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| Focus on eHealth |
September 1, 2007 |
PDF version (1.6MB)
Transforming health care
Canada has a solid health-care system. Technology is set to make it even better
Canada is no stranger to using technology as a foothold for the future. It built a railroad across an entire continent to bring its people together and prepare for the modern age. Today, it is doing something similar with its health-care system as it makes the leap into the 21st century. Paper-based records are being digitized, so information can be passed around more quickly to the people who need it. Reformers believe that more accurate, comprehensive and accessible data in the form of electronic health records held by hospitals and electronic medical records held by doctors will lead to a revolution in health care, and better treatment for patients.
 Branham Group Inc.which conducted a 2006 report into the state of Canada’s electronic health services, has also identified another prevailing trend underpinning the modernization process. “There is a growing trend towards enabling the consumer to take a more active role in managing their own health and wellness,” said Michael Martineau, vice president public sector research and eHealth practice lead with Branham. Consumer-focused service culture, which is already pervasive in sectors such as finance and tourism, is set to dramatically alter the healthcare landscape. “We see a fundamental shift happening in medical services, in that the relationship with health-care providers will change,” Martineau said. “In looking after their health and engaging health-care providers, individuals will alternately and sometimes simultaneously act as a patient and as a consumer. In each role individuals will think and act differently and may consequently have a need for different applications.”
This trend is already manifesting itself in the form of patient and healthcare consumer portals. Canadian healthcare organizations such as University Health Network in Toronto, Grand River Hospital in Kitchener-Waterloo, and Atlantic Health Sciences in St. John, New Brunswick, have each developed patient portals to engage specific patient populations such as diabetics and those undergoing cancer treatment. Many provincial governments have created health-care web sites designed to help their citizens become more educated health-care consumers. The Ontario Ministry of Health and Long Term Care, for example, has established HealthyOntario.com as a “web destination for trusted health information, services and advice for healthier living.”
Expect to see resources such as online diaries, prescription information, and coordinated information from specialists, offered up in a web browser. By helping to keep people healthier, these systems will have a welcome side effect on the economy by bringing direct benefits to employers. “If I can keep my employees healthy, then I reduce my insurance premiums and keep them more productive at work,” Martineau concludes.
The good news is that we are in the middle of the health care transformation process, and are succeeding at taking health Informatics mainstream, said Don Newsham, CEO of COACH, Canada’s health informatics association. COACH supports the people who are implementing electronic health records, in order to make that transformation easier. The organization is identifying the core competences needed by a health Informatics professional, thus creating a framework to build and advance the careers of individuals in this field, and attract new entrants from other source disciplines. COACH has also been instrumental in defining guidelines for protecting health information and patient privacy. These guidelines will help maximize the integrity and safety of health-care information and instill increasing confidence in the system.
“We bring all of these areas together and provide a venue at the national e-health conference, along with other events throughout the year,” Newsham said. COACH is pulling together with many different organizations to help make Canada’s health-care information work harder. This supplement collects views from some of the technology providers about what we can expect to see on the journey.
Canada Health Infoway
 Richard Alvarez believes that Canada’s medical services need a healthy dose of IT. The industry is contending with an aging population, warns the president and CEO of Canada Health Infoway. “Today, almost 80 per cent of our costs are going into the relief of chronic diseases like heart failure and diabetes,” he said. Canada requires a significant investment in its health-care system to meet these challenges and the smartest place to put that money is in technology that can help make it more efficient.
“If you look at other industries, that investment is relatively high,” Alvarez said. For example, when the banks first deployed ATM networks, they spent more than 10 per cent of their revenue on IT. “And yet in Canada, we are only spending around two per cent on health care,” he said. “Health care is an information- intensive industry. Our goal is therefore to take that investment up to four per cent, thus giving us a chance to create advances that would support a quality health-care system.”
As the non-profit agency set up to facilitate the modernization of Canada’s health-care system, Canada Health Infoway has already invested at least a billion dollars in electronic systems to bring information around medication, diagnostic imaging and laboratory work to clinicians’ screens. The focus is on providing information at the point of consumption, giving medical practitioners the best intelligence possible on patient conditions during treatment.
 Such investment would help in numerous ways. Not only will it reduce potentially dangerous miscalculations in treatment thanks to incomplete data, but it will also facilitate advances in other areas, such as chronic disease management, Alvarez said. “Being able to treat patients and keep them well, rather than treating them only when they’re ill, is something that can happen very quickly,” he said.
However, the health-care community faces significant challenges before it can build a truly pervasive electronic records system. Only one in four family doctors working in acute care in Canada are using electronic medical records, compared to other regions where more than 90 per cent of doctors use computers, Alvarez said. He feels the health-care community will meet Canada Infoway’s target of creating hospital-level electronic health records for all Canadians by 2012. “But we want to push the jurisdictions to automate doctors’ offices, and that is essential,” he said.
 This objective is intimately connected with another Canada Infoway goal: integrated health-care records that revolve around the patient, rather than around locations. “Not a penny has been invested in any systems that don’t propose to be integrated in this way,” Alvarez said, advocating a move away from ‘stovepipe’ systems that don’t talk to each other. “Interoperability is an enormous challenge, and we need standards to overcome that.”
Significant steps have already been made in moving Canada’s health care community along the path outlined in Vision 2015, Canada Infoway’s planning document for the digitization of health care in Canada. And the cost of completion? “It’s around $10 billion, which equates to about $350 per person on a per capita basis,” he said. “But the benefits will be up to $7 billion annually.” It doesn’t take a doctor to approve of that prescription.
Motion Computing
One of the biggest challenges for healthcare professionals working with electronic records is collecting data at the bedside. In frenetic environments where staff members work long hours, electronic devices must be easy to use, long lasting and durable.
To date, the tablet PC has been the most successful hardware format but generic tablet devices have their limitations. “Nurses would say, ‘What happens if I drop it? How long does the battery last?’ said Scott Ball, Canadian country manager of Motion Computing, a well-established manufacturer of tablet devices.
The company responded by working with focus groups consisting of healthcare workers to create a stylus-based device tailored for physicians and nurses. The result, called the C5, has received critical acclaim from those working at the sharp end of the health-care profession. “The device is disinfectable and sealed. It has a 10.4-inch screen, which hits the sweet spot for busy mobile medical professionals,” Ball said. With a built-in camera and wireless connectivity, the device can even be used to take pictures of wounds which can then be sent to remote specialists over the Internet. “They took one look at the device, and said ‘That’s the unit,’” he said. With electronic health-care record implementation progressing at full speed, having a resource like this at the point of contact solves the final piece of the efficiency puzzle.
Jonoke Software
For many companies, moving from paper- based to electronic records is only the first part of the modernization process. The real benefits come when those digitized assets are integrated into a workflow system, which can introduce new levels of efficiency into the organization.
“A provincial electronic health record system is like a super freeway, without on-ramps or off-ramps,” said Jody Bevan, president of Jonoke Software. “It’s when you get a system that’s in the physician’s office that links up to it that you get on-ramps and off-ramps. That’s when it becomes useful.”
As an expert provider of end-to-end integrated workflow systems for healthcare organizations, Jonoke Software offers a solution to help doctors make use of their investment in electronic medical records. The software, called JonokeMed, handles everything from appointment scheduling and billing, through to electronic medical records and clinical analysis.
Jonoke Software has sold its product with great success across the country and outside Canada, but has experienced particular success in its home province of Alberta, supporting the Alberta Medical Association’s Toward Optimized Practice (TOP) initiative, and the EHR. Alberta Netcare, which has been showcasing clinics running on JonokeMed with the EHR system-to-system link for three years, is moving towards a province-wide network that will enable medical practitioners to share electronic records, as appropriate, using a single interface.
 “This will enable us to populate JonokeMed in such a way that our various clinical tools can analyze that data and highlight problems, monitor deficiencies and clearly state where things are going well,” Bevan said. The real benefits from a mature, modern health care system will arrive as medical organizations learn to connect practitioners in new and innovative ways.
ebackup
Many hospitals and clinics perceive the move to electronic health records as the most significant challenge in the health care modernization process. But the preservation of that data is just as important, especially in the light of national legislation such as the Personal Information Protection and Electronic Documents Act (PIPEDA).
ebackup makes it its business to protect company data, said Rowland Perkins, CEO of the company. “Many hospitals and clinics are trying to figure out the best way to move into the new world of electronic data protection, and that’s where we live.”
Moving away from traditional tape-based backup carries numerous benefits. “The tapes traditionally used as backup media are typically not very reliable,” said Perkins, adding they can also be lost or compromised in transit. “Consequently, the move to online and off-site data backup has become very mainstream now.”
ebackup’s solution offers a combination of fully encrypted on-site and offsite backup. Health care organizations can back up their data to an on-site appliance, which then sends the encrypted information to the off-site data centre. “We sit on one spot on the organization’s network and back up everything, meaning that people don’t have to install software elsewhere or pay licensing fees for every computer they protect,” Perkins said. Fees are based on the volume of data backed up, rather than on a per computer or per-seat basis.
Other features of the service include central management of multiple remote sites, along with incremental backup (meaning that, following the first backup session, only changes to the data are copied). This reduces the demand on network bandwidth and dramatically accelerates the backup process.
Just as health-care professionals work to ensure the safety and health of their patients, their IT administrators should be working to preserve the health of the data. Now, a Canadian company with an established track record is here to help.
Fujitsu
The move to electronic health records in the Canadian health-care system gives the term “data warehousing” a whole new meaning. Imagine warehouses stacked full of paper records. Some will be double sided, some will have paper clips, staples and different colours of folded and unfolded paper. Some will be in folders and some will be loose-leaf documents. Administrators tasked with digitizing years of records must scan these as quickly as possible while also coping with the never-ending stream of new documents being created.
Fujitsu provides scanning solutions to cope with these different challenges, which imaging product marketing manager Steve Oblin categorizes as ‘back-day’ and ‘forward’ scanning. “Our back-day scanners are dealing with high volumes, so they are big machines with very large document hoppers, designed to handle thousands of sheets each day,” he said.
For forward-scanning tasks, the requirements are markedly different, Oblin said. “You don’t want a loud scanner in that environment,” he points out, because forward scanning will probably be carried out by someone at an office. “Both footprint and noise are critical, but you still want something that is going to feed documents reliably. You don’t want to be fiddling with image quality adjustments.”
Reliable and fast equipment is critical at hospitals and clinics for which document scanning will not be a core competency. “They must understand the way that things are happening now, and then decide how they want it to be in the future,” said Oblin, explaining that each hospital and clinic will have to decide where it wants to draw the line in terms of backday scanning. There will be a certain date before which a hospital may not want to scan any documents. “You can draw that line in the sand anywhere you want, and take small steps towards scanning if you prefer,” he said. “Alternatively, you can implement a larger project.”
 Even if an organization only handles scanning during a secretary’s downtime, there are still structured project management plans that can be implemented to make the process smoother and more transition to an electronic future need not be a painful one.
xwave
Modernizing a health-care system is a complex process and requires a unique mix of skills. xwave, a division of Bell Aliant, brings unparalleled end-to-and expertise in ICT together with an intimate knowledge of the challenges facing Canadian health-care organizations as they move into the electronic age. The company draws heavily on its partnerships with other technology providers, marshalling the appropriate skills to best serve its health-care clients. xwave has already demonstrated its experience at health-care record implementations in BC, Ontario, Québec and New Brunswick.
As Canada moves towards an electronic health-care record system, the focus should be on integrated records, said Nadeem Ahmed, national sales director for xwave’s health-care practice. Medical records may exist in physicians’ offices while electronic health records will typically reside inside a hospital. “An integrated record ties those two together, with community care as well,” he said. “So it gives us a comprehensive health-care picture across primary, acute and community care.”
Connecting these previously siloed areas of information offers health-care organizations significant analytical capabilities at a provincial level. Sun Microsystems, with which xwave has formed a strong partnership in the health-care sector, is particularly impressed with the ICT specialist’s application service provider (ASP) model, which enables health-care records to be managed online. “The ASP utility comput-reliable. For hospitals and clinics, the ing network model fits perfectly with our strategy,” said Lynne Zucker, director of the health industry practice within Sun’s Canadian subsidiary. “The more vehicles we can provide for patients’ own disease management, the more likely it becomes that integrated healthcare records will prove valuable and useful. An ASP model is one technique for providing ubiquitous access.”
As xwave and its partners achieve further successes implementing electronic records systems for health-care organizations across the country, they are laying the foundation for value-added applications including patient self-management and chronic disease management. These will drive much needed efficiencies into the health-care system, Ahmed promises, helping to tackle headline problems such as patient waiting times. “It will also help healthcare organizations to make better health policy decisions,” he said.
For now, xwave and its partners are busy establishing the foundation for such developments, but one thing is clear: in the long journey towards health care modernization, they clearly have their eyes firmly on the prize.
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