feature report: wireless and mobile solutions – …...healthcare information management and...

BY JERRY ZEIDENBERG

AS VEGAS – St. Michael’s Hospital, inToronto, has created a business intelli-gence (BI) and forecasting tool that

enables the acute-care centre to answerquestions in just two hours, down from thethree to five days it took previously.

“Now it takes us longer to get a goodquestion than to answer it,” quipped JeremyPetch, PhD, Project Direct, Quality and An-alytics, who gave a presentation on how St.Mike’s built the AI-powered system.

Dr. Petch was a speaker at the annualHealthcare Information Management andSystems Society (HIMSS) meeting, whichattracted over 40,000 health I.T. profession-als to sunny Las Vegas. It was held in March.

St. Mike’s “rapid response” tool, devel-

oped in partnership with the hospital’s Deci-sion Support team, enables managers in thehospital to forecast, for example, expectedvolumes in the Emergency Department. Andit’s doing it within a 6 percent error rate.With 200 or so visits per day to the ER, the

tool is off by only 12 visits, at most, whichstill gives managers a pretty accurate idea ofwhat to expect.

By knowing what to expect in the way ofpatient volumes, hospitals also get a betteridea of their staffing needs.

It can be deployed, moreover, to forecast

whether various programs will meet theirquarterly or annual targets.

And it can also be used for retrospectivestudies – to determine whether a change im-plemented by a department actually worked.

Moreover, a group at the 463-bed hospitalis now using the system to develop an EarlyWarning System for the intensive care unit. Itwill determine which patients on medicalfloors are about to crash, so they can be helpedbefore they need to be moved to the ICU.

For years, as Dr. Petch described, it wasdifficult to answer various questions aboutpast performance and to forecast the future,as the information needed was housed indifferent silos. As well, the hospital lacked apowerful analytics tool.

“Any analyses that were done were purely

St. Michael’s devises high-powered forecasting tool

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Simon Fraser University alumni Karim Merhi and Gautam Sadarangani have launched TENZR, a technology that uses hand and wrist move-ments as a human-machine interface. Their company, BioInteractive Technologies, has developed a whole platform that can be used to controlmedical equipment in operating rooms, complex robots, as well as in rehab medicine, training and other applications. SEE STORY ON PAGE 17.

It’s all in the wrist action

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The tool is also being used tocreate an Early Warning Systemfor the Intensive Care Unit.

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DI machines across CanadaOttawa-based CADTH has re-leased a survey of DiagnosticImaging equipment installedacross the country. CADTH re-ports on the age of variousmodalities and on growth rates.Page 4

Regional telepharmacyFive hospitals in northeastern On-tario have signed on for telephar-macy services with NorthwestTelepharmacy Solutions. They willreceive extended hours for med-ication reviews, reconciliation in-terviews with patients, and more.Page 8

Region-wide PACS Interior Health, in British Colum-bia, has established a PictureArchiving and CommunicationSystem that ties together the im-ages and reports generated bytertiary care and community hos-pitals, as well as local DI clinics. 0

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FEATURE REPORT: WIRELESS AND MOBILE SOLUTIONS – PAGE 16

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 23, NO. 3 APRIL 2018

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descriptive,” said Dr. Petch. “There wasn’tmuch rigor behind the analysis.”

However, a group of managers in theQuality, Performance, Information Tech-nology and Information Managementportfolio, and scientists at the hospital,wanted to change this.

“A few of us had a vision to transformSt. Michael’s into a data-driven organiza-tion,” he said. The goal was to supporthigh-quality patient care and to increaseoperational efficiency.

In 2016, they created the Centre forHealthcare Analytics and Training(CHART), based at St. Michael’s, which ispart of a new network with St. Joseph’sHealth Care Centre and Providence Health-care. And they have started to recruit datascientists with expertise in machine learn-ing, neural networks, biostatistics, simula-tion modelling and industrial engineering.

Dr. Petch commented that hospitalshave to compete with companies likeGoogle for AI-experts and other data sci-entists, but in Toronto they had somethingattractive to offer. As a teaching hospital

and affiliate of the University of Toronto,St. Michael’s was able to facilitate profes-sorships at the university for highly quali-fied individuals.

This attracted high-calibre talent, asmany data scientists also want to make animpact as teachers and academic researchers.

“That’s something that Google andother companies can’t do,” commented Dr.Petch. “We can give them a good salary,plus an academic career.”

Finding talented junior staff is also achallenge. Many younger people, in searchof fame and fortune, take quickie coursesin Deep Learning or neural networks, andthen dub themselves data scientists.

“There’s a proliferation of onlinecourses available,” said Dr. Petch. “Peopleare taking them, but then you discoverthey can’t write a line of code.”

To weed out the better candidates,CHART invited applicants to come in todo three or four hours of coding. “75 per-cent don’t even show up,” he said. “Theyknow they can’t do it.”

By assessing the skills of those who doshow up, CHART has been able to recruita talented team.

On a lighter note, hecommented that St.Mike’s has created alooser “culture” forits CHART think-tank, as computerprofessionals like amore free-wheelingatmosphere. To solve the problemof disparate sourcesof information, with

data separated into silos throughout thehospital, the team spearheaded the creationof a data warehouse.

Dr. Petch said there was a decision to bemade about whether to invest in a datawarehouse or a data lake. Data warehousescontain information of a more structuredvariety, while data lakes contain “rawdata”, in all and any formats.

As the information in a data warehouseis more usable to researchers, and can beused more quickly to answer questionsand solve problems, the team decided to gowith this option.

To build the BI tool itself, the CHARTteam used R software – a language and en-

vironment for statistical computing andgraphics. Not only is it high quality, but italso happens to be freeware – a big advan-tage for cash-strapped hospitals.

Today, the forecasting tool enables St.Michael’s Hospital to answer questionsfaster and more accurately than before. Itis also reducing the staff time needed forforecasting and analytics.

Dr. Petch noted that in the ED, it couldpreviously take 1.5 person days to answer aparticular question; now, that can be donein a couple of hours.

Of course, not everything is perfect.He observed that data quality is still anissue, and that often, the problem occursright at the point of entry – when clini-cians are entering their data into varioussystems.

Dr. Petch said some organizations havebeen successful at improving their dataquality, and singled out the Centre for Ad-diction and Mental Health (CAMH) inToronto, as a leader in this area.

For its own part, in building the tool,Dr. Petch said that St. Michael’s learned agreat deal from others. In particular, he ac-knowledged InterMountain Healthcare, inthe United States. “They were mentors tous,” he said.

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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. Return undeliverable Canadian addresses toCanadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9. E-mail: [email protected]. ISSN 1486-7133.

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

Volume 23, Number 3 April 2018

Contributing EditorsDr. Sunny MalhotraTwitter: @drsunnymalhotra

Dianne [email protected]

Richard Irving, [email protected]

Dianne [email protected]

Friday, May 4th, 2018

REGISTER ONLINE: www.miit.ca #MIIT18

Connecting Imaging and Information in the Era of AIConnecting Imaging and Information in the Era of AI

Jeremy Petch

St. Michael’s devises a high-powered forecasting and analytics tool

CALGARY – Concussion is one of themost talked about injuries in sporttoday. Yet, there is no accepted way

to image a concussion. University of Cal-gary scientist Jeff Dunn, PhD, hopes tochange that. He and his team have devel-oped a portable brain imaging system thatuses light to detect and monitor damage inthe brain from concussion. Researchersand doctors will be using the technology inan upcoming study at the Alberta Chil-dren’s Hospital.

The device, using Near-Infrared Spec-troscopy (fNIRS), measures communica-tion in the brain by measuring oxygen lev-els. When the brain is working well, majorregions on each side of the brain are com-municating and so have similar patterns ofblood flow and oxygen levels in blood.

Researchers measure the changes inblood oxygen levels as a marker of brainfunction. “The one thing we know is thatthere can be physiological changes in thebrain that last for months to years after abrain injury due to concussion. We discov-ered a new technology that is portable tomeasure those changes,” says Dunn, direc-tor of the Experimental Imaging Centre atthe Cumming School of Medicine (CSM).

Portable imaging couldshed light on concussions

2 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y A P R I L 2 0 1 8 h t t p : / / w w w . c a n h e a l t h . c o m

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

BY JERRY ZEIDENBERG

BRAMPTON, ONT. – After a year-and-a-half of development, test-ing and partnership with Sunny-brook Health Sciences, William

Osler Health System (Osler) has rolled outits MyChart patient portal to patients at allthree of its sites – Brampton Civic Hospi-tal, Etobicoke General Hospital and PeelMemorial Centre for Integrated Healthand Wellness. The web-based MyChartsystem allows patients on-line access totheir lab and pathology results, along withtheir diagnostic imaging and diagnosticcardiology reports.

While lab results are available in real-time, pathology, diagnostic imaging anddiagnostic cardiology reports are availableto patients 14 days after being electroni-cally signed.

The hospital engaged in significantstakeholder consultation including withOsler’s Patient and Family Advisory Coun-cil (PFAC), along with clinicians and ad-ministrators about this decision.

“The technology supports real-time ac-cess to the results,” noted Mary Jane Mc-Nally, Chief Patient Experience Officer atOsler. “Some of our patients said they pre-ferred hearing important clinical informa-tion from their care provider, while othersacknowledged the value of accessing theirown test results right away. As an organiza-tion, we had to find a middle ground.”

The hospital will be monitoring the useof the system and will be continually inter-acting with patients and clinicians to re-visit which results should be posted earlier.As well, in the next couple of months, theplan is to post patients’ scheduled appoint-ments in MyChart.

So far, over 18,700 patients at Oslerhave signed up to use MyChart, notedMarla de Souza, Project Manager for theOsler initiative. Osler continues to pro-mote this and other new patient-facing

technologies to the communities it serves,and is confident the number of active userswill continue to grow.

De Souza said that in December, Sun-nybrook implemented a new accountmanagement feature allowing patients touse a single login to access their recordsfrom multiple MyChart network sites. Inaddition to Sunnybrook and Osler, mem-ber sites include St. Michael’s Hospital,Michael Garron Hospital, Baycrest and theOttawa Hospital.

Opening up access to patient informa-tion is a top priority for Osler. “It’s all aboutaccess to information,” commented JamesMoolecherry, Osler’s Chief Technology Of-ficer. “The patients own the informationthat is collected about them. MyChart givesthem access to their own information, andthe patients can approve access to familymembers and caregivers when needed.”

Moolecherry explained that in the past,“Patients would have to physically comeinto the hospital and make a request fortheir records. MyChart makes it much easier– they can access their information when-ever they want, from wherever they may be.”

He also added that making a patient por-tal available to Osler patients and enhanc-ing the patient experience is a key part ofthe organization’s corporate strategic plan.

Not only is it a matter of patient rightsand satisfaction, it’s also a way of improv-ing medical outcomes. “Patients are ulti-mately the experts in their own condi-tions,” said McNally.

They do even better when they have up-to-date information about their health.“People have been coming in to see theirdoctors, armed with information fromGoogle,” said McNally. “Now, as a result ofhaving timely efficient access to their re-sults, they are coming in with questionsand concerns based on their own factualinformation.”

McNally also points out that if patientsare able to ask their clinicians about their

own test results and therapies, they canachieve better outcomes.

Osler’s implementation of MyChartdraws its data from multiple sources, inreal-time, using the Corolar healthcare in-tegration engine from Dapasoft, com-mented Joe Cossu, Osler’s Director of In-frastructure and Applications.

The combination of the Corolar solu-tion and Biztalk technology ensures thatthe information presented to the patient –and his or her health team – is the mostup-to-date.

Moreover, Cossu said that patients canrest assured their data is secure and pro-tected, as the system has been validated bya privacy impact assessment and threatrisk assessment.

MyChart is part of a group of new solu-tions at Osler that are designed to improvethe patient experience, as well as medicaloutcomes and organizational efficiency.

Interestingly, McNally said technologyis no longer seen as just an “enabler”, but asa significant part of the patient experience.

Technology is now a regular part ofeveryone’s day-to-day life – one just thinksof how often people are using their smart-

phones and apps like Facebook, Googleand texting. “Technology no longer takesthe humanity out of your experience, it’snow part of it,” said McNally.

Indeed, technology can be used to en-hance nearly every part of the patient ex-perience at Osler, and the hospital has abroad range of projects planned for thenear future.

For example, the hospital is working onan early check-in system for patients that al-lows them to register from home or wher-ever they might be, to avoid lineups andwaits at the hospital. “It’s based on what theairlines are doing,” said Moolecherry.“We’re just working out now how far in ad-vance patients need to check in.”

Osler has already set-up self-servekiosks for check-in at its Peel Memorialsite, which is being met with great patientapproval. “Eighty-five percent of the peo-ple who have been shown how to use thekiosks are continuing to use them after-wards,” said Moolecherry.

Systems are also being designed withsmartphone access in mind, as that’s theplatform most people are using today forweb access.

CADTH produces Canadian inventory of diagnostic imaging equipment

OTTAWA – Ever wonderwhat kind of diagnosticimaging machines areavailable in differentprovinces or territories?

Will a patient be able to get a CT or MRIscan nearby, for example, or will theyneed to travel to another jurisdiction?What is the ideal location to place a newimaging machine and where should up-grades take place?

An updated, pan-Canadian inventoryof DI equipment has just been released,containing a wealth of information tohelp answer these questions and more.

The Canadian Medical Imaging Inven-tory (CMII) is now available, with open-access at www.cadth.ca/imaginginventory.

Developed by CADTH, the CMII re-ports contain high-quality data obtainedin 2017 on the quantities, locations, ages,technical specifications, and uses of imag-ing machines installed across the country.

Since 2001, national statistics have been

collected on imaging modalities by variousCanadian organizations – with CADTHtaking on the responsibility in 2015.

As these technologies rapidly advance,the continual need for an updated pic-ture is imperative to help decision mak-ers understand the evolution of medicalimaging, the influence of emerging tech-nologies, and the expansion of clinicalapplications and population needs.

Public and private health care admin-istrators were invited, on a voluntary ba-sis, to complete a comprehensive web-based survey on six specialty imagingtechnologies including:

• computed tomography (CT)• magnetic resonance imaging (MRI)• single-photon emission computed to-

mography (SPECT)• positron emission tomography/com-

puted tomography (PET/CT)• single-photon emission computed to-

mography/computed tomography(SPECT/CT)

• and positron emission tomography/magnetic resonance imaging (PET/MRI).

Analysis revealed that every provincehas at least one CT machine and that thisimaging modality is the most commonamong those surveyed, with 561 ma-chines in Canada, up from 419 a decadeprior. This represents growth of approxi-mately 35 percent in the 10-year period.

Although an increase was observed,this technology actually experienced theslowest rate of growth compared to theother machines studied, which may bedue to market saturation.

The number of CT exams being per-formed increased, with 5.61 million ex-

ams completed in 2017, up from 3.38million in 2007.

With a 65 percent increase in thenumber of machines, MRI is the secondmost common technology surveyed,with 366 machines, up from 222 units in2007. There were 1.86 million MRI ex-ams performed in 2017, up from 1 mil-lion in 2007.

SPECT was the only modality in thesurvey to show numbers dropping overthe past 10 years. There were 330 SPECTmachines accounted for in the 2017data, with trends suggesting that SPECT-CT machines are replacing SPECT ma-chines. In fact, SPECT-CT experiencedthe fastest rate of growth compared withall other imaging machines.

There was a total of 261 SPECT-CTmachines, 51 PET-CT machines, andthree PET-MRI machines captured inthe latest survey results. At this time, allthree PET-MRI machines are located in

SPECT-CT experienced thefastest rate of growth,compared with all otherimaging machines.

William Osler Health System launches MyChart and other technologies

Managers at the William Osler Health System see tech as a key part of a high-quality patient experience.

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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 8

Watch the session and learn how to mitigate the pandemic of issues surrounding sub-optimal enterprise image management.

Rasu Shrestha, MD, MBAChief Innovation Officer, University ofPittsburgh Medical Center, UPMC Enterprises

Cheryl Petersilge, MD, MBAMedical Director, Integrated Content andEnterprise Imaging, Cleveland Clinic; ClinicalProfessor of Radiology, Cleveland ClinicLerner College of Medicine – Case WesternReserve University

Christopher J. Gelabert, MDDepartment of Emergency Medicine,University of Texas Health San Antonio

Kim GarriottPrincipal Consultant, Healthcare Strategies,Logicalis Healthcare Solutions

THE BIG PICTURE MADE TANGIBLEREALIZING THE VALUE OF ENTERPRISE IMAGING IT

Learn how to lead your institution’s Enterprise Imaging strategy effectively and efficiently for tangible, value-based care results.

To thrive in a value-based world and truly transform healthcare, hospitals and healthcare networksneed to integrate knowledge, systems, culture and care. The need exists to control patient data

and the custody of medical imaging data.

It’s time for a wake-up call about the challenges in medical imaging and IT: the fragmentation oftechnology and difficulties in accessing the information required for timely, appropriate care delivery,

and the inherent risks in security, data accuracy, cost control.

Watch the session and learn how to take charge of sub-optimal enterprise image management.

Watch the Full Panel Session Video at: https://global.agfahealthcare.com/us/himss18-lunch-learn-video/

C L O U D S O L U T I O N S

BY MOHAMMAD QADIR

Arecent Time magazine articlefound that infectious-diseaseoutbreaks are increasing aroundthe world at an alarming rate. In

fact, the number of outbreaks per year hasmore than tripled since 1980.

In the United States alone, close to onemillion critically ill people remain undiag-nosed each year, and many of them spenda long time in the hospital because of it, oreven die. The cost to the healthcare systemis staggering, estimated at US$27 billion.

Interestingly, tackling pandemics is at thevery centre of our business model, thanks toleading-edge genomic technology and theIBM Cloud. Based in Vancouver, the FusionGenomics team comes to work every day fo-cused on reducing the impact of infectiousdisease through better diagnosis and detect-ing pandemics before they happen.

We’ve developed a process to identifyany known pathogen in a single test, givingdoctors the potential to diagnose illnessesat a much faster rate.

The solution involves disruptive DNAand RNA capture technology that we be-lieve can positively identify infectious dis-eases and enhance the surveillance ofemerging pathogens like MERS, SARS,avian flu, and swine flu.

So how exactly does this work? Let’sstart with the fact that there are roughly1,400 known human pathogens, and ourbodies contain more bacteria (good andbad) than human cells.

Current tests look for pathogens one ata time. Then our medical practitionershave to determine the strain, choose theappropriate drug and begin treatment.

Each step in this process takes up time

that a very ill patient may not have. Ourtechnology, on the other hand, can diag-nose all known human pathogens in a sin-gle test within 12 hours and give detailedgenomic data to guide treatment.

When employed for pre-emergencesurveillance, the technology can helpproactively identify threats, like swine flu,by taking aerosol samples in high risk ar-eas, then analyze the sample to determineif there is potential to affect humans.

If there is a risk, Fusion Genomics canhelp groups like governments and hospi-tals make rapid and informed decisions forthe health and safety of those that rely onthem before an outbreak occurs.

Fusion Genomics has developed a next-generation sequencing-based set of assaysfor infectious diseases. Our platform,known as ONETest, sets us as apart fromother genomics companies, because it is

up to 10,000 times more sensitive thanother genomic solutions. Eventually, webelieve, the cost per test using our plat-form will be one-tenth that of other ge-nomic solutions.

With an increasingly urban and rapidlygrowing global population, any potentialoutbreaks of infectious diseases are a riskthat Canada and the world cannot affordto overlook.

Cloud capabilities allow for the rapidrecruitment of computational resources,whenever and wherever they are needed.Fusion Genomics chose IBM Cloud to en-sure we had a highly flexible and securecomputing platform so that we couldstrengthen our ability to react to potentialoutbreaks that continually threaten ourpublic health and economy.

How is this being received by ourhealthcare providers who are on the front

line diagnosing patients and identifyingpotential outbreaks within their commu-nities? With limited funding and re-sources, the challenges associated withmanaging pandemics within a hospital en-vironment are significant.

Many diseases are not detected prop-erly, driving up costs with incorrect, de-layed decisions, and in some instances,there is no diagnosis at all. This is furthercompounded by the prevalence of hospitalacquired infections and increasing pres-ence of antibiotic resistance.

The ONETest is being used by publichealth agencies in Canada and the assayscan serve any reference testing laboratory,public health agency, hospital or pharma-ceutical company involved in pathogentesting and monitoring. With this singletest, and timely results within 12 hours,front-line care delivery can be improvedand costs contained with comprehensivegenomic data to guide therapy.

This is, in fact, precision medicinespecifically for infectious diseases. By suc-cessfully identifying the disease at the out-set, our healthcare providers can nowavoid contributing to antibiotic resistanceby using the correct antibiotic for the dis-ease.

Better surveillance of infections,whether they are acquired within a hospi-tal or not, can lead to further targeted pro-grams that can slow or prevent the spreadof epidemics. This is a unique and com-pelling made-in-Canada story about howinnovation and technology are being in-terlaced to help solve a significant and life-impacting medical challenge.

Mohammad Qadir is CEO of Fusion Ge-nomics.

Shareable immunization record available on iOS and Android phonesBY NEIL ZEIDENBERG

An Ontario-developed applica-tion that safely stores a per-son’s immunization records,and those of their families inthe Amazon cloud, is now

available as a mobile app on iOS and An-droid phones. It can be downloaded forfree on Google Play or the App Store.

CANImmunize (www.canimmunize.ca)is a free digital immunization recordwhere users can safely store, update andshare their immunization records amongfamily members. By setting up an ac-count and registering a PIN, users canaccess their records using everyday tech-nology like a smartphone.

The actual apps have been around inseveral forms for about six years, but nowit’s being connected to the cloud. “TheAndroid version is already available, andthe iOS is being rolled out over the nextfour or five-weeks,” said Cameron Bell,Lead Technical Architect at The OttawaHospital mobile health lab.

The concept emerged a few years agowhen Dr. Kumanan Wilson, a general in-ternist at The Ottawa Hospital, whose

current research focuses on public healthinnovation, chatted with a frustratedmom in a park about the difficulty shehad tracking and sharing her family’simmunization records.

Dr. Wilson and his team sawthis as an opportunity to make adifference for the public and thehealthcare system.

“Originally, it was meant forpeople in Ontario to track theirimmunization records on theirphones,” said Bell. “We re-createdthe yellow card everyone gets totrack their immunization records,and digitized it.”

Then in 2014, the Public HealthAgency of Canada expanded theprogram to meet the needs of allCanadians. “So, we digitized theimmunization schedules of allprovinces and territories – trans-lating them into both English andFrench,” said Bell.

In 2016, the app became cloud-basedor account-based so people could createaccounts and share their data betweendevices and between family members.

Since 2012, there have been over

215,000 downloads of the app, and itwent live on Amazon this past October.

Amazon protects the data with severallayers of security, auditing, and firewalls.“We also have stand-up servers on the

inside, databases wherewe store our applica-tion data and function-ality,” said Bell. “Rightfrom the start Amazonsupported our technol-ogy stack really well.”A cloud-based record isa big improvement overpaper, as the old yellowcards can be incom-plete and easily mis-placed. “Either peoplewould lose them or for-get to take them totheir appointment, andwould go home with anew one,” said Bell. It’salso harder to share

those paper records between spouseswhen taking their kids to the doctor.

“Using today’s technology, we canhelp people capture better data and en-gage them in the process of managing

immunization records. Public Health isdependent on parents to keep track oftheir records, and a parent is in the bestposition have a comprehensive view oftheir child’s immunization records.”

Moreover, it empowers Public Healthto communicate with people over theirmobile devices. “We’re creating a two-way communication channel betweenPublic Health, individuals, and theircommunities,” explained Bell.

Previously, people couldn’t reliablyback up their information. But with anaccount on a cloud-based system, userscan sync their records by default.

Even if you lose your phone, it can berestored. “Our primary user is a parenttaking their child through the firstcourse of vaccinations when they’re firstborn, so we tend to have very engagedusers. They care about this information,and care that they have it forever. Over-all, we get a lot of positive feedback.”

Features of the app include a vaccinefact sheet, provincial vaccination sched-ules, pain management techniques and amodule for kids that uses games andvideos to help them understand the im-portance of getting immunized.

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Looking to enhance their phar-macy services and improvemedication management initia-tives, five small hospitals innortheastern Ontario have en-

gaged Northwest Telepharmacy Solutions(NTS) after a successful award by Health-PRO Procurement Services, Canada’s na-tional group purchasing organization.

Implementing a regional telepharmacyservice will help hospital pharmacy de-partments provide extended pharmacyhours and a timelier clinical review ofmedication orders.

The service also supports the develop-ment and implementation of programssuch as antimicrobial stewardship, med-ication reconciliation, pharmacy adminis-tration, specific policies and procedures,and pharmacy and therapeutics commit-tee work.

The five committed hospitals will re-ceive medication order review from 8amto 8pm, Monday to Friday, with on-callservices outside of those hours for physi-cians and nurses to have 24-hour access toa pharmacist.

The hospitals are Lady Dunn HealthCentre, Hornepayne Community Hospi-tal, Services de Santé de Chapleau HealthServices, Temiskaming Hospital, and theWeeneebayko Area Health Authority.

“It is very exciting to see these smallhospitals implement enhanced compre-hensive pharmacist services to support pa-tient safety,” says Northwest TelepharmacySolution’s Director and founder, KevinMcDonald.

“My heart is in northern Ontario, andour very first telepharmacy hospital clientwas the Weeneebayko General Hospital, inMoose Factory, back in 2004. As a result of

this procurement, all of the com-mitted hospitals will now receivelonger hours of pharmacist supportand valuable project hours to investinto more patient safety initiativesaround medication management.”

Hospitals in many small commu-nities like those across much ofnorthern Ontario have struggled torecruit pharmacists with extensivehospital pharmacy experience.

“Telepharmacy is revolutionaryfor introducing hospital-trainedpharmacists, virtually, into smalland rural hospitals for providingcare,” says Sammu Dhaliwall of NTS.“Now, a team of pharmacists locatedin a completely different geographi-cal location can provide services tosmall hospitals in northern Ontario,all done by embracing innovativetechnologies which we are assessingand implementing across Canada.”

One of those pharmacists isSatvir Bains, who recently receivedthe Hospital Practice in a Rural Set-ting Award from the OntarioBranch of Canadian Society of Hos-pital Pharmacists.

“While covering several hospitalsremotely has its challenges at times,”says Satvir, “there is certainly a satis-faction that comes with the positive im-pacts we are able to make on patient care.The need for pharmacists to clinically re-view the impact of new medicationsstarted in the hospital is even more crucialtoday, as we have an aging population withpolypharmacy challenges, dealing with an-timicrobial resistance and of course, theopioid crisis.”

“This is the first service-based contract

in our pharmacy portfolio,” said Health-PRO’s Christine Donaldson, Vice Presi-dent of Pharmacy Services. “We know hos-pitals are looking for cost-effective ways toenhance their in-patient pharmacy ser-vices and believe telepharmacy is a viableoption for many hospitals to consider. Thisservice contract will help Ontario hospitalsreach a higher level of compliance withmore rigorous patient safety standards.”

“Northwest Telepharmacy Solutionshas been instrumental in improvingpharmacy care for patients across theJames Bay Region,” says Crystal Culp,Director of Professional Practice atWeeneebayko. “Theresa Crann hasbeen one of our own in leading pro-jects for improving pharmacy’sreach across the hospital. In the out-patient space, the pharmacist-as-sisted warfarin dosing program hasbeen a consistent care improvementthat is welcomed by physicians,nurses, and patients.”As quality improvement initiativesusing technology such as AutomatedDispensing Units, Bedside Medica-tion Verification, and ComputerizedPrescriber Order Entry become a re-ality across the province, the need forpharmacist involvement for ex-tended hours (including 24/7/365 asthe goal) grows.“Telepharmacy is the most efficientmeans to extend hospital hours,” saysMcDonald. One area where telephar-macy may help with reducing hospi-tal readmission is in the medicationreconciliation process. Medicationreconciliation associated interviewsand teaching may best be providedby face to face interviews with hospi-

tal inpatients; however, NTS is striving toovercome this face-to-face barrier by re-searching the use of a telepresence robotnicknamed “Sheldon” to conduct those in-terviews. “Patients really light up whenSheldon wheels into their room to conducta pharmacist interview,” says Ms Bains.

The contract is open for commitmentto all Ontario HealthPRO members to ex-pand their pharmacy services.

How artificial intelligence is speeding up diagnosis and drug discoveryBY YING TAM

The complexity of the humanbody is mind blowing. A singlechromosome can be up to 300million base-pairs long, our

genome contains 30,000 genes and in-side our heads sits a tangle of 86 billionneurons.

The human mind can’t make sense ofall that information – so researchers areturning to minds that aren’t human. Arti-ficial intelligence has arrived in healthcare.

Here are three areas where Canadiancompanies are bringing AI technologiesto bear in medicine. Many of these prod-ucts are in still in development, but theypoint to a future where AI can improveclinical efficiency and sound the alarmabout early signs of disease.

Drug discovery – without the guess-work: Researchers are using the vastdata-crunching power of AI to shrinkthe haystack in the needle-in-a-haystacksearch for new therapeutics.

At the height of the West AfricanEbola epidemic in 2015, Atomwise, amedical AI company founded inToronto, took a virtual model of the

virus and ran it past an AI systemtrained to analyze molecular interac-tions. In less than a day, the AI programhad digitally thrown 7,000 existing drugsat the virus and identified a shortlist of20 that could block a claw-like structurethe virus uses to enter healthy cells. Hu-man researchers then tested the short-listed drugs on real Ebola virus andfound two that could be potential treat-ments in the future.

Deep Genomics is taking a similar ap-proach to the search for therapies to blockgenetic mutations such as those that causeHuntington’s disease or cystic fibrosis. Onthe back of a US$13-million investmentfrom Khosla Ventures, Deep Genomics isbuilding a biologically accurate AI-pow-ered platform will allow scientists to honein on specific disease-causing genetic mu-tations and identify pre-clinical drug can-didates to target them.

Diagnosis for the digital age: Com-puters already outperform humans incertain diagnostic tests, such as scanninglesions for skin cancer. But now ma-chines are proving their worth in moredifficult-to-diagnose diseases.

Determining cognitive impairment is

challenging and time consuming. Stan-dard neurological checks involve an exam-ination of reflexes, co-ordination, speech,sensation and sometimes brain imaging.Importantly, they are usually only orderedafter symptoms become severe enough fora patient or their family to notice.

WinterLight Labs is taking a differentapproach: looking at speech patterns. Its

software analyzesrecordings of pa-tients speakingand weighs hun-dreds of factors –such as verbchoice, sentencelength and com-plexity, changes inloudness or in-stances of repeti-tion – to detectsigns of dementia

or Alzheimer’s disease. The ease of test-ing means it could be used to spot signsof cognitive decline earlier than tradi-tional testing methods.

Toronto-based company Analytics 4Life is applying machine learning to de-tect another difficult-to-diagnose condi-

tion: coronary artery disease. The com-pany’s CorVista device and machine-learning software use skin-surface elec-trode measurements and other physio-logical data to determine signals of thedisease. The company’s goal is to elimi-nate the need to subject patients to inva-sive procedures involving radiation, con-trast agents or cardiac stress testing.

Better wound care: Hospitals treatthousands of patients every year whohave cuts, scrapes and other skinwounds. Swift Medical, a Toronto-basedventure that recently announced its U.S.expansion, has developed an AI-poweredapplication to assist clinicians in evaluat-ing the severity of wounds. Doctors cap-ture an image of the wound using asmartphone, and Swift Medical’s AI pro-gram rapidly analyzes thousands of datapoints to provide an accurate indicationof its size, depth and severity risk, help-ing clinicians treat the wound more effi-ciently, with reduced danger of infection.The technology is already being used onover 100,000 patients a month.

Ying Tam is Managing Director, Health Ven-ture Services at MaRS Discovery District.

Sheldon, the robot, is ideal for remote medication reconciliation.

Ying Tam

Five hospitals in northern Ontario sign-on for telepharmacy services



BY JERRY ZEIDENBERG

Interior Health may be the only ma-jor jurisdiction in Canada that hascreated a region-wide PACS thatconsolidates the medical images ofboth hospitals and community

imaging clinics.It was no small task, as the project inte-

grated PACS and RIS of two tertiary hospi-tals – in Kelowna and Kamloops – as wellas 35 other acute care centres that doimaging, along with eight independentimaging clinics.

The unified network has resulted insubstantial benefits for radiologists andpatients.

“It doesn’t matter where the patients go,the radiologists can easily access their im-ages and reports,” said NormaMalanowich, Vice President, Clinical Sup-port Services & Chief Information Officerat Interior Health.

That translates into time-savings andaccess to more accurate information by al-lowing radiologists to see previous examsand make comparisons.

As well, noted Malanowich, radiologistscan go from one hospital to another, andeven to independent clinics, and still usethe same PACS. They don’t have to learnnew systems, or try to remember how tocall up exams or use the tools from onesystem to another.

GPs and other clinicians can also accessthe system from any site across InteriorHealth, which reduces the need to orderduplicate exams.

The regional PACS had its origins in

2004, when Interior Health was deployinga McKesson PACS. (The company is nowknown as Change Healthcare.)

Management at that time had the fore-sight to realize that it would make sense toextend the PACS to community clinics aswell as hospitals, so that all images and re-ports could be captured and accessed.

“They knew from the start that therewould be a hole in the data if the commu-nity clinics weren’t included,” said TimRode, Program Director, Medical Imaging.

The clinics account for 18 percent ofthe images in Interior Health – less than inmany other jurisdictions, but still repre-senting nearly one in every five exams.

It was necessary to provide an incentivefor the independent clinics to comeaboard, change their workflow and investin the region-wide PACS. So InteriorHealth offered to pay the upfront costs ofthe PACS licensing and workstations. Theclinics would only have to shoulder thecost of ongoing support and storage.

All the clinics jumped at the offer – withthe exception of an MRI clinic in Kelownathat remains the only community clinic to-day that’s not part of the regional solution.

More recently, Interior Health has beenshifting to a centralized storage model,where community clinic images can behoused in regional servers, note John

Geistlinger, Corporate Director, ClinicalInformatics. This means lower storagecosts for the community clinics, but they’vehad to invest in faster online technology toupload and download images efficiently.

“After testing and seeing that it works,two of the largest community clinics areintending on moving to this model,” saidGeistlinger.

Creating a region-wide PACS would beharder if they had to start today, as it’slikely that some community clinics wouldhave their own PACS. That would requiremuch more time, effort and money to in-tegrate them into the IH PACS.

Still, Malanowich says, it’s a model thatsome jurisdictions in Canada might wantto look at, especially if many of their com-munity clinics haven’t installed PACS.

“It fits a rural environment,” she says.“And there are lots of places across Canadathat have a similar mix of urban and ruralhospitals and clinics.”

Interior Health continues to innovate.It has implemented voice recognition tech-nology for dictation/transcription, and hasextended the solution to radiologists incommunity clinics. The system has been agreat success.

“97 percent of the radiologists haveadopted it,” commented Geistlinger. “Theydon’t see a transcriptionist which has re-sulted in faster report turn-around timesand lower costs.”

A patient portal has also been deployedallowing patients access to their imagingreports online. Over 30,000 patients arenow enrolled and reviews are very positive,Geistlinger said.

St. Mike’s improves accuracy of AI by teaching it with simulated imagesBY JAMES WYSOTSKI

TORONTO – A novel approach toobtaining big data has allowedthe Machine Intelligence in Med-icine Lab of St. Michael’s Hospi-

tal to improve the ability of artificial intel-ligence to interpret medical images.

Radiologist Dr. Joe Barfett, one of thefounders of the MIMLab, said the hospi-tal databases of medical images that re-searchers typically use to train AI haveimbalanced datasets. While the databaseshave numerous examples of commonailments, there are too few of the rarerconditions that also tend to be more life-threatening.

He said AI requires big data – the rep-etition of hundreds of thousands of la-belled images – before it can recognizepatterns well enough to identify medicalconditions, but hospitals don’t en-counter enough cases of rare conditionsfor there to be enough sample images intheir databases.

Not only is the amount of data aproblem, but so is ensuring they are cor-rectly labelled, said Dr. Barfett.

A standard approach to machinelearning begins with importing a data-base of medical images, said Hojjat Sale-hinejad, an AI expert at the MIMLab

who is also a PhD student in the Electri-cal and Computer Engineering Depart-ment of the University of Toronto.

Next, a computer would scan the ac-companying reports and use them to labelthe images. Once the images are labelled, aneural network – the AI – is trained toidentify normal and abnormal cases.

Lacking sufficient information in themedical reports means some of the im-ported database images don’t get properlyclassified, said Salehinejad. Having abnor-mal images classified as normal couldconfuse the AI system and prevent it frombeing able to identify medical conditions.

To overcome the problems of dataquantity and the quality of its classifica-tion, Salehinejad said the MIMLab cameup with two solutions. First, he set up AIto analyze radiology reports so that itcould learn from the more thorough re-ports how to classify other images withless sufficient data.

“At the end of the day, you get moredata that’s better labelled,” said Dr. Bar-fett. “Because of our AI, the data is suffi-cient to train a big artificial neural net-work to analyze it.”

The second solution is what reallymakes the MIMLab unique, said Dr.Barfett. Instead of relying solely on realmedical images, the team augmented its

database by programming AI to createcomputer-generated normal and abnor-mal chest X-rays.

The team used several methods tocreate the images, including a generativeadversarial network, or GAN, which hadtwo AI computers “play a little game” of

sending ever-improving simulationsback and forth, said Salehinejad.

Eventually, the collection of simulatedimages was added to the database. Theteam created enough images of rare con-ditions that the combined number ofreal and simulated images matched thetotals of the more common conditionsthat were already sufficiently representedin the database.

Dr. Barfett said the technology isn’tnew, but the MIMLab’s use of it is.

“Its principles are similar to what’sused online to create fake images ofcelebrities,” Dr. Barfett said. “But we areone of the few in the world to createsuch simulations for radiology.”

To the untrained human eye, the simu-lated medical images are no match fortrue X-rays, said Salehinejad. But from theviewpoint of a machine or radiologist,there are enough features to distinguishone class of chest X-rays from another.

“You can train these neural networkswith predominately simulated data, andmaybe even completely simulated data,”said Dr. Barfett. “And you’re actually bet-ter off because you’re appropriately rep-resenting the cases that you don’t wantto miss, not just the common ones.”

The Machine Intelligence in MedicineLab proved the effectiveness of thismethod by comparing the classificationaccuracy of one AI trained with just theoriginal imbalanced dataset and anotherthat used a dataset augmented with sim-ulated images, said Dr. Barfett. For com-mon diseases, classification accuracy im-proved by 20 percent. For rarer condi-tions such as pneumothorax (a collapsedlung), the improvement was about 40percent.

Artificial intelligence expert Hojjat Salehinejadcompares real medical images with simulationscreated by a generative adversarial network.

Interior Health’s diagnostic imaging network includes hospitals, clinics

Interior Health’s Tim Rode, Norma Malanowich, and John Geistlinger lead the region’s PACS strategy.

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© 2018 Cerner Corporation

Discover health care as it should beSince 1985, we’ve helped lead the charge in Canada, connecting health care and IT for a better future. And throughout our journey, we’ve gained insight. The insightto see value that can’t always be seen.

When it comes to providers, we value delivering intelligent solutions and services, like our flagship EHR platform Cerner Millennium®, that continue to improve the health and care of individuals and their communities – from day one.

For clients, we value smarter ways to do the everyday – communicating, coordinating and improving the efficiency of your workforce. Knowing that at the end of the day, every second saved is a life benefited.

And for patients, we value a brighter future – empowering them to get involved with their own well-being through patient-centered care tools. Because an engaged patient will always make a healthier person.

When it comes to health care, we’ve turned insights into wisdom. The wisdom to know that we’re never done learning, growing and sharing, side by side, with you. Because change is progress and health care is too important to stay the same.

Visit cerner.ca for more information


TORONTO – When studying thebrain, you might imagine scientistspeering into test tubes. That isn’tthe case for researchers at Baycrest.

Imaging technology and big data arefront and centre in Baycrest’s aging andbrain health research, work that lays thefoundation towards the prevention, diag-nosis and treatment for dementia and cog-nitive decline.

As Baycrest celebrates its centennial,media were invited to hear from re-searchers how combining care with re-search has led to many critical brain healthand aging discoveries. They also learnedabout current work that will enable manymore innovations to help people live longand live well.

“One of the unique aspects of Baycrestis that we are basically a one-stop-shop forcognitive neuroscience imaging,” says Dr.Allison Sekuler, VP Research and SandraA. Rotman Chair in Cognitive Neuro-science at Baycrest Health Sciences. “Weare one of the few places in the world withfacilities for magnetic resonance imaging(MRI), magnetoencephalography (MEG),electroencephalography (EEG), and tran-scranial magnetic stimulation (TMS) allwithin a single building, and a diversegroup of scientists – from physicists topsychologists – to support research inthese different imaging modalities.”

Using MEG to guide treatment recom-mendations: As one of the few institutionsaround the world using MEG to study thebrain, researchers can map an individual’sbrain activity while they are undergoingtreatment.

Dr. Jed Meltzer, Canada Research Chairin Interventional Cognitive Neuroscience

and scientist at Baycrest’s Rotman ResearchInstitute, is using this technology to deter-mine a person’s direct response to treat-ment and pinpoint areas of the brain thatare responding positively to interventions.

“During a stroke, some areas are de-stroyed, but some regions are affected in away that may be reversible,” says Dr.Meltzer. “There are interventions out therethat have enhanced brain function amongpatients. By improving our methods tocharacterize abnormalities in brain regionsaffected by disease, we will be able to tellwhich interventions are most effective atrestoring healthy function and are likely towork for an individual.”

Understanding this could fast-track re-

covery for acquired disorders, such asstroke and traumatic brain injury, and im-prove resilience to progressive disorderslike dementia by providing doctors withimmediate insight into whether a treat-ment is restoring function in the appropri-ate regions, adds Dr. Meltzer.

Treating depression and dementia withTMS: Brain stimulation has the potential tobolster an individual’s natural process ofneuroplasticity (its ability to “rewire” orcompensate at any age). TMS is a non-inva-sive procedure that uses magnetic fields tostimulate and inhibit targeted brain regions.

RRI Clinical Scientist, Dr. Linda Mah,and Dr. Meltzer are exploring TMS’ abilityto reduce symptoms of depression and

Alzheimer’s disease among patients. Up to70 percent of people living withAlzheimer’s also suffer from depression.

“Long-term sessions of brain stimula-tion are already being used in the clinicalsphere to treat depression and improve apatient’s mood,” says Dr. Meltzer. “Wehope to tap into TMS’ benefits to treatother neurological conditions, such as de-mentia, as studies have shown that it canimprove motor function and cognition.”

MEG will be used to determine whetherthe treatment can reverse physiological ab-normalities caused by brain disorders.

Detecting dementia earlier with fMRI:Scientists have demonstrated that bloodflow to the brain declines with age, and au-topsies have shown that vascular disease(disorders with abnormal blood circula-tion) are present in more than 90 percentof patients with dementia.

Dr. Jean Chen, Canada Research Chairin Neuroimaging of Aging and a RotmanResearch Institute scientist, has developedan innovative functional magnetic reso-nance imaging (fMRI) technique thatstrives to alert doctors earlier of a person’srisk of developing certain brain diseases,such as Alzheimer’s disease and related de-mentias, mini-strokes (transient-ischemicattacks) and stroke.

Her approach aims to measure blood-vessel stiffness, which impacts blood flow,in the brains of older adults. “There areways to improve blood flow through every-day activities, such as exercise and healthyeating,” says Dr. Chen. “With our work, wecould provide a brain health measurementfor doctors to help them decide whether apatient should start preventive interven-tions before the disease develops.”

e-Health 2018 seeks to ‘celebrate, grow and inspire bold action’

The 2018 e-Health Conference& Tradeshow seeks to Cele-brate, Grow and Inspire BoldAction in Canada’s digitalhealth community. As

Canada’s largest national digital healthevent, the conference brings togetherpassionate individuals from coast tocoast to learn from digital health leadersand innovators from Canada andaround the world.

Now in its 18th year, the conferenceoffers top-quality learning and an op-portunity to network with organizationsand people that value quality health in-formation and effective integrated sys-tem solutions. There is no shortage ofactivities to partake in and attendees canlook forward to special events such asthe Showcase, and Hackathon, and net-work with old and new colleagues at theTradeshow and social events.

This years’ event will be held in Van-couver Canada at the brand new JWMarriott Parq Vancouver, from May 27 toMay 30, 2018. We hope to see you there!

Conference Program Highlights: Withover 250 abstract presentations and pre-senters, e-Health 2018 offers an abun-

dance of education and learning oppor-tunities for all attendees.

This years’ opening ceremony keynoteaddress is: Grand Debate: Systemic Trans-formation versus Incremental Change:Canadian Digital Health for the Future.This session will examine strate-gies, approach, challenges andlessons learned on the journeyto connected care.

In addition to plenary ses-sions and presentations, this yearwe are introducing ‘Rapid Fire’ –a live, interactive presentationformat that will feature approxi-mately six presenters, who willhave three minutes to rapidlypresent their ideas. The resultwill be an engaging, fast-pacedsession covering a variety of topics.

Here is a look at some of the topicsthat have been selected for the confer-ence program, created by the many greatabstracts that were submitted fromacross Canada and internationally.

Monday, May 28 – 11:30am to 12:30pm.Emerging Technologies – Block Chain/Genomics• Blockchain in Healthcare: Separating the

hype from reality. Glenn Lanteigne, Tec-tonic Advisory Services Inc., CA• Patient Control: How Blockchain canTransform Health Care and Society.David Wiljer, University Health Net-work, CA

• Genomics Data and Cancer: Risk Pre-vention to Diagnosis and Treatment.Brandon May, CGI Group Inc., CA• Multi-Omic Analysis: RevolutionizingPersonalized Health. Robert Fraser, Mole-cular You Corp, CA

Tuesday, May 29 – 1:00pm to 2:00pmExpanding EMR Use in Communities• Increasing Access to Care with PatientPreferred Secure Communication. Scott

Wilson, Brightsquid Secure Communi-cations Corp, CA• Electronic Medical Records: InformationAggregators or Gateway Systems?Matthew Leduc, OntarioMD, CA• Standardizing Free Text in EMRs: Au-tomating Data Coding in Primary Care.Karim Keshavjee, InfoClin Analytics, CA• Optimizing your EMR: Tools andProcesses for Understanding Patient Pan-els. Delrae Fawcett, Doctors of BC, CA

Wednesday, May 30 – 10:30am to 12pmDisrupting Technology into the NextDecade• Distributed Consent Management byBlockchain. Edward Brown, MemorialUniversity, CA• Deep Learning Techniques to ImprovePatient Care with Neural Networks. DanConnors, Allscripts Analytics, US• The Power of Patient/Provider Messag-ing: From Human to AI. Anne Weiler,Wellpepper Inc, USA• Iris Scanners as an Identification Toolfor Individuals Experiencing Homeless-ness. Cheryl Forchuk, Parkwood Insti-tute, CA• Using Blockchain To Enable Informed

Artificial intelligence expert.

Baycrest has become a one-stop shop for cognitive neuroscience imaging and uses a variety of modalities.

Imaging tech and Big Data key in Baycrest’s brain health research



2018 course schedulePhysician Leadership Institute (PLI)

NEW ONLINE Navigating Your Career: Essential skills for the modern physician

May 28 – July 8

DATE

NEW ONLINE Navigating Your Career: Essential skills for the modern physician

Oct 22 – Dec 2

ONLINE Leadership Begins with Self-awareness

May 28 – July 8

Oct 22 – Dec 2

Leadership for Medical Women June 11 – 12

Engaging Others Oct 21 – 23

Physician Leadership Focus Oct 24 – 25

OTTAWA, ON

NEW Leading High Performance Culture June 13 – 14

ONLINE Leading Change Sept 17 – Oct 28

NEW ONLINE Making Patient-centered Care a Reality

Sept 17 – Oct 28

Sept 17 – Oct 28

Self-awareness an ective Leadership

Sept 23 – 25MONTREAL, QC

TORONTO, ON

Leading Systems in Healthcare Sept 26 – 27

NEW Physician leadership Institute (PLI) certi te

A new cert te recognizing physicians that have taken a minimum of ve PLI courses to deepen their knowledge of fundamental leadership concepts, theories and skills.

• Demonstrates knowledge to be an tive leader

• Asset to progress into leadership positions

• Can act as a stepping stone to CCPE

ONLINE Dollars & Sense

CORE

: PLI c hysicians interest

a position o leadership. These courses may be taken in any order. All PLI courses are also available in-house.

ONLINE Engaging Others

For more information visit

joule.cma.ca/learn or email [email protected]

One of the most controversial topicsin healthcare today is timely accessto care and long wait times. Overthe past months, members of thepublic have expressed their frus-tration on social media, with many

responding to health columnist Andre Picard’s callfor wait time stories (#CanadaWAITS). The contro-versy rages over how to make improvements whenfunding is limited and infrastructure is aging. Longwait times associated with emergency departments(ED), result in decreased quality of care for patientsand stress and burnout for healthcare providers. Toaddress the problem, most governments have settimely access to care as a priority area.

To date, improvement strategies have centered onpublic reporting and transparency. While these ef-forts are a start, they don’t address the innate prob-lems, one of which is inefficiency. Ensuring each de-partment is performing effectively, without addi-tional HR, is difficult but can be done with the use ofdata and analytics.

Using data and analytics can shed light on patientflow patterns and group performance. Most EDs cananecdotally tell you when they are busy, and qualifyingthat with math allows the department to strategicallyplan for improvement. When the right complement ofphysicians is scheduled to meet the patient flow needs,there are fewer peaks, valleys and bottlenecks resultingin improved patient movement and lower wait times.

There are many positive outcomes resulting fromlowered wait times. Not only does patient care im-prove, but the likelihood of a patient returning, oftensicker, decreases, as does the number of patients wholeave without being seen. We often forget about thepatients who leave after registering but before beingseen by a physician. The obvious problem this creates

is that patients were not treated for their illness or in-jury. Less obvious, but equally important, is that thehospital is not compensated for the care or tests thepatient may have had while waiting. When patientswait a reasonable amount of time to see a physician,they are less likely to leave, more likely to give a bet-ter medical history and are better positioned to fol-low through on their discharge orders.

Improvements to patient flow are also felt byhospital staff. When a department is working at a

more consistent and predicted level, there is lessburnout resulting in improved staff retentionand satisfaction.

There will always be unknowns in medi-cine but understanding trends can help adepartment strategically plan for sustainedimprovement. One company that under-stands the issues behind improving accessto care is MetricAid. The Ontario-based

company leads the industry by delivering an intelli-gent, data-driven service that is transforming physi-cian scheduling for healthcare facilities.

“After 15 years of working in Emergency Depart-ments and recognizing how an optimized physicianschedule can greatly improve patient flow, Dr. ScottDaley and I partnered to build an innovative solu-tion to address these scheduling challenges,” says LesBlackwell, CEO.

Having started with ED schedules but now grownto include other in-hospital departments, MetricAidhas developed proprietary software that uses multipleaxes of data to create physician schedules that opti-mize department performance, while minding physi-cian preferences. Having a service that includes expertschedulers assigned to each physician group allowsusers to request a schedule suited to both their profes-sional and personal needs. MetricAid’s service in-cludes efficiency analysis and recommendations. An-

nually, the team reviews hospital data to ensure de-partments are on track to maintain or improve

their standards; they work collaborativelywith their clients to ensure that gains madeare sustained, year over year. Timely access to care should be available toall who need it; whether in an emergencydepartment or while waiting for an outpa-

tient test. Though achieving this for every-one may be a few years out, there are steps

that can be taken presently to effectchange and improve the patient ex-

perience. Patients and healthcareprofessionals invoke a 2005Supreme Court of Canadadecision that stated “Accessto a waiting list is not accessto healthcare”.

VI

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MetricAid’s software optimizes departmental performance while minding physician preferences.

#CanadaWaits and emergency departmenttechnology solutions

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

Patients and healthcare professionalsinvoke a Supreme Court of Canadadecision that stated, “access to awaiting list is not access to healthcare.”

How Blockchain will transform the delivery of healthcareBY ANYA KRAVETS

Heralded as one of the mostfundamental inventions inthe history of computer sci-

ence, blockchain is set to revolution-ize and disrupt hundreds of indus-tries that rely on intermediaries – fi-nance, banking, real estate, insur-ance, education, and legal, amongothers. And health care is most defi-nitely one of them.

What is blockchain: Think ofblockchain as a beehive with multiplecontributors, where all the cells arelinked to one another and are visibleto all the participants of the network.By (more formal) definition,blockchain is a digital ledger in whichtransactions made in Bitcoin or an-other cryptocurrency are recordedchronologically and publicly.

Essentially, blockchain is a distrib-uted database that maintains a sharedlist of records, or blocks, time-

stamped and containing history ofevery block that came before it. Thedecentralized, open and crypto-graphic nature of blockchain alsomeans that it allows storing and shar-ing data in a highly secure manner –when someone wants access to yourblockchain data, you will know it.

Medical records: The need for in-novation in electronic medicalrecords (EMRs) is well-known, butthe restrictive regulatory environmentas well as privacy issues have createdsignificant challenges for innovation.

Enter MedRec, a solution cateringto the needs of patients, health careproviders as well as researchers. It isa decentralized record managementsystem relying on blockchain tech-nology to handle electronic healthrecords. MedRec does not storehealth records but a signature of therecord on a blockchain, notifying thepatient and providing a means toshare that record as required.

This prototype also has a tremen-dous potential to power medical re-search by providing an opportunityfor patients to share their personalmedical information with researchers.

Digital medicine: Some of themost exciting opportunities exist in

the consumerhealth space,whereblockchaincombines caredelivery withrewards to en-courage con-sumers’ pre-ventative ac-tions when itcomes to theirhealth.

CoverUS, a U.S.-based startup,proposes an idea to monetize health-related data through a blockchain-powered marketplace, also makinginsurance cheaper and encouraging

consumers to become healthier in theprocess by rewarding them for takinggood care of themselves. CoverUSCoverCoin rewards can be redeemedfor everything from medical co-paysto the transportation needed to keepthat doctor’s appointment.

PointNurse is a blockchain-basedvirtual care network platform for de-livering direct primary care and caremanagement services to targetedpopulations. The platform enablesnurse practitioners and other healthcare team members to conduct as-sessments, behaviour managementprograms and care coordination. Asmart-contract-based cryptocur-rency called Nursecoin is in develop-ment as well, with a goal to incen-tivize community growth, close gapsin care, reward patient behaviourand provider performance for im-proved health care delivery.

These solutions have a great po-


Anya Kravets


V I E W P O I N T

BY ALEX MANEA

As BlackBerry’s Chief Security Of-ficer, I regularly speak with For-tune 500 C-Suites and leadersrepresenting the world’s top

global brands, listening and learning aboutwhat security concerns keep them up atnight. I also try to spend just as much timespeaking with security researchers – ethi-cal hackers devoted to discovering securityflaws and vulnerabilities.

Based on countless conversations overthe past 12 months with customers, part-ners, government officials, our internal cy-bersecurity experts, and leaders from boththe security and research communities, be-low are my predictions for 2018.

2018 will be the worst year to date forcyberattacks: With 2017 being the worstyear ever for cyberattacks, it’s tempting to

think that we’ve hitrock bottom, butwhat we’ve seen sofar is just the tip ofthe iceberg.The fundamental is-sues that have causedthe majority of recentcyberbreaches havenot been resolved. ITdepartments are be-ing tasked to manageincreasingly complex

networks, support new types of endpoints,and protect more and more sensitive data.

Legacy systems are still rampantthroughout most industries and cannot beeasily upgraded or replaced. These systemsoften contain publicly known softwarevulnerabilities which can be exploited topenetrate the corporate network.

At the same time, attackers are gettingincreasingly sophisticated and have moreincentives than ever to mount cyberattacks.From building ransomware or mountingDDoS attacks and demanding bitcoin pay-ments, to working with organized crimeand even national governments, malicioushackers have numerous ways to monetizetheir skills and to protect themselves.

Governments and enterprises are recog-nizing these new threats and deployingmodern security solutions, but it will takeyears to decommission all of the legacysystems. 2018 will be yet another yearwhere the shortcuts of the past come backto haunt us.

More importantly, we need to startplanning for the future by addressing thenew threats posed by the Internet ofThings (IoT), which go well beyond any-thing that we see in today’s cyberattacks.

Cyberattacks will cause physical harm:Securing the Internet of Things is evenmore important than securing traditionalIT networks for one simple reason: IoT at-tacks threaten public safety.

A hacked computer or mobile devicetypically cannot cause direct physicalharm. While it’s certainly frustrating tohave our personal information stolen, itdoesn’t compare to the impact of being in-volved in a car accident or having your in-fusion pump or pacemaker compromised.IoT security will literally become a matterof life and death, and we cannot simplywait for that to happen.

I’ve spoken recently about the need forstronger IoT security standards, especiallyas we continue to move towards smartcities. With the growing ubiquity of IoTand lack of focus on security, it’s only amatter of time until malicious hackersbreach critical connected infrastructure

and devices and cause direct physical harmto individuals and innocent bystanders.

Hackers will target employees as a grow-ing cybersecurity vulnerability: IT depart-ments typically focus their spending onpreventing external attacks, but the reality isthat most data breaches start internally – ei-

ther by sharing documents through unse-cure, consumer applications or clicking onincreasingly sophisticated phishing attacks.

While hackers are often depicted as tech-nical geniuses using complex algorithms tobreak advanced cryptography, the reality is

You can try hacking your own network to really see how secure it is

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h t t p : / / w w w . c a n h e a l t h . c o m A P R I L 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 1 5

BY DIANNE DANIEL

In ancient Roman mythology, the god Janusis depicted as having two faces, one lookingforward to the future and one looking backto the past. As the legend goes, he was wellsuited to presiding over beginnings and peri-ods of transitions.

In today’s fast-moving world of mobile health, re-searchers and medical graduates coming out of Cana-dian academic centres are no different, says Dr. KendallHo, a professor in the Department of Emergency Med-icine at the University of British Columbia and lead ofthe faculty’s Digital Emergency Medicine unit.

“They are learning what all of the giants before ushave done to bring us to where we are, but they alsohave a way to look forward to identify gaps and chal-lenges that still exist,” said Dr. Ho, who believes it’sprudent to put historical context around future in-novation. “As we build a digital culture, it’s impor-tant that we not lose sight of history but continue toadvance as a profession to support our patients thebest way we can.”

UBC’s Digital Emergency Medicine unit is doingjust that as it engages medical, pharmacy, nursing andgeneral science students – including interna-tional students – to assist on projects aimed atbringing new mobile solutions to the forefrontof healthcare. One example is TEC4Home,which is applying remote monitoring technolo-gies to keep heart-failure patients healthier athome after discharge from hospital.

The first phase targeted heart failure patientsat Vancouver General Hospital, St. Paul’s Hospi-tal and Kelowna General Hospital. Upon dis-charge, they were provided with a touchscreentablet, blood pressure cuff, weight-scale andpulse oximeter, supplied by partner TelusHealth. Patients would take their measure-ments daily for a period of 60 days, and their re-sults were automatically delivered to a web por-tal for monitoring by a TEC4Home nurse.

Patients were also asked to answer ques-tions about their other HF signs and symp-toms, such as shortness of breath, cough-ing and dizziness. By examining the re-sults daily, the nurse could contact the patient aboutadjusting medications, visiting his or her family doc-tor, or going directly to the ED. The nurse could alsoanswer questions from patients and coach themabout taking care of themselves.

“Patients can start to measure, to know, to feel, sowhen they say, ‘I’m dizzy’, they can see their bloodpressure or oxygen saturation is dropping and thatmaybe they should back off from exercise,” said Ho.“They can actually see it in action.”

Dr. Ho is one of the principal investigators, alongwith Dr. Chad Kim-Sing, department head and med-ical director, Emergency Medicine, at VancouverAcute Community of Care VCH (VGH, UBCH, GFStrong), and Mary Ackenhusen, president and CEOof Vancouver Coastal Health. Also involved are re-searchers, ED physicians, family physicians, cardiolo-gists, nurses, patients, technology partners, andhealthcare administrators.

Early on, the study showed a reduction in thenumber of hospital readmissions as well as an in-crease in patient quality of life. Based on those find-ings, it is now being expanded from 70 to 900 pa-

tients within 20 communities, including regionalcentres like Surrey and Abbotsford as well as smaller,rural communities like Clearwater and Sechelt.

A second TEC4Home project has since launchedto provide similar monitoring for COPD patients atVancouver General Hospital, Richmond Hospitaland St. Paul’s Hospital, adding a pedometer to theequipment provided.

Remote monitoring allows healthcare profession-als to intervene before a change becomes problem-atic, by reminding patients to restrict fluids or start amedication, for example. The sensors also help pa-tients to improve their own health management be-cause they start to see correlations between measure-ments and symptoms, and begin to monitor theirconditions on their own, explained Dr. Ho, who callsthe sensors “digital mirrors.”

Just as dancers learn how to correct certain movesby dancing in front of a mirror, the wearable sensors

help patients to learn and track theirown symptoms, he said.

Each Digital Emergency Medicineproject draws on the expertise

of students in some way, while also providing an op-portunity to learn. In the case of TEC4Home, stu-dents are involved in collecting and analysing patientdata, as well as conducting focus groups to under-stand how patients and health professionals perceivethe technology. An added benefit is the opportunityto observe a patient’s lived experience.

Whereas TEC4Home supports the patient transi-tion from hospital to home, other projects under waywithin UBC’s Digital Emergency Medicine unit arefocused on using smartphone apps and online re-sources to improve digital health literacy among thegeneral population, including seniors, children ingrades four to seven, and multicultural populations.

In Toronto, the first cohort to enrol in OCADUniversity’s new Master of Design in Designfor Health will graduate this year. Intended to

fill a gap in the need for health design, and fuel anappetite to find solutions, the first-of-its-kind pro-gram attracted 12 students in each of its first twoenrolments.

“We realized an enormous potential and need for

design in the healthcare sector because challenges arenot being met through regular avenues,” said pro-gram director Kate Sellen.

The interdisciplinary program has four mainthemes delivered through studio-based learning:health context; research and application; design andinnovation; and, proficiency and leadership within in-terdisciplinary collaborations. For the most part, part-ners approach the school with their challenges, but stu-dents also work independently in their final year. AsSellen explained, each project provides a blueprint forchange that usually involves reorienting their thinking.

One project, for example, looked at fall mitiga-tion at Baycrest, a research and teaching hospital forthe elderly in Toronto. Instead of examining theproblem through the classic lens of fall prevention,which may include restraints or alarms, studentslooked at how design choices could improve fall re-sponse. The resulting prototype integrates unobtru-sive fall detection sensors, embedded into the light-ing of resident rooms, with a smartphone app car-ried by nursing staff.

When a fall occurs, nurses receive more than analert; they also know whether it was a high impact

fall or a slow crumple to the ground, or howlong the person has been down, all ofwhich informs the type of responserequired.Alison Mulvale is among the first tograduate from OCAD’s Design forHealth program. After obtaining

her Bachelor of Science in GeneralSciences from the University ofOttawa and Bachelor of Envi-ronmental Design at OCAD, she

considered it the “perfect av-enue” to blend the two.For her independent studyproject, Mulvale is working onan early warning system to

detect the possible onset ofconcussion in sport. The idea

sprouted after she sustained a con-cussion while playing soccer. “Ithought I knew everything aboutconcussions until I actually expe-

rienced one,” she said.Drawing on her lived experience, she reached out

to the Concussion Legacy Foundation Canada andoriginally set out to evaluate and redesign concus-sion training and awareness resources. Then she re-framed her thinking. “The really key thing aroundconcussions and awareness that began to emergewasn’t that concussion in sport happens necessarily,but that there are some pretty serious complicationsthat emerge if they’re not managed early and appro-priately,” she said.

The exercise led her to examine how smart sensorsand emerging nanotechnology materials might helpto form a solution. The result is a prototype that in-corporates a smart, tape-like material, capable of de-tecting force, which can be adhered to the outside of asports helmet. The idea is that as hits occur duringplay, the tape changes colour – from green to yellow tored, for example – to indicate when an athlete mayhave sustained a concussion, enabling them to be re-moved from play immediately.

“If you’re going to impact concussions, you have to

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UBC, working with Vancouver Coastal Health, has spawned a leading-edge tele-monitoring system.

Universities across Canada foster the growth of healthcare innovation

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W I R E L E S S A N D M O B I L E S O L U T I O N S

BY MICHAEL ORESKOVICH

TORONTO – Runnymede Health-care Centre, a 200-bed complexcare and rehab hospital, has im-plemented a new, voice-activated

technology to streamline collaborationamong clinical staff. The centre is now us-ing Vocera’s hands-free, communicationbadges to support coordinated care forsome of the most complex patients in theGreater Toronto Area (GTA).

By leveraging the new technology, Run-nymede has increased its responsiveness topatients’ needs, enhanced safety and ele-vated the patient experience.

Worn on lanyards, the badges recognizevoice commands and respond by allowingstaff to easily start conversations or receiveincoming calls.

“The technology is lightweight enoughto be comfortably worn at all times, so staffare always accessible during their shifts,”said Runnymede’s Vice President, PatientCare, Chief Nursing Executive & Chief Pri-vacy Officer, Raj Sewda. “All they have todo is say the name of a person or depart-ment into their badge, and a conversationcan start.”

Prior to the badges’ roll-out, clinicalstaff used mobile phones to communicate.Although practical, they were not ideal be-cause staff often handle clinical instru-ments while treating patients. Hands-freebadges enable staff members to talk witheach other without interfering with thehands-on care they are providing.

The badges’ ease of use also promotesincreased collaboration among membersof the clinical team.

This enhanced collaboration alsostrengthens patient safety at Runnymede.If a patient has care needs that must bemet urgently, the rapid communicationfacilitated by hands-free badges makes itpossible for clinical team members to callothers for support, or to quickly ask foradditional supplies – all without everleaving the patient’s side or interruptingtheir care.

If the staff member they wish to reach is

on their break, the system automaticallysends the call to a designated back-up.

To further strengthen patient safety,badges will soon be linked to the hospital’snurse call system. “Before badges were im-plemented, it was only possible for nursesto be notified about patient calls through adigital display, and they had to go to thepatient’s room in order to talk with them,”said Runnymede’s Director of PatientCare, Frederick Go.

“Now we have the technology for noti-fications to be triggered on the badgeworn by the patient’s assigned nurse, whowill soon be able to speak with the patientimmediately after pressing their call but-ton, to find out what they need and re-spond accordingly.”

The badges are currently integratedwith the hospital’s main phone system,providing family members with a directline to the clinical team if they have anyquestions.

“When a family member phones Run-nymede, they’re able to access our voice-activated system, and by simply saying theroom and bed number of their loved one,they can be connected to the nurse who isassigned to them,” said Go.

“This provides families with convenientaccess to our clinical team members when-ever they need it.”

If discussions are confidential and notsuited to an open-air conversation, staffare trained to protect the patient’s privacyby switching the badge’s mode so that itworks like a conventional mobile phone.

Runnymede anticipates the badges’ re-cent implementation will support its deliv-ery of safe, high-quality care. “The tech-nology vastly simplifies communicationand increases the accessibility of our clini-cal team, which benefits patients, familiesand staff alike,” says Sewda. “It’s an excel-lent tool for strengthening collaborationand enhancing our responsiveness to pa-tients’ needs.”

Michael Oreskovich is a CommunicationsSpecialist at Runnymede Healthcare Centre,in Toronto.

change the conversation,” said Sellen.“Alison started to look at the momentof concussion and the motivators foractually changing behaviour and that’swhat led to this proposal with the hel-met stickers.”

Many of the projects under way inthe program are designed for not-for-profit clinical environments whereresearch and development resources arelimited. There’s no push tocommercialize, but designs are oftenleveraged by other companiesperforming similar work, or furtherdeveloped using government fundssecured by the partner.

One student, for example, is workingwith the Schizophrenia Society ofCanada’s Youth Advisory Council tocreate a peer navigation app, intendedto facilitate a more positive experiencefor youth with Schizophrenia throughtexting. Another project, led by Sellen,is developing an integrated digital strat-egy to provide easily accessible andbrief first aid training to accompanynaloxone kits used to treat opioid over-dose. Randomized controlled trials ofthe digital training, available as a smart-

phone app, are scheduled to start at St.Michael’s Hospital in Toronto.

At a time when mobile health appsare so pervasive, two Simon FraserUniversity (SFU) alumni have

found a way to stand out from the rest byfocusing on a next-generation, human-machine interface: wrist movement. Bio-medical engineers Lukas-Karim Merhiand Gautam Sadarangani started to workwith gesture recognition technology dur-ing their tenure as researchers at SFU.

They’ve since partnered with industryveteran and medical doctor Jose Fernan-dez to launch BioInteractive Technologies(BIT) and to develop a proprietary plat-form that accurately detects hand pos-tures. Their flagship product is TENZR, awearable wristband that detects six ges-tures out of the box: hand open, handclosed, up, down, left and right.

The product can be used to controlmedical equipment in operating rooms,complex robotic systems or mixed realityenvironments through gestures. It canalso be applied to accurately monitorhow people are using their hands.

TENZR is currently being evaluatedby a lower mainland hospital as a tool toassist in stroke rehabilitation. Essentially,

the product is a smart strap, using sen-sors embedded along its entire length tomeasure tendon and muscle movementwithout the need for calibration or anyexternal beacons and cameras.

“The clinicians are interested in usingthe device to tell the number of timesthat a stroke survivor opens and closestheir hand in a day,” explainedSadarangani, who serves as the com-pany’s chief technology officer, withMerhi and Fernandez taking on roles of

chief executive officer and chief operat-ing officer respectively.

“The premise is to encourage patientsto move more or be more aware of dayswhen they’re not moving and to relaythat information back to the primarycare physician so they can intervene,” hesaid, adding that up until now, that typeof information was typically self-re-ported by patients.

TENZR is also well poised to play a

role in the emerging world of ubiquitousspatial computing, where shared realityenvironments are emerging to solvechallenges related to pain management,rehabilitation, surgical simulations andclinician training.

“Imagine that these digital assets you’relooking at are all around you in 3D, andyou’re interacting with those assets, usingyour hands in the same way you interactwith physical objects today,” said Merhi.

BioInteractive Technologies is cur-rently based out of SFU’s Surrey, B.C.,campus as an incubator client of CoastCapital Savings Venture Connection. Re-cently, the company was selected to takepart in the Techstars Anywhere program,which provides access to hands-on men-torship, funding and lifelong access tothe Techstars Network, one of NorthAmerica’s biggest start-up accelerators.

As their company marches steadilyforward, the support of their alma materis not lost on the two alumni.

“SFU prepared us for the challengeswe took on beyond grad school,” saidSadarangani. “Coast Capital Savings Ven-ture Connection is bridging the gap be-tween when an idea is in a founder’shead and those first few crucial monthsto get things started.”

Hands-free communications enhances patient care at Runnymede

Runnymede Healthcare Centre’s adoption of Vocera communication badges enhances collaboration and thepatient experience by increasing access to staff; the technology’s portability is demonstrated by thehospital’s Director of Patient Care, Frederick Go; Patient Care Manager, Simin Faridani; and Patient CareCoordinator, Victoria Forrest.

TENZR is currently beingevaluated by a lowermainland hospital for stroke rehabilitation.


Universities across Canada foster the growth of healthcare innovation


Patient Consent For Research. Bruce Mc-Manus, PROOF Centre of Excellence, CA• Improving Management of Long Stay Pa-tients with Machine Learning Prediction.Patrick Tan, Fraser Health Authority, CA

Visit the e-Health Conference andTradeshow website for the full program.

Hacking Health 2018: This year, HackingHealth is partnering with the eHealth Con-ference on a #patientsincluded hackathonset to tackle the pressing healthcare issue ofchronic disease management. Participantswill work hand-in-hand with patients andclinician experts, building innovative soft-ware solutions focused on prevention, homecare, and community care.

The challenge will begin with the open-ing ceremonies on Sunday, May 27th,where the leaders of selected projects willgive short pitches explaining the health-care problems they seek to solve. Teamswill then spend the next day and a half de-signing, building, testing, validating andtuning their prototypes in preparation forthe demo competition, working with men-tors to refine and improve their solutions.

Once the hacking is complete, the teamswill present to conference delegates and beevaluated by an expert panel of judges onMay 29th. Awards will be presented shortlyafter to the winners.

Registration is now open.Patients Included: We are proud to an-

nounce that this year’s conference is an ac-credited Patients Included event.

This means that we are committed toincorporating the experience of patients asexperts in living with their conditions

while ensuring they are neither excludednor exploited.

As part of this commitment, patientspeakers have been invited to be a part ofthis years’ program curriculum. Patientadvisors were also involved in the programplanning.

Social Events and Wellness Programs:This conference offers many opportunitiesto mix and mingle with your peers – inboth formal social settings, as well as activ-ity-based programs.

The social events include Happy Hours,the Presidents Reception, the Welcome Re-ception, and the Pre-Gala reception andCanadian Health Informatics Award(CHIA) Gala.

For those of you who want to be physi-cally active, this year we offer MorningYoga and Morning Kickboxing sessions!

Register Now to Save: Registration fore-Health 2018 is now open. Regular regis-tration rates are available until April 19,2018. More information can be found inthe Registration section of the e-Healthwebsite.

A New Conference Venue: e-Health2018 will be held in Vancouver, Canada at

the JW Marriott Parq Vancouver, locatedin the city’s exciting urban entertainmentand resort complex, Parq Vancouver.

The complex rises against a backdrop of

majestic coastal mountains on Canada’spristine pacific coast.

The City of Vancouver is a highly di-verse and multicultural city with peoplefrom all around the world. It is a populartourist destination and has been regardedas one of the most outstanding conventioncities in the world.

The city offers plenty of fine dining andshopping, but it is also an excellent placefor more outdoor pursuits such as hiking,golfing, boating, and surfing.

See you at e-Health 2018. We look for-ward to seeing you at this year’s must at-tend event as we showcase the success sto-ries, products, new ideas, and amazingpeople leading the way on Canada’s digitalhealth journey.

Visit our website at www.e-healthcon-ference.com.

Ontario and are being used solely for re-search purposes.

Most imaging equipment has been op-erating for 10 or fewer years, which is inline with the Canadian Association of Ra-diologists guidelines. SPECT is the excep-tion, with 57.5 percent of units being morethan 10 years old.

Not surprisingly, the greatest numberand variety of machines are located in thehighly populated provinces of Ontario,Quebec, Alberta, and British Columbia.Prince Edward Island and the territorieshave the lowest number of machines. Foreach imaging modality, approximately 60percent of all growth in the last decade canbe attributed to Quebec and Ontario.

As medical imaging continues to remaina vital part of modern health care, aiding indiagnosis, staging, and monitoring of anarray of conditions and diseases, it is im-portant to take stock of what is happeningin our communities and in Canada as awhole. Trend watching will continue as a2020 update is scheduled for publication.

CADTH extends an invitation to thoseinterested in hearing more about these re-sults to sign up for a free, online webinar aspart of the official CMII launch on April16, 2018 at the 2018 CADTH Symposium.Register at: www.cadthevents.ca/cmii/reg-istration. To learn more about the CMIIand other related reports, visitwww.cadth.ca/imaging.


This year, Hacking Health willpartner with the conference ona patients included hackathon,with input from patients.

that simpler techniques can be just as effec-tive. Criminal hackers aren’t seeking stylepoints; they’re simply looking to breach thesystem as efficiently as possible.

As our technical defenses continue toimprove, employees will become the weak-est link, increasingly targeted by attackersas part of their overall strategy.

My simple advice to all CIOs andCISOs: go hack yourself. You can spend allof your time building and buying systemsthat you believe will stop intruders in theirtracks, but until you bring professionalethical hackers and let them simulate areal-world cyberattack (including phish-ing and other social engineering tech-niques), you won’t ever know if you’retruly secure.

Our cybersecurity services team re-cently gained access to a customer’s net-

work by simply getting T-shirts madewith their company logo on it and statingthat they were “with IT.” If your employ-ees don’t know how to use the technologyyou put in place, or realize that they allplay a critical role in keeping your com-pany secure, everything a CIO/CISO doesis for naught.

Insurance and cybersecurity productswill go hand and hand: In 2018, it won’tmatter which system or employee provesto be the weakest link, major corporatedata breaches will happen and insurancecompanies are taking notice. They are tak-ing notice because attacks to their clientscould be as harmful to their bottom line.

This year I predict we will see firms notonly add more cyber policy holders totheir roster, but also seek out two strategicavenues to help manage risk for them andtheir customers: products and experts.

Just like Progressive’s Snapshot plug-in

device, which helps the insurer providepersonalized rates based on your actualdriving, insurance companies will startselling products to help track their client’ssecurity posture.

They will even partner with security ex-perts to appropriately evaluate a com-pany’s ability to protect against a cyberat-tack. Scorecards will be given and compa-nies that perform the best will be rewardedwith a lower policy amount.

Next Steps: While many other thingswill impact the cybersecurity industry thisyear, I believe these are some of the biggesttrends for 2018. We’ll be diving deeperinto these topics over the next fewmonths, so make sure to follow me onTwitter and check the Inside BlackBerryblog for more updates.

Alex Manea is Chief Security Officer withBlackBerry.


Try hacking your own network to see how secure it is

tential of improving medication adher-ence, helping reduce morbidity anddeath and decrease costs – a great impactto the health care system worldwide.

Clinical trials: Patient enrolment,personal data privacy concerns and lackof reproducibility are significant chal-lenges for clinical research, andblockchain can help address them. Thecurrent system makes it extremely diffi-cult to process all the data generatedand recorded. Blockchain could simplifyand link the diverse, disconnected sys-tems for accelerated medical innovation.

The smart contract functionality canhelp by streamlining the complex dataflow of clinical trials, where consent forprotocols and their revisions should bevisible to patients and stakeholders.Blockchain allows storing and trackingconsent in a secure, verifiable way andenables sharing of the information inreal time, as required.

E-prescriptions: One of the more obvi-ous applications of blockchain in healthcare is e-prescribing. Blockchain-poweredsolutions would make it easier for patientsliving with chronic illnesses to renew andrefill prescriptions in a secure way.

An already successfully implemented

e-solution in the space demonstrates theconvenient access and savings. In Esto-nia’s cutting edge e-health-care system,the electronic ID card system is poweredby blockchain to ensure data integrityand provide secure access to a patient’srecord to authorized individuals.

Medications are prescribed electroni-cally, and at the pharmacy, all a patientneeds to do is present an ID card. Thepharmacist then retrieves the patient’s

information from the system and issuesthe medication.

Medication quality: IBM submitted aproposal to the province of British Co-lumbia outlining the use of blockchain toregulate and transparently capture thehistory of cannabis products. The com-pany says it can do this, “through the en-tire supply chain while exerting regulatorycontrol, ultimately ensuring consumersafety from seed to sale.” Other companiesare already working in this space, leverag-ing blockchain, include Budbo, LibertyLeaf Holdings and Blox Labs.

Opioid crisis: Canada’s opioid over-

dose crisis is getting worse, with morethan 4,000 lives lost in 2017 accordingto the Public Health Agency of Canada(PHAC), a significant increase from2,861 opioid-related fatalities recordedin 2016. This public health crisis is a dif-ficult, multi-faceted problem; however,according to some experts, blockchainhas a potential to help resolve this com-plex challenge.

By incorporating traceable technol-ogy into the drug delivery process, man-ufacturers have the ability to safeguardmedications produced and sold,throughout the entire system, includingsuppliers, distributors, physicians, hos-pitals and pharmacies.

Challenges: Blockchain technologytranslates into massive exciting oppor-tunities for healthcare; however, organi-zational, regulatory, technical and be-havioural challenges must be addressedbefore blockchain can be fully adoptedand implemented by healthcare organi-zations across the board.

Governance and collaboration issues,and how Canadian organizations chooseto tackle them in both public and pri-vate spheres, will determine adoptionand implementation of blockchain inhealthcare.

Anya Kravets is Director, Engagement, atCossette Health.

Blockchain transformsCONTINUED FROM PAGE 14

Blockchain would make iteasier for patients living withchronic illnesses to renewprescriptions securely.

eHealth ConferenceCONTINUED FROM PAGE 12

CADTH producesinventory of equipment

h t t p : / / w w w . c a n h e a l t h . c o m A P R I L 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 1 9

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