feature report: developments in telehealth – see … · feature report: developments in...

BY JERRY ZEIDENBERG

MedviewMD, a telehealth companybased in Chatham, Ont., is workingwith provincial governments across

Canada to build networks of doctors who canquickly examine patients through the use ofe-visits. Patients are able to connect withphysicians at MedviewMD studios, which areequipped with videoconferencing and med-ical equipment.

Since its launch in September 2015, thecompany has set up over a dozen of its special-ized studios for e-visits in drug stores in On-tario, and another four of them in British Co-lumbia. It is currently in discussions with gov-ernment officials in Alberta to set up studiosthere, so that Albertans can walk into pharma-cies and interact with an online physician.

Expansion plans are under way forSaskatchewan, Manitoba, Nova Scotia and

New Brunswick. By the end of 2016, Med-viewMD expects to have 40 e-visit studios upand running across Canada.

Governments are pleased with the arrange-ment, said Dan Nead, CEO of MedviewMD,because the e-visits alleviate the problem ofpatients who are without a regular family

physician and will often go to a hospital emer-gency room for treatment of minor problems.

According to Statistics Canada, 15 percentof Canadians, or about 4.5 million patients,were without a regular family physician in2014. Services like MedviewMD can providequick access to a GP.

“We’ve done 12,000 consults since last Sep-

tember,” said Nead. “We’re surprised at howfast this has taken hold.”

Nead said that MedviewMD is improvingthe health of Canadians while simultaneouslyreducing costs for provincial health min-istries. In turn, the ministries are compensat-ing MedviewMD, based on the numbers ofexams that are performed.

Physicians, for their part, bill their healthministries for the services they provide. In abreakthrough arrangement, Ontario physi-cians are able to conduct examinations ofB.C. patients using the MedviewMD tele-health system; to be paid, the Ontario doctorscontinue to bill OHIP, the provincial healthprogram, while the province in turn invoicesBritish Columbia for remuneration.

While some onlookers have questionedwhether MedviewMD and other online med-ical services can provide the continuity of care

CONTINUED ON PAGE 2

MedviewMD creates network of medical studios for e-visits

The University of Saskatchewan’s Re-mote Presence Medicine Program hasbeen using several leading-edge tele-health systems to deliver care to pa-tients in distant and under-served com-munities. They include a tall robot thatstands on wheels, with two-way videoand communications, and the ability forphysicians to remotely ‘drive’ the unit towhere they need to go. Doctors can alsoequip nurses with a lunchbox-sized de-vice, containing a video monitor andspeaker, to deliver care in homes whilestill under the doctor’s supervision. Athird system involves surgical mentoring(as seen in photo), and allows a remotesurgeon to teach other doctors or tomonitor a remote surgery. A fourth solu-tion consists of a telerobotic ultrasoundsystem. SEE STORY ON PAGE 6.

Saskatchewandeploys varietyof advancedtelehealthsolutions

INSIDE:

Deep learningA tutorial-based website, calledTeachingMedicine.com, enablesphysicians and trainees to learnand practice medical skills – espe-cially diagnostic interpretation, in-cluding ECG and ultrasound. Page 4

The collaborative EMRInputHealth, a Vancouver-basedcompany started by doctors, hasdeveloped a collaborative EMRthat highlights patient engage-

ment with their own records. Thesystem also tracks the quality ofpatient outcomes.Page 4

The cannabis EMRWith the growing use of medicalmarijuana and the anticipated le-galization of marijuana in Canada,some companies have devised aspecial electronic medical recordthat allows doctors and pharma-cists to track usage.2

Remote diagnosesDr. Ivar Mendez is spearheadingthe use of remote presence tech-nologies that enable physicians todiagnose or monitor their patients,

even if they are thousands of milesaway from each other. The toolsinclude robots on wheels, withtwo-way video,Page 6

Pub

lication

s Mail A

greem

ent #

40018238

FEATURE REPORT: DEVELOPMENTS IN TELEHEALTH – SEE PAGE 14

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 21, NO. 7 OCTOBER 2016

The fast-expanding company hasconducted over 12,000 videoconsults in the past year.

FOCUS REPORT:

VIRTUAL CAREPAGE 10

of a regular family physician, Nead pointsout that patients who visit its studios canrequest to see the same online physicianwhen booking appointments.

The doctor may be in another city orprovince, but he or she will continue tomanage the patient and will be familiarwith the patient’s history.

As a result, patients are more ‘tethered’ toan online physician than if they go to a walk-in clinic or emergency room, where they arelikely to see a different doctor each time.

MedviewMD came up with the uniquestrategy of installing ‘studios’ in pharmacies,where a registered practical nurse assists theonline doctor with the examination.

There is also a person booking appoint-ments, although walk-ins can be accom-modated, too.

At the Durham Drug Store, in Pickering,Ont., RPN Danielle Doering makes use ofinstruments such as an electronic stetho-scope, otoscope, blood pressure cuffs and avital signs monitor, along with a high-pow-ered medical camera. “Using the exam cam-era, we can take detailed pictures and videos

of wounds or skin problems,” said Doering.“We can take images of the inner ear,

and show them onscreen to the patients aswell as to the doctors.”

The medical devices are supplied byAMD Global Telemedicine, of Chelmsford,Mass., a company that has a long history intelehealth in Canada and around the world.AMD also provides software that integratesimages from the medical devices beingused, and allows for easy sharing of the in-formation among doctors and nurses.

All of the information and images arealso loaded into a secure electronic med-ical record. MedviewMD is using the OS-CAR EMR, an open system that has beentailored to its own requirements. Patientsare able to gain access to their electronicrecords if they wish.

During the exam, the online physicianguides the nurse and sees all of the patientimages; the doctor and patient also see andtalk to each other using standard video-conferencing.

With today’s computerized systems andmedical equipment, physicians are able toaccomplish a great deal even when locatedat a remote location.

In many cases, the patient will be given aprescription to treat common problemssuch as rashes, infections, colds and coughs;he or she can walk out of the room and fillthe prescription at the pharmacy counter.

That’s the attraction for the pharmacyand reason why they’re willing to installthe e-visit studios – they increase traffic tothe stores and result in more business.

At the Durham Drug Store, pharmacistand owner Zeinab Abdulaziz says patientsare arriving every day; she expects the traf-fic will increase during the back-to-school

month of September, and in the flu seasonof November and December.

Awareness of e-visits at the pharmacy isgrowing through word of mouth and post-ings by Ms. Abdulaziz on the store’s website, as well as on Facebook.

At the same time, the pharmacies areacting as one-stop shopping outlets formedical problems. Patients can be diag-nosed by an online physician; they can ob-tain their prescriptions and medical sup-plies at the same location. Pharmacists inOntario can also give flu shots to patients.

The studio, with its computer and med-ical equipment, is offered to pharmacies ata cost of about $80,000; it can be pur-chased outright or leased.

MedviewMD covers the salary of theregistered practical nurse, who acts as thefrontline medical professional and the as-sistant for the online physician.

When the problem the patient presentswith is severe – such as chest pain or a se-vere wound – the doctor will advise the pa-tient go right away to an emergency room,just as a family doctor would do during anin-person appointment.

MedviewMD is now adding specialiststo its ranks. Nead said that mental healthspecialists, as well as dermatologists, inter-nal medicine specialists and urologists arenow available online. In this way, the com-pany is expanding the range of services topatients – many of whom have great diffi-culty accessing a specialist close to home.

As with GPs, much of the work of a spe-cialist can be done online.

And many GPs and specialist are happyto provide services online. “It’s not as hardas you might think to recruit them,” saidDr. Chad Burkhart, a medical lead withMedviewMD and a general practitionerwho is based in Owen Sound, Ontario.

Indeed, there are many female physi-cians on maternity leave who still wish towork, and find they can provide onlineservices from home. Other physicians pre-fer to work online part of the time, andmany doctors find they can fill up emptyschedules with online appointments.

CONTINUED FROM PAGE 1

Art DirectorWalter [email protected]

Art AssistantJoanne [email protected]

CirculationMarla [email protected]

Publisher & EditorJerry [email protected]

Office ManagerNeil [email protected]

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

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

Volume 21, Number 7 October 2016

Contributing EditorsDr. Sunny MalhotraTwitter: @drsunnymalhotra

Dianne [email protected]

Richard Irving, [email protected]

Rosie [email protected]

Andy [email protected]

A nurse examines patient with a medical camera.

MedviewMD working to build network of medical studios for e-visits

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

AN ARTICLE IN THE SEPTEMBER EDITION OF

CANADIAN HEALTHCARE TECHNOLOGY thatreferenced Sunnybrook’s MyChart servicecontained inaccuracies. MyChart is usedby multiple hospitals, and patients withrecords at these hospitals can maintain aconsolidated record in MyChart. Paperrecords can be uploaded in scanned for-mats by patients; the system also accessesand stores information from the electronicrecords in the member hospitals.

Correction

4 Million 95,000 15 YearsTELEHEALTHPATIENT MONTHS

PATIENTSON SERVICE

DEVELOPINGTELEHEALTHMARKET

Through a combination of remote patient monitoring platforms, proprietary software, patient engagement, and care coordination, Medtronic Care Management Services serves as an extension of patient care teams

populations at home.

EXTEND YOUR REACH WITHMEDTRONICCAREMANAGEMENTSERVICES

N E W S A N D T R E N D S

BY ROSIE LOMBARDI

Millennials are starting to re-design the EMR systems thatdoctors have used over thepast decade, and they’re giv-

ing them a new twist. Vancouver-based In-putHealth is a prime example of a freshapproach to collecting and sharing patientinformation.

InputHealth was founded in 2011 bythe company’s CEO Dr. Damon Ramseyand CTO Shawn Jung, who were then intheir early twenties and working out ofDamon’s uncle’s basement. Dr. PuneetSeth, another millennial doctor, joined in2013 as CMO to create a dream team thathas moved rapidly to develop a modularpatient engagement system that offers gen-uinely useful features and functions thatgo beyond the typical EMR system.

Many major medical organizations areusing the company’s systems. The MayoClinic in Jacksonville, Fla., has adoptedone of InputHealth’s modules, and manyprominent organizations are followingsuit: the University of Texas at Austin, Sun-nybrook Hospital, Jewish General Hospi-tal, University of British Columbia’s Stu-dent Health Service, and more.

Dr. Ramsey and Dr. Seth are membersof a much-needed group that is growingsteadily: doctors with deep IT experience.Ramsey was a Microsoft Certified SystemsEngineer at the tender age of nine, andSeth worked at Nortel Telecommunica-tions before entering medical school.

“We built this company from theground up to address a massive oversightin the existing paradigm of electronicmedical records – that the patient does notexist in any meaningful way. From therecame a fundamental shift in approach:every patient encounter becomes a data

capture opportunity where that data isgenerated by the patient themselves,” saysDr. Ramsey.

To that end, InputHealth initially devel-oped a patient engagement platform thatallowed people to convert paper question-naires to digital, and to use mobile devicesto collect data from patients remotely.

Over the years, the company has addedmodule after module to tackle different ar-eas, says Seth. “We started with our ihQ-naire system, which is a questionnaire datacapture engine, then we moved on to on-line appointment booking, to a kiosk sys-tem, to an electronic referral system, andto a more robust outcome tracking systemwhich is what’s used at Mayo Clinic, UBCand McGill. The most recent module is anintegrated tele-medicine engine that’s inte-grated into all of this. Our platform is con-stantly evolving that way.”

Clients were soon clamouring for a full-

blown EMR system from InputHealth in-stead of modular add-ons, says Dr. Seth.“Our clients said they loved the way oursystem worked and they didn’t want to goback to their EMRs. They asked: ‘Why can’twe do everything off your system?’ We de-cided to take a risk and develop a newEMR system from the ground up that wasgenuinely forward-looking.”

Dr. Seth says forward-looking meansmoving away from the ‘transactional med-icine’ model our current healthcare systememploys. “Today, EMRs track what hap-pens when a patient is in front of me dur-ing a visit. I give them medication and theyleave. Instead, the healthcare system ismoving to more distributive models likecommunity-based care, where you con-tinue to provide healthcare even when thepatient’s not in front of you.”

Traditional EMRs have no capacity at allto manage the workflow associated with

continuous, distributed healthcare, he says.The InputHealth team set out to develop anew type of EMR system best described asa ‘collaborative health record’ – a CHR.“Collaborative means that the patient andthe clinician and the entire healthcare teamwork together to deliver care.”

InputHealth’s platform is able to collectdata from different sources and makethem meaningful with one another, hesays. A patient with a mood disorder, forexample, might complete questionnairesperiodically, as will his spouse, to provide asecond view of his condition. The systemhas the intelligence required to sort out themost significant elements of the two ques-tionnaires’ responses.

“What the clinician will see is a para-graph summary of the person’s condition.The documentation is automatically gen-erated, because the system was able to con-vert the patient’s responses to a clinicalnote. Almost 80 percent of a clinical note isactually subjective history-taking. The in-formation can then be trended, visualizedand manipulated in various ways.”

InputHealth has many features that gobeyond the typical EMR offerings, says Dr.Matthew Chow, a psychiatrist who works atthe Youth Wellness Associates clinic and St.Paul’s Hospital in downtown Vancouver.

It’s not just a system for sending outquestionnaires to patients to pre-collectinformation, he says.

“The questionnaires are adaptive. De-pending on how the patient answers, thesystem asks follow-up questions, some-thing that intake forms can’t do. I spend mytime during the actual appointment talkingto patients about their concerns instead ofcollecting data because InputHealth has al-ready done most of that job for me.”

The natural language output reports

Educational website helps physicians and trainees sharpen their skillsBY NEIL ZEIDENBERG

Atutorial-based website, calledTeachingMedicine.com, pro-vides physicians and traineeswith the means to acquireand practice medical skills –

especially their abilities in diagnostic in-terpretation, such as ECG, chest X-ray,echocardiography and ultrasound interpretation.

The participants then get valuable im-mediate feedback from a clinical expert.

And users can practice as often asnecessary to acquire and retain the skills.The goal is to increase the competencylevel of trainees.

“TeachingMedicine.com started outin 2005 in a much different form. It wassimply a place to store handouts – a pdflibrary if you will,” said Dr. JasonWaechter, an intensivist-anesthesiologistand clinical associate professor at theUniversity of Calgary. Dr. Waechter hasled the development of the website.

“In 2004, I was at UBC teaching ECGinterpretation and created small group

ECG practice workshops. Students withan expert mentor had two hours to cover12 different ECGs to interpret and pro-vide diagnosis – one attempt at each.”

Results from the workshop confirmedthat one attempt at ECG interpretationdoesn’t provide the means to master theskill.

The solution was to create an onlineformat that provides theory, practice andexpert feedback on a student’s ECG in-terpretation.

“It requires many rounds of practiceand feedback to learn a skill such as ECGinterpretation and to gain an accuracy of80 percent or better.

Without enough practice, not onlywill a person’s diagnosis skills be inaccu-rate, but so will their treatment,” said Dr.Waechter. “An incorrect diagnosis andtreatment can cause serious harm to apatient, or at the very least delay propertreatment.”

The web site currently features mod-ules for ECG, chest X-ray, echocardiog-raphy, ultrasound and CT. There are7,000 registered users to the website and

there were 35,000 site visits in 2015, re-sulting in 400,000 minutes of learning.“The average site visit lasts approxi-mately 16-minutes, so we know peopleare using it,” said Waechter.

For its part, medical school providesplenty of theory but often little or nostructured practice. But TeachingMedi-cine.com offers unlimited access to

practice a skill as often as necessary toretain the knowledge and provides im-mediate feedback.

“We offer tutorials followed by an op-portunity for students to practice. Weare constantly adding new content. Wetest it, get feedback, then make changesand revisions,” said Dr. Waechter.

Dr. Waechter has partnered with sev-eral Canadian medical schools (including

McGill, University of Calgary, UBC, Uni-versity of Saskatchewan and University ofOttawa) to make use of the website partof the required curriculum.

He is also in discussions with multi-ple U.S. medical schools. Yale MedicalSchool was the first American school toformally start using the online modulesfor their medical students, with the Uni-versity of North Dakota and UCSD (SanDiego) following.

TeachingMedicine.com provides doc-tors and trainees with an opportunity topractice and/or maintain their medical-re-lated skills, ensuring competency through-out the various stages of their career.

Dr. Waechter said the idea is based onCompetency By Design (CBD), an initia-tive by the Royal College of Physicians andSurgeons of Canada to improve physiciantraining and lifelong learning.

Training is organized around desiredoutcomes and ensures physicians demon-strate the medical skills and behavioursnecessary to meet their patient’s needswhether they’re in residency or nearing

Dr. Puneet Seth (left) and Dr. Damon Ramsey are physicians who also have deep experience with I.T.

It requires many rounds ofpractice and feedback tolearn a skill such as ECGinterpretation.

CONTINUED ON PAGE19

CONTINUED ON PAGE18

Facebook-like EMR acts like a ‘collaborative health record’ system

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

Information is everywhere.But it’s required here.

Getting complete information from connected sources

As a medical specialist you need information. Patient information that is actual and complete.

But how do you bring together all the available data from different sources in one virtual patient

file? And how do you add your information? How do you secure a streamlined workflow, without

interruptions because of missing images or data? Forcare gives you the answers with powerful

interoperability tools. Solutions that help you unlock, share, enrich and protect patient information

from different sources. Without efforts. Request a demo for a personalized tour.

W W W . F O R C A R E . C O M


BY DR. IVAR MENDEZ

As part of the Remote PresenceMedicine Program at the Uni-versity of Saskatchewan, wehave been using a number ofremote presence mobile de-

vices to provide medical expertise to un-derserviced communities in Saskatchewan.

We have worked with the communities,their leadership and local healthcareproviders to identify areas of urgent, un-met need, such as access to pediatric acutecritical care. We have also used remote de-vices for mentoring of senior surgical resi-dents and for post-operative follow up vis-its in the patient’s home.

Remote presence robotic technologiesprovide the sense that the user is “present”,enabling physicians to provide real-timeclinical services remotely.

The robotic device can be controlled fordirect visualization, examination, and di-agnosis of the patient, as well as communi-cation with local healthcare professionalsand family members.

These devices have multiple electronicports for peripheral diagnostic devicessuch as stethoscopes, dermatoscopes,otoscopes and ultrasonography that fa-cilitate the examination of the patient inreal-time.

We have employed a number of remotepresence platforms (from In Touch HealthInc., of Santa Barbara, Calif.) such as theRP-Vita remote presence robot (Figure 1),the portable RP-Xpress, for home visits(Figure 2) and RP-Vantage for surgicalmentoring (cover photo, page 1).

These systems are designated by theUS Food and Drug Administration

(FDA) as class II medical devices andmeet the prerequisites for application inacute patient care.

We are also trialing a novel teleroboticultrasound, the Melody system (SociétéAdEchoTech, of Naveil, France) consistingof a robotic arm that is capable of beingcontrolled by a sonographer to scan a pa-tient located in a remote location in real-time (Figure 4).

The experience so far with this system

indicates that telerobotic ultrasonographyhas the potential to answer a large unmetneed of access to sonography in rural andremote communities.

The Saskatchewan experience: Over thepast two years we have deployed 14 remotepresence devices to a number of healthcarefacilities, ranging from tertiary hospitals inSaskatoon and Regina to small nursing sta-tions in remote First Nation’s communities.

We have focused mainly on testing thefeasibility of using remote presence ro-botic technology to answer urgent unmetneeds in underserviced communities andvulnerable populations, such as young

children, pregnant women and the elderly.A recently completed pilot study in pro-

viding pediatric specialized critical care ac-cess to acutely ill children in the NorthernFirst Nation’s community of Pelican Nar-

rows demonstrated that 63 percent of theacutely ill children who presented to thenursing station were able to be effectivelymanaged locally by a pediatric intensivistlocated in Saskatoon with the help of theremote presence technology.

The triaging decision and interven-tions using this technology were sus-tained as none of the children treatedneeded to be transported up to the 14-dayreassessment time.

Furthermore, 43 percent of the childrenthat required specialized transport weresafely triaged to a regional centre, therebyeasing the overcapacity issues that oftenstrain the pediatric intensive care unit intertiary care centres.

The potential cost savings in trans-portation alone can be substantial as a spe-cialized pediatric inter-facility transportby air costs approximately $10,000 and thenumber of pediatric transports in theprovince of Saskatchewan is over 400transports per year.

Our work with the telerobotic ultra-sound system has shown considerablepromise. We have completed a study com-paring conventional direct abdominalsonography with telerobotic sonographyusing the Melody system.

There was no significant difference inthe capacity of the systems to visualize theintra-abdominal organs as 92 percent oforgans visualized on conventional exami-nations were also visualized on teleroboticexaminations. Furthermore, there was nodifference between the two modalities inmeasurements of the liver, spleen, and di-ameter of the proximal aorta.

Providing sonography access to under-

SPE 3000 is changing the medical electrical devices landscapeBY SIMON KNIGHT

This past July, the landscape ofthe Canadian medical deviceindustry underwent a signifi-cant change with the adoption

of a new model code, SPE 3000. In orderto address the needs of medical electricalequipment (MEE) and medical electricalsystems (MES) sold in Canada in limitedquantities; CSA SPE 3000-15 has beenimplemented as the model code for thefield evaluation of medical electricalequipment and systems.

This model code specifies construc-tion, marking, and testing requirementsfor MEE and MES with the aim of miti-gating any risks for electric shock, fireand mechanical hazards associated withthese types of products.

SPE 3000 would include productssuch as custom-built equipment for spe-cial applications; equipment sold on anon-repetitive basis; equipment not ob-tainable as “certified” under a regularcertification program; or equipmentpurchased in quantities of not morethan 500 on a national basis, per model,per year, per field evaluation body.

Though applicable to products such

as those mentioned above, SPE 3000does have limitations in its scope andapplication. It cannot, for instance, beused to evaluate products such as X-rayequipment and systems, cosmetic andhygiene equipment, MRIs, CT scanners,and laser equipment.

Furthermore, it is not intended to ap-ply to re-evaluating equipment that hasbeen rejected due to the results of a pre-vious evaluation conducted by a certifi-cation organization through any otherexisting certification service. Also worthnoting is that hazards inherent in the in-tended physiological function of MEEand MES within the scope of SPE 3000are not covered within the model code.

The testing requirements laid out inSPE 3000 involve a variety of proceduresaimed at identifying and working to miti-gate different risks associated with compo-nents of MEE and MES. These include di-electric voltage withstand testing to assessthe insulation of devices, strain relief test-ing to analyze the strength and durabilityof the strain relief mechanism on equip-ment, and input rating testing to confirmthat the measured input of MEE or MESat rated voltage does not exceed themarked rating by more than 10 percent.

The adoption of SPE 3000 will havesweeping implications for those in themedical community including doctors,dentists, hospitals, medical clinics, med-ical distributors and others. ThroughSPE 3000, inspection bodies may nowconduct field approval, whereas previ-ously they could only offer full certifica-tion. As of July 1, 2016, qualified inspec-

tion bodies accred-ited by the SCC arenow able to con-duct field inspec-tions under themodel code.To ensure compli-ance with the MEEand MES at youroffices and hospi-tals, all involvedshould familiarizethemselves with

SPE 3000 and its requirements, to gain agreater understanding of the model codeand how it will impact their medicalelectrical devices.

It is important to bear in mind thatmanufacturers of MEE and MES outsideof Canada may not always take these reg-ulations into consideration when develop-

ing their devices. As such, one shouldn’tassume that all products imported intoand sold in Canada automatically meetthe applicable standards and regulations.It is up to you to ensure that your equip-ment complies with Canadian standards

Taking a proactive approach to com-pliance with SPE 3000 will save time andmoney for your operation as your de-vices can be pre-inspected before gettingred taped and deemed unsafe. Workingwith a field inspection body can help toensure that your devices meet the re-quirements set out in SPE-3000 and willremain in service as they will not get shutdown by authorities having jurisdiction.

Intertek, with its extensive expertiseand experience in field inspection, aswell as medical electrical testing and cer-tification, is equipped and fully accred-ited to meet all of your needs for com-pliance with SPE 3000.

Simon Knight, Products Manager,Canada, is based at Intertek’s Vancouverfacility. Simon is responsible for Intertek’sBuilding & Construction and Electricaltesting, inspection and field service busi-nesses in Canada. 1.800.967.5352.www.intertek.com/medical/spe-3000.

Remote presence healthcare technology: The Saskatchewan experience

Simon Knight

Figure 1. Dr. Mendez and the remote presence robotRP-Vita Remote presence robotic technology is usedin Saskatchewan to provide medical attention in un-derserviced communities.

Figure 2. The portable RP-Xpress that is connectedto regular available cell phone networks is beingused by surgeons to conduct follow-up, postopera-tive home visits on surgical patients.

CONTINUED ON PAGE 18



BY ZAYNA KHAYAT

Earlier this summer, Boston’s Life Sci-ence Nation brought its RedefiningEarly Stage Investments (RESI) con-

ference to the MaRS Centre in Toronto,drawing 220 North American investors toscope investment prospects among the city’sfast-growing cluster of healthcare startups.

At least half the investors had traveledfrom outside Canada and were keen tolearn about emerging Canadian healthtechnologies.

Usually, RESI moves only between SanFrancisco, Houston and Boston. Its arrivalin Toronto – the first time RESI has beenheld outside the U.S. – is a sign of the city’srapidly rising star as a hotspot for healthinnovation. In this respect, Toronto’s repu-tation is catching up to reality. In the lastdecade, the elements required to create a

thriving innovationecosystem have beenassembled around acluster of researchhospitals and uni-versities – includingthe renowned Uni-versity of Toronto –located in the city’sdowntown core. Thearea attracts over $1billion annually inresearch funding.

MaRS Innovation was created to com-mercialize the best discoveries coming outof 15 of these research institutes, includingthe University Health Network, the OntarioInstitute for Cancer Research and SickKids.

To complete the discovery pipeline,MaRS Discovery District, the world’slargest urban innovation hub, sits at thecentre of this innovation cluster and pro-vides the business expertise and connec-tions to capital necessary to grow high-po-tential startups, including those formed byMaRS Innovation, into high-growth com-panies that can impact millions of lives.

Synaptive Medical, for instance, hasbeen dubbed the “Google Maps of brainsurgery,” providing tools that help neuro-surgeons digitally explore the complex webof nerve fibers in the human brain andplan surgeries. eSight, another startup, cre-ates electronic glasses that help some peo-ple with vision loss to see again. MeanwhileBresoTec has created BresoDX, a wearabledevice that uses sound and movement todetect the signs of sleep apnea and which issignificantly more patient-friendly than ex-isting diagnostic tests for this disease.

But – to paraphrase one speaker at RESI– what Canada has now is not a startupproblem, it’s a finishing up problem. We’reinnovating like crazy, but our healthcaresystem has not kept pace in adopting thesenew technologies.

After entrepreneurs have jumped thehurdles of clinical trials and regulatory ap-provals, they frequently complain that ourhealth system is slow to adapt to the digitalage and isn’t set up to integrate innova-tions. Purchasing departments struggle tofully analyze the potential costs, benefitsand implications of new technologies, re-sulting in risk-aversion when it comes todecision-making.

At MaRS, our EXCITE (Excellence in

Clinical Innovation and Technology Evalua-tion) program is working with high-poten-tial companies like BresoTec to speed adop-tion through technology testing that goesbeyond the clinical information required forregulatory approval, providing data on thevalue-for-money of the technology to the

healthcare system. This kind of robust evi-dence can help companies convince health-care providers to invest in their technology.

But more needs to be done. The qualityof healthcare innovation coming out ofToronto is world class. If Canadian pa-tients are to truly benefit, we need to put as

much focus on getting these technologiesinto clinical practice as we do on gettingthem out of the lab and into the market.

Zayna Khayat is Director, MaRS EXCITEand Senior Advisor, Health Systems Innova-tion at MaRS, in Toronto.

Our healthcare system must adopt technologies created by Canadians

© 2016 Cerner Corporation

To learn more go to www.cerner.ca

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

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

Working together for a healthier tomorrow today.

Zayna Khayat

h t t p : / / w w w . c a n h e a l t h . c o m O C T O B E R 2 0 1 6 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y 7


BY JERRY ZEIDENBERG

TORONTO – After helping with province-wide integration projects in Ontario andAlberta, where it lent a hand connectinghuge imaging databases, interoperabilityexpert Forcare is now aiming to connect

the IT systems of Canadian hospitals anddoctors.

Forcare offers a suite of interoperabil-ity tools based on Integrating the Health-care Enterprise (IHE) standards. IHEstandards and profiles are sometimescalled the ‘plumbing’ that connects the

flow of information through healthcaresystems, although this plumbing can befairly complicated.

“The problem to solve now is that ofpatient-empowered, collaborative care,”said Harm-Jan Wessels, CEO and co-founder of Forcare, which is headquar-

tered in the Netherlands. “Doctors need towork together, but increasingly, under thedirection of their patients.”

Forcare already supplies solutions tonetworks of doctors in the Netherlands,where the healthcare system is much likethat of Canada’s, says Wessels. “It is largelypublic owned, and in the Netherlands,consists of about 100 hospitals.”

There, for example, Forcare has tied to-gether the mammography screening sys-tem, which does about 1 million exams peryear. “There’s a lot of client data, but it’s of-ten from separate hospital infrastructures,”says Wessels.

The Forcare system is used to link the im-ages, reports, patient consent data and refer-rals for follow-ups.“It’s all connected,”notes Wessels, whoobserves that it en-ables various care-givers to quickly ob-tain the informationthey need.

Patients can alsoaccess the data, if theywish, and they canalso set up the con-sents, which deter-mine who can look at the data and who can’t.

“We’re looking to bring this technologyto Canada,” comments Niles Geminiuc,Forcare’s Regional VP for Canada.

Netherlands-based Forcare has openedan office in Toronto, where it has five em-ployees, including developers who areadapting its software to the needs of theCanadian marketplace. Geminiuc notesthe technology can be used in the cloud,which drives down costs.

Forcare is working with eHealth On-tario to connect the four large regional di-agnostic imaging repositories (DIRs) inthe province. This initiative is betterknown as the Diagnostic Imaging (DI)Common Service. The project is expectedto be up and running by the end of thisyear, meaning that clinicians across On-tario will be able to access images and re-ports from any region.

In addition, the company is currentlyworking on a project with eHealth Ontariothat will connect the data of primary carephysicians, making it easier for them toshare the records of their patients. One ofthe leading-edge features of the Forcare sys-tem is the role-based access system that canbe determined by the patient. As a result,the patient is in charge of his or her record.

For his part, Wessels is well-acquaintedwith Canada and the Canadian healthcaresystem. He lived in Mississauga, Ont., justoutside Toronto, for two years when work-ing for ISG Technologies, a leading-edgedeveloper of medical imaging systems andsurgical solutions now owned by IBM.

Wessels observes that in the drive toconnectivity, standards are constantlyevolving. In particular, the healthcareworld is now moving towards the FHIR(Fast Healthcare Interoperability Re-sources) standard as a better way of shar-ing data. It is eclipsing HL7 v3.

“HL7 v3 tried to model the wholeworld, which is impossible,” commentsWessels. “It went too far. It even tried to in-clude semantic interoperability.”

Forcare finds growing demand for its expertise in Canada and the U.S.


Harm-Jan Wessels


BY DIANNE DANIEL

The flow of blood at the Nova Sco-tia Health Authority (NSHA) hasvastly improved following a re-cent ‘what if ’ exercise and the in-

troduction of a new analytical tool to aidin the decision-making regarding the or-dering of blood products.

In the fall of 2014, the NSHA decided torethink its red blood cell inventory prac-tices when a routine review revealed a highvariance in ordering methods among tech-nologists, a rise in red blood cell wastage,and an overall need to simplify its bloodordering process.

At the same time, the health authoritywas due to update its inventory, a cumber-some process that requires a significantamount of time and effort related to man-ual data manipulation.

The goal, says hematopathologist Dr.Calvino Cheng, was to look at blood or-dering through an “informatics lens,” tooptimize procedures and reduce waste us-ing statistical methods. If the in-house ITteam could develop an algorithm to applymore rigour to decision-making, perhapsthey could identify changes that would im-prove the overall ordering process.

“We realized we weren’t effectivelymanaging our inventory. Inventory wasgoing up, overall demand was going down,and we found that our O-Negative supply

was especially troublesome,” says Dr.Cheng. “We had all of these factors thatwere basically pointing us towards askingthe question: How can we do this better?”

Prior to embarking on the project, tech-nologists at the QEII Hospital were spend-ing roughly 20 minutes, twice daily, to per-form manual blood inventory calculations.Reports were run nearly three hours beforemorning orders were placed and one hourbefore afternoon orders, meaning data wasnot always reliable.

A significant effort was also requiredto account for blood inventories locatedin different areas of the lab, hospital andhealth system.

The NSHA Pathology Informatics Groupused its in-house expertise with the CernerMillennium database and Cerner Visual De-veloper to write a custom Cerner CommandLanguage (CCL) program. (CCL is Cerner’sversion of the SQL Structured Query Lan-guage.) The group devised an algorithm thatblends historical data with future predic-tions to provide more precise data related tohow much blood to order.

The report is an easy-to-read summaryof what is to be ordered and why.

“What makes it novel is that it looksbackwards and forward, and it uses the in-formation to tell us how much blood is re-quired,” says Dr. Cheng. “There is no othersoftware platform out there that could dothat for us.”

Technologists still place the actual order,but now have the information they need to

make better decisions faster, with the abil-ity to override the report’s recommenda-tions when necessary. For example, if a pa-tient is undergoing an emergency transfu-sion at the time of ordering, the orderingtechnologist can make the adjustment andorder more than the report suggests.

“We made it a more standardized andthoughtful process,” says Dr. Cheng. “Tech-nologists are spending less time orderingand less time thinking about how big theirorder has to be. We made it an intelligentdecision rather than a decision based onoutdated information or gut feel.”

Deployed in June, 2015, the new tool isnow used at Halifax Infirmary and Victo-ria General (which together comprise theQEII), as well as at Dartmouth Generaland Hants Community Hospitals.

According to a recent survey of the trans-

Decision-aid tool keeps blood flowing at Nova Scotia Health Authority


The group devised an algorithmthat blends historical data withfuture predictions to determinehow much blood to order.

merge.com

Merge, an IBM Company, is a leading provider of innovative enterprise

imaging, interoperability and clinical systems that seek to advance

healthcare. Merge’s enterprise and cloud-based technologies for image

intensive specialties provide access using a standard internet browser or

mobile device. With solutions that have been used by providers for more

than 25 years, Merge is helping to reduce costs and improve efficiencies,

which enhances the quality of healthcare worldwide.

To learn more, visit merge.com

Connect providers. Streamline workflow.

Enable efficient patient care.EnablConne

e efficienect providers.

nt patientreamline wS

.nt care.orkflow

which

than 25 years, M

. mobile device

intensive specia

. Mehealthcare

imaging, inte

, an IBMMerge

h enhances the quali

Merge is helping to r

With solutions that h

alties provide access

s enterprise and’erge

eroperability and clin

, is a leadM Company

ity of healthcare wor

educe costs and imp

have been used by p

s using a standard int

cloud-based techno

nical systems that see

ing provider of innov

ldwide

prove efficiencies,

roviders for more

ternet browser or

ologies for image

ek to advance

vative enterprise

which

merge

, o learn moreTTo

h enhances the quali

com

com.visit merge

ity of healthcare wor

.e

.ldwide

h t t p : / / w w w . c a n h e a l t h . c o m O C T O B E R 2 0 1 6 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y 9

V I R T U A L C A R E

BY GILLIAN WANSBROUGH

Yanekah suffered a serious car acci-dent at age 18. After years of chronicpain, as well as depression and anx-

iety, the stress of pregnancy made life evenharder to manage.

“I have days where I’m in tears,” saysYanekah, who falls into the 15-20 percent ofnew mothers in Ontario who face depres-sion and other mental health disorders,such as anxiety, during and after pregnancy.

“I have days where I question myself,and there are so many things that I want to

be able to do that I’m just not able to doany more and it causes a lot of anxiety.That can be incredibly depressing.”

She began mental healthcare right awaywith a specialized perinatal therapist atToronto’s Mount Sinai Hospital, part ofSinai Health System. When attending in

person became too challenging because ofher pain, she started receiving psychiatriccare at home via telemedicine.

The hospital’s perinatal mental healthtelemedicine program launched in early2014 and now involves about six physi-cians who do 80 percent of their consulta-tions virtually. It caters to women frompre-conception through pregnancy to thepostpartum period.

Telemedicine eliminates the struggle oftravelling while pregnant or later with aninfant in tow, while coping with sleep depri-vation, breastfeeding and other logisticalchallenges, according to Dr. Ariel Dalfen,Head of the Mount Sinai Hospital PerinatalMental Health Telemedicine Program.

The program uses the Ontario Telemed-icine Network’s (OTN) private and secureeVisit videoconferencing technology. Aftera simple plugin installation, patients, nursesand psychiatrists click a secure video visitlink and are instantly connected on screen.

“I would 100 percent recommend thistool to other practitioners in psychiatry andin mental health,” says Dr. Dalfen, who notesthat telemedicine enables the program tomore widely share its specialized services.

“We all feel the tremendous advantagein terms of reaching out to patients whomight not be able to have service otherwiseand really in terms of offering patient-cen-tred, patient-focused care where and whenpatients want it.”

The desire to increase access and createcapacity also drives the Trillium HealthPartners/Halton Healthcare TelementalHealth and Addictions Nursing Program,according to Telemedicine CoordinatorNorma Rayner, RN.

Patients are referred via One-Link, a sin-gle point of access for referrals to 10 addic-tion and mental health service providersfunded by the Mississauga Halton LocalHealth Integration Network.

Initiated in 2012, the program helpsthose who might typically go to the ER forsupport. It also alleviates wait times formental health services, which can be two tofour weeks for an initial assessment. Patientscan access care from home or a number ofcommunity “hubs” using OTN services.

The program provides an initial assess-ment, up to 10 counselling sessions basedon client goals and support needs, medica-tion initiation or review, symptom man-agement, self-referral information forcommunity resources and health teachingfor any other co-morbidities.

Dr. Ian Dawe, Program Chief and Med-ical Director of Mental Health at Trillium,has a “longstanding positive attitude to-ward telemedicine” – having himself car-ried out some 600 clinical telemedicine en-counters over the past four years – not justto reach remote areas but as a “mainstreamconvenience delivery mechanism.

“There’s a competitive advantage to be-ing able to meet the needs of your clientelein the time and place of their choosing, es-pecially in high-risk situations,” he says. AtTrillium he sees the greatest potential fortelemedicine for urgent consultations andtimely follow-up after discharge.

As well, he increasingly shares his psy-chiatric expertise using OTN’s eConsultservice to facilitate virtual “hallway con-versations” with family practitioners.

Virtual house calls provide patients with faster, more convenient care

Head for the top of the line: the DR 600 high performance digital X-ray room. With high productivity, innovative features and ZeroForce Technology, the fully

experience of patients and operators alike, even in busy imaging environments. At its heart lies the ‘gold standard’ MUSICA image processing software, offering consistently reliable, high-quality image visualization. The bottom line is, the DR 600 takes Agfa HealthCare’s latest technologies and puts them to use to help you provide top-of-the-line imaging and delivery of patient care!

Find out more, visit agfahealthcare.com

LOOKING FOR SPEED, PRECISION AND COMFORT?

h t t p : / / w w w . c a n h e a l t h . c o m1 0 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y O C T O B E R 2 0 1 6

V I R T U A L C A R E

BY DR. EDWARD BROWN

On November 7th, I will co-chairan event at HealthAchieve, atthe Metro Convention Centrein Toronto. The session will

look at the integration of virtual care intothe home and its impact on overall healthand well-being across the care continuum.

It’s an exciting opportunity to look atinnovation, but also an important chanceto explore the value of virtual care and theways we can integrate it seamlessly intoour models of care to streamline and im-prove the care we deliver to our patients.Learn more at www.healthachieve.com.

At the Ontario Telemedicine Network,we are excited to help lead the charge whenit comes to useful and scalable innovationbecause we know firsthand that it makes adifference.

OTN is actively engaged in projects de-signed to evaluate mobile solutions in theareas of diabetes, mental health, chronic

kidney disease, pal-liative care, woundcare and enhancedconsumer access toprimary care. Ourgoal is to help ourpartners spread themodels of care thatdemonstrate successto all Ontarians.As a long-time ad-vocate for telemedi-cine as a tool to im-

prove access to care, quality of care andthe sustainability of healthcare systems,the fact that we now have the tools to ef-fect this kind of change at our disposal isexciting to me. The technology of the fu-ture really is here, but it’s just one piece ofthe puzzle.

We’re in the middle of the journey tointegrate technological solutions into amore patient-centred healthcare system ina way that supports better care. A criticalpart of that process is engaging patientsand providers in virtual care. The key is toget everyone thinking about how to usevirtual care to solve problems, and to em-brace new ideas as opportunities to im-prove patient care.

But implementation requires change,and change is difficult because it’s not justdependent upon the technology. In orderto make headway people will be asked todo things differently and to take on differ-ent roles. They will work with different setsof people. Sometimes, it will empowersome and disempower others, and unfor-tunately those aren’t always easy adjust-ments to make.

OTN has a long history of helping toimprove access to specialist care in ruralareas. Over the past few years we’ve alsobeen looking at the following big problemsand working with partners to addressthem:

• Chronic disease: We need to engage pa-tients in their own care, and we now haveamazing solutions that support and trackpatient health.

• Access: We have the electronic means tosupport patient access to primary careanywhere.

• Continuity of care: When patients are

discharged home from the hospital,there’s an abyss when it comes to informa-tion and collaboration. This often resultsin re-admissions.

• Complex care/palliative care: We havetrouble navigating the system when it comesto complex care. Technology can bring

teams together and enhance outcomes. • Mental health: There is a shortage of

service providers and an access problemwhen it comes to mental health. Techno-logical solutions can provide an online so-cial network and access to mental healthcourses and supports.

To its credit, OTN’s Telehomecare pro-gram has reduced hospitalizations and ERvisits by 50%.

Dr. Edward Brown, MD, is founder andChief Executive Officer of the OntarioTelemedicine Network (OTN)

HOW CAN YOU PREPARE FOR

THE FUTURE OF HEALTHCARE?

You start today with the right partner,

the right tools and the right insight.

Evident. A leading solution for hospitals combines Thrive, our HIS/CIS solution offering

seamless integration across the continuum of care and LikeMind, our unique

support model featuring a dedicated team of experts and a promise of partnership.

877-418-2210 evidenthealth.ca

Committed to helping improve the quality of healthcare for the people you serve.

Learn about the future of virtual care: attend OTN’s event at HealthAchieve

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

Dr Ed Brown

BY DR . SUNNY MALHOTRA

Medical cannabis has receivedmuch attention in Canada andhas been a topic of significantdebate, due to expectedchanges in legislation. In theUnited States, the medical

cannabis market has been flourishing with recentchanges in regulations, and the option to consumemedicinal and recreational marijuana in some stateshas made it easier to obtain.

Entrepreneurs have picked up on this and a bur-geoning technology sector has been emergingaround the ordering and delivery process.

In Canada, we are starting to see the nascentstages of this occurring under the new federal gov-ernment, which is developing new legislation formedical and recreational marijuana.

Already, many startups and companies are pro-viding medical cannabis through couriers andCanada Post – which has aroused some controversy.And due to the changing political climate, some en-trepreneurs have felt emboldened to provide illegalservices and storefront dispensaries.

On the technological front, online marijuana dis-pensaries have arisen in this evolving market.

Herbal Dispatch is an example of an online dis-pensary which accepts new members with a validdoctor’s recommendation, MMAR or who have aterminal/late stage illness.

Bruce Linton from Canopy Growth Corporationis the CEO of a medical cannabis growing companyin Ontario. CGC has 20,000 patients and has beenadding 1,000 patients per month, says Linton. Theuse of cannabis for chronic pain includes those withcancer, as well as those with neuropathic pain from

diabetes, and people living with multiple sclerosis,Crohn’s or post-traumatic stress disorder and otherpsychiatric conditions.

There are approximately 6,000 to 8,000 healthcareproviders in Canada servicing this need. CGC fore-sees future opportunities to leverage technology inthis market in EMR integration, e-verification, andplant inventory tracking.

Linton noted that companies hoping to partici-pate in this market can target integration, distribu-

tion, and identifying active plant ingredients andtheir efficacies for particular diseases.

Mettrum is a medical cannabis growingcompany in Bowmanville, Ont., which seeslegislation and technology as integral tothe growth of the market.

Currently, they service 13,500 clients.Mettrum uses an e-verification serviceand a primarily online system for distri-

bution. It is using a proprietary platform called theCannabis Electronic Medical Records (C-EMR)system.

C-EMR handles client and physician registration,renewal, product selection and real-time pharma-covigilance reporting and medical research.

This C-EMR concept has the potential to be apowerful tool to bridge the gap between physiciansand patients while improving accessibility.

Companies such as Herbsy (disclosure: poweredby PopRx) have teamed up with licensed Canadianproducers and have provided technology to facilitatedelivery through brick and mortar dispensaries, aswell as via major pharmacy chains.

Herbsy leverages a mobile application to breakdown barriers and to improve accessibility, enablingmedical cannabis producers, pharmacies and med-ical professionals to better serve patients.

Pharmacies and dispensaries can partner withHerbsy and maintain accepted methods of pre-

scribing generic medications (taking picturesof pill bottles or e-renewals) to offer a par-allel verification and delivery service.This is a highly debated topic and Cana-dian physicians and patients are watchingthe market evolve. Regardless of our opin-ions on the consumption of medical

cannabis, Health Canada has licensedgrower operations in Canada to fill a void in

the market. There are both private and public com-

panies looking to create distribu-tion channels for consumers. It

will be interesting to see howthe demand is satisfied andhow technology is leveragedto serve these patients.

VI

EW

PO

IN

T

Canadian companies are devising technologies to help patients benefit from medical and recreational cannabis.

Electronic solutions have emerged to trackand monitor medical marijuana usage

Dr. Sunny Malhotra is a US trained cardiologistworking at AdvantageCare Physicians. He is anentrepreneur and health technologyinvestor. He is the winner of Bestin Healthcare - Notable YoungProfessional 2014 and thenational Governor General’sCaring Canadian Award 2015.Twitter: @drsunnymalhotra

Canopy Growth Corporation, a growerof medical marijuana, has 20,000patients and has been adding 1,000patients per month.

A bad boy’s story: Don’t try this in your hospital!

R E B O O T I N G e H E A L T H

BY DOMINIC COVVEY

Iwas a really bad boy! I’ll confess to you in a little while,but first I want to remind you

briefly of some of the threats to pri-vacy and security that everybodyprobably knows about, but need to bementioned, at least for completeness.

In my last article, I mentionedplain, old curiosity as a very com-mon driver, particularly related tounauthorized access to medicalrecords. This can be the curiosity ofan individual or of a corporation.For example, an insurance companymight want to assure itself that youor I have no previous medical condi-tions affecting a pending policy.

In the case of identity theft, theobjective is to get a spectrum of in-formation about an individual. Thatinformation would enable a fraud-ster to act as a proxy and get access

to the individual’s good reputationand possibly other resources, not theleast of which is money.

Similarly, one would steal a pass-word as a key to one’s identity infor-mation or to directly access items ofvalue or just screw around with theindividual’s psyche by mass de-friending on Facebook.

Crashing systems is a bit differentfrom these actions, in that the objec-tive is to do direct damage to an on-line system and, perhaps, what thesystem controls.

There is great fear that our powergrid is susceptible to an attack thatcould have effects like great inconve-nience or even the loss of life. Theattack on systems becomes an acutethreat particularly related to theemerging Internet of Things.

There are myriad possibilities ofgaining access to systems that con-trol life-support systems, pacemak-

ers, implanted defibrillators, nuclearreactors and many other devices. Ithink a lot of us believe that we arenot, as usual, ready for this advance-ment in the face of our very vulnera-

ble technology.So, the curios-ity threat Ipreviouslyidentified per-haps dims inthe glare ofthese moredevastating at-tacks. How-ever, it seemsto be a rela-tively common

threat to which our healthcare sys-tem seems particularly vulnerable.

Given that detecting the curiositythreat currently requires humanawareness, attention and manual de-tection, as well as responsive adminis-

trative action, we are very dependenton the clarity of our policies, thequality of our staff and the visibilityof our punishment for infractions.

However, there is another threatthat turns out to be a real and pre-sent danger and that brings us backto the Bad Boy story.

In the 1970s, the Krever Com-mission undertook investigationsregarding the vulnerability of med-ical records – which at that timewere virtually entirely on paper –and the reality of violations of pa-tient confidentiality.

During the time I worked with theCommission, I had the chance to re-view evidence that had been gar-nered under sworn testimony. Thatwas pretty easy. Towards the end ofthe Commission’s investigatoryphase, Justice Krever, Commissioncounsel and a few others were invited

Dominic Covvey



V I E W P O I N T

As healthcare organizations see thebenefits of telemedicine, usage issurging to an all-time high. Yourhospital or clinic may also want

to invest in a program, but you’re unsettledby the superabundant supply of telemedi-cine technology and equipment optionsavailable. No worries, here are six key ele-ments for you to consider when research-ing your telemedicine equipment options:

• Medical devices for specialties. The spe-cific medical devices you need may vary de-pending on the specialties you plan to ser-vice with telemedicine. The good news isyou don’t need to have all the answers rightaway, because many equipment providershave scalable and modular telemedicinesystems. This means you can purchase justwhat you need to get started and then addadditional devices later on as your programexpands into additional specialties.

• Communication platform and videoconferencing needs. How you plan to man-age the patient-to-remote encounter is akey factor. Since you are communicating apatient’s critical diagnostic data, the opti-mal choice is to do it securely and in real-time. After all, the beauty of telemedicine isthe functionality to have a live interactionbetween a patient and a remote specialist.

Using a web-based encounter manage-ment portal to communicate and share livemedical images from the patient side withthe remote provider is truly the best way tooffer telemedicine services. This makes itas close to an in-person visit as possible.

For video conferencing, first evaluateany technology investments your organi-zation might have already made to see ifthese can be leveraged for your current ap-plication. Many times they integrate seam-lessly with encounter management plat-forms. If no initial investments have beenmade for video conferencing and mightwant to consider software-based videoconferencing for a small initial investment.

• Packaging design and mobility. Telemed-icine carts, cases, wall mounts and otherequipment are all just various ways to pack-age the telemedicine hardware and software.Although there is a difference in how aes-thetically pleasing they are (or are not), themain thing to keep in mind is whether thispackaging will fulfill your intended use, notjust now but also in the future.

Ideally you want a telemedicine cart orcase that is modular and can be easily con-figured for additional medical specialtiesso it can evolve with your program.

• Bandwidth and Internet connectionrecommendations. You may not need toinvest in a significant infrastructure over-haul to make telemedicine a reality for yourclinic. Of course your specific needs willvary depending on factors such as locationand size of your organization, but the mostimportant consideration is not how muchbandwidth you need, but rather how reli-able and consistent your bandwidth is.

If possible, purchase a business-gradeservice so you experience a more consistentbandwidth capability to ensure your real-time data is not interrupted or compro-mised in any way.

• Training. The next step is to provide yourdoctors, nurses and technologists with theskills they need to best make use of your newtelemedicine technology in daily operations.

Fortunately, clinical telemedicine equip-ment training isn’t a complicated need tomeet, especially if your staff has any famil-iarity with basic medical devices and mod-ern communication technology.

• Support. Finally, the increased relianceon network connectivity and Internet

technology at your office means that you’llneed to ensure that you have adequate ITstaff support. This is likely more of a con-cern for smaller practices that may nothave an in-house IT department. Find outif your vendor provides installation ser-vices, as well as what technical support op-

tions are available if you don’t have an ITstaff of your own. For additional informa-tion on how to move forward with yourclinical telemedicine program, downloadthe ebook How to Ensure Sustainability forYour Telemedicine Program atamdtelemedicine.com/cht-ebook.html.

Your health organization wants to ‘do telemedicine’: What’s involved?

Why this is important:To meet the need of approval of medical equipment sold in Canada for limited

quantities. Often products coming into Canada are of limited quantities or “one offs”. This program allows members of the medical community to get field approval for the

equipment being used to ensure it meets standards that is set by the Standards Council of Canada.

Who is Impacted:

• Medical clinics• Medical distributors• Doctors’ offices• Hospitals

Types of Equipment:

• Custom built • Imported in small quantity• Electrical devices used on or around patients

For more information please contact [email protected], call 1-800-WORLDLAB (967-5352) or visit intertek.com/medical/spe-3000

Field Labelling of Medical Electrical Equipment


BY DIANNE DANIEL

There’s no place like home, but whenyou’re heading there after majorsurgery, living independently or deal-ing with a chronic illness or disabil-ity, it can sometimes be a bit fright-ening. Wouldn’t it be a relief to know

some of the healthcare services you trust were rightthere beside you?

That’s the goal of new developments in remotepatient monitoring. From seniors aging in place tocardiac patients recovering at home to those suffer-ing with sleep apnea, the number of patient groupsbenefitting from remote monitoring is growing inCanada. Fueled in part by advances in signal pro-cessing, cloud-based computing and the emergenceof low-cost, wearable devices that incorporate dis-creet sensors, researchers are applying technology toquickly and accurately assess our health in ways thatwere unattainable just a decade ago.

“We’re using technology that’s ubiquitous,cost-effective, totally reliable and verysimple … all of the things that really needto happen for uptake,” says Rheta Fanizza,chief business officer and senior vice pres-ident of innovation at Saint Elizabeth, anational healthcare provider. Whereasearly remote monitoring pilot projects re-lied on expensive equipment that was com-plicated to operate and often required ahome visit by a caregiver to set up, saysFanizza, today’s applications are simple touse, leveraging off-the-shelf devices andcloud technology.

Saint Elizabeth’s remote patient mon-itoring solution is based on a game-changing product it originally discov-ered in Denmark and now resells inNorth America as TelePowerShift.Combining a web portal and tablet-based app, the platform operates asSoftware-as-a-Service and canbe tailored to support disease-specific clinical workflows as wellas national or local clinical guidelines.

At one end is the patient, armedwith a tablet and Bluetooth peripheral de-vices. At the other is a team of clinicians,monitoring information such as weight, lung func-tion, blood pressure, pulse or blood glucose level.The TelePowerShift PatientApp sits in the middle,customized according to condition-specific and pa-tient-specific healthcare plans, and alerting clinicianswhen specific triggers are met.

Recently, Saint Elizabeth allied with TrilliumHealth Partners (THP) in Mississauga, Ont., to helpcoordinate services around the needs of cardiac pa-tients who are recovering at home. The resulting pro-gram, called Putting Patients At The Heart (PPATH),focuses on providing continuity of care and main-taining connection between patients and theirhealthcare teams.

Initially, PPATH established a 24-hour phoneline for patients to use, so they could get answers totheir questions without visiting the emergency de-partment. Saint Elizabeth nurses can also consultwith the THP cardiac team while visiting recover-ing patients at home, using secure phones and

tablets to communicate and viewing informationon a shared dashboard.

“Patients are getting out of hospital sooner andthey’re being supported in the community with acombination of care and technology,” explainsFanizza. “The whole service model is being re-designed and innovated on.”

Launched in February 2016, PPATH is already re-ceiving positive feedback and showing a significantreduction in post-discharge emergency room visits.Moving forward, the program is adding remotemonitoring capabilities.

Instead of being discharged with paper-based orverbal instructions only, patients also receive a kitcontaining a tablet and peripheral devices.

The tablet is pre-populated with an app cus-tomized with the best practices for a specific condi-tion and designed to solicit useful information, suchas blood pressure and other vital signs. In addition,patients are prompted to answer key questions like:‘How much pain are you in?’ or ‘Did you sleep well?’

All responses are monitored at the backendby staff at the Saint Elizabeth virtual clini-

cal call centre who can intervene when specific trig-gers are met.

In one instance, a patient developed a high feverone week after surgery. She called the 24-hour phoneline and a Saint Elizabeth nurse was immediately dis-patched to her home. Using the TelePowerShift plat-form, the nurse sent a photo of the patient’s incisionto the THP care team where a wound complicationwas identified and a prescription subsequently faxedto the patient’s pharmacy.

One benefit is the system’s flexibility to be adaptedto any condition. When used to help patients withcongestive heart failure, for example, the home kitwould include a scale. Every morning, the app wouldprompt users to check in to the TelePowerShift app,enter their weight and reply to tailored questions. Iftheir weight goes up by a predetermined amount, thesystem will flag it so caregivers can intervene before aproblem develops.

Ease of use is another benefit. While the averageage of users in Denmark is 74, no difficulties in using

the system were reported, says Fanizza, who calls thetechnology “disruptively simple.”

“Sometimes they’re supported by caregivers, butgenerally, people find it pretty intuitive and straight-forward,” says Fanizza. “What we’re most excitedabout is that it really helps shift the power to the pa-tient … It engages patients and caregivers in newand different ways that really puts the power back intheir hands to understand how to take care of them-selves,” she says.

At the Toronto Rehabilitation Institute, which wasintegrated with University Health Network in 2011and is considered one of North America’s leading re-habilitation sciences centres, researchers are workingto solve common problems experienced by peoplecoping with injuries, illness, age-related health con-ditions and other disabilities. When it comes to re-mote monitoring solutions, their goal is “zero effort,”says Dr. Geoff Fernie, institute director, research.

“As a caregiver, you’re already at your wit’s end …the last thing you need is to spend a lot of time set-ting up bits of equipment,” says Dr. Fernie. “A system

has to customize itself; it has to learn theneeds of the person it’s caring for and

do better over time.”One team of researchers, led byToronto Rehabilitation Institutescientist Frank Rudzicz, PhD.,founder and chief science officerat Winterlight Labs Inc., isworking to monitor mental andcognitive health remotely usingmachine learning. Marketedby Winterlight Labs, the tech-

nology can quickly and accu-rately detect signs of cognitiveimpairment by analysing ashort, one- to five-minutespeech sample.Spontaneous speech is recordedthrough a variety of means,transcripts are obtained usingspeech recognition technology,and acoustic, lexical, syntacticand semantic measures arethen extracted and input into amachine learning model. Theresult is a rich and detailed

analysis of an individual’s cognitive performanceand researchers say the technology can also be ap-plied to help monitor depression, assess aphasia instroke victims and assist with early detection oflanguage symptoms related to developmental dis-orders like autism.

The legwork was the intensive part, says Dr. Rudz-icz. Using dozens of hours of recorded speech fromhundreds of people, combined with years of acade-mic, peer-reviewed research, the team developedcomplex computer models that help paint a pictureof someone’s cognitive state. The software measuressome 400 variables, including how many words areused, how long the speaker pauses before certainwords are spoken, how they use pronouns and thesimplicity of their word choices.

Typically, clinicians or speech language patholo-gists will examine as many as two dozen measuresindependently to arrive at a cognitive score. By ap-plying modern machine learning, the technology

FE

AT

UR

E

RE

PO

RT

Better sensors, more powerful networks and easy-to-use gadgets help, but organizations make it work.

Advances in remote monitoring technologymake it easier to help patients at home

ILLU

STRA

TIO

N:

LIN

DA

WEI

SS



T E L E H E A L T H

Hospitals, post-acute care providersand provincial health ministriesare all driving demand for post-

discharge monitoring and chronic diseasemanagement. They are seeking to monitorcomplex, chronic-care populations, andthis requires both standardized approachesas well as an ability to tailor services toeach patient’s unique condition.

According to Ontario’s Ministry ofHealth and Long-Term Care, 5 percent ofthe patients in the province have complex,chronic conditions, and they account forroughly 66 percent of the ministry’s health-care spending. A similar situation can befound in provinces across the country.

Better monitoring of these patients canimprove their health. Improved care coor-dination can also keep them out of hospi-tal emergency departments and reduce in-patient readmissions.

For its part, Medtronic has years of ex-pertise in patient monitoring. Its remotepatient monitoring services range from in-home monitoring of patients dischargedfrom hospital with chronic diseases or af-ter certain medical procedures, to moni-toring of patients with implantable andwearable medical devices.

Such devices include insertable cardiacmonitors, pacemakers, insulin pumps andcontinuous glucose monitors.

A few examples of implantable andwearable device monitoring:

• Diabetes: Medtronic has collected 125million patient days of anonymous data,with consent, from insulin pumps and glu-cose monitors. Medtronic is working withother companies to combine analytics andcognitive computing with diabetes devicesand health data to develop new insights.The information can be anonymouslycombined with other sources of data suchas electronic medical records, health insur-ance claims and population health data touncover patterns and predict health risksusing advanced analytics models.

• Heart: Medtronic also has pacemakers,ICDs, and insertable cardiac monitors thatcan be remotely monitored using the com-pany’s CareLink Network. At the moment,there are over 1 million patients on theCareLink Network worldwide.

Information collected by the im-plantable devices is automatically routedthrough Medtronic’s secure network to thepatient’s clinic, which instructs patientswhen to send their transmissions. They canalso sign up to receive notifications of suc-cessfully received transmissions via emailor on the MyCareLink Connect Website.

Although Medtronic has historicallybeen known as a medical device company,it also offers in-home patient monitoring.

Medtronic Care Management Services(MCMS), which was formerly known asCardiocom and acquired in 2013, “is aleader in post-acute patient monitoring,”said Geneviève Lavertu, Senior Director,Medtronic Care Management Services,Canada, at Medtronic of Canada Ltd.

“After having deployed MCMS in theUnited States for more than 15 years andaccumulated over 4 million patient monthsof experience monitoring patients, MCMSis actively evaluating expansion into othercountries – including Canada.”

MCMS offers over 20 different moni-

toring programs focused on specific dis-eases and comorbidities, including chronicdiseases such as heart failure, hyperten-sion, diabetes, weight management, andCOPD, which can be combined together tohelp monitor the more complex, co-mor-bid patient.

These programs are designed to enableclinicians to identify problems and inter-vene upon signs of patient risk, as well ashelp patients manage their own self-care.There are currently over 95,000 patientsbeing monitored through Medtronic CareManagement Services in the United States.

Patient support staff, with over 15 yearsaverage clinical experience, are available tosupport patients as they engage with theservice. Staff members gain contextual in-formation from the patient, and theyspeak with the clinical care providers whoare making clinical care decisions.

Medtronic evaluates expanding remote patient monitoring in Canada

14 –17 NOVEMBER 2016DÜSSELDORF GERMANY

WORLD FORUM FOR MEDICINE

BE PART OF IT!

www.medica-tradefair.com

Every year in November, MEDICA provides a remarkable experience for experts from around the world. The World Forum for Medicine presents a broad product spectrum from some 5,000 exhibitors. Take advantage of MEDICA and its special products for your area of expertise.

Canadian German Chamber of Industry and Commerce Inc.Your contact: Stefan Egge

480 University Avenue _ Suite 1500Toronto _ Ontario _ M5G 1V2

Tel.: (416) 598-1524 _ Fax: (416) 598-1840E-mail: [email protected]

For Travel Information: LM Travel /Carlson WagonlitTel: 1-888-371-6151 _ Fax: 1-866-880-1121

E-mail: [email protected]


T E L E H E A L T H

BY OSMAN HAFEEZ

Canada’s growing population ofseniors presents several issuesrelating to accessibility and re-quires a paradigm shift in thecurrent healthcare system.

A 2014 survey conducted by the WorldHealth Organization found that 23 percentof geriatric patients faced issues accessinghealthcare within a reasonable time pe-riod. I wanted to combine my MBA train-ing and passion for healthcare to identifyinnovation gaps in healthcare.

In collaboration with Dr. Raza Naqvi,an Ontario-based geriatrician, I conducteda survey of Geriatric Medicine specialistsin Ontario to better understand generalperceptions towards telehealth of amongthis group.

I also had an opportunity to present keyfindings at the 2016 Annual ScientificMeeting organized by the Canadian Geri-atrics Society. Literature indicates thattelehealth is growing at a rapid pace andwe wanted to conduct a live survey to cor-roborate these findings.

The research revealed some interestingtrends that are worth highlighting. Out ofthe 24 respondents, 44 percent offeredconsultations via telehealth.

More interestingly, 78 percent ofthose not offering telehealth expressed

willingness to offer such services in thefuture.

In reference to the target patient group,18 percent of the respondents highlighted60-75 year olds to be the primary users oftelehealth at their practice. While 82 per-cent of the respondents mentioned 76-90year-olds as primary telehealth users intheir respective practices. These findingshighlight the demand for innovation inhealthcare that needs to be met and recentresearch confirms this demand.

A recent survey conducted by the Cana-dian Health Informatics Association founda 45.7 percent aggregate growth rate in thevolume of clinical telehealth sessions be-tween 2012 and 2014. The survey furtherfound a 120 percent increase in Health Fa-cility Endpoints since 2010, with mostcommon services related to Psychiatry,Neurology and Pediatrics.

Jurisdictionally, Ontario and Quebec ob-served the biggest growth rates with 78 per-cent increase in patients seeking telehealthservices from previous reported figures.

When asked what have been some of thechallenges adopting telehealth, 27 percentof the respondents said that finding theright technology has been challenging.Right now Ontario Telemedicine Network(OTN) provides the technology that is mostextensively used by geriatricians. This wasconsistent with survey responses as well.

However, there is still a need for bettertechnology with better scheduling andcommunication tools. Other challengeshighlighted by respondents were, lack ofunderstanding of what are the accountingor, more specifically, billing and legal is-sues related to offering telehealth.

A few respondents mentioned thatscheduling for telehealth sessions has beenchallenging at their practice when tele-

health sessions arecancelled or need tobe moved. Lastly,communicating vir-tually with patientswho have difficultyunderstanding Eng-lish was highlightedas a difficult process. Some of the specificcomments made bypractitioners pro-vide insights into

general perceptions towards telehealth. One respondent stated, “I don’t always

feel I am able to do a complete assess-ment without a physical exam, but pa-tients, and more so their families, like theconvenience.”

Another commented on the impor-tance of face-to-face clinical encountersthat simply cannot be replaced by virtualtechnology. There were also comments

made on telehealth’s great potential for usein remote and community-based prac-tices. And so it seems that an ideal ap-proach could involve an initial consultdone at a health facility and later, tele-health can be leveraged when patients re-quire follow up assessments.

Some of the limitations found withinthis research centres on the fact that thereis still missing data on how telehealth hasimpacted some of the smaller communi-ties in Canada.

It would also be interesting to factorin common perceptions of the widerhealthcare community, including nurses.And so further research is needed to un-derstand the complexities noted in thisresearch.

Technology-based solutions much liketelehealth, will serve as a complementarymodel rather than a silo to our currenthealthcare systems. This research reiteratesthe need to develop a model that comple-ments the universality of the Canadianhealthcare system while ensuring health-care equity across the spectrum.

Given that accessibility and health edu-cation are some of the most fundamentalaspects to healthy aging, policy-makerscontinue to evaluate the economic viabil-ity and feasibility of telehealth. The goal, ofcourse, is to establish a path to a healthcaresystem that is truly universal.

Canadian geriatricians ready and willing to adopt telehealth systems

measures multiple changes in speech si-multaneously, arriving at a cognitive scorewithin minutes. And instead of exertingthe effort and strain to travel to an ap-pointment and wait anxiously for a test tobe administered, patients convenientlyprovide their speech sample from home.

The team is currently investigatingthree possible delivery mechanisms. Thefirst is a tablet that caregivers could handto patients, asking them to describe im-ages that appear on the screen. Their re-sponses would be automatically recordedfor later analysis.

The second is an artificially intelligentrobot named Ludwig, developed by a re-search team at the University of Torontowith the support of Mitacs, a nationalnon-profit organization. Currently un-der trial at One Kenton Place in Toronto,the robot stands two feet tall and ismade to look and act like a young boy.The intent is that Ludwig will draw se-niors into conversation while he moni-tors for subtle indicators of Alzheimer’sdisease or dementia in the background.

The third, and perhaps the mostpromising for immediate real-world ap-plication says Rudzicz, is the phonemethod whereby a patient supplies aspeech sample by responding to auto-mated questions over a mobile or land-line. Though most of the research is cen-tred on testing for dementia or aphasia,the system can also track and monitoranxiety and depression.

“What the modern machine learningallows is the combination of these vari-ous cognitive scores in non-linear ways,”explains Dr. Rudzicz. “It’s not just thatthey’re taking longer to rememberwords, but the words they use are simpleand when they do say those words,there’s a particular pattern in their voice.It’s really how these things combine thatallows us to be so accurate.”

An added benefit of the technology isthat it eases the assessment burden. Pa-tients can very casually provide multiplespeech samples over the period of a fewmonths from the comfort of home, “pro-viding a much better picture of how theyusually operate,” says Dr. Rudzicz, whobelieves at-home assessment tools will beincreasingly important to help manageCanada’s growing aging population.

Another development coming fromthe Toronto Rehabilitation Institute iswearable technology to help diagnosesleep apnea. Rather than enduring anight in a specially designed sleep lab,hooked up to electrodes, patients areequipped with a cordless, battery-oper-ated device they use at home, in theirown bed. Marketed by start-up BresoTecInc., the BresoDx uses proprietaryacoustic and movement recording tech-nology to help make a diagnosis.

To use the BresoDx, patients simplypull a tab and press the start button. Ablue light flashes for five minutes to in-dicate recording has started and the de-vice – which includes adjustable headstraps – is fitted snugly so that it sits

just under their nose. In the morning,the device automatically turns off,users remove the SD card and mail itback to the company in a prepaid enve-lope provided.

“Increasingly, we’re doing morework where we listen to the body,”notes Dr. Fernie, pointing out that it’sreally no different than a physician us-ing a stethoscope to make assumptionsabout health.

Another research project at the insti-tute is looking at the possibility of plac-ing sensors in the head of a bed or on anearby piece of furniture in order to

analyse sleep patterns. “We’re doing alot more analysis by listening to peo-ple’s sounds, either by attaching micro-phones directly to their body or placingthem in various places close to theirbody,” he says.

At a high level, Toronto RehabilitationInstitute researchers are investigatingthree approaches to remote patientmonitoring. One is to embed intelligentsensors into the “fabric of the home,” in-cluding walls, ceilings and floor tiles.Such systems can be configured to pro-vide automated reminders for dailytasks, detect falls using ceiling-mounted

vision sensors, or, in the case of the floortile, apply ballistocardiography to re-motely measure weight, heart rate andblood pressure. Researchers are also in-vestigating how unobtrusive sensingtechnologies like infrared motion detec-tors and contact sensors can be used tomonitor the at-home activity of seniorsaging in place.

The second approach is to designwearable devices. Researchers are consid-ering innovative uses for “little micro-processors you can wear discreetly, thatare light and don’t have batteries,” saysFernie. “They can monitor things interms of what you’re doing, how you’refeeling and how your body is function-ing. There are new opportunities for usthere.” For example, wearable deviceshave been developed to measure electro-cardiography, electromyography (electri-cal activity of muscle tissue), galvanicskin response (measures emotionalstress), respiration rate, blood pressureand body temperature.

The third area incorporates robots,like Ludwig. Following the pilot project,Rudzicz’s team aims to roll out similarrobots at other Canadian organizations.

“What this means is you don’t haveto endlessly take your relatives to thehospital for clinical assessment, which isreally quite burdensome, especially asthey get dementia,” says Fernie. “It takesa lot of work to take someone out andget them assessed. This sits in the back-ground, monitors for cognitive statusand warns of changes.”

Ludwig, a robot, cancontinuously monitor thespeech of the elderly at hometo diagnose dementia.

Osman Hafeez


Advances in remote monitoring make it easier to help patients at home


T E L E H E A L T H

BY NANCY GABOR

Early in August the VancouverSun’s personal health re-porter, Erin Ellis, describedBC’s online eHealth environ-ment as ‘freewheeling’. Thearticle highlighted a handful

of new, private telehealth services, most of-fering on-line medical consultation to pa-tients who don’t have a doctor or don’twant to come to a doctor’s office.

The article showcased both the conve-nience of this new type of care, as well asconcerns about its impact on care continu-ity. I left the article thinking “If I was a readerwho didn’t work in telehealth, would I runtowards or away from this type of care?”

Since I work in telehealth in BC, peopleoften ask me what’s going on out here. BC isoften viewed as the harbinger for virtualcare, as it was the first Canadian province toallow primary care doctors to bill for web-based clinical services delivered to patients,regardless of the location of either party.

BC has stated its support for telehealthas a means to improve the health of prior-ity populations in primary and commu-nity settings, surgical services and remoteand rural care in its 2014 policy paper ‘Set-ting Priorities for BC Health Care System’and in the supporting policy discussionpapers released in 2015.

Indeed, dozens of new virtual care pro-jects and programs are under way in BC, inaddition to the bevy of speciality servicesavailable to British Columbians throughHealth Authority managed clinical video-conferencing.

Provincial projects have been devel-oped by provincial agencies or health au-thorities, such as online interactive careservices like GetCheckedOnline.com,SmartSexResource.com, MindHealthBC,and Mindcheck.ca.

Other pilots and projects are driven byhealthcare providers themselves, often withthe support of the Doctors of BC ClinicalCommittees or other provincial agencies.

For example, the Healthlink BC Physi-cian Triage Pilot Project is demonstratingthat integrating a physician into the 8-1-1Nurse Services triage algorithm can de-crease caller referrals to the emergency de-partment (ED).

The ConsultDermBC TeledermatologyInitiative is another successful projectleveraging Alberta’s Telederm platform toimprove primary care access to specialistdermatology consultation.

While these innovations have beenwell-received by patients and providers inthe province, the rapid emergence of di-rect-to-consumer virtual medical clinicshave triggered skepticism from somehealthcare providers and administrators.

Clearly, on-line medical services offerreal patient-centered care. They are conve-nient, bring service choices for patients whomay not have had options in the past, andoffer hope for primary care attachment forpatients in rural and remote communities.

On the other hand, one-off virtual caretransactions can result in service duplica-tion, care disruption and increased healthsystem costs by circumventing regular carerelationships.

Medeo, an early entrant in the direct-

to-patient primary care service model,shook the market by launching a web-based medical service in 2013. They adver-tised directly to patients in Vancouver EDsand carried a strong social media presenceincluding Facebook feeds.

It was evident that patients liked the ser-vice. A recently released Canada Health In-foway study from 2015 reported that 399BC patient users of Medeo said their onlinevisit replaced a visit to a walk-in clinic(48%), a visit to their regular doctor (20%),a visit to the ED (11%) or that they other-wise would have not sought care (13%).

Meanwhile, with 735% growth in tax-payer-funded primary care telehealthbillings in the first year alone, Terry Lake,BC’s Minister of Health, ordered a reviewof telemedical care in BC. The results ofthe review are expected to inform the yet-to-be released provincial Virtual CareStrategic Plan.

Medeo was quickly followed by a smallnumber of virtual clinics, each applying aslightly different service model; all offeringmedical services from BC-based physicians.Livecare, a Vancouver-based on-line clinic,has contracts with remote First Nationscommunities to provide medical services.

Quebec-based Equinox LifeCare uses theMedeo platform to deliver its EQ VirtualClinic. They offer direct-to-consumer, cor-porate extended-care services and supportcommunity-based medical programs suchas the Positive Access Link, which providesmental health services for marginalized pa-tients on the downtown east side.

MedviewMD, a new entrant to the BCmarket from Ontario, has opened fourpharmacy-based clinics in Kamloops,Kelowna, Chilliwack and Langley this year,

with plans to open another in Victoria inthe near future.

MedviewMD clinics are staffed bynurses who operate peripheral diagnosticdevices like digital stethoscopes and oto-scopes on behalf of a remote doctor. Pa-tients can pick up their prescriptions be-fore leaving the pharmacy. MedviewMDoperates other pharmacy-based telehealthwalk-in clinics in Ontario with plans tobuild more across Canada.

Realizing the challenges facing virtualwalk-in clinics in BC, Medeo changed itsbusiness model significantly. They stopped

selling medical ser-vices and started li-censing their soft-ware to any doctoror clinic wishing touse it in their regu-lar practice. At the end of 2014QHR Technologies,the Kelowna-baseddeveloper of Accuro,Canada’s largest elec-tronic medical record

(EMR), purchased Medeo with an eye to in-tegrating the platform into their EMR.

In spring 2016 Telus Health and QHRannounced their intention to collaboratein the development of a national, open andsecure, standards-based, communicationsolution that will make it possible to sharereferrals, prescriptions and asynchronousconsultations between providers. Plans toexpand the solution to interprofessionalsand privately funded healthcare servicesmean patients will be able to coordinatetheir care and connect their care teammembers.

Through the partnership Telus Healthcustomers will have access to the Medeoweb portal and mobile app for onlinebooking, messaging and video confer-encing between healthcare providers andpatients.

And this summer, Loblaw, the owner ofShoppers Drug Mart, announced its intentto purchase QHR, along with its Medeotechnology.

It looks like virtual care is here to stay.Are we ready? Certainly there is a strongdemand for virtual care, both on the pa-tient and provider side. BC has a strong,established room-based telehealth serviceintegrated to mainstream specialities likeoncology, mental health and cardiology.

We have most of the specialist billingcodes we need, and specialists can chargefor email consultations with other clini-cians. We have many practice standardsand policy statements supporting the useof telemedicine, but we don’t yet have a sin-gle, stand-alone legislation governing thesharing of personal health information.

We don’t have consistent texting poli-cies or even the ability to bill for text-based care. We don’t have any sanctionedclinical collaboration tools to practicewith and we don’t even have directories toknow who offers telemedicine or how toaccess those services.

Clearly, there is more work to be doneon the legislative and policy side. Mean-while, the market is speeding ahead, creat-ing new forms of healthcare delivery withboth benefits and challenges.

Nancy Gabor is a Telehealth Strategist,within the IMIT Services group at BC’sProvincial Health Services Authority.

British Columbia is seen as Canada’s trail-blazer for online, ‘virtual care’

Nancy Gabor

Register now. Reserve your place. Go to algonquincollege.com/digitalhealth

Effectively Leverage and Use IT in Healthcare EnvironmentsThe Algonquin College Digital Health Graduate Certificate program delivers the proven benefits of integrating management, healthcare, and technological skills.

Put technology to work. Stay current for safer patient care.

60of the program is offered online.

%

Learn while staying in your current healthcare environment.


serviced communities remotely is poten-tially transformative. We envision a net-work of telerobotic ultrasound systems lo-cated in remote or low-volume centres tobe serviced by sonographers at central tele-robotic sonography facilities.

Such clinics could provide routine ex-aminations for patients in low-volume orunderserviced communities, as well as fa-cilitate after-hours imaging for emergentcases, possibly avoiding transport to a

larger centre for imaging. In small to mid-sized centres, telerobotic sonography mayalso allow access to subspecialized sonogra-phy which would otherwise be unavailable.

Potential barriers and the future: Poten-tial barriers for the implementation of re-mote presence robotic technology wouldnot likely be technological. Rapid advancesin telecommunications, robotics, and mo-bile device development are providing asolid technological platform for the future.

The barriers are likely to be related toissues pertaining to medical liability, juris-dictional legal considerations, provider re-muneration, perceived costs of capitalequipment, data and patient confidential-ity, competing health priorities, and lack ofregional and national strategies and stan-dards for implementation of telemedicineapplications.

Issues related to the disparity in accessto telecommunication infrastructure mayalso be a factor in remote communities ordeveloping countries.

Public expectations and pressure forcost-effective and decentralized healthcareprovision may play a significant role in re-moving cultural barriers and streamliningof regulatory and remuneration issues.

The rising costs of transportation andthe unsustainable strain on tertiary carecentres of a system that encourages theconcentration of services in a few largehospitals may open the way for the imple-mentation of a cost-effective remote pres-ence healthcare strategy.

It is clear that the healthcare industry islagging behind the banking and airline in-dustries in the implementation of decen-tralized consumer-centre solutions that re-move barriers of time and distance.

Remote presence robotic technologyand other telehealth solutions are rapidlyexpanding. The provision of point-of-care diagnosis and treatment will trans-form the current paradigm of centralizedhealthcare delivery.

Our experience in Saskatchewan leadsus to believe that this technology can alsohelp to narrow the gap of inequality inhealthcare access to the most vulnerableand underservice populations in theProvince.

Dr. Ivar Mendez is the Fred H. Wigmore Pro-fessor and Chairman of Surgery at the Uni-versity of Saskatchewan and the Unified Headof Surgery for the Province of Saskatchewan.

fusion service, technologists are welcomingthe simplicity of the printout and appreciat-ing the time savings since they no longer needto perform complex manual calculations.

Daily ordering times are down from ashigh as 45 minutes to 10 minutes on aver-

age, with some technologists completingtheir orders in seconds.

The tool also introduces new function-ality, such as the ability to take anemic pa-tients into account and to order enoughblood supply to cover a weekend, remov-ing the need to place weekend orders.

In addition to greatly reducing excess

blood inventory, the tool is significantlyreducing the amount of red blood cellunits discarded due to expiry.

Prior to deploying the new report, out-date rates hovered between 1% and 2.5%.Following implementation, the health in-stitution sustained an outdate rate of lessthan 0.5% for several months in a row – afirst, he says.

“Each unit we save from wastage is about$450 and that comes off the bottom line ofour provincial budget,” says Dr. Cheng.

The project reflects a true team effortthat brought together software expertise atthe back end with business know-how atthe front end. While creating and validat-ing their mathematical models – designedto assess the probability of transfusion –database analysts collaborated closely withmanagement and supervisors from theBlood Transfusion Services department.Business input was required to ensure thealgorithm’s feasibility, including what fea-tures to include and the risks to address.

One reason the new tool is trusted isthat the algorithm is positively biased,meaning it recommends ordering slightlymore blood than is required. The infor-matics team has also included safeguardsto prevent inventory from getting too low.

“We have a variable that allows you topeek into the future and that variable hasbecome a very trusted one,” says Dr. Cheng,noting that analysts were able to take a‘what if ’ situation and make it real. “Ourphilosophy, moving forward, is that our labinformation system, Cerner Pathnet, is avery powerful tool that can be used formore than single patient encounters. It’s upto us to unlock that potential,” he says.


Decision-aid tool keeps the blood flowing in Nova Scotia

to visit the Government Data Centre. We were invited because evidence had

been presented that brought the securityof the Data Center into question. The Di-rector of the Centre wanted to prove tothe Commission that its new capabilities,including IBM’s RACF, effectively madetheir systems impenetrable. I thoughtinviting our crowd into the Centre was it-self a security foible and inadvisable, butthey really wanted us there!

Well, it was pretty easy, with our smallgroup being led by only two Data Centrestaff (no ‘caboose’!), for me to drop backand look at people’s desks to see if anyonehad left behind a computer room passcard instead of wearing it, as mandated.

Sure enough, there lay one on a deskand I took it. Later in the tour, we wereshown the access system to the com-puter room and how difficult it was justto get in. Of course, the person admit-ting us seldom went into the room andtherefore entered the numeric code onthe keyboard quite slowly so I could

memorize it and write it down. After he did that, I asked to take a

look at his card, giving me the opportu-nity, if I had wished, to switch cardswith him.

After the tour, on the way out, Ishowed the card to the other Commis-sion members. At first they didn’t be-lieve it, but finally broke up laughing.

I then tried to give the card to the re-ceptionist, who initially refused, because

she was not authorized to even touchthose cards. I left it on the desk and weleft the facility. The Director hated mefor years – I guess I am an equal oppor-tunity offender.

So here’s the message. Another im-portant security threat is individual ego,inability to resist proving one is right,and simply having the bloody-minded-ness to prove the other person wrong.

I admit that doing this was wrong, andI strongly advise against doing this athome, so to speak. Note: there is some-thing called a DIY career: Destroy It Your-self! However, no amount of money, noset of locks, no fancy software, no policieson the wall will stand in the way of a de-termined intruder, especially if we aredumb enough to bring the fox into thehenhouse without first getting the hens(and chickens) to 100 percent awarenessand compliance with security policy.

Security starts with people, dependson people, and (unfortunately) ends withpeople. Remember the sign from WorldWar II: “Loose Lips Sink Ships”? Oursshould be: “Loose Lips (or Actions), PinkSlips”! The lessons we learn every dayabout terrorism bring home the need forthe personal dimension of protection andmakes it clear that fences may make goodneighbors, but they don’t keep out crimi-nals … or the curious or someone withsomething to prove.

Dominic Covvey is President, NationalInstitute of Health Informatics, and anAdjunct Professor at the University ofWaterloo.

Dominic CovveyCONTINUED FROM PAGE 12


Security starts with people,depends on people, and(unfortunately), also endswith people.

Figure 4. The Melody telerobotic sonography system can be used to perform an ultrasound study on a patientin a remote location. The photo shows a nurse holding the ultrasound probe frame over the patient but thesystem is controlled by an expert sonographer performing the exam in real-time from a distant location.

Remote presence healthcare technology: Saskatchewan’s experience

retirement. “Everyone needs to maintaintheir skills – even established physicians.There are modules on the website thatwould be too advanced for a student, butwith CME (continuing medical education)on the site, established doctors can main-tain their echo skills.

And they can practice up to 50 different“focused TTE” cases over and over untiltheir accuracy of diagnosis is highenough.”

Doctors of all ages practice medicalskills at times that are convenient for them,and receive meaningful feedback fromclinical mentors.

ECG and chest X-ray interpretation areskills needed by most practicing physi-cians.

They can practice multiple cases ofECG, chest X-ray or ultrasound interpre-tation, as often as required until they reacha high level of competency.

“I’m very passionate about teaching,and the positive feedback I receive fromusers makes my entire week,” said Dr.Waechter. “It’s a great feeling to have ahand in helping someone learn, acquireand maintain their skills.”


Educational websitehelps sharpen skills


the system generates are particularly help-ful in the mental health field, where re-ports are very narrative.

“Instead of looking like a survey –yes/no, 3 out 5 – it actually creates nice sen-tences, as if I had taken the informationand dictated the report myself: ‘The patientreported that he had these symptoms for aweek and it affected his life in this way.’”

However, Dr. Chow believes the systemwould be equally useful in more data-dri-ven medical fields such as cardiology, forexample, because it can also collect vitalsigns remotely in advance of a visit andgenerate meaningful clinical notes basedon hard data.

“Cardiologists need to collect all man-ner of information – height, weight, med-ications, and so on. InputHealth can col-lect all of those things ahead of time andspit them out in a readable format. It candetect trends and display them in graphi-cal format. It can also track vital signs overtime. The patient can punch in their bloodpressure results every day. And you can setup alerts in InputHealth to notify the doc-tor if there’s more than, say, a 10 mmHgchange in the systolic pressure.”

On the administrative front, Dr. Chowsays there are fewer no-shows for his ap-pointments using InputHealth, and he canuse questionnaire completion – or lackthereof – to predict no-shows and otherpatient behaviour.

“In the past, about 20 to 30 percent of pa-tients don’t show up for appointments, butthis is not uncommon in the mental healthfield. Now my no-show rate is about 1 to 2percent. And I can see if someone’s filled outtheir questionnaire or not at my end.

“If they haven’t, I know they probablywon’t show up. I can now reliably predictwho’s engaged and who’s not. So I have ashorter wait list now and I waste less timeon admin. Patients clearly feel invested be-cause when they fill out the questionnaire,they want to show up.”

For all its complexity, it’s very easy tolearn how to use InputHealth, he adds. “Itfeels like using Facebook instead of Excel.You just learn how to use it intuitively. Evenmy less technologically inclined staff canpick it up within a few days, unlike otherEMRs that require weeks of training.”

InputHealth’s customer service team isextremely responsive when he’s asked forhelp or reported a bug. “If there’s some-thing I don’t understand or a feature I don’tlike, I usually get a response within five or10 minutes. Their people are always intouch because they do a new release of thesystem every few weeks. And I always get lit-tle pop-up messages when I log into In-putHealth to notify me about new features.”

Overall, the system has a modern, 21stcentury look-and-feel that works intuitivelylike iPhones, iPads and other technologythat everyone’s accustomed to using ineveryday life, says Chow. “The feeling I getfrom other EMRs is that they’re essentiallymainframes with a user interface slapped ontop, whereas InputHealth was created fromthe ground up to be usable. InputHealth is alot like Apple in the sense that I really feelthat the user experience is top-of-mind, nota second or third consideration.”

At present, InputHealth is the solutionof choice for niche practices such as men-tal health clinics, community care centers,chronic pain clinics, and perioperative

clinics, says Dr. Seth. “It’s useful for anytype of practice that sees one or two differ-ent types of clinical conditions and re-quires routine data collection. The marketfor our system right now is enterprise or-ganizations such as hospital networks andacademic institutions – healthcare organi-zations that need to know how a patientpopulation is doing in a specific region.”

However, the company is laying thegroundwork to expand its reach by pursu-ing certification in Ontario and otherprovinces as a full-fledged EMR system

that any medical practice, big and small,can use. “We’re doing the developmentwork needed to create a robust productthat can replace existing EMRs altogether.We believe we’ll be able to replace tradi-tional EMR systems over time.”

The company is working to fulfill theregulatory and other requirements neededto launch InputHealth as an EMR acrossCanada. All the provinces have differentrules governing EMR system certification,and provincial laboratory and other sys-tems are at different stages of develop-

ment and integration, explains Dr. Seth. “In British Colombia, for example, In-

putHealth can replace all the functions ofan EMR. Our collaborative health record isa full-blown system that a clinic can use inits entirety, because we’ve integrated it withB.C.’s provincial billing and lab systems. InOntario, we’re working toward that andwe’re actively collaborating with OntarioMD. If you’re using Practice Solutions orAccuro in Ontario, depending on yourpractice type, very soon we’re going to beable to say we’re ready to take you on.”

Need skilled IT or managerial staff?Try the CHT Job Board!If you’re seeking:• Project Managers & Team Leaders• IT Designers, Programmers & Analysts• Marketing & Sales StaffAdvertise your positions on the Job Board!

Our site is visited by 12,000 individuals each month.These visitors are healthcare professionals, with expertisein information technology.

We are also proactively marketing the Job Board with adedicated, monthly HTML blast to promote the site, along withads in our publications – the e-Messenger and Technology forDoctors Online.

Reach the people with the skills you need!

Modestly priced at $250/month

www.canhealth.com/jobs

SPECIAL

OFFERNo charge for job

postings until

October 1, 2016

Use promo code

00248


Facebook-like EMRCONTINUED FROM PAGE 4

Continuing our LegacyToshiba Canada Medical Systems

Thousands of minds and millions of hours over a century of time have built a legacy of innovation that continues to evolve as we do. From our collaboratively rich research and development past, we advance towards a bright future of technological innovation that is “Made for Life.”

Toshiba Canada Medical Systems continues to serve the Canadian healthcare community as its own organization reporting directly into Toshiba Medical Systems Corporation (TMSC). This provides close ties to our research, engineering and product specialists, enabling the

needs of our customers.

www.toshiba-medical.ca

©Toshiba Canada Medical Systems Limited 2016. ULTRASOUND CT MRI X-RAY SERVICES

To learn more about us, visit our booth at RSNA 2016 | North - Hall B: 7334

Continuing our LegacyToshiba Canada Medical Systems

Thousands of minds and millions of hours over a century of time have built a legacy of innovation that continues to evolve as we do. From our collaboratively rich research and development past, we advance towards a bright future of technological innovation that is “Made for Life.”

Toshiba Canada Medical Systems continues to serve the Canadian healthcare community as its own organization reporting directly into Toshiba Medical Systems Corporation (TMSC). This provides close ties to our research, engineering and product specialists, enabling the

needs of our customers.

www.toshiba-medical.ca

©Toshiba Canada Medical Systems Limited 2016. ULTRASOUND CT MRI X-RAY SERVICES

To learn more about us, visit our booth at RSNA 2016 | North - Hall B: 7334

feature report: developments in telehealth – see … · feature report: developments in...

Documents