FEATURE REPORT: DEVELOPMENTS IN TELEHEALTH – SEE PAGE 10 Publications Mail Agreement #40018238

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 20, NO. 7 OCTOBER 2015 INSIDE:

APPS FOR HEALTHCARE PAGE 14

Real-time ED clock Patients are able to check how long they will be waiting to see a doctor in the Emergency Depart- ment at Markham Stouffville Hos- pital, in Markham, Ont. The system allows them to plan their visits, and to make arrangements for children, family and friends. Page 6

Remote pharmacy support Five small and mid-sized hospitals across Ontario have implemented a cloud-based system that includes quick and effective review of physi- PHOTO: DALE MACMILLAN Edmonton prepares for gamma knife centre cian medication orders by pharma- The ground has been broken on the site of a $17.5 million Gamma Knife and Clinical MRI Centre. Pictured with the augur operator are: cists, around the clock. The tech- Guy Scott, Brain Centre Campaign Co-Chair; Alberta Health Minister Sarah Hoffman; Vickie Kaminski, CEO of Alberta Health Services; Jim nology is supplied by Ricoh Canada Brown, Campaign Co-Chair; and Dr, Keith Aronyk, Director, Division of Neurosurgery, University of Alberta Hospital. SEE STORY ON PAGE 7. and North West Telepharmacy. Page 4

Super-nurses for homecare An innovative eShift system is en- Video-visits with doctors are taking off in U.S. abling remote nurses to supervise and care for up to six patients in BY HUGH MACKENZIE tool (by 57.8 percent) and the most widely of time it takes to get an appointment, and their own homes, assisted by care considered for future use (by 67.1 percent). sitting too long in the doctor’s waiting room. technicians. ideo-visits with doctors are steadily The American Medical Association On the other hand, a video-visit makes it Page 10 growing in Canada, especially in (AMA) recently opined that a hands-on visit easier to see the doctor, and some organiza- the province of British Columbia. is the preferred form of doctor-patient inter- tions are providing 24/7 availability. Home monitoring tests But the trend of patients talking to action, and for serious health issues, a person- Employees of the technology giant Ora- The Ontario Telemedicine Network theirV doctors using computer-based video- to-person visit remains the gold standard. cle, which uses American Well’s telehealth is working with partners to test conferencing appears to be positively explod- But for everything else, especially ail- platform and virtual network of physicians, systems for three types of home ing in the United States. ments like colds, coughs, rashes, and minor pay only a $5 co-pay to see a board-certified In 2014, a study by Parks Associates, a re- doctor online, which they can do at home or search firm in Dallas, Tex., focused on the A video-visit makes it easier to at their desks at work. And even patients growth of videoconferencing for physician- who pay retail rates are generally charged patient visits. It predicted that virtual visits see the doctor, and some less than $50, a bargain compared with the in the United States are about to triple – services provide 24/7 availability. alternatives. from 5.7 million in 2014 to over 16 million As well, many doctors like providing in 2015 – and will skyrocket to over 130 mil- aches and pains, video-visits might be the video-visits. A national survey of 2,016 pri- lion in 2018. best solution. mary care doctors in the U.S., conducted by Also in 2014, a HIMSS Analytics report Too often, patients will avoid a trip to the American Well in collaboration with Quan- patient monitoring: diabetes, men- revealed that of over 400 hospitals and physi- doctor for these seemingly minor conditions. tiaMD, found that 57 percent of physicians tal health and chronic kidney dis- cian practices surveyed, 46 percent already Among the top reasons for postponing a are willing to conduct video visits with their ease. There are benefits for both use some form of telemedicine technology, visit, a Harris Poll survey found, were an in- patients. Just 12 percent of physicians were patients and caregivers. with videoconferencing the most widely used ability to take a day off from work, the length CONTINUED ON PAGE 2 Page 13 Computer-based videoconferencing with doctors taking off in U.S.

CONTINUED FROM PAGE 1 And the country’s largest health insur- at their disposal. But it seems that hurdle, ported by a trained wellness attendant ance provider UnitedHealthcare and three too, is now being surmounted. who can help the patient as needed from unwilling to see a patient over video, while leading telemedicine companies, Now- One of the most interesting and ambi- check-in to check-out. 31 percent remained uncertain. Clinic, Doctor on Demand, and American tious developments in the video-visit arena Through the HealthSpot stations, cus- In November 2013, for example, the Well, will make virtual doctor’s visits avail- has been the emergence of HealthSpot, an tomers will be able to access a variety of University of Pittsburgh Medical Center able to many Americans. The insurer is Ohio-based start-up that is producing en- healthcare services including pediatric (UPMC), which includes 21 hospitals and rating telemedicine as equivalent to a trip closed kiosks where consumers can con- care. The HealthSpot stations are located 400 outpatient sites, began offering pa- to the doctor’s office. duct private video-chats with doctors. inside select Rite Aid pharmacies in Akron, tients throughout Pennsylvania 24/7 access In Canada, organizations offering In July, Rite Aid, one of the leading Cleveland and Dayton. Rite Aid and to a physician via videoconferencing or video-visits include Medeo, now part of drugstore chains in the United States, an- HealthSpot first announced their partner- telephone. The cost to patients: $38. The Kelowna, BC-based QHR Technologies, ship in November 2014. savings to the UPMC Health Plan are an and LiveCare, of Vancouver. Business is “The opening of the first HealthSpot average of $86.80 per member visit com- growing for both. Healthspot stations are self- stations inside select Rite Aid pharmacies pared with the cost of an office visit. Indeed, the number of video-visits in enclosed kiosks that enable in Ohio is another step in our transforma- Just as importantly in the U.S. context, B.C. rocketed from just 897 in 2013 to video chats with physicians tion into a retail healthcare company,” said insurance companies are funding video- 8,253 in 2014 – a jump that caused the Robert Thompson, Rite Aid executive vice visits with doctors. They’re finding the Ministry of Health to announce the formal using interactive devices. president of pharmacy. “This first-of-its- technology-enabled encounters are more review of cost/benefits of this form of tele- kind model pairs licensed healthcare cost-effective than visits to emergency de- health. Doctors are paid $41 for each vir- nounced the opening of HealthSpot sta- providers with state-of-the-art technology partments, urgent care centres and even tual visit. tions at 25 Rite Aid pharmacies in Ohio. to deliver a truly unique solution to con- primary care offices. Particularly for minor While the ministry said a report would Using cloud-based telemedicine soft- sumers looking for convenient and quality ailments, video-visits are proving to be just be released in the Spring of 2015, it has yet ware, HealthSpot allows users to interact healthcare.” as effective. In December, Anthem, the na- to make its findings public. with medical providers in a private, 40- Customers ages three and above can be tion’s second-largest insurer, announced Patient-to-doctor video visits are just square-foot station using high-definition treated for minor and common health that it would begin offering telehealth vis- getting off the ground in other provinces. videoconferencing and interactive med- conditions, including cold and flu, rashes its with no co-pay to its Medicare Advan- Some physicians are still wary of video- ical devices including a stethoscope, an and skin conditions, eye conditions, ear- tage members in 12 states, including Cali- conferencing with patients, because they otoscope, a pulse oximeter and a mag- aches and seasonal allergies. A record of fornia, Florida and New York. don’t have traditional medical instruments nascope. Each HealthSpot station is sup- the visit is maintained, ensuring continuity of care. The software platform also inter- faces with insurance eligibility, electronic medical records and billing systems. The cost of the eVisit with a doctor is approximately $60, which can be paid by insurance or via cash or cards by unin- sured patients. “HealthSpot brings to- gether a set of unique technologies, devices and local healthcare providers to create a one-of-a-kind healthcare experience,” said Steve Cashman, HealthSpot CEO. “We are thrilled to be working with Rite Aid to pi- lot this new healthcare model as the first retail clinic truly integrated with local health systems to expand access to afford- able and convenient healthcare in Ohio.” In Ohio, customers will be able to con- nect with a network of medical profession- als from Cleveland Clinic, Kettering Health Network and University Hospitals, including pediatric specialists from UH Rainbow Babies & Children’s Hospital, as part of HealthSpot’s Care Network. The care network, a key component in building the infrastructure necessary to of- fer affordable, quality healthcare in retail, enables clinicians to extend their reach into local communities and serve more pa- tients with expanded hours through HealthSpot stations. Since opening in late May, HealthSpot stations at Rite Aid have served thousands of Rite Aid customers. Rite Aid Corporation is one of the lead- ing U.S. drugstore chains, with nearly 4,600 stores in 31 states and the District of Columbia and fiscal 2015 annual revenues of $26.5 billion.

Publisher & Editor Contributing Editors Art Director CANADA’S MAGAZINE FOR MANAGERS AND USERS Jerry Zeidenberg Dr. Alan Brookstone Walter Caniparoli OF INFORMATION TECHNOLOGY IN HEALTHCARE [email protected] [email protected] [email protected] Volume 20, Number 7 October 2015 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 2015. 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. ©2015 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 OCTOBER 2015 http://www.canhealth.com However they choose to contact you...

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BY REBECCA AGAR “The old way of doing things was to scan physician orders into PDF files. How- ith increasing pressures ever, there were numerous issues with this to reduce turn-around method, including quick retrieval of time for delivery and/or archived scanned orders and obtaining access to medication, pharmacy workload statistics. We looked five small-to-medium at various software solutions and felt that Wsized hospital sites across the province of Ricoh’s was the most versatile and best Ontario have turned to a centralized solu- suited to interface with the remote phar- tion for physician order review by their re- macy services we already provide.” spective pharmacy departments. In April 2015, The North West Com- St. Francis Memorial Hospital, Lady pany partnered with Ricoh Canada to pro- Dunn Health Centre, Glengarry Memorial vide a cloud-based Pharmacy Medication Hospital, and Muskoka Algonquin Health- Order Management scanning solution to care (Huntsville District Memorial Hospi- increase pharmacy workflow efficiency for tal site and South Muskoka Memorial hospital clients. Hospital sites) have all implemented Ri- The Ricoh solution features Do- coh’s Pharmacy Order Manager Solution, a cuScripts software; an automated med- fully automated medication ordering, pro- ication order management system for cessing and fulfillment solution. hospitals that integrates with any scan- These five hospitals now have a virtually ning device or Computerized Physician Team members at the Glengarry Memorial Hospital, which has deployed Ricoh’s pharmacy solution. paperless medication order management Order Entry (CPOE) system to send or- system with full pharmacist support and ders directly to the pharmacy with the Hospital administrators were pleased to Dhaliwall, business development man- rapid drug profiling for their patients’ elec- touch of a button. learn that the new solution will now pro- ager and clinical pharmacist with NWTS. tronic medical records. The solution sur- Pharmacists can process orders more vide them with reliable pharmacy work- “The hospitals not only share the costs of passes the level of pharmacy service at efficiently, based on their priority, time, load statistics, including order turn- implementing this solution, but also many larger, urban Canadian hospitals. and location. Caregivers can track the around time, staff productivity and full or- share the costs of the remote pharmacists. Each of the hospitals reached out to progress of their orders in real-time, der audits, all instantly available. Essentially, you can have one or two phar- North West Telepharmacy Solutions which reduces phone calls to the phar- One of the best features of Ricoh’s macists reviewing physician orders for (NWTS) to help provide remote pharmacy macy. Back and forth communication Pharmacy Order Manager Solution is its numerous small hospitals at the same services and were recommended by NWTS tools allow both pharmacist and caregiver ready-to-use functionality. St. Francis time, which frees up other pharmacists to to implement Ricoh’s Pharmacy Order to clarify, consult, and correct medication Memorial Hospital in Barry’s Bay, Ontario, maintain clinical programs to improve Manager Solution for secure transfer of questions and errors. was brought on line and all users were patient safety.” physician orders. “We are excited to partner with North trained in one business day. The solution Joan Sullivan, a registered Pharmacy Kevin McDonald, director of NWTS, a West in delivering a valuable solution to can leverage a hospital’s existing infra- Technician at St. Francis Memorial Hos- division of Health Products and Services, hospitals in Canada,” said Brent Brand- structure including scanning technologies pital in Barry’s Bay, had this to say about The North West Company LP, realized the meyer, Sales and Support Manager for Do- and other multi-function devices, to sig- the DocuScripts software: “The Do- need for a sophisticated but simple soft- cuScripts. “Together we are helping to nificantly reduce start-up costs. cuScripts scanning program has im- ware solution to allow his remote pharma- drive down costs while improving patient “This is an efficient and cost-effective proved the link with the healthcare team cists to safely view physician orders in a outcomes. It is incredible to be part of a solution for small to medium-sized hos- in providing patient medications accu- timely manner. solution where everyone benefits.” pitals to strongly consider”, says Sammu rately and safely. “Communications are documented di- rectly on the order scan and keep all mem- bers informed as to the order status. I love the colour-coding of scans, as it prioritizes the workflow, which helps deliver timely medication access.” North West Telepharmacy and Ricoh have teamed up to provide an innovative, cost effective solution for hospitals who wish to streamline remote pharmacy ser- vices to reduce costs, increase departmen- tal productivity, improve patient safety, and maximize the impact of limited phar- macy resources. As the leading Canadian provider of re- mote pharmacy solutions, North West Telepharmacy Solutions currently sup- ports over 40 hospital clients across Canada with services including around- the-clock real-time pharmacist medication A Canadian order review. For more than 50 years, Ricoh has been delivering solutions for healthcare clients Innovation across North America. Their solutions in- clude on-site and off-site managed ser- vices, technical services and support, and Allscripts Sunrise™ connects people, places and insights by integrating customized workflow design and imple- clinical and operational data across all care settings. This delivers a mentation. Ricoh’s team of dedicated complete view of a patient’s health that follows them through each healthcare solutions experts work with stage of care. healthcare organizations to drive efficien- The Power to Transform Canadian Health Care. cies, support information security initia- tives, and improve patient care. That’s the Power of Allscripts.

www.allscripts.com | @allscriptsCAN For more information about DocuScripts Copyright © 2015 Allscripts Healthcare Solutions, Inc. and North West Telepharmacy, visit www.ri- coh.ca/pharmacy and www.northwesttele- pharmacy.ca

4 CANADIAN HEALTHCARE TECHNOLOGY OCTOBER 2015 http://www.canhealth.com When he reduced costs by 13% with a new RTU, he wasn’t just saving money. He was setting a precedent.

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Subject to additional terms and conditions found at saveonenergy.ca. Subject to change without notice. OMOfficial Mark of the Independent Electricity System Operator. NEWS AND TRENDS Wait-clock manages expectations of ED patients, both on-site and online

BY ALANNAH SMITH In early 2015, MSH introduced the first access to the same information at the wait clock in the ED at the Markham site, same time.” ollowing the expansion of followed by the launch of the online wait The wait clock displays wait times in 30 Markham Stouffville Hospital clock and Uxbridge site wait clock. minute increments and updates every five (MSH), the emergency depart- Now, anyone sitting in the ED at either minutes with high accuracy; 90 per cent of ment (ED) was facing a chal- site, or anyone with a computer or mobile patients are seen within the projected time. lenging time meeting the expec- device can access, in real-time, informa- Every 5 minutes a file with ED data is tationsF of patients. Patients felt they tion about the current state of the generated from our Meditech Data Repos- weren’t being kept in the loop on wait Markham and Uxbridge site EDs. itory. The Meditech Data Repository holds times; registration and triage staff were be- “Staff and patients have appreciated all the data that is inputted into the ing pulled away from their duties to an- having ready access to the information and Meditech System. swer questions about who would be seen have found the wait clock to be a very use- The file in the Meditech Data Reposi- next – all while the number of emergency ful tool,” says Clint Atendido, director, tory is then uploaded to our Oculys server. visits continued to grow. emergency, surgical services and patient Using a wait time algorithm designed by The number one question patients ask flow. “The numbers also speak for them- Oculys, data from the file is used to predict in the ED is how long will I wait? To help selves – we have had over 15,000 visits to an estimated wait time at the 90th per- satisfy patients’ needs for constant progress the wait clock online alone since the online centile, meaning the wait time information updates without interrupting the flow of launch on April 1, 2015.” displayed is 90 percent accurate for the the ED, MSH searched for an answer that From the minute you realize you need time it takes between when the patient has provided patients with the information to visit the ED, life is on hold for patients been registered in the system until the time they were looking for without the need for and their families. For some people, that they are seen by a doctor. extra manpower. means figuring out what to do with chil- Cari McCulloch, Markham Stouffville RN The Markham and Uxbridge site wait The solution: a real-time wait clock in dren, figuring out work schedules and clocks are one more step in improving and the ED and online. planning for rides to and from the ED. sion about whether the ED, a walk in clinic enhancing the patient experience at MSH. The real-time wait clock is a patient- Having access to the wait clock not only or a phone call to Telehealth Ontario is the An informed patient is an empowered pa- centered communication tool designed to helps patients and families within the ED – best option for them. tient – and the best outcomes happen enable real-time information on the cur- it helps them prior to their visit. Patients “The wait clock is visual and easy to when patients are partners in their care. rent wait times in the ED. and their families can access the Markham understand. It keeps patients informed Together with Oculys, the wait clock tech- Designed and formulated with input and Uxbridge site clocks online and make and frees up staff to provide direct patient nology provider, MSH is changing the pa- from the very patients who visit and make plans to accommodate their visit with accu- care,” says Cari McCulloch, ED RN. “Our tient experience – one click at a time. use of ED services, the wait clock delivers a rate information, making their time less ED puts a high importance on good pa- MSH’s real-time ED wait clocks can be simple, visual message that indicates the stressful and more about direct patient care. tient/provider communication and this accessed online at www.msh.on.ca estimated wait time to see a physician, as The online clock also lists other care clock is another tool we can use to keep well as the projected wait time over the fol- providers/alternatives to the ED in the area patients informed. Most importantly, it Alannah Smith is a corporate communications lowing six hours based on past trends. to help patients make an informed deci- ensures staff, patients and visitors all have specialist at Markham Stouffville Hospital

Scarborough Hospital delivers care through integrated EHR, ECM

ORONTO – To improve care deliv- Emergency Departments at the hospital’s tensive and document identification and a time that physicians spend addressing ery and workflow, The Scarbor- two campuses (Birchmount and Gen- management system like OnBase saves deficiencies in patient charts. Tough Hospital (TSH) has been in- eral), has nearly 30,000 inpatient admis- significant time for our staff. Physicians must complete charts in a tegrating its OnBase enterprise content sions, and performs over 40,000 surgeries. Immediate and long-term benefits timely fashion, as per provincial health management (ECM) solution with its As a result, the organization generates for TSH: In Ontario, all hospitals are re- regulations. Patient records can be Meditech EHR. an average of 25,000 pages of scanned quired to submit patient visit and clini- inches thick and it can be tedious and Patients’ paper records – such as images per day. Prior to the ECM solu- cal information to reconcile the funding time-consuming when looking for a clinician transcribed reports – are tion, this massive volume of paperwork they receive from the province’s Ministry document, such as a surgeon’s operative scanned directly into OnBase by Hyland strained the ability of the Health Records of Health and Long-Term Care. Coding note, Perna explains. and the information is directly accessi- department to make the documentation OnBase enables TSH to organize ble in Meditech, reducing duplicate available in patients’ paper charts. charts in such a way that physicians can processes. “Before implementing the ECM solu- click on a tab and go directly to the con- While other hospitals and health sys- tion, TSH took time to understand how tent they are looking for. Signatures are tems across Canada are also scanning clinicians accessed and used patient in- also captured electronically, so that patient information to create digital formation,” explains Dion Maxwell, physicians are able to complete their records, most of them do not have ad- Manager, IT Applications and Clinical documentation even when they are not vanced workflow processes in place, says Health Informatics. Once the processes at the hospital. As a result, TSH physi- Devee Perna, Manager of Health Records and workflows were evaluated, Hyland cian and Health Records staff satisfac- at TSH. Nor do they make the informa- and TSH customized OnBase to meet tion has risen significantly. tion easily available to other providers in user needs. Looking to the future: TSH continues the continuum of care. “OnBase has allowed us to make to innovate with its EHR strategy. On- “We were early adopters in completely changes to the way we utilize health Base is now being used in the Human automating the process,” said Perna. “We records,” Perna says. “Now with an auto- Scarborough’s Dion Maxwell and Devee Perna. Resources department to scan and easily share information twenty-four-seven mated workflow, every scanned docu- retrieve employee files, and it is being within our own organization, as well as ment is identified and bar coded by form departments at each hospital must com- implemented in other areas of the hospi- with our circle of care providers, includ- and then put into a universal chart order.” plete charts and submit information on tal as well. ing long-term care facilities and Com- “We’ve done significant work,” a timely basis, or face penalties and fines. In addition, TSH is exploring OnBase munity Care Access Centres.” Maxwell adds. “We’re not just scanning; Through OnBase, documents are to allow clinicians to view patient infor- In July 2015, the Health Records de- we’re really using the software as a con- scanned directly into the system and are mation, complete patient charts, and partment further integrated OnBase tent management system.” available within seven days of a patient’s capture clinical images at the point-of- records into the ConnectingGTA portal, As a result, the organization has greatly discharge, allowing coders to easily care from their mobile devices. Ontario’s regional electronic health reduced the amount of time required to search online for patient information, “Our goal is to provide world-class care record at the point-of-care. pull files to provide clinicians with access thereby greatly reducing reconciliation to the global community of Scarborough, Customizing document management: to patient records. “You have to measure delays, penalties, and fines. while continuing to build on our history Each year, The Scarborough Hospital re- the cost of labour,” Perna says. “Tracking For Perna, another important impact of leadership and innovation in health in- ceives more than 100,000 visits to its down specific information is labour-in- of this ECM solution is the reduction of formation technology,” says Perna.

6 CANADIAN HEALTHCARE TECHNOLOGY OCTOBER 2015 http://www.canhealth.com NEWS AND TRENDS University of Alberta Hospital set to acquire gamma knife, 3T MRI

DMONTON – Alberta’s first gamma Images taken with the 3T MRI scanner a brain tumour treated with a Gamma tough decisions on how to handle devas- knife and clinical 3T MRI Centre have proven so crisp and clear that they Knife in Winnipeg, says he’s delighted with tating brain conditions. – with the capability to pinpoint have been known to pick up aneurysms in news of the new local centre. “With the Gamma Knife, they will re- hard-to-reach brain tumours and patients during routine imaging, and to “Future brain care patients in Alberta ceive the best treatment in the world and performE life-saving surgery without a also provide pinpoint guidance for deli- are incredibly fortunate to have access to their lives will carry on with minimal im- scalpel – will be installed at the University cate surgeries. this remarkable technology,” says Freeman. pact,” Freeman added. “This is an exciting of Alberta Hospital. Edmontonian Brad Freeman, who had “Patients in the past had to make really day for all Albertans.” Construction on the new Gamma Knife and Clinical 3T MRI Centre begins in Oc- tober. With $17.5 million in donor sup- port, the hospital will acquire the two medical devices that offer the most ad- Christie Innomed is pleased to announce vanced, non-invasive and pain-free tech- nology now available for treating brain- the appointment of Mr. Martin Roy as its surgery patients. QHZ3UHVLGHQWDQG&KLHI([HFXWLYH2I´FHU “Gamma Knife radiosurgery is pain and incision-free,” said neurosurgeon Dr. Keith Aronyk, director, division of neurosurgery, An outstanding leader, Mr. Martin Roy has a solid back- University of Alberta Hospital. “There’s no ground in health care, strategic management and re- operation. So there’s no anesthesia. You source development. His knowledge of the Canadian come in the morning and go home in the health system, his vision and his ability to develop long- afternoon, having had the definitive treat- term business relationships with the clientele will allow ment for many brain conditions. It’s al- Christie Innomed to further the company’s growth on most miraculous.” the Canadian market. “Our vision for the Brain Centre has al- ways been to provide the best doctors with the most advanced equipment,” said Jim With over 10 years of experience as an executive and Brown, Brain Centre Campaign co-chair manager of Canadian health sector companies, Mr. Mar- with the University Hospital Foundation. tin Roy has gained a reputation for his dynamism and “Breaking ground on the new Gamma EXVLQHVVNQRZOHGJHLQD´HOGLQFRQVWDQWHYROXWLRQ Knife and Clinical 3T MRI Centre is the culmination of tremendous community - support and a shared commitment to pro- $VWKHQHZ3UHVLGHQWDQG&KLHI([HFXWLYH2I´FHUXQGHUVFRUHGª,EHOLHYHWKDW&KULVWLH,QQR vide the best care possible to brain patients med has all the assets needed to become the undisputed leader in technological optimization across northern Alberta.” and software solutions for improving the performance of health care institutions in Canada. Vickie Kaminski, president and CEO of Christie Innomed, it is more than 175 dedicated and skilled employees, our company’s most Alberta Health Services (AHS), agrees. “This YDOXDEOHUHVRXUFHDPRQJRI´FHVDFURVV&DQDGD2XUZRUNIRUFHDOUHDG\OHWXVUHDFKWKH project has the potential to revolutionize LQGXVWU\­VKLJKHVWVWDQGDUGVDQG,´UPO\LQWHQGWRFRQWLQXHLQWKHVDPHGLUHFWLRQE\HQFRX- neurosurgery in this province and to pro- raging innovation and collaboration at every level of the organization.” Mr. Martin Roy added vide new hope to individuals who need, but cannot undergo, traditional brain surgery,” WKDWª&KULVWLH,QQRPHGDOVRJHQHUDWHVGLUHFWDQGLQGLUHFWHFRQRPLFEHQH´WVLQH[FHVVRIPXOWL said Kaminski. “This is another outstanding millions of dollars in Canada and I am extremely proud to be a member of this organization.” example of foundation dollars being in- vested in areas that are advancing the health Born in Montreal, Mr. Martin Roy is a business administration graduate of the Université du system’s priorities and overall direction.” 4XpEHFj0RQWUpDO+HSXUVXHGDQGREWDLQHGYDULRXVDFFUHGLWDWLRQVLQWKH´QDQFLDO´HOGDQG Gamma Knife radiosurgery focuses we are deeply pleased to welcome him as a member of the extended Christie Innomed family. close to 200 tiny beams of radiation on a Mr. Martin Roy currently lives in Toronto with his wife and their two children. target to treat brain tumours, malforma- tions and movement disorders such as Parkinson’s disease. With no need to open the skull, not only is the patient spared scalpels, general About Christie Innomed inc. anesthetic, blood loss, infection risks and prolonged recoveries, but they typically re- Christie Innomed and its divisions, headquartered in the Greater Montreal region, develop, turn home the same day. distribute, integrate and support innovative solutions and software products that have been They’re back to living their regular lives improving the performance of Canadian health care institutions for over 60 years. within 24 to 48 hours with a noticeable difference – their debilitating headaches, terrifying seizures or life-threatening tu- The professionals at Christie Innomed help hospitals and clinics optimize their medical ima- mours are either completely gone or re- ging technologies and improve their performance in screening, diagnosing and treating the duced enough for them to live a life that’s health problems of their patients. It also provides all the technical and clinical support nee- not dictated by their condition. GHGWRLPSURYHZRUNµRZVDQGSDWLHQWFDUHHQVXULQJWKDWLWVFOLHQWHOHFDQGHOLYHUWKHEHVW If a picture is worth a thousand words, service possible. Christie Innomed brings to bear its expertise in radiology, systems architec- then the complementary technology – a 3T ture and application development, as well as its extensive knowledge of a range of comple- MRI (magnetic resonance imaging) scan- ner – provides an encyclopedia of brain de- mentary products, in order to produce effective, adaptable and lasting solutions. tails for neurosurgeons. The ‘T’ stands for tesla, a unit of measurement used to quan- Together we deliver better care to more people. We are proud of the entrepreneurial spirit tify the strength of a magnetic field. underlying all of Christie Innomed’s activities. It is the driving force behind our growth, the Twice as powerful as the more common IXHOWKDW´UHVRXUFRPPXQLW\FXOWXUHDQGWKHUHDVRQZK\ZHUHPDLQRQWKHOHDGLQJHGJH 1.5T device, the 3T MRI scans up to four times faster, meaning patients who struggle to lie perfectly still in a confined space for long periods, such as those with movement Visit us at christieinnomed.com disorders, won’t have to. 3T MRI images let neurosurgeons make more precise diag- or call 1-888-882-8898 noses and deliver more focused disease management in many therapeutic areas. http://www.canhealth.com OCTOBER 2015 CANADIAN HEALTHCARE TECHNOLOGY 7 2015 Canadian Telehealth Report charts the rise of services in Canada, notes key issues Since 2013, there has been a 45 percent increase in the number of clinical sessions delivered.

VIEWPOINT BY GRANT GILLIS to predominate the conditions being monitored. The to the ongoing growth and development of tele- report features a cameo from Bobby Gheorghiu of health; and how clinical professional educational rom COACH and the Canadian Tele- Canada Health Infoway exploring some of the chal- programs can better support virtual care. health Forum, and on behalf of our fed- lenges in growing this area of telehealth. The responses, as might be anticipated, were eral, provincial, territorial and First Na- In terms of devices used as clinical peripherals in wide-ranging, reflecting the implications and nu- tions partners, we are pleased once again telehealth, not surprisingly the scope of digital de- ances of how telehealth affects not just patients and to deliver the 2015 Canadian Telehealth vices (and their portability) continues to increase, providers but the entire healthcare system. Report. ranging from dermatology cameras, exam cameras, Just a few of the responses included: the tracking FThe report is a bi-annual, survey-based publica- stethoscopes, otoscopes, ophthalmoscopes, ocular of carbon emissions avoided through travel not be- tion of national telehealth programs and services. It cameras, retinal cameras (for diabetic retinal exams), ing required; the closer scrutiny and analysis of user is unique in providing Canada’s only coast-to-coast- ultrasound scanners, home health monitors (HHMs) experiences; considering ‘cultural competency’ as it to-coast compilation of available telehealth pro- as well as tablet and smartphone-based apps. relates to the capacity of providers to engage with grams and services, including detailed information The 2015 report once again features the progress First Nations patients about their health and well-be- on program demographics and volumes, clinical ser- and success of First Nations Telehealth programs in ing; the value of on-demand and self-scheduling of vices, client/stakeholder engagement, accreditation, care; improved patient self-management and more education and training as well as new/emerging tele- immediate access to disease-specific information; the health technologies and techniques. Almost 90 distinct types of clinical beneficial transformation and evolution of clinical Widely recognized domestically and internation- services are now delivered or facilitated practice for isolated healthcare providers; streamlin- ally for contributing key information for analysis at via telehealth, including an array of ing the governance, management and operation of the local, regional and jurisdictional levels, circula- telehealth services as part of the healthcare contin- tion of the 2013 Report included approximately 300 mental health services. uum; and incorporating telemedicine and virtual printed and electronic copies, along with more than care as a (much) greater part of the core curricula for 1,000 downloads/view of the online version. all major categories, including program statistics, healthcare providers. So, what’s new for 2015? Well, a lot really. Since clinical and educational services, medical peripher- An excellent closing cameo from Carol McFar- the last report in 2013, there has been a 41 percent als, software video technology, etc. lane of the Ontario Telemedicine Network de- growth in the number of telehealth endpoints across Responses from the First Nations Health Author- scribes telehealth agencies in the role of virtual care Canada and an even greater 45 percent growth in ity Telehealth Program of British Columbia, the Al- stewards and catalysts supporting the larger techno- clinical sessions delivered. berta region of First Nations and Inuit Health logical transformation of the health- Almost 90 distinct types of clinical services are (FNIH), and the Keewaytinook Okimakanak care system. now delivered or facilitated via telehealth, including eHealth Telemedicine Services (KOeTS) in On- The 2015 Report profiles the contin- an array of mental health services, along with pedi- tario profile the substantial progress and ued remarkable, ongoing growth of atrics, rehabilitation therapies, internal medicine, achievements that First Nations continue to telehealth across Canada, in par- cardiology, nephrology (including dialysis), diabetes make on expanding the scope and scale of ticular the development and evo- care, discharge planning, and a range of surgical ser- telehealth to their communities. lution of service creation, adop- vices from plastics to transplant. Finally, another new component in the tion and diversification. While Telehealth-based education delivery continues to 2015 Report involves the ‘perspectives’ of delivering on its traditional bene- be prominent in services, as the number of sessions telehealth professionals on: alternative met- fits of eliminating distance barri- for patients/families as well as healthcare providers rics assessing the impact of telehealth; new ers and improving access to ser- increased to over 400,000, a very substantial increase emerging practice trends and techniques of vices that often would otherwise not of 78 percent since 2013. telemedicine/virtual care; key barriers be available to remote and rural com- This year’s report also features the latest data in munities, telehealth today is telehomecare services and remote patient monitor- Grant Gillis is Executive Director, Forums transforming care, making ing. Ontario, New Brunswick, British Columbia and & Practices, with COACH: Canada’s Health it more virtual, imme- Québec have telehomecare programs in place and Informatics Association. For additional diate and ‘disrupting’ the number of patients cared for increased 54 per- information on the topics covered in this accepted practice cent since the last survey. Congestive heart failure article, or more information on the CTF and paradigms to improve and chronic obstructive pulmonary disease continue COACH, please visit www.coachorg.com health tomorrow.

Who champions information governance in your organization?

BY DANIEL GAUVREAU Because information is at the core Historically, we viewed information files, an email, DICOM or audio of sound decision-making and im- as what was written or printed on files, etc. Not only have the types of anaging patient informa- proved communications, whether it paper, whereas current information formats increased, but so too have tion when it was on paper is during a patient consultation, the sources of its generation. did have its challenges, but staffing for the operating room or Information continues to be gen- M There is a need for in today’s hybrid environment, with reporting to the ministry, informa- erated from the traditional sources, its mixture of electronic and print tion is a strategic asset. guidelines on how to such as clinicians, administrators data, managing healthcare informa- Like all assets, there is a need for maximize the utility of and researchers, but new sources are tion has grown in complexity and guidelines on how to properly maxi- also playing a significant role; pa- importance. mize the utility of this asset while healthcare information. tient portals, EHRs, wearable devices Healthcare organizations are of- balancing cost and risk. and facility management devices are ten reactionary when it comes to Information Governance policies formats and sources have multiplied. only a few examples. managing patient information, its for healthcare have evolved over Information is now in both physi- All these variables have added growth, its accuracies and more of- time, along with the way in which cal and electronic media; it can be complexity to proper information ten than not, its breaches. information is used in healthcare. hand written, pictures or electronic CONTINUED ON PAGE 11

8 CANADIAN HEALTHCARE TECHNOLOGY OCTOBER 2015 http://www.canhealth.com VIEWPOINT Capita Healthcare Decisions leads the way in clinical decision support r. Charles Young is Chief Medical hard job. Non-clinically trained people CHT: What has been the most important Commissioned by Healthdirect Australia, Officer for Capita Healthcare have a much better understanding of clin- thing you have worked on recently? who provide services on behalf of the ma- Decisions, based in Basingstoke, ical concepts and clinical terminology jority of state governments, and working UK. The following Q&A with than they used to have, which is fantastic Dr. Young: In addition to the patient-fo- in partnership with a service provider Dr.D Young informs us about the company’s and important, but it’s still hard finding cused project, we have also just success- called Medibank. industry-leading solutions for telephone- sensible everyday alternatives to phrases fully completed a major installation of The new service went live in July 2015, based triage. Capita has developed systems like ‘erectile dysfunction’! our software and content in Australia. CONTINUED ON PAGE 14 for both clinicians and the public. CHT: Hello Dr. Young, please tell us about yourself. Dr. Young: I’m an emergency physician and I work one day each week helping medical and trauma patients in the emer- gency department at St Thomas’ Hospital in London, UK - directly across the river Thames from the Houses of Parliament. For the rest of my week, for the last 15 years, I have worked in healthcare IT/healthcare information. My previous roles have included Executive Editor at The Lancet, Editor in Chief at the BMJ Evidence Centre (where one of the teams I led cre- ated the clinical deci- sion support tool, BMJ Best Practice), and Vice President for Clinical Solu- tions at Wiley, look- ing after the world’s most important evi- dence based medi- Dr. Charles Young cine resource, the Cochrane Collabo- ration, and another clinical decision sup- port data base, Essential Evidence Plus. My interest in all of those roles has been understanding and using the inter- face between technology, different types of clinical information, and clinicians them- selves, to drive improvements in the care patients receive. CHT: Who do you work for now? Health care is Dr. Young: In my non-clinical time, I now work as Chief Medical Officer for Capita too important to Healthcare Decisions. I also sit on commit- tees for the UK’s National Institute for ™ Health and Care Excellence (NICE), and stay the same. the Cochrane Collaboration. CHT: What do they do? Dr. Young: At Healthcare Decisions we lead the world in making clinical decision support software and content which is pri- That’s why we collaborate with clients across the globe to advance marily used to support telephone triage. health and care. With our clients, we are creating a future where the Our products and services are have been deployed globally, translated into more health care system works to improve the well-being of individuals than 10 different languages, and have ef- fectively and safely supported over 90 mil- and communities. lion patient interactions - at the last count! When NHS Direct launched their tele- phone triage service in the UK, it was the Be a part of the answer. Talk to us today to learn how together, largest of that type of service in the world, we can transform the next era of health care. and was entirely based on our content and software. This summer we have just finished a large project to convert all our clinical in- formation, called TeleGuides, into infor- mation suitable for patients and their care- To learn more go to cerner.com givers to use directly, via the internet. We call this new product WebGuides. Our aim is to empower patients to make their own healthcare decisions, us- ing exactly the same information re- © 2015 Cerner Corporation sources their clinicians use. Just from a linguistic perspective it was a surprisingly http://www.canhealth.com OCTOBER 2015 CANADIAN HEALTHCARE TECHNOLOGY 9 10

CANADIAN HEALTHCARE TECHNOLOGY OCTOBER 2015 FEATURE REPORT ied, theeShiftproject intheSWCCAC cuthospital enabling home care workers to work differently.” a problem thatneedssolving,” saidMilak. “It’s about Ont., eShift. thedeveloper of Technologies, Sensory partner nology London, of NursesOrder andCarePartners, of tech- alongwith to Owen the Sound. with InVictorian partnership whose catchment area stretches from London, Ont., southwestern Ontario. care forpalliative of patientsandtheirfamilies in ity gency rooms, cuttingcosts, andimproving thequal- care,cess theright nomatter live. where they Because theRNisremote, itmeanspatientscanac- ulated technician actsastheireyes, earsandhands. are inconstant thepatient. contact with Theunreg- and theirfamilies. overruns. contributes to hospital crowding andcost- (SW CCAC). the South West Community Care Access Centre senior director andtheleadfore-homecare at tal emergencydepartment,” saidGordon Milak, patient would away betaken right to thehospi- and acaregiver panicked, they’d call911andthe readmissions. orhospital emergencydepartment use of unnecessary acycletrouble of –andtrigger specialized nursing care,without into canrun tient needsthemcanbeastumblingblock. thespecialized skillswhenthepa- nurse with beds, canreturn to they theirhomes. needsinexpensive higher tients with hospital youngsters complex with needs. ailments –from seniorsto frail housebound of avariety canbeusedforpatientswith nology tionize care andabroad, inOntario asthetech- required. summon anothernurse if even direct thetechnician to provide care, or on thepatient, theRNcanassess, monitor and thepatient. of real-time view With eyes’ ‘virtual reported intheapplication. Theresult isarobust, patientdata,nician inthecollection of which isthen tinuously by connected theRN. to andsupervised a homecare technician, attheirbedside, whoiscon- Each patienthasanunregulated provider, as known homes–simultaneously.as sixpatientsintheirown ables aregistered nurse to remotely care forasmany U A remote registered nurse cancare live. homes, for they where intheirown upto sixpatients regardless of Milak noted inatwo-year thatwasstud- period Together, thepartners “are to technology bringing The project waspioneered by theSWCCAC, That’s reducing thepressure onhospitalemer- Milak explained thatundertheeShiftsystem, RNs It isalsoagreat inconvenience to patients Moving patients into theED, course, of only something went“It wrong, usedto bethatif Those patientswhohave returned home, But whenhomecanbeanywhere, gettinga keepingIt thesepa- meansthatinstead of simplesolutionmayThis seemingly revolu- enablestheRNtoThe technology direct thetech- eShift isasecure, web-based thaten- technology Innovative helpsnurses eShiftplatform BY JERRYZEIDENBERG tients intheirhomes. andpalliativeplex pediatric pa- care forcom- use anewmodelof hasbeenabletowestern Ontario nology, south- of alargeportion sing aninnovative, web-based tech- monitor home-care patients that haven’t skillednurses highly beenable to attract care.4,000 patientsand loggedover 750,000 hoursof eShift nurses andtechnicians have cared formore than point-of-care, too. Since theproject in2010, started the technicians, it’s alsolike having thenurse’s handsatthe patient,” saidMilak. seven days aweek. “It’s eyes onthe like having virtual I have ever nursing.” ledinmy 43years of estly cansay, eShiftisthemostexciting that program velopment &Innovation atCare Partners. “I hon- rately,” saidCharlotte Koso, Program Director De- of technicians isshared consistently, timelyandaccu- collected thattheinformation guarantees by the complexdren with medicalneeds. The technology ities to provide palliative expert care andcare to chil- arewho beingcared forathome. 60beds, predominantlypervising palliative patients on six. In theSWCCAC, eShiftnurses are now su- patients, andinsomecases, thenurse cankeep tabs tient inaninstant. dashboard thatshowsvisual thepa- thecondition of thing unusual comes up. tacted aboutpatientsinemergenciesorwhensome- breath. charted, of such aspainandshortness theirphysicians.with documentation aboutpatientscanbealsoshared an RNto care forpatientsthrough atechnician, but just 1.9percent, reduction. adramatic re-admissions forpalliative care from 35percent to Significantly, to areas expertise brings theservice closecollaboration betweenAnd nurses with and What’s more, thesystem 24hoursaday, operates “eShift hasrevolutionized Registered Nurses’ abil- Significantly, oneremote nurse canmonitor four In additionto thedocumentation, there’s alsoa alsohelpsRNswhoareThe information con- There are several key indicators thatare regularly As Milak explained, theapproach notonlyenables and it’s to stillrunning thisday.” tool set, and created a newsolution. It wassuccessful, work,” saidBlanshard. “So we modified ourexisting patientsintheirhomes. care forpediatric (technicians)regulated to provide staff overnight whether thesystem could beused by RNsandun- approached problem: itsown Blanshard with thopedic surgeonsinhospitals. ing in-homedirections to physiotherapists from or- provid- nally launched in2006, of thepurpose with logged by thesystem. and operatesdatacentres thatstore theinformation smartphones. In Ontario, Technologies Sensory owns icine centre, technicians andinteract whouse with to thedatathat’s report neededby thenurses. puterized platform. Thetechnicians how are taught thecom- nurses andtechnicianstrains intheuseof care, which requires similar, intensive care forpatients. could beprovided 24/7. nurses connected to technicians inthehome, care out.burn remote But by pediatric makinguseof too difficultfortheparents to doalone. watching around theclock, outto which turned be conditions athome. Thesechildren often needed forchildren complexinitially focusedoncaring with from government,in seedmoney theOntario and technicians to careteam of forpatientsintheirhomes. Now, aremote nurse hasbeenableto a work with able to offershiftnursing forsixyears. care atnight Grey-Bruce Ontario, area of theCCAC hadnotbeen to provide overnight care. Milak saidthatintherural The CCAC couldn’t nurses to findenough dothis theproject,The localCCAC of and wind caught Blanshard explains thatthecompany wasorigi- Directing RNscanwork from homeoratelemed- The system wasthenexpanded to includepalliative As Milak observed, theparents would quickly $100,000 in2009with started effort The original To make thispossible, Technologies Sensory home, orstay athomelonger. care. Now, have they thechoice to dieat rently would monitoring likely beinhospital lution wasn’t inplace, thepatientsitiscur- In Technologies many theSensory cases, if so- cally rolls over to anothernurse to take charge. isn’t gettingaresponse, thesystem automati- ample, and whenatechnician needssupport The system hasmany usefulfeatures. For ex- and chronic failure.) heart used foradultcomplex care, includingCOPD Technologies system inMichigan isbeing theUnited of and parts States. (ASensory as well asto care-givers intheU.K., France It’s beingrolled CCACs, outto otherOntario ners. platform, several inconjunction part- with Technologies,Sensory the thedeveloper of trepreneur Patrick Blanshard, launched who en- of isthebrainchild The eShifttechnology cancrash.”“They ways know whatthey’re infor,” saidMilak. “They’re brave andstoic, don’t butthey al- too, andeShiftisalife-saver forthem. to rest andrecuperate,tients needtimeoff palliativeFamily support memberswho pa- alize how thetaskcanbe. challenging intentions, don’t thebestof butthey with re- loved oneshomeforend-of-lifecare start Milak their noted thatfamilieswhobring http://www.canhealth.com

ILLUSTRATION: LINDA WEISS TELEHEALTH Who is the Information Governance champion in your organization?

CONTINUED FROM PAGE 8 the IT department may be very proficient and add it to the current EHR and provide ers. A well-executed IG plan with assigned at managing clinical and administrative a complete view of the patient history for stakeholders will drive a higher level of reg- governance. In the current environment, data, they require guidance from the ad- the clinician. The coordination of this sce- ulatory compliance and assure organiza- IG is based on practical experience, infor- ministrators and clinicians on how the in- nario and countless others are contingent tional information is properly managed. mation theory and legal doctrine. formation is to be consumed. upon a well-structured approach to infor- It is aimed at providing an overarching For example, the IT department can ren- mation guidance that will build alignment Daniel Gauvreau, M.Sc., is Canadian Di- framework that offers assurances to pa- der prior patient history available in a PDF in policy and procedure and key stakehold- rector, Healthcare, for Iron Mountain. tients, clinicians and administrators that all decision in the healthcare environment are made using trustworthy information. To assure effective and proper use of information, healthcare organizations must have an IG strategy in place. Abrams and Gibson, in Fundamentals of Health Information Management (2013), explain that the governance and accountability of the delivery of the health information ser- 16–19 NOVEMBER 2015 vices relies on a framework managed by the organization. DÜSSELDORF GERMANY The internal policies and procedures that will constitute this framework must be spe- cific and responsive to the organizational www.medica-tradefair.com environment and be compliant with the HIM Lifecycle standards and best practices. For example, policies and procedures put in place for a single site facility will not be representative of those required for a regional or provincial initiative. This Oc- WORLD FORUM tober will be an opportune time to review and validate these organizational policies and procedures, as this is when eCHIMA anticipates publishing the updated Cana- FOR MEDICINE dian HIM Lifecycle stage document. Assuming that all organizations engage and integrate a Life Cycle Management BE PART OF IT! process in their organizations, they need to New show days have a tactical plan on how to adopt it and from Monday to who will execute it. Roles and responsibili- Thursday! ties vary in organizations due to their re- spective environment. Certain facilities have dedicated HIM professionals while other fa- Onlineis required!registration cilities have other resources tasked with this and other responsibilities. Either approach is acceptable if it is meeting the organiza- tional objectives of a the LCM, with the un- derlying assumption that in both scenarios key stakeholders are well identified, that their roles are well defined and that they can be effective at carrying out their duties. Interestingly, IG frameworks have yet to be widely adopted. In a recent survey of healthcare organizations, only 36 percent of survey respondents indicated that their or- ganizations have designated a senior execu- tive to sponsor IG. (AHIMA, 2015). While this represents an increasing trend over pre- vious years, it shows that not all organiza- tions have a well-defined IG plan. Organizations that do not have an IG plan are exposed to greater risk. With the advent of Bring Your Own Device to Work (BYODW), increased bidirectional infor- mation flowing through patient portals, the potential of data breaches, new research us- ing data mining, increases in regulatory compliance are but some to the areas where an improper governance of information augments the potential of errors and risk. Poor governance of information also im- pedes organizational efficiencies and opera- tional excellence by creating situations Canadian German Chamber of Industry and Commerce Inc. where information is not available when it Your contact: Stefan Egge is needed, is not accurate or is incomplete. 480 University Avenue _ Suite 1500 Toronto _ Ontario _ M5G 1V2 For organizations that are evolving Tel.: (416) 598-1524 _ Fax: (416) 598-1840 their IG principles for healthcare, the first E-mail: [email protected] For Travel Information: LM Travel /Carlson Wagonlit area for consideration is who in the orga- Tel: 1-888-371-6151 _ Fax: 1-866-880-1121 nization will be responsible for setting the E-mail: [email protected] IGPHC vision and implementing it. While http://www.canhealth.com OCTOBER 2015 CANADIAN HEALTHCARE TECHNOLOGY 11 TELEHEALTH The ‘Virtual’ Family Health Team: a concept whose time has come

BY RONAK BRAHMBHATT, ical record (EMR), and quickly get an un- A virtual FHT (vFHT) with remote tele- The first is to assign a fixed set of tele- KARIM KESHAVJEE AND JIM MURPHY derstanding of Rina’s medical history. providers, which could include every type health providers to a particular set of clinics After her assessment, and feeling more of allied health professional that is found in using contractual mechanisms. The draw- urrent State: Mary Jones, a confident, she recommends that Rina stay a traditional site based FHT, could allow back of this approach is that economies of 79-year-old widow, wakes up home and see her doctor in the morning. 24/7 care to be provided almost immedi- scale are lost when providers are assigned to at 1 am not feeling well. She The nurse accesses the doctor’s schedule ately, at a fraction of the cost of bricks and very small groups of patients. calls the Provincial Nurse and books Rina in for a 10:30 AM ap- mortar FHTs. In addition vFHTs can be de- A more acceptable approach would be to Triage line to get some ad- pointment. The nurse is able to do this in ployed in rural areas where a bricks and have a fixed set of telehealth providers as- Cvice. The remote tele-nurse does a thor- spite of being at a virtual location as part mortar FHT would not even be possible. signed to clinics to maintain continuity of ough assessment asking her about her pre- of a telehealth program. vFHT providers would also be attractive care, but have a single and scalable backup sent illness and other health problems. Rina is able to rest easy, knowing she to existing FHTs, as it is often a challenge for queue with providers who can handle calls But Mary has several diagnoses, is cur- has a confirmed appointment. When her FHTs to provide high-quality care after on a 24/7 basis, such as is available in every rently on 13 different medications and symptoms worsen, she waits it out. In the hours and during peak hours when the province through their provincial nurse line can’t remember all her recent procedures. morning, her doctor is able to reassure her phones are busy. They are also attractive be- programs. Patients can decide whether they The tele-nurse is at a disadvantage without that there is nothing that requires urgent cause they can support patients between vis- want to speak to someone immediately or access to the medical record, including a attention and sends her for some outpa- its by helping them to implement recom- wait for someone they know. list of medications and care plan. tient tests. Rina leaves confident that her mended care plans, make better lifestyle How is privacy and confidentiality Based on her professional assessment, symptoms are being investigated. maintained in vFHTs? There are several she recommends that Mary stay at home The future state is not science fiction. It practical tools to help maintain patient and book an appointment with her doctor is achievable using today’s technologies. A virtual family health team, confidentiality and privacy. in the morning, but also states that if Mary The recent report from the Conference with remote teleproviders, could Health professionals’ ethical and profes- feels worse to please call her back or if it is Board of Canada on the success of Family allow 24/7 care to be provided sional codes of conduct act as a basis for an emergency to call 911 right away. Health Teams (FHTs) in Ontario should en- the service. Mary feels that’s a good idea ... until courage us to pursue inter-professional care almost immediately. • Audit trails identify the telehealth 3:30 am, when, unable to go to sleep, she even more aggressively. Yet, the Ontario provider who entered the system and when does feel worse. Mary believes that she Government has backed away from ex- choices and navigate the increasingly com- and which part of the EMR was viewed or won’t get in to see her doctor because the panding this successful model. Why? Be- plex healthcare system. altered. phone is always busy when she calls. She cause costs are high and expansion into re- The vFHT is an attractive model, but • accessing care, patients can enter their panics and calls 911. mote and rural areas is fiscally unattainable. also faces some barriers to implementa- healthcare number, providing consent for Mary ends up in the Emergency De- Bricks and mortar FHTs can be expen- tion. Barriers and their solutions are dis- the telehealth provider to access his/her partment where her entire medical history sive because professionals are often co-lo- cussed below. medical record. is recreated through a myriad of tests that cated in actual clinics. They are limited to How would continuity of care be man- • Regular third-party threat risk assess- she is certain she has already had. Mary is a 9-5 clinic day with a few evenings avail- aged? Continuity of care is shown to im- ments can identify holes in security sent home and told to follow-up with her able for after-hours care. FHTs require ex- prove patient adherence to treatment and arrangements. family doctor the next day. She still doesn’t tensive planning and capital investment to patient outcomes. Telehealth systems that • Regular reviews of audit logs can help know what is going on. house all health professionals under a sin- rotate healthcare providers so that patients identify lapses in protocol and breaches. Future State: 79 year-old Rina Patel gle roof. Hiring new staff, developing orga- never get to know their healthcare providers, How should patient referrals to a tele- wakes up at 1 am, not feeling well. She tries nizational processes and the expertise to and healthcare providers never get to know provider be managed? Patients don’t like to go back to sleep unsuccessfully, so she manage multiple health professions takes their patients, detract from continuity of surprises and they certainly don’t like to calls her doctor’s office. The nurse on the time, delaying the return on investment, care. There are two ways to maintain conti- get calls from strangers. They also don’t line is able to access Rina’s electronic med- sometimes for many years. nuity of care in a virtual provider system. like getting unsolicited calls about their health. The best time to refer a patient to a tele- provider (other than having the patient call and be routed to one) is after a discus- sion with the patient during an in-person visit. The patient’s motivation and readi- ness for change can be assessed during the encounter and a referral to a remote tele- provider can be negotiated at that time. Using existing technologies in creative new ways, we can help patients with evi- dence-informed healthcare services on a 24/7/365 basis. The virtual family health team can provide most of the benefits of the bricks and mortar solution, and do so for more people in more communities at a fraction of the cost. The virtual family health team is an idea whose time has come.

Ronak Brahmbhatt is a physician trained in India. He is currently working on a variety of health related projects, including a sys- tematic review on interventions in multi- morbidity and the analysis of EMR data to better understand opioid prescribing. Karim Keshavjee is a family physician and CEO of InfoClin, a leading health-informatics con- sulting firm. Karim is a clinical and research architect, designing large-scale research and interventional projects using information technology. Jim Murphy is the Vice-Presi- dent Healthcare Strategy & Business Devel- opment at Sykes Assistance Services Corpo- ration, a leading Canadian telehealth ser- vice provider. Jim has over a decade of expe- rience in healthcare governance with a spe- cial interest in quality and patient safety.

12 CANADIAN HEALTHCARE TECHNOLOGY OCTOBER 2015 http://www.canhealth.com TELEHEALTH New telehealth projects target diabetes, mental health and kidney failure he Ontario Telemedicine Net- scribed the medication they sought, only work (OTN) has launched 65 percent received the therapy they felt three new demonstration they needed. Access to evidence-based psy- projects this fall under its chotherapy is limited and wait-lists are “Home is the Hub” umbrella. long. As of April 30, 2015, Ontario Shores Working with the private sec- Centre for Mental Health Sciences alone Ttor and established healthcare providers, had hundreds of patients on waiting lists OTN’s initiatives are designed to discover for outpatient treatment. whether new patient groups can benefit Working with partners Ontario Shores from remote patient monitoring. and Lakeridge Health, OTN will pilot a so- OTN already oversees a well-established cial media-based online early intervention and successful Telehomecare program that service for people 16 and older who suffer supports Chronic Obstructive Pulmonary from mental health problems. Disease (COPD) or Congestive Heart Fail- Members come together online anony- ure (CHF) patients with self-management mously to share feelings, join guided on- coaching and remote monitoring. line courses and assess themselves to set The new projects, supported by Canada goals and track progress. The online inter- Health Infoway and the Ontario Ministry actions are monitored by an automated of Health and Long-Term Care, use remote OTN partners in its new remote patient monitoring initiative for diabetes, BlueStarSC. Left to right, Harry system that issues alerts if ‘danger words’ patient monitoring in the management of Kim, Global Director, Samsung Healthcare Enterprise Business Team; Anand K. Iyer, Chief Data Science Offi- are used and by clinicians trained in how chronic kidney disease, mental health and cer, WellDoc; Dr. Ed Brown, CEO, OTN; Kevin McRaith, CEO of WellDo. to intervene. diabetes. For Sheila Neuburger, executive vice “We’re testing the potential for innova- grated part of everyday life. Telehomecare, lifestyle tracking tool. Jane DeLacy, execu- president of clinical services at Ontario tion in the healthcare system, not just these projects – and all the iterations that tive director of clinical programs at Shores, the bottom line on the trial is through the outcomes of these particular will come after – are the first steps.” William Osler Health System, draws on her straightforward: “We’ve been looking for projects, but through the approach we’re Diabetes: The rising prevalence of all experience with Osler’s successful OTN something to help our waiting list people. taking to create an evaluation frame- forms of diabetes in Ontario outstrips the Telehomecare program to project the im- I think we’ve found it.” work,” says Ed Brown, OTN’s chief execu- healthcare system’s ability to provide pre- pact of the new trial. Moreover, she says, the online commu- tive officer. ventive and disease management services. “The combination of immediate feed- nity can be a constant in people’s lives, “We want to learn to fail fast or succeed Fewer than half of all people with type 2 back and the availability of a healthcare even when patients have a therapist. “Your quickly. We want to create the conditions for diabetes are regularly tested for blood professional has a huge impact on hospital therapist appointments might be once a patient empowerment and faster, cheaper, sugar levels, blood pressure and choles- and ER visits,” she says. “And it’s more pa- month. This is a 24/7 resource people can better healthcare that can be sustained. terol levels or kidney function. tient-centred.” access from wherever they are.” “In every case, we have to test for pa- Surveys indicate that people with dia- DeLacy says the frail elderly, those with Chronic kidney disease: In Ontario, tient-centredness – whether the patient will betes receive too little education and too mobility issues and those who don’t have about 10,500 patients receive some form of like and use it. We have to find out if little support. anyone to take them to appointments, will dialysis, either hemodialysis (HD) in a providers like it and use it. We have to learn With partners WellDoc, a digital health have better access to healthcare. healthcare setting or peritoneal dialysis if the expected outcomes are achieved and technology company, and Samsung, OTN Mental health: In any given year, one in (PD) that can be performed at home. we have to ensure it adds value to health- will work with three diabetes education five people in Canada experience a mental PD is associated with numerous benefits care delivery and supports the Ministry of centres to provide patients with a cus- health problem. According to a 2012 study, over HD, including a survival advantage. It Health’s transformation agenda. tomized mobile self-management and while 91 percent of Canadians were pre- CONTINUED ON PAGE 14 “Finally,” says Brown, “we have to fig- ure out how it can scale. If it doesn’t scale, it isn’t an innovation – it’s just an- other invention.” That’s why for Brown and the OTN team, the new remote patient monitoring PartnersPartners in RemoteRemote PharmPharmacyacy projects are vital to the future of healthcare in Ontario. “It’s exciting because we’re going to OrderOrder ManaManagementgement learn so much,” says Laurie Poole, OTN’s vice president of telemedicine solutions. “With Telehomecare, we learned about technology as an enabler in the home and about the fact that coaching for self-man- agement works. But the most important thing we learned is that there is so much more to do.” PatientPatient and medicationmedication safetysafety is ourour MMakingaking informationinformation workwork A key component of the process will be evaluation. “We’ll be working with a toptop prpriorityiority – iit’st’s wwhwhyy wwee wworkork 224/74/7 fforor healthcarehealthcare leading academic research organization Ricoh’sRicoh’s PharmacPharmacyy OOrderrder ManaManagerger Solution ffeaturingeaturing that will help us study this in real-time so PatientPatient andand medicationmedication safetysafety is our toptop prioritpriorityy – itit’s’s whywhy DocuScriptsDocuScripts softwaresoftware automates automates the submissubmissionsion and we can learn and adjust as we go along,” wwee wworkork 224/74/7 says Rhonda Wilson, OTN’s Telehome- trackingtracking of medicatimedicationon oorders,rders, sisignificantlygnificantly imimprovingproving care executive lead, who spearheaded • A Around-the-clockround-the-clock memedicationdication ororderder rrevieweview communicationcommunication betbetweenween the ppharmacistharmacist and the project development. • After-hours on-call services caregiver. “Real-time research will allow us to • Comprehensive and complete hospital pharmacist services learn if the approach works for the pa- For more than 50 years, Ricoh has been delivering tients, for the family and volunteer care- Mission Statement: To be the leading comprehensive pharmacy solutions for healthcare customers across North givers, as well as whether the healthcare services provider to Canadians and health care related institutions in America. For more information on our pharmacy providers like it.” under-served markets and times, utilizing innovative technologies. solution, please visit us online. The evaluation process will also shed light on whether the projects have a posi- northwesttelepharmacy.ca ricoh.ca/pharmacy tive impact on the sustainability of the healthcare system, Poole adds. VisitVisit our bboothooth at bbothoth OOHAHA HeaHealthlth AAchievechieve (Nov(Nov2 2-4,-4, 22015)015) and CSHP PPC ((JanJan 31 - FFebeb 4,4, 2016)2016) in Toronto,ToToronto, ON. For Wilson, the projects are a dream OHA Health AAchievechieve booth # 553434 OHA Health Achieve Achieveb booth #917 & 919 come true. “All my working life I’ve tried to CSHPCSHP PPCPPC boothbooth #101#101 figure out how to make healthcare an inte- http://www.canhealth.com OCTOBER 2015 CANADIAN HEALTHCARE TECHNOLOGY 13 FOCUS ON APPS FOR HEALTHCARE Hamilton’s Mohawk College is poised for the rise of medical apps

BY ANDREA JOHNSON “These devices and applications pro- clinicians for diagnostic purposes, like di- Epocrates have been collecting and devel- vide a degree of self-empowerment that agnosing a disease or condition, are regu- oping medical content for many years and ight in your pocket is one of patients have never had in the past. This is lated by Health Canada or the USA FDA. have tremendous platforms. the most powerful and exciting great opportunity to lead to more mean- This is a much more complex and expen- “Public agencies such as Canada Health tools that is currently being ingful clinician-patient interactions,” ex- sive process which requires proof of clini- Infoway and eHealth Ontario have also used to improve healthcare. plains Bender, who advocates that clini- cal effectiveness.” been building sophisticated infrastructure Mobile technology, which in- cians and consumers alike use a good The exacting process that is involved in in recent years that will enable the next cludesR your smartphone, tablet and wear- “dose of common sense” when adopting the development of clinical grade mHealth generation of highly integrated medical ables, has become an unavoidable force that healthcare apps. products and solutions is an area that Ben- apps for Canadians.” is changing how you can monitor and sup- “While I highly doubt that counting der and the MEDIC team are familiar with. Bender is optimistic that the pace of port your patients – both in and out of the your steps and estimating your caloric While MEDIC doesn’t provide end-user mHealth adaptation and development will doctor’s office. burn in a day will hurt you, there have been apps directly to consumers, it does assist increase thanks to these infrastructure in- So how can we effectively use healthcare cases where apps have been provided di- organizations in de- vestments. He points out that Mohawk’s apps and mobile health (mHealth) to help rectly to consumers which claim to be able veloping their apps Apps for Health Conference continues to patients? to diagnose complex medical conditions, in the research cen- grow, with upwards of 400 attendees at- The first step, says Duane Bender, is not such as melanoma. This is obviously a tre. It’s Bender’s own tending last April, to hear from startups, to think about how you can include and highly risky practice and I suspect that peo- personal knowledge, small and medium enterprises, govern- adopt mobile health, but instead consider ple could be seriously harmed by a delay in gained from work- ment agencies and hospital systems that how you are already using it. seeking appropriate medical attention.” ing on over 20 dif- are developing and using mobile health Bender is the director of Mohawk Col- It’s also important to remember that ferent mobile health technologies. Bender suggests that Canada lege’s mHealth and eHealth Development mHealth isn’t pure science, it is a confluence apps, that allows him is still in a “wait and see” mode while most and Innovation Centre (MEDIC) in of forces, including healthcare, technology, to articulate the com- of the commercial activity in healthcare Hamilton, Ont., and one of Canada’s lead- consumer demand and public policy. plexity of developing apps is happening in the USA and abroad. ing experts on mobile health. In a sense, it is a contradiction: easy to Duane Bender a mHealth app. “Canada has a world-class health system He is a professional software engineer use but hard to understand. Understand- “Healthcare tech- with both some of the best clinicians in the who researches the application of systems ing the types and features of healthcare nology development has aspects unique to world, as well as some of the best engineer- engineering, software engineering, infor- apps that are currently available for clini- the health industry – such as specialized ing and innovation talent in the world,” mation technology and mobile technology cians and for consumers is the first step to privacy and security requirements and de- says Bender. “I hope to see a change in our to healthcare. evaluating the best way to integrate them tailed specifications for the structured ex- mHealth focus in the next few years.” Even if you aren’t actively using clinical into practice. change of health information,” says Bender. Innovation and adoption – those are healthcare apps on your phone, suggests “There is a clear distinction in the in- There is more to mobile health than just the two paths that Bender sees for the fu- Bender, there is a good chance that your dustry between apps and devices that are the actual app and there continues to be a ture of mHealth in Canada. patients have already embraced consumer used by patients to collect and record data desire and need to integrate apps and de- “I see massive potential in mHealth for wearables or apps, such as Fitbits, MyFit- about their conditions and devices and vices together, he adds. alleviating some of the pressure from the nessPal and the Apple Health Kit, or apps that are used by clinicians for diag- “Most people don’t realize the tremen- healthcare system through virtualized care looked up healthcare information on their nostic purposes,” says Bender. dous amount of infrastructure that is be- and patient self-management,” says Ben- smart phones. “The first type are not currently regu- hind modern smartphone apps. Have you der. “The only way that we can sustain the “If your patients are using it, then you lated by Health Canada or the FDA and ever tried to use an app without the net- current level of care without raising costs are using it,” says Bender. “In fact, most their clinical effectiveness is not really work connected? You generally don’t get is to become more efficient through the clinicians would be surprised by the level known. Devices and apps that are used by too far. Companies such as WebMD and use of technology.” of consumer demand for mHealth. We know now that consumers and patients are extremely interested in these technologies and I think some providers would be sur- Capita Healthcare Decisions leads in clinical decision support prised to learn how many of their patients are experimenting at home with Fitbits CONTINUED FROM PAGE 9 closely with the Medibank Chief Medical ings in multiple time zones between us and and Fuel bands.” Officer, Dr Georgia Karabastos, and one of our customers can prove challenging. But That ease of consumer adoption is im- and provides high quality health informa- my clinical team based in Australia we always manage it somehow. portant for the integration of mHealth tion online and over the phone enabling all worked hand-in-hand with the Medibank A key concern in dealing with a very ex- into patient care, but this ease of use also Australians access to healthcare advice clinical team. perienced partner like Medibank is pro- comes with some risk. While it allows for where and when they need it most. Clearly This type of close communication with viding them with enough support and easy integration, it also means that clini- a huge responsibility for us. customers is absolutely essential. Without guidance so they understand our content cians may have to be more vigilant about The project was excellent, from my per- it we can’t work out what our customers how patients use the technology. spective, partly because I was able to work really need, and so we can’t give it to them. We also learn a massive amount from We learn a massive amount our customers in this type of working en- from our customers, and our lated quality of life and peritoneal dial- vironment. In fact, our approach is much approach is much like a close Telehealth projects ysis (PD) management for patients un- more like a close working partnership working partnership. CONTINUED FROM PAGE 14 dergoing PD. than a transactional relationship, and that Dr. Arsh Jain, LHSC medical director partnership continues for as long as, and is also the least costly form of dialysis. for peritoneal dialysis, says home-based sometimes even after, they continue to use and its complex architecture, while still al- But studies show that the low uptake of peritoneal dialysis creates a burden for our products. lowing them the freedom and control to home dialysis is the result of patients’ patients who experience anxiety about make the changes they need to. CHT: What went well? fear of caring for themselves once sepa- all of the tasks associated with choosing CHT: What’s going to happen in the future? rated from their healthcare team. home dialysis over the more costly in- Dr. Young: The best thing about working Support for patients to successfully centre dialysis. with Georgia and Medibank was the com- Dr. Young: More sophisticated linking of transition to independent dialysis at “We had tele-home-monitoring for a munication. We found they were excellent different types of clinical decision support home may be achieved with the addi- number of years, but it was such old partners in working together to develop tools. I can already see a spectrum of dif- tion of technology to the patient’s technology. We needed to move things the content to suit Healthdirect’s require- ferent types of information-based clinical care plan. on, replace the pen-and-paper strategy ments, and it was fantastic to see the new decision support tools emerging and ma- Working with the London Health patients used for recording data, auto- system go-live without a hitch. turing, but they still seem to work in very Sciences Centre (LHSC) and eQOL Inc, mate the ordering of supplies, do away isolated environments. CHT: What were the challenges? a company started up through with nurses transcribing data. This In the future, I’m sure this will change Toronto’s MaRS innovation hub, OTN technology gives us the opportunity to Dr. Young: All very large projects face chal- as information systems progressively link will conduct a randomized control trial do that. Best of all, the trial gives us lenges. For example, the Healthcare Deci- together to give clinicians and their pa- to study the use of a remote telemoni- eyes in the home so we can see how the sions editorial team is based in many dif- tients a more seamless flow of the infor- toring solution to improve health-re- patient is doing.” ferent locations around the world, and so, mation they need, exactly when and where coordinating calls and web-based meet- they need it.

14 CANADIAN HEALTHCARE TECHNOLOGY OCTOBER 2015 http://www.canhealth.com “Aggregated and normalized patient data?” Frank just feels better.

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