homes. Responsive hadn’t discouraged related questions. Responsive initially implemented sending text messages in the past, but By facilitating direct interaction be- PointClickCare Secure Conversations with rather was looking for ways to make that tween doctors and nurses at the Mill Creek its registered nurses, management and action more secure and productive. Care Centre, PointClickCare Secure Con- physicians, but has since realized secure Senior Nurse Consultant Marion versations ensures better communications texting would be a tremendous benefit for Godoy said that data security was a big and response time and accurate decision- the organization’s personal support work- concern; nurses were using unsecure tex- making. This, in turn, leads to quicker and ers, especially because they carry iPods for ting to convey information to staff physi- more precise interventions and ultimately documentation. cians in the Mill Creek Care Centre, where improved resident outcomes. Godoy believes this will help stream- the average staff age is 28. “The application is easy to use and the line reporting, corresponding, notifying Moreover, when using conventional on- staff can securely communicate resident and exchanging resident and healthcare- phone SMS texting apps, information and non-resident information without the related information. Once the implemen- would not always reach a physician or challenge of waiting for a call back,” Godoy tation occurs, these workers will be able nurse in a timely manner, which occasion- said. “Since most of the staff members Senior Nurse Consultant Marion Godoy. to use PointClickCare Secure Conversa- ally led to delayed orders. were already very familiar with texting, tions to alert one another to help with a “For example, a nurse would send an they adapted well to this technology.” PointClickCare Secure Conversations resident transfer and be better equipped email earlier in the day and have left work “Secure Conversations software has im- software, nurses and physicians at Mill to address early sign and symptom by the time the physician was able to re- proved efficiency among physicians and Creek Care Centre can also track conver- changes in residents. spond,” Godoy said. “And the evening eliminated delayed responses from them as sations on the facility’s PointClickCare “Like its EHR, PointClickCare’s Secure nurse would not be aware of this message physician mobile phones are now alerted EHR home page and decide if a conversa- Conversations software has proved to be because it had been sent to a personal when they receive a new text message,” tion needs to be part of the progress notes very useful in getting key information to work email or phone.” Godoy added. section of the EHR. appropriate staff in a timely manner,” said Responsive implemented PointClick- Physician order transcription has also This avoids time-intensive duplicate Godoy. “This means care can be delivered Care Secure Conversations, a medical- improved due to there being a record of a charting for clinicians that is the case with to the right person at the right time and grade messaging application enabling conversation and order. With the smartphones’ native SMS apps. Nurses can right place, and in a secure way.”

Saint Elizabeth uses SoapBox to spur innovation from employees

BY JESSICA WEISZ ment, and vote on it. Once the idea re- employees have commented, voted, and difference in their lives. For example, ceives 25 or more positive votes, a team shared techniques and best practices suggestions regarding a virtual social aint Elizabeth is leveraging its of Innovation Partners at Saint Eliza- from across the country to help support network where caregivers could anony- 8,000 employees to help drive beth review, evaluate, and respond to both the family of the client and mem- mously share their experiences and con- innovation and improve the idea by providing an “Official Re- bers of the healthcare team. nect with others in similar situations are healthcare delivery for the sponse”, a statement from the leaders Recently, best practices generated in being brought to life through Elizz more than 18,000 people it that shares the status on the idea and SoapBox around bereavement were in- Group Support. visits daily. The social enter- next steps. corporated into a guideline to support In 2016, Saint Elizabeth plans to fur- Sprise has become the first Canadian According to Brennan McEachran, nurses with bereavement visits and also ther engage its workforce with an excit- healthcare company to adopt SoapBox, a CEO and co-founder of SoapBox, “official helped to inform program enhance- ing roster of Challenges. These Chal- SaaS platform that flattens organizations responses are critical to sustaining and in- ments. Saint Elizabeth re-launched the lenges will focus on tying ideation to by connecting leaders with the best ideas creasing engagement in the community, bereavement visit process for nurses, as strategic projects or initiatives the or- from frontline workers. as they close the feedback loop and ganization is working on from the early “Our front-line home care employees demonstrate that leaders are listening.” planning stages, so that the employee have the very best ideas for making As Saint Elizabeth is working to lever- In one instance, Saint voice can really have an impact on things better for clients. SoapBox allows age technology in a number of ways, Elizabeth used Soapbox to execution. these ideas to come to life,” said Shirlee they were able to integrate ideas from refine its delivery of The organization is also teaming up Sharkey, President and CEO of Saint SoapBox into their technology and mo- with Radboudumc’s REshape Center to Elizabeth. “On the site, the ideas are bile strategy. The organization recently bereavement support. launch a SoapBox to their network of broadly shared in real-time within the initiated a major rollout of new tablets global health care innovators. Their ob- organization and because of our virtual and smartphones to team members well as a Guide for Leaders on support- jective is to create a people-powered work, this allows staff to collaborate with across the country. ing staff with grief. healthcare system, improve the method- colleagues everywhere – many of whom, For the first year of the rollout, Saint When Saint Elizabeth launched Elizz, ology of healthcare innovation, and to they never see in person.” Elizabeth engaged its workforce to a new brand dedicated to all things care- identify and break down challenges to The way that Saint Elizabeth handles come up with ideas to derive value giving, the company leveraged SoapBox innovation in healthcare SoapBox ideas cuts through the typical from their new devices. The ideas and and the wisdom of its employees to in- “At Saint Elizabeth, we see possibility organizational challenges that get in suggestions led to optimization of the form the development of new services everywhere,” said Sharkey. “With our the way of implementation and ex- features, customizations, and which and resources for caregivers. employee SoapBox, our aim is to harness pands the innovation capacity of the apps were most helpful. As home care providers, Saint Eliza- the passion and imagination of our mo- organization. As one example, SoapBox has been a beth staff work alongside family care- bile, national workforce – all eight thou- “Ideas are framed around the client significant source of insight into Saint givers every day and bring a unique un- sand of them.” experience, which aligns to Saint Eliza- Elizabeth’s bereavement strategy. Saint derstanding of their challenges and beth’s top priorities” said Sharkey. Elizabeth uses SoapBox to tap into em- needs. The Family Caregiver Challenge Jessica Weisz is Chief, Client Success Of- When an employee shares an idea on ployee insights around bereavement and generated more than 100 ideas about fice, at Soapbox. Please visit the website: SoapBox, their peers can view, com- supportive conversations. More than 100 ways to support caregivers and make a https://soapboxhq.com/

6 CANADIAN HEALTHCARE TECHNOLOGY APRIL 2016 http://www.canhealth.com NEWS AND TRENDS Web innovator offers unique, personalized health information

AS VEGAS, NEV. – A U.S.-Israeli start- Finding and converting the papers into Medivizor is a free resource for individ- record, which then populates the Medivi- up company – with substantial accessible English is accomplished through a uals, but it is also being marketed to zor record. In that way, the information Canadian ties – has created the mixture of computer algorithms and hu- healthcare organizations, who pay a fee sent to the individual become highly rele- world’s first “personalized health man effort. Carbonara said the company has and can then provide it to patients, doc- vant and specialized. Linformation service.” The web-based solu- several dozen reviewers around the world. tors, and staff. The platform can also aid pharmaceuti- tion pushes information about the latest “Each adheres to the same editing and writ- In these cases, the system can be con- cal companies find patients who might be medical research and treatments to sub- ing process,” she said. “We call it ‘one voice.’” nected to the facility’s electronic health ideal participants for clinical trials. scribers and tailors that information to match their particular medical conditions. Called Medivizor, the system combs a wide variety of sources, including medical journals, for the most recent research find- ings, and also alerts subscribers to clinical trials that may interest them. In March, Medivizor exhibited at the HIMSS conference in Las Vegas, which at- tracted over 35,000 attendees from around the world. If you have certain type of skin cancer, for example, Medivizor will keep you posted – weekly or even daily – on the lat- est medical findings and treatments. And knowing your approximate location, it will also tell you about the newest clinical trials in your area. “It’s perplexing that health information has not been personalized before,” said Tal Givoly, CEO and co-founder of the com- pany, which has been offering its service for the past two years. “We’re all unique, shouldn’t our health information be?” Indeed, the more detailed the informa- tion that a subscriber provides Medivizor about the person whom is coping with ill- ness, the more precise and pertinent the Working together resulting information will be. And while some might be put off by the thought of entering highly personal infor- for a healthier mation, no names or personal identifiers are required. “You don’t need to enter a tomorrow today. name, address or phone number – all you need is an e-mail, so we can send you the updates,” said Givoly. Subscribers are able to use email addresses that have no per- sonal identifiers in them. So far, tens of thousands of subscribers have signed on, said Givoly, who prefers not to divulge precise numbers. At the moment, the service is available Cerner’s health information technologies connect only in English, and it has become popular in the United States, Canada, the U.K., Ire- people, information and systems, putting information land, Australia and New Zealand. The company is mulling its next languages, and where it’s needed most. says it is deciding between Spanish and Mandarin Chinese. A large portion of software develop- Together with our clients, we are committed to ment for Medivizor is conducted in Van- couver. Overall, the company is a global improving the health of individuals and communities. enterprise – its headquarters are in Israel and New York, software development is concentrated in Vancouver, business devel- opment is in Atlanta, it’s lead blogger works in Boston, and dozens of contribu- tors are located in a variety of countries, including Ireland and the U.K., in addition to Canada and the United States. While most medical research papers are written for medical professionals and con- tain highly technical language, Medivizor’s team of contributors around the world convert them into easily readable English To learn more go to www.cerner.ca for the layperson. “They’re digestible, 300-word sum- maries,” said Kim Carbonara, director of business development. “Medical papers are incomprehensible to most people, so we © 2016 Cerner Corporation turn them into readable summaries, like Cliff’s Notes.” http://www.canhealth.com APRIL 2016 CANADIAN HEALTHCARE TECHNOLOGY 7 ADVANCEADVVAANCE PPAAATTIENTTIENT CARECARE WWITHITH MMOBILEOBILE HEALTHCAREHEALLTTHCARE TTECHNOLOGY.ECHNOLOGY. WWEE GGETET ITIT.T.

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implementilimplement td andand supportsupport eeffeffectiveffectitive solutionssolutioltins CDW.ca/healthcareCDW.ca/healthcarre | 800.493.7651800.493.7651 3D apps for diagnostic imaging improve medical education and patient care Virtual reality is being used to teach anatomy, improving upon the traditional methods.

VIEWPOINT BY DR. SUNNY MALHOTRA The founder of BioDigital, John Qualter, hopes in hospitals during operations and surgeries. The com- that one day this technology can also be used in a panies hope this technology will aid surgeons in oper- iagnostic imaging has always been clinical setting to help physicians illustrate condi- ating theatres and make surgeries more time efficient. a key part of making a medical di- tions to their patients. Recently, BioDigital used their The use of medical imaging in cardiology has al- agnosis. Constantly improving technology at New York University School of Medi- ways been crucial to make a rapid and accurate diag- medical imaging has enabled med- nosis. In electrophysiology, imaging the inside of the ical students and practitioners to atria has been done with less fluoroscopy over the gain a wider and deeper under- The use of 3D technology in anatomy years to reduce radiation exposure. “Cardiac Map- standingD of the human body. The technology has classes and self-directed study has ping” is like a GPS system to navigate the inside of also improved workflow and productivity, allowing disrupted the traditional medical the heart and find dangerous heart rhythms. Topera physicians to make accurate and earlier diagnoses. Medical is a system with a Rhythmview workstation Lastly, it has enabled the sharing of important infor- education format. and FIRMap catheter that opens up with a wired ball mation among healthcare professionals. with sensing electrodes along its surface. Medical students are steadily increasing their use cine in their anatomy labs to give students a 3D in- Carto and ESI are systems that use endocardial of technology for studying and learning the intricate teractive experience. electrograms to correlate with local electrogram and details of human anatomy. With the use of 3-D glasses created by a com- cardiac anatomy. The use of 3D technology in anatomy classes and pany called Nvidia, BioDigital was able to cre- Progress is also being made in tele-echocardio- self-directed studying has disrupted the traditional ate a simulated human body that students graphy. Tele-echocardiography allows for medical education format. There are multiple plat- could dissect by giving a unique perspective medical professionals to work alongside forms and companies that have developed 3D tech- into living human anatomy in a way that dis- cardiologists to gain a specialist reading on nology for medical students through the use of apps secting cadavers fails to do. their patient’s echocardiograms through and practical classes. Similarly, developing companies such as 7D imaging firms such as USARAD.com, An- Commonly used apps that can be downloaded on Surgical Navigation and Ourotech have begun gus Radiology and Real Time Radiology. Apple and Android devices are Human Anatomy At- to create real-time 3D images that can be used Tele-echocardiography allows for rapid las, Essential Anatomy 5 and BioDigital Human. The sharing and collaboration among health social use of mobile apps includes such products as Dr. Sunny Malhotra is a US trained cardiologist professionals, and facilitates rapid interpre- Figure 1 and InsightMedi to display medical images working at AdvantageCare Physicians. He is tation of echocardiograms. This is espe- for educational purposes. an entrepreneur and health technology cially useful for clinics and hospitals BioDigital Systems, a visualization firm based in investor. He is the winner of Best in remote locations that could New York City, created BioDigital Human. BioDigi- in Healthcare – Notable Young not have echocardiogram tal creates virtual human replicas of multiple body Professional 2014 and the readings done immedi- systems for anatomy education, and includes simu- national Governor General’s ately on location due to lated diseases and conditions. Caring Canadian Award 2015. limited staff.

Healthcare apps should be treated like over-the-counter meds

BY PUNEET SETH, MD sent some solutions in this article. vealed a sense of optimism about the low physicians to be aware of which AND DORIAN MURARIU, MSC mHealth apps can be categorized potential of mHealth apps to change apps to comfortably recommend to based on the intended user, being healthcare for the better. Many in- their patients. t can be daunting for clinicians, healthcare providers and patients dustry developers believe that Before apps are adopted in prac- who are already overwhelmed (who are termed as ‘consumers’ of mHealth apps show great promise tice it is necessary to determine their Iwith patient-care responsibilities, mHealth apps). With respect to con- and potential for improving health- safety and effectiveness. According to to now screen and manage an en- sumer mHealth apps, a survey of care delivery and health outcomes. one industry report, over 300 clinical tirely new modality – the mobile 2000 app developers from around According to one survey, the ma- trials using mHealth apps were regis- ‘apps’ that run on smartphones and the world found these applications jor ways in which this will happen tered on ClinicalTrials.gov in 2015, tablet computers. are being used diversely to monitor include improved prevention and ed- representing a huge leap forward in However, the potential for im- fitness data (e.g., steps, speed, HR, ucation, reduced or slowing down of their validation. proving outcomes and reducing sys- hydration, calories, mood), patient Regulatory bodies such as the US tem costs is significant through the vitals (e.g., BP, blood oxygen, glu- FDA will play an important role in use of mHealth apps. On the other cose, temp, medicine adherence, Just as they are asking testing these apps by defining hand, patient harm is also a real brain waves, posture), and medical about over-the-counter whether they are “medical” or “well- possibility, through inappropriate exams (e.g., respiratory rate, EEG, meds, patients will quiz ness” apps (the latter will be exempt use or through the use of apps with ECG, blood test, US, urine test.) from some regulations). Similarly, false claims. With the presence of Fitness and wellness apps are cur- doctors about apps. Health Canada has expressed intent mobile devices in society increasing rently the most commonly used, but to have a regulatory process for and the growing number of developers agree that apps targeting healthcare costs, and improved inter- “higher risk” medical apps; however mHealth consumer apps, clinicians chronic illnesses will gain a larger action between patients and doctors. what defines this remains to be seen will inevitably be crossing paths share of the market in coming years. As the demand for health infor- and only a handful of mHealth apps with patients who seek advice about Among the most common disease- mation and health services increases, can be found through Health mHealth apps. specific apps are those targeting dia- mobile health apps will take a more Canada’s website. How then, should physicians in- betes, obesity, hypertension and coro- prominent place in healthcare. How- The Canadian Medical Association teract with patients using or asking nary heart disease, and to a lesser ex- ever, this demand should be met in 2015 released a policy report to about apps? What approach should tent asthma, depression, and cancer. with some sort of regulatory or cer- help guide physicians on recommend- they take to learning about the best Surveys of healthcare providers tifying body in order to protect con- ing mobile health apps to patients. or most appropriate apps? We pre- and industry developers have re- sumers, and, on the other end, to al- CONTINUED ON PAGE 15

10 CANADIAN HEALTHCARE TECHNOLOGY APRIL 2016 http://www.canhealth.com VIEWPOINT Expect more intelligent machines and smart computers in healthcare

BY JERRY ZEIDENBERG summary of the most important pieces Mahmood. Qibo extracts structured and rather, to enhance the accuracy and speed of information. unstructured reports, and can use pattern of the physician’s work. AS VEGAS – At the latest HIMSS con- This task is sometimes assigned to resi- analysis on numerous types of imaging “If I had a serious illness, I’d always ference, in early March, one major dents, and it may take 15 minutes or more studies, such as echocardiograms and CT want a doctor looking after me, with Wat- theme was artificial intelligence and to compile. Qibo, by contrast, can do it in scans. Iaso and Qibo are meant to be used son as an assistant,” said Robert Merkel, its application to healthcare. seconds. as tools in the hands of physicians. They Healthcare & Life Sciences Leader within LA session on The Rise of Machine Intel- “It acts like a smart assistant,” said Syeda- are not designed to replace physicians, but IBM Watson Group. ligence in Healthcare, led by Kenneth Kleinberg, discussed how far artificial in- telligence has come and speculated on how much better it will probably get. We’re now seeing smart anesthesiology systems that can replace anesthesiologists. There are robots, like the guided vehicles at Humber River Hospital, in Toronto, that can carry medications, open elevators and warn people to stand back. And soon, there will be radiology and pathology sys- tems that can spot diseases as well as hu- man doctors. Clinical logistics solution “The world is far from prepared for what is going to happen,” said Kleinberg, who has monitored AI and machine intelligence for External & internal transport decades. One indication of this occurred when the floor was opened to questions and Patients Attendants Isolation precautions comments. One participant told the audi- ence that he foresees the day when robots will demand their own equal rights amendment. Instead of Isaac Asimov’s Blood samples Organ transports Medical equipment three rules of robotics, which protect hu- mans, robots and computers may develop the consciousness needed to demand pro- tection for themselves. One of the leaders in machine intelli- gence is IBM. Who would have thought that it could build a computer that would defeat two Jeopardy champions? Execu- tives at IBM came up with the notion in 2006, and for the first few years, the results were abysmal. But after stumbling, rapid progress was made. By 2011, they had a high-functioning system called Watson that trounced the Jeopardy champs. And that’s a microcosm of what’s oc- curring, in general, in machine intelli- gence. A kind of self-sustaining take-off has happened, where very quick progress is REDUCE INCREASE being made. That’s why Kleinberg says we’re unprepared for the future. Costs Productivity At HIMSS, the IBM Watson Health group showed the work it is doing on sev- Accidents Control and reporting eral projects. One of them, code-named Iaso, is looking through the medical Length of stay (JIT) Patient satisfaction records of patients to discover which of their conditions were unreported. When Cancelled transports Savings up to 25% the unreported pieces are put together, they can paint a picture of a serious condi- Spoiled Samples tion – like an aneurysm. Radiologists or cardiologists, when looking for specific conditions in diagnos- tic images, may not report ancillary prob- lems. Or they might simply miss them. “Unfortunately, this happens more than you might think,” said Dr. Tanveer Syeda- Mahmood, Chief Scientist for the Medical Sieve Radiology Grand Challenge project in IBM Research. Iaso, however, can spot these conditions in records and images. It can then create a more comprehensive re- port – one that could save your life. Right now, Iaso is a work-in-progress, but IBM plans to soon apply for regulatory For more information, please contact your approvals in the U.S. sales representative at 1 888 882 8898 Another Watson project, code-named Qibo, can act as a physician’s assistant by Christieinnomed.com automatically combing through diag- nostic images and records to produce a © Christie Group Inc. Company. http://www.canhealth.com APRIL 2016 CANADIAN HEALTHCARE TECHNOLOGY 11 QoC helps healthcare innovators turn ideas for apps into real-world solutions The company is working with creators in the public and private sectors in Canada and abroad.

BY DIANNE DANIEL Healthcare apps spring to life in a variety of places. ture required to scale, supported by secure data cen- It might be a researcher in a lab, a physician in a clini- tres in Canada, the U.S. and U.K., is already in place ou may think you’ve invented the next cal setting or a service provider in the community who and managed by QoC Health. great, transformative healthcare app. comes up with the notion; no matter where the idea By leveraging that foundation, customers are free And maybe you have. But when it comes originates, the creators eventually reach a point where to focus on what their app might look like and who time to move your idea beyond your test their idea is proven in a small test group or pilot pro- it might connect, says QoC Health co-founder Sarah group so the entire hospital, commu- ject and it’s time to roll out to a wider population. Sharpe, who is responsible for Healthcare Analytics nity, province or country can benefit, That’s when the complexities of privacy manage- and Quality Improvement and works hands-on with FEATURE REPORT FEATURE Ywhat then? Do you have the foundation and resources ment, interfacing to legacy systems, seamlessly inte- clients to evolve their ideas. “What we try to do in to navigate your way through the complexities of secu- grating with an electronic medical record (EMR) or any discovery process is to imagine the ideal scenario rity, privacy and interoperability that follow? adhering to strict regulations can prove challenging. because it actually may be possible,” says Sharpe. As easy as it is to build mobile health products and “There’s a temptation to go it alone and that typ- For most clients, the starting point involves concep- services, scaling them is an entirely different story ically doesn’t end well,” says Shih, noting that each tualizing a circle of care: Who needs to be connected to says Raymond Shih, co-founder and president of jurisdiction has its own set of requirements. who and what do they need to do? From there, QoC Toronto-based QoC Health. That’s where QoC Health steps in, partnering Health helps to establish a framework for moving for- “Every week you see or hear about a pilot app be- with innovators to expand their ideas by adding the ward, including objectives, timeline and cost. Several ing tested at a hospital and there’s always the promise foundational layer beneath. “We provide all of the development methodologies are used, from experi- that if it’s validated, and people use it across the ence-based co-design to research-based design. healthcare system, it’s going to save money,” says “We can look at any scenario and say, ‘Here’s Shih. “But very rarely do you see that article a year where you need help. Here are the points where later that says everybody’s using it.” you’re strong. Here’s where we can step in and actu- One of the first healthcare-related companies to ally help you through the journey of actually devel- join the growing global community of Certified B oping an app, making sure it’s evaluated and sustain- Corporations, sustainable companies in business for able,’” explains Sharpe. the greater social good, QoC Health is on a mis- Sometimes the electronic circle of care is already sion to change that scenario. Founded in 2010, well established and the mobile app is the fast-growing company is bridging the gap proven. All that’s required from QoC Health between innovation and scalable products for a is the expertise to grow. diverse group of healthcare clients. Robyn Henderson, founder and CEO of The Leveraging a highly skilled in-house team of Uncomplicated Family, a progressive organi- healthcare experts, IT professionals and entre- zation based in Alberta, approached QoC preneurs, QoC Health has developed a cloud- Health in the fall of 2015. Her company’s rev- based platform it says provides all of the func- olutionary technology called Teleroo, devel- tionality required to rapidly prototype mobile oped in 2011, is a collaboration tool healthcare solutions. It also provides the under- designed to create efficiencies in the lying infrastructure to scale those solutions way essential services are managed and across multiple stakeholder groups and jurisdic- delivered to children with complex needs. tions, all for the purpose of supporting others. “Our goal is to un-complicate things so that As Shih explains, the company isn’t in the people can enjoy the best quality of life,” business of coming up with game-changing says Henderson, who at the time, was look- ideas. Rather, its job is to ensure those ideas ing for a technology partner to help scale don’t end up on a shelf, collecting dust. the product. “We don’t want to be a healthcare company The idea for Teleroo was born from Hen- that’s just making money,” he says. “We really derson’s desire to make a difference in the want to be a company that tries to improve the lives of families. The mobile app is permis- overall quality of care in the system.” sion based and designed to be used by any- Obtaining B Corp certification is one way to one in a child’s circle of care, including par- demonstrate that commitment. B Corp compa- ents, speech/language pathologists, occupa- nies are routinely evaluated on many levels to en- tional therapists, physical therapists, behav- sure they meet rigorous standards of social and ioural consultants, physicians or teachers. environmental performance, accountability and One of the most engaging features is a video transparency. One of the core principles is that a library that enables users to capture and se- B Corp is “purpose-driven and creates benefit for curely store behaviours or events on a mo- all stakeholders, not just shareholders.” bile device as they occur in a child’s natural

Collectively, B Corporations are leading a environment. The company has written a LINDA WEISS ILLUSTRATION: growing global movement of “people using ground-breaking algorithm to blur every- business as a force for good.” Individually, each one components out of the box so that healthcare one else out of the frame so that the videos can be aspires to use its business power to solve social and providers are spending their time, effort and re- shared without compromising privacy. environmental problems. sources on improving their tool, doing rapid itera- For example, one family used Teleroo to film a pe- QoC Health’s self-declared B Corp mission is to re- tions and testing rather than spending a year build- culiarity in their child’s gait. After waiting six months imagine the patient care experience by shifting care to ing something that’s already been built,” he explains. to see a specialist, when the appointment finally the community, reducing healthcare costs and im- Some of the core components provided by QoC came, the doctor was unable to assess the child due proving access to care. Its cloud-based platform-as-a- Health’s Cloud Connected Platform include profile to behavioural issues. Using Teleroo, the parents service and infrastructure-as-a-service offerings do management, multi-directional collaboration, shared the video that had been captured and the doc- that by helping to create and grow electronic circles of HIPAA/PHIPA compliance, analytics and business tor was able to provide treatment. care, applying the company’s technology to securely intelligence, and turnkey EMR integration. “The whole point is to build local capacity,” says connect patients, providers and other community Each building block is white labelled, meaning Henderson. “If a speech/language pathologist has an support services in a way that fosters stronger collab- how a customer applies the technology will be excellent idea for how to work with a particular child oration and ultimately improves patient outcomes. unique to their solution. The underlying infrastruc- CONTINUED ON PAGE 15

12 CANADIAN HEALTHCARE TECHNOLOGY APRIL 2016 http://www.canhealth.com Read all about it.

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IF YOU HAVE SUBMITTED A SUBSCRIPTION REQUEST IN THE PAST 12 MONTHS, EITHER ONLINE OR BY FAX, PLEASE DISREGARD THIS NOTICE. QUESTION PERIOD Teamwork key to improved quality of care, especially with patient hand-offs r. Tepper is a Toronto physi- take measures of their key clinical practice rates of drug, surgical and other medical cian who still practices when and every few months send them a confi- errors? And what about innovative tools away from his quality im- dential personalized report showing them such as checklists? Can they reduce errors? provement agency’s desk – how their performance compares to their Dr. Tepper: Last year, we participated in a both with the St. Michael’s peers. We also combine that with giving national report called ‘Never Events for Hos- familyD health team and in the North York them practice tips and tools they can adopt pital Care in Canada’. It was the first report of General Hospital’s emergency department. if they see from our reports that there is a its kind in Canada on things that should But he also bristles with high level health particular area they can improve on. never happen in Canadian hospitals. Work- care management smarts and wide experi- As well, are very pleased to be co-lead- ing with the Canadian Patient Safety Insti- ence including a stint as the province’s first ing a program called Adopting Research to tute we developed a ‘never’ events list that in- assistant deputy minister responsible for Improve Care (ARTIC). This program cludes errors like doing surgery on the providing Ontarians with the right mix of takes proven examples of best practice in wrong body part, or on the wrong patient; health care providers. Keen on marginal- one part of the system and helps other or- conducting the wrong procedure, or giving ized populations, Dr. Tepper has been ac- ganizations adopt the same approach. wrong tissue, biological implant or blood tive with groups addressing inner city As you may know, the Ontario Ministry product to a patient, or leaving behind an health and rural healthcare. His academic of Health and Long-Term Care has devel- unintended foreign object in a patient. credentials include a degree in public pol- oped something called Health Links, As for checklists, yes, there’s a large icy from Duke University, an MBA from which are virtual communities of practice, body of evidence showing that checklists Western University, and a Master of Public focused on quality improvement and tar- can be remarkably effective in increasing Health from Harvard. Dr. Tepper spoke re- geting that one percent of the population patient safety. There’s also evidence show- cently with CHT contributor Andy Shaw. that is the most unwell. Health Quality Tepper: providers want to know how to improve. ing that checklists are no more than a tool Ontario provides support to more than 80 and not a ‘magic bullet’ or solution. As such Health Links across the province. CHT: Dr. Tepper, we’re always curious to such, they have limits. You need to embed Finally, every year we collect formal CHT: Is there one thing among Health know how the medical leaders we talk to them in a larger effort of cultural and ‘Quality Improvement Plans’ from more Quality Ontario’s accomplishments under got to where they are now. So what led you structural change. Just dropping in check- than 1,200 healthcare organizations across your direction that you are most proud of? to being Health Quality Ontario’s leader? lists into the healthcare system will not the system. We then provide feedback and Dr. Tepper: I think that people in the or- necessarily lead to improvement. Dr. Tepper: I think it was the chance to com- share the ideas of new and innovative ways ganization take pride in the very broad bine my frontline experiences as a physician of doing things that we spot in those plans. range of accomplishments that occur each CHT: Aside from greater patient involve- and take a system level approach to address- This initiative started with about 160 hos- year. However, one new area of activity ment, what are the other human factors at ing better quality care. You know, every day pitals, but now we also have participation that I think has been critically important play in quality improvement? hundreds of thousands of people go to work from primary care, home care, and long- in our work is the way we involve the full in the healthcare system with a deep com- term care facilities. So it’s fair to say that Dr. Tepper: Collaboration and teamwork spectrum of patients, families, caregivers, mitment to providing the best possible care Quality Improvement Plans have really had are paramount. We tend to think of things and the public. for their patients. So the mandate of Health an impact on our provincial healthcare like medical errors and safety as being very Quality Ontario is to give those people bet- local and specific to one hospital. But what CHT: How do you involve patients, exactly? ter support in doing their work. For me, it is CHT: How do those Quality Improvement thing we need to do is think more broadly a very important opportunity. Plans get shared? Dr. Tepper: First, we make sure that we and collaborate regionally, provincially have patients on our committees; they and even nationally on these issues be- Dr. Tepper: One way is that we post all CHT: As I understand it, you provide sup- share their experiences in our reports; and cause the same challenges are everywhere. those plans on our (hqontario.ca) website. port largely in the form of more and better they give us guidance on what we should The other opportunity for teamwork is The second way is to re-shape the plans information, so you are essentially an advi- look at next. We also have caregivers on to focus on local systems and the entire care into broader themes and findings reports, sory agency. But do you ever wish you our Board and have set up a provincial Pa- journey a patient might experience. Quality could instead just crack a whip over peo- tient and Family Advisory Council (PFAC) risks and gaps occur most often when peo- ple’s heads and say, “Do quality improve- Adopting Research to Improve as well as a wider reaching Patient and ple are moving between sectors: from hos- ment this way, now!”? Care (ARTIC) takes proven Family Advisory Network (PFAN). So, in- pital, to homecare, to primary care, to com- creasingly patients and care providers are munity services, to rehabilitation hospitals Dr. Tepper: Well, one of the things we know examples of best practices and active participants in our work. That’s a and back. We need a better integrated sys- from our experience is that we are tackling helps with their adoption. pivotal shift which has been really good for tem for all that movement and you need ef- very difficult quality issues every day. We us. If what you are about is improving the fective teamwork to produce it. also know that people are working hard at quality of patient care as we are, then you them already. So, I really believe it’s best to which we send back out to the managers need to involve patients in order to benefit CHT: Getting back to your 2016-2019 support them by giving them better infor- and caregivers on the front lines. And, of from their experience and wisdom. strategic plan, how will you measure Health mation, but also better tools by creating course, many healthcare organizations put Quality Ontario’s own performance? ‘communities of practice’. Overall our ap- their Quality Improvement Plans on their CHT: So what now are your priorities go- proach is to support people where they al- own websites. Dr. Tepper: I think it’s very important that ing forward through the rest of 2016 and ready have a strong desire to go in providing we just don’t report on other parts of the beyond? the highest quality of care. I don’t hear any- CHT: Are there other models for you any- healthcare system but also hold ourselves one in healthcare, saying, “We don’t want to where else, or is what you are doing at Health Dr. Tepper: We are committed to keep on accountable. So we have developed a num- participate in better quality care.” Rather we Quality Ontario pretty much unique? improving our reporting activities at the ber of performance indicators that mea- hear, “Can you help me get there?” provincial, regional, facility and even – sure our own ability to deliver on our Dr. Tepper: There are other health quality where appropriate and possible – the indi- strategy. Once they are finalized we will councils in Canada and other parts of the CHT: You have had just over two years vidual level. This information sharing is a share them publicly. world. Each one is a bit different in how leading Health Quality Ontario. How well critical part of quality improvement. Peo- they are structured and their mandates. But do you think you’ve done so far? ple and organizations need to know how CHT: Is there anything about quality im- what truly sets us apart is we have a man- they are doing and how their performance provement that maybe we haven’t touched Dr. Tepper: First, it’s not about what I have date to look carefully at the evidence sur- is improving over time. Accordingly, we on, Dr. Tepper – something you would like done but rather about what the remark- rounding new interventions and technol- are looking to significantly enhance our our readers to take away with them? able group of people here at Health Qual- ogy in healthcare, and then make recom- online reporting and allow people to find ity Ontario and the many partners we mendations to government about funding Dr. Tepper: Yes, and it’s this: quality im- information more easily. work with in the healthcare system have them. We’re very aware that just because provement should never be about blaming We’ve also launched a new 2016-2019 done. Quality is, after all, a ‘team game’. something’s new and shiny doesn’t neces- and shaming. Rather it should be about cre- strategic plan for Health Quality Ontario – But I do think there are areas where sarily mean it works well or is cost effective. ating a culture in which everybody is com- Better Has No Limit: Partnering for a Health Quality Ontario has demonstrated Also, on February 10, we launched our mitted to providing excellent care today and Quality Health System – which sets out our success. In the area of surgery, for example, new Quality Standards program. We are then committed to finding a way to be a lit- priorities and goals for the next three years. we are helping Ontario to adopt the Na- working with experts, providers, patients and tle better tomorrow. Quality improvement is tional Surgical Quality Improvement Pro- families to create a set of concise standards about creating a culture that improves care gram (NSQIP). We are also working hard to for the best evidence-based care possible CHT: In that plan do you address such top- continuously. We want the highest quality support primary care-givers. To do that, we given to patients with selected conditions. of-mind healthcare quality issues as high care to be the job, not just part of the job.

14 CANADIAN HEALTHCARE TECHNOLOGY APRIL 2016 http://www.canhealth.com Sansoro Health wins Venture+ Forum pitch competition at HIMSS16

AS VEGAS – Sansoro Health, of EMR integration,” continued Burde. “The physicians, real-time analytics tools, and said Jeremy Edes Pierotti, CEO of Sansoro Minneapolis, Minn., has been commitment of the U.S. Department of improved patient medical record portals. Health. “We are thrilled to be seen as one named the winner of the 10th an- Health and Human Services and major Third-party developers benefit from of the most promising investments that a nual Venture+ Forum pitch com- electronic medical record vendors to open Emissary’s standardization by avoiding the healthcare customer or healthcare IT in- petitionL for startup companies in the Application Program Interfaces (APIs) vestor might make. That reflects the healthcare technology industry as part of represented an important announcement. strength of Sansoro’s business plan, our the 2016 Healthcare Information and More important, Sansoro does that hard Sansoro’s solution helps with vision for seamless EMR integration, and Management Systems Society (HIMSS) work now. We believe it earned the HIMSS interoperability between of course the outstanding work of our en- Annual Conference & Exhibition. Venture+ Forum victory by providing the systems. HIMSS has highlighted tire team.” “The HIMSS Venture+ judges picked solution that meets the commitment.” “Experts and leaders all across our in- Sansoro for its innovative solution, Sansoro Health’s innovative software, this as a major issue. dustry, from federal government to the strong business plan, and value proposi- Emissary connects any software to an EMR private sector, have highlighted the need tion for customers and investors,” said through an open API model. Using this complications of integrating with multiple for open APIs to share EMR data. Sansoro Venture+ Forum Founder and Modera- rapid, scalable, and secure approach, EMR systems. Health’s Emissary software fulfills that tor Howard Burde, Principal of Howard health system customers easily deploy con- “The Venture+ Forum award recog- need today by providing open APIs that Burde Health Law, LLC. solidated patient records from multiple nizes Sansoro as an innovator in the dy- are both proven and deployed across “Sansoro represents the leading edge of EMRs, mobile healthcare applications for namic healthcare IT startup community,” health systems, creating better experiences and outcomes for physicians and pa- tients,” said Dave Levin, MD, CMO of Sansoro Health. QoC helps innovators turn ideas into real-world solutions Sansoro Health’s team includes experi- enced health IT executives, EMR experts, CONTINUED FROM PAGE 12 antidepressants do indeed have very high iterations; they were the ones who pro- and sought-after software engineers. The levels of decisional conflict, and second, to vided the frame for doing that.” company’s Emissary software is currently – or even across children – it can be shared better understand the barriers to making The resulting decision aid is accessible by used at some of the leading healthcare sys- with all practitioners, for example.” an informed decision. phone, tablet or PC, and accessed via a se- tems across the United States, and is con- Kids with autism make up 80 percent of Dr. Vigod could have gone the route of cure login. tinuing to expand its presence. Teleroo’s current user base in Alberta. The developing a paper-based decision aid, but Users peruse information about why or The Venture+ Forum spotlights top in- company has successfully demonstrated in today’s connected world, an electronic why not to take antidepressants, what other novative early and growth-stage compa- improved efficiencies in its local commu- solution made more sense. Once her re- treatment options are available, and an nies and provides business-building edu- nity and is now widening its reach to span search was complete, she partnered with overview of the risks associated with treat- cational resources and networking oppor- across Canada and the U.S. Earlier this QoC to start development. ment versus non-treatment. As they read tunities for innovators with leading deal- year, it received an education grant from She says QoC Health was able to work each benefit or risk, they assign it a ranking. makers, investors and health industry the Ohio Department of Education to roll within the boundaries of strict Interna- In the end, they are presented with a sum- partners. Over 60 companies applied to out a cloud-based version of Teleroo to mary that reviews everything they read, participate in the Venture+ pitch competi- benefit hundreds of thousands of school how they valued it and what pieces they feel tion. Sansoro Health was selected as the children in the Ohio area. QoC Health is Public and private organizations they’re struggling with. winner from the final four companies that playing an instrumental role in making often have good ideas for apps. “The idea is they go back to their doctor had delivered live presentations to an ex- sure the technology will scale as needed. The challenge is in creating and sit, having done this, and make a more pert panel of healthcare industry leaders “We had been vetting different plat- timely and effective decision,” says Dr. and investors. forms to help us achieve that goal and they them and scaling up. Vigod. “Because it’s one of those situations According to the company, Sansoro were just a beautiful fit for us,” says Hen- where as a physician, I can’t say for sure Health transforms healthcare information derson, noting that the two companies are tional Patient Decision Aids Standards and that it will be better if you take antidepres- technology by providing robust web ser- well aligned. “We’re not just building cool offered impressive ideas to help grow the sants than if you don’t.” vices integration across the major elec- technology. It needs to be built based on product. “In a lot of ways, they gave us a Dr. Vigod’s patient decision aid is cur- tronic medical record (EMR) platforms. what kids and families need.” leg up because by the time we applied for rently being piloted by a group of 50 The Minneapolis-based company’s award- The Uncomplicated Family is an exam- funding, we had a prototype,” says Dr. women. It has also gained the attention of winning software, Emissary, embraces a ple of how a private sector company is ben- Vigod. “We couldn’t have done it on our the National Health Service in the U.K. and rapid, scalable, and secure approach to efitting from QoC Health’s scalable plat- own. We provided the content, the patient QoC Health is helping to scale a version provide a bi-directional, proven set of form and white-label approach to building steering committee to go over the various that is applicable to women there as well. EMR-agnostic, open APIs. mobile solutions. Innovations from the public sector also stand to benefit. One example is the Women’s Mental providers for advice on their use; they velop a robust and agile framework for Health Program at Toronto’s Women’s Healthcare apps carry potential risks and benefits that screening and categorizing such apps, College Hospital, where psychiatrist Dr. Si- CONTINUED FROM PAGE 10 need to be weighed to the individual pa- and provide material to educate both mone Vigod has launched an important tients and there is a broad selection of patients and healthcare providers alike. decision aid for women faced with decid- The document, however, provides only uses, as well as a growing market of Medical schools and residency pro- ing whether or not to use anti-depressants basic high-level recommendations and companies selling the products that can grams need to incorporate topics during pregnancy. Roughly one in 10 preg- lacks a useable approach that can be ap- make selection difficult. around health information privacy and nant women will suffer from depression. plied to practice. Just as a clinician may have a pre- mobile health applications as a standard While there can be a negative impact when Navigating the ever-evolving space of ferred choice of over-the-counter med- practice. Until then, frontline clinicians the illness is left untreated, since it often mHealth apps can be a challenge for ications that they may recommend, clin- must take the responsibility for develop- leads to drinking, smoking or general dis- both the clinician and the patient alike. icians through experience, research and ing their own lists of ‘preferred apps’ regard for personal care, there are also the- As patients further turn to their health- and sharing them within their networks oretical risks to the baby when medication care providers for advice and informa- and associations, and ensuring time is is prescribed. tion regarding the use of such tools, it Clinicians can begin to allocated to discussing this important “That really leaves women in a Catch- will become critical for providers to have develop a list of their topic with patients. 22 and some of our earlier work had a practical approach towards making preferred apps for specific shown that even when these women come such recommendations. This is particu- Puneet Seth, MD, is a practicing physician from specialized clinical care, they still larly true in this transition period where therapeutic purposes. in Ontario and is Chief Medical Officer of don’t know what to do about this situa- there is no centralized regulation or eval- InputHealth, an award-winning digital tion,” says Dr. Vigod. uation of these applications.We propose sharing within their networks can begin health company connecting patients and As lead for the hospital’s Reproductive that clinicians evaluate and treat to develop a list of their “preferred providers through the Collaborative Health Life Stages Program, Dr. Vigod decided to mHealth apps with a very similar frame- apps” for specific therapeutic conditions Record. You can follow him on twitter create a patient decision aid to assist work to the way OTC (over-the-counter) and purposes. @psethmd. Dorian Murariu, MSc, is a women in making the best decision for medications are treated. Conceptually, There needs to be more work at mul- Clinical Research Coordinator in Ontario their own set of circumstances. Prior to both groups of “interventions” share tiple levels of the healthcare system to and a co-investigator on clinical studies in reaching out to QoC Health, she per- many similarities: they don’t need a pre- approach this topic. diverse fields including head and neck formed a comprehensive needs assessment scription for usage; patients will still ap- Medical associations and the Min- surgery, cardiology, medical education, and to first validate that pregnant women fac- proach clinicians and other healthcare istry of Health need to continue to de- global health. ing the choice of whether or not to take http://www.canhealth.com APRIL 2016 CANADIAN HEALTHCARE TECHNOLOGY 15 Reacts – a digital collaborative platform that brings remote interaction to the next level through “hyperpresence”.

In their day to day clinical environment, health care professionals constantly need to interact with their patients and colleagues, wherever they may be. They need to share knowledge and expertise, reassure their patients, train and assess the competency of their students. What they need is a tool that allows them to remotely interact in a dynamic, engaging and user- friendly way. Reacts was created with this perspective in mind.

Reacts (“Remote Education Augmented Communication, Training, Supervision”) helps improve access to care, decreases costs, and improves efficiency and satisfaction among both patients and health care professionals. It has been designed to meet the highest performance and security standards of the medical industry.

Reacts is a feature rich, integrated solution that allows you to: Communicate face-to-face using high quality secured video calls, • either peer-to-peer or between multiple remote sites • Share virtual pointers to direct attention to anything on live streams Connect and stream multiple video feeds simultaneously, using • any medical device that has a video output • Securely share your applications or your desktop screen • Share instant messages, files and documents easily and securely Manage your files and multimedia elements from your • Reacts library Store and retrieve files centrally, with 2 GB of cloud storage • per licence Perform virtual guidance by superimposing semi-transparent images, • 3D objects, or live video streams onto a remote user’s live stream Take snapshots or video recordings, and add annotations to any • image, video, or asset Create checklist and report templates to ensure a standardized • approach to care or to document your virtual encounters Use Reacts in simulation sessions to capture and record multiple video feeds that can then be reviewed • offline for briefing / debriefing purposes

Reacts goes beyond the medical world. It can be used in several other fields such as education, field services, public safety, business, and any other area in which interactive, multimedia collaboration is needed.

Reacts provides a highly secured virtual environment and allows you to interact with colleagues, patients, clients or friends in an unparalleled way. It will make you rethink the way you communicate.

Welcome to hyperpresence.

www.iitreacts.com Telephone: 514-223-1717 • Toll free: 1-844-423-1717 • Email: [email protected]