see page 18 - canadian healthcare technology€¦ · when the pace of change in healthcare was less...

BY JERRY ZEIDENBERG

TORONTO – West Park HealthcareCentre, a 470-bed rehab and com-plex care facility, is working with aprivate-sector partner to develop

an “intelligent vision” system that can im-mediately spot aggressive behaviour in pa-tients by using autonomously monitoredvideo camera feeds and machine learning.

The system – which makes use of videocameras placed in strategic spots in the hos-pital – employs artificial intelligence to de-tect signs of aggression. It then connects tothe nurse call and alerting system to send forhelp in instances of conflict, potentially sav-ing staff and other patients from injuries.

The problem it solves is that there’s usu-ally not enough staff in hospitals and long-term care facilities to adequately monitorpotentially aggressive patients.

In some cases, this lack of resources pre-vents patients moving from ALC beds inhospitals to nursing homes and other facili-

ties, as there aren’t enough resources to carefor them. That, in turn, creates logjams inthe acute care centres.

“Many hospitals and long-term care cen-tres have patients with behavioural issues,”said Jan Walker, VP, Strategy, Innovationand CIO at West Park. “What we’re creating

here will have benefits for all kinds of facili-ties, as well.”

West Park’s private-sector partner,Toronto-based Spxtrm AI (pronouncedSpectrum AI), is developing an automated,visual alerting system in the Acquired BrainInjury Behavioural Services, which cares forpeople with severe brain injuries who alsohave behavioural issues.

These residents require quite a bit of at-tention – staffing for this group is normally

one-to-one, and sometimes two staff mem-bers for a patient. Moreover, the patients canbe challenging.

“They can be quite an aggressive popula-tion,” explained Walker. They may have suf-fered a brain injury from a road or boatingaccident, and when they become upset orangry, they can be difficult to control.

It’s difficult to have adequate staff keep-ing an eye on them around the clock.

So, when it was suggested that today’s AItechnology is capable of monitoring patientslike these, Walker and the team at West Parkwere extremely supportive.

On a related note, West Park is about toembark on a renewal and expansion– it’sconstructing a new building on its 27-acrecampus to replace older structures that dateback 50 years or more. And it intends to in-corporate the latest innovations in technol-ogy to help achieve the highest medical out-comes for its patients.

To do that, said Walker, it is creating joint

Video cameras and AI help manage aggressive patients

CONTINUED ON PAGE 23

West Park Healthcare Centre has a strategic plan to boost innovation at the hospital as a way of improving quality and establishing a leader-ship position in rehab and complex care. The plan includes collaborations with small, technologically savvy companies, such as Spxtrm.AI.Pictured above: Tim Pauley, Manager, Research; Jan Walker, VP, Strategy and Innovation at West Park; and Jay Couse, CEO of Spxtrm AI.

It’s difficult to constantly keepan eye on aggressive patients;AI-powered video is a big help.

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Non-urgent consultsAn electronic system for non-urgent questions, sent fromGPs to specialists at ProvidenceHealth Care in Vancouver, isproving to be extremely useful.Page 4

Cornwall reaches EMRAM 6Cornwall Community Hospitalimplemented a new HIS fromCerner, and quickly jumped toStage 6 in the HIMSS EMRAMrankings for hospital IT systemperformance.Page 6

Advanced cardiologyA new tower at the University ofOttawa Heart Institute offerssome of the most innovativetechnology available in Canada.As well, the facility provides anappealing environment for staffand patients. That’s improvingmorale and is expected to createa better place for healing. 0

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40018238

FEATURE REPORT: DEVELOPMENTS IN CONTINUING CARE – SEE PAGE 18

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 23, NO. 6 SEPTEMBER 2018

DIAGNOSTICIMAGING

PAGE 10

BY RICK TIDMAN

There was a time, not long ago,when the pace of change inhealthcare was less dramatic anddisruptive, and the turnover of

medical technology was measured in years.As healthcare technology management(HTM) professionals, we know better thananyone that those days are gone.

A coalescing of technology, informationand analytics is under way on a global scale– its momentum is inescapable and thepotential for better care is unlimited.

However, we also know better than any-one that this staggering and disruptive rateof change within medical technology iscausing organizations to struggle.

Behind each technology decision madein local health integration networks, hospi-tals and clinics are people doing the bestthey can. Yet the problem remains that nei-ther purchasing organizations, administra-tors nor clinic professionals are equippedwith the professional experience or acade-mic knowledge and training needed to nav-igate the complexity and far-reaching ef-fects of their technology decisions.

It’s important to note that fault doesnot lie with these parties. Fingers need notbe pointed.

The reason why the myriad of medicaltechnology decisions made every day –from the extraordinarily complex to theroutinely mundane – are being done with-out the necessary expertise is because todate, the right specialist has not existed.

But take heart – a new type of health-care leader is on their way.

This month, the labs and classrooms atDurham College (DC) will welcome thefirst cohort of students in the HonoursBachelor of Health Care Technology Man-agement program, the first degree of itskind in Canada.

Yes, the first HTM degree in Canada isbeing launched by a college. It’s a perfectfit too, as Durham College is already hometo Ontario’s leading Biomedical Engineer-ing Technology program.

In collaboration with our graduates inthe field and industry partners, we havenot only identified the need for a new kindof practitioner but taken swift action toaddress it. Our program will produce thepractitioners needed to fill the knowledge

gap and lead the rapid, ever-evolving techtransformation of our healthcare system.

Ontario’s colleges have been offeringdegree programs since 2002, providingunique options for students who want thebenefits of theory integrated with intensiveapplied learning.

So, then, who are the members of thisinaugural cohort? What’s drawing them toour program and qualifies them to pursuethe role of the modern HTM professional?

The answer is as diverse as the field itself.

Based on the conversations I’veenjoyed with our incoming stu-dents, I can tell you that theyare indeed innovative thinkersand early adopters who are fas-cinated by technology. Theyshare traits with the clinicalspecialist who is passionateabout the life sciences. They understand and aspire tobecome leaders whose strategicminds chart the most effectiveroutes to achieve short and long-term operational goals. Most ofall, like each of us, they share inthe satisfaction that comes with

helping others restore their health.These students are recent high school

graduates; they are experienced nurses andengineers.

We have drawn a diverse, ambitiousgroup of people who are choosing to studyat DC because they want to engage inhands-on learning. They want to accessand contribute to our leadership in artifi-cial intelligence (AI), and to develop theinterdisciplinary skill set that will preparethem for the jobs and careers – jobs thatmay not even exist today, but will be real-ized tomorrow.

There is a transformation under way inour healthcare sector, the likes of whichhas never been experienced. Behind everydifferential diagnosis is a series of tests in-volving medical technology, and behindevery clinical advancement and contribu-tion to patient outcomes are new and in-novative medical technologies.

Disruptive medical technologies – AI-embedded medical technology, in particu-lar – are game changers that will transformthe sector. They will also pose the greatestchallenge to our healthcare system as AI-enhanced medtech continually learns,tests, analyzes, predicts, treats and movesinto the surgical theatre.

The launch of the Honours Bachelor ofHealth Care Technology at DC is therecognition of this coming reality.

It only makes sense that in the most dis-ruptive period in the history of healthcare,a specialist should exist who can guidetheir organization through such transfor-mation, ensuring it reaps all the benefitstechnology has to offer.

This is the domain and role of thehealthcare technology manager, and it isthrilling to be part of the emergence of thisentirely new discipline in HTM.

Rick Tidman is a professor at Durham Col-lege and the program coordinator of the col-lege’s Biomedical Engineering Technologyprogram and the Honours Bachelor ofHealth Care Technology.

Rick Tidman coordinates the Honours Bachelor of HTM program.

Durham College offers bachelor’s degree in healthtech management

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 2018. 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. ©2018 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. Returnundeliverable Canadian addresses to Canadian 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 23, Number 6 September 2018

Contributing EditorsDr. Sunny MalhotraTwitter: @drsunnymalhotra

Dianne [email protected]

Dianne [email protected]

Dave [email protected]

[email protected]

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BY VANESSA MILLAR

In June, The Hospital for Sick Children(SickKids) launched its Epic integratedhealth information system. SickKidspartnered with Ottawa’s CHEO, which

was already using Epic, to implement thefirst integrated paediatric health informa-tion system of its kind in Canada.

Prior to the launch of the new informa-tion system, SickKids staff used numerouselectronic systems, combined with papercharts, to document patient information.In SickKids’ ambulatory clinics (whichsupport over 200,000 visits per year), allclinical notes, flow sheets, charting and as-sessments were manual.

Staff were required to spend time look-ing for information in multiple placeswhen looking after patients. This meantmore time at the computer, on the phoneand looking through paper files, and lesstime at the bedside with their patients.

All patient information is now in onesystem with real-time access to the infor-mation the care provider needs. Patientsand their families can feel confident that nomatter where they go in the hospital, staffwill have the full view of their information.

This means patients and families willspend less time repeating their informa-tion as they interact with different staffthroughout the hospital. The burden is re-moved from parents to have to carryaround their child’s records to ensureeveryone on the care team has the same,most up-to-date information.

Having all information in one placeenables SickKids’ collaborative approachto care.

As part of the implementation of Epic,SickKids launched a patient portal, My-

Chart. The portal provides patients andtheir families with better access to theirhealth information.

Enhancing the patient and family expe-rience at SickKids to provide the best childand family-centred care was an importantpart of SickKids’ transformation to Epic.Patients can access parts of their SickKidshealth record online and through a mobileapp, including their medications, allergies,upcoming appointments and lab results.

They also have the ability to send a mes-sage directly to members of their careteam. Like their partners at CHEO, Sick-Kids staff and patients and their familieshave been quick to adopt MyChart.

“Our patient portal is an importantpart of our transformation. We are eager to

grow the platform across the hospital andenhance it to meet our patients’ needs, en-abling patients and their families to be wellinformed and better able to be active intheir own care,” says Helen Edwards, Di-rector of Clinical Informatics and Tech-nology-Assisted Programs.

Through this transformation SickKidshas refined its processes and made im-provements. The new system enhances pa-tient safety because it provides an inte-grated view of the patient’s care.

It also includes alerts, flags and hardstops to prevent potential errors. Numer-ous efficiencies have been created by re-moving manual transcription, allowing forphysician personalization, including com-mon orders and notes, and introducing

front-end dictation that immediately pop-ulates in the system.

This enhances the high-quality care thatSickKids delivers by empowering best prac-tices and standardization. SickKids has alsoseen a significant reduction in paper!

A key safety feature consists of new pa-tient ID bands, which have been en-hanced with barcodes to enable safer pa-tient care. Additionally, patients with al-lergies wear black ID bands, instead of thestandard white ID band, prompting thechecking of the allergy before administer-ing any treatment.

If medication needs to be given, themedication will be scanned and the patientID band will be scanned. This ensures thatthe right medication is given to the rightpatient at the right time. The barcodes canbe scanned with a barcode scanner or asmartphone camera, used by nurses whendelivering care. SickKids is the second or-ganization to ever use the native cameraon the iPhone for barcode scanning.

The partnership between SickKids andCHEO has allowed for better coordinatedpaediatric care. When a child has been apatient at CHEO and then comes for anappointment to SickKids, the SickKidscare team can immediately gain access tothe health information that was docu-mented at CHEO, avoiding costly delays,duplication and errors. The same is truefor a SickKids patient visiting CHEO.

SickKids has not only gone completelydigital, it has also adopted mobile applica-tions to allow for flexible and remote ac-cess. The Epic mobile apps, Haiku andCanto, are being used by SickKids physi-cians and nurse practitioners and Rover isbeing used by nurses, phlebotomists, pa-tient service aides and transport aides.

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

Joshua came for a visit to SickKids and Ivy, a registration clerk, gave him a new patient ID band, which is bar-coded for enhanced patient safety. It’s part of the new Epic integrated health system at the hospital.

SickKids patients and staff see benefits after Epic implementation

Electronic system for non-urgent consultations proves valuable

VANCOUVER – Waiting for anin-person visit with a spe-cialist can delay a patient’streatment, especially if aconfirmation of the refer-

ring physician’s initial treatment plan isall that’s required.

Waiting to see a specialist for a non-urgent case can also cause unnecessarystress for a patient. Since the introduc-tion of dr2dr Secure Messaging intoProvidence Health Care’s eCASE projectthis past year, however, healthcareproviders are seeing greater improve-ments in patient care and treatmenttimeframes.

Providence Health Care now operates17 sites in British Columbia. In 2016-2017, it had almost 635,000 patient visitsand 118,000 ED visits alone.

In 2010, Providence Health Carelaunched Rapid Access to ConsultativeExpertise (RACE), an organized tele-phone-based service to connect GPswith specialists who could respond tourgent consultation requests over thephone within a two-hour timeframe.

As soon as RACE was introduced, theprogram was quickly picked up as both

GPs and specialists recognized its poten-tial. With RACE’s quick response time,urgent consultations could be dealt withalmost immediately, expediting thetreatment plans and care of patients.

However, as the adoption of RACEincreased, Providence Health began tosee an increased, non-urgent use. GPswanted a system for clinical questionsthat might not be urgent, but still re-quired a specialist’s consultation.

In 2017 Providence Health launchedeCASE, electronic Consultative Access toSpecialist Expertise, using Microquest’sdr2dr Secure Messaging Platform.

According to Providence Health Care,“for traditional referrals, patients mightwait months to see a specialist, however,minor advice may be all that is needed.”

Enter dr2dr. Using a number ofdr2dr’s built-in features, ProvidenceHealth Care created a unique consultationservice: Specialists are grouped togetherbased on their specialty, and given accessto a clinic mailbox.

Depending on which specialist is oncall, that specialist will be set to receivenotifications when a new message hasarrived in the clinic mailbox. When thatspecialist is done their on-call rotation,

notifications are turned off for them andturned on for the next on-call specialist.

Providence Health Care has alreadystarted seeing dramatic results withdr2dr and eCASE. Since the pilot started,the majority of eCASE questions sentthrough dr2dr have avoided unnecessaryspecialist referrals.

For Dr. Micaela Coombs, dr2dr andeCASE have become a welcome tool forpatient care. “As a rural family physician,I use eCASE frequently,” says Dr.Coombs. “The consultants are able to

provide definitive, practical advice. It hasallowed me to safely reduce the numberof investigations and referrals I order.With each consultation I learn somethingnew. And my patients are happy theydon’t need to travel to see a specialist.”

In cases where a consultation with aspecialist might be needed, but wherethat particular consult doesn’t require an

in-person visit between the patient andspecialist, dr2dr provides GPs the abilityto still consult with a specialist.

“A recent case that I recall involved aquestion about some incidental findingson an echocardiogram, which was doneon a 29 year old woman with a familyhistory of bicuspid aortic valves,” recallsDr. Brett Heilbron of St. Paul’s Hospital.“I was able to reassure the physician thatthe echo findings were likely of no clini-cal significance, and hence avoided theneed for an office consultation.”

The value of dr2dr and the eCASEsystem has been recognized throughoutthe dr2dr user base.

“eCASE is a great tool for clinical careand for education,” says Dr. StephaneVoyer, General Internal Medicine at St.Paul’s Hospital. “I recently addressed aGP’s concerns about a DVT. There werequestions about the need for a workup,the choice of agent to use, and the dura-tion of treatment. I was able to answerthe questions to the referring doctor’ssatisfaction, providing an up-to-date,tailored plan, without having to bringthe patient in for an in-person assess-ment. In my opinion, this provides in-credible value for the patient.”

Using eCASE, the majority ofquestions sent through dr2drhave avoided unnecessaryreferrals for patients.

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With today’s residents requir-ing more support of theirdaily activities, and providersfacing funding and resource

limitations, long-term care in Ontario ison the brink of profound change. UnionVilla, a highly regarded long-term carehome based in Markham, Ont., is leadingthe charge.

Over the past year, Union Villa has beenan early adopter and champion of a vitalprogram to bring technology, in the formof Clinical Support Tools (CSTs), to long-term care homes across Ontario.

This innovative initiative is funded bythe Ministry of Health and Long-TermCare (MOHLTC), and is being rolled outacross the province by Think Research,along with two long-term care associa-tions: AdvantAge Ontario and the OntarioLong Term Care Association (OLTCA).

The associations play a strong role inensuring the continuous spread of the pro-gram, which will deliver meaningful bene-fits for Union Villa residents, families, clin-icians, long-term care homes and the sys-tem at large, ensuring that residents receivethe highest standard of care.

Union Villa, an AdvantAge Ontariomember, has already seen success throughimplementing a new evidence-based CSTinto their home.

A CST is a decision support tool that en-ables clinicians to provide individualizedand holistic care for residents, from assess-ment to care planning and beyond. TheCSTs provide guidance for clinical practi-tioners, enable an efficient, paperless workenvironment and assist in the individual-ized care planning that greatly impacts aresident’s quality of life.

The CSTs developed as part of this pro-gram target six specific clinical conditions,including urinary continence, behaviouralsymptoms of dementia, hypoglycemia,palliative care, and end of life. The CSTsalso integrate with an organizations’ exist-ing health information systems, such asPointClickCare and are tailored to alignwith individual workflows.

Based on a strategic decision to improvecontinence, along with a provincial qualityindicator related to this area, Union Villaselected the Urinary Continence CST touse at the bedside and as a training tool toinform staff of best practices.

Helping to standardize continence as-sessments, this new tool outperformed allprevious continence tools used by UnionVilla, allowing clinicians to identify andalso fully address the root causes of incon-tinence – a level of decision support thatprevious tools did not provide.

In collaboration with Think Research,Union Villa began planning and imple-mentation in late 2017, with staff trainingcompleted in February 2018.

By March they had trained 12 nursingchampions and had completed 20 assess-ments. The tools have been in use at UnionVilla now for over 5 months, and in this

short time, have already helped tostrengthen communication amongst careteam members, reduce administrativework, improve assessments, increase effi-ciency and support informed and struc-tured clinical decision-making.

For residents, the result is an increasedquality of care in this fundamental area.Regular quarterly assessments and partici-pation in scheduled toileting programs hasdramatically reduced the demoralizing acci-dents that can negatively impact a resident’sexperience within a long-term care home.

Union Villa’s project lead, RAI-MDS/Informatics RPN Mackenzie Ralph,was instrumental in ensuring the uptakeand utilization of the tool. She says, “We’vefully replaced our previous continence as-sessment tool with Think Research’s Clini-cal Support Tool. The innovative technol-ogy has opened lines of communicationamong our care team and helped to stan-dardize assessment, as well as other carepractices within Union Villa.

She added, “It’s completely changedhow we approach continence manage-ment. Now, residents, families and care-givers are all speaking the same language.”

Mackenzie Ralph recently presented theoutcomes of the project to several long-termcare homes in the Greater Toronto Area,with adoption expected to increase as morehomes implement CSTs across Ontario.

Building upon this early success, UnionVilla also plans to advance to their pro-ject’s next phase, which involves imple-menting the Skin and Wound Manage-ment CST under the direction of Eli Vega,Director of Care.

It’s a program that marries the ideals of

Cornwall Community Hospital reaches Level 6 on HIMSS EMRAM scale

CORNWALL, ONT. – Corn-wall Community Hospitalrecently stepped up to Stage6 on the HIMSS AnalyticsEMRAM ladder. The adop-

tion of a leading-edge Electronic HealthRecord (EHR) has provided significantclinical and operational benefits.

The hospital undertook a 20-monthproject to install a fully integratedHealthcare Information System inclusiveof the majority of modules available toan acute care hospital. Cornwall Com-munity Hospital successfully went livewith the fully integrated electronichealth record in December 2016, withofficial accreditation in April 2018.

The transformation to the electronicsystem required collaboration of the en-tire organization, from senior leadershipto front line, from housekeeping andporters to physicians.

The silo approach of building out in-dividual applications was removed andintegrated, with cross-departmentalteams formed. The assessment of ap-proximately 136 current state workflows,transitioned to 257 future state work-flows, with the goal of improving patientcare and efficiencies.

The custom of maintaining historicalprocesses and practices was discouragedwithout adequate review of their appro-priateness in the digital world. A muchmore sophisticated maturity model wasused in the build out of processes in thedigital workflow for the clinicians.

With that, the review of efficiency,quality, risk, and mandatory data collec-tion was incorporated within eachfunctional build. Cornwall clinicalstaff now have a better understand-ing of the system they helped buildand the rationale behind much of itsdesign approach.

A secondary organizational bene-fit realized from this cross-func-tional team philosophy was thegrowth of relationships and aware-ness of departmental processes af-fecting the delivery of service andquality of care a patient receives.

Of great benefit are the clinical de-cision support tools that were built. Com-prehensive screening tools and promptsto mitigate risks for (VTE) clotting, delir-ium (CAM), Influenza, and others weredesigned to assist the clinicians to use abest practice methodology to treatment.

Together with Zynx Healthcare, Cerner

Corporation, and Think Research, Corn-wall Community Hospital employed evi-dence-based practices to improve patientoutcomes using Computerized PhysicianOrder Entry (CPOE).

Cornwall Community Hospital devel-oped approximately 300 ‘powerplans’(electronic order sets) across clinical dis-ciplines and effectively addressed the as-

sessment, monitoring and treatment ofthe many of the Ontario Quality BasedProcedures (QBP). Most broadly usedare plans for COPD, heart failure, hipand knee arthroplasty and stroke.

The ability to report on the utiliza-tion of the powerplans and clinical sup-

port tools provides the organization anopportunity to analyze and address anyshortcomings with corrective actions.

Dashboard reports include metricsoutlining compliance with best practicesand clinician use of the powerplans, thusensuring that patient outcomes are atthe forefront of orders.

Prior to the electronic health record,and working with paper tools, theorganization was not able to ana-lyze the adoption of its quality-based procedure metrics and pa-tient outcomes effectively. Inclu-sive in the powerplans created,approximately 30 Quality BasedProcedures incorporate thou-sands of clinical categorized stan-dards that can now be monitored.Cornwall Community Hospitalcontinues to revise the QBPpowerplans as new handbooksare published, and is refining the

analysis and utilization of the QBPmetrics. The transition from paper to afully integrated electronic health recordhas resulted in a clinical transformationfor Cornwall that continues to evolveand improve the medical outcomes forour patients.

Union Villa early adopter of quality program to improve care delivery

Union Villa’s Project Lead Mackenzie Ralph and Unit Nurse Maria Bautista make use of the quality system.

Members of the health information system team at CCH.

CONTINUED ON PAGE 8


BRAMPTON, ONT. – William OslerHealth System – a bustling com-munity hospital with three sites –decided five years ago that it

wanted to boost the amount of research anddevelopment it does. The move to moreR&D was made to improve the health of thelocal patient population and act as a driverof economic development in the city.

Today, Osler is running more than 200research projects in partnership withlarge pharmaceutical and medical devicecompanies, as well as with start-up tech-nology firms, other hospitals and with ed-ucational institutions. That rapid growthin R&D is unusual for a community hos-pital – it’s like zooming from 0 to 100 kmin 5 seconds, in automotive terms.

“It’s an elaborate R&D program that’sevolving and coming together very nicely,”says Dr. Ron Heslegrave, with his charac-teristic modesty. Dr. Heslegrave, CorporateChief of Research at Osler, was given re-sponsibility for organizing the expansion ofR&D at the hospital. He was recruited fromthe University Health Network and hasbrought his real-world expertise, and cor-porate and academic connections to Osler.

Dr. Heslegrave also credits the hospital’sleadership with providing the right corpo-

rate culture for R&D. Osler’s President andCEO, Dr. Brendan Carr, is a strong propo-nent of the program, as are Executive VicePresident of Quality, Medical and Acade-mic Affairs, Dr. Naveed Mohammed andChief of Staff, Dr. Frank Martino. Tellingly,both Dr. Mohammed and Dr. Martino arerunning their own research projects, as-sisted by students.

“Osler has one of the busiest Emer-gency Departments in Canada, we delivermore babies than most hospitals in theprovince, and our clinicians still maketime for research and innovation,” saidDr. Mohammed. “That shows you ourcommitment to R&D.”

Another key to igniting the fast take-offof healthcare R&D in the region has beenthe close partnership between the City of

Brampton and Osler’s executives and clin-icians. For its part, Brampton is alreadyhome to over 800 health sector businessesand agencies, and the city is activelybuilding a health cluster by providing in-centives to new companies, and creatingsynergies with existing corporations –which include Medtronic Canada, CanonCanada, Dynacare labs and surgical robot-ics developer MDA Corp.

“We’re very collaborative here,” notesMartin Bohl, Sector Manager, Health andLife Sciences at the City of Brampton. Abrand-new collaboration is with RyersonUniversity, which has just announced theconstruction of a campus in Brampton.With a focus on science, technology, engi-neering and math (STEM), the school willprovide a new source of talent for localhealthcare and tech businesses.

Moreover, Brampton is encouragingRyerson to establish a business accelera-tor, along the lines of its top-ranked DMZand Biomedical Zone incubators, which itruns in downtown Toronto. The goal is togenerate new biomedical businesses inBrampton, in collaboration with the hos-pital and the large base of players that arealready there. “Ryerson will be a game-changer for Brampton,” asserts Bohl.

Through Osler’s efforts, the Bramptonregion has already become a centre of ex-cellence for leading-edge solutions in cardi-ology, diabetes, kidney disease and oncol-ogy. Indeed, the region is a living laboratoryfor researching solutions to these ailments,due to the nature of the local population.“Fifty percent of the population here is ofSouth Asian origin,” notes Dr. Heslegrave.“Research shows South Asians carry aheavier incidence of these diseases.”

Studies currently under way include:• AutoRIC. This armband, likened to thecuff worn to measure blood pressure, ap-plies pressure to the arm, but in this case,it is intended to trigger a cascade of molec-ular events designed to protect the heartand vascular system in patients experienc-ing heart attacks. The creators of the de-vice, Toronto-based CellAegis Devices Inc.,found through research that the device canset off a physiological response in the bodythat rescues heart cells during a heart at-tack and the re-perfusion injury that oc-curs during treatment. It’s now beingtested in ambulances, in Peel Region andHalton Region in Ontario. The company isworking with Osler’s team, and researchersat the Institute for Clinical Evaluative Sci-ences, to determine the efficacy of the de-vice and has enrolled 1,800 patients in thetrial. Funding of $700,000 was obtained forthe project with the Ontario Centres of Ex-cellence. “If we obtain the expected result,such as decreased readmissions to hospi-tals, autoRIC could be put into ambulances

across the province,” said Dr. Heslegrave.“It could have a huge impact on the com-munity we serve.” • An innovative platform is being devel-oped to help aging patients, who need as-sistance at home, manage their day-to-daytasks when discharged from hospital andliving at home. Called MATCH (Market-place to Access Trusted Care at Home),the system connects patients with peoplewho can help, usually provided by family,with regular tasks in the home and per-sonal support. “A patient and their fami-lies may qualify for a certain number ofhours of help from the local LHIN, and af-ter that, they’re on their own,” said Dr.Heslegrave. “This gives them a safe andeasy way to obtain the extra help theymay need.” This innovative project has at-tracted $250,000 in funding from the Cen-tre for Aging and Brain Health Innovation,powered by Baycrest; the technology plat-form has been developed by uCarenet. • A new app that is under developmentcalled RELIEF, will link – in real time – thedaily symptoms, pain and distress levels of

palliative patients living in the community,with their palliative care team at Osler. Itwill help ensure, for example, that an el-derly patient whose symptoms, pain anddistress levels are increasing, are sent totheir clinical team to determine whetheran earlier intervention or home visit is nec-essary to avoid a trip to the Emergency. Al-ternatively, knowing that your condition isbeing monitored on a regular basis by yourclinical team and assured that there is noneed for an earlier intervention, may pro-vide psychological support and relief.

For the City of Brampton, the goal is tobuild synergies among Osler, large andsmall biomedical companies, and the newRyerson University campus, which willsoon start construction. The city intendsto become a powerhouse among biomed-ical clusters in Canada. “We’ve positionedourselves as a hub to evaluate new drugs,devices, procedures and technologies, inorder to get real-world experience in amulti-cultural community,” said Dr. Hes-legrave. “We do represent the diversity ofCanada here in Brampton.”

Osler collaborates with Brampton, private sectorand Ryerson to fuel growth of biomedical clusterThe Brampton region is home to a fast-growing number of clinical trials and tests, centred on diabetes, cardiac care, long-term care and home-care technologies.

MED-TECH INFRASTRUCTUREEDUCATIONAL SUPPLEMENT

“We’ve positioned ourselves as a hubto evaluate new drugs, devices,procedures and technologies, in orderto get real-world experience in amulti-cultural community.”

– Dr.Ron HeslegraveCorporate Chief of ResearchWilliam Osler Health System

Dr. Ron Heslegrave displays an autoRIC armband, which is being tested by paramedics in Peel and Halton.

Osler’s Peel Memorial Centre for Integrated Health and Wellness is a major part of the biomedical cluster.

h t t p : / / w w w . c a n h e a l t h . c o m S E P T E M B E R 2 0 1 8 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

MARKHAM, ONT. – At theend of a two-week bootcamp, held in July at theMarkham Stouffville Hos-pital, five teams of young

innovators stood up and made their pitches.The participants, including students fromSeneca College and York University, had cre-ated solutions to challenges in the hospital’semergency and childbirth departments.

Their ideas included technologies andapps seldom seen in hospitals – including‘heat maps’ that measure whether patientsare content or irate in waiting areas; AI-powered kiosks that can translate lan-guages when patients and clinicians can’tunderstand each other; and wearables thatcan be used en route to the emergency de-partment, to automatically collect data be-fore a patient arrives.

They’re technologies and applicationsthat have been used in consumer and retail

settings – often by youthful, early adopters –but which haven’t yet appeared in hospitals.

The entrepreneurs were enrolled inSeneca College’s Helix Summer Institute,which partnered with the hospital to pro-vide workshops and meetings with men-tors, clinicians, staff and patients. The goalwas to devise solutions to real-world,healthcare problems – all in a tight, two-week timeframe.

“For the second year, Markham Stouf-fville Hospital has been our lead partner,and has given us access to staff and pa-tients,” said Chris Dudley, director of Helix,the college’s accelerator and innovationunit. Other partners included IBM Canada;local business accelerator VentureLAB; andthe regions of Markham and York.

Each of the five teams came up with vi-able solutions to problems that seem tostymie all hospitals, such as long wait-times in the ED, communication gaps be-tween patients and clinicians, and thequality of the patient experience.

The groups, said Dudley, plan to go ondeveloping their solutions, after being en-couraged by hospital staff and partners.

Moreover, the hospital itself has bene-fited from the experience. “We’ve madesome changes already, and we want to con-tinue to work with the groups and to in-novate,” said Elena Pacheco, VP of SupportServices and Transformation at MSH.

In a nutshell, here is what the fivegroups devised:

Emerge.AI: Hospitals often conductsurveys about the patient experience – inthe ER or other areas – but it’s done wellafter the fact. However, what if you couldgauge the patient experience in real-time,as it was happening? That’s what Emerge.AIis working on.

The group is using AI-powered voiceand video technology, placed in waiting ar-eas of a hospital, to monitor facial expres-sions and voice patterns. No facial recogni-tion is being used, nor are conversationsbeing monitored. Instead, it’s whether pa-tients are content, happy, sad, or irate thatcan be determined through both visual ex-pressions and the tenor of the voice.

Using this technique, colour-codedGIS maps can be created showing ‘hotspots’ in the hospital, where patients maybe discontented. A red area on the mapcan alert hospital staff that there’s a prob-lem in need of fixing. If an area – such asthe ER or DI waiting room – constantlydisplays red, rather than green or yellow,it signals to staff that processes need to beimproved.

As one of the group members ex-plained: “It’s emotion mapping of the ER,with instantaneous feedback.”

Another team member noted the tech-nology is already being used in the retail sec-tor; it has been tested by fast-food chains, tomonitor customers in drive-throughs. The

restaurants, too, want to measure – in real-time – whether their processes are resultingin satisfied customers.

Becka – The Digital Concierge: Becka isusing artificial intelligence to create an in-stant translation system. If a new Canadianfrom Sri Lanka, for example, is havingtrouble explaining her pain to a clinician,the Becka device could be used to translate.

As one team member noted, “Ontariowelcomed 100,000 immigrants last year.And in this area, Markham, 63 percent ofthe population has a mother tongue otherthan English.”

Needless to say, communication can bea challenge, especially in an emergency sit-uation. But Becka can translate and giveanswers in a person’s own language.

Of course, the device could translate thephysician’s diagnosis and instructions backto the patient. It can also provide directionsaround the hospital, answering questionslike, “Where is the fracture clinic?” It mighteven offer clinical information, such as,“Why am I taking a certain medication.”

Team members said it’s like Apple’s in-telligent assistant, Siri, but optimized forthe hospital environment. The self-learn-ing database will be initially set up withdata and scenarios that are envisioned tobe most useful, but it will be able to addmore as it goes along – likely through itsown intelligence.

The group members are now looking atforming an alliance with providers like Mi-crosoft, Google, Amazon, or possibly withIBM and its Watson AI engine.

Passport: The team at Passport wants tospeed up the registration process at hospi-tals by adopting the techniques used at air-port check-ins. “We want to bring the air-port experience to hospitals,” said a pre-senter from the group. “It should be likescanning your passport.”

The group envisions a multi-lingualkiosk that can speed up the check-inprocess at Emergency Departments andother intake areas; the plan is integrate thesolution with the Meditech electronic pa-tient record system, which is used atMarkham Stouffville Hospital and manyother Canadian hospitals.

Proactive Triage: The group is using in-

telligent “wearables” as a way of trackingand recording vital signs in patients ontheir way to the hospital. By using technol-ogy like the Hexoskin wearable, data canbe automatically collected and transmittedto the hospital, where it can be reviewed –even before the patient arrives.

This means the hospital will be awareof patients who are on the way and willhave a better idea of their medical condi-tion. Moreover, by automatically takingreadings, a good deal of rote work will beeliminated.

The group is primarily concerned withlow-acuity patients – called C4s and C5s.

As another innovation, it is reaching outto Uber Health, which is providing rides tohospital for low acuity patients, as well astransports between medical facilities.

The key to this association is that Uberis already highly computerized; it is track-ing patients and performance, and theProactive Triage app could be connected tothe Uber app.

“It’s possible that we could do 60 percentof the registration and data collection in thecar, before the patient reaches the hospital,”said a Proactive Triage team member.

Along Comes Baby: When partners ar-rive at a hospital with the wife in labour,they’re often excited – and sometimes in afrenzied state. As one presenter said, “Thewife may be yelling for an epidural, and thehusband is irate, and asking why she isn’treceiving it.” In short, there’s lots that ex-pecting couples don’t know about preg-nancies and hospital processes.

The Along Comes Baby app is designedto inform them about labour and delivery– from before they get to hospital, to whatto do when they arrive, as well as what toexpect during their stay and what shouldbe done afterwards.

In essence, it’s like a ‘best practices’guide to pregnancy and childbirth, opti-mized for a specific hospital.

It should be noted that the projects are,so far, works-in-progress. The teams hadonly 10 working days to put together theirgame plans. Now, they’re out to developthem further. For more information,please contact Chris Dudley at Seneca Col-lege. [email protected]

“We’ve made some changesalready, and we want tocontinue to work with thegroups,” said Elena Pacheco.

Youthful entrepreneurs adapt consumer technologies to healthcare

The Emerge.AI team created a system that gauges the emotions of patients in the ER, to improve quality.

holistic care with the potential of tech-nology, and partners are delighted withits early success.

Alka Modi, Program Manager andproject lead at Think Research, is in-spired by the experience of workingwith Union Villa: “This sector is de-manding change and deserves it. TheClinical Support tools are beingadopted by leading homes like UnionVilla, and this adoption is having in-credible impact on the system. Withthese tools, nurses, personal supportworkers, administrators and other carestaff can spend less time reporting andmore time on what matters most –keeping residents healthy and happy.”

Shilpi Majumder, Director of PublicPolicy at AdvantAge Ontario and amember of the CST Advisory Commit-tee, is also delighted to see early

adopters Union Villa take an active rolein implementing this innovative tool.

“We have been collaborating with theproject partners and our members tospread the uptake of the Clinical Sup-port Tools across the sector. Our mem-bers have provided valuable feedbackabout the process which we’ve broughtback to the team and worked with themto facilitate ease of uptake and minimizebarriers. The learnings from Union Villawill help other LTC homes implementthis program more effectively.”

Union Villa Administrator RoxanneAdams noted the progress on this ini-tiative: “Our staff are committed toproviding resident-centred care whileenhancing the quality of life for ourresidents as they age well and live bet-ter, one person at a time.

“In collaboration with our partners,we are happy to share our outcomes inorder to advance the quality of life forresidents living in long-term carehomes across Ontario.”

Early adopterCONTINUED FROM PAGE 6


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BY DAVE WEBB

The expansion of the University of Ot-tawa Heart Institute gives the facilitysome of the most advanced surgicaltechnology available, but a focus on astate-of-the-art working environmentis almost as important.

Inaugurated in the Spring, the Life SupportTower – “The Tower,” to its staff – marks the com-pletion of Phase 3 of the planned hos-pital improvement project, says Dr.Tim Zakutney, Vice-President, Med-ical Equipment and Chief MedicalTechnology Officer.

The five-story building, three yearsin construction, adds 145,000 squarefeet, 27 critical care beds, nine cardiaccatheterization and electrophysiology(EP) labs, and six cardiac operatingrooms.

One room is a 1,000-square-foothybrid OR, featuring robotic and im-age-guided surgical equipment. (An-other room is shelled in for a futureuse hybrid OR.)

The hybrid OR is home to the hos-pital’s da Vinci Surgical System, pro-duced by surgical robotics manufac-turer Intuitive Surgical Inc. of Sunny-vale, Calif.

Da Vinci is a surgeon-helmed robotthat allows less invasive surgical pro-cedures, minimizing danger and re-covery time. The Institute has one ofthe world’s largest installations ofAzurion image guided therapy equip-ment from Philips, which helps per-form complex procedures more con-sistently and efficiently.

In fact, surgeons could performvarious procedures – open heart, ro-botic and image-guided – simultane-ously in the hybrid OR, says Dr.Thierry Mesana, President and ChiefExecutive Officer of the Institute.

The Institute performs about 12,000surgical and non surgical procedures ayear, about 80 percent of them complexoperations – such as open heart surgery,coronary bypasses, heart transplants –that can only be done in a handful ofOntario hospitals, says Mesana.

It’s the cardiac referral hospital for14 others in the Champlain LocalHealth Integration Network (LHIN),which serves about 1.2 million people.

“We need very specialized operat-ing room procedures,” Mesana says.Much of the Institute’s infrastructuredates back to its 1976 opening, and“needed updating,” he says.

The redevelopment began in 2014with new cardiac magnetic resonance imaging(MRI) and computed tomography (CT) facilities.They were bumped up in the schedule, a sort of “pre-Phase 1” project, according to Zakutney.

“We needed to address that immediately for ourpatients, so we moved that ahead,” Zakutney says.

Phase 4 will see a new cardiac imaging centre (toopen in the first quarter of 2019), new general radi-ology and gamma photography equipment, and therelocation of stress and CT labs. It will be 2020 be-fore the five-phase redevelopment is complete, Za-kutney says.

“It’s about creating more space, safer space forstaff and patients, and having space to expand,” Za-kutney says.

Perhaps nowhere is this theme more obvious

than the relocated surgical intensive care unit(ICU), its beds moved from a windowless room inthe basement of the Institute to the top floor of thenew tower. The spacious rooms include a nursingstation for a one-to-one patient-nurse ratio; impor-tantly, they’re brighter and quieter.

“Being in the basement for so long (a post-surgi-cal stay) was traumatic to patients,” Mesana says. Andit could be demoralizing to staff as well. “The well-ness of our staff is very important,” he says. The ef-fect of the new environment has been “invigorating”,he observes. “The staff is much happier.”

The ceilings lift for more headroom. Articulatedarms can position patients to allow them a windowview. There’s even a balcony for chronic care pa-tients. “The windows we had downstairs were some-

thing you’d see in your own base-ment,” Zakutney says.One ICU room is dedicated tomorbidly obese bariatric patients,but the other four can be adaptedto accommodate them as well.And new monitoring equipmentis designed to integrate with thehospital’s coming electronichealth records (EHR) system.Zakutney and Mesana are moni-toring a number of metrics tovalidate the performance im-provement at a hospital that al-ready ranks well below the Cana-dian average in post-operativemortality rate and 30-day read-missions, according to a three-year study by the Canadian Car-diovascular Society and theCanadian Institute for Health In-formation. The Institute alsoboasts a 98 percent patient satis-faction rate.“The bar was pretty high already,”Mesana says.Mesana has already seen a 10- to15-percent volume increase intreatments, shortened wait listsand wait times; he’s expecting adrop in wait times to two to threeweeks for non-emergency patientsfrom the current six weeks.Zakutney says the opening of an-other shelled floor in the towerwill have “a dramatic impact” onpatient volume. Better heating andventilation systems should reduceinfection rates and more non-in-vasive surgical procedures, usingrobotics and image-guided tech-nology, should lead to shorterhospital stays. More imaging equipment willhelp shorten patient wait times,and the centralization of imagingdisciplines will allow closer col-laboration and the selection ofthe best imaging options for eachpatient.Zakutney stresses that while theconstruction of the Life SupportTower was funded to the tune of

$135 million by Crown agency Infrastructure On-tario, the local share, which included all medicalequipment, was funded through community dona-tions to the University of Ottawa Heart InstituteFoundation, which provided an additional $63 mil-lion for the project.

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Expansion provides new advanced technology, a state-of-the art working environment, and better outcomes.

The University of Ottawa Heart Institute’simprovement project reaches Phase 3

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 S E P T E M B E R 2 0 1 8

An electrophysiology lab at the University of Ottawa Heart Institute contains the latest technologies.

A hybrid operating room at the hospital allows for both open and minimally invasive procedures.

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VANCOUVER – The importance ofpatient-centric approaches to dig-ital health was an overarchingtheme at the 18th annual e-Health

Conference and Tradeshow, which tookplace in Vancouver in May.

The opening session of the Sunday

Symposium set the tone with the story ofGreg Price, a young man from Albertawho lost his battle with cancer in 2012after spending much of the previous yearnavigating a disconnected healthcaresystem. Throughout Greg’s journey,there were many gaps in the continuity

of care, which led to delays in treatmentand may have contributed to his un-timely passing.

There were a number of takeaways fromthis session and for a digital health audi-ence. In particular, the need to break downthe current siloed approach to healthcare

delivery is greater than ever and that tech-nology can help drive the change.

After all, one of the culprits in thestory was the fax machine – a technologythat is largely considered extinct. Exceptin healthcare.

The message hit home that innovationand interoperability between EMR andEHR systems can reduce harm and savelives. And it needs to happen fast.

Since Greg’s passing, the Health QualityCouncil of Alberta (HQCA) launched aninvestigation into his story. The result wasa report that recommends 18 changes thatcan lead to better care delivery – includinga province-wide personal patient portaland e-referral system.

Greg’s story has catalyzed patients andcitizens to become engaged in healthcareissues and use their voices to effect change.

More and more, patients are drivingchanges in the healthcare system. Theyhave first-hand experience of navigatingour hospitals and clinics. As recipients ofcare, they also have invaluable input onwhat works well, and how to improve in-teractions among care-providers.

Patient engagement at e-Health 2018:“Nothing about us without us” has be-come a popular turn of phrase used by hu-

man interest groups, including those rep-resenting patient groups.

To that end, the e-Health organizerscommitted to incorporating the experi-ence of patients as experts in living withtheir conditions.

In fact, e-Health 2018 received PatientIncluded Accreditation for meeting all fivecriteria identified by the Patient IncludedCharter.

As part of this commitment, e-Health2018 Conference awarded two scholar-ships to patients and/or caregivers to at-tend the conference: Kerri Mackay of Win-nipeg, and Francine Buchanan of Toronto,were the recipients of the scholarships.

The conference brought together someof the top minds in digital health, but they,like everyone else, were able to learn frompatients who are passionate about sharingtheir stories to improve the health system.

As in most things, there is always roomfor improvement. Patient Scholarship win-ner, Kerri Mackay, who has represented thepatient voice in a number of conferencesacross North America, said: “I think includ-ing patients via a scholarship program is justthe beginning of good things to come for thee-Health conference.

“There were some sessions where the pa-tient experience was highlighted, but I dofeel there were many missed opportunitiesfor patient engagement that could be growninto in the future, to become a more truly

e-Health 2018 emphasized the patient experience, electronic solutions

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and effectively Patients Included conference.In the future, I’d love to see patients present-ing on a greater majority of panels, and ses-sions led by patients.”

On your mark, get set, HACK! The “pa-tients included” theme carried into this

year’s hackathon, which set out to tackle thepressing issue of chronic disease manage-ment. According the Public Health Agencyof Canada, chronic disease affects three outof five Canadians over 20 years of age.

The theme struck a chord with hackersand attracted 29 participants from as faraway as Newfoundland and Labrador.Over the course of the conference, partici-pants from five teams worked hand-in-

hand with patients and clinician experts,building innovative prototype solutionsfocused on prevention, home care, andcommunity care.

Nancy Roper received a patient scholar-ship sponsored by Gevity and Tableau. Asan IT professional and patient, Nancy wasdriven to build a solution to help patientsget to appointments.

“I was really thrilled at the number of

people who came up to me and said, ‘Inever thought about how hard it is for pa-tients to get to their appointments – thankyou for enlightening me about that chal-lenge.’ So even if our application doesn’tcome to market, I still think there was ben-efit,” she commented.

From her idea, the Patient-appointmentDrop-Off Assistant was born, which tookaway the Patient Choice Award.

CareCircles (now ShareMyCare) was astand-out winner this year, walking awaywith three of the six prizes (CIHI, Infoway,People’s Choice).

The team of nine built a patient-centricplatform that connects the circle of care(clinical) with the circle of support (family& friends) to enable the flow of informa-tion between the groups based on consentset by the patient.

Since e-Health, ShareMyCare continuesto be in development. A research team hasbeen established at Memorial Universityand the team anticipates being able to de-ploy the solution in Newfoundland &Labrador as a pilot project.

Other Hacking Health winners included: • SAM: The Smart Automated Medical

Assistant (Digital Health Canada Winner)• Wikimeds (Orion Health Winner)• Patient-appointment Drop-Off Assis-

tant (Patient Choice Award Winner)Plenaries to talk about: The plenary

sessions peppered throughout the confer-

ence offered a range of invigorating dis-cussions on topics ranging from the futureof Canadian digital health, the trials andtribulations in the health start-up industryand space medicine.

To close the conference, Nova Browning-Rutherford offered a powerful message, re-minding us of the importance of wellnessand self-care to prevent us from one day be-ing on the other side of the hospital bed.

Towards the future – e-Health 2019:The vision for e-Health 2018 was to Cele-brate, Grow & Inspire Bold Action inCanada’s Digital Health Community. Be-tween the 250+ presentations, social eventsand award ceremonies, the event offered anabundance of opportunities to do all three.

There is no doubt that the patients-in-cluded movement is building steam acrossthe sector and we can expect this will con-tinue to shape the e-Health Conferenceand Tradeshow.

Mark your calendars, as e-Health 2019will take place in Toronto at the BeanfieldCentre from May 26-29.

Missed Out on e-Health 2018? If youcould not attend e-Health 2018, you donot have to miss out on all of the fun. TheVirtual Library, available at http://li-brary.e-healthconference.com/virtual-li-brary offers access to recorded presenta-tions (including all the plenary sessions),and all PDF/Presentation slides that tookplace at the conference.

E-health 2018CONTINUED FROM PAGE 6

Panel discussion at eHealth 2018 in Vancouver.


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BY DR . SUNNY MALHOTRA

Clinical trials are expensive and ofteninefficient ways to validate newdrugs, devices and medical interven-tions. Enter the age of digital clinicaltrials. Pain points include recruit-ment, data collection, adherence and

logistical challenges. A remote trial is a form of a digital trial that

leverages digital technology to improve clinicaltrial efficiency. Web-based outreach increases thepool of potential qualifying patients and can speedup recruitment.

Increasingly, organizations are using new softwareand services to streamline the clinical trial process.They’re utilizing hardware and coaching mecha-nisms to promote adherence and reduce losing pa-tients during the study.

Hardware can objectively track patient outcomesand digital pills, which have been newly FDA-cleared, to objectively measure patient outcomes. Ifdata input can be automated, there is accuracy andadherence data improvement which can validate theabove issues.

Doctors can attempt to conduct a randomized con-trol trial and recruit patients online. This allows pa-tients to participate from their homes via drug deliver-ies and a mobile application without a clinical trial site.

Science 37 (www.science37.com) is a leader in thespace and can tackle issues of geographical con-straint by developing patient-centric models for clin-ical research to accelerate biomedical discovery.

It is important to recognize the value of telemed-icine’s role in conducting remote trials. It needs to beubiquitous and reimbursable to overcome barrierssuch as patient dropout. (Go on Science 37’s websiteand you see that participants are compensated – insome cases, $50 to $100 — for completing clinical

trials, in addition to learning more about their ownconditions and possibly finding remedies.)

There is a focus on improving the patients experi-ence during a clinical trial and improving ways ofcommunicating patient data. Site-less trials can bedistributed through mobile devices like Apple’s re-search kit platform. This is an open-source platformthat researchers built medical applications and re-cruit patients for clinical trials.

For its part, Science 37 uses telemedicine technol-ogy to accelerate biomedical discovery and bring

down the costs of clinical trials. In addition to itsown researchers, the company also works closelywith physician-scientists and leading telemedi-cine companies.

Based in Los Angeles, S37 is focused onthe development of networked patient-centric models for clinical research. It usespartnerships with national mobile nursingcompanies, pharmacy chains, patient ad-vocacy groups, virtual e-consenting, mo-

bile devices, and other techniques to bring clinicaltrials right to their homes.

The company’s proprietary technology platform,NORA (Network-Oriented Research Assistant),bridges the gap between traditional trial manage-ment software, an EMR, and an advanced telemedi-cine platform to support all participants in Net-worked Clinical Trials (NCTs).

On a related front, Pillo (www.pillohealth.com) isa company which makes personal home robots toimprove medication adherence as an adherence toolin their Phase 3 and Phase 4 trials.

The device provides facial recognition, time stamp-ing and a digital interface inside the patient’s home asanother method to communicate patient data.

Pillo will tell you when it’s time to take a particu-lar medication, lets you know whether you’re out ofpills, asks you if you want a refill, and will also an-swer questions about diet.

If you are looking after someone, it can send youalerts by email or other formats, to let you know if

the person forgot to take his or her meds.It can even provide videoconferencing with a

clinician.The digitalization of clinical trials hasmany benefits but needs to overcome mul-tiple barriers to become a widespread prac-tical solution. The rise of digital outcome-driven research and development has

piqued the interest of pharma and biotech-nology stakeholders. Many have started to

embrace digital adjunct solutions to im-prove interactions and insights while

also improving operational andscientific efficiencies. This has

led to many opportunitiesin digital health space wheremany sectors are updatingtheir clinical trial strategies.

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New applications bring trials right into the patient’s homes and help with compliance.

Telemedicine and automation are hitting the clinical trials sector

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

Science 37 brings clinical trials into thehomes of patients using telemedicine,mobile nursing companies, pharmacychains, and other methods.

FHIR delivers more effective interoperability, at lower cost BY CARYN HARRIS

Gone are the days when pa-tients saw one doctor for alltheir health needs. Now pa-

tients are often cared for by a teamof providers with different special-izations. This is especially true forpatients with chronic conditions,who often see multiple clinicians ona regular basis as part of their ongo-ing management.

A chronic-care patient, in thecourse of a week, could visit a pri-mary care physician, a radiologyclinic, a lab, and a cardiologist, forexample.

The stakes are high, as cliniciansrequire comprehensive patientrecords to ensure they make the bestdecisions for the safety of the pa-tient. Getting the latest test resultsand encounter records can be prob-

lematic, however, as many systemsstill don’t talk to each other.

Interoperability: Interoperability– or sharing information betweensystems – is a frequent pain point forhospitals and clinics for a number ofreasons, including the lack of agreedstandards that make information ex-change possible, and frequent ad-vances in technology that are onlypartially adopted – leaving many sys-tems incompatible with each other.

Cost is also a major factor. Thesheer volume of data that needs tobe stored, shared, exchanged and ac-cessed quickly becomes a major ex-pense. Coupled with the fact thatthere are many different systemsspeaking to one another, interoper-ability is a modern healthcare issuein need of fixing.

The FHIR standard: Fast Health-care Interoperability Resources

(FHIR) is the next generation HealthLevel Seven (HL7) internationalstandard in healthcare data integra-tion. It is focused on reducing thecost of interoperability in terms of

both time andmoney andunlockingtechnical in-novation inhealthcare. Itwas createdwith imple-menters inmind and isbroadly sup-ported in thevendor com-

munity, as well as by many health-care providers.

FHIR provides a framework forthe exchange, integration, sharing,retrieval and even storage of elec-

tronic health information. Builtaround existing industry approaches,FHIR’s purpose is to make it easierto exchange all healthcare data be-tween systems in a straightforwardyet secure manner.

Central to FHIR is the concept ofresources – self-describing, discreteblocks of data that make sense in thehealthcare environment, and whichcan be adjusted (or “profiled” in FHIRspeak) to meet specific scenarios.

FHIR aims to speed applicationdevelopment and interoperability,thereby giving a boost to informa-tion sharing in healthcare.

FHIR helps to make health infor-mation easily and securely accessedfrom any device, anywhere. It is anopen source standard, available forall to use at no cost. As well as beingeasy to use for implementers, it is de-

Caryn Harris



EDUCATIONAL SUPPLEMENT

AGFA HealthCare and Greenville Health System –based in Greenville, S.C. – have announced thesuccessful implementation of a comprehensiveEnterprise Imaging system. The solution willfacilitate greater efficiencies in clinicaloperations, improve clinical confidence, andenable cost reduction through convergence ofsystems and timely access to medical images anddiagnostic tools.

The solution consolidates access and allows forcare-team collaboration with Radiology, Cardiology,and other medical images while converging multiplelegacy picture archive communication systems(PACS) onto a single platform. The result is thecreation of one of the United States’ largestintegrated digital imaging systems in the prestigiousHIMSS Electronic Medical Record Adoption Model(EMRAM) Stage 7-awarded health network.

VNA (vendor neutral archive) services facilitateVisual Intelligence – rapid cross-enterprise accessto clinically relevant imaging information – andleverage diagnostic information from EnterpriseImaging PACS’ advanced task-based workflow.Merging the familiarity and functionality of PACSwith the power, access, and scalability provided bya single standards-based technology platform, the

solution is designed to improve both the delivery ofpatient care and operational efficacy throughoutmultiple locations and clinician groups.

ADVANCING CONNECTIVITY

The recently implemented system has convergedmultiple PACSs onto a single platform, allowing the1,627-bed multi-hospital system to seamlesslyconnect over 400 imaging modalities across 50individual provider facilities to patients’ medicalimaging data. Nearly 4,000 clinicians are nowrelying on the Enterprise Imaging system to deliverpatient care daily throughout the greater northwestSouth Carolina region.

Greenville Health System is renowned for itsclinical efficiency improvements and commitmentto transform the quality of care and patient safetyusing innovative information technology. Thehealthcare system recently achieved theprestigious HIMSS Electronic Medical RecordAdoption Model (EMRAM) Stage 7 Award, thehighest achievement level awarded. The nearpaperless environment achieved by GHS harnessesthe integration of EMR and Enterprise Imagingtechnologies to advance the clinical, operational,and financial vitality of the health system.

The complex implementation exemplifies recognitiongiven to AGFA HealthCare recently by KLASResearch, the healthcare research and insights firm.The KLAS Enterprise Imaging Performance Report2018 identifies AGFA HealthCare as a ‘strong andguiding partner’ and cites strategic guidance,strength of the new platform, and integration as keysto the company’s success in driving desiredoutcomes for clients. No vendor scored higher thanAGFA HealthCare as a strong partner to createand/or develop an organization’s enterprise imagingstrategy. The study found that organizations seeing

the most outcomes are those using AGFAHealthCare VNA and universal viewer, both of whichGHS elected to rollout in their initial stage of themulti-year deployment

“We are proud of the technical and clinicalenhancements accomplished across the GreenvilleHealth System that will help improve the care wedeliver to the patients we serve. The EnterpriseImaging platform integrates with our EMR to benefitour growing network’s clinical, operational, andfiscal health,” said Richard Rogers, vice presidentand CIO, Greenville Health System. “In reducingcomplexity and cost – and increasing efficienciesacross our clinical and operational processes – weview AGFA HealthCare’s solution as key to ourdigital health strategy. The AGFA HealthCare teamhas been an excellent business partner and theirguidance and collaboration have been instrumentalto our controlled rollout’s continuing success.”

“Two years ago, GHS and AGFA HealthCareembarked on a journey together with a sharedstrategic vision of leveraging an integrated patientdata platform and it is wonderful to see this cometo fruition,” commented Frank Pecaitis, senior vicepresident, North America, AGFA HealthCare. “Theimplementation of Enterprise Imaging withGreenville Health System continues validation ofthe platform’s scalability, convergence power, andthe fundamental contributions Enterprise Imagingcan deliver to a health network’s transformation tostandardize and personalize care.”

AGFA HEALTHCARE ADVANCES GREENVILLE HEALTH’S IT STRATEGYThe go-live of the latest version of AGFA HealthCare Enterprise Imaging is enhancing patient care and clinician workflow at one of the most innovative health systems in the U.S.

ENTERPRISE IMAGING PLATFORM

The Enterprise Imaging system implementedat GHS includes the following suite ofapplications on a single platform:

• Enterprise Imaging for Cardiology (PACS) –improves clinical productivity and reducesapplication overload by using a single userinterface supporting all cardiology clinicalworkflows.

• Enterprise Imaging for Radiology (PACS) – ahighly customizable diagnostic workflow tooldesigned to help radiologists achieve optimalefficiency in reading radiological studies.

• Standardized Departmental Workflows –allows all image-producing service lines,including Point of Care Ultrasound,Dermatology, photo capture for Wound Care,and Opthalmology to capture and associateimaging studies with an episode of care anddrive enterprise-wide efficiency.

• Enterprise Imaging Vendor Neutral Archive(VNA) – consolidates all imaging data frommultiple systems, departments, and vendorsinto a central clinical data foundation.

© Agfa HealthCare Corp.

BY DIANNE DANIEL

What’s your emergency?”“Thanks to community paramedi-cine, I no longer have one.”This is the new reality in several

populations across Canada as community paramedicprograms continue to make a positive impact, fromimproving patient wellness to preventing 911 callsand emergency room visits, to helping chronic dis-ease sufferers manage conditions better at home.

Starting in remote areas of Nova Scotia, commu-nity paramedicine programs have launched in sev-eral provinces, each with its own success story.

One of the primary challenges, however, is to sus-tain funding so programs can scale. That’s wheremeasurable outcomes and technology implementa-tions are helping.

In Ontario, the Community Paramedicine atClinic (CP@Clinic) research program led by Dr.Gina Agarwal, a primary care epidemiologist and as-sociate professor in the Departmentof Family Medicine at Hamilton’sMcMaster University, publishednoteworthy results earlier this year.

The report showed that a “para-medic-led, community-based healthpromotion program significantlylowered the number of ambulancecalls, improved QALYs (quality-ad-justed life-years) and ability to per-form usual activities and loweredsystolic blood pressure among olderadults living in subsidized housing.”

What started out as an evidence-based trial study in one social hous-ing building is now operating in 16of Ontario’s 52 paramedic services.

Funding was also acquired tosupport an expansion project calledCP@Home in which communityparamedics make house calls in ad-dition to operating drop-in clinics.

“These are community para-medics who are designated for a different role, anew role,” explained Dr. Agarwal. “You’re actuallygetting to people before they call 911, and that’s thewhole point.”

Both CP@Home and CP@Clinic target frequent911 callers identified by the McMaster CommunityParamedicine research team. The drop-in clinics areheld in social housing buildings identified as havinghigh need populations.

Paramedics take participating residents throughhealth risk assessments, using the CP@Clinic app ona laptop as a support tool to identify next steps andmaintain records for each visit, which are sharedwith primary caregivers and other communityhealth professionals.

In addition to providing guidance and coun-selling, they connect patients to community re-sources and provide health educational materials.

Paramedics involved in CP@Home complete asimilar patient assessment using computer tablets,considered less obtrusive in a home setting. Bothprograms use Bluetooth-enabled blood pressurecuffs, weight scales and other wireless devices asrequired.

When assessing patients, the software provides in-

telligent decision support based on the informationthey input.

“We developed a database with automatic, algo-rithm-based decision support in it. Once they put therisk assessment information in, the database tells themwhat they need to do next,” explained Dr. Agarwal.

By comparing buildings running CP@Clinic tosimilar buildings without it, McMaster researchersfound a 22 percent decrease in 911 calls over a one-year period. Considering that the cost for one 911call is anywhere between $500 and $2,500, and theaverage building has 200 units, a savings of roughly$20,000 per building per year is plausible, she said.

The study also measured sustained decreases inparticipants’ blood pressure leading to a lower risk offuture heart attack or stroke and showed a lower riskof developing diabetes due to participants makinglifestyle changes.

Primary care paramedic Allen Rennie, from the

Cochrane District EMS in Timmins, Ont., workswith both CP@Clinic and CP@Home programs.

Because funding for community paramedicine islimited in the north – the program receives $20,000per year from the North East Local Health IntegrationNetwork (LHIN) – every paramedic is dually trainedto be a community paramedic and to deliver primarycare. If an emergency occurs during clinic hours or ahome visit, the 911 call takes obvious precedence.

Rennie averages four to five home visits per shift,each one lasting 30 to 60 minutes. His initial assess-ment of a patient includes a list of criteria-basedquestions, a cognitive function test and a generalhealth check of their blood pressure, weight andother baseline measures. He also captures the layoutof their home.

CP@Home is easy to administer, he says, becauseall activity is governed by the app designed and sup-ported by McMaster researchers and available on hisApple iPad. If a participant answers yes to one of thescreening questions, the app automatically determinesif they are eligible to participate in the program andprovides the next question and/or suggested activity.

Response to the home visits is very positive, hesaid. “We’ve had people quit smoking. We can refer

them to meal plans. We’re allowing them to becomehealthier and to live a better lifestyle,” said Rennie.“We’re there as their voice. A lot of times they don’tactually know how to receive the services they need.”

The Cochrane District EMS currently staffs 12community paramedic hours each week, which ismore than its funding can support.

It has been running clinics at Cochrane DistrictSocial Services Administration Board housing unitsfor two years and became the first EMS to start usingCP@Home in May. Members of the PorcupineHealth Unit are also present at each communityparamedicine clinic.

According to Derrick Cremin, Commander, Oper-ations and Community Paramedicine for the district,the number of patients with high blood pressure hasdecreased by two-thirds and 911 calls are fewer.

Among the success stories is a patient who lost 67pounds, another who quit smoking and one who washousebound due to a poor-fitting prosthetic who hassince been fitted properly.

“We’re not here to duplicate services. We’rehere to augment services,” said Cremin. “Thenice thing is we’re reaching people who’venever had interventions, nor would theyhave been intervened.”

Donald MacLellan, general manager ofMedavie EMS Ontario, ChathamKent, agrees that community para-medicine is a complement to ex-isting programs, not a replace-ment. After four years, the pro-

gram in Chatham Kent is re-ducing 911 calls and emer-

gency room visits by about70 percent on average, he

said. Hospital bed dayutilization is down byroughly 72 percent.

The program operatesseven days a week, eight hours

a day and is staffed by one full-timeand three part-time community paramedics.Referrals come through primary care

providers in conjunction with Ontario’s Health Linksprogram, as well as through regular operation para-medics who identify patients requiring follow-up.

Some clients are also referred through FutureHealth Services, a service that monitors chronicallyill patients at home, including those with congestiveheart failure and chronic obstructive pulmonary dis-ease (COPD).

A paper-based system initially, the program is inthe process of implementing an electronic medicalrecord from Interdev Technologies Inc. that will inte-grate with the region’s paramedic operations software.

It is also working with Sensory Technologies Inc.and the Erie St. Clair LHIN to implement the chart-ing function in Sensory Technologies’ eShift plat-form, giving community paramedics access to real-time patient care information while they are in a pa-tient’s home, and ensuring clinicians in the regionreceive updated records related to the visit.

“This model is working,” said MacLellan, who ex-pects the integration of technology will simply addefficiency so that more patients can be served. “Thepartnerships are there. The communication isthere…We’re all striving toward the same client goal

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Paramedics are becoming pro-active in reaching out to the elderly and infirm, reducing trips to the ER.

Community paramedicine reduces trips to the ED, before patients need to call 911

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C O N T I N U I N G C A R E

BY DAVE WEBB

soon-to-be-released white paperfrom Queen’s University willshow an astonishing return oninvestment for a paramedicprogram involving 20 ser-

vices in southwestern Ontario. The pro-gram provides remote technology to fre-quent 911 callers with chronic illnesses;using the technology, they can alert staff tochanges in their condition.

In what’s being called the biggest studyof its kind providing objective cost-benefitof such a remote monitoring program, thepaper from the Smith University School ofBusiness reports a 542 percent ROI to thehealth system for the Community Para-medicine Remote Patient Monitoring(CPRPM) pilot project. The program ranfrom April 2015 to December 2017.

Patients who suffer from chronic ob-structive pulmonary disease (COPD), con-gestive heart failure (CHF) and diabeteswere equipped with plug-and-play wirelesstechnology to report changes in their con-dition, so staff from the Middlesex-LondonParamedic Service could follow up withphone calls or home visits, as necessary.

Rick Whittaker, general manager ofWellington-Waterloo Community Fu-tures, which helped finance the pilot withCanada Health Infoway, said while severalprograms were looked at in the develop-ment of CPRPM, “a lot of the other pro-grams had an extra layer of technology.”

He explained that some systems havepatient information going to an interme-diary who makes the judgment call ofwhether to escalate. In contrast, CPRPMoperates on an “ATM” model – paramedicsself-serve, rather than having a figurativebank teller handle the transaction.

Paramedics handling 911 calls are tiedup until their patient is admitted to a hos-pital, consuming a lot of time and stretch-ing resources to the point where a dreaded“Code Zero” – no available transport –could occur, said Harvey Goldberg, direc-tor of Ideal Life Inc., the platform providerfor the CPRPM system.

Users are equipped with self-pairingBluetooth-enabled sensors that connect to atransmitter in the home, which is constantlyscanning for and connecting to new devices.

The transmitter sends readings over thecellular network. This no-touch approachwas necessary to the ROI equation. Withthe break-even point calculated at savingthree 911 visits per patient per year, techsupport calls would eat into balancequickly, Whittaker said.

The study shows a 26 percent reductionin 911 calls at a cost reduction of almost$4.8 million for 650 users, or about $7,300a patient. Patient-centred outcomes alsoshowed a remarkable improvement, with30 to 35 percent reductions in ER visits,hospital admittance and readmissions.

Ideal Life had anticipated setting up thein-home equipment for the 90-plus peopleinvolved in the pilot, Goldberg said, butfound the paramedics wanted to do itthemselves – it gave them an opportunityto do a home visit and to check that userenvironments were safe and healthy.

“That relationship is the very most im-portant part of the program,” he said.

The model makes the community para-medic a sort of lynchpin in the manage-ment of patients with chronic illnesses.When glucometer readings or O2 satura-tion levels pass predefined thresholds,paramedics have several escalation op-tions, said Dustin Carter, superintendentof community paramedicine for the Mid-dlesex-London Paramedic Service.

If oxygen levels report slightly low, aparamedic can phone the patient and askclinical questions: Was there shortness ofbreath after exertion? Or the paramediccould pay a visit in a non-emergent re-sponse vehicle for a more thorough assess-ment, communicating with healthcareproviders, rendering care on scene, or fur-ther escalating to the 911 system.

“We encourage people to do daily mon-itoring,” Carter said, a personal touch thatleads to better patient compliance andcontributes to patient education. Whilepatients are receiving education from clin-ical visits, it’s often a struggle for them tosee a primary care doctor or specialist. Andthose clinicians don’t have the in-the-fieldview of patient circumstances.

Community paramedic John Clarke re-calls a diabetes sufferer who was generatingas many as 100 911 calls a year. She was re-ceiving instruction from a specialist andhad been issued a Glucagon kit for severehypoglycemic episodes; the specialist had-n’t been aware that the family member shelived with was developmentally delayedand couldn’t safely handle the mixing of in-gredients and injection of the solution.

Recently, an emergency call led Carterand Clarke to a chronic illness sufferer“living in squalor,” unable to ambulate,dress or feed herself.

“You think of impoverished areas,”Clarke said. “This wasn’t the case at all. Youwould never have known what was goingon if you didn’t walk through that door.

“There are certain things it’s beneficialto lay your eyes on.”

The system also allows inclusion of thepatient’s entire “circle of care”, such as theGP, nurses, specialists, and family mem-bers. For her part, Jocelyn Kohlmaier canmonitor the vital signs of her parents, both87, from her office in Toronto. It’s coinci-dental that she’s the executive director ofCanada Health Infoway’s Ontario Region.

Infoway ponied up about $1.6 millionto Community Futures’s $500,000 for theCPRPM pilot as part of a mandate to fos-ter innovation in healthcare.

CPRPM resonates with Infoway’s goals:Innovating cost models. Many pro-

grams are short-term and funded on thecheap with no continuity; CPRPM’s costmodel is sustainable and scalable; Innovat-ing delivery models. CPRPM allows in-home management of chronic illnesseswithout the cost of mobile nursing staffhospitalization; Innovating care models.Traditionally, clinicians have access to pa-tient information in a siloed fashion, whileCPRPM includes the entire circle of care.

The Kohlmaiers – a father with COPDand a mother with diabetes, daughters inToronto and Cambridge, and a primarycare physician in Waterloo – are posterperfect for the paramedic-patient relation-ship. “They listen to their paramedicsmore than to my sister and I,” she said.

Study shows benefits of paramedics managing the chronically ill at home


John Clarke, paramedic, and Dustin Carter, Superintendent, Community Paramedicine, Middlesex-LondonParamedic Service, are among the leaders in a regional test to manage the chronically ill in their homes.

signed to be comprehensive with re-sources already defined for much ofhealthcare. Examples of resources includea Patient, Condition, or an Observation.

Use of this standard will help to breakdown the information silos that exist inhealthcare. For example, a readily avail-able patient health history can help ERphysicians make educated assessmentsabout an appropriate medication whenthere is no one to speak for a patient.

FHIR supports access to such vitaldata at the push of a mobile app button.It also supports the creation of an “appstore” of independently developed mobileapplications because it supports the col-lection of data and availability via APIs.

Using FHIR and APIs, interfaces canbe quickly produced that offer patients

the ability to add their own health datato patient portals, even from theirsmartphones – an emerging trend.

In addition, data from genomics andprecision medicine has increased theamount of data available in a patient’srecord. As the population of aging pa-tients and the prevalence of chronic dis-ease has increased, the ability to datamine and to be proactive with popula-tion health management has emerged asa key driver for health systems. Imple-menters needed a modern standard tohandle this huge increase of data.

For clinicians, FHIR improves accessto a more complete, higher quality EHRby including data from traditionalsources like lab results and also evolvingsources such as personal devices and ge-nomic information. The standard allowsfor a greater choice of applications anddevices to support clinical workflow. Theability to share information seamlessly

will result in time-saving for clinicians,placing their focus back on the patient.

The proliferation of patient appsmeans more forms of asymmetrical dataexist than ever before. FHIR helps re-move the technical barriers for datafrom patient engagement apps and al-

lows it to be included in clinical systemswhile also preserving provenance.

A boon for developers is that FHIRuses familiar tooling and web relatedtechnologies such as XML/JSON,HTTP, REST, SSL and OAuth2. Prede-fined resources and APIs allow imple-menters to focus on the core applica-

tion functionality.FHIR has resulted in lower cost-of-en-

try for new vendors, improved access todata and an increase in the commercialviability of app development. The stan-dard encourages the development of anecosystem of FHIR compliant apps thatcan work with different FHIR servers.

Challenges: Despite all its advantages,FHIR is not a panacea for interoperabil-ity. There are many other requirementsthat need to be met, particularly estab-lishing data-sharing agreements betweenthe involved business level participants,developing and verifying safeguards forsecurity and privacy, defining a commonterminology among healthcare partners,and agreeing on the workflows involved.

Caryn Harris is the Canada Health In-foway eReferral FHIR Working GroupCo-Chair, and Principal Consultant atOrion Health.

FHIR deliversCONTINUED FROM PAGE 16

FHIR makes it easier toinclude information fromevolving sources of data,such as personal devices.

A


BY NEIL ZEIDENBERG

TORONTO – A recent nationalstudy by Teva Canada, a globalleader in generic and specialtypharmaceuticals, found that

more than 8 million Canadians are unpaidand unrecognized caregivers – peoplehelping family or friends with acute orchronic conditions.

Moreover, seven in 10 Canadians be-lieve caregivers aren’t supported by thecurrent healthcare system, and almost halfsay they don’t have anyone to speak toabout their experiences as a caregiver.

Teva Canada has teamed up with Cana-dian Caregiver Network (CCN) to launcha new caregiver pilot project in Quebec.

The pilot provides in-pharmacy supportto caregivers and an accredited caregiver-focused training program for pharmacyteams. It also encourages caregivers to join

Huddol – a social collaboration platformconnecting caregivers to a network of peersand healthcare professionals.

“It’s really about people helping peo-ple,” said Mark Stolow, Founder and CEOof Huddol, and President of CCN.

Huddol (www.huddol.com) refers tothe word huddle, meaning a gathering, andaims to connect individuals caring forfriends or family with healthcare experts.“Whether they’re seeking expert insight, orthe life experience of their peers, caregiversalways have a network to depend on,” saidStolow. The pilot program with Tevalaunched in Quebec on June 1, and theplan is to start rolling it out to other Cana-dian provinces beginning in January 2019.

By joining Huddol, caregivers can con-nect with healthcare professionals who cananswer questions, find other caregivers on asimilar path, and locate information on abroad range of health conditions. “They canalso participate in live group chats and makeuse of other supports like online learningand more,” said Christine Poulin, SVP andCountry General Manager, Teva Canada.

A key goal of the pilot is to optimize thepharmacist-caregiver team, making thempartners in the care of patients and ensur-ing the well-being of caregivers in theprocess. Pharmacists can play a more sig-nificant role in interacting with and sup-porting caregivers, and hopefully improvepatient outcomes.

They can help by providing a medica-tion review with both patient and care-giver present, so it’s more clearly under-stood what the medication is, and how itshould be administered.

They can also provide informationabout an illness of the patient being caredfor, and offer health tips and recommen-dations on how to manage the caregivers’

own health and well-being during thisstressful period.

“Caregivers who wish to communicatedirectly with a pharmacist on a patient’sbehalf can simply download and fill out aproxy template at TevaAidants.com. Oncesigned and shared with the pharmacist,

they can communicate by phone, email ortext,” said Poulin.

Success from the pilot will be deter-mined in various ways. “The pilot programin Quebec is designed to generate learningand opportunities for future enhancementsfor a planned national roll out,” said Poulin.

“We’ll be aggregating caregiver survey re-sults, tracking the numbers of Care Kits dis-tributed, tracking the number of pharmacistsregistered and completing our related contin-uing education program, measuring traffic toour Caregiver website and click through rateson our email communication to pharmacists.”

Huddol and Teva Canada find solutions to caregiver challenges

h t t p : / / w w w . c a n h e a l t h . c o m S E P T E M B E R 2 0 1 8 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 2 1

Christine Poulin Mark Stolow


BY REBECCA IHILCHIK

Toronto caregiver Ron Belenoknows what it’s like to have aloved one with dementia go miss-ing. “My dad had Alzheimer’s for

over 10 years. He used to be a wanderer –he’d go on walks, become confused and getlost,” Beleno says. “As a caregiver, it’s one ofthe scariest times. Worst-case scenarios al-ways pop into your head. You know theirlife could be at risk.”

Beleno’s father wasn’t the only one. Wan-dering is one of the many anticipated symp-toms of dementia; it’s commonly cited thatthree out of five people with dementia willwander from home. For families and care-givers, the disappearance of a loved onewith dementia can be devastating.

Motivated by his own experience andthose of other families he knows, Belenoset out to find a better solution. He teamedup with Dr. Lili Liu, a professor of occupa-tional therapy at the University of Alberta,to create Community ASAP: an alert sys-tem that allows first responders to triggerlocalized notifications to community vol-unteers when an older adult goes missing.

“When you interview individuals after aperson who goes missing is found, eitherinjured or deceased, you find out manymembers of the community spotted theperson but didn’t report it because theydidn’t think the person was lost,” Dr. Liusays. “It seemed first responders were notusing the biggest resource at their finger-tips, which is community citizens.”

With support from the Centre for Aging+ Brain Health Innovation (CABHI) – asolution accelerator focused on driving in-novation in the aging and brain health sec-tor, led by Baycrest Health Sciences –Community ASAP is on its way to chang-ing how we search for missing seniors.

How it works: When a volunteer signsup for Community ASAP, that individualcan select up to five neighbourhoods theyusually frequent – for example, those neartheir home and work. If an older adultgoes missing in one of the designated areasthe volunteer selected, all volunteers whohave signed up to monitor that neighbour-hood will receive an immediate alertthrough email or an app notification witha description of the older adult.

Community members are asked to keepan eye out and contact first responders ifthey come across the individual.

Alerts will be sent out by the designatedcommunity coordinator, which, depend-ing on the area, could be the police or anorganization such as the local Alzheimer’sSociety. In some jurisdictions police al-ready have their own public alert strate-gies, says Dr. Liu, in which case they wouldsimply integrate Community ASAP intotheir protocols.

The hope is that the service will ulti-mately lead to shorter searches for missingolder adults, which will in turn save firstresponders time and money.

The alert system, once available to thepublic, will be free for volunteers. Users

will be able to customize their experienceby selecting the exact radius of areasthey’re willing to receive alerts for. Byhoning in on such a localized level, theapp founders hope to prevent “alert fa-tigue” – the desensitization to a constantbarrage of alerts.

Community groups, police, businesses,caregivers, and individuals living with de-mentia alike are eager to get involved, Be-leno says. And, with support fromCABHI, the Community ASAP team hasbeen able to mobilize the grassroots-levelinterest quickly.

The CABHI connection: The Com-munity ASAP team successfully appliedto CABHI’s Spark Program, receiving$50,000 to test and validate their earlystage innovation.

“I was just thrilled to hear that CABHIinvolvement comes with a whole fleet ofacceleration services like guidance andconsultation related to commercializa-tion, licencing, and intellectual property,”Dr. Liu says. “Those are services on top ofthe financial support which, I think, isbrilliant.”

The Community ASAP team is now inthe process of testing early versions of thesoftware in simulations with groups ofvolunteers, caregivers, and police in Cal-gary, Toronto, and Coquitlam, BC. They’llbe using the feedback from participants inthese trials to tweak the system.

The plan is for Community ASAP to re-cruit thousands of subscribers acrossCanada. In this way, the program will actas an awareness campaign in its own right:a call to action that will educate those whowouldn’t necessarily know about demen-tia-related wandering.

Hope for those living with dementiaand their families: The first target group,and the heart of the project, includes fam-ilies of older adults with dementia andtheir communities. By harnessing thepower of communities, the CommunityASAP model has the potential to save thelives of older adults living with dementia –and give caregivers more peace of mind.

Sam Noh, a caregiver from Coquitlam,is hopeful about the prospect of Commu-nity ASAP. His father Shin Noh, who livedwith Alzheimer’s, has been missing sinceSeptember 2013. “There were confirmedsightings of my father on the day he wentmissing. Unfortunately, news of my fa-ther’s disappearance spread slowly and wereceived confirmed sightings days after,”Noh says. “I truly believe if an alerting sys-tem such as Community ASAP were inplace, my father may have been found.”

Roger Marple is an individual livingwith dementia from Medicine Hat, Albertawho recently joined the Community ASAPteam as a lived experience advisor. He, too,sees tremendous potential in the system.

“I’ve wandered and gotten lost aboutfour times in my life – I even got lost at myjob. It’s a dreadful feeling when you’re in asituation like that,” Marple says. “Commu-nity ASAP resonated with me personally. Isee such a benefit from this program inour communities. It’s different from otherprograms because it’s so localized. It makestotal sense.”

To learn more about CABHI, visitwww.cabhi.com.

at the end of the day and that’s improv-ing their overall healthcare and confi-dence in their ability to care for them-selves at home in a very safe and appro-priate manner.”

In Alberta, the model for communityparamedicine is working so well, it re-cently expanded to be a province-wideinitiative under Alberta Health Services(AHS). Referred to as EMS Mobile Inte-grated Healthcare, the programlaunched in Calgary in 2013 and in Ed-monton in 2014. By last year it was sup-ported by 33 paramedics who handledapproximately 12,000 patient events.

This year, as it rolls out to includePeace River, Grand Prairie, Camrose, RedDeer, Lethbridge and Medicine Hat, it isexpanding to more than 100 paramedicswith 25,000 patient events anticipated.

Intake for community paramedic re-ferrals is handled by two coordinationcentres located in Calgary and Edmonton.

When the team first goes into anarea, it partners with communityhealthcare and continuing care staff –primarily supportive living, long-termcare and private home care facilities – aswell as with primary care networks toidentify patients who may be managingchronic illness or are experiencingsymptoms that require triage.

“Our team focuses on what we con-sider providing acute, episodic illness

support,” explained Ryan Kozicky, direc-tor, AHS’s EMS Mobile IntegratedHealthcare. “So, we do diagnostic treat-ments and assessments in the home, butnot case management.”

Activities performed by Alberta’scommunity paramedics range from col-lecting blood work or performing ECGs,to applying sutures or administeringblood transfusions. Uniforms are busi-ness casual and the paramedics driveSUVs, working seven days a week from 6a.m. to 10 p.m. in most regions.

Paramedics are using tablets, as wellas Bluetooth-enabled devices, but coor-dination of information is expected to

improve when the province’s Epic elec-tronic health record implementationgoes live within the next few years. Pre-liminary cost analysis indicates that thetreatments provided by paramedics inthe home are $1,100 less expensive onaverage compared to providing the sametreatments in a hospital’s emergencyroom, said Kozicky.

“The paramedic scope of practice re-ally meets the needs of what we’re doingin terms of providing those skills-basedtreatments,” he said, adding that “theEMS infrastructure itself in terms of be-

ing able to provide mobile medicine, issomething that’s quite unique and para-medics can leverage.”

Quebec-based Prehos Inc. is takingthe same approach, leveraging its three-year investment in developing EMS op-erational software to develop an EHRtailored to community paramedicine.Originally developed for Renfrew Coun-try in Ottawa, the software is being usedby five services in Ontario, includingParry Sound and Lanark County.

The app runs on an Apple iPad andis centrally managed by Prehos. “If atablet gets stolen, we can erase it. If wehave updates, we can push them overthe air,” said Prehos CEO and co-founder Christian Chalifour. “There’sno IT involved at the user end and onour side, it’s quite simple.”

In addition to providing portable ac-cess to patient health records, the softwareis integrated with dispatch and schedulingso that an employee at the paramedicbase knows what’s happening in the fieldin real time, explained Chalifour.

Each patient record has a progressnote that covers past visits and past re-ports, as well as information on medica-tions, allergies and medical contacts.Paramedics can also take photos andadd media files to their notes when vis-iting patients.

Chalifour heard about one incidentwhen a paramedic observed a strangerash on a patient’s leg, took a picture andsent it to the primary caregiver, receivinga response before the visit was complete.

ParamedicineCONTINUED FROM PAGE 18

Treatments provided byparamedics in the home are$1,100 less expensive onaverage than in the ER.

Ron Beleno Dr. Lili Liu

Community ASAP recruits from public to help adults living with dementia


BY IAN FISH

Many of us appreciate the op-portunity to disconnectfrom the hustle and bustle ofour everyday lives to give our

bodies and minds a chance to re-charge.But when solitude becomes long-term andturns into persistent loneliness, the resultscan be detrimental and potentially devas-tating, particularly for older adults.

In fact, as evidenced by the followingmedia headlines, the risk related to “lone-liness” is a new and emerging public healththeme in Canada:

• Loneliness even unhealthier than obe-sity, should be a public health priority(Global News, August 17, 2017)

• Loneliness and Social Isolation Becom-ing an Epidemic (Global National News,January 18, 2018)

• Should Canada Develop a Strategy toCombat the Growing Problem of Loneli-ness? (CBC Radio, January 21, 2018)

For many, loneliness arises from unmetneeds for social interaction.

Representing more than just an unwel-come break in one’s fabric, loneliness is aprecursor to a host of poor health risks in-cluding heart disease, dementia and in-creased risk of mortality.

Loneliness also has an economic andsocial ripple effect across families, indus-

try, and society. In Canada, while citizensaged 65 and older account for 15 percentof the population, they consume morethan 45 percent of the public-sectorhealthcare dollars, according to CIHI.

So, where do we go from here? Establishing a flexible platform for

sharing, disseminating, and accessing in-formation is sorely needed and the powerof a host of innovative technologies, suchas machine learning, artificial intelligence,IoT platforms, and blockchain-enabledconsumer consent, can open the door to ahost of new possibilities, including:

• Seniors creating a virtual community:To maintain mental wellness, it is crucialto communicate and stay connected, feelmotivated to engage with other people,and have a sense of purpose.

A virtual community – virtual “townhalls” so to speak – can help seniors leadfuller lives by helping them connect witheach other over personal interests, shop-ping, health support, entertainment, andsocial events accessible to them.

• Both current and new service providerscould gain new insights from large datastores, information previously locked intoinformation silos (finance, retail, govern-ment, healthcare, etc.) to identify and pre-dict adverse events such as financial fraud.

• Similar to treating illnesses such as dia-betes and heart disease, the most effective

approach to addressing loneliness is earlyidentification of the problem and takingpreventive action. Knowing when peopleare at risk, family and provider organiza-tions can proactively help them build andmaintain their “social capital” as well asmitigate the physical and social losses thatnaturally occur as one ages.

• Descriptive: Is Mom okay today? Is sheshowing signs of decline? What help does

she need?• Predictive: Is Momlikely to be okay to-morrow? What prob-lems is she likely tohave? What help isshe likely to need?• Prescriptive: Whatsteps can we take togive Mom the bestchance of being oktomorrow?• Cognitive: How do

we learn to understand elderly individualsso that we can help them achieve their bestoutcomes, self-sustainability?

Avamere (an independent healthcareprovider for seniors based in Wilsonville,Ore., is a great example of an initiative fo-cussed on addressing the specific needs ofthe aging and lonely population.

Together with IBM Accessibility Re-search, Avamere has embarked on a six-

month project that will use IBM Watson’sdata interpretation capabilities to decidehow best to care for individual elderlyresidents.

This pilot will involve hundreds of peo-ple in Avamere’s independent living, as-sisted living, and skilled nursing settings,as well as its rehabilitation arm.

The pilot will use Avamere’s historical,de-identified patient data, plus real-timedata from sensors placed throughout eachresident’s living space.

Most sensors will be set in residents’rooms and will collect data related to anindividual’s behaviour and movements,such as gait analysis, factors that could leadto fall risk, and daily activities, includingpersonal hygiene, sleeping patterns, incon-tinence and trips to the bathroom.

For example, a higher frequency oftransitions from bedroom to bathroomcould predict higher fall risk, possible uri-nary tract infection, or increasing confu-sion with respect to time and place.

This is an example of “Global Age-Friendly Cities” as proposed by WorldHealth Organization, which allows seniorsto remain in their homes, close to friendsand social support, and contribute activelyto their communities.

Ian Fish is Canadian Healthcare ServicesLeader, IBM Canada.

Addressing aging and loneliness: What role can technology play?


ventures with innovative companieslike Spxtrm AI. Other areas in whichWest Park has formed partnerships in-clude 3D printing, for prosthetics, andsmart textiles.

In this instance, “We’re actively look-ing at ways to reduce aggressive behav-iour,” said Walker. “We brought SpxtrmAI in, so they could contribute.”

Indeed, Spxtrm AI has set up shop atthe hospital so that it can not only de-vise a solution right on the premises, butso it can also readily draw on the exper-tise of West Park’s clinicians and IT staff.“They’ve provided us with a develop-ment sandbox,” said Jay Couse, co-founder and CEO of Spxtrm AI. “We candevelop the solution four times fasterhere than we could in a lab.”

Meetings are held with West Park staffevery two weeks to discuss progress andwork out solutions to new challenges. Andby being embedded right into the WestPark campus, there’s a constant flow of in-formation to the developers. “It’s the wa-ter cooler effect,” said Couse, explainingthat even informal discussions can havean enormous impact on the solution.

Couse leads the project as the “entre-preneur-in-residence”. The company alsohas a computer vision expert and Spx-trm AI Co-Founder on site at West Parkguiding the application development,along with two other staff members. Aswell, an AI team in Edmonton is alsoworking on the project.

The company and West Park were

awarded a $75,000 grant from the On-tario Centres of Excellence, to whichthey have contributed matching fundsand resources. Couse said Spxtrm AI willraise additional development funds fromprivate investors.

Both Couse and Walker emphasizedthat patients and their families haveprovided full consent for the researchproject, and that a formal privacy impactassessment was conducted. The teameven met with the Ontario Privacy Com-missioner’s office to ensure it was com-pliant with the rules and regulations.

As well, over 99 percent of the au-tonomously monitored video that is in-gested by the AI system is discarded im-mediately; the less than 1 percent of theimages that remain – consisting of theincidents of aggressive behaviour orother aberrant conditions, such as falls –are securely stored in a blurred, redactedformat for a minimum period of timeto allow for professional staff review. It’sall designed to protect the identities ofthe patients.

Couse noted that West Park alreadyhas cameras mounted throughout theAcquired Brain Injury Behavioural Ser-vices unit. The problem has been that it’sdifficult for humans to monitor thevideo feeds 24 hours a day. “Very quickly,there’s a 98 percent drop-off in attentionafter 20 minutes when people are moni-toring video screens,” said Couse.

However, by using machine learning,computers can be taught to detect signsof aggression and to alert the appropri-ate staff. And of course, computersnever get tired.

How does a computer detect aggres-

sive behaviour? What is it looking for?Couse noted that machines can betrained to recognize certain types of mo-tions that signify violence or pre-cursorsto violence. “As well, loud noises may setoff certain patients, and some patientsmay be annoyed by the actions of certainpeople,” said Couse. “This can all bebuilt into the algorithms.”

While the system currently makes useonly of images, in future it may add au-tonomous audio analytics. As such, itwill be able to detect when patients raisetheir voice in anger or when objects fallor are smashed.

Continuous learning and a leanmethodology is being used, meaning a

new iteration of the system is rapidly de-vised and tested to obtain feedback. Itthen goes into a new round of develop-ment, so that an increasingly effectivesolution is produced.

West Park’s Manager, Research andEvaluation, Tim Pauley, noted they don’twant the system generating too manyalerts, which can create alert-fatigue andtend to be ignored. Neither should thesystem produce false alerts. “It has to beable to determine the difference betweenaggression and a handshake or a pat onthe back,” said Pauley.

It also has to know the difference be-tween something that may look like a

fall, but really isn’t. For example, some-one bending down to tie a shoelace, orpicking something up off the floor.These actions shouldn’t be confusedwith a fall.

As an added benefit, Pauley said thesystem could be trained to offer real-time advice to care-givers. For example,if it spots them trying to lift a patientout of bed, and they’re using the wrongposture, it could offer advice via voice-technology – sort of like a GPS correct-ing your route when you make a wrongturn in your car.

The computer vision system couldalso detect when patients have spent toolong in bed, and need to get up or beturned, to avoid bedsores.

Moreover, Spxtrm AI aims to makethe solution available to other facilities.And it will expand the range of behav-iours that it can detect.

At the top of list is falls detection – amajor problem for the frail and elderly.

“Up to seventy-five percent of falls infacilities are un-witnessed in the pa-tient’s or resident’s private room,” com-mented Couse, whose co-founder atSpxtrm AI is an orthopedic surgeon.And in cases where the patient suffers afracture, the faster you get him or her tosurgery, the better the outcome.

So, it’s a real benefit if you can detectfalls and call for help as soon as possible.

Moreover, with enough learning, thecomputer vision system could be taughtto predict falls, and not just detect themafter the fact.

“As the datasets build up, we plan tostart to provide predictive capabilities,”said Couse.

Cameras and AICONTINUED FROM PAGE 1

“We can develop the solutionfour times faster here thanwe could in a lab,” says JayCouse, CEO of Spxtrm AI.

Ian Fish

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