BY JERRY ZEIDENBERG

Cornwall Community Hospital, inCornwall, Ont., has become one ofthe first hospitals in Canada to im-

plement a brand-new wireless technologythat runs as fast as 2.6 gigabits-per-second –as rapidly as a high-speed wired system.

The installation means the CornwallCommunity Hospital could conceivably gowith a completely wireless strategy in the fu-

ture – where no computer workstation,phone or medical device requires cabling.

It is also an important step in the orga-nization’s mission to reach HIMSS Analyt-ics Level 6 in the EMRAM scale, which re-quires it to be a completely paperless hospi-tal. “That means no more jotting down vi-tal signs or other notes on paper,” com-mented Mario Alibrando, director of infor-mation technology.

“We’re soon going to acquire an inte-

grated system that can wirelessly transmit allinformation to the electronic health record,”he said. “So all IV pumps, and all medicaldevices, will automatically transfer informa-tion wirelessly.”

The benefit, of course, is an increase inpatient safety, as the automated transfer ofvital signs and other information wouldreduce the transcription errors that occurwhen data is keyed-into computers. As

Cornwall hospital races ahead on wireless technology

CONTINUED ON PAGE 2

INSIDE:

Dragon’s Den for LTCInnovators with solutions for nurs-ing homes and other LTC facilitiespresented their ideas to a panel ofjudges at a recent OLTCA confer-ence in Toronto. The solutions aredesigned to improve care and re-duce its costs.Page 4

Diabetes careGlooko, a startup company, hasproduced a web-based systemthat’s able to read the data from29 of the most popular blood glu-cose meters. It’s enabling doctorsto manage whole populations ofdiabetic patients.Page 7

Surgical checklistsMontreal’s Jewish General Hospitalwas the first in Quebec to imple-ment the NSQIP and WHO’s Surgi-cal Safety Checklist. The organiza-tion found that checklists have im-proved patient outcomes and com-munications among caregivers.Page 9

Vencap fuels health ITHIMSS ‘14 in Orlando was host tothe Venture+ conference, whereinvestors discussed what they’relooking for when it comes to

healthcare IT innovators. There is ahealthtech boom going on, withinvestors backing new solutions.Page 8

Former U.S. secretary of state Hillary Clinton, a keynote speaker at HIMSS ‘14 in Orlando, Fla., observed that health reform in the UnitedStates is providing millions of people with medical insurance for the first time. To an overflowing audience, the possible 2016 presidential con-tender argued that continued debate on healthcare reform is needed, aided by evidence rather than ideology. SEE MORE HIMSS COVERAGE ON PAGE 8.

Hillary lauds Obamacare for improving lives

Making a difference where it really matters

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FEATURE REPORT: WIRELESS AND MOBILE SOLUTIONS – PAGE 12

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 19, NO. 3 APRIL 2014

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well, it would reduce the paper burdenon nurses and allow them more time forpatient care.

The new wireless standard that’s sup-porting all of this is called IEEE 802.11ac.It just became available last year, and it is adramatic improvement over 802.11n,which it supersedes.

Cornwall has acquired the leading-edgesystems from Meru Networks, of Sunny-vale, Calif., a leader in wireless and a sup-plier of solutions to more than 12,500 cus-tomers in 59 countries.

802.11ac’s operating speed of 1.3 giga-bits per second, per radio, compares withjust 300 megabits per second, per radio, for802.11n – which was considered to be in-credibly fast just a few years ago.

Just as importantly, the new standardcan support a huge number of users with-out a drop in performance. “On any givenday, we have about 200 wireless users con-necting to the network at the same time,”said Alibrando. “Nobody has experiencedany degradation with the new system.”

Alibrando noted that most hospitals

have implemented wired systems that de-liver gigabit speeds to the desktop – whichis considered to be a major achievement.However, they’re still struggling on thewireless side, as they’re using the older802.11n at a time when demand for wire-less bandwidth is exploding.

That’s because large groups of cliniciansand administrators want to make increas-ing use of wireless devices, such asiPhones, iPads and Android phones.

According to Alibrando, the new802.11ac wireless technology is more reli-able than traditional cabled systems –something strange but true. He explainedthat 802.11ac has complete failover capa-bilities; by contrast, wired systems makeuse of routers and hubs that require man-ual resets if they go down.

Cornwall tested the 802.11ac technol-ogy before acquiring it, and found that itdelivered even large image files to radiolo-gists using wireless devices – quickly andwithout system degradation.

Alibrando said that radiologists would-n’t typically work on mobile devices, but inthe future, their workstations could beoutfitted with wireless cards and wouldn’t

need cabling. It’s possible that cablingwon’t be needed at all, in any area of thehospital.

“That will save us $300 per cable drop,”he said, explaining that hospitals require aspecial way of running cables above ceil-ing tiles to avoid contaminating the roomswith dust and potentially infectious parti-cles. “It takes four times as long to run ca-

ble in a hospital as it does elsewhere,” saidAlibrando. “The installers need to userolling hoarding units, and they moveonly one ceiling tile at a time. It’s verylabour intensive.”

“If we had this technology when weconstructed our new building, we couldhave saved $120,000 in cabling,” he said.Cornwall Regional recently constructed agleaming 95,000 square-foot wing at a costof $120 million.

Wireless computing throughout thehospital has been optimized by creatingthree levels of access, based on the priorityof the users.

The first tier consists of ‘Life Critical’applications, such as wireless IV pumpsand telemetry.

The second level is called ‘Mission Crit-ical’ and covers applications such as EMR,VoIP, Citrix-based CPOE and barcodemedicine administration.

The third category consists of ‘PatientCritical’ applications, such as WiFi for pa-tients and their family and friends.

Wireless channels are dedicated to each,but Meru does the job in a virtual way,meaning that performance is enhanced andfewer radios or access points are needed.

Alibrando noted that Cornwall Com-munity Hospital installed only 150 accesspoints to cover the entire facility; by con-trast, other hospitals using older technolo-gies typically use a far larger number.

According to Meru, the company’s802.11ac runs on standard power overEthernet supplied by existing networkswitches. Most other 802.11ac solutionsneed additional voltage, requiring com-plete switch infrastructure upgrades.

Given the increased throughput, thenew 802.11ac technology could even sup-port wireless TV sets. The limitation rightnow, however, is that devices in current usedon’t have the cards needed to take full ad-vantage of 802.11ac’s blazing speed.

New devices will likely contain them inthe future, as the standard catches on. Un-til then, devices equipped with other wire-less cards can still benefit, as they will runat speeds of up to 300 megabits per secondwithout experiencing any signal loss.

Meru customers, including RoyalCaribbean Cruise Lines and the Universityof Houston, have publicly reported asmuch as 40 percent increased throughoutwhen using the old 802.11n devices on the802.11ac network.

Older 802.11n wireless systems boast atop speed of 300 megabits per second, butin reality, “you never get 300,” commentedManish Rai, Meru Network’s vice presi-dent of corporate marketing. “You mightget half of that,” he said.

Cornwall Community Hospital has alsodeployed many VoIP phones that use thehigh-powered wireless network. Instead ofusing cellular or wired technology, theyrun on the 802.11ac network.

Overall, the hospital is well placed tomove ahead with a completely wirelessstrategy in the future, if it chooses. It alsohas the wireless infrastructure in place tosupport the move to the paperless hospital,with its attendant benefits of reducedmedical errors and increased productivity.

CONTINUED FROM PAGE 1

Cornwall Community hospital races ahead on new wireless technology

Art DirectorWalter Caniparoliart@canhealth.com

Art AssistantJoanne Jubasjoanne@canhealth.com

CirculationMarla Singermarla@canhealth.com

Publisher & EditorJerry Zeidenbergjerryz@canhealth.com

Office ManagerNeil Zeidenbergneilz@canhealth.com

Address all correspondence to Canadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill, ON Canada L4J 7R9. Telephone: (905) 709-2330.Fax: (905) 709-2258. Internet: www.canhealth.com. E-mail: info2@canhealth.com. Canadian Healthcare Technology will publish eight issues in 2014. 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. ©2014 by Canadian Healthcare Technology. Thecontent of Canadian Healthcare Technology is subject to copyright. Reproduction in whole or in part without prior written permission is strictly prohibited.Send all requests for permission to Jerry Zeidenberg, Publisher. Publications Mail Agreement No. 40018238. Return undeliverable Canadian addresses toCanadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill, ON L4J 7R9. E-mail: jerryz@canhealth.com. ISSN 1486-7133.

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

Volume 19, Number 3 April 2014

Contributing EditorsDr. Alan Brookstonealanbrookstone@shaw.ca

Dianne Danieldianne.daniel@cogeco.ca

Richard Irving, PhDrirving@schulich.yorku.ca

Rosie Lombardirosielombardi@hotmail.com

Andy Shawandy56@telus.net

Some hospitals are strugglingwith wireless, as they’re usingolder technology when demandfor wireless is exploding.

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

BY ANDY SHAW

It was hard to choose between thehighs and the lows at the OntarioLong-Term Care Association’s 5thAnnual Research Day – high-techand low-tech innovation, that is.Held as part of two frozen OLTCA

February days at the Hilton Hotel in down-town Toronto, the event featured six 90-second presentations by long term care(LTC) innovators to a TV-style den of threesharp and experienced LTC dragons. Allwith the purpose of identifying new waysto improve LTC care and reduce its costs.

At the high tech end, the dragons andmany of the other LTC researchers, innova-tors, home directors, physicians, policymakers, and even students in the audienceheard the quick pitch by Tracy Milner, CEOof BrainFx, based in Markham, Ont. ItsBrainFx 360 tablet-based brain health as-sessment tool wowed them all. In the handsof a trained operator, the 360 can measurethe effects of mild to moderate brain disor-ders and spit out a comprehensive profileof a patient’s entire neurofunction.

That profile, which is immediately ac-tionable by caregivers, ranges across theperson’s cognition, mood, behaviour, bal-ance, sleep, diet, and the normal activitiesof daily lives.

“It’s a process that with traditional,manual methods would take professionals20 to 30 hours to produce such a profile;but with the tablet we can get it down toless than two hours,” said Milner, a practis-ing occupational therapist. “So with the360 tablet, we can get the cost of a com-plete neurological assessment that wouldnormally run from $2,000 to $3,000, downto $75 or less.”

Just as impressive was a $15 innovation,dubbed the ‘Hidden Pocket’, pitched to thedragons by Lynne Beer, a personal support

worker (PSW). This 11-year veteran of theVision Nursing home in Sarnia, Ont., hasworked the gamut of long-term carethrough transfer-and-lifts, palliative care,continence and best practice teams. But itwas a brief discussion with Vision’s fallsprevention squad that first turned Beer to-wards her home sewing machine.

She designed Hidden Pockets to holdand hide a fall monitor securely on the backof a wheelchair. In that position, it is nearlyimpossible for a patient to remove the tat-tle-tale tab from their clothing before theyattempt to get up without assistance.

Eschewing Velcro in favour of the ven-erable button, Beer designed Hid-den Pockets to be held in place withan elastic, adjustable, button-holedstrap that will fit any size of wheel-chair back rest, or bed headboard,or lounging chair. Virtually any-where a patient is not supposed torise from without help. And if theydo, they set off the hidden moni-tor’s piercing beeps.

So impressed was Dragon DonFenn with Beer’s innovations thathe subsequently offered to helpBeer develop full-fledged businessand marketing plans for hernascent business. Fenn is renowned inCanada for his commitment to LTC, espe-cially in the home. He is chairman of theFenn Group of Companies, president ofCaregiver Omnimedia, and publisher ofthe Family Caregiver newsmagazine.

The other two Dragons in the OLTCAden were: Sarah Ferguson-Maclaren, a for-mer North Bay General Hospital registerednurse who is now the eastern region opera-tions director for OMNI Health Care Ltd. inPeterborough, Ont., an extended and nurs-ing care provider, and Christine Ozimek, a20-year LTC veteran who now is COO forPLTC, which owns and operates five long

term care/retirement living facilities. Bothhave a keen eye for new LTC technologiesand the early phase companies, care facili-ties, or individuals developing them.

Accordingly, they and Fenn took carefulnote of what Lindsay, Ontario-based Ex-tendicare Kawartha Lakes, a 64-bed longterm care home, is doing with a Swedish-developed innovation, TENA Identifi, a72-hour voiding assessment tool being pi-loted for the first time ever anywhere.

“It gives tremendous help to caregiversdesigning toileting plans for incontinentpatients,” explained Shelley Gallant, theclinical director for SCA Personal Care, a

Swedish multi-national handling TENAproducts in Canada from its Drum-mondville, Quebec headquarters.

The pattern of voiding is tracked bysensors in the TENA undergarments pa-tients are wearing and the resultant data isuploaded wirelessly directly to the TENAIdentifi web portal. “The incontinence re-ports for caregivers are then generated bythe portal meaning there is no software in-volved,” said Gallant. “And importantly,you’re not relying on patients to enter theirvoiding times manually.”

Also in the wireless vein, Mark Seiden-feld, president and CEO of BCI Networks,

gave the dragons a fast-paced pitch for thecompany’s SARA Wireless Emergency CallSystems.

“What it does is create a ‘Wireless Bub-ble’ as we call it around any facility,” saidSeidenfeld.

“And the Bubble encompasses not onlythe nurse call systems, but just about everyother generator of emergency signals, in-cluding wireless repeaters, wireless pulland plunger stations, wireless smoke de-tectors, wireless temperature controls, andwireless pendants that can all be pluggedinto any 110-volt outlet.

“So it doesn’t require any rewiring orchanges to conduit infrastructure.That makes it affordable for retro-fitting LTC homes and facilitiesthat are often older buildings.” Seidenfeld ended the Dragon’s Denpitches on a high tech note, butthey had begun earlier by the dra-matic entrance of a presenter artifi-cially disabled by a low tech “aging”suit. The $3,000 Japanese-devel-oped, tan-coloured overalls withred restraining straps and disablinghead and eye-ware are being usedby the Baycrest Centre for Learn-ing, Research and Innovation in

Long-Term Care – in partnership with theMichener Institute – to mimic the ambula-tory, hearing, vision, and other physicallimitations of the elderly as they experi-ence the healthcare system.

“We call it ‘Taking a Walk in Their Shoes’and we use it to shift the values and attitudestowards elderly patients of Baycrest staff, aswell as our support workers and visiting stu-dents,” said presenter Jennifer Reguindin, amultiple degree-holding former RN who isnow the interprofessional educator at theBaycrest Learning Centre. “They get in thatsuit and they can feel the limitations of ag-ing themselves.”

LTC ‘Dragon’s Den’ draws innovators, both high-tech and high-touch

Early warning helps prevent unexpected code blues in pediatric patientsBY RAJESH SHARMA

Unfortunately, the harrowingscene of doctors and nursesrunning with crash carts to achild’s bedside after an ‘unex-

pected’ code blue is a familiar one tomost hospital workers. In 2002 Dr.Christopher Parshuram, a physician andsafety scientist in the Department ofCritical Care Medicine at The Hospitalfor Sick Children (SickKids) recognizedthat in most cases it was possible toidentify children well before the imme-diate call for help was made. With thehelp of Kristen Middaugh, a paediatricintensive care nurse, they began carefulresearch to see which vital signs could berelied upon to provide early identifica-tion of clinical deterioration in children.

“Through our research, and with thecollaboration of 300 health care profes-sionals and data from 5000 patients, theBedside Paediatric Early Warning System(BedsidePEWS) was developed to helpclinicians identify children who are clini-

cally deteriorating, allowing medicalteams the time they need to interveneand prevent the need for immediate as-sistance from a resuscitation team,” ex-plains Dr. Parshuram.

In 2009, Parshuram and Middaughpublished their results in Critical Carehighlighting the development and initialvalidation of the Bedside PaediatricEarly Warning System (BedsidePEWS)based on data from hospitalized childrenwho were stable and those who were de-teriorating.

The study concluded that a seven-item score can quantify severity of illnessin hospitalized children and identifycritically ill children with at least onehour notice.

In Critical Care 2011, a multicentrestudy involving 2,074 patients confirmedearlier results that BedsidePEWS scorecould identify children at risk for car-diopulmonary arrest. In the same year, aprospective observational study waspublished in Paediatric and Child Healthshowing that after implementing Bed-

sidePEWS, there was an 83 percent re-duction in the rate of late transfers to re-ferral centres and a 77 percent reductionin stat calls to in-house paediatricians.

Recognizing the need for appropriatedissemination of BedsidePEWS, and therequirement to develop a robust elec-tronic form of BedsidePEWS, SickKids

and MaRS Innovation collaborated to es-tablish Bedside Clinical Systems (BCS).

The program digitally logs, charts,and helps clinicians evaluate the sevenvital signs that are part of routine clini-cal assessments and then summarizesthem into a single score. From the Bed-sidePEWS score, care providers can bet-ter match the level of care with the pa-tient’s required needs, thereby improving

patient outcomes and reducing thenumber of urgent calls, code blue inci-dents, and related deaths.

“Identifying at-risk patients is signifi-cant since approximately 5,000 childrenin North America experience a code blueevent each year, from which too manychildren die or sustain neurologicaldeficit. BedsidePEWS hopes to improveoutcomes for these patients and theirfamilies,” says Dr. Parshuram.

BedsidePEWS is currently being usedin hospitals in Canada, the United States,UK, Italy, and New Zealand. Unlikeother systems, BedsidePEWS can be usedon all pediatric patients regardless oftheir condition. It is the only FDAcleared system for children. For hospitalswithout electronic charting systems, BCSoffers a paper documentation solution.

Rajesh Sharma is president & chief mar-keting officer at Bedside Clinical Systems.He can be reached at rsharma@bedside-clinical.com. For more info visit: www.bed-sideclinical.com

BedsidePEWS, developed atthe Hospital for Sick Children,is lowering the number ofcode blue events.

h t t p : / / w w w . c a n h e a l t h . c o m4 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y A P R I L 2 0 1 4

Participants presented their innovations to the three seated dragons.

Advanced Health Technologies is one of four key areas of focus at

Ontario Centres Excellence. OCE develops strong sector opportunities

that align with the province’s innovation agenda for driving economic

growth and position Ontario as global leader.

Some key initiatives:

• Partnering with Quebec in life sciences to support research projects that develop innovative

tools and technologies – an initiative out of the cross-provincial Life Sciences Corridor, one

of the three largest life sciences research clusters in North America.

• Investing in early-stage medical technologies to help stimulate commercialization and

provide citizens with cutting-edge healthcare facilities and patient care while generating

economic activity for the province.

• Turning neuroscience researchers into neuro-entrepreneurs by supporting the

commercialization of discoveries that help diagnose, treat or cure brain disorders.

If you want to learn more about the latest in healthcare discoveries, plan to attend OCE’s multiple award

winning Discovery conference and trade show on May 12-13, 2014 in Toronto. For more information and

to register, visit ocediscovery.com

Ontario Centres of Excellence (OCE) is Ontario’s leader in industry-academic collaborations that result in innovative business ideas and solutions.

We invest in Ontario companies of all sizes in sectors that benefi t the province’s economy from IT and health tech to energy and the environment.

We also facilitate the mentoring of entrepreneurs of all ages and help turn promising business ideas into successful companies.

TORONTO | MISSISSAUGA | OTTAWA | WATERLOO | WINDSOR | LONDON | HAMILTON | MARKHAM | OSHAWA

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Ontario Centres of Excellence is a member of

Leveraging Ontario’s world-renowned research

capacity in advanced health technologies

Advanced Health Technologies

PR

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CA

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BY BRANDI CRAMER

Joanne Aspin considers herself fortunate tohave enjoyed good health throughout herlife. But she hasn’t come by it easily. “Eachyear, subject to what stage of life I was at,due diligence was done by way of appropri-ate healthcare maintenance – routine blood

work, mammograms, paps, etcetera.”Still, as a professional businesswoman who trav-

elled extensively, it took a lot of time to stay on topof simple tasks like booking annual checkups. “Atone time, this whole process – from booking an ap-pointment, to getting results – took 14 businesshours of my time and this was for a healthy person,”she says. Now 60, Aspin is starting to experiencehealth issues that come naturally with age. “This ofcourse means more time is required from my nu-merous healthcare providers.”

But thanks to the introduction of Mihealth, Aspinhas become an empowered partner in her healthcare.Mihealth is a messaging and personal health record(PHR) system that gives subscribers quick access totheir personal health records and caregivers, whenand where they need them.

Developed in 2011 by Dr. Wendy Graham,founder and CEO of Ontario-based Mihealth GlobalSystems Inc., there are now thousands of patientsutilizing the technology. The application can bedownloaded to a patient’s smartphone, tablet orcomputer, giving them unfettered access to personalhealth records with medical information validatedby their physician.

Mihealth also allows bi-directional messaging be-tween patient and provider and incorporates high-end security certified by Canada Health Infoway(Pre-Implementation 2011). Offered on more than236 mobile platforms, Mihealth is interoperable withEMRs and Remote Monitoring Devices.

“This is about empowering the individual toknow about themselves and their family and takethat data worldwide for the rest of their lives. It’s acontinuum of healthcare information,” says Dr.Graham.

Traditionally, physicians took on more paternalis-tic roles with exclusive access and control of their pa-tients’ medical records. Technological advances aremaking it possible for patients to take some of thatcontrol and contribute to their own path of care.

Recently, Aspin put the EHR to the test when sheexperienced a health emergency. “I ended up in thehospital on Christmas day. What I was able to do wasactually print off reports relevant to my particularcase, take them with me to emerg and provide themto the doctor on call,” she says.

Her ability to provide her medical history on thespot helped her get the care she needed. “I think anytool whereby patients have access to their ownrecords instantaneously is invaluable,” Aspin says.

Being able to outline allergies, fill in detailed med-ical history and see lab results shortly after they areavailable to her doctor has made a loyal user ofAmanda Carvalho, vice-president of academics at acareer college in Ontario.

“Through using it I’ve actually come to better un-derstand my health and the treatment that my doc-tor gives me,” Carvalho says.

It can be difficult for a patient to remember all thequestions they want to ask about lab results or health

issues they are having during a 15- to 30-minute ap-pointment. Having access to their records, patientsare afforded the time to review results, research is-sues and in turn message their health provider withadditional queries. “I’ve done that before and I cansay that getting a Mihealth message back from a busymedical office has often been easier than trying to getlucky and get through when lots of other patients arecalling,” Carvalho says.

Aspin and Carvalho are two of a growing trend ofpatients who are actively seeking out ways to facili-tate interactions with their healthcare providers.

In a 2012 Harris Interactive Poll of 2,311 adults,17 percent of patients had online access to doctorvisits, prescriptions, test results and medical history,a number greatly outweighed by the 66 percentwithout the service who deemed it important orvery important.

Results showed a similar disparity for all the tested

services including email access to doctors (12 percenthave, 53 percent important or very important) andonline appointment setting (11 percent have, 51 per-cent important or very important).

So what’s the hang up?Like other innovative technological advances that

make their way into the marketplace, it takes time togrow and convince the more conservative commu-nity it’s a good place to go, explains Bill Pascal, Prin-cipal at Richard Warren and Associates and formerChief Technology Officer for the Canadian MedicalAssociation.

“This is like any new capability that enters theworkplace. There are early adopters. They are willingto take the risk because they see the value. They are15 to 20 percent of the potential market,” he says.

The other 80 percent are more conservative, butnot necessarily against the technology. “They alreadyhave something that is working and for theseproviders to change, there has to be an increasedvalue to go through a process to introduce new tech-nology and the costs of making the changes.

A large portion of that group has already startedto move to electronic health records, and increas-ingly, peer-reviewed research shows the benefits ofphysicians using a more digital environment to sup-port patients.

The interesting part, Pascal says, is the fact thetools the people are utilizing – mobile technology –in their personal lives can be used in the health sec-tor, much like the way we do our banking.

“We will see that grow into the care sector as theconsumer is going to say ‘Why can’t I have an emailchat or Skype with my doctor?’”

Mihealth is currently building a secure connec-tion with Microsoft’s Skype which will allow usersvideo conferencing and real-time communicationcapabilities.

This opportunity is one that Dr. Adam Moir, ageneral practitioner in Dryden, Ont., believes couldbe of great value for a case conference with a patientwhose family members are located remotely.

Dr. Moir, who recently received a grant to enroll400 of his patients in Mihealth, says he does antici-pate the added technology will increase his workloadbut believes the pros outweigh the cons.

“Here is a smartphone that can show a complete listof a patient’s current medications. This makes patientcare safer and has infinite potential,” Dr. Moir says.

On average, established doctors have about 1,500patients. Of those, Pascal estimates 20 percent need80 percent of that physician’s time – such as thosewith chronic diseases and geriatric patients.

Mihealth creates the ability for the consumer towork with healthcare providers, who have all thesame devices and can interact in a virtual way. Itlessens the need for face-to-face consultations basedon the type of issues the patient has.

Mihealth users can also allow family members toaccess their records, giving peace of mind to childrenof aging parents seeking medical care.

The Alzheimer Society of Canada states e-health,such as Mihealth and other technology, is helpingCanadians become more active partners in manag-ing their healthcare needs. These tools are especiallyimportant for the caregivers of people living withAlzheimer’s disease and other forms of dementia.

“It provides quicker access to medical informa-tion, doctor care and for people affected with de-mentia, this means they feel more empowered, in-formed and confident, helping them to remain activeand independent longer,” says Rosanne Meandro, aspokeswoman with the Alzheimer Society of Canada.

An eHealth policy paper published by the OntarioMedical Association in February delved into topicsincluding governance, creating electronic records,data sharing and interoperability currently beingtackled by provincial jurisdictions across the coun-try. Pascal says a lot of these issues can be facilitatedwith Mihealth.

By way of example, the issue of data governanceand who gets to see the information and for whatpurpose becomes a little easier when using thetechnology.

“If you give the information to the patient, the pa-tient determines who gets to see the data. It is the pa-tient’s data. The file in the doctor’s office is for regu-latory purposes,” Pascal says. “There is no one solu-tion to solve all issues. But Mihealth goes a long wayto make some of these issues go away or becomemore manageable.”

The application can be downloaded to a patient’s smartphone, tablet or computer.

Mihealth gives patients quick access to their records, eases communication

Mihealth links Joanne Aspin to her health records and providers.

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BY JERRY ZEIDENBERG

ORLANDO, FLA. – Many compa-nies have produced diabetestrackers that upload readingsfrom a patient’s glucose meter

to a computer or smartphone; some caneven store the data in the web. However,most are proprietary systems from devicemanufacturers, and physicians using soft-ware from one company are unable to readthe data when patients are using solutionsfrom another supplier.

That makes supervising a large groupor patient population difficult, if not im-possible.

Now, however, Silicon Valley-basedGlooko has produced a system that is in-teroperable with 29 different blood glu-cose meters, including devices from mar-ket leaders Lifescan, Freestyle and Roche.

“Our system covers 85 percent of themeter market,” commented Rick Altinger,CEO of Glooko. “Providers love it, becausethey need just one package and they’re ableto monitor a whole patient population.”

Blood glucose readings can be uploadedto iOS or Android devices, and then to theweb, where the results can be monitored bythe patient on a secure dashboard. “When

patients log in, they see only their own in-formation,” said Altinger. They can anno-tate the readings, leaving comments aboutreadings, diet, exercise and insulin, andthey can also print out reports.

Glooko exhibited at the HIMSS ’14conference, held in Orlando in February.The company’s booth was located in theSamsung pavilion, where many of Sam-sung’s partners were also exhibiting.

Earlier this year, Glooko announced itraised $7 million in venture funding, someof which was supplied by Samsung.Glooko Inc., of Palo Alto, Calif., was co-founded in 2010 by technologist YogenDalal, formerly of the Mayfield Fund and aone-time student of Internet pioneer VintCerf, who is now a vice president and chiefInternet evangelist at Google.

The company introduced the technol-ogy to Canada in 2012 at a Vancouver con-ference sponsored by the Canadian Dia-betes Association. Altinger said Glookonow has hundreds of users in Canada.

According to the Canadian Diabetes As-sociation, the prevalence of diabetes inCanada has doubled since 2000, and isprojected to affect nearly 11 percent of thepopulation by the year 2020.

Many people with Type 2 diabetes cankeep the disease under control throughclose management of medication, diet, ex-ercise and logging their blood glucose lev-els through products such as Glooko, thecompany said.

At HIMSS, Glooko announced the re-lease of software that provides populationmanagement with analytics and a graph-like interface. Called Glooko PopulationTracker, the solution enables clinicians to

monitor large groups of diabetics and im-mediately see which individuals are at riskof becoming hypo or hyperglycemic.

Drilling down into the patient’s record,the physician can see average blood glu-cose levels over various periods of time, aswell as ‘outliers’, the BG results that are well

outside the averages.“The clinician can monitor the patient,

and know what’s happening, even before thepatient comes into the office,” said Altinger.

The doctor and patient can then workon the care plan, adjusting insulin levelsand how the individual eats and exercises.

Close monitoring of a patient’s glucosereadings is a critical part of maintainingthe health of at-risk individuals. However,Altinger said fewer than 10 percent of pa-tient encounters include an analysis oftheir blood glucose records. “Few peopledo it, because it is so hard,” he said.

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Glooko works with 29 differentblood glucose meters, includingdevices from Lifescan, Freestyleand Roche.

Glooko brings interoperability, analytics to monitoring of diabetes patients

F O C U S O N S O C I A L M E D I A

A P R I L 2 0 1 4 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

The health industry strives to deliver high-quality care and the best-possible outcomes for patients and citizens at lower costs. It’s a goal that health organizations, communities, partners, and Microsoft can all rally around.

Innovative, flexible, and cost-effective health solutions from Microsoft and its partners help connect people, processes, and information to help advance collaboration and enable health teams like yours to make more insightful decisions, faster. These solutions work in concert with your existing systems to help improve ef fciency and quality of care.

Learn more at www.microsoft.ca/health

Real impact for better health

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

BY JERRY ZEIDENBERG

ORLANDO, FLA. – Health-care used to be called theslowest industry to adoptnew technologies, espe-cially those of the elec-tronic variety. Now, how-

ever, the sector is something of a SpeedyGonzalez, and is racing ahead of others –thanks to venture capitalists and invest-ment bankers, the folks who are financingmany of the innovations.

“For once, healthcare is taking the leadin technology,” asserted Lucian Iancovici,investment manager for Qualcomm Ven-tures of San Diego, Calif., and keynotespeaker at the Venture+ forum, part of theHIMSS ’14 conference that was held insunny Orlando in February.

“Every medical device is now being re-invented,” said Iancovici, who was a NewYork-based medical doctor before joiningQualcomm Ventures.

Moreover, he noted the explosion ofsoftware apps in recent years, with moreappearing each month. “There has been a10-fold increase in apps in the last fewyears. Will there be a few big winners or awide variety of successful apps? Nobodyknows.”

For its part, Qualcomm is a giant in thecell-phone industry, and since 2007 hasbeen investing in startup companies thatbring innovation to the healthcare sector. Ithas an investment fund of $100 millionand, so far, has put money into 12 health-care start-ups.

They include Fitbit, which has produceda wearable fitness tracker that uploads met-rics to your smartphone and to the web; For

its part, Qualcomm invested a sizeable $43million.

Iancovici said that in the three yearsfrom 2011 to 2013, US$4 billion was in-vested overall in healthcare technologystartups in the United States. He expectsthat figure to soar to US$30 billion by 2019.

Qualcomm Ventures views six areas ofhealthcare as having the most potential forgenerating successful new tech-nology businesses:

• Wellness. There is incredibleopportunity in creating devicesto promote health and to helpconsumers avoid becoming sick.Fitbit is a prime example, alongwith trackers of all sorts – for ex-ercise, diet, sleep quality, and oth-ers.

• Chronic disease management.The healthcare system is havingtrouble dealing with an epi-demic-like growth in diabetes, aswell as cancer, hypertension, andother chronic illnesses. Solutions that tiepatients to care-givers and help to keeptheir conditions under control are in de-mand.

• Re-admission reduction. Hospitals aretrying various strategies for keeping pa-tients well once they have been discharged,so they are not re-admitted.

• Aging in place. Another strategy for re-ducing the pressure on healthcare facilitiesis to help the aged stay healthy while stillliving at home. Various types of monitor-ing systems can assist.

• Clinical trials. Getting new medicationsinto the marketplace faster, but with the cor-rect testing beforehand, is a major challenge.

• Telemedicine. Physician shortages are

being experienced in rural areas of theUnited States and Canada, and sometimesin urban centres, too. Telemedical solu-tions are being developed to bring special-ist care to regions that face shortages ofskilled physicians.

Iancovici offered several examples ofleading-edge devices that solve some ofthese quandaries.

• Cell-phone-based glucometers, whichease glucose testing and mean that patientsnever have to write anything down – all ofthe data is captured and logged by thephone. Results can be immediately sent tothe doctor, who with the assistance ofcharting and analytics, can monitor manymore patients than before.

• Diagnostics tests that are moving frominside the hospital or doctor’s office andinto the home. “There are EKGs availablefor $2,000,” said Iancovici. “One with a sin-gle-lead attaches to a cell phone.”

• New sensors that can be attached to cellphones, enabling point-of-care screeningdiagnostics. For example, a device that canmeasure electrolyte levels.

• Ambient intelligence, meaning systemsthat passively collect information, insteadof requiring the patient or consumer topump data into a device. Iancovici men-tioned the example of a solution that mon-itors how often the elderly go to the bath-room – which could be an indication of aurinary tract infection.

There are plenty of problems to besolved, and many scientists andentrepreneurs are working onthem and producing new tech-nologies. However, Iancovicistressed that evidence will be keyin validating the benefits of digitalhealth solutions. “You have tobuild out studies in the way thathealthcare professionals under-stand,” he said.Iancovici noted the Mayo Clinicdid a study of Fitbit, to find outhow well patients recovering fromsurgery did with the help of thetracking device. Just as impor-

tantly, companies have to show up frontsavings to the healthcare provider. “Theydon’t want to hear that the solution willpay for itself in five years,” he said. “Theywant to see immediate benefits.”

According to Mercom Capital Group, aconsulting firm based in Austin, Tex., theTop Five venture-capital funded compa-nies in 2013 were:

• Evolent Health, a population healthmanagement services organization that in-tegrates technology, tools and on-the-ground resources to support health sys-tems in executing their population healthand care transformation objectives. Itraised $100 million.

• Practice Fusion, a web-based EMRprovider, which raised $85 million in twodeals.

• Fitbit, a fitness and health tracker com-pany, which brought in $73 million in twodeals.

• MedSynergies, a provider fo revenueand performance management solutionsto healthcare providers, which raised $65million.

• Proteus Digital Health, a provider of adigital health feedback system, whichraised $45 million.

While there are large players makingdeals, there are hundreds and perhapsthousands of financings from smaller ven-cap funds, investment banks, angel in-vestors, as well as loans from governmentand university-backed economic develop-ment agencies and incubators.

Katya Hancock, director of strategicpartnerships with StartUp Health, an incu-bator and company that runs StartUpHealth Insights, a healthcare vencap data-base, said the healthcare sector has “histor-ically stifled innovation,” but is now in aperiod of creative destruction. She notedthat many industries are going throughmassive transformations – they includemedia, music, retail and commerce, andnow healthcare.

According to Hancock, the biggestgrowth areas for healthcare technology arein ‘patient engagement’, meaning solutionsthat empower patients to take charge oftheir own health. Similarly, solutions forchronic disease management are also onthe rise, she said.

Venture investors fueling surge in healthcare technology innovation

A panel of investors addresses an audience at the HIMSS Venture+ forum.

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BY DANA FRANK

In its ongoing quest to improve patient careand provide top-of-the-line surgical services,the Jewish General Hospital (JGH) was thefirst hospital in Quebec and only the third inCanada to join the National Surgical QualityImprovement Program (NSQIP), in 2009.

Soon after, the JGH was again first in Quebec to im-plement the World Health Organization’s SurgicalSafety Checklist.

Both NSQIP and the Checklist positively impactpatient care and outcomes, identify areas to target forquality improvement, increase efficiency, and reducecosts that could then be re-invested in areas of clini-cal services and care.

NSQIP is an international program that comparesa hospital’s surgical outcomes to those in hundredsof other hospitals. Since some hospitals are largerand more specialized than the JGH while others areconsiderably smaller, all participating institutionssend their data to NSQIP which uses a sophisticatedstatistical method of adjusting for differences be-tween hospitals.

NSQIP then provides hospitals with the tools, re-ports, analysis and support to make informed deci-sions and monitor quality improvement initiatives. Arisk-adjusted report is submitted to the JGH everythree months, which provides information aboutwhere there remains room for improvement, andhow the hospital is doing compared to others.

General Surgery, Colorectal Surgery and VascularSurgery were the focus from the start at the JGH.Then recently, Orthopedics, Neurology and Urologywere added. The intention has been to target morecomplex surgical areas that could potentially benefitfrom NSQIP.

“The hospital’s membership in NSQIP shows ourcommitment to improving for the benefit of ourpatients, which is fantastic,” says Anna Pevreal,head nurse for the operating rooms.

“It’s a very humbling process, because youmay learn you’re not quite as good in someareas as you previously thought,” explainsDr. Lawrence Rosenberg, executive directorof the Jewish General. “The investment inour membership in NSQIP has alreadyyielded impressive improvements in surgicalservices at the JGH.

Dr. Rosenberg was chief of surgicalservices when the JGH joinedNSQIP and adopted the Checklist.

Surgical clinical nurse re-viewers with a clinical back-ground and unique NSQIPtraining coordinate the col-lection of data at the JGH.After submitting this data toNSQIP, the hospital receivesbenchmarked results on itsperformance. Once a trend isflagged, the JGH puts intoplace a multi-disciplinarytask force to address and cor-rect the issue.

“We’re now looking at 60

cases per week,” explains Gina Ciccotosto, JGH sur-gical clinical reviewer. “We review each patient’schart from one year prior to their surgery until 30days after, which is unique. By calling patients athome and reviewing the surgeon’s follow-up charts,we are now identifying complications such as infec-tions after discharge.”

Corrective action to reduce post-surgical compli-cations often alleviates services across the institution.Since NSQIP was introduced at the JGH, it has be-come clear that it is not just a surgical improvementprogram; it has proven to be a hospital-wide im-provement initiative.

There are reductions in patient length of stay, de-mand on resources, consultations andtherapies such as medications and ad-ditional surgical procedures. Whenthese hospital services are relieved byimproving complications, the qualityand safety of care are also improvedand institutional costs come down.

“An added benefit of this post-sur-gical follow-up and of the improve-ments implemented is that it furtherpromotes the patients’ quality of lifeafter their surgery,” says Ms. Pevreal.

The JGH’s Department of SurgicalServices has gained a deeper under-standing of where improvement isneeded and has achieved substantial reductions inthe rates of surgical site infections and post-surgicalurinary tract infections since joining.

For example, the rate of surgical site infectionsamong patients in colorectal surgery has continu-ously decreased since it was flagged in 2009. Also,since Orthopedic Surgery was brought in, NSQIP re-vealed a trend of over-reliance on transfusions.Thanks to that flag, another multidisciplinary team

has come together to research protocols andbest practices in order to address and correct

the issue. Today, there are over two million cases inthe NSQIP’s centralized and extensive

database that can be accessed by member institutionsfor research purposes. As a member, the JGH can au-thorize any staff member to access cumulative datafrom other participating hospitals to conduct re-search and explore hypotheses.

“Accurate, ongoing measurement is essential toimproving quality,” says Dr. Rosenberg. “It ultimatelyreduces the overall cost of treatment and care, high-lights weaknesses and offers a realistic understandingof how we compare to other hospitals.”

“Ms. Ciccotosto adds, “Our goal is simply togather the most reliable information possible to im-prove the quality of surgical care.”

The pursuit and culture of improvement at theJGH is continuous. As such, SurgicalServices opted to join the growingranks of leading hospitals around theworld in making systematic safetychecks mandatory in all types ofsurgery. The Checklist is a quick, sim-ple and inexpensive, yet remarkably ef-fective means of reducing infectionrates and lowering the number ofmedical complications and errors. These procedures, which usually addno more than one or two minutes tothe surgical process, ensure that thesurgeon and other members of theteam are familiar with the patient’s

health, and that every necessary precaution has beentaken to protect the patient if something unexpectedhappens. Among the points covered are the patient’sallergies; the availability of blood products in case ofblood loss; the likelihood of complications; con-cerns, if any, by the anesthesia team; and the need forpost operative antibiotics.

Everyone in the operating room is also required toidentify themselves before the first incision is made.Research has shown that the simple act of statingone’s name and job description makes each personfeel like an active participant whose voice deserves tobe heard.

“The process that comes along with using theChecklist promotes communication among the teamand flattens the hierarchy of those in the OR,” says Ms.Pevreal, who co-chairs the committee that introducedthe Checklist. “Everyone gets an equal voice for the pa-tient, which in the end, reduces the risk for error.”

The JGH completed the last Accreditation Canadaprocess in 2012 and was awarded Exemplary Stand-ing. As such, the JGH met all compliance criteria forinfection rates including tracking, analyzing and pre-vention. Additionally, all criteria were also met forthe implementation of the Checklist.

The final Accreditation Canada report stated,“The JGH demonstrates a constant desire to beamong the best healthcare institutions, first andforemost to provide patients with services of thehighest quality. The institution never ceases to com-pare itself to others to keep an eye on best practicesthat could help them become more effective andmore efficient.”

“In the end, our team is able to celebrate our suc-cesses with these initiatives in place,” says Ms.Pevreal. “We can now see progress and results, andwe can be certain we are on the right track.”

Dana Frank is Communications Coordinator for SpecialProjects at the Jewish General Hospital, in Montreal.

Gina Ciccotosto and Anna Pevreal,Head Nurse, Operating Room

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The hospital was the first in Quebec to implement the World Health Organization’s surgical checklist.

Jewish General Hospital finds that surgicalchecklists have improved outcomes

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Dr. Lawrence Rosenberg

BY RICHARD IRVING, PHD

In a series of columns I will discuss the stepsto improving organizational processes. Let’sbegin with step 1: Getting the decision-mak-ing process right. In a series of studies ofmanagerial decision-making, professor PaulNutt showed that half of all organizational

decisions fail. He concluded that the reasons for thissurprising failure rate are lack of consultation andimposition of decisions, limiting the search for alter-natives, and the use of power to implement plans.

By way of contrast, managers who tended to makesuccessful decisions spent time to communicate theneed for action, focused on a clear set of objectivesrather than specific results, carried out an unre-stricted search for alternatives and got key people toparticipate.

Perhaps the most underused technique is partici-pation. Managers are often action-oriented and areconsequently reluctant to spend the time to consultwidely. However, according to Nutt, this is one actionthat can substantially increase the probability of asuccessful decision outcome.

Another key success activity is developing clearobjectives to be achieved rather than focusing di-rectly on problem solving. The difficulty with a di-

rect problem solving focus has two aspects. First, itoften leads to defensiveness and finger pointing.

Who is to blame for the problem? Second, it tendsto unduly limit the search for alternatives. A focus onthe objectives to be achieved, such as reducing oper-ating costs, improving quality, etc., opens the searchto a wider range of possibilities and increases theprobability that a successful decision will be madeand implemented.

Based on Nutt’s conclusions and my own ob-servations, here are several steps you can take toimprove the decision-making process in yourown organization.

First, be careful to probe any informa-tion you receive that indicates there is aproblem. Often the initial definition of theproblem is actually a description of a set ofsymptoms. Once you are convinced thatsomething needs to change, take the time

to convince others of the need for change rather thanimposing your solution. Once the need for action isestablished, define a set of clear objectives to beachieved and open the consultation process. Whiledoing this, stress the need for idea creation and en-courage people to think broadly about the problem.

As the decision process begins to narrow, insistthat more than one option must be considered. Thishelps to avoid the problem of group think and cre-

ates a set of arguments which will be useful toconvince others that this is the best op-

tion. Finally, you must engage politicallyto ensure that the decision is imple-mented. Nutt’s results show that wherepeople are engaged and convinced ofthe correctness of the decision, success

follows. Where political coercion isused, failure often results.

Managing the decision processes youuse is one of the first steps tocreating a high-value organi-zation. Good decision-mak-

ing thrives in an open andsupportive environment

and withers in a blameand shame culture. The

choice is yours.

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A series of studies of managerial decision-making showed that half of all organizational decisions fail.

How to improve organizational processes:Step 1: Get decision-making right

Richard Irving, PhD, is an associate pro-fessor of management science in theSchulich School of Business, YorkUniversity, Toronto. If youhave comments or ideas onthis topic, he can be reachedat rirving@schulich.yorku.ca.

After tests prove benefits, organizations adopt mobile solutions BY BARRY BURK

Arecent IDC study predictsthat mobile workers willconstitute 72 percent of thetotal workforce in 2015. In

healthcare, however, that number ismuch higher. Doctors, nurses andhealthcare workers need to be withtheir patients round-the-clock, nottied to a desk in front of a computerscreen.

Healthcare in Canada has beenfeeling the pressures of growing ex-pectations for better quality care.That coupled with increasing patientload, critical resource shortages andescalating costs results in strains onan already overloaded system.

With precious workforce re-sources stretched so thin, providersmust be able to quickly contact acolleague, who may be anywhere onthe floor or in the hospital. Oftenthat means caregivers have to stopwhat they’re doing, leave their pa-tient to look for someone or place aphone call or a page – time thatcould make the difference betweenlife and death in an emergency.

In such an overwhelming, fast-paced environment, it is possible forpagers, phones or overhead speakersto go unheard or unanswered lead-ing to repeated attempts. This cre-

ates a chaotic environment wherehigh noise levels add to the stress.

But the scene in Sherbooke, Que-bec and more than 80 other facili-ties in Canada is different.

Le Centre de santé et de servicessociaux – Institut universitaire degériatrie de Sherbrooke (CSSS-IUGS) is a short and long-term geri-atric care facility, serving the needsof 760 residents.

It recently equipped staff with Vo-cera hands-free, voice-operatedwearable badges that provide instanttwo-way voice communication. TheStar Trek-like devices make it easierfor nurses and other healthcare pro-fessionals to connect, increasing staffproductivity and improving patientcare response time.

The badges allow caregivers to re-lay simple spoken commands be-tween each other while they’re tend-ing to patients, and can also relaytext messages and alerts.

Instead of responding to pagersor keying phones, a single voiceprompt instantly connects staff tothe caregiver they need, thereby re-ducing phone tag, overhead paging,or the need to physically search for aperson. The system includes an opti-mized speech recognition enginewhich responds to more than 100voice commands.

In Sherbrooke, the system wasalso customized to instantly alertstaff when residents assigned to theircare use their bedside call buttons.

Last year, the system was rolledout to cover almost all of the beds atthe facilities; early trials in severalwards have already seen a significantreduction in noise levels and im-proved response time to patients’calls. “The residents are calmer. Aswe spend less time moving aroundand are thereby more efficient, weend up spending more time with

those for whom we care,” says CSSS-IUGS spokesperson Jean-ClaudePoirier.

Across Canada, we have workedwith many healthcare facilities toinstall the Vocera communicationssystem.

The University of Ottawa Heart In-stitute (UOHI) is the first Canadianhospital to integrate this system with aHIPAA-compliant smartphone appli-cation, which enables clinicians to usetheir personal mobile devices to text,

access and share clinical informationand images on a secure database,without any confidential patient in-formation becoming stored or resi-dent on their personal device.

“This new system enables ourteams to respond faster, ensures thatour patients and their families bene-fit from the best care possible, andsaves time and money on our sys-tem, ” says Dr. Robert Roberts, presi-dent and CEO of UOHI.

Kingston General Hospital startedwith a pilot of the system on one ofits surgical floors. As with any newinitiative, it had to prove its useful-ness and user-friendliness to beadopted and accepted. After all,nurses’ routines and best practicestend to be well-developed over manyyears.

But when the pilot netted results,including a 45 percent reduction intime looking for others, a 61 percentreduction in time to respond tophone calls, a 54 percent reductionin time looking for assistance and areduction in frequency to trips to atelephone from 6.8 times per shiftdown to 2.9 times per shift, the or-ganization decided on a full-scaleimplementation.

Barry Burk is Vice-President, Health-care Industry, with IBM Canada.

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A pilot project at KGHshowed a 45 percentreduction in time spentlooking for others.

BY CRISTIN O’BRIEN

Every provider I talk with wouldlove to improve the way they getpatient test results. After placingan order, whether for a CT scan, a

blood panel, or other test, many providerswait for hours to get the results. They oftenwaste time periodically logging into thepatient’s electronic medical record (EMR)to check for updates or play phone tagwith the Lab and Radiology departments.

Mobile devices are changing this processand generating significant time savings,both for providers and patients. A test re-sults management application, integratedwith the hospital’s staff directory, can auto-matically send notices to the mobile de-vice(s) of the appropriate clinician, lettinghim or her know when results are available.

This can mean faster treatment for pa-tients, and potentially faster discharge. Iffindings are critical and indicate a life-threatening situation, this fast notificationis especially important to cut out wastedtime and improve clinical outcomes. A testresults management solution works for in-cidental findings as well, such as a radiolo-gist noting a suspicious looking lung nod-ule. The application can prompt a follow-up about the nodule later from the pri-mary care physician.

Looking beyond test results, mobile andwireless devices help care providers workmore efficiently when they need to gethold of one another. For example, if an in-patient needs more pain medication thanthe prescribed dosage, his or her nursemust contact the physician to get anotherprescription.

By linking the hospital’s directory andstaff mobile device(s) with intelligent soft-ware, the nurse can get a message to thecorrect physician right away. Perhaps a pa-tient being treated for cancer develops car-diac complications and an on-call cardiol-ogist needs to be consulted quickly. Addingon-call schedules and provider preferencesto mobile device integrations means theright cardiologist is contacted swiftly todiscuss treatment planning.

Another topic that comes to my mind isalarm fatigue, which has been getting a lotof attention lately. Pulse oximeters, heartmonitors, ventilators, and even hospitalbeds are just a few of the devices that rou-tinely monitor patients and trigger alarmswhen a patient’s vitals venture outside thenormal range. The reason these alarms arebeing talked about is because there are somany of them.

A study at Johns Hopkins estimatesthere are 350 alerts per patient bed, perday. Many of these are false positives, butthe large volume of alarms means that im-portant ones can be accidentally missed orresponses could be delayed. Failure toquickly react to an actionable alert maycause patient harm and death.

Mobile devices and mHealth solutionscan play an essential role in alarm man-agement by routing alert details directlyfrom monitors to clinicians for assessmentand acknowledgement. In addition, theseand related solutions also offer significantindirect benefits – audit trails, escalationoptions, and encryption of sensitive pa-tient details.

I frequently hear that while providersand hospitals value the quick messagingcapabilities of mobile workflows, some ofthe other features available with mHealthsolutions are just as vital. Being softwaredriven, mobile communications leave adigital trail that documents when every

message is sent, received, and acknowl-edged. And, of course, digital communica-tions can be encrypted to provide infor-mation security.

This is especially relevant in Ontariobecause of the Personal Health Informa-tion Privacy Act (PHIPA). Encrypting

texts, images, and videos protects sensitivepatient information from being uninten-tionally disclosed to someone who isn’tsupposed to see it.

Cristin O’Brien is Clinical Marketing Man-ager with Amcom Software.

V I E W P O I N T

Avoiding delays in reporting results means patients discharged earlier

Connected Care across the Continuum GoldCare’s mHealth Solutions give your field staff connectivity and information when and where it’s most needed: at the point-of-care. Our award-winning suite of software solutions efficiently manages the full continuum of care to ensure accurate and timely service delivery and maximize resources and workflow.

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BY DIANNE DANIEL

In 2012, Dr. Joshua Landy, a busy intensivecare specialist at Scarborough General Hos-pital in Toronto, was catching up with twofriends over dinner. Today, the three are co-founders of Figure 1 Inc., a start-up that re-cently raised $2 million in seed funding to

grow its healthcare photo sharing app.Years ago, doctors Rahul Mehta and Aravind

Ganesh became fast friends while first-year residentphysicians at the University of Calgary, spendingmuch of their post-call time chatting about chal-lenges in their daily rotations. Now, they’ve part-nered with software engineer Hisham Al-Shurafa tolaunch SnapDx, a mobile app that simplifies com-plex medical knowledge using infographics.

In today’s world of smartphones and tablets,there’s no shortage of ideas for developing mobilehealth apps. How is it that extremely busy physiciansare achieving success?

Ask the founders of Figure 1 and SnapDx andthey’ll tell you serendipity was on their side, but ittakes more than luck to bring an idea from idle con-versation to fruition. You also need a strong desire toimprove the way healthcare professionals work, awillingness to put in a ton of sweat equity, and themodesty to seek help when you need it.

At Figure 1, founded by Landy, mobile developerRichard Penner and GregoryLevey, an associate professor inRyerson University’s School ofProfessional Communication,in Toronto, the idea for an appwas born after Landy spent a sum-mer studying on-line approaches tomedical education at Stanford Uni-versity, in California. He took theage-old notion of a teaching file, es-sentially a file of interesting or per-fectly classic cases that physicians col-lect over time, and applied it to thenew world of digital media.

Rather than simply convertinga paper-based process to an elec-tronic one, he wanted to leverage on-line technology to offer improvements. “You need toinvent a new process instead of just translating it intoa digital one, the same way shopping for diapers onAmazon.com is different than shopping for diapersat a grocery store,” he says. “People are taking thesepictures with the objective of sharing and teaching inmind … there’s no reason why anyone should keep apaper copy in a desk drawer where after a while, theydon’t get used.”

Taking its name from the nomenclature used intextbook captions, Figure 1 is a secure app for shar-ing medical images that can be used as an interac-tive reference and teaching tool. A mobile, crowd-sourced platform, it enables healthcare profession-als to upload images from their smartphone ortablet, tag them, rate them for accuracy or searchthem, all in a manner that is in line with privacyand ethics requirements.

The goal is to take social behaviours – like check-ing a phone multiple times throughout the day – andconvert those to professional behaviours, says Landy,and the concept is catching on. With tens of thou-sands of users in three countries, the app is currently

available on iPhone and iPad with plans to expand toAndroid and desktop versions this year.

Reflecting back, Landy counts himself lucky thatPenner and Levey had the technical and marketingknow-how he was lacking. “I sort of thought I mightend up as the guy with the idea who never did any-thing with it,” he admits. “I didn’t have any clue howto get started with something like this.”

That’s where business incubators and technologytransfer offices come into play. Many universities andcolleges across Canada have them in place. The in-tent is to serve as an accessible infrastructure to sup-port entrepreneurs in the early stages of launching aproduct or service.

Within six weeks of that initial dinner meeting in2012, Figure 1 co-founders had a working prototype.They pitched it to gain acceptance into Ryerson Uni-versity’s Digital Media Zone incubator and Ryerson

Futures accelerator programs in Toronto, receivingcrucial advice, support and investor backing in theearly stages of their company’s growth.

“Only about 15 percent of companies that applyend up getting into the DMZ,” says Matt Saunders,president and managing director, Ryerson FuturesInc. “Of those who come in and start to gain traction,only a small percentage gain access to the acceleratedfutures program and potential funding.”

Both programs look for “coachable” teams, hesays, people who have some expertise or edge intheir sector, and are attempting to solve a real-world problem.

“Very rarely do you find someone who has thetechnical skills to build the app, the marketingskills, background and insight to be able to go selland market it, and the operational background tohire a team and grow and scale,” he says. “Early on,when you can’t afford all of those pieces, we helpyou scale faster and accelerate the development ofyour business.”

From December 2012 to August 2013, DMZ pro-vided office space to Figure 1, along with access tomentors and investors. In addition to arranging fi-nancial support from family and friends, the com-pany has since announced $2 million in seed fund-ing, co-led by Version One Ventures and Rho Accel-erator Fund, and including a number of prominentangel investors.

Right now the company remains dependent on in-vestor capital, but Landy remains optimistic that a rev-enue-generating model is within reach. It means Landymust continue to manage two jobs, working two weeksa month in the hospital’s intensive care unit, and twoweeks at the Figure 1 office, now relocated down thestreet from DMZ, but he says he loves both.

“For the time being they expect us to focus onbuilding a very solid, likeable, useful, enjoyable andeasy product,” he says. “From our perspective we

want to make sure it reaches asmany healthcare providers as pos-sible and provides the best ormost educational experience aswe possibly can.”Making money is not the firstpriority. What’s more importantis delivering a tool that makes adifference.“We are not socialized as Canadi-ans to be entrepreneurial in ourhealth sector,” says Anne Snow-den, professor and chair at TheUniversity of Western Ontario’sInternational Centre for HealthInnovation, situated within theRichard Ivey School of Business.“We’re socialized to achieve thebest possible outcome for thepeople we care for … It wouldn’tbe surprising at all to me if theywere to say, ‘Look. This isn’t goingto make $1 million, that’s notwhy I’m in it. I’m in because Ithink it’s going to offer peoplesome value,” she says, referring toa growing group of clinicians-turned-app-developers.From her vantage point at theCentre, where the mandate is to

be a catalyst for healthcare innovation by supportingmulti-disciplinary education and research, Snowdenis seeing a growing number of ideas come forth forhealthcare apps. One challenge facing clinicians whowant to turn those ideas into products, she says, islearning how to juggle exhausting patient care com-mitments with the demands of a start-up.

“We are a country that is well-known for devel-oping and coming up with very important and in-novative ideas and new knowledge,” she says. “Butwe are not a country that has a strong record interms of getting those ideas or new products intoour health system.”

Both Figure 1 and SnapDx are on track to buck thetrend. Like Figure 1, SnapDx has its first clinical assess-ment product available for the iPad and iPhones withplans to offer Android and on-line versions this year.The first version of the product targets the interactionbetween patients and doctors at point-of-care, provid-ing doctors with quick access to evidence-based prac-tices and knowledge and allowing them to generate pa-

Coming up with an idea is one thing, but turning it into a product takes time, effort and partnerships.

Moonlighting physicians are creating usefulapps, as well as providing healthcare

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tient-specific treatment plans that can beeasily explained to patients using graphics.

Inspired by infographics he routinelyread in The New York Times, Mehtawanted to take the concept of simplifyingcomplex data and adapt it to the medicalcommunity. “We started punting ideasback and forth and this model started tocome together,” says Ganesh, adding thatthe ultimate goal is to transform the pa-tient-doctor visit.

Knowing they needed the help of a soft-ware engineer, the two approached Al-Shurafa who was enjoying early success de-veloping software tools for plastic sur-geons as co-founder of Startup Calgary.They were simply looking for a recom-mendation. Instead, Al-Shurafa came on-board and the three struck a friendship.

For now, the SnapDx co-founders workout of a travelling office, meeting whereverand whenever it’s convenient. It might beSecond Cup or Starbucks or somebody’shome, and they average 10-15 hours of of-fice time per week, or roughly one hour forevery three hours Mehta and Ganeshspend performing clinical duties.

In 2013, SnapDx beat out 13 otherhealthcare start-ups to win first place atthe W21C Innovation Academy at the Uni-versity of Calgary, earning a $10,000 cashprize. Beyond that, they’ve been workingon “sweat equity” and have yet to look forexternal sources of financing. The goal isto have a strong, working beta product be-fore they “start playing with other people’smoney,” says Ganesh.

In the meantime, the team is tappinginto available resources at the University ofCalgary and is looking to partner with as-sociations and groups that produce evi-dence-based knowledge. It also intends tojoin an incubator program, either in theU.S. or Canada.

“The great thing about knowledge isthat facts can’t be patented,” says Ganesh.“One of the passions we share, in additionto trying to improve the quality of health-care, is also trying to improve the equalityof access to information. As we’re lookingat big academic centres like university hos-pitals compared to the average family prac-tice or community hospital, there’s a biggap in the knowledge that can be accessed.”

Ganesh believes one reason for thesuccess of SnapDx to date, includ-ing its overwhelming acceptance at

W21C Innovation Academy, is that it isstrongly rooted in clinical experience anddriven by the need to solve challenges.“What we found is that it doesn’t reallymatter how knowledgeable you are aboutdifferent conditions or how up to date youare on the literature, when it actuallycomes down to the point-of-care, yourbrain falls back on more simplistic modelsfor trying to figure out how you want tomanage a problem,” he explains.

SnapDx solves the problem of informa-tion overload, allowing doctors to rely onmore than just their memories and givingthem a visual way to present data to pa-tients. For example, the side effect visual-ization tool uses a grid diagram ofcoloured boxes to depict possible side ef-fects, correlating the sizes of the boxes tothe likelihood of a patient developing thatparticular side effect.

This year, SnapDx is teaming with agroup of students from University of Cal-

gary’s Haskayne School of Business to par-ticipate in the Clinton Global Initiative’s2014 Hult Prize President’s Challenge.Teams are being asked to build sustainableand scalable social enterprises to addressnon-communicable diseases in urbanslums. The idea is to develop a creative so-lution that can change the way medicine ispracticed in the developing world.

“The students were thinking of some

way to incorporate telecommunicationsinto their solution,” says Ganesh. “Our solu-tion was born in a North American envi-ronment, but perhaps its biggest calling willbe in the developing world, in places wherepeople don’t have the hope of accessinghigh-end technology and everything restson the patient-physician interaction.”

Such altruistic or selfless goals are com-mon among physician entrepreneurs, says

Snowden. Faced with increasing and sig-nificant demands for care from the popu-lations they serve, it’s natural the numberone priority is to create an app that makestheir work life better or more efficient.Apps are exploding in the mainstreamconsumer world as useful tools to helpnavigate, manage and organize effectivelyso it’s just a matter of time before health-care gets there too, she says.

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JOSEPH CAFAZZO, PHD, PENG

It’s inevitable that the next genera-tion of IT products for healthcareproviders will be mobile-based.The convenience and utility of ac-cess to information at the point-of-care that mobile health apps

provide will continue to drive the demand. But the real excitement in mobile health

apps is to be found in the patient-con-sumer space. This includes those who arewell, the informal care provider (mom!),and of course, the patients themselves. It’san area where significant innovation cantake place, as patient-consumers have beenunder-appreciated, under-utilized, andjust plain ignored by the healthcare systemand technology companies.

With face-to-face encounters betweenhealthcare providers and patients becomingshorter, less frequent, and more expensivewith each passing year, we’re discovering thenear-ubiquitous smartphone is becoming achannel to reach those who are seekinggreater involvement in their own care, or thecare of someone they are responsible for.

This notion of patient self-care is notnew. What is new, however, is the ability todeliver it in a way that is simpler and moreconvenient than ever before. Throughone’s phone it’s possible to create a channelfor accessing information, tools, and moretimely communication with providers.

The Next Wave: With the rise of patientself-care, where can the next wave of tech-nology innovations take us? Our teams atthe Centre for Global eHealth Innovationhave been busy developing the next gener-ation of mobile health apps, focused onensuring that we truly improve the healthof the patient.

In our approach, we do what most oth-ers don’t; we use rigorous evidence to in-form our design. It’s expensive, time-con-suming and often really hard, but conduct-

ing clinical trials and using existing pub-lished science is necessary in this space.

Unlike other parts of the consumermarketplace, there is an expectation inhealthcare that any claim of what yourtechnology will do needs to be supportedby evidence. At a minimum, you need toshow it will not harm the most vulnerable.

Unfortunately, the developers of thefirst generation of mobile health apps did-n’t necessarily share this view, and releasedcountless apps that did little more than re-place paper and pen, substitute for aGoogle search, or simply made falseclaims. With regulators now well-awareof mobile health apps, guidance andnotices have been published, so theground rules have been set.

An app for chronic illness: Beingbased at Toronto General Hospital,we’re particularly aware of the effects ofchronic illness on the healthcare system.Too often, we witness congested emer-gency departments and in-patient bedsthat are used for conditions thatshouldn’t require an acute-care setting.For this reason, it’s no surprise that weturned our focus to the most prevalentchronic conditions when designing apps.

Our latest is Medly, a play on wordswhereby the app is designed to deal withpatients with multiple chronic conditions.It brings together nearly a decade of re-search that we’ve conducted on the use ofmobile phones for tackling serious chronicconditions.

We learned that patients with uncon-trolled high blood pressure (BP), could self-manage their condition with the use of aBluetooth-enabled BP monitor coupledwith our app. Reminders to take readingsrang their home phone; it was a little annoy-ing until patients realized their importance.

Serious trends were identified to bothpatient and provider. After a year, the co-hort using the app showed a dramatic im-

provement: a 20 percent reduction in theirrisk of heart attack and stroke, while thecohort with usual care showed no change.Incredibly, it didn’t result in more medica-tions and more doctor visits, the fear fromthe beginning.

This was truly patient self-care, wherepatients were doing the heavy lifting, andnot their overwhelmed providers. Furtherwork showed that the technology could beused for heart failure patients, who are of-ten some of the sickest patients we see. By

adding a weight scale and some targetedquestions around symptoms, we showedthat these patients could be more tightlymanaged, with improved health outcomesand improvements in their ability to carefor themselves.

Medly is a modern redesign of the systemused in this research. By adding the ability todeal with COPD and CKD patients, we’vefurther rounded out its ability to deal withthe sickest patients, as well as patients whooften have more than one condition.

An app for diabetes: One of our mostpopular apps has been bant – named afterFrederick Banting, who first tested insulinjust steps away from where we develop ourapps at Toronto General. It is one of thefirst mobile health apps released for themanagement of diabetes, and it has been

used by tens of thousands of peoplearound the world.

A pilot at SickKids in Toronto last yearshowed that teenagers tested 50 percentmore frequently using bant than beforethey used the app. A combination of afriendly design and some novel featuresencouraged them to test more often.

bant integrates the notion of social me-dia into diabetes management, so that userscould connect with teens like themselves. Italso rewarded them for positive behaviors –

for example, tracking their glucose levelsthrough the automated transfer of bloodsugar readings. By gamifying this task,they earned points for their efforts, even-tually accumulating enough to earniTunes gift codes, which could be re-deemed for music, movies, or apps. This year, a more advanced version ofbant is being tested with a larger groupat SickKids and Trillium Health Part-ners. The project aims to show if the appcould bring down a teen’s A1c level. As well, a new version of bant that moreclosely targets the management of Type2 diabetes will be released and trialed. It

will focus on certain lifestyle aspects thatare a problem for this group. The ability totrack activity levels will be added throughuse of popular devices such as the Fitbitand Jawbone Up.

A simpler way of tracking diet will beadded, without resorting to completing adreary food diary. Finally, bant will enterthe Android ecosystem later this year,where the demand on this popular plat-form has been high ever since our firstiPhone-only release.

Joseph Cafazzo is Lead for Centre for GlobaleHealth Innovation at the University HealthNetwork and Executive Director of Health-care Human Factors. He is an Associate Pro-fessor of Health Informatics and ClinicalEngineering at the University of Toronto.

Mobile health apps for the patient-consumer: where the real action is

How smartphones can help you keep your healthy 2014 resolutions

With apps, patients become more active in their healthcare.

BY SCOTT R . HERRMANN

It seems that every year, we start withthe best intentions to stay fit, eathealthier and maintain healthy lifestyle choices throughout the year.

According to the University of Scranton,Journal of Clinical Psychology, losingweight and getting fit both were in thetop five New Year resolutions. But howlong will our goals to a healthier life last?The same study stated that 45 percent ofAmericans made New Year’s resolutions,however only 46 percent actually main-tained these resolutions past six months.

So what do we need? What we are find-ing is that modern technology, combinedwith people becoming more engaged withtheir own health, is making it easier tomeet fitness goals. For example, fitnesstrackers have the ability to give insight onhow you sleep, move and eat. This is a sig-nificant evolution over the standard pe-dometer, which only measures the quan-tity of steps you take in a day.

Now, this may seem like an odd arti-cle to come from me, the leader of mo-bile solutions for a home care company.But bear with me, as I have a point.

As the popularity of fitness trackerscontinue to grow, so does the opportu-nity to create similar fitness tracking ap-plications for smartphones. New re-search has found that workers who exer-cise are able to manage their stress levelsbetter, which increases their efficiencyand effectiveness at work and at home.

Russell Clayton of Saint Leo Univer-sity’s Donald R. Tapia School of Business,in the Harvard Business Review, states,“while exercise may seem like one moretask to add to an already busy workday, itdecreases stress, and a reduction in stressis tantamount to an expansion of time.”

So how can we leverage the use of fit-ness tracking applications to maintaintheir fitness and health goals? Can fit-ness trackers help us to be better en-gaged with our physicians through theconstant health feedback we receive

when we upload information? And moreimportantly, how will this lead to lowercosts of healthcare?

Allow me to explain how this works:fitness trackers have the ability to providethat extra level of motivation to encour-age you to make health-conscious deci-

sions throughoutthe day. For exam-ple, I chose tomonitor my fitnessand health goalsusing a mobile ap-plication. My goalfor 2014 is to walk500 miles this year. Does that soundoverly ambitious?Absolutely not; bywalking the dog

daily and hiking each weekend, I willbe able to achieve this goal. Each day Iam able to sync my activity with mycomputer and compare my results tothe previous days, allowing me to stay

competitive with myself, pushing me totry harder.

At Procura our goal is to provide tech-nology that ensures care all the way to thehospital door. Monitoring daily activityand food intake is what we call preventa-tive healthcare, or pre-acute care. By en-gaging patients in their health, we can fo-cus on lowering healthcare costs throughreduced readmission and increased healthself-awareness, by diminishing enteringthe hospital in the first place.

Like many other years of resolutionsleft unfinished, good intentions withoutexecution won’t lead to better results. Itis still up to us as individuals to makeourselves want to stay healthy and fitnesstrackers are one way to stay inspired. Yetwe are part of a massive continuum, nolonger looking after our own health, butalso the health and wellbeing of ourneighbours, friends and family.

Scott R. Herrmann is Director of MobileSolutions at Procura. www.goprocura.com

Scott R. Herrmann

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© 2014 InterSystems Corporation. All rights reserved. InterSystems and InterSystems HealthShare are registered trademarks of InterSystems Corporation. 4-14 Ability3 CaHeTe

Theinteroperability

to engage communities

We offer a platform for Strategic Interoperability.Our technology is essential if you want to makebreakthroughs in strategic initiatives such as coordinating care, managing population health, andengaging with patient and physician communities.

Add our HealthShare platform to your EMRs.InterSystems HealthShare® will give you the ability to link all your people, processes, and systems – and to aggregate, analyze, and share all patientdata. With HealthShare, your clinicians and admin-istrators will be able to make decisions based oncomplete records and insight from real-time analytics.

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S A V E T H E D A T E ! May 23-24, 2014

Venue: The Fairmont Hotel Vancouver

900 West Georgia Street, Vancouver, British Columbia

To register, please visit www.toshiba-medical.ca

“Topics-at-a-Glance” include:

• Single Energy Metal Artifact Reduction (SEMAR)

• Dose Reduction Technologies

• Cardiac Imaging

• The Radiographer’s Perspective

• The Focus of the Physicist

• Role of CT Scanning in MSK

• Initial Experience Using 160 Slice CT

• Radiation Dose Considerations

• Ultra Low Dose Chest CT

• Pediatric Imaging

• Organ Perfusion & Dual Energy in the Abdomen

• Neurological Imaging Using Volumetric CT

International CT Symposium 2014

May 23-24, 2014

Fairmont Hotel Vancouver

Functional CT Imaging - Moving Forward

Guest Speakers

• Professor Alain Blum - CHU Nancy, France

• Dr. Russel Bull – Royal Bournemouth Hospital, UK

• Dr. Marcus Chen – NIH, USA

• Ms. Kate Clough - Bradford NHS, UK

• Dr. Cupido Daniels – Dalhousie University

• Dr. Bruce B. Forster - University of British Columbia

• Dr. Mark Kon - Bradford NHS, UK

• Dr. John Mayo – Vancouver General Hospital

• Dr. Narinder Paul – UHN, Toronto

• Dr. Daniel Podberesky – Cincinnati Children’s Hosp. Med. Ctr.

• Professor Patrik Rogalla – University of Toronto

• Dr. Donatella Tampieri – Montreal Neurological Institute

S A V E T H E D A T E !

Early Registration extended to April 18th

Toshiba Canada is pleased to announce our 2014 International CT Symposium “Functional CT Imaging – Moving Forward”.

The early registration deadline has been extended to April 18th and Toshiba encourages all who plan to attend the 2014 CT Symposium –

held May 23-24th at the Fairmont Hotel Vancouver – to take advantage of hotel reservation discounts by registering by April 18th, 2014.

Early reservation at the Fairmont Hotel Vancouver secures a 10% discount

Registration for the event is open at www.toshiba-medical.ca

One only has to scan the exceptional list of some of the most highly regarded and internationally renowned speakers that comprise the faculty

for this Symposium, to appreciate the caliber of this unique and exceptional opportunity. The comprehensive two day program will allow

participants to share their experiences and update their knowledge. All sessions are eligible for Continuing Professional Education (CPE) units.