hospital news 2016 april edition

INSIDEEvidence Matters ...............................14

From the CEO’s desk .........................16

Nursing Pulse ..................................... 17

Legal Update ......................................22

Ethics ..................................................24

Careers ...............................................27

FOCUS IN THIS ISSUEHEALTH PROMOTION/PERSONALIZED MEDICINE/VOLUNTEERS AND FUNDRAISING:An examination of developments in personalized medicine. Innovative approaches to fundraising and the role of volunteers in healthcare. Programs designed to promote wellness and prevent disease including public health initiatives, screening.

APRIL 2016 EDITION | VOLUME 29 | ISSUE 4

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HOSPITAL NEWS APRIL 2016 www.hospitalnews.com

2 Focus HEALTH PROMOTION/PERSONALIZED MEDICINE/VOLUNTEERS AND FUNDRAISING

randi Ng-See-Quan returned from an adventure of a lifetime – attempting to climb one of the highest mountains in the

world, Mount Kilimanjaro – and it was a journey she’ll never forget. Her journey is one everyone at Rouge Valley Health Sys-tem (RVHS) will also never forget.

This was no ordinary climb and no or-dinary woman. Ng-See-Quan chose this adventure as a way to give back to the mental health programs at RVHS’s Cen-tenary hospital campus and help combat the stigma surrounding those with mental health issues.

As someone who struggled with depres-sion, she wanted to show herself and oth-ers that you can still live a fulfi lling life, despite any obstacle.

“The outpatient mental health pro-gram really helped me get my life back on track!” she says. “Without them, I don’t think I would have bounced back too quickly. With their help, I was able to re-gain confi dence in areas of my life where it was lacking. I want the funds raised to help this department help others as they helped me when I was struggling.”

The journey took place last fall, but it didn’t end when she returned. Ng-See-Quan is already considering repeating the feat, and taking more of her friends and hospital supporters with her next time.

Although she fell short of the peak, she was happy to have made the attempt. She says all of her sup-porters have expressed their admira-tion for her effort. On November 16, 2015 she brought a cheque for more than $6,000 to the RVHS Foundation and received a warm greeting from her friends in the mental health program who were excited to see her again and hear fi rst-hand what the climb was like.

In dreaming up and execut-ing this unique way to raise funds for Rouge Valley Health Sys-tem, Ng-See-Quan worked with Maureen Dowhaniuk, associate director, events, at the Rouge Valley Health System Foun-dation. Although she has worked with countless third-party fundraisers and community group events, this was still a special opportu-nity, Dowhaniuk says.

“We were so excited when she told us what she was planning,” she says. “I think the world of Brandi, she is such an amazing young woman. Not only for giving back to the program in this way, but also for being brave enough to give voice to those with mental health issues and show what is possible.”

Julie Kish, interim director, mental health and addictions at Rouge Valley Health System, calls Ng-See-Quan “an inspiration to everyone who is struggling with mental health issues,” including ev-eryone in the community and the clients being seen at the program.

“It’s diffi cult for people to seek help when they are feeling at their worst, but I’m hoping Brandi’s story will inspire them to see what they can look forward to if they accept help from our clini-cians,” says Kish. “Our mental health team is proud of Brandi and is thrilled she is brave enough to share her personal story so others can benefi t from her ex-perience.”

On why she chose Kilimanjaro, Ng-See-Quan says it goes back to her youth. “As a young child, I would constantly watch any sort of nature/education or documentary regarding Africa in gener-al,” she explains. “I’ve always been fasci-nated and was determined from a young age that I would visit this amazing con-tinent. With my newfound confi dence, I thought this would be a great test for everything I’ve learned while in the out-patient program.”

The climb was arduous at times, with diffi cult terrain and problems due to the altitude. But she was well cared for by her guide aptly named ‘Good Luck’, she says.

“When I began to get a little loopy from the lack of oxygen, I’d say, “Have no fear, Good Luck is here,” she says. “I’m glad I did it. I would do it again.”

The trip to get close to the top took three days, but when they had to turn back for her health, they had to do it in one day. It was a scary journey at times and emotional, she admits.

“Of course I cried. They consoled me... but I was nauseous and liquids only made it worse... my body was shutting down,” she explains. “They saw me coughing throughout the night. So they knew what condition I was in.”

The 12-hour descent was dark to start at 7 a.m. and at the end when they ar-

rived at the camp. She is grateful for the care they gave her and to console her, her guides pointed to the registration book where there were many names of people who had to turn back for similar reasons. She also took solace in knowing her new-found friends were able to complete what they’d started.

“I was happy for the rest of my group, but I really wished I was up there with them,” she adds.

Back in Canada, she refl ects on the amazing journey she made and says “I’m excited to see what’s next for me!” ■HDave Stell is Manager, Communications and Government Relations – RVHS Foundation

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It’s diffi cult for people to seek help when they are feeling at their worst

N/PERSOONNALIZED MEDICINE/VOLUNTEERS AND FUNDRAISING

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From depression to the top of the

world

Brandi Ng-See-Quan and her guide ‘Good Luck’ at the start of her ascent of Mt. Kilimanjaro.

Brandi Ng-See-Quan, second from right, with her friends from RVC’s Mental Health Program, Kendra Wright, Jennifer Lewis and Amanda Forrester.

www.hospitalnews.com APRIL 2016 HOSPITAL NEWS

3 In Brief

New recommendations suggest screen-ing with low-dose CT scan for high-risk populations should take place in con-trolled environments

A new guideline on screening for lung cancer with low-dose CT technology pres-ents a new opportunity for the control of lung cancer – currently Canada’s most common cause of cancer death.

The Canadian Task Force on Preven-tive Health Care now recommends screen-ing using low-dose CT scans in high-risk adults aged 55-74 years who are current or former smokers with a smoking history of at least 30 pack-years, defi ned as the aver-age number of packs smoked daily multi-plied by the number of years of smoking.

A recent study found a 15 per cent re-duction in lung cancer mortality associat-ed with screening using low-dose CT scans compared to chest x-ray.

However, CT scans carry the risk of exposure to radiation and a positive scan could lead to an invasive procedure, such as a lung biopsy. Because of this, screen-

ing should be monitored and controlled in order to minimize harms and maximize the benefi ts through appropriate follow-up.

It should also only be offered to a restrict-ed group of people identifi ed as high-risk, as the risk/benefi t ratio is only known for this group.

“It’s always good news to have new pos-sibilities to decrease mortality from this very common cancer. However, any pro-

gram performing these tests needs to be able to collect information on their results, to ensure quality. Data also need to be collected to add to further knowledge on such issues as the frequency of screening after the fi rst three tests,” says Dr. Heather Bryant, Vice President, Cancer Control at the Canadian Partnership Against Cancer (the Partnership) and chair of the Pan-Ca-nadian Lung Cancer Screening Network.

An estimated 26,600 Canadians were diagnosed with lung cancer in 2015, and almost as many – 20,900 – died from the disease. Those with a history of heavy smoking are at the greatest risk of devel-oping lung cancer.

“Most lung cancers are not symptomat-ic until they have advanced to late stages of the disease and are incurable. That’s why it’s encouraging to see these guide-lines, which recommend a screening test that could lower mortality – representing a chance to save lives,” says Dr. Natasha Leighl, President of Lung Cancer Canada.

Screening must be paired with high quality smoking cessation programs to support people who are still smoking at the time of screening. A 2013 review found that, because smoking reduces the effectiveness of many cancer treatments and increases the likelihood of complica-tions and death in cancer patients, quit-ting smoking can be benefi cial. ■H

guidelines recommend screening for Canada’s deadliest cancer

Lung cancer

The Canadian Task Force on Preventive Health Care now recommends screening using low-dose CT scans in high-risk adults aged 55-74 years who are current or former smokers with a smoking history of at least 30 pack-years

Paediatricians continue to encourage doctors to ‘watch and wait’ before treat-ing most ear infections with antibiotics in healthy children over six months of age. An updated statement released last month echoes previous recommendations for doc-tors to look for signs that the infection is rel-atively severe before prescribing antibiotics, which are not needed or effective for mild ear infections.

“Doctors should look for defi nitive signs that it is a severe ear infection,” says Dr. Joan Robinson, co-author of the updated CPS statement and chair of the CPS Infec-tious Disease and Immunization Commit-tee. “It’s important to be looking for a bulg-ing eardrum rather than just a red eardrum before prescribing antibiotics. Even then, many children will get better just as quickly with pain relief as with antibiotics. Side ef-fects are common with antibiotics”

Ear infections are extremely common, es-pecially in children between six months and three years of age. They are usually not seri-ous and aren’t contagious. Most ear infec-tions happen when a child has already had a cold for a few days. Symptoms include un-explained fever, diffi culty sleeping, tugging or pulling at the ears, and overall irritability.

“Most children will have relief with just acetaminophen or ibuprofen,” says Dr. Rob-inson. “However, the message to parents is, if your child has a cold and then develops signs of an ear infection that do not improve with pain relief, take them to the doctor to check it out.” ■H

Paediatricians continue to encourage watch-and-wait for ear infections

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UPCOMING PROFESSIONAL DEVELOPMENT PROGRAMS for nurses and other health care professionals

45% of adults have researched cancer with few turning to health care professionals fi rst

Nearly half of all Canadian adults are asking questions about cancer, and most turn fi rst to the web for information, leav-ing them confused, overwhelmed and stressed out, a new survey commissioned by the Canadian Cancer Society reveals.

Demand for cancer information is poised to climb even higher as the country’s aging population drives an expected 40 per cent surge in cancer cases by 2030. People can avoid search-engine overload by calling the Society’s Cancer Information Service at no cost to speak with a cancer informa-tion expert who will help answer questions and navigate available resources.

As part of the annual Daffodil Month launch, the Society is celebrating the 20th anniversary of the free Cancer Informa-tion Service. For the last 20 years, people from across the country have been able to call or email trained cancer information specialists with their questions about can-cer. By calling 1-888-939-3333 or email-ing [email protected], Canadians can receive reliable information on more than 200 types of cancer, including prevention, treatment, diagnosis, care and services.

When it comes to getting defi nitive can-cer information, doctors and health care professionals are trusted by 94 per cent

of Canadians, yet only eight per cent of Canadians contacted them fi rst with ques-tions. Cancer organizations and charities are trusted by 87 per cent, but only 4.5 per cent of Canadians searching for cancer in-formation reached out to them.

People are more skeptical of online sources with only 69 per cent trusting the information – dropping to 61 per cent for adults under 35. Yet, 85 per cent of peo-ple with cancer questions fi rst turned to a search engine.

Convenience is an issue. While the web is easily accessible, more than half of Ca-nadians (54%) say it is challenging to get time to speak with their health care team. But ease of use comes with unexpected side effects. Two-thirds (66%) of people felt overwhelmed with information, and 62 per cent felt stressed out and worried, jumping to 70 per cent among Canadians 18 to 34.

Since 1996, the Canadian Cancer Society has answered 1,250,000 questions through its Cancer Information Service. Flynn deHamilton is one of the many people helped by a cancer information specialist.

“Speaking to the Cancer Information Specialist was such a positive experience. It’s hard to digest a cancer diagnosis, espe-cially when its terminal, and having coping services available makes all the difference, says Flynn. “I’d highly recommend the Cancer Information Service. It’s comfort-ing to know that there’s help out there.” ■H

Canadians relying on the web to answer cancer questions

Ear infections are extremely common, especially in children between six months and three years of age

www.hospitalnews.comHOSPITAL NEWS APRIL 2016

4

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from dis-tribution racks in hospitals in Ontario. Bulk subscriptions are avail-able for hospitals outside Ontario.

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Cindy Woods, Senior Communications OfficerThe Scarborough Hospital, Barb Mildon, RN, PHD, CHE , CCHN(C)VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

Helen Reilly,PublicistHealth-Care CommunicationsJane Adams, PresidentBrainstorm Communications & Creations David Brazeau Director, Public Affairs, Community Relations and TelecommunicationsRouge Valley Health System

Bobbi Greenberg, Health care communicationsSarah Quadri Magnotta, Health care communications

Dr. Cory Ross, B.A., MS.C., DC, CSM (OXON), MBA, CHEDean, Health Sciences and Community Services, George Brown College, Toronto, ONAkilah Dressekie,Ontario Hospital Association

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MAY 2016 ISSUEEDITORIAL APRIL 11ADVERTISING: DISPLAY APRIL 21 CAREER APRIL 26MONTHLY FOCUS: Surgical Procedures/Pain Management/Palliative Care/Oncology:Non-invasive surgery, plastic surgery, orthopedic surgery and new surgical techniques including organ donation and transplantation procedures. New approaches to pain management andpalliative care delivery. Approaches to cancer diagnosis and treatment.+ NATIONAL NURSING WEEK SUPPLEMENT

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UPCOMING DEADLINES

Guest Editorial

A LEGACY THAT WILL KNOW NO BORDERSLEAVE A GIFT IN YOUR WILL TO MSFHelp us provide medical assistance wherever the need is greatest by remembering Médecins Sans Frontières/ Doctors Without Borders with a gift in your will.

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msf.ca/mylegacy

n 1928, a petri dish in Alexan-der Fleming’s lab was acciden-tally contaminated by a mold spore, leading to the discovery

of penicillin and, in time, a revolution in medicine. Deadly infectious diseases like pneumonia, meningitis and tuberculosis could now be reliably treated. Everything from childbirth, to transplant surgery, to chemotherapy was made safer through the use of antimicrobials to prevent infection.

The trouble is that bacteria and other pathogens are constantly evolving into ‘superbugs,’ capable of resisting our cur-rent cache of antimicrobials, which in-clude antibiotics like penicillin as well as antifungals, antiparasitics and antivirals. The WHO warns that “a post-antibiotic era – in which common infections and mi-nor injuries can kill – is a very real possibil-ity for the 21st century.”

Recent studies predict that by 2050, antimicrobial resistance will claim more lives annually than cancer and drag down the global economy by as much as 3.5 per-cent of GDP. There are considerable costs in the here and now, as 18,000 patients are infected with superbugs every year, contributing $1 billion in added health care costs.

In the arms race between germs and medicine, the global community has two complementary strategies at its disposal: First, we can develop new antimicrobials, and secondly, we can slow the emergence of resistant strains through judicious use of current antimicrobials.

As the WHO’s warning suggests, nei-ther strategy is being executed effectively at the moment. Very few antimicrobials have been brought to market over the past 30 years – they are unprofi table for drug companies – and we continue to squander the available cache through over- and mis-use in healthcare and animal agriculture.

The bulk of antimicrobial prescribing is done by general practitioners, for outpa-tient treatment of things like coughs and sore throats. Though there is an element of guesswork in treating these generic symptoms, there appears to be a great deal of overprescribing. In moments of candor, GPs admit to prescribing antibiot-ics to placate pushy patients – two-thirds of whom wrongly believe that antibiot-ics are effective in treating colds and fl u. That physicians bow to patients in this way is understandable because there is little regulatory pressure pushing them to be careful stewards.

Other countries have national strate-gies in the works that appear more rigor-ous and accountable. Last year, President Obama announced a system of monitor-ing and incentives, aimed at reducing inappropriate use of antibiotics in outpa-tient settings by 50 per cent by 2020. In England, the NHS has likewise set targets for reduced outpatient prescribing of an-timicrobials, backed by fi nancial incen-tives. Senior offi cials with the country’s National Institute for Health and Clinical Excellence (NICE) have mused that doc-tors who overprescribe antibiotics may face disciplinary action.

Where is Canada on this issue? There is consensus that the federal

government must play a leadership role on antimicrobial stewardship, coordinat-ing efforts by provinces and health pro-fessionals. Yet according to a 2015 report by the Auditor General of Canada, nearly two decades of study and consultation have yielded little by way of actual targets and deadlines.

Instead what we see is a heavy emphasis on information gathering and awareness-raising. For example, the Public Health Agency of Canada’s Framework for Ac-tion on antimicrobial resistance, released

in 2014, acknowledges the problem of over-prescribing, but the only concrete proposal mentioned is an annual Anti-biotic Awareness Week. A bewildering array of initiatives by the provinces and non-governmental agencies is also en-gaged in surveying and raising awareness about antimicrobial resistance.

Unlike the U.S. and England, there appear to be no fi rm targets for reduced antimicrobial prescribing, let alone clear lines of accountability for their achievement.

A key challenge here is that respon-sibility for health is shared between the federal government and the provinces, with the further wrinkle that physicians are self-regulated by the Colleges of Phy-sicians and Surgeons. Unsurprisingly, our search of the Ontario College of Physi-cians and Surgeons’ database turned up zero cases of doctors investigated for poor antimicrobial stewardship.

Given the national and international implications of this issue, the federal gov-ernment needs to take the lead and en-sure that the provinces and in turn physi-cians make tangible progress.

In our view, the most straightforward path through this jurisdictional morass would be for the federal government to use its spending power to lead by carrot-and-stick – offering the provinces fi nan-cial incentives for targeted reductions in antibiotic use. ■H

Colleen M. Flood is a Professor in the University of Ottawa and a University Research Chair in Health Law & Policy. She is inaugural director of the Ottawa Centre for Health Law, Policy and Ethics and Bryan Thomas is a Research Associate with the Centre for Health Law, Policy and Ethics, University of Ottawa.

By Colleen M. Flood and Bryan Thomas

Superbugs and over-prescribing? I


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upporting healthy pregnancy weight gain is a critical topic for antenatal providers due to an increasing trend of exces-

sive weight gain during pregnancy among women of all Body Mass Index (BMI) cate-gories as well as the associated health risks for the mother and child.

Risks to the mother include cesarean birth, gestational diabetes, hypertensive disorders, and premature rupture of mem-branes. And to the baby: fetal over- or undergrowth, preterm birth, and child obesity, diabetes, and hypertension later in childhood.

To address these issues, the Canadian Obesity Network (CON) formed a na-tional working group of nurses, midwives, primary care physicians, obstetricians, re-searchers, and policymakers to adapt the

network’s 5As of Obesity Management toolkit for pregnancy. The 5As approach takes the provider through a sequence of steps – Ask, Assess, Advise, Agree and As-sist – to ensure sensitive, realistic, measur-able, and sustainable obesity management strategies that focus on improving health and well-being rather than simply moving numbers on a scale.

Available from the CON website at obesitynetwork.ca/5As, the new 5As of

Healthy Pregnancy Weight Gain toolkit includes a practitioner guide, practitioner checklist, and presentation and helps pri-mary care providers discuss and manage gestational weight with their patients.

Perinatal Services BC (PSBC) was part of the national working group and led a provincial advisory committee and work-ing group to develop a training strat-egy on the 5As of Healthy Pregnancy Weight Gain for primary maternity care

providers. PSBC worked with the Continu-ing Professional Development Program at the University of British Columbia’s Faculty of Medicine and engaged family physicians, obstetricians, registered mid-wives, nurse practitioners, and registered dietitians across the province.

The goals of the training strategy are to: 1. increase care provider awareness of the

Institute of Medicine gestational weight gain guidelines;

2. increase their awareness of the evidence identifying excessive gestational weight gain as an independent and modifi able risk factor for a range of maternal, ob-stetrical, infant, and child outcomes; and

3. increase their confi dence and compe-tence to engage women in effective gestational weight gain counselling and healthy behavior change. The training consists of regional work-

shops in BC as well as an accredited online education module, which is available to family physicians, midwives, nurse practi-tioners, and obstetricians across Canada. For more information on training, visit perinatalservicesbc.ca. To join the Canadi-an Obesity Network, visit obesitynetwork.ca/join. ■H

Lubna Ekramoddoullah is Communications Offi cer, Perinatal Services BC

Healthcare provider trainingBy Lubna Ekramoddoullah

S

The new 5As of Healthy Pregnancy Weight Gain toolkit includes a practitioner guide, practitioner checklist, and presentation.

to facilitate dialogue with patients about pregnancy weight gain

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7 HEALTH PROMOTION/PERSONALIZED MEDICINE/VOLUNTEERS AND FUNDRAISING Focus

wo years ago, Michelle De-veau-Brock, a Social Worker at the North Bay Regional Health Centre’s Mental Health Clinic

(MHC), began to see a pattern from par-ents not able to attend their therapy ses-sions. “I was receiving calls from mothers and fathers cancelling because they had no child care available to them for their appointments,” explains Deveau-Brock. “I realized the lack of child care served as an obstacle by preventing parents from ac-cessing our services or keeping them from completing their support.”

At fi rst the Clinic tried to accommodate parents by allowing their children to re-main in the room during therapy sessions. This arrangement was less than ideal be-cause it made it harder for parents to focus on themselves.

“Some of the discussions we have dur-ing therapy can be tough and it is often challenging for parents to talk about issues with their children in the room. We’ve had situations where children have tried to comfort their mom or dad when they’ve become upset,” says Deveau-Brock.

Deveau-Brock decided to connect with the Health Centre’s Volunteer Depart-ment to pilot a new child care program. The idea was that under the new program parents can have a volunteer care for their children while they attended their therapy session.

Kathleen Lievers, a retired Pediatric Nurse, is one of these volunteers. Lievers says her background helped naturally draw her to this new role. “Children have been the focus of my life for so many years, and the volunteer child care program is one way that I can participate in their lives and also give support to the parents,” Lievers explains.

Now parents are informed during their intake that childcare is available and ar-rangements are made for their children to be cared for by a volunteer. Deveau-Brock says with the new program, parents are better able to address and treat the issues affecting their health. “There is so much value for parents just to be able to sit and focus on themselves for 50 minutes,” says Deveau-Brock. “When parents are able to look after themselves, they are more likely to fi nd themselves better prepared to face the varied challenges of raising a child.”

The child care volunteers also play an essential role in creating a safe, healthy and caring environment for the children. For Lievers this is one of the joys of vol-unteering at the MHC. “I work closely with the Social Workers and the parents to arrange appointments that work best for everyone’s schedule,” explains Lievers. “That way we can provide some consisten-

cy with the children by having the same volunteer available while under our care. This gives the children an opportunity to socialize, learn new skills and build trusting relationships.”

The MHC is a community-based pro-gram with the Health Centre designed to assist individuals with mental health prob-lems achieve wellness and enhance quality of life. The Clinic uses a patient-centered and interdisciplinary approach to care that promotes the active participation of indi-viduals in their own recovery through a wide variety of programs.

Deveau-Brock works closely with in-dividuals experiencing mental health ill-nesses such as depression and anxiety. Through group and one-on-one appoint-ments, individuals work with Deveau-Brock or another Social Worker to learn healthy and effective strategies to manage these symptoms.

The child care role is part of the Clinic’s efforts to create a strength-based, family-centered practice, and to de-stigmatize mental illness and what it means to be a “perfect parent.”

“Some parents may be reluctant to ac-knowledge their mental health issues or afraid to seek help, because there is a per-ception that it makes you a bad parent. In reality, parenting is hard work for everyone and it is quite common to face challenges,” says Deveau-Brock. “For parents coping with a mental illness these issues can be amplifi ed. However, with the right support and resources, it is perfectly possible to be a good parent while managing a mental health problem.”

The child care role, now in its second year, has become a permanent component of the ways the MHC works to help those in the community. Both Deveau-Brock and Lievers hope to see the program ex-pand in the years ahead. “Right now the volunteers have been very creative turn-ing an offi ce space into a play room,” says

Deveau-Brock. “The next step is getting a dedicated nursery room. It will be just one more way we can create a support-ive and welcoming environment for the entire family.”

Until then the volunteers will continue to play an integral part in the child care program. In February 2016, Lievers was presented with the Lifetime Achievement Award by the District of Nipissing Social Services Administration Board (DNS-SAB) for devoting more than 40 years to the health and wellbeing of the North Bay area.

“We are so thankful to have Miss Liev-ers’ as part of our team here at the MHC,” says Deveau-Brock. “For many parents leaving their little one can be diffi cult even if it is just for a short time. However, once they meet Miss Lievers, their concerns fade. Her kind-heartedness, understand-ing, and gentleness put parents at ease, and make the time spent with her for the little ones such fun.” ■H

Taylor Grant is a Communications Assistant at North Bay Regional Health Centre.

Volunteer program removes barriers to mental health services By Taylor Grant

T

The child care volunteers also play an essential role in creating a safe, healthy and caring environment for the children.

Mental Health Clinic Volunteer Kathleen Lievers and Social Worker Michelle Deveau-Brock.

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The best path is rarely a straight line.

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Whether in the classroom, on the field, or on the stage, with every new undertaking, every question asked, and every challenge met, each girl is coming into her own and preparing for her next journey.

Our enriched curriculum leads to inspired girls and outstanding women.

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Does your daughter belong in a red blazer? Come and find out.



very volunteer has their own story. Samantha Nicholas be-came a volunteer because she wanted to honour her grand-

mother’s cancer journey. Haley Brough became a volunteer be-

cause she was inspired by all the people who helped her family through their can-cer experience.

Harnoor Sidhu became a volunteer be-cause she wanted to give back to her com-munity through understanding cancer in all of its complexities, beginning with the people who walk through the Cancer Cen-tre’s doors each day.

This shared desire to help improve the lives of others is what makes volunteers special. When Friday at noon hits, it’s their time to shine. Volunteer students Haley, Samantha and Harnoor offer their time and assistance to Lakeridge Health’s Can-cer Centre every Friday afternoon.

Even with their busy school and work schedules, Lakeridge Health’s student vol-unteers know that even if in a small way, they are making a huge difference in the lives of cancer patients and their families.

“I know that by volunteering I’m doing something meaningful and worthwhile,” says Haley Brough, TrentU graduate. “I’m helping my community in a unique way that I wouldn’t ordinarily be able to do.”

Lakeridge Health depends on its volun-teers to deliver the highest level of patient care. Even though these student volun-teers don’t deliver direct patient care, their contribution to patient well-being is vital.

Harnoor Sidhu, who is a Health Sci-ences Student at UOIT, says, “Most of the time it’s the simplest things that count the most. Bringing a patient a warm blanket or a cup of tea can make a world of difference.”

These student volunteers agree that the biggest part of their role at Lakeridge

Health is to make sure that patients are comfortable and to help them with any anxiety they may be feeling.

Adult and student volunteers bring a feeling of warmth and personal connec-tion to the Cancer Centre. People coming through the doors feel more comfortable when they are greeted by the friendly face of a volunteer.

Samantha Nicholas, a third year nurs-ing student at UOIT, says, “The best part is the conversations you get to have with patients. The connection feels especially

meaningful when they come to get cancer treatment alone.”

“It’s actually kind of the reverse effect of what people might expect. The pa-tients bring us joy,” says Haley, “And when patients fi nally complete their treatments, I can only begin to imagine what that must feel like.”

Lakeridge Health’s chemotherapy suite has a tradition where patients who fi nish their fi nal treatment get to ring a bell.

“I love that patients have such a genuine happiness when they ring the bell,” says Samantha, “I’m extremely grateful that we get to all be a part of that celebration together.”

Harnoor also volunteers in other areas of the hospital. She says that when she is in the Cancer Centre, she is taken aback by the amount of patients and families who have surprisingly uplifting attitudes.

“People are incredibly strong in ways that can completely astonish you,” says Haley, “It is important to remember that even though cancer may change a person, it defi nitely does not defi ne them.”

Samantha, Haley and Harnoor plan to continue volunteering at Lakeridge Health. ■H

Jillian Starkie is a Communication Student at Lakeridge Health.

warmth to cancer centreBy Jillian Starkie

E

Student volunteers (left to right) Harnoor Sidhu, Haley Brough and Samantha Nicholas.

Student volunteers bring



t was a simple phone call with enormous implications for the future of healthcare. Just hours after Women’s College

Hospital’s team of medical and founda-tion leaders had presented their proposal to the board of directors of The Geoffrey H. Wood Foundation, John Broley – the Foundation’s executive director – called with the news: the Foundation would be investing $1 million in Women’s College Hospital’s Institute for Health System So-lutions and Virtual Care (WIHV).

In other words, The Geoffrey H. Wood Foundation was to become a pioneering investor in ideas. As Ontario’s hub for the development and scaling of bold new ideas to transform the healthcare system across the province, WIHV is where ground-breaking solutions are born – but not without the process of imagining, testing and failing necessary on the path to any great success.

If you think this scenario sounds a bit like an investment in a Silicon Valley start-up, you’re not far off. The Wood Founda-tion’s belief in the potential of WIHV’s impact can be considered part of a growing interest in venture philanthropy – or the application of venture capitalist principles to charitable investments, with a goal to effect broad change at the system level.

First coined in 1969 by prominent American philanthropist John D. Rock-efeller III, venture philanthropy was originally viewed as “an adventurous ap-proach to funding social causes” not wide-ly known to the public. Since then, the term has evolved to defi ne philanthropic investments that seek to improve society as a whole by taking risks on innovative new ideas.

Not only did the news of the Founda-tion’s decision mark a major step forward for WIHV, it also marked a step forward for one of the great challenges faced by the charitable sector today: how to successfully raise leadership-level funds for innovation – which sometimes comes in the form of intangible ideas that will become tangible solutions in the future. For the healthcare system, which is facing a growing crisis as the population ages, new models of care that will reduce costs while improving patient care are bold ideas that are more critical than ever. So, too, is the funding.

Here, Women’s College Hospital Foun-dation shares its top three learnings from its journey with The Geoffrey H. Wood Foundation.

1. Identify and champion a shared appetite for risk.

With a mandate to develop, test and scale new ideas to improve the health system, WIHV has a healthy appetite for risk that is deeply engrained in the hospital’s culture and vision. But not all philanthropists share that passion for taking risks, especially when it comes to where they choose to invest their philanthropic dollars.

The Geoffrey H. Wood Foundation was founded by its namesake – a great Canadi-an businessman, innovator and risk-taker

who had a vision to improve public health. Among his numerous successful business ventures, Mr. Wood was the inventor of the Konex cup, a cone-shaped paper wa-ter cup that revolutionized the way people drink water in public spaces.

As The Geoffrey H. Wood Founda-tion prepared to wind down and grant its remaining assets, its board of directors wanted to ensure Mr. Wood’s legacy of pioneerism and innovation would live on through the projects they chose to fund. This led directly to their interest in WCH’s innovation mandate, an alignment the hospital championed throughout the pro-posal process.

The result was a mutual recognition and celebration of each organization’s passion for taking acceptable risks and, ultimately, the creation of an extraordinary legacy of impact in Mr. Wood’s name.

2. Have a good business sense for the future.

Attracting the support of venture phi-lanthropists requires a strong business case, dedicated research and a credible team of leaders with a track record of pushing the “successful envelope.” These philanthropic investors want to under-stand how their dollars will lead to gains – both social and economic – for a com-munity, province, nation or on a global scale. They understand that the path for-ward will have pivots and shifts, but they also demand returns. Those returns come in the form of system change.

Key questions answered by the Wom-en’s College Hospital team that tipped the scale include: • Has your organization clearly identifi ed

the challenges it’s seeking to address and articulated its proposed solutions?

• How will solutions to that challenge im-prove society as a whole?

• Can you back that up with well-researched data and projected dollar fi gures?

• Are the solutions you’re proposing wor-thy of leadership-level funding?

• Why is your organization the right one for our investment?

Venture philanthropists have a penchant for asking tough questions, so you must go in prepared with the answers.

3. The big idea, vision and leadership.

Venture philanthropists are passionate about bringing big ideas to life through the powerful combination of extraordinary vi-sion, courageous leadership and transfor-mational fi nancial investment. To warrant

their attention and support, your hospital’s big idea needs to have a clear destination, a well-articulated plan and the strong lead-ership – from both the hospital and foun-dation sides – to drive it there.

As the facilitator between philanthropy and your hospital’s ideas, the foundation team is the pathway through which the venture philanthropist’s goals are ulti-mately achieved. The natural partnership between hospital, foundation and funder must be highlighted and championed through demonstrated alignment of vision and values on all sides – such as by bringing the hospital and foundation teams togeth-er throughout the preparation, proposal development and presentation processes.

The bottom lineAs the healthcare sector continues to

pursue widespread system change through innovation and bold new ideas, the poten-tial for impactful partnerships with ven-ture philanthropists – people committed to making the world a better place by taking carefully measured risks – only continues to grow. For The Geoffrey H. Wood Foun-dation, the right investment was one that would create an enduring legacy in the spirit of its founder, a great risk-taker and passionate visionary in his day.

To achieve greater success in connecting venture philanthropists with your cause, fi nd and champion the value alignments, chart a course forward together toward the achievement of your ideas and demon-strate clearly how a vital infusion of funds will enable the acceleration and scaling up of a shared vision – one that will change the world. ■H

Emily Dontsos is Senior Development Offi cer, Community Engagement, Women’s College Hospital Foundation.

Venture philanthropy and healthcare’s big ideas By Emily Dontsos

I

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or a non-descript box it wields a mighty name and even more impressive possibilities for peo-ple with heart disease. Called

the AngioDefender, the machine – no big-ger than a shoebox – holds much promise in the ability to personalize cardiac care, say researchers at Lawson Health Research Institute, the research arm of St. Joseph’s Health Care London.

St. Joseph’s Hospital in London is the only Canadian cardiac rehabilitation centre testing the AngioDefender, a non-invasive tool that can assess the health of blood vessels by using a simple blood pres-

sure cuff. At the October 2015 Canadian Cardiovascular Congress in Toronto, Law-son researchers presented fi ndings of their research study, which assessed the feasibil-ity and reliability of the AngioDefender in patients undergoing cardiac rehabilitation.

“It’s very exciting,” says Dr. Neville Suskin, Lawson scientist and medical di-rector of St. Joseph’s Cardiac Rehabilita-tion and Secondary Prevention Program. “Right now everyone basically gets similar treatment in terms of maximizing therapy based on risk factor profi les. With this ma-chine, if it does what we hope it will do, it gives us insight into a person’s vascular health so that we can know if the treat-ment is working and adjust and individual-ize their care.”

Also key, says Dr. Suskin, is the machine can be used by any medical professional in any doctor’s offi ce.

The AngioDefender system, manu-factured by Everist Health, measures the health of the endothelium – the interior lining of blood vessels. Using a blood pres-sure cuff, the device runs through a se-ries of infl ations and defl ations to analyze the endothelium’s response to changes in

blood fl ow. When the blood pressure cuff is infl ated, blood fl ow decreases and stops. When the blood pressure cuff defl ates, blood fl ow increases and the main artery in the arm responds by getting bigger (dilat-ing). How well it dilates is a sign of endo-thelial (vascular) health.

Using a specially designed data analysis algorithm, the AngioDefender system pro-duces each patient’s “fl ow-mediated dila-tion” score. When the information is com-bined with the patient’s other risk factors, it calculates the patient’s vascular age. The whole process takes 15 to 20 minutes.

“The ability for a health professional to obtain a measure of vascular health in such a straightforward manner is very novel,” says Dr. Suskin. “The gold-stan-

dard tool to measure fl ow mediated dilata-tion is ultrasound but this is not regularly used in clinical practice because it takes a substantial expertise to operate. It’s not practical in a broad clinical setting so we have not been able to obtain this mea-sure clinically.”

The Lawson study involved 26 patients who had their vascular health assessed before beginning cardiac rehabilitation and then after completing the six-month program. Among them was Bob Hughes, 77, of London, who had double bypass sur-gery in September 2014. During his recov-ery, Hughes, a competitive tennis player who is used to being active, has struggled with debilitating side effects from heart medications.

“I’m for anything that can help custom-ize medicine and make it easier and faster to administer tests,” says Hughes. “The trial was another chance to check how I’m doing.”

Dr. Suskin and his team found that the machine is feasible to use in a busy cardiac rehabilitation practice setting. “It doesn’t take long, patients tolerate it, and they are also very keen to know their vascular health as determined by this machine.”

Already found in other studies to be is statistically equivalent to the gold stan-dard ultrasound technique to measure the health of the endothelium, St. Joseph’s is now one of fi ve sites – once again the only Canadian site – taking part in testing the AngioDefender for Food and Drug Ad-ministration approval in the United States. It has already been approved by Health Canada and has CE marking – a mandato-ry conformity marking for certain products sold within the European Economic Area.

If successful, the device may become part of the standard screening to assess early-stage cardiovascular disease and atherosclerosis, and an innovative way to monitor the effectiveness of treatment. ■H

Dahlia Reich works in Communications & Public Affairs at Joseph’s Health Care, London.

Small box holds big promise in cardiac careBy Dahlia Reich

F

The AngioDefender is a non-invasive tool that can assess the health of blood vessels by using a simple blood pressure cuff.

Study shows AngioDefender device a novel tool for personalized screening and treatment

Dr. Neville Suskin explains the AngioDefender to patient Gerry Whittingham while research coordinator Tim Hartley operates the novel device.

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ike everyone else, Billy wants to fi t in. Lucky for him, his co-workers have gone out of their way to make him comfortable

and welcome in his workplace. From tak-ing him to dinners and sporting events, to inviting him to their family cottages, Billy has become “one of the guys” at Markham Stouffville Hospital (MSH).

Billy isn’t a doctor, nurse or a support staff member. He is one of twelve adults with intellectual disabilities who work in various departments as part of a unique volunteer program MSH has with York South Community Living.

Billy, who has Down syndrome, has worked at the hospital’s print shop and stores department for the past 20 years.

“He is a hard worker who makes a big contribution every day,” says John Rich-ardson who works with Billy in the print shop and stores department. “He is a huge asset to our team and to our hospital. Everyone values the work that Billy does.”

The MSH/Community Living York South partnership program is the only one of its kind in Canada. It’s been running since 1991, yielding 25 years of success for everyone involved. Community Living York South is a local chapter of Communi-ty Living Ontario, a non-profi t association that advocates for people who have intel-lectual disabilities to be fully included in all aspects of community life.

Although they are categorized as “vol-unteers” at MSH, participants do receive an honorarium in an amount that does not interfere with their Ontario Disability In-come Support eligibility. Participants also receive a chance to contribute to their community every day.

“The hospital has welcomed these in-dividuals since the day it opened,” says Nancy Ogunniya-Clyke, the onsite sup-port worker for the program. “They have consistently been embraced as part of the team. They feel valued here, and are con-stantly aware of the huge contribution they’re making towards the hospital.”

Ogunniya-Clyke acts as the liaison be-tween the adults in the MSH program and the York South Community Living. She

holds monthly meetings for the group, dur-ing which she goes over general hospital training, which has been modifi ed for them. “These monthly meetings have helped the group come together and break down the social barriers they had when they started the program. Most of them had trouble so-cializing when they fi rst started and used to keep to themselves. Now, we have lunch together every day, and they have all be-come really good friends.”

Beyond the satisfaction of making a contribution to their community, these volunteers enjoy feeling like a part of something bigger.

“Our staff consistently go above and be-yond to make these special volunteers feel like part of the teams that they work in. It’s such a mutually benefi cial relationship,” says Lisa Joyce, Vice President, Corporate Communications and Engagement. “Some people might think that we have had a big impact on Billy’s life but in fact, and hope-fully we have but he has had a big impact on the lives of so many people who work at MSH. He has taught us the value that everyone can bring to our organization and that our hospital is better and stronger be-cause of people like Billy.”

Billy isn’t the only person who’s greatly benefi ted from York South Community Living program at MSH. Vikki has been at MSH as part of this program for 25 years, during which she’s been in charge of pick-ing up and delivering selected physician reports, lab specimen, OR reports and as-sessments to the appropriate department

anywhere in the hospital. Cecilia, another team member with Down syndrome, has been working at MSH for 18 years. She performs a variety of essential tasks around the hospital, including disinfecting and sterilizing hospital toys in the paediatric unit for infection prevention and control.

The most unique aspect of the MSH/York South Community Living Program is the way it is integrated into the hospital.

“It’s the staff,” says Ogunniya-Clyke. “They make this program actually work. There is only one of me, and the volunteers are each in their own departments across the hospital. People with intellectual dis-abilities don’t always know when they’re

doing something inappropriate, and the staff members really understand the pur-pose of this program so they do a great job of taking advantage of those teachable moments, which I’m usually not there for. They teach them right there and then, which leads to changing that behavior and advancing their development. That is the ultimate goal. This program has a huge im-pact on quality of life – for the individuals in this program, for the staff and ultimately for the patients.” ■H

Peri Elmokadem is a Corporate Communications Associate at Markham Stouffville Hospital.

Celebrating the ability in everyone

By Peri Elmokadem

L

Community Living York South is a local chapter of Community Living Ontario, a non-profi t association that advocates for people who have intellectual disabilities to be fully included in all aspects of community life.

Cecilia, a MSH/York South Community Living volunteer, disinfects and sterilizes hospital toys in the paediatric unit for infection prevention and control.

Unique volunteer program for people with intellectual disability



t’s an eye-opening fact: As many as 10 per cent of pre-schoolers don’t see clearly. A scary statistic consider-

ing vision plays a critical role in how a child learns.

But a new vision screening research program of St. Joseph’s Ivey Eye Institute is spotting problems early.

Amblyopia, known generally as “lazy eye,” is the leading cause of decreased vision among children. Resulting from abnormal visual development in infancy and early childhood, it’s fairly easy to treat early in life but becomes diffi cult to treat after the age of six when vision may never recover to its full potential.

“Early detection is key with amblyopia,” says Dr. Inas Makar, pediatric ophthal-mologist at Ivey Eye Institute. “The de-crease in vision results when one or both eyes send a blurry image to the brain. The brain then learns to only see blurry with that eye, even when glasses are used later in life. Without early detection and treat-ment, amblyopia may result in permanent vision impairment.”

The main risk factors for amblyopia in-clude long or short sightedness, astigma-tism, eye turns and drooping eyelids.

“The preschool years are imperative,” says research coordinator Afua Oteng-Amoako. “According to research, 80 per cent of what children learn in the fi rst 12 years is through what they see. So if vision problems could be detected and treated

before children start school, we can help to ensure optimal vision and subsequently fewer learning diffi culties.”

The goal of the research study is to assess the effectiveness of photoscreen-ing as a vision screening tool for children aged 18 months to four years in London, Ontario and surrounding communities. Because most of this age group is pre-verbal and diffi cult to examine by tradi-tional methods, the study aims to identify the risk factors of amblyopia in children and evaluate the reliability of the Plu-sOptix S12 photoscreener as a screening tool. The camera creates an environment where even pre-verbal children can be screened easily. The screening process takes a few seconds and is as easy as taking a picture. Using special automated digital cameras, children have a “photo” taken. The camera automatically detects issues or concerns requiring further testing by an eye care professional. The innovative re-search program is called Ivey Special Eye Exam (iSee) Vision Screening.

“iSee will provide an immediate refer-ral report if a risk factor for amblyopia is detected,” says Dr. Makar. “Guardians re-ceive the report and instructions to guide them on next steps.”

In the past seven months, 793 children have been screened and of those, 43 have been identifi ed as having possible lazy eye. “The identifi ed children were referred to community optometrists for further ex-aminations, and two have been further

referred by optometrists to the Ivey Eye Institute,” says Oteng-Amoako. “Within two weeks of screening, most parents who received referral reports had followed up with an optometrist. We are thrilled to see the research program helping children.”

iSee not only tests screening modality, but also educates and creates awareness on the importance of detecting and test-ing young children for vision problems.

While an excellent tool, the screen-ing doesn’t eliminate the need for regular eye exams with an optometrist for young children, cautions Oteng-Amoako. The Ontario Health Insurance Plan (OHIP) covers individuals under the age of 20 for eye exams by an optometrist or physician

once every 12 months, plus any follow-up assessments that may be required.

iSee is a research program of St. Jo-seph’s Ivey Eye Institute made possible by donations to St. Joseph’s Heath Care Foundation along with philanthropic and volunteer support from the London Cen-tral Lions Club for this important commu-nity research program.

For more information on the research program, what warning signs to look for, screening locations and times visit iseevision.ca. ■H

Amanda Jackman is a communication consultant at St. Joseph’s Health Care London

Preventing kid’s

By Amanda Jackman

I

St. Joseph’s Health Care London’s new eye screening research program for children is identifying issues resulting in referrals to ongoing care.

Dr. Inas Makar, pediatric ophthalmologist,left, and Afua Oteng-Amoako, research coordinator, holding one of the vision screening cameras for St. Joseph’s Ivey Special Eye Exam (iSee) Vision Screening.

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Youth Leadership Program develops speaking skills

n a room fi lled with people, Carlos Khalil is randomly assigned a topic that he has two minutes to prepare a

speech about. This “impromptu speaking activity” is one of the many development opportunities Carlos has participated in through the Toastmasters International Youth Leadership Program (YLP). Of-fered to high school student volunteers at Trillium Health Partners, the YLP is designed to develop participants’ public speaking and presentation skills through practical application. Carlos was one of fourteen high school student hospital volunteers who participated.

“When I heard about the program, I knew that I had to do it,” explains Car-los, a grade 12 student and founder of his high school’s debate club. “I was really excited about the opportunity to become a more confi dent public speaker. After I completed the program, I found that I was more at ease during all aspects of my daily communication.”

Implementing skill development pro-grams such as YLP at Trillium Health Partners is part of its long-standing tra-dition of offering value-added training programs to volunteers.

“We are always looking for new edu-cational programs to train and enhance our volunteers’ skills for their roles in

the hospital and for their own personal growth,” says Deb Folkes, Director, Vol-unteer Resources, Trillium Health Part-ners. “Helping our high school students hone their public speaking abilities as well as one-on-one communication is a skill they can draw on throughout their personal and working life, and one that will open many doors.”

The YLP is a national skills develop-ment initiative offered within local com-munities by Toastmasters International, a world leader in communication and leadership development. Aman Sangha, volunteer at Trillium Health Partners, Toastmasters Club member and mentor initially suggested a partnership between Toastmasters and the hospital to Folkes.

IBy Dora Guzina

Trillium Health Partners’ Youth Leadership Program Participants

Continued on page 15

vision loss



sliding Chinese economy, shrinking commodity prices, the loonie’s fall, regulatory changes, and low interest

rates – these are among the factors driv-ing lower 2015 returns for the Healthcare of Ontario Pension Plan.

In fi gures released March 3 at a To-ronto press conference, HOOPP’s CEO, Jack Keohane, reported a 2015 invest-ment return of 5.3 per cent on its invest-ment portfolio versus 2014’s stellar 17.7 per cent. Net investment income dropped to $3.1 billion from $9.1 billion in 2014.

“We suspected that 2015 might turn out to be a very challenging year, and that’s how it played out,” said Keohane, noting the general deterioration in the global fi nancial landscape and the par-ticularly poor performance of the Toronto Stock Exchange last year.

“There was a sharp drop in commod-ity prices, especially oil, and that had a big impact, particularly on the Canadian economy,” Keohane said. “We entered a technical recession. If I had to summarize the year, I’d call it a year of very high vola-tility and very low returns.”

Nonetheless, HOOPP’s net assets grew to $63.9 billion, up from 2014’s $60.8 billion, and on a net assets basis, the plan’s comfortable 130 per cent funded ratio remained unchanged at year-end from 2014’s.

Of 2015’s posted 5.12 per cent return, 3.95 per cent represented benchmark re-turn and 1.17 per cent – or $700 million – represented return from active manage-ment strategies.

That translated to a fi ve-year annual-ized return of 12.03 per cent, a 10-year re-turn of 9.32 per cent, and a 20-year return of 9.46 per cent, which, said Keohane, “I think ranks with the top funds for that pe-riod of time.”

Member contributions for 2015 ex-ceeded benefi ts paid by $174 million (versus 2014’s $302 million). As this rela-tively young plan matures, however, this positive cash fl ow gap is expected to nar-row. With a surplus of almost $14.8 bil-lion, up from $13.9 billion in 2014, the plan maintains its strong funded status of 130 per cent. Keohane attributed this po-sition in part to the maintenance of low investment costs.

With its contribution rates unchanged since 2004, HOOPP is committed to keeping the fund affordable for employees and employers alike and to maintain pen-sioners’ CPI-linked cost-of-living allow-ance at 100 per cent.

In 2015, membership topped 300,000 for the fi rst time, and now counts 222,000

active and deferred members and 87,000 retirees. Membership includes 70 pen-sioners over 100 years old – one a Lon-don, Ont., woman of 106. “I recently saw a picture of her and she actually looks very good for 106,” said Keohane. “I guess that’s a testament to receiving a defi ned-benefi t pension!” He noted that in some communities as much as 20 to 38 per cent of revenue comes from defi ned-benefi t income.

In another 2015 milestone, HOOPP garnered its highest-ever client satisfac-tion scores and the largest rise in score from one year to another. In the interests of better service to members, the plan has upgraded its telephone system and is in the process of streamlining its pension administration scheme.

In 2015 HOOPP purchased interests in two large Ontario shopping centres and acquired an interest in a large Manhattan offi ce tower. It has committed $1.1 bil-lion to real estate investment funds glob-ally and is a partner in the construction of a gigantic warehouse for Amazon in the U.K. ■H

Diana Swift is a freelance writer in Toronto.

Worsening investment milieu softens HOOPP’s 2015 returnsBy Diana Swift

A

HOOPP CEO, Jack Keohane

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14 Evidence Matters

he idea that we are in the midst of a genetic revolution has been with us for decades. The latest iteration of this

promise of paradigm-shifting transforma-tion comes in the guise of “personalized medicine” – which, we are consistently told, will revolutionize our health care system and reduce the burden of chronic disease. But can personalized medicine live up to the hype? Will it really result in healthier Canadians?

These are the issues that were tackled by Professor Timothy Caulfield during his recent presentation in Ottawa (and live-streamed across the country) as part of the CADTH Lecture Series. CADTH – an independent agency that finds, as-sesses, and summarizes the research on drugs, medical devices, tests, and pro-cedures – regularly invites prominent scholars and opinion leaders such as Professor Caulfield to participate in the CADTH Lecture Series (well known on social media as #CADTHtalks) where they can discuss pressing issues facing

health technology assessment (HTA) and healthcare today. Tim Caulfield is a Canada Research Chair in Health Law and Policy, a Professor in the Faculty of Law and the School of Public Health at the University of Alberta, and Research Director of the Health Law Institute at the University of Alberta – not to men-tion the author of two recent national bestsellers: The Cure for Everything! Untangling the Twisted Messages About Health, Fitness and Happiness (Penguin 2012) and Is Gwyneth Paltrow Wrong About Everything? When Celebrity Cul-ture and Science Clash (Penguin 2015). For more information about the CADTH Lecture Series or to attend the next lec-ture in person or online you can visit www.cadth.ca and follow us on Twit-ter: @CADTH_ACMTS (watch for the #CADTHtalks hashtag). Tim Caulfield can also be found on Twitter: @Caul-fieldTim. ■H

Dr. Janice Mann is a Knowledge Mobilization Offi cer at CADTH.

Is Timothy Caulfi eld right about everything?By Janice Mann

T

Personalized Medicine:

JM: Tim, before we jump into things, can you explain the term “personalized medi-cine”? What does it mean?TC: Personalized medicine – which is also often called precision medicine – is the use of genetic information to guide decisions. A person’s genetic profi le could help infl uence decisions about the pre-vention, diagnosis, and treatment of med-ical conditions.JM: And during your presentation, you reminded us of the defi nition of “revolu-tion.” It’s a term thrown around so much in the media that we might have forgot-ten.TC: The Oxford dictionary defi nes “revo-lution” as a “dramatic and wide-reaching change in conditions, attitudes, or opera-tion.” This is a pretty high standard!JM: Why is personalized medicine a promised revolution?TC: It is often touted as something that will lead to individual empowerment and healthy behaviour change and, more broadly, as a tool that will address chronic disease. The idea is that by knowing your genetic risk information you will change your behaviour. JM: So… is personalized medicine a rev-olution then?TC: In the context of personal empow-erment and behaviour change, the an-swer has to be no. All the best available evidence tells us that providing genetic risk or predisposition information does not lead to signifi cant behaviour change. And, in fact, the personalized advice that is provided by direct-to-consumer genetic testing companies often tells us to do the

things we already know we should do (ex-ercise, eat healthy, manage our weight, don’t smoke, get enough rest). For ex-ample, and I’m guessing here, reducing smoking by 5 per cent would likely do more to improve health than the big push to personalize our lifestyle decisions. And when only 15 per cent of Canadian kids meet minimum activity targets, should we be spending time worrying about or tailor-ing our lifestyle choices to fi t our genes? Let’s focus on the basics! JM: In fact, there is some evidence that it could even potentially lead to harms. Can you explain that?TC: If you know you’re not genetically at risk for a serious chronic disease like dia-betes, would you still eat healthy and ex-ercise regularly? You might just say: “Why bother?” Not only that, but the hype of a revolution itself can be harmful, skew-ing policy priorities away from important public health initiatives. JM: Is it true then, that a weigh scale re-ally is a better predictor of future health risk than genetic testing?TC: I think the information that you receive from low tech devices like your bathroom weigh scale and a blood pres-sure machine probably provide more pow-erful risk information than the vast major-ity of data you will receive from a genome scan. JM: Apart from improving our health, there’s a whole other side to genetic testing and personalized medicine. It sounds like businesses are cashing in – even dating sites! Can you tell us a little about this?

TC: It is true. There are a lot of crazy direct-to-consumer genetic services out there. Dieting, exercise and, even, dat-ing. I call it “scienceploitation” – taking a legitimately exciting area of science, like genetics, and exploiting the research results with hyped language to sell products that have little actual science behind them. JM: And genetic testing to predict your child’s performance in different sports? Is that really happening?TC: Yes. There are companies that are selling testing services for this ex-act thing. Once again, the data to sup-port these products is pretty iffy. Want to know how fast your kid is? Just time him running. I’m a lifelong track athlete. Still love it. But when I underwent ge-netic testing – it didn’t predict I’d be a sprinter. Why not just try it out and see what happens?JM: What do you think might be the real revolution in medicine then? Can you tell us about it?TC: Do less. There is a counter-revolu-tion to the big push for more data. This is the idea that we should be doing less medicine. Fewer tests. Less screening. There is an increasing body of data to suggest it may be the best approach. The Choosing Wisely movement is a good example of this trend. JM: What would your take home mes-sage on genetic testing and personalized medicine be?TC: There have been successes in per-sonalized medicine – such as pharmaco-genetics and determining who will re-

spond well to certain medications – but progress is slow. Good things will happen. But it’s not a revolution – it’s a slow and iterative evolution, like most areas of sci-ence. Talk of personalized medicine as a revolutionizing social force seems to be largely hype. JM: Speaking of hype, you talked about the “hype pipeline.” Can you tell us a lit-tle about that and why we’re hearing so much hype about personalized medicine when the evidence just isn’t there?TC:: Science hype is complex phenome-non. It involves many actors and a range of systemic pressures. I’m not blaming anyone. It includes publication and grant writing pressure, the writing of overly op-timistic abstracts and press releases, the media interest in a good story, and, of course, the market. JM: To wrap it all up – based on your presentation and our conversation today – what’s your call to action?TC: Let’s stop with the revolution lan-guage. Focus on the science and not the hype. Report science in plain language that is understandable – but if it isn’t re-ally translatable don’t sex it up. Recog-nize that science takes time. Change the incentives. And embrace truly interdis-ciplinary research, as this is how you get different perspectives on the true social impact of a technology. JM: And Tim – one fi nal question for you. Is Gwyneth Paltrow really wrong about everything?TC: No, but she’s a great example of pop culture twisting medical/science info into hype!

I sat down with Tim after his talk – the most popular #CADTHtalks event yet – to chat more about personalized medicine and what it really means for Canadians, our health, and our health care system.

Timothy Caulfi eld speaking at the CADTH lecture series.

S P E C I A L P U L L O U T S H O W G U I D E


J U N E 5 – 8 , 2 0 1 6E2

Monday, June 6, 2016

13:30-15:30CS01 – Application Implementation: Consumer Health – Privacy PatientsTrack: Not RatedLocation: MR 7

■ 13:30 Sharing Is Caring: Managing Privacy in Consumer Health SolutionsDarcelle Hall, MD+A Health Solutions, CA

■ 14:00 Transforming Healthcare through Consumer Engagement and Health LiteracyAngela Kennedy, Louisiana Tech University, US

■ 14:30 Innovating Privacy through the Advanced Privacy Monitoring SolutionBeth Dewitt, Deloitte, CA

■ 15:00 Identity, Consent and Privacy Solutions for a Brave New WorldJoe Greenwood, MaRS Discovery District, CA

13:30-15:30 CS02 – Exploring EHR Landscape in Canada: Clinical Analytics – Big ThinkingTrack: ClinicalLocation: MR 8

■ 13:30 Growth of the iEHR in Canada:Maturity of Benefi tsSukirtha Tharmalingam, Canada Health Infoway, CA

■ 14:00 Growth of the iEHR in Canada: User Adoption LandscapeBobby Gheorghiu, Canada Health Infoway, CA

■ 14:30 Clinical and Organizational Value: Benefi ts Realization in South West OntarioTed Alexander, London Health Sciences Centre, CA

■ 15:00 The Patient Safety Impact of EHRsChris Hobson, Orion Health, CA

13:30-15:30 CS03 – The Changing Face of Care Delivery: PHR – PortalTrack: ClinicalLocation: MR 10

■ 13:30 Strengthening the Circle of Care: First Nations Personal Health RecordKarl Mallory, Mallory Consulting Ltd., CA

■ 14:00 Managing Change as Patients Access Their Personal Health RecordSelina Brudnicki, University Health Network, CA

■ 14:30 Complex Care Coordination – Delivering Effi cient Service and Quality Health OutcomesBrent Elsey, Barrie Community Family Health Team, CA

■ 15:00 Patient Portal Interface Design Models Based on Psychological TheoriesGhdeer Tashkandi, Dalhousie University, CA

13:30-15:30 PS01 – Digital Health benefi ts Across Settings: Big ThinkingTrack: ClinicalLocation: MR 11

■ 13:30 Adoption and Benefi ts of EMR use in Canadian Outpatient ClinicsChad Leaver, Canada Health Infoway, CA & Colleen Rogers, Canada Health Infoway, CA & Brenda Jameson, Saskatchewan Cancer Agency, CA

■ 14:30 Activating e-Health: Successful Change through Policy, Organizations, and PatientsMatthew Chow, Doctors of BC, CA & Martin Addison, Mood Disorders Association of BC, CA & Damon Ramsey, InputHealth, CA

13:30-14:30 PS02 – Regional Approach to Implementation; Implementation 2HTrack:Location: MR 12

■ 13:30 Linking Practice, Technology and Quality: A Clinical Standards JourneyJill Breker, Vancouver Island Health Authority, CA & Ainsley Young, Vancouver Island Health Authority, CA & Victoria Schmid, Vancouver Island Health Authority, CA & Joanne Maclaren, Vancouver Island Health Authority, CA

13:30-15:30 CS05 – Virtual Care Delivery Models: Technology vs HealthTrack: ClinicalLocation: MR 13

■ 13:30 Practicing on the CloudChris Cavacuiti, TrueNorth Health Centre Inc, CA

■ 14:00 Rethinking Telemedicine Strategic DesignCarol McFarlane, OTN, CA

■ 14:30 From Obsolete Technology to a Better Wound Care Teleassistance ServiceJonathan Lapointe, CIUSSSE-CHUS, CA15:00 Supporting Clinical Diagnosis of Febrile Disease in Tanzania with mHealthMaureen Perrin, Gevity Consulting, CA

13:30-15:30 CS06 – Standard – How to make them work? Standard 1cTrack: ClinicalLocation: MR 15

■ 13:30 Synoptic Reporting: Project to Provinical ProgramAndrea Hilchie-Pye, Nova Scotia Health Authority, CA

■ 14:00 Using CDA for Clinical InteroperabilitySilvio Labriola, Intrahealth, CA Sophia Buvyer, Northern Health/Interior Health, CA

■ 14:30 Project QBIC – Quality Based Improvements in CareMohamed Alarakhia, CFFM FHT eHealth Centre of Excellence, CA & Masood Darr, Centre for Family Medicine Family Health Team, CA

■ 15:00 Pan-Canadian Strategy for Adoption and Use of Nursing Data StandardsPeggy White, Institute for Clinical Evaluative Sciences, CA & Lynn Nagle, University of Toronto, CA

13:30-15:30 CS07 – App – Impl – Engagement: Patient Care CoordinationTrack: ClinicalLocation: Ballroom A

■ 13:30 Community Shared Services – by the Community for the CommunityJennifer Wilkie, Reconnect Mental Health Services, CA

■ 14:00 Streamlining Community Support Service Referrals in TC-LHIN to Increase Clinician AdoptionKatie Fong, University Health Network, CA

■ 14:30 Reactive to Proactive: Delivering Improved, Safe Care in the CommunityMartin Trépanier, Bell Healthcare Practice, CA

■ 15:00 Cross-Sector Client Journey: Intergration of Primary and Community Care DataStephanie Carter, Reconnect Community Health Services, CA

13:30-15:30 CS08 – Application – Implementaton – Consumer Health: Using Digital Health to Manage Chronic ConditionsTrack: ClinicalLocation: MR 17

■ 13:30 Delivering Integrated Health Care through a Virtual Patient Engagement PlatformBryce Kelpin, Continuum Medical Care, CA

Conference Program

Continued on page E4

08:30-10:00CONFERENCE OPENING KEYNOTE ADDRESSLocation: Vancouver Convention Centre, East Building, Exhibit Hall A

Opening Keynote Speakers:Zayna Khayat, Co-Founder, Senior Advisor, MaRS Discovery

Marilyn Emery, President & CEO, Women’s College Hospital

Travis McDonough, CEO & Founder, Kinduct

APRIL 2016 HOSPITAL NEWSwww.hospitalnews.com

E3 J U N E 5 – 8 , 2 0 1 6

We of course take it for granted that whenever we fl y our fl ight is being watched and managed in real-time by an air traffi c control system. In overly simplistic terms, every fl ight must fi rst have a destination, take off , be routed to its destination and fi nally, safely land. Referral from one physician to another or to a clinic, hospital or other site is a very similar process. The referring physician must determine the best destination for the referral, then send it. The receiving physician, hospital or clinic must accept the referral, schedule the patient and inform the sending physician.

As you read this, thousands of aircraft are fl ying over Canadian airspace. At the same time, tens of thousands of health-care referrals are in progress. The diff erence of course, is that each aircraft is being tracked and managed by air traffi c control while referrals in Canada are largely paper based and not centrally managed.

In other similar western industrialized countries, like The Netherlands, the UK, New Zealand and beyond, referrals are electronic which allows for real-time tracking and coordinated referral management.

Canadian based Novari Health traveled the world and studied the successes and technologies around eReferral. We combined this knowledge with cutting edge Microsoft cloud technology and have recently been chosen among our compet-itors as the leading eReferral technology and team to deliver air traffi c control like functionality for referrals serving millions of Canadians.

Let our eReferral technology and experience transform your referral processes.

John Sinclair | President | Novari Health

www.novarihealth.com

Air Traffi c Control for Healthcare Referrals


J U N E 5 – 8 , 2 0 1 6E4

Monday, June 6, 2016■ 14:00 Digital Health Decision Support Eco-System for Standardized Atrial Fibrillation CareRaza Abidi, Dalhousie University, CA

■ 14:30 CPRPM-A Sustainable Model for Integrated Community-Based Care Coordination and PreventionRick Whittaker, Wellington Waterloo CFDC, CA

■ 15:00 Assessing Smartphone Application Usage with Google Analytics and Other MeasuresAkib Uddin, Centre for Global eHealth Innovation, CA

13:30-15:30CS09 – Planning and Governance to Drive Health System: Big ThinkingTrack: ExecutiveLocation: MR 18

■ 13:30 Overhauling your IM/IT Governance Engine for Optimal PerformancePeter Bascom, eHealth Ontario, CA

■ 14:00 Our Journey to a Single Health Record within Fraser HealthCorinne Tillyer, Fraser Health Authority, CA

■ 14:30 How CIHI’s Data SupplyStrategy Will Maximize Your eHealth InvestmentsAnne Motwani, Canadian Institute for Health Information (CIHI), CA & Ms. Isabel Tsui, Canadian Institute For Health Information, CA

■ 15:00 Driving with the Headlights On: Automating Complex Capacity PlanningMike Krasnay, eHealth Ontario, CA

14:30-15:30 CS04 – Regional Approach to Implementation; Implementation 2HTrack: ClinicalLocation: MR 12■ 14:30 Lab Interoperability – More than Just LOINC MappingElla Steele, Manitoba eHealth, CA

■ 15:00 Reconfi guring Provincial Health Information Project Success with CMMargie Kennedy, Gevity Consulting Inc, CA

Tuesday, June 7, 2016

11:00-12:30 CS10 – EMR/EHR Transformation: 2C Application/Implementation:Benefi ts RealizationTrack: ExecutiveLocation: Ballroom A

■ 11:00 Achieving Clinical Transformation with an Electronic Health Record: Progress ReportJane Paterson, Centre for Addiction and Mental Health, CA & Carrie Fletcher, CAMH – Centre for Addiction and Mental Health, CA

■ 11:30 Leveraging the EMR: Lessons from Canada’s HIMSS Davies WinnerSanaz Riahi, Ontario Shores, CA

■ 12:00 Up the HIMSS Stages, Across the ContinuumMary Lyn Fyfe, Island Health, CA & Suzanne Fox, Island Health, CA

11:00-12:30 CS11 – EMR Analytics: Big Thinking – Analytics 3aTrack: ClinicalLocation: Ballroom B

■ 11:00 EMR-Enabled Improved Outcomes and ROI: Internationally Examples of Local AdaptabilitySteven Shaha, Center for Public Policy & Admin, and Allscripts, US

■ 11:15 EMR-Enabled Continuous Improvement: EMR-Facilitated Highest Safety and OutcomesSteven Shaha, Center for Public Policy & Admin, and Allscripts, US

■ 11:30 The Connected EMR: Increasing Clinical Value App by AppRoy Wyman, South East Toronto Family Health Team, CA

■ 12:00 Bending the Surgical Cost Curve: Engaging Surgeons with Actionable AnalyticsJason Goto, Analysis Works, CA

11:00-12:00 PS03 – Opportunity Challenges of Interoperability: 1c Techonology/InteroperabilityTrack: ExecutiveLocation: MR 7

■ 11:00 Everyone Hates Interoperability – Let’s Fix ThatGavin Tong, Gevity, CA & Attila Farkas, Canada Health Infoway, CA

12:00-12:30 CS12 – Opportunity Challenges of Interoperability: 1c Techonology/InteroperabilityTrack: ExecutiveLocation: MR 7

■ 12:00 Partnerships to Drive Clinical InteroperabilitySophia Buvyer, Northern Health/Interior Health, CA & Silvio Labriola, Intrahealth, CA & Larry Chrobot, AIHS, CA

11:00-12:30 CS13 – Keeping Patients at Home: Appl/ImplentTrack: ClinicalLocation: MR 8

■ 11:00 Casting a Wide Net: Integrating Home Medications into an EHRRuss Swaga, Island Health, CA & Douglas Arndt, Vancouver Island Health, CA

■ 11:30 Implementing a Multi-Jurisdictional Telepathology Solution – a Pan-Canadian Proof of ConceptEmma Housser, NL Centre for Health Information, CA

■ 12:00 People First, Technology Second- Best Practice Sharing for Telemonitoring ProgramsSusan May, GE Healthcare, CA

11:00-12:30 CS14 – Medication System, C & E, App/Implemt, Design: DesignTrack: Clinical and ExecutiveLocation: MR 10

■ 11:00 Building Acceptable EMR Decision Supports for Seniors’ Medication ManagementRobert Hayward, University of Alberta, CA

■ 11:30 Medication Administration Documentation: Better Traceability in eMAR ?Genevieve Mercier, CHU Sainte-Justine, CA

■ 12:00 Implementation of a Cross-Continuum Closed Loop Medication SystemTracy Martell, Island Health, CA

11:00-12:00 PS04 – Large Scale ChangeTrack: ExecutiveLocation: MR 12

■ 11:00 Interjurisdictional Collaboration Connecting Provincial Pharmacy Data in Health Authority SystemsCindy Convey, Fraser Health, CA


Conference ProgramContinued from page E2

14:30-15:30COACH SESSION: 2016 Location: Vancouver Convention Centre, East Building, MR 162016 National Digital Health Leadership Survey Results –

Presenters: Mark Casselman, CEO, COACH & Carina Andreatta, Coordinator, Special Projects and Communities of Interest, COACHShaping the Digital Health Community One Member at a Time (interactive Town Hall session)

16:00-17:30SPEAKER PANEL SESSIONLocation: Vancouver Convention Centre, East Building, Exhibit Hall A

Panel Speakers:Peter Vaughan, Deputy Minister of Nova Scotia, Department of Health and Wellness

Catherine Claiter-Larsen, Vice President and Chief Information Offi cer, Vancouver Island Health Authority

Neil Fraser, President, Medtronic Canada

08:30-09:30Morning Plenary SpeakerWhy Entrepreneurship is Essential for Bold Change in Healthcare (and why it’s needed right now)Location: Vancouver Convention Centre, East Building, Exhibit Hall A

Speaker: John DeHart, Co-Founder, Nurse Next Door, Vancouver Island Health Authority

TOGETHER,WE WILLCOLLABORATE WITH HEALTHCARE SYSTEMS AND PROVIDERS TO HELP IMPROVE HEALTHCARE – TO GET THE RIGHT TREATMENT TO THE RIGHT PATIENT AT THE RIGHT TIME.Learn more at Medtronic.ca


E5 J U N E 5 – 8 , 2 0 1 6

ONEDAY

COULDNEED

YOU

ANMRI


J U N E 5 – 8 , 2 0 1 6E6

Tuesday, June 7, 2016 12:00-12:30 CS15 – Large Scale ChangeTrack: ExecutiveLocation: Room 12

■ 12:00 Architecting for an Innovative Digital Health Enterprise in Nova ScotiaTeemu Lehtonen, Government of Nova Scotia, CA

11:00-12:00 PS05 – Keeping Pace with data sharing: Big Thinking–Information + Data GovernanceTrack: ExecutiveLocation: MR 11

■ 11:00 Data Sharing Agreements – Are They Friend or Foe?Joan Roch, Canada Health Infoway, CA & Abigail Carter-Langford, eHealth Ontario, CA & Mariana Diacu, Ministry of Health, CA & Alyssa Daku, eHealth Saskatchewan, CA

12:00-12:30 CS16 – Keeping Pace with data sharing: Big Thinking – Information + Data GovernanceTrack: ExecutiveLocation: MR 11

■ 12:00 Unlikely Bedfellows? Innovation and Data Meet Privacy and Access!Elizabeth Iwaskow, Governement of Nova Scotia, CA

11:00-12:30 CS17 – Digital Health Expertise: Big Thinking: StrategyTrack: ExecutiveLocation: MR 13

■ 11:00 Integrating Consumer Health in Next Generation Teaching for Patient-Centred HealthcareAnne Fazzalari, Canada Health Infoway, CA

■ 11:30 Peer Networks to Integrate Digital Health Competencies in Nursing EducationRichard Booth, Western University, CA & Gylnda Doyle, BCIT, CA & Elizabeth Borycki, University of Victoria, CA

■ 12:00 Train the Trainers – Medical Education in an Era of eHealthRobert Hayward, University of Alberta, CA

11:00-12:30 CS18 – User Experience, C, App/Implemt/Design: DesignTrack: ClinicalLocation: Ballroom C

■ 11:00 Understanding How Physicians Process Data in Critical Care Information SystemsDarren Hudson, University of Alberta, CA

■ 11:15 Physician Satisfaction with a Provincial Critical Care Information SystemDarren Hudson, University of Alberta, CA

■ 11:30 Remote Monitoring and Self-Management Support to Prevent Exacerbations in COPDSara Ahmed, McGill University, CA

■ 12:00 A New Framework for Generating Clinical Requirements for eHealth SolutionsSusan Sepa, Canada Health Infoway, CA

11:00-12:30 CS19 – Innovations in SchedulingTrack: ExecutiveLocation: MR 16

■ 11:00 Digitization of the Provincial Mobile Mammography Screening Program at BCCAJanette Sam, BC Cancer Agency, CA & Valerie Lukac, Gevity Consulting Inc., CA

■ 11:30 Solving the Relief Shift DilemmaKeri Fraser, Vocantas, CA & Gary Hannah, Vocantas, CA

■ 12:00 Utilizing learnings from Cervical Screening Reminder Calls Pilot for SpreadZabin Dhanji, Cancer Care Ontario, CA

11:00-12:00 PS06 – Large Scale Adoption: Application/Implementation/AdoptionTrack: Clinical and ExecutiveLocation: MR 17

■ 11:00 eHealth or eShelf?Ashwin Kutty, WeUsThem Inc., CA & Faten Alshazly, WeUsThem Inc., CA & Stan Kutcher, .Org, CA

12:00-12:30 CS20 – Large Scale Adoption: Application/Implementation/AdoptionTrack: Clinical and ExecutiveLocation: MR 17

■ 12:00 Transforming Alberta’s Referral Experience: Connecting Patients and Healthcare ProfessionalsJodi Glassford, Alberta Health Services, CA

11:00-12:30 CS21 – User Engagement: Application /Implementation – Adoption USETrack: ClinicalLocation: MR 18

■ 11:00 We’ve Come a Long Way, Maybe? Clinicians and ITJulia Zarb, University of Toronto, CA & Wei Qiu, eHealth Ontario, CA & Emily Seto, University of Toronto, CA & Michael Li, Vancouver Coastal Health, CA

■ 11:30 Driving Clinical Adoption and Change with PhysiciansDonna Foster, Healthtech Consultants, CA

■ 12:00 Implementation of an Ambulatory EMR: Lessons LearnedMelissa Marriott, Fraser Health Authority, CA

14:30-16:00 CS22 – Transformational Change Through Innovation: Big Thinking-StrategyTrack: ExecutiveLocation: Ballroom A

■ 14:30 Aligning IT Services to Business Needs: Business Relationship Management ApproachTerra Ierasts, University Health Network, CA

■ 15:00 Clinical Knowledge and Content Management – A Program’s JourneyDebbie Pinter, Alberta Health Services, CA

■ 15:30 Clinical Governance through Transformational Change and Creating a Learning OrganizationMary Lyn Fyfe, Island Health, CA & Suzanne Fox, Island Health, CA

15:30-16:00 CS23 – Incentivizing ChangeTrack: Clinical and ExecutiveLocation: Ballroom B

■ 15:30 Why ePrescribing in Canada Needs a Kick-StartVincent Ng, TELUS Health, CA

14:30-15:30 PS08 – Approaches to accessing Health Data: Big Thinking – Data GovernanceTrack: ExecutiveLocation: MR 7

■ 14:30 Minors Access to Their Information: Pandora’s Box Is OpenFraser Ratchford, Canada Health Infoway, CA & Joan Roch, Canada Health Infoway, CA& Jennifer Gillert, Children’s Hospital of Eastern Ontario (CHEO), CA

15:30-16:00 CS24 – Approaches to accessing Health Data: Big Thinking – Data GovernanceTrack: ExecutiveLocation: MR 7

■ 15:30 eHealth Federation – Boldly Going Where No One Has Gone BeforeRon Soper, eHealth Ontario, CA

14:30-16:00 CS25 – Making Interoperability Work for Clinicians: Interoperability – TechnologyTrack: ExecutiveLocation: MR 8

■ 14:30 Applying a New Generation of Standardization for Clinical CareDon Newsham, 4C Consulting, CA

■ 15:00 Clinical Information Systems Integration: Connecting Health Authority and Provincial SystemsAneet Sahota, Fraser Health Authority, CA

■ 15:30 Moving the Yard Sticks in the CommunityDale Anderson, HNHB/HITS eHealth, CA & Barbara Teal.anderson, Harvard Medical Group, CA


14:30-16:00INFOWAY SESSIONLocation: Vancouver Convention Centre, East Building, MR 11Virtual visits in British Columbia: System, Patient and Physician Perspectives

Presenters: Chad Leaver, Kimberlyn McGrail, and Dr. Eric CadeskyLaunching Canada’s First Multi-Jurisdiction Electronic Prescribing Initiative

Lynne Zucker and Bobbi Reinholdt

• Certifi ed EMRs: A robust EMR Certifi cation Program ensures certifi ed EMRs meet the needs of Ontario physicians

• Hospital Report Manager (HRM): Hundreds of medical record reports, diagnostic imaging reports, eNotifi cations and Ontario Telemedicine Network telehomecare reports delivered electronically from hospitals and specialty clinics to physicians’ EMRs for added clinical value

• Ontario Laboratories Information System (OLIS): Patient lab results delivered electronically to certifi ed EMRs to avoid ordering duplicate tests and providing the most up-to-date information

• Peer Leader Program: Expert advice from physicians, nurses and clinic managers who understand physician practice needs and can guide physicians to achieve clinical improvements using an EMR

• EMR Practice Enhancement Program (EPEP): Support from Practice Advisors with a wide range of EMR knowledge to aid physicians to get the most from EMR functionality to enhance patient care and practice effi ciency

• EMR Every Step Conferences: EMR workshops, physician-led sessions that share EMR experiences and innovations with the goal of providing practical advice physicians can use in their practices and that are eligible for Continuing Medical Education Mainpro-M1 credits.

Your Trusted Advisor for EMR Technologies,Products & ServicesOntarioMD works with over 13,000 physicians who use certifi ed EMRs and is advancing eHealth in Ontario:

Visit us at eHealth 2016, Booth 300OntarioMD.ca | @OntarioEMRs | [email protected]


E7 J U N E 5 – 8 , 2 0 1 6

14:30-15:00 CS26 – Collaboration Across Organizational Boundaries: Big Thinking-StrategyTrack: ExecutiveLocation: MR 10

■ 14:30 Matching Policy to Innovation: The Champlain BASE eConsult ServiceClare Liddy, University of Ottawa, CA

15:00-16:00 PS09 – Collaboration Across Organizational Boundaries: Big Thinking-StrategyTrack: ExecutiveLocation: MR 10

■ 15:00 Overcoming the Many Challenges of Multi-Organizational CollaborationJeremy Smith, Vancouver Coastal Health, CA

14:30-16:00 CS27 – mHealth: Strategy, Standards & Approach: MhealthTrack: ExecutiveLocation: Ballroom C

■ 14:30 Got Mobile? The Building Blocks of Mobile HealthTiffany Chui, Fraser Health Authority, CA

■ 15:00 Interoperability: Jaded, Bitter but HopefulGavin Tong, Gevity, CA

■ 15:30 UHN ACD Notes: Innovation Supporting Interprofessional Care and Patient OutcomesVicky Ramirez, University Health Network, CA

14:30-16:00 CS28 – Telehealth for chronic disease management: Technology – TelehealthTrack: ExecutiveLocation: MR 12

■ 14:30 Innovative Care Delivery Models: the Success of Home Health MonitoringLisa Saffarek, Island Health, CA

■ 15:00 Evaluating the Value of Telehomecare for Three New Patient GroupsRhonda Wilson, Ontario Telemedicine Network, CA

■ 15:30 Where Does Telemonitoring Fit in Our Healthcare System?Emily Seto, University of Toronto, CA

14:30-16:00 CS29 – Big Data Analytics: Big Data/ApplicationTrack: ExecutiveLocation: MR 13

■ 14:30 H-DRIVE: Health Data Analytics Platform to Optimize Pathology Laboratory OperationsRaza Abidi, Dalhousie University, CA & Samuel Stewart, Dalhousie University, CA

■ 15:00 Framework for Aligning Health Analytics to Digital Health for CanadaAlex Mair, Canada Health Infoway, CA

■ 15:30 Big Data in Manitoba, Linking Primary Care and Administrative DataAlexander Singer, University of Manitoba, CA

14:30-16:00 CS30 – App-Implementation: Patient Engagement: Patient Engagement and InnovationTrack: Clinical and ExecutiveLocation: MR 15

■ 14:30 Chatham-Kent Health Link High User Management Program: Impressive Initial ResultsJean Mireault, Logibec, CA

■ 15:00 e-Patients in B.C: Building eHealth Capacity through Public ParticipationJennifer Cordeiro, University of British Columbia, CA

■ 15:30 HearMe: An Automated Transcripts, Sign Language, and Keywords GeneratorAhoora Sadeghi Boroujerdi, Memorial University of Newfoundland, CA

14:30-16:00 CS31 – Developing Expertise: Big Thinking-StrategyTrack: ExecutiveLocation: MR 16

■ 14:30 Integrating Today’s Health Information Technology into Health Professional EducationAndre Kushniruk, University of Victoria, CA & Kendall Ho, University of British Columbia, CA


Your Trusted

Advisor for EMR

Technologies,

Products and

Services

Visit us at eHealth 2016, Booth 300

OntarioMD.ca | @OntarioEMRs | [email protected]

OntarioMD helps physicians across Ontario optimize their EMR use with:

Hospital Report Manager (HRM): sending patient reports from hospitals to primary care EMRs electronically for better continuity of care

eNotifications through HRM: near real-time electronic messages sent to primary care EMRs when patients are discharged from Emergency Departments or in-patient units eConsult: reducing wait times for patients by accessing specialist advice electronically


J U N E 5 – 8 , 2 0 1 6E8

Tuesday, June 7, 2016 ■ 15:00 Researching the Realities behind Our Talent ShortageMary Beth Seaman, Greythorn, US & Glenn Lanteigne, Tectonic Advisory Services, CA

■ 15:30 Catching Godot: Competencies for Today’s and Tomorrow’s ChallengesDominic Covvey, National Institutes of Health Informatics, CA

14:30-16:00 CS32 – Using Analytics to Drive Improvement: Big Thinking – AnalyticsTrack: ExecutiveLocation: MR 17

■ 14:30 Population Grouper Decision Support for Health Care and Policy DecisionsGreg Zinck, Canadian Institute for Heath Information, CA & Martha Burd, BC Ministry of Heath, CA

■ 15:00 Using Standards to Inform Quality, Drive Improvement in Long-Term CareLacey Langlois, Canadian Institute for Health Information, CA

■ 15:30 Closing the Data Gap in Ambulatory CareAnne Motwani, Canadian Institute for Health Information (CIHI), CA & Ginette Therriault, Canadian Institute for Health Information (CIHI), CA

■ 15:30 “Uber”-fi cation of Healthcare is Coming to CanadaVincent Ng, TELUS Health, CA

14:30-15:30 PS10 – Impact of Technology: Technology InnovationTrack:Location: MR 18

■ 14:30 Doctor, the Patient Will See You Now on Screen 4!David Thomas, TELUS Health, CA

15:30-16:00 CS33 – Impact of Technology: Technology InnovationTrack: ExecutiveLocation: MR 18

■ 15:30 “Uber”-fi cation of Healthcare is Coming to CanadaVincent Ng, TELUS Health, CA

Wednesday, June 8, 201608:30-10:00 CS34 – Big thinking in ICT and EHR: Big ThinkingTrack: Not RatedLocation: Ballroom A

■ 08:30 Healthtech Maturity Model – Beyond EMRAM for Better Clinical OutcomesBill Meredith, Healthtech Consultants, CA

■ 09:00 No More Borders: Expanding Successful Ehealth Solutions across CanadaMatthew Leduc, OntarioMD, CA

■ 09:30 Building Effective IM-IT Governance in the Community SectorLynsey Turchet, MD+A Health Solutions, CA

08:30-10:00 CS35 – Clinical Decision Support: Big Thinking – InnovationTrack: Not RatedLocation: Ballroom B

■ 08:30 An Intelligent WBAN System for Heart Disease Prediction Using NSGABabak Emami Abarghouei, Memorial University of Newfoundland, CA

■ 09:00 Enabling Advanced Analytics: Alignment of Strategy, Technology, and Organizational StructureChristine Grimm, Government of Nova Scotia, CA & Jill Casey, Government of Nova Scotia, CA

■ 09:30 Identifying Patients at Risk of Heart Failure Using Semantic TechnologyRussell Buchanan, Gevity Consulting Inc, CA

08:30-10:00 CS36 – Improving Medication Management: ImplementationTrack: Not RatedLocation: MR 8

■ 08:30 IV to PO Transitions: Reality-Based, Impactful Medication Management through TechnologySteven Shaha, Center for Public Policy & Admin, and Allscripts, US

■ 09:00 Digital Order Sets Support Patient Safety by Increasing VTE ProphylaxisBarbara Chapman, St. Josephs Healthcare Hamilton, CA

■ 09:30 A Disease Specifi c Drug Alert – Interpreting Alert DataScott Kraft, Alberta Health Services, CA

08:30-10:00 CS37 – Focused Strategy for Improved Communications: ImplementationTrack: Not RatedLocation: MR 10

■ 08:30 E-magine ePROs: Personalizing Care with Electronic Patient Reported Outcomes CollectionTran Truong, University Health Network, CA

■ 09:00 CCO’s Analytics Driven Cancer Screening Marketing Campaign Design in ActionEli Kane, CCO, CA

■ 09:30 Improving Transitions through Implementation and Evaluation of Standardized Discharge SummaryPatrick O’Brien, St. Michael’s Hospital, CA

08:30-10:00 CS38 – Telehealth and video conferencing: TechnologyTrack: Not RatedLocation: MR 11

■ 08:30 Transforming Hyperacute Stroke Care through Telehealth: The Manitoba ExperienceSusan Boles, Manitoba eHealth, CA

■ 09:00 TeleMS Virtual Consultations in Vancouver IslandAmber Holden, Island Health, CA

■ 09:30 EHealth Enabled Aged Care Nursing for Rural and Regional AustraliaHelga Merl, =The University of Newcastle, AU

08:30-10:00 CS39 – Patient Engagement – Mobile Mental Health App: Application/ImplementationTrack: Not RatedLocation: MR 12

■ 08:30 Innovative Applications for Redesigning Youth Mental Health Experiences: myEXP AppsGillian Mulvale, McMaster University, CA

■ 09:00 Design Guideline for Mobile Applications for Mental-Health Conditions in SeniorsPeyman Azad Khaneghah, University of Alberta, CA

■ 09:30 Depression Screening App and Users Motivation to Seek Professional HelpEman Alanazi, Saudi Electronic University, SA

08:30-09:30 PS11 – Continuity of Care: Implementation & DeliveryTrack: Not RatedLocation: MR 13

■ 08:30 What interRAI Interoperability Means for Continuity of CareFinnie Flores, Canadian Institute for Health Information, CA & Lynn McNeely, Canadian Institute for Health Information, CA & John Hirdes, University of Waterloo, CA & Adam Prybyl, Momentum Healthware, Inc., CA

09:30-10:00 CS40 – Continuity of Care: Implementation & DeliveryTrack: Not RatedLocation: MR 13

■ 09:30 Continuity of Care Delivery – Planning, Enabling and AssessingPatrick Powers, HIMSS Analytics, US

08:30-10:00 CS41 – Professional Development: Big ThinkingTrack: Not RatedLocation: MR 15

■ 08:30 Developing Business Intelligence Expertise through Academic-Public-Private PartnershipsJustin St-Maurice, Conestoga College ITAL, CA

■ 09:00 Promoting Continuous Professional Development for Clinical Information SpecialistsMelisa Gregorio, Fraser Health Authority, CA & Ricki-Lee Prestley, Fraser Health Authority, CA

■ 09:30 Mentoring and Developing Change Management LeadersKatie Jarick, Waypoint Centre for Mental Health, CA & Catherine Renwick, Gevity Inc., CA

08:30-10:00 CS42 – Process and Modelling: Implementation & DesignTrack: Not RatedLocation: MR 16

■ 08:30 Front-Line Adoption of Champlain BASE eConsult – A Success StoryAmir Afkham, Champlain Local Health Integration Network, CA



E9 J U N E 5 – 8 , 2 0 1 6

■ 09:00 Improving Outcomes by Automating Clinical Documentation Workfl owsSylvain Fournier, CHU Sainte-Justine, CA

■ 09:30 Innovative Bed Management Technology: Real Time, Real Change, Real ImpactLeah Matteis, Chatham-Kent Health Alliance, CA

08:30-10:00 CS43 – Patient Communication Tools: Technology -mHealthTrack: Not RatedLocation: MR 17

■ 08:30 Power of Interactive Video Dramas for Men’s Smoking CessationGayl Sarbit, University of British Columbia, CA

■ 09:00 Understanding Usage Patterns from Asthma Patients – Lessons from BreatheJoseph Cafazzo, Centre for Global eHealth Innovation, CA

■ 09:30 Mobile Patient Diary with Decision Support for Chronic Disease Self-ManagementRaza Abidi, Dalhousie University, CA

08:30-10:00 CS44 – Approaches to Public Health: Application Technology 2HTrack: Not RatedLocation: MR 18

■ 08:30 Panorama Implementation Challenges: A Case of Manitoba First NationsTatenda Bwawa, First Nations Health and Social Secretariat of Manitoba, CA

■ 09:00 Innovative Approach to Improve Immunization Management in CanadaBeverly Knight, Canada Health Infoway, CA

■ 09:30 One Root, Many Routes: Impacts of User-Based System DesignRosalie Tuchscherer, Saskatchewan Ministry of Health, CA

10:30-12:00 CS45 – EMR Adoption Use: TechnologyTrack: Not RatedLocation: Ballroom A

■ 10:30 Pulling Together: A Team-Based Approach to Enhancing EMR UseKnut Rodne, OntarioMD, CA

■ 11:00 Cultivating EHR Success: Collaborative “Linking Thinking” to Realize Benefi tsJill Breker, Vancouver Island Health Authority, CA & Corinne Eggert, Island Health, CA & Kennard Tan, Vancouver Island Health Authority, CA

■ 11:30 Big Data in Small PlacesBruce Hobson, Physicians Data Collaborative, CA

10:30-12:00 CS46 – Data & Dashboards: Technology & AnalyticsTrack: Not RatedLocation: Ballroom B

■ 10:30 Enhanced EMR Value for Physicians with an EMR Physician DashboardDarren Larsen, OntarioMD, CA

■ 11:00 Supporting Local Analysis with National Data Through Data VisualizationJanine Kaye, Canadian Institute for Health Information, CA

■ 11:30 Using Data Transparency to Delays and Interruptions to Patient CareSamantha McLachlan, Mackenzie Health Centre, CA

10:30-12:00 PS12 – Consumer Health: Big ThinkingTrack: Not RatedLocation: MR 8

■ 10:30 Identifying the Value to the Client in Consumer Health SolutionsJoanne Maxwell, Holland Bloorview Kids Rehabilitation Hospital, CA & Sanaz Riahi, Ontario Shores Centre for Mental Health Sciences, CA & Phyllis Bettello, Group Health Centre, CA

■ 11:15 Use of Innovative Consumer Health Solutions to Manage Chronic DiseaseBobby Gheorghiu, Canada Health Infoway, CA & Kendall Ho, University of British Columbia, CA & Scott Lear, St. Paul’s Hospital, CA & Richard Lester, University of British Columbia, CA

10:30-12:00 CS47 – Professional Education: AdoptionTrack: Not RatedLocation: MR 10

■ 10:30 Thinking Big about EMR: Fostering Extended Usage in Medical PracticesMarie-Claude Trudel, HEC Montreal, CA

■ 11:00 An Innovative Approach to Integrate Health Informatics into Pharmacy CurriculumHarold Lopatka, Association of Faculties of Pharmacy of Canada, CA



J U N E 5 – 8 , 2 0 1 6E10

Wednesday, June 8, 2016■ 11:30 Transformational Learning: Preparing 40,000 Users for Electronic Health Record ImplementationDiana Trifonova, Clinical & Systems Transformation, CA

10:30-12:00 CS48 – Public Health – Lessons Learned: Application and Benefi ts RealizationTrack: Not RatedLocation: MR 11

■ 10:30 Lessons Learned from the Greatest System Implementation That Never WasJulian Wong, University Health Network, CA

■ 11:00 An Audit of the Panorama Public Health IT SystemSarah Riddell & Pam Hamilton, Offi ce of the Auditor General of BC, CA

■ 11:30 Lessons Learned: Applying Lean Principles to EHR ImplementationsKeith Dipboye, Vancouver Coastal Health, B.C. Provincial Health Services Agency and Providence Health Care, CA

10:30-12:00 CS49 – EHR Implementation: Implemenation 2HTrack: Not RatedLocation: MR 12

■ 10:30 HIS Canadianization: Challenges and SolutionsBrendan Kwolek, Women’s College Hospital, CA

■ 11:00 Implementing an Interoperable Electronic Health Record in NunavutCharlene Pickles, Healthtech Consultants, CA & Shawn Doyle, Healthtech Consultants, CA

■ 11:30 What You Need to Know about First Nation eHealth ProjectsDonna Williams, Keesic Health Strategies, CA

10:30-12:00 CS50 – Planning Best Practices: ImplementationTrack: Not RatedLocation: MR 13

■ 10:30 Improving Care and Analytics through CDM-QIPDavin Church, eHealth Saskatchewan, CA

■ 11:00 The Impact of eHealth on Pharmacetuical CareAbdulgader Almoeen, King Faisal Specialist Hospital and Research Centre, SA

■ 11:30 Promoting Evidence-Based Best Practices Through Clinical Practice Guidelines (CPGs)Wendy Odell, Ontario Shores, CA & Kelly Delaney, Ontario Shores Centre for Mental Health Sciences, CA

10:30-12:00 CS51 – Cross Continuum Analytics-Connecting Data for Better Care: Benefi ts EvaluationTrack: Not RatedLocation: MR 15

■ 10:30 Supporting “One Client, One Team” in Palliative CareKamini Milnes, Toronto Central CCAC, CA

■ 11:00 Analyzing Health Data Across Care Systems: Joint Data WarehouseMarjan Moeinedin, North York Family Health Team, CA

■ 11:30 Promoting Use of Clinical Analytics in Primary Care SectorMark Nenadovic, Canada Health Infoway, CA

10:30-12:00 CS52 – Telehealth = Urban and Rural: TechnologyTrack: Not RatedLocation: MR 16

■ 11:00 Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine NetworkJohn Hogenbirk, Laurentian University, CA

■ 11:30 Extending Telehealth in a Multi-Site Academic Hospital – Anytime, Anyplace, AnywherePeter Rossos, University Health Network, CA

10:30-12:00 CS53 – Communities of Care: DeliveryTrack: Not RatedLocation: MR 17

■ 10:30 Imagine... Opportunities for Virtual Health Care in Manitoba First NationsBrenda Sanderson, First Nations Health and Social Secretariat of Manitoba, CA

■ 11:00 Redefi ning Healthcare Emergency Management Communications for 2015 Pan American GamesMatthew Kelsey, University Health Network, CA

■ 11:30 From Smart to Smarter – First Nation Health Centres Utilizing BroadbandPenny Carpenter, Keewaytinook Okimakanak, CA

10:30-12:00 CS54 – First Nations Health: Big ThinkingTrack: Not RatedLocation: MR 18

■ 10:30 Building the Manitoba First Nations Network of the Future InitiativeLisa Clarke, First Nations Health and Social Secretariat of Manitoba, CA

■ 11:00 Improving Access to First Nations Population Health Information through PartnershipsSharon Rudderham, Eskasoni Community Health Centre, CA

■ 11:30 BC First Nations Telehealth Expansion: Connecting Communities with ProvidersJeffrey Yu, First Nations Health Authority, CA nH

12:00-14:00CLOSING KEYNOTE ADDRESSLocation: Vancouver Convention Centre, East Building, Exhibit Hall A

Speaker: Louis Francescutti, Visionary Storyteller, Royal Alexandra Hospital, Northeast Community Health Centre, University of Alberta


The good news is that Telehomecare reduces hospital stays and emergency room visits for patients with chronic conditions. The better news is that patients love it.

“We’ve known almost from the beginning that Telehomecare’s health coaching and remote patient monitoring help people remain at home, reducing unnecessary hospital visits,” says Laurie Poole, vice president of telemedicine solutions at the Ontario Telemedicine Network (OTN). “Now we have data that indicates high levels of patient satisfaction, demonstrating that virtual health care is key to system transformation focussed on patient-centred care in the right place at the right time.”

The OTN program, delivered through Local Health Integration Networks in most of Ontario, provides easy-to-use equipment that allows patients to monitor vital signs and answer daily questions about how they are feeling. The results are monitored by a clinician who also provides health coaching to educate patients about how lifestyle choices affect their well-being.

Focused on satisfaction with the health coaching, goal setting and self-management education provided by the program, the survey was completed by patients and their volunteer caregivers.

“Telehomecare gave my mother the opportunity to recover in the comfort of her home…a major contributor to her recovery. It was also a great relief and support as a caregiver to be able to recognize and control potential crisis/anxiety with this condition…we always received quality advice and speedy assistance.”

Results indicate 98 per cent of respondents were satisfied with Telehomecare and more than 98 per cent responded positively to the quality of health care, teaching and coaching.

“Telehomecare causes me to become more aware of everything I am supposed to do to improve my present health conditions. Thanks to my nurse who… often communicated with me and gave me helpful advice. My goal is to continue being cautious of what I do to improve my health. Everyone who needs this assistance should be helped. Thank you.”

As with other OTN telemedicine programs, the survey indicated a significant benefit to patients and their caregivers in reduced travel and wait-times. In the case of patients, a time-saving of 8.5 hours a month was reported. About 9.6 hours a month were saved by volunteer caregivers.

with

Telehomecare patient experience survey

Using integration engine technology to improve interoperability and the patient experience By: Gary Folker, EVP, Orion Health, North America

For healthcare providers to properly care for the health of their patients, data exchange is vital. Yet the lack of interoperability between health systems makes it diffi cult to achieve consistent data exchange. With more and more healthcare organizations having an integration engine coming to end of life, using a robust integration engine like Rhapsody can capture data and process that data in a way that allows it be available so that important decisions can be made. This core functionality contributes to improving the overall patient experience and creates a sustainable foundation to deliver optimal care by harmonizing the collection, management and distribution of patient data across the community of care.

Hospitals like Quinte Health Care, Sunnybrook Health Sciences and Rouge Valley Health System selected Orion Health’s Rhapsody Integration engine to help ac-cess critical information. After installing Rhapsody, Brockville General Hospital was able to save thousands of dollars annually by being able to share discharge summaries, x-rays and other medical reports electronically. OntarioMD also uses Rhapsody to power the award-winning Hospital Report Manager which enables the speedy exchange of patient data across Ontario.

On a larger scale, Alberta Health Services used Rhapsody to launch Alberta Netcare, which connects Electronic Healthcare Records (EHR) with practically all public health delivery sites in Alberta within the Alberta Health Services region and their community partners. Through Netcare, Rhapsody allows most of Alberta’s community pharmacies to submit their dispense data. Netcare has produced impressive results for the province, including a 40% decrease in hospital admissions and a 30% reduction in length of hospital stays.

Rhapsody provides robust interoperability, scalability, data analytics and aggregation capabilities. Its ease of use and short learning curve can be represented in threes: three minutes to install, three weeks of training and three months to transition for small to medium sized hospitals and health organizations.


E11 J U N E 5 – 8 , 2 0 1 6

SOLUTIONS FOR: Healthcare Integration | Population Health Management | Electronic Health Records

For more information, please visit us at eHealth booth#416 or e-mail [email protected]

Health information has the power to change the quality of our lives, and we’re working hard to improve healthcare across generations. When clinicians have access to complete patient information from the entire care continuum,

analysis. Increased insight. Informed decisions. And that adds up to a better quality of life for everyone.

Open platform technology built for today with the vision to adapt to tomorrow.

Another adventure. And the future-proof technology to keep them healthy for many more.


J U N E 5 – 8 , 2 0 1 6E12

Meet the speakers

Zayna KhayatCo-Founder, Senior Advisor

MaRS Discovery

Dr. Zayna Khayat is a senior advisor in health system innovation at MaRS Discov-ery District, an innovation hub in Toronto with a major focus on the health sector. She is also Director of the MaRS EXCITE health technology evaluation program. Za-yna’s mission is to help healthcare systems in Ontario, Canada and around the world adopt health technology that improves public health while driving the Canadian knowledge economy. Dr. Khayat is also adjunct professor in health sector strategy at the Rotman School of Management at University of Toronto.

Marilyn EmeryPresident & CEO

Women’s College Hospital

Marilyn Emery has been leading trans-formational change and reimagining the future of healthcare in Ontario for over 25 years.

Since 2007, as President and CEO of Women’s College Hospital (WCH), Mari-lyn’s job and her passion have been to rev-olutionize health care for women and girls.

She has literally and fi guratively broken new ground in Ontario – overseeing a half billion dollar redevelopment project to build Canada’s preeminentacademic am-bulatory hospital with a focus on health for women and health system solutions.

Her visionary ideas are refl ected within and beyond the walls of this new hospital that was designed to keep people out of hospital.

Catherine Claiter-LarsenVice President

and Chief Information Offi cerVancouver Island Health Authority

Catherine Claiter-Larsen joined Is-land Health in August 2005.

As Vice President, Quality Systems and Chief Information Offi cer, Catherine is responsible for advancing the infra-structure that enables excellence at Island Health.

Catherine provides strategic oversight for major quality systems capital projects, including IHealth, Island Health’s trans-formational Electronic Health Record (EHR) initiative, and the Unit Dose Med-ication Distribution project. Catherine is also responsible for Island Health’s strate-gic relationship with Cerner, the ORCAH Institute, which aims to improve popula-tion health through innovation using Is-land Health’s Cerner-based EHR.

Neil FraserPresident

Medtronic Canada

Neil Fraser joined Medtronic Canada in 1984 and, follow-

ing numerous com-mercial positions, was

promoted to President in 2004. Under Neil’s leadership,

Medtronic Canada has been a signifi cant leader in business model innovation, mar-ket position, productivity and effi ciency. He is proud of the high level of engage-ment among employees, faced with a challenging healthcare environment and one of the largest integrations in medical device history, following to acquisition of Covidien in 2015. Medtronic Canada is honoured to receive numerous awards in-cluding: Canada’s Best Large Workplaces, Top 100 Employer in Canada fi ve years in a row, and LEED Silver Certifi cation of our new Brampton headquarters.

Dr. Peter W. VaughanCD, MA, MD, MPH

Deputy Minister of Nova ScotiaDepartment of Health and Wellness

Dr. Peter W. Vaughan is Deputy Minis-ter of Nova Scotia Department of Health and Wellness.

Prior to becoming Deputy Minister, Peter was the presi-dent and Chief Executive Offi cer, and Medical Di-rector of the South Shore District Health Authority. Dr. Vaughan’s international clinical medical experience spans several jurisdictions in Canada, United States, Central America and Europe.

He completed his Master of Public Health at The Johns Hopkins Univer-sity Bloomberg School of Public Health in Baltimore, Maryland. He has an Honors Bachelor of Arts and a Master of Arts in Philosophy from the University of Guelph, and a Doctor of Medicine from McMaster University in Hamilton, Ontario. He also completed the Queen’s University School of Business Queen’s Executive Program in 2007.

John DeHart Co-FounderNurse Next DoorVancouver Island Health Authority

John DeHart’s purpose in life is to cre-ate systemic change by building companies and building culture. The co-founder and CEO of Nurse Next Door Home Care, John has helped shape the company into one of Canada’s most successful health care brands, with over 85 locations in North America. Speaking on inspired en-trepreneurship, workplace culture, and leadership, DeHart takes the idea of “cor-porate vision” and turns it on its head, to leave audiences with a fresh perspective, energized, reinvigorated, and inspired to take themselves and their organizations to the next level.

Panel Speakers

Dr. Travis McDonoughCEO & Founder

Kinduct

Travis McDonough has turned a passion for sports into a career of helping people achieve their physical best. As an elite com-petitor in both boxing and tennis, Travis was drawn to healthcare after experiencing the benefi ts of physical medicine treatment for a neck injury. After becoming a health care practitioner, Travis moved to Ireland where he started a series of health and wellness clinics designed to help patients obtain optimal health. Through a unique multidisciplinary network of practitioners, the clinics provided a range of services to help everyone from the elderly to elite ath-letes gain mobility, improve performance, increase physical fi tness, and prevent and recover from injuries.

Prof. Louis Hugo Francescutti, MD, PhD

Visionary StorytellerRoyal Alexandra Hospital, Northeast Community Health Centre, University

of Alberta.

Dr. Francescutti received his com-bined Doctor of Philosophy (Immunol-ogy) in 1985 and his Doctor of Medicine in 1987 from the University of Alberta. In 1994, he completed his further stud-ies in injury control while working to-ward a Masters of Public Health at Johns Hopkins University in Baltimore, Maryland.

He is currently an emergency physi-cian at the Royal Alexandra Hospital and the Northeast Community Health Centre in Edmonton. As a professor in the School of Public Health at the Uni-versity of Alberta, he teaches graduate courses in injury control, advocacy and public health.

Wednesday, June 8, 2016Closing Plenary Speaker



t looks like an ordinary cup of tea being offered to someone sitting at the bedside. But this simple transaction has a far

greater impact than simply quenching a thirst. This cup of tea is a result of the new approach to the role of service volunteers at North York General Hospital (NYGH).

In January 2015, a multi-disciplinary group of NYGH staff, physicians and vol-unteers met to discuss new service volun-teer programming that would enhance the patient and family experience. “At North York General, a patient- and family-cen-tred approach is expected of all staff, physi-cians, students and volunteers,” says Sheri Loosemore, Manager, Volunteer Services. “Looking at the service volunteers’ roles from this perspective provided the hospi-tal with an opportunity to evolve the tra-ditionally transactional nature of the vol-unteer position into one which works with patients and families for greater impact.”

The brainstorming session left the newly-formed Volunteer Services Advi-sory Working Group with several initia-tives to explore. Over the next 12 months, the Working Group took on the challenge of implementing not one, but three of these initiatives.

The fi rst to be implemented was the am-bassador program which places volunteers at the entrances to greet patients and visi-tors and provide them with detailed direc-tional assistance, including walking them directly to their destination, if needed.

Another initiative which is set to launch soon is to incorporate volunteers into the Hospital Elder Life Program (HELP) – a comprehensive patient-care program that ensures optimal care for older adults while in the hospital. HELP prevents delirium, which is a sudden state of confusion or change in mental state. This program is led by staff and supported by volunteers.

The third initiative involves that cup of tea in the Emergency Department (ED).

In September 2015, the volunteers re-turned to the ED providing support from 9 a.m. to 9 p.m., seven days a week. Volun-teers had not provided service in the ED since October 2014 due to the global Ebola crisis. This hiatus provided an opportunity to consider how volunteers could enhance the patient and family experience. Work-ing in conjunction with the ED team, the Working Group identifi ed several ar-eas volunteers could improve the patient and family experience during this often diffi cult time.

The fi rst was to provide all ED volun-teers with Gentle Persuasive Approach training which involves learning how to use a person-centred, compassionate, gentle persuasive approach to respond respectfully to challenging behaviours. The purpose of this training is specifi cally to enhance the patient experience with the volunteers.

The second area of change was to move the volunteers out of triage and focus all the volunteer resources in the patient care

area. There, volunteers not only visit pa-tients as assigned, they also promote and assist patients and visitors in completing patient satisfaction surveys. Volunteers also provide wayfi nding, helping patients get to where they need to be within the emergency department and other depart-ments as needed.

Finally, volunteers are now providing refreshments to patients and their loved ones. The aim is to provide some comfort and relief to patients and families who may not want to leave the bedside for long pe-riods of time. The ED and Volunteer Ser-vices recognize that most patients do not need to limit their intake of food or bev-erages and something as simple as a warm drink and a biscuit can provide much-needed comfort to someone in distress.

The positive feedback Volunteers Ser-vices has received on these initiatives has been overwhelming. The ambassador pro-gram helped guide over 8,000 visitors in its

fi rst three months, the HELP program is looking to launch imminently and the re-evaluation of the volunteer role in the ED has been a great success, from the perspec-tive of the volunteers, the staff and physi-cians, and most importantly, the patients and visitors.

Patient- and Family-Centred Care at NYGH is described as partnering with pa-tients and families; working WITH them instead of doing TO or FOR them; learn-ing to see through the eyes of patients and families to make their experience the best it can be.

The NYGH Volunteer Services ap-proached their new program development through that lens and has proven that when the patient comes fi rst, everyone wins. And sometimes all it takes is a simple cup of tea. ■HNoémie Terrio works in Corporate Communications and Public Affairs at North York General Hospital.

By Noémie Terrio

I

Margaret Carrington and Houshang Moshrefzadeh, NYGH service volunteers, provide patients and visitors coffee in the Emergency Department.

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A cup of tea makes a world of difference

“YLP has been running at another lo-cal chapter and is very popular. I wanted to extend the program and bring it to Tril-lium Health Partners, a place where I knew there was already a strong sense of commu-nity and a lot of youth who could benefi t,” says Aman, who leads the program at Tril-lium Health Partners.

The YLP debuted at Trillium Health Partners in the fall of 2015 and consists of eight one to two-hour after-school ses-sions, specifi cally designed to develop participants’ speaking abilities and speech organization by practicing proper voice control, vocabulary and gestures in a sup-portive and judgment free environment.

Aysha Qamar, Student Coordinator, Volunteer Resources, sat in on all eight sessions and noted the positive impact of the program.

“By the end of the YLP program, I ob-served a notable change in the students, there was a tremendous increase in their confi dence and they grew so much closer to one another,” she says. “Some of our high school student volunteers are in-credibly dedicated and greatly surpass the required forty-hour amount they need to complete for school. I’m so happy we could provide them with this program as a way to acknowledge their hard work.”

Maya El-Zahed, YLP participant, is one of many student volunteers who has shown exemplary service to Trillium Health Part-ners, having clocked over 130 hours at the hospital to date.

“My favourite part about volunteering is being able to interact with the patients and health care staff, and to see how even a small gesture can go a long way in mak-ing their day better,” she says.

Trillium Health Partners has over 2,200 dedicated volunteers across its three sites, and routinely offers them access to devel-opment opportunities such as seminars in customer service and valued conversa-tions. YLP will continue to be offered an-nually by Trillium Health Partners for its student volunteers. ■H

Dora Guzina is a Communications Intern at Trillium Health Partners.

Continued from page 12Youth Leadership

The ambassador program which places volunteers at the entrances to greet patients and visitors and provide them with detailed directional assistance, including walking them directly to their destination.


16 From the CEO's Desk

istorically, community hos-pitals have not always been viewed as the most innova-tive. Add to that, the fact

that innovation has not always risen to the top of priorities for investment when hospitals face restrictive budgets and ris-ing patient volumes. This is a particular challenge because hospitals may lack the necessary resources to fund the infrastruc-ture needed to cultivate an environment of innovation.

Innovation isn’t just a buzz word any more. By necessity, it has become a way of life for hospitals, for healthcare and for everyone in the service and caring busi-ness. The dictionary defi nes innovation as “… the action or process of innovating or the introduction of new things or methods that create value or make things better.” So in our ever changing world of health-care, it has become a necessary part of our evolution.

As part of our strategic plan, we identi-fi ed innovation as a priority and as an im-perative for future success. We determined that innovation must be purposeful, meet a need and that any innovation we embrace must solve a problem and must be in align-ment with our goal of providing safe, high quality care.

As a large community hospital provid-ing care to one of the fastest growing com-munities in Canada, Markham Stouffville Hospital is located in what is considered to be the technology capital of the country – Markham, Ontario.

Innovation provides the perfect oppor-tunity for us to blend technology with pa-tient care, outcomes and effi ciency.

Providing excellent patient care in an environment characterized by increasing expectations with fi xed resources is not new to healthcare. What is new is bringing

innovation to the table as a way of doing business and embedding it in everything we do. The result has meant a signifi cant culture change for health care providers and leaders. In the new innovation-based world, there must be a tolerance for mis-takes and failures and a higher tolerance for risk. As a leader, I will continue to sup-port and encourage staff and our Board of Directors to embrace innovation and to also embrace failure as a possible part of our journey. This is not easy for large, bureaucratic organizations, particularly hospitals, where we are always working to reduce risk and minimize error. So in many ways, the risk taking that is necessary for innovation is counter to the healthcare culture. We often talk about doing more with less but the problem is that if we can-not fi nd a way to do things differently, then we are simply doing less with less. Innova-tion can come from adversity and neces-sity but it can also arise incrementally over time, as with the evolution of healthcare practices. Regardless, it must be fostered, developed, and nurtured.

Innovation, by its nature, needs to be nimble and quick and in many cases, not bound by the bureaucracy that can be present in large organizations. This can be diffi cult because it is that machine that can help us to minimize variation and reduce risk. The challenge has been to develop a process and framework that encourages innovation but that also includes enough checks and balances to make sure that precious time and resources are being used effectively. It is also important to put mea-surements and targets in place to gauge the success of various innovations.

In addition, we must ensure that any potential innovations align with our strat-egy and that we have the capacity to test concepts and ideas. Great ideas can of-

ten begin and end on paper. We want to make sure that our process evaluates the resources required prior to moving forward and that we do not waste time working up great ideas that do not support key priori-ties or that are not feasible. This is an on-going piece of work that requires diligence and rigor.

What we are learning at Markham Stouffville is that our innovations must be practical for our different audiences: pa-tients, physicians, or staff for example. For this, we created an intentional structure to support our efforts – a virtual ‘Offi ce of Innovation’. We knew that we needed in-ternal champions to make this successful so we named an administrative champion – one of our Executive Vice Presidents as well as a Medical Chief of Innovation to help support our efforts. The administra-tive and physician leads are working close-ly with their respective teams as well with the leadership team to make the numerous and necessary internal and external con-nections. We are also engaging our inter-nal and external stakeholders in ‘Design Thinking’ methodology to co-design new processes, models of care, and services and then spreading the innovative learning to other settings. We have learned over time to look beyond the healthcare sector as in-novations in other industries can be trans-lated into opportunities for healthcare.

We are also eager to learn from others and are proud to be a founding member of an innovation collaborative with fi ve other community hospitals. The Joint Centres for Transformative Healthcare Innovation came together as a way to share our collec-tive resources and work together to bring innovation to patients in communities

across the GTA. The group has created an annual event – InnovationEx to show-case innovative projects from the partner hospitals. This collaborative creates an ex-cellent opportunity to share new innova-tions, trial them and spread them quickly. A great example is an initiative led by Markham Stouffville Hospital focused on reducing C-section rates. This initiative was showcased at our fi rst InnovationEx two years ago and has spread to most of our partner hospitals. The healthcare sys-tem benefi ts when this type of information is shared, and ultimately patients and their families benefi t when we encourage new and different ways of doing things.

We also look outside the Joint Centres to organizations that may help advance our innovation agenda. We continue to connect with our neighbouring technology companies to share our priorities, and learn how we can support an entrepreneurial and academic environment that is open to trialing and developing technologies that benefi t health and the healthcare system.

Healthcare is often considered an in-dustry that moves in inches not miles – especially when it comes to making and implementing changes. But when we look at innovation, small incremental change is not always enough to deal with the chal-lenges we face today and into the future. Disruptive innovation that challenges the way we think, work, and deliver care is needed to meet the needs of our patients and our community, as well as the broader healthcare system which demands more integration and coordination.

As a sector, we have no choice but to embrace innovation. For many of us, that can mean moving outside of our comfort zone and accepting the risk of failure that can be associated with innovation. With-out risk, there often isn’t great reward. And in healthcare, we need to get com-fortable with taking calculated risks. Our patients and their families are depending on it. ■H

Jo-anne Marr is the President and CEO of Markham Stouffville Hospital.

When administration meets innovationBy Jo-anne Marr

H

We often talk about doing more with less but the problem is that if we cannot fi nd a way to do things differently, then we are simply doing less with less.

Jo-anne Marr


17 Nursing Pulse

azim Virani has never been afraid to dream big. In fact, she says she does her best work when she’s free to make

things even bigger than anyone thinks they might be. Perhaps that’s why she says – almost two decades after she helped to launch the Registered Nurses’ Associa-tion of Ontario’s (RNAO) Best Practice Guidelines (BPG) Program – she’s not surprised the guidelines have become as “big” as they have. She never doubted they would have an important impact on nursing.

“The fi re was lit and it was blazing ga-lore,” she says of her seven years laying the groundwork for RNAO’s guidelines.

Originally from Uganda, Virani is no stranger to challenge. She fl ed her home country with her family in 1972, during Idi Amin’s brutal dictatorship. Although only 11-years-old when she arrived in Canada, she felt fortunate to have come from a place that was once a British col-ony. She had learned English in school, and understood western culture. Virani’s parents had big dreams for their daugh-ter, and it was understood she would go to university. She did well in high school, and always knew she wanted to do some-thing in health care. She decided on nurs-ing when a guidance counselor told her

the job prospects and income were good. This meant she could help her family.

“It was one of the most diffi cult edu-cational experiences I’ve ever had,” she admits of nursing school. Feeling like an outsider in a sea of white students and professors at University of Toronto, Vi-rani’s impressive marks dropped.

In third year, a professor suggested nurs-ing may not be for her, and that she try something else. Fortunately, she was un-deterred, and in fourth year met a supervi-sor she describes as “absolutely amazing.” She looked at things from a very differ-ent vantage point, Virani recalls. In fact, she achieved an A in most courses her fi nal year.

She graduated and was hired in ICU at Toronto East General Hospital, work-ing 12-hour shifts. On her days off, Virani studied critical care at Humber College to acquire skills she could apply immediately in her workplace. Her initiative led to of-

fers of leadership and management roles, and eventually inspired her to pursue a master’s degree.

“I see my career as just a whole bunch of things that happened in a serendipi-tous manner,” Virani admits. After com-pleting her master’s at Western Univer-sity in 1991, she was immediately hired at Toronto’s Mount Sinai Hospital. It was there she met Doris Grinspun (now RNAO CEO), who would ask her eight years later to lead the BPG program. Launching BPGs, and creating advanced clinical practice fellowships (ACPF), was an opportunity to step outside the box, Virani says. It was also an opportunity to right a small wrong.

As director of RNAO’s BPG program, Virani found herself face-to-face with the professor who suggested she quit nursing and try something else. She can’t help but refl ect with some satisfaction that, when the woman, a BPG panelist, suggested she knew Virani from somewhere, Virani was able to remind her of their history. “Thank God you didn’t listen to me,” the woman joked.

In retrospect, that experience taught Virani how to go with her gut when faced with a challenge. “I use my heart instead of my head when it comes to my career,” she says.

As an independent consultant who does a lot of strategic planning, program development and evaluation work now, Virani still follows her heart, but she also has the freedom to take on projects that allow her to step out of her comfort zone. She looks back to her time at RNAO and recalls the same kind of freedom to think big.

“You didn’t have boundaries – there were infinite possibilities and it was ex-tremely energizing,” she recalls, adding it was also challenging. Virani had one support staff when she started at RNAO. She had a few weeks to launch the first BPG; a rigourous process that now takes months. The program has since launched 42 clinical and 10 healthy work environment BPGs, supported hundreds of ACPF fellows, designated 92 Best Practice Spotlight Organizations that represent almost 500 health-care and academic organizations, and hired numerous expert staff.

This growth is a fitting legacy for someone who believes there’s no such thing as dreaming small. ■H

Kimberley Kearsey is managing editor/communications project manager for the Registered Nurses’ Association of Ontario (RNAO).

In pursuit of infi nite possibilityBy Kimberley Kearsey

T

“I see my career as just a whole bunch of things that happened in a serendipitous manner.”



recision medicine – the emerg-ing approach of tailoring of medical treatment to the indi-vidual characteristics of each

patient – is set to transform the delivery of health care.

No less a personage than the president of the United States said as much in his State of the Union address at the beginning of last year when he announced a $215 mil-lion initiative in precision medicine.

“I want the country that eliminated po-lio and mapped the human genome to lead a new era of medicine – one that deliv-ers the right treatment at the right time,” President Barack Obama said.

This is a world – no more than a decade away according to the CEO of Genome Canada – where a person’s genome will be sequenced at birth and used to guide their health care. It is an approach that marries all the big buzzwords in health care today – genomics, big data and the electronic medical record.

In Canada, a well-developed network of academic centres and researchers coordinated through the Canadian Institutes of Health Research (CIHR) and Genome Canada is making this coun-try one of the global leaders in precision medicine research.

In 2012, Genome Canada, with its vi-sion to harness the transformative power of genomics for the benefi t of Canadians, funded 17 major, innovative projects (de-scribed below) to apply precision medicine to the Canadian health care system. The initiative was a collaboration with CIHR, who co-funded many of the projects.

Last month (March), Science Minister Kirsty Duncan announced a $2 million initiative to create a network of research-ers involved in these projects to analyze fi ndings on some of the major ethical and economic issues involved in the approach.

Those issues – which Genome Canada characterizes as GE3LS (Genomics and its Ethical, Environmental, Economic, Legal and Social aspects – are huge and range from the lack of Canadian legislation pro-tecting against genetic discrimination, to determining the economics of providing tailored genetic testing and treatment to individuals with rare disorders.

Precision medicine was one of the areas highlighted in the report of the Advisory Panel on Healthcare Innovation commis-sioned by the federal government and re-leased last summer.

Chaired by Dr. David Naylor, former president of the University of Toronto, the panel saw its work released without fanfare by the previous Conservative gov-

ernment, but the report has been reborn under the new Liberal government, which has praised its fi ndings.

The report discusses at length the ad-vances made by precision medicine in re-cent years.

“A patient with a cancer that has stopped responding to intravenous chemo-therapy can now contemplate surprising and truly personalized options, such as oral treatment with a drug used for high blood pressure or a now little-used antibiotic,” the report states.

However, Naylor and his fellow panelists go on to note that “for reducing one’s risk of most common diseases, individualized prevention through precision medicine is a side-show at present ...”

The report references work done in Canada in precision medicine and said the panel would be remiss if it did not “ap-plaud the investments in applied genomics and precision medicine research that have been made by CIHR (Canadian Institutes for Health Research), Genome Canada, many other national foundations and grant-making bodies, provincial research agencies and ministries, private industry and other supporters.”

But once again, the report sounds a cautionary note: “Despite these advances, the panel also heard warnings from clini-cians, researchers, and healthcare stake-holders that Canada may squander its research investments without a more strategic approach.

“…without a cogent strategy, without the right infrastructure – both biobanks and databanks, without mechanisms

to translate successful discoveries into both improved clinical care and excit-ing new businesses, Canada runs a risk of wasting opportunity and money – and falling even further behind our peers.”

Genome Canada CEO Marc LePage feels his organization and CIHR are do-ing a good job in coordinating the Cana-dian research agenda for precision medi-cine at the national level.

While Canada is in the forefront of nations researching this area, in an interview LePage said the current im-pact of this approach on the health care system is very limited although there is a “tsunami of new practic-es” on the way. He mentioned ini-tiatives in BC, Quebec and Ontario as examples of where this process is being accelerated.

LePage noted that not only did Obama boost precision medi-cine by his announcement last year but he has further promoted the field with his “cancer moonshot” funding announcement this January because of the close association be-tween advances in genomics and cancer detection and treatment.

Given the provincial nature of health care delivery in Canada, LePage said na-tional approaches can only go so far in bringing precision medicine approaches to the bedside.

However, as the field advances, LeP-age said the Naylor report is correct in identifying the need for a “cogent strat-egy” to translate advances in precision medicine to clinical applications.

Precision medicine:By Pat Rich

P

Personalized medicine in the treatment of epilepsy

Every time someone with epilepsy has a seizure there is a risk of brain damage. This is particularly true for children. Unfortunately, today’s anti-epileptic drugs simply don’t work on about one third of patients. The team will identify genes that are associated with epilepsy and that are predictive of the response to various antiepileptic drugs. This will result in earlier and more effective care and potentially prevent cognitive decline in children.

Biomarkers for pediatric glioblastoma through genomics and epigenomics

A type of incurable brain cancer called high-grade astrocytomas (HGA) is taking the lives of children and young adults. Genome Canada and CIHR-funded researchers have identifi ed mutations in a particular gene in a signifi cant fraction of children and young adults with this brain tumor. These mutations partly explain why this cancer remains unresponsive to treatments.

The team will develop new tools that will help healthcare providers identify these mutations in brain tumors, allowing children to receive the best treatment strategy. Using next-generation genomic technologies, they are looking for potential targets for drug treatment.

Personalized cancer immunotherapy About half of patients with a hematologic cancer

develop resistance to chemotherapy. For these patients, the usual treatment is to transplant bone marrow cells from a healthy donor. This is known as immunotherapy because immune cells from the donor target tumor cells in the recipient. Unfortunately, there are two problems with this treatment: the effectiveness of the transplanted cells varies widely; and there is the chance of rejection by the patient. In some cases, the donor cells actually attack the patient―something known as “graft versus host disease” (GVHD).

The team is developing a genetic test that will predict GVHD, leading to safer use of bone marrow

transplants. This will also improve immunotherapy by targeting the right immune cells to the right tumor cells, leading to more effective treatment.

IBD Genomic Medicine Consortium (iGenoMed): Translating genetic discoveries into a personalized approach to treating Infl ammatory Bowel Diseases

With over 230,000 cases, Canada has among the highest frequency of people in the world with inflammatory bowel diseases (IBD), including Crohn’s and Ulcerative Colitis. While there are several drugs available on the market to treat IBDs, currently physicians are unable to predict which drug would be most effective for a given patient.

The team will develop tests allowing doctors to match the right drug with the right patient. This will prevent patients from receiving ineffective (and often expensive) medication and improve the quality of patient life. In addition, once the project is fully implemented, it will save the health care

Two areas of precision medicine that are going to be with us, in volume, relatively quickly; improved early diagnosis of cancer and appropriate treatments; and testing for rare genetic disorders.

Changing the nature of health care

Cover story

The 17 successful projects resulting from the 2012 Large-Scale Applied Research Competition in Genomics and Personalized Health



Canada’s doctors are still coming to grips with precision medicine both from a high-level policy perspective and for the immediate impact it will have in doctor’s offi ces.

At its annual meeting in Halifax last August, the general council of the Canadian Medical Association (CMA) passed four resolutions relating to precision medicine.

In an interview, Dr. Jeff Blackmer, who is VP of medical professionalism for the association, said the association has been “carefully” monitoring developments in precision medicine over the past decade.

“There’s no question that the CMA (Canadian Medical Association) supports these kinds of initiatives,” said Blackmer.

However, he added, “the main area we have been focused on … is direct-to-con-sumer genetic testing, which for practising physicians right now would be one of their main areas of concern.”

“For the average family physician, who would be the normal front-line person the patient would go to for help in interpret-ing these tests, it can be very diffi cult and extremely time-consuming, and we re-ally haven’t put the tools in place to allow them to do that in a meaningful way.”

Blackmer said the CMA is working with geneticists at the Children’s Hospital of Eastern Ontario to develop a formal ad-vocacy plan to bring more standardization to direct-to-consumer genetic tests. The association’s committee on ethics will be looking at this issue at its spring meeting.

LePage said researchers are probably divided about the value of direct-to-con-sumer genetic testing, especially since companies such as 23andMe have been limited in the type of diagnostic informa-tion they are allowed to provide in the U.S.

He said the reality of using genetic testing at birth to help guide health care delivery is no more than 10 years away and both he and Dr. Karen Dewar, director of genomics programs for Genome Canada, referenced one of the 17 Ge-nome Canada-funded projects, which is investigating the value of pre-natal testing

of maternal blood to obtain information about the fetus.

In talking about innovation, LePage also specifi cally referenced a new partner-ship between the Structural Genomics Consortium – a public-private partnership that supports the discovery of new medi-cines through open access research – and the Montreal Neurological Institute, to test new drugs for neurological diseases.

In discussing the major projects be-ing funded by Genome Canada, Dewar described them as encompassing a number of disease areas and approaches.

“Many of them are touching areas where personalized medicine (an alter-nate, earlier term for precision medicine) are more advanced,” she said, as well as areas where Canada has particular re-search capacity.

In an interview, Dewar noted that the call for research proposals stipulated that

projects have deliverables capable of being translated into cost-effective use in the health care system.

Dewar referenced the newly funded network of the research teams to look at some of the common themes in the precision medicine work and to try and address them.

Dr. Chris McCabe, Capital Health Endowed Chair in Emergency Medicine, at the University of Alberta is co-lead-ing the precision medicine networking project with Dr. François Rousseau of Uni-versité Laval.

In an interview, McCabe said he felt there is still time “but not lots of time” to establish frameworks for incorporating ge-nomics into health care delivery.

He identifi ed two areas of precision medicine “that are going to be with us, in volume, relatively quickly”; improved early diagnosis of cancer and appro-

priate treatments; and testing for rare genetic disorders.

McCabe said he agreed with the Nay-lor report that for the vast majority of common diseases “you get as much in-formation from a good family history and standard clinical testing as you do from a genetic test.”

For these common conditions, he says, “we’re not in the short-term, going to see a sea-change in how health care is delivered because the information (from genetic testing) is not specifi c enough to guide current clinical or behavioral decisions.”

“That said, this technology (genet-ic sequencing) is out there: patients will be presenting with their own se-quenced DNA and we need to know how to use that information when it’s clinically actionable.” ■HPat Rich is an Ottawa-based medical writer.

A photo taken of Andrew Penn’s project (Reducing stroke burden with hospital-ready biomarker test for rapid TIA triage).

system more than $10 million annually by avoiding costly hospitalizations and surgeries.

While the research will focus on two specifi c drugs, the project is in fact creating a system that will become an even greater asset for a large number of new drugs, which are expected to reach the Canadian market in coming years.

PEGASUS: Personalized Genomics for prenatal Aneuploidy Screening Using maternal blood

Every year in Canada, about 10,000 pregnant women undergo amniocentesis to screen for genetic abnormalities such as Down syndrome.

This procedure represents a non-negligible risk and tragically, 70 healthy fetuses are lost due to complications from the procedure. Recently, however, scientists have discovered that fetal DNA present in the mother’s blood can be used to test for genetic abnormalities, and this through a simple blood test.

The team will compare different genomic technologies for their effectiveness to successfully detect genetic abnormalities using the mother’s blood. The goal of the study is to implement the most suitable technology into the Canadian health care system to eventually offer, in the context of standard clinical care, non-invasive prenatal screening to all Canadian women.

Innovative chemogenomic tools to improve outcome in acute myeloid leukemia

Acute myeloid leukemia is a particularly lethal type of cancer among young people, with most dying within two years of being diagnosed. At the moment, analyzing cancer cell chromosomes is the best way to determine the prognosis for patients. Unfortunately, about 45 per cent of those tested show no anomalies, leaving doctors with little information to go on. Recent developments in DNA sequencing, however, allow for a more complete analysis of these tumors.

The team will use personalized DNA from patients to determine how they should be treated, based

on the specifi c genetic makeup of their tumors. This will lead to better diagnosis and improved outcomes for patients. They are also developing new models for tracking cancer cells that are left behind after a patient is treated. These cancer stem cells can multiply over time and lead to a relapse. This research could lead to new ways of preventing such relapses by providing new insights into the biology of this disease.

Personalized risk stratifi cation for prevention and early detection of breast cancer

Currently, mammography is used to screen for breast cancer in women over 50 years of age. While screening younger women could have signifi cant benefi ts in terms of early detection and intervention, it is simply not economical. What’s needed is a way of identifying those who are most at risk, based on a wide variety of factors.

The team is developing just such a screening program so that women with a high risk of breast cancer will be identifi ed―and tested sooner.

Younger women who are currently missed by age-based screening will have their cancer caught at an earlier stage, leading to better treatment, improved prognosis and lower costs for the healthcare system.

t th $10 illi ll b idi

Photo courtesy of Genome Canada




Personalized medicine strategies for molecular diagnostics and targeted therapeutics of cardiovascular diseases

Cardiovascular disease is the leading cause of death and hospitalization in the world. In Canada 80,000 people died in 2010 of cardiovascular disease, which accounts for 35 per cent of all deaths in the country. Currently, 1.3 million Canadians suffer from cardiovascular disease, causing a serious economic burden. The cost is estimated to $22.2 billion per year, which constitutes the highest direct healthcare costs.

The team will be applying their expertise in how genes infl uence drug effi cacy and toxicity to provide guidance to health professionals in the selection and dosing of a specifi c drug. This will improve patient care, reduce harmful side effects and lower health care costs by reducing the use of ineffective drugs and unnecessary spending by healthcare payers.

Enhanced CARE for RARE genetic diseases in Canada

Gene mutations cause not only well-recognized rare diseases such as muscular dystrophy and cystic fi brosis, but also thousands of other rare disorders. While individually rare, these disorders are collectively common, affecting one to three percent of the population. It is estimated that as many as half of Canadians with rare disorders are undiagnosed. The team will use powerful new gene sequencing technologies to identify the genes implicated in many of these rare diseases.

Besides providing important new understanding into human disease, this project will yield other benefi ts, including: avoiding invasive procedures, stopping ineffective treatments, developing earlier and better diagnoses, devising more appropriate treatment, and predicting the chances that one of these rare diseases could be passed on to offspring.

Once the disease-causing genes have been identifi ed, researchers will test drugs that are currently on the market to identify those that might be effective against these rare diseases.

Autism spectrum disorders: genomes to outcomes

Genome Canada and CIHR-funded research has already led to some exciting breakthroughs in our understanding of autism spectrum disorder, a complex condition that affects normal brain development, social relationships, communication and behaviour. Among these breakthroughs is the identifi cation of specifi c DNA anomalies associated with the illness. The team is going to the next level, aiming to identify the remaining genetic risk factors.

This ground-breaking work will mark Canada’s contribution to an ambitious international initiative that aims to sequence and analyze the genomes of 10,000 people with autism spectrum disorder. With a more complete understanding of the genetic elements of autism, doctors will be able to make earlier diagnoses, provide better, more personalized care to patients and reduce the enormous cost autism imposes on our health care system.

Early detection of patients at high risk of esophageal adenocarcinoma

Chronic heartburn can damage the lining of the esophagus, leading to a condition known as “Barrett’s esophagus”. Patients with Barrett’s esophagus have a much higher chance of developing cancer of the esophagus.

Until recently, the only way to diagnose Barrett’s esophagus was through endoscopy – an uncomfortable and time-consuming procedure. However, a swallowable sponge under development in the United Kingdom allows for quick and painless diagnosis of Barrett’s esophagus in a doctor’s offi ce. The team aims to supplement this test with genomic technologies, allowing doctors to follow patients over time to identify and treat those progressing to cancer. Early detection, treatment

and even prevention of these cancers could save the healthcare system over $300 million a year.

The microbiota at the intestinal mucosa-immune interface: A gateway for personalized health

Infl ammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis, are incurable debilitating lifelong diseases that can affect children. Early detection is critical to avoiding complications and improving their quality of life. At the moment, however, there is no single test to determine the presence or type of IBD and the tests that exist are very uncomfortable for children.

The team is developing a simple, non-invasive approach to detecting IBD that will also be more cost effective. Using cutting-edge technology, the scientists will examine intestinal bacteria to develop better ways of identifying IBD and determining its severity. This work could also lead to new treatment, enhancing the quality of life for children everywhere.

PACE-‘Omics: Personalized, Accessible, Cost-Effective applications of ‘Omics technologies

Personalized medicine should allow doctors to tailor treatment to patients’ biological characteristics. This should mean better treatments with fewer adverse reactions to drugs and other therapies, which could make for a much more effi cient and cost-effective healthcare system. However, current processes for developing and licensing medical technologies are a threat to the realisation of this potential.

The project will give policymakers and investors the tools they need to make the right investment decisions on technology development, regulatory pathways, cost-effectiveness and benefi t to the Canadian health system. The project will develop approaches to properly refl ect the views and values of Canadians in making decisions for introducing personalized medicine into cash-strapped healthcare systems. Bringing together experts in health economics, health policy, regulation, commerce, law and ethics, they will provide practical decision-making tools and completed analyses that will lead to informed policy-making. At the same time, by helping to establish the “ground rules” for the development of personalized medicine, the project will make Canada a less risky and more attractive base for developers, thereby supporting economic development in the Canadian life sciences industries.

Personalized treatment of lymphoid cancer: British Columbia as model province

Thanks to new research, scientists can now decode the genetic instructions in both normal and malignant cells. Armed with this information, doctors will soon be able to select the best cancer treatment for each individual. Lymphoid cancers are special because even when they have spread widely in the body they can still be cured. Recent research has shown that genomic sequencing can recognize special lymphoid cancers that are often not cured today but which could be treated more effectively using personally designed treatments.

The research team will apply genetic sequencing to lymphoid cancers – the fourth most common type of cancer. This research could increase the cure rate of several lymphoid cancers by 20 per cent – this means more than forty lives saved annually in BC and upwards of $2.5 million savings to the healthcare system in that province alone, and immeasurable dollars recovered from the ripple-effect of disease impacts such as lost work days and family suffering. This research will use BC as a pilot project to show how to use genomic analysis to cost-effectively cure more cancer patients in a

way that can readily be duplicated elsewhere around the world.

Viral and human genetic predictors of response to HIV therapies

The HIV drug “cocktail” has transformed AIDS from a fatal disease to a manageable condition. Unfortunately, HIV can become resistant to these drugs, leading to the development of fullblown AIDS in the patient and increasing the chances of further transmission of the virus.

The research team will develop a test for drug resistance personalized to an individual’s DNA and the DNA of the virus. Lifetime drug costs for HIV are between $250,000 and $500,000 but there are numerous multipliers of the economic impact of an HIV infection. Nations with high HIV-infection rates see the signifi cance of those impacts on GDP to a point of unsustainability.

The project is also developing real-time surveillance systems for monitoring drug resistance to provide an early warning of geographic or population “hotspots” where resistance rates are highest and the risk of transmission greatest.

Reducing stroke burden with hospital-ready biomarker test for rapid TIA triage

Every year, 50,000 Canadians have a stroke, making it the leading cause of disability in the country. However, an equal number of people suffer what are called transient ischemic attacks, or TIAs, which, while less serious, can lead to strokes. The problem is that many conditions, including migraines, can present as TIAs, leading to expensive neuroimaging testing. What’s needed is a quick, inexpensive test that would differentiate TIAs from other conditions.

The team is developing just such a test, which will provide results within an hour or so, for a fraction of the cost of imaging. With the results of this test, doctors will know whether to keep patients for further care or send them home. This will reduce unneeded imaging risks and costs as well as prevent TIAs from progressing to a full stroke. Averting just 4,000 strokes would save $210 million per year in direct health care costs. The Heart and Stroke Foundation of Canada will work to ensure that physicians, allied healthcare providers, the public and other stakeholders are aware of the outcomes and clinical impacts of this project.

Clinical implementation and outcomes evaluation of blood-based biomarkers for COPD management

Chronic Obstructive Pulmonary Disease (COPD) damages the airways inside of our lungs, making it diffi cult to breathe. Patients suffer “lung attacks”, characterized by coughing, breathlessness and a dramatic increase in sputum.

If caught early enough – or better yet, prevented – these lung attacks can be effectively treated with medication. Unfortunately, many of the symptoms of lung attacks can resemble pneumonia, heart attacks or even the fl u. Lung attacks reduce patient quality of life and cost the Canadian health care system nearly $4 billion dollars each year in direct and indirect costs.

The team will develop new blood tests that will identify patients at high risk for lung attacks as well as differentiate these attacks from other conditions.

This means lung attacks can be prevented or treated earlier than was previously possible. Ultimately, patients who need preventative drugs will receive them, resulting in fewer attacks, as well as reduced hospitalization and emergency visits. At the same time, patients at low risk of an attack will be able to avoid unnecessary drugs and their potential side effects

Continued from page 19Successful genome projects



t sounds like something out of science fi ction, but it’s al-ready taking place in hospitals and clinics around the world.

Researchers have cracked the human DNA code through genome sequencing, allowing them to map the body’s genetic, molecular and cellular makeup, and then design a care plan specifi cally for the pa-tient’s DNA blueprint. This is personalized medicine: diagnostics and treatment based on each individual’s genetic traits.

“The innovations behind personalized medicine are potentially disruptive tech-nologies that are going to have a signifi -cant impact in a number of ways,” says Dr. Brian Hodges, executive vice president of education at University Health Network (UHN) in Toronto.

And as the fi eld of personalized medi-cine continues to evolve – and it is evolv-ing rapidly – health care leaders must address an urgent challenge: how can they ensure the health system and the people in it are well prepared for this medical revolution?

“We have to build into our system the ability to do things like rapid genetic test-ing, which is moving out of a boutique re-search lab function into a standard part of our clinical operation,” says Dr. Hodges.

“That creates a whole new job category in the health care system, and it also has a downstream effect because it changes what every other health care professional is doing.”

Thankfully, health care organizations have plans in place to anticipate these changes. In a ground-breaking move that will get Ontario’s health professions ahead of personalized medicine, UHN integrated with The Michener Institute – A 55-year-old Toronto school that trains future ap-plied health sciences professionals such as radiological and medical imaging technol-ogists, radiation and respiratory therapists and anaesthesia assistants.

Michener is known for its unique rapid-response curriculum design, which allows its programs to stay current in the evolving fi eld of health care. It recently redesigned the curriculum for its nuclear medicine and molecular imaging technology pro-gram – which it runs jointly with the Uni-versity of Toronto – to refl ect the changing practices and technology in the fi eld.

Michener is able to develop curricula very quickly based on research and clinical practice, including continuing education curricula for working health care profes-sionals. The integration with UHN has created a sweet spot where research, clini-cal practice and education come together.

Prescribing personalized careThis is good news for students like

Amanda Betts, a genetics technology student at Michener who is training in a fi eld that is particularly devoted to personalized medicine.

When a man with symptoms of leuke-mia came to the hospital where Amanda was doing her clinical placement, Amanda did what she had been trained to do in school: run genetic tests to help doctors determine the most appropriate treatment.

“Under the microscope we were able to look at the specifi c chromosome arrange-ment between bone marrow cells, and nar-row down the patient’s condition to a spe-cifi c type of leukemia,” recalls Ms. Betts, who did her clinical placement last year at Eastern Health hospital in St. John’s, NL, as part of her studies in Michener’s genet-ics technology program.

“The results of the tests helped the doc-tors prescribe a treatment designed for this type of cancer.”

The use of genetics technology in can-cer diagnosis and treatment design is part of a broader advance towards personalized medicine. As researchers and health care practitioners continue to gain DNA-deep insight into the workings of the human body, that knowledge is opening up oppor-tunities to tailor treatment plans to each patient’s specifi c condition and, in some cases, specifi c ability to respond to therapy.

Personalized medicine promises to transform treatment planning for a myriad of conditions and diseases. It can help de-termine how a particular kind of cancer will respond to radiation versus chemo-therapy, whether an organ donation will meet transplant requirements and even how individuals will respond to particular treatments for depression.

As she prepares to write her exam for clinical certifi cation, Amanda Betts looks forward to applying all she has learned about personalized medicine at Michen-er. But she knows what she’s learning in laboratories and classrooms today is but a glimpse of what personalized medicine will look like in the future.

“It’s a rapidly developing fi eld, and what’s being taught at Michener chang-es every year because there’s so much

research going into genetics,” she says. “I’m really excited to see how this evolves further in the future.” ■H

Stefany Asimakis is a Communications Associate at The Michener Institute of Education at UHN.

Preparing for the future of medicineBy Stefany Asimakis

I

Personalized medicine promises to transform treatment planning for a myriad of conditions and diseases.

Genetics technology student Amanda Betts loads a tray for BRCA1 gene sequencing samples onto the genetic analyzer at Michener. BRCA1 mutations are implicated in cases of familial breast cancer.

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22 26APRI

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APRI

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• Commitment• Dedication• Excellence• Compassion

ill 119, the Health Informa-tion Protection Act, 2015, was “carried on division” at second reading before the Legislative

Assembly on February 18, 2016, and is being considered by the Standing Com-mittee on Justice Policy. If passed at third reading and proclaimed, it will repeal and replace the Quality of Care Information Protection Act, 2004 (QCIPA 2004) with the Quality of Care Information Protec-tion Act, 2015 (QCIPA 2015).

QCIPA 2015 refl ects the Ontario gov-ernment’s response to the Recommenda-tions of the QCIPA Review Committee dated December 23, 2014. The Commit-tee was asked by the Health Minister to review current practice in the interpreta-tion and implementation of QCIPA 2004 and its intersection with other related legislation, and to make recommendations for improvement, if needed. As set out in the Executive Summary of the Recom-mendations, many individuals and organi-zations have raised concerns that QCIPA 2004 is being used to prevent patients and families from being fully informed about what went wrong in a particular critical incident and what will be done to improve care in the future. There are also concerns

that QCIPA 2004 has inhibited the shar-ing of information about critical incidents among institutions in Ontario.

In the course of the Committee’s “de-liberative dialogue” with patients and families who had experience with critical incidents, six principles that should guide the investigation of critical incidents were adopted by the Committee as the princi-ples underlying the report, including that:

• Critical incident investigations should assume good intentions from all parties,

• Critical incident investigations should be patient inclusive,

• Critical incident investigations should be transparent,

• Staff need to communicate effectively with patients and families before, during and after critical incident investigations,

• Critical incident investigations should entail an obligation to share lessons, and

• Critical incident investigations should be consistent and predictable.On the basis of these principles, the

Committee made twelve recommenda-tions, all of which the Ontario govern-ment has committed to implementing through Bill 119. Because the implemen-tation of these changes represents a fun-damental overhaul of QCIPA 2004, the government has elected to replace QCI-PA 2004 altogether. At the beginning of QCIPA 2015, for example, there is a lengthy preamble that is absent from QCIPA 2004 which sets out similar prin-ciples, including that “[t]he people of On-tario and their Government: … Believe that quality health care and patient safety is best achieved in a manner that supports openness and transparency patients and their authorized representatives regarding patient health care.” In implementing the guiding principles the new provisions of QCIPA 2015 include noteworthy amendments to defi nitions, including:

• Introduction of a defi nition of “critical incident” that means “any unintended event that occurs when a patient re-ceives health care from a health facility that, (a) results in death, or serious dis-ability, injury or harm to the patient, and (b) does not result primarily from the patient’s underlying medical condition or from a known risk inherent in pro-viding the health care.” The defi nition \is intended to prevent over-application of QCIPA 2015 to less serious incidents, such as “near misses” that do not result in harm to any patient,

• A redefi nition of “health facility” to include a “prescribed entity that pro-vides health care,” which could allow the Health Minister to prescribe virtu-ally any public or private health facility as being subject to QCIPA 2015 (e.g., Out-of-Hospital Premises, long-term care homes, private clinics, etc.),

• A redefi nition of “quality of care com-mittee” to include a prescribed “quality oversight entity” that performs “qual-ity of care functions,” and which might oversee not only health facilities but also health care providers or classes of health facilities or providers, and

Potential impact of the new Quality of Care Information Protection ActBy Michael Watts and David Solomon

B

Many have raised concerns that QCIPA 2004 is being used to prevent patients and families from being fully informed about what went wrong in a particular critical incident




Look around you. Have you been inspired, encouraged or

empowered by an employee or a colleague? Have you or your loved

one been touched by the care and compassion of an outstanding

nurse? Do you know a nurse who has gone above and beyond the

call of duty? Now is your chance to acknowledge and recognize the

nursing heroes in your facility or community.

Hospital News will once again salute nursing heroes through our

annual National Nursing Week (May 9th to 15th) contest. We hope

you will share your stories with us so that we can highlight the

exceptional work that our nurses are doing and how they touch our

lives.

Nominations can be submitted by patients or patients’ family

members, colleagues or managers. Please submit by April 15th and

make sure that your entry contains the following information:

Along with having their story published, the winner will also take home:

www.HospitalNews.com

All nominations will receive a confi rmation of receipt from the Editor. Until you receive confi rmation that your nomination has been received, your nomination has not been entered into the contest. If you do not receive confi rmation within 24 hours of emailing your nomination, please follow up at [email protected] or by telephone 905 532 2600 x2234.

Hospital News’ 11th Annual Nursing Hero Awards

NOMINATE A

NURSING

HEROAWARDS!

11th Annual

Please email submissions to [email protected]

or mail to: Hospital News, 610 Applewood Crescent, Suite 401, Vaughan, ON, L4K 0E3

1ST PRIZE:$1,000 Cash Prize

2ND PRIZE:$500 Cash Prize

3RD PRIZE:$300 Cash Prize

• Full name of the nurse • Facility where he/she worked at the time • Your contact information • Your nursing hero story

COMMITMENT

DEDICATION

COMPASSION

LEADERSHIP

NURSING HERO!


24 Ethics

n my previous column I high-lighted – as one of the major ethical challenges associated with implementing assisted

death – whether patients should be able to request assisted death through an ad-vance directive. I wanted to continue the discussion this month for two reasons: 1) I received emails from a few readers chal-lenging the language I had used in the column; and 2) Since that column was published the Parliamentary Report of the Special Joint Committee on Physician-As-sisted Dying was tabled, which provided a recommendation specifi cally addressing that issue.

Some readers were concerned that my use of the phrase “advance directives” was legally inaccurate and risked giving people the false impression that wishes expressed in advance function as literal directives that directly impact the deci-sions made by health care providers. The fi rst point is correct – we don’t technically have advance directives in Ontario. The Health Care Consent Act doesn’t use that terminology at all. What we have is a leg-islative scheme that enables people to ex-press wishes about treatment in advance, either in writing or verbally. I was merely using the phrase “advance directives” as a short-hand for this mechanism because it is a widely used and familiar phrase to readers.

With respect to the second point, under Ontario law wishes expressed in advance don’t function as literal directives. They

function as evidence of a patient’s wishes related to medical care, which must be followed by the substitute decision maker – the person legally authorized to provide consent on behalf of a patient who is men-tally incapable of doing so. Health care providers in Ontario are not authorized to act on previously expressed wishes, ex-cept under certain unique circumstances. They are obligated to seek consent from the substitute decision maker, who in turn is obligated to follow those previously ex-pressed wishes (assuming they are appli-cable to the current circumstances).

Turning to the issue of advance re-quests for assisted death, the Parliamen-tary Special Joint Committee took the controversial step of recommending the use of advance requests for assisted death (or “medical assistance in dying” as the committee called it) but only after some-one has been diagnosed with a condition that will, at some point in the future, meet the eligibility criteria. This recommenda-tion is particularly relevant to people di-

agnosed with conditions that will cause them to lose their mental capacity over time, so that they are no longer mentally capable of consenting to assisted death late in the illness. Alzheimer’s dementia is a prime example of such an illness. It is a devastating illness that begins with memory loss but causes progressive de-terioration in all brain functions, includ-ing mobility, awareness of and interaction with the outside world, and basic activi-ties of daily living.

Advance requests for assisted death in the case of Alzheimer’s dementia is highly challenging largely because of the diffi cul-ty of assessing suffering late in the illness. Someone with end-stage dementia doesn’t have the capacity to tell us, “I’m suffering and I don’t want to live like this anymore.” Making an advance request for assisted death would require being able to set out in advance clear conditions upon which assisted death should be provided, based on the assumption that the person now thinks their suffering will be intolerable when those conditions are met at a future stage in the illness. Honouring advance requests in this context would require in-tentionally putting to death someone who not only is unable to communicate about their suffering, but also likely doesn’t have the cognitive awareness to realize they are being put to death. ■H

Jonathan Breslin PhD, is an Ethicist for Southlake Regional Health Centre and Mackenzie Health.

Advance requests for assisted deathBy Jonathan Breslin, PhD

I

Advance requests for assisted death in the case of Alzheimer’s dementia is highly challenging largely because of the diffi culty of assessing suffering late in the illness.

• A redefi nition of “quality of care infor-mation” that reinforces protections over “discussions and deliberations of a qual-ity of care committee,” while carving out information that should be disclosed re-lating to the facts of a critical incident, causes identifi ed by a quality of care committee, consequences of the critical incident for the patient, and any actions taken or recommended, including any systemic steps to avoid or reduce the risk of future similar incidents.QCIPA 2015 also provides for the dis-

closure of quality of care information among committees of different facilities for the purposes of carrying out common qual-ity of care functions and making systemic improvements to quality of care across the province. Finally, QCIPA 2015 confi rms that nothing in it interferes with existing legal requirements for health facilities to interview patients and their authorized representatives after a critical incident, and disclose information relating to criti-cal incidents to patients and their autho-rized representatives as required by law. Accordingly, hospitals and other health in-stitutions should review and update their quality of care committee charters and related critical incident policies in response to QCIPA 2015 if and when it becomes law. ■H

Michael Watts is a Partner and David Solomon is an Associate in the Toronto offi ce of law fi rm Osler, Hoskin & Harcourt LLP.

Continued from page 22

Quality of Care Information Protection Act


25 Healthcare Technology

Educational & Industry Events

To list your event, send information to “[email protected]”.

We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “[email protected]”

To see even more healthcare industry events, please visit our website

www.hospitalnews.com/events

April 2, 2016 Review of Health Assessment Across the Lifespan Toronto, Ontario Website: www.bloomberg.nursing.utoronto.ca

April 5–6, 2016 Together We Care OLTCA & ORCA Annual Convention and Trade Show Metro Toronto Convention Centre, Toronto Website: www.together-we-care.com

April 15-17, 2016 Managing Urgent / Emergent Clinical Problems in Adults: A Course for Nurse Practitioners Toronto, Ontario Website: www.bloomberg.nursing.utoronto.ca

April 16–19, 2016 The Canadian Conference on Medical Education Fairmont The Queen Elizabeth, Montreal Website: www.mededconference.ca

April 17–19, 2016 Putting the Pieces Together – Collaborating for Quality Hospice Palliative Care in Ontario The Sheraton Parkway and Convention Centre, Richmond Hill Website: www.hpco.ca

April 26–27, 2016 2016 Medec Medtech Conference Sheraton Toronto Airport Hotel & Conference Centre Website: www.medec.org

April 28–29, 2016 Institute on Advancing Chronic Pain Assessment and Management Toronto, Ontario Website: www.bloomberg.nursing.utoronto.ca

May 9–12, 2016 2016 CAHSPR Conference – Hilton Toronto, Ontario Website: www.cahspr.ca

June 5–8, 2016 eHealth Conference Vancouver, BC Website: www.e-healthconference.com

June 5–7, 2016 Annual OACCAC Conference Westin Harbour Castle Hotel, Toronto Website: www.oaccac.com

June 6–7, 2016 National Health Leadership Conference Westin Ottawa, Ottawa Website: www.nhlc-cnls.ca

July 7-8, 2016 eLearning Alliance of Canadian Hospitals Toronto, Ontario Website: www.eachconference.ca

October 16, 2016 Sustainable Compassion Training Workshop Emmanuel College, University of Toronto Website: https://bit.ly/ECABSI

n 2013-14, almost 7 million patients spent at least one night in an Ontario hospital. If you add hospital emergency

departments (ED) visits, (approximately 6 million), the total is approximately 13 million visits to hospital in-patient units or EDs annually. Imagine how much paper is generated (e.g., discharge summaries) by hospitals for these visits. To get an idea of how much paper this represents yearly, 13 million reports would stack up to about 4 times the height of the CN Tower and is a signifi cant cost in paper, ink and, in some cases, postage, for hospitals to send the reports to community-based primary care providers. Wouldn’t it be great to elimi-nate this paper? There is an electronic solution – OntarioMD’s Hospital Report Manager (HRM).

HRM is an innovative application that converts reports from the Hospital Infor-mation System (HIS) into a format that is understood by a primary care provider’s certifi ed EMR. HRM is available from On-tarioMD.

OntarioMD is a subsidiary of the On-tario Medical Association. It provides community-based physicians with infor-mation technology (IT) services that en-hance patient care. Central to the use of these services is the electronic medical re-cord (EMR), which makes it easier for pri-mary care providers to deliver preventive care, monitor patients, and improve care quality. OntarioMD’s mandate and fund-ing come from the Ministry of Health and Long-Term Care.

HRM started as a pilot project in 2010 with fi ve hospitals (Collingwood Gen-eral and Marine, Georgian Bay General, Headwaters Healthcare Centre, Markham Stouffville and Royal Victoria Regional Healthcare Centre) and 170 physicians. The pilot confi rmed the benefi ts of trans-mitting text-based medical record and diagnostic narrative reports to primary care EMRs via HRM. The benefi ts for hospitals were:• A reduction in readmissions• Administrative and operational savings

from reducing printing, fi ling, mailing• Secure delivery over than paper reports• One interface to HRM instead of mul-

tiple interfaces to many EMRs• Audit records showing when reports

were retrieved by the EMR• Strengthened privacy and security of

patient information through audit trailsThe pilot also highlighted benefi ts for primary care providers and patients:• Improved continuity of care from hos-

pitals to the community where follow up with patients can now occur more quickly

• A more complete picture of the patient’s health for more informed deci-sion making

• Administrative and operational savings from reducing printing, fi ling, scanning

The success of the HRM pilot led to expansion to all Ontario hospitals and to some specialty clinics (e.g., radiology and cardiology clinics). To date, 142 hospitals and independent sending facilities are us-ing HRM and have sent over 5 million reports to nearly 5,000 community phy-sicians and nurse practitioners across the province. That’s a lot of savings in time and paper. For a complete list of hospitals on HRM, please visit OntarioMD.ca.

HRM supports Health Links, an initia-tive to provide more coordinated care for complex needs patients in 69 communi-ties across Ontario. With its ability to send many types of patient reports, from every hospital connected to it, HRM helps realize the Health Links objective of bet-ter coordinated and effective care in the patient’s community and even when they receive care outside their community.

Hospitals appreciate the simplicity and fl exibility of HRM. They are working with OntarioMD to send near real-time mes-sages from the HIS to primary care EMRs, known as eNotifi cations. eNotifi cations inform primary care providers, through messages sent to the EMR, whenever a patient has been discharged from the ED and admitted to, or discharged from an in-patient unit. They include a Health Links patient identifi er and the patient’s Community Care Access Centre. eNoti-fi cations have added to HRM’s ability to send patient information to primary care providers quickly for follow-up with pa-tients within the recommended seven-day guideline, which is considered critical for preventing avoidable hospital readmis-sions. Currently, about 1,500 physicians and nurse practitioners are also receiving eNotifi cations.

If your Ontario hospital has not yet connected to HRM, contact Ontari-oMD at [email protected] for more information or to get the very straightforward process started. The On-tarioMD HRM team can present your IT team with the requirements and provide you with an HRM agreement. Eliminate the paper reports you send to primary care providers and go electronic with HRM. Your hospital, primary care providers and patients will be glad you did. ■H

Kathy Tudor is the Director, Communications & Marketing at OntarioMD.

Hospital Report Manager:

By Kathy Tudor

I

HRM is an innovative application that converts reports from the Hospital Information System (HIS) into a format that is understood by a primary care provider’s certifi ed EMR.

A win-win solution for hospitals, primary care and patients



Denise Hodgson – Advertising [email protected]

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— Reporting on Canada’s Health Care News & Best Practices for over 25 years

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• How telehomecare makes a world of difference• Long term care planning• Crisis placement into long-term care• Caring for someone with dementia

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hey’re calling it ‘the stetho-scope of the future’. A por-table technology called point-of-care ultrasound is

helping doctors at The Hospital for Sick Children (SickKids) provide better and more efficient bedside care in the emer-gency department, and it’s having a huge impact.

Point-of-care ultrasound is used in about 25 to 30 per cent of the cases com-ing through SickKids’ emergency depart-ment. “Since using ultrasound at the bedside, I find I’m using my stethoscope less. We’re identifying medical issues more efficiently and accurately which is essentially leading to better decision-making, better care for our patients, and even a reduction in ED wait times for some patients,” says Dr. Mark Tessaro, Staff Physician in Paediatric Emergency Medicine and Research Lead in the PO-CUS Program at SickKids.

Ultrasound is a safe and radiation-free medical device that uses sound waves to produce images of what’s going on inside the body. It was first used in obstetrics in the 1950s and since then its use has expanded to include a number of diag-nostic and therapeutic applications.

The Paediatric Emergency Medicine point-of-care ultrasound program was launched at SickKids in 2011. The goal was to improve the care of injured and ill children through a new application of this reliable and well-established tool. SickKids is Canada’s only training centre for paedi-atric point-of-care ultrasound and in fi ve years, 10 fellows have been trained and have subsequently brought their expertise and experience to other hospitals across the country and internationally.

The applications for point-of-care ul-trasound in the ED are far reaching. It enables doctors to detect internal bleed-ing, cardiac, and/or intestinal problems, it can uncover foreign bodies, an abscess that needs to be drained, a twisted teste or ovary, and even retinal detachment in the eye, which is very challenging to identify in children. It also helps with procedures like inserting an airway tube, or deliver-ing an anaesthetic injection (nerve block) for example.

“There is no doubt in my mind that point-of-care ultrasound has improved the care I provide my patients. Before I began using it, I would order more tests, which later proved to be unnecessary, and spend more time doing physical exams in

efforts to fi gure out the root problem,” says Dr. Charisse Kwan, Staff Physician in Pae-diatric Emergency Medicine and Educa-tion Lead in the point-of-care ultrasound program at SickKids. “Point-of-care ultra-sound does not replace the physical exams but in some ways gives us ‘magic fi ngers’ that enhance the physical exams and help to confi rm diagnoses much faster than before.”

In mid-December, after several days of illness and an outpatient chest X-ray that suggested pneumonia, Hannah Diamond,

12, was rushed to SickKids’ emergency de-partment when her fever spiked to 40 C, her lips suddenly turned blue, and she be-gan shaking and shivering.

Dr. Tessaro was working that evening, and within fi ve minutes of Hannah’s ar-rival at SickKids’ emergency department, Dr. Tessaro told Hannah and her mom, Sari, that he’d like to do an ultrasound at the bedside to get a better picture of any potential complications that could have caused Hannah’s sudden distress.

Point-of-care ultrasound leads to more effi cient and accurate diagnoses in emergency

By Caitlin Johannesson

T

Portable technology improves patient care, leads to better decision making and is expected to reduce wait times


Hannah Diamond benefi tted from the point-of-care ultrasound.



anadians are among the most digitally connected in the world. Combined with our geographic spread, this digi-

tal presence makes Canadians ideal users of remote patient monitoring, which is already being used by thousands of Cana-dians. The latest trend in remote care is mobile app technology, with over 100,000 healthcare apps already at the disposal of patients, caregivers, and clinicians. One of the latest apps is the world’s fi rst app-based remote monitoring system for pacemakers, launched in Canada in February 2016. For the fi rst time in Canada, patients with select pacemakers can use their smart-phones to transmit their pacemaker data to their clinic, rather than relying on dedi-cated technology provided by the pace-maker company.

Remote patient monitoring provides signifi cant benefi ts to patients who are able to reduce the number of trips they have to make to a clinic, while still being able to perform a check-up. In June 2014, a study commissioned by Canada Health Infoway cited several other benefi ts of re-mote patient monitoring, including fewer hospital readmissions and emergency room visits, better health outcomes, and im-proved quality of life for patients. It also noted that remote patient monitoring had been growing at a rate of 15 to 20 per cent annually.

In 2015, comScore estimated that over 62 per cent of Canadian phone owners 55 years and older owned a smartphone and over 1.5 million Canadians used mobile devices exclusively to access the internet. The ease and simplicity of using an app on a mobile device provides a platform that can be used by patients of any age, from children to seniors.

The same platform is also versatile enough to allow monitoring and reporting from virtually anywhere in the world, and/or enable transmission to a family mem-ber or care provider to ensure patients are keeping to their reporting timelines. One such example is Earl Bakken, 92, who lives in Hawaii and uses his smartphone to send his pacemaker transmissions from the comfort of his home. If the name sounds familiar, it’s because Bakken developed the fi rst external, battery-operated, transistor-ized, wearable artifi cial pacemaker in 1957 and is the founder of Medtronic, one of the largest medical technology companies in the world. He now benefi ts from the technology he helped create.

Since the introduction of the pacemaker fi ve decades ago, it has the distinction of being among the fi rst medical devices to enable data transmission over analog tele-phone lines, as a means to reduce the num-ber of visits to a clinic for routine checks.

That being said, early iterations were cumbersome and information gathered was rudimentary (mainly battery status). Just over a decade ago, second genera-tion devices were introduced that took reporting to full device checks, includ-ing battery status, historical data and diagnostic information.

Monitoring required a dedicated instru-ment that needed to be connected to a standard analog telephone line. A wand would have to be passed over the device to take and transmit readings. Given pacemaker patients are generally older, the process was often too cumbersome, leading to double or triple transmissions or omissions. Another limitation was that these systems could only be used within continental North America, restricting travel options.

The shift to smartphones and tablets, combined with near-ubiquitous access to Wi-Fi or cellular services has altered the landscape considerably. Not only is the technology familiar to most patients and/or their family members, monitoring and reporting to clinicians can be conducted from anywhere in the world where there is access to an internet connection. Mon-itoring can also be set up in such a way that family members and caregivers can be automatically notifi ed if a transmission is scheduled to be done or has taken place.

Patients also have the option of which service providers and platform they wish to use. The MyCareLink Smart™ Monitor for Medtronic implantable pacemakers, for example, allows patients to use their own Apple® or Android™ smartphone or tablet to transmit data to their physi-cian or other caregiver over Wi-Fi or cel-lular signal, through the service provider of their choosing. Users simply download the free app to their smartphone or tablet, place the reader over the heart device and follow the instructions on the screen.

Having a simple, fl exible and portable option for patients plays an integral role in ensuring the sustainability of remote patient monitoring. As the population of patients requiring remote monitor-ing grows, it is essential that technology keeps pace with solutions that encourage patient acceptance and engagement. We have seen signifi cant strides in the area

of app-based solutions on all fronts – a factor that bodes well for remote patient monitoring’s future. ■H

Kathy Schreiber is the Marketing Manager of Cardiac Diagnostics and Monitoring at Medtronic Canada. A former Registered Nurse, Kathy is passionate about healthcare technologies that allow patients and healthcare providers to receive and deliver care virtually, improving access to clinical expertise irrespective of where one lives.

Almost immediately, Tessaro was able to rule out serious complications like fl uid on the lungs, and he and the Diamond family had their answer – it was a straightforward bacterial pneumonia.

“Having a clear picture of what we were dealing with meant I didn’t need to order the usual chest X-ray, avoiding unneces-sary radiation exposure for Hannah,” says Tessaro, who quickly prescribed Hannah IV antibiotics and acetaminophen.

Within 90 minutes, Hannah was back on her smartphone, texting friends about her adventure in the Emergency Depart-ment and posting photos and updates to Snapchat. About two hours later, she was discharged, and the next morning, Han-nah woke up fever free for the fi rst time in a week.

The emergency team has multiple ex-amples of how the use of point-of-care ul-trasound in the emergency department is improving care and has even led to quick detection of rare congenital diseases, heart conditions, and cancers that likely would have taken many emergency and specialist visits before a diagnosis was uncovered.

“As ED doctors we have a responsibility to assess patients quickly and detect prob-lems accurately, in all areas of the body. Point-of-care ultrasound is helping us do that better,” says Tessaro.

The goal is to have virtually all SickKids staff emergency medicine physicians fully trained to use point-of-care ultrasound. Currently fi ve are fully trained.

Drs. Tessaro and Kwan are Assistant Professors in the Department of Paediat-rics at the University of Toronto. ■H

Caitlin Johannesson is a Senior Communications Specialist at The Hospital for Sick Children.

Are you a Registered Nurse?ONA Wants You!Empower yourself by empowering others: Come join the Ontario Nurses’ Association’s growing team!

www.ona.org/careers.htmlvisit us at

Since using ultrasound at the bedside, I fi nd I’m using my stethoscope less. We’re identifying medical issues more effi ciently and accurately which is essentially leading to better decision-making, better care for our patients, and even a reduction in ED wait times for some patients.

Continued from page 26

CareersDEADLINE FOR MAY 2016 ISSUE:

APRIL 21, 2016

VIEW CAREER ADS AT: www.hospitalnews.com

Patients use their Smartphones to transmit pacemaker dataBy Kathy Schreiber

C

Pacemaker inventor and Medtronic founder, Earl Bakken, transmits his own pacemaker data through a smartphone app.

Dr. Mark Tessaro and Dr. Charisse Kwan use the point-of-care ultrasound in the SickKids’ emergency department.

Point-of-care ultrasound

Remote patient monitoring is already being used by thousands of Canadians.



It takes a lot to be a Registered Nurse.

An intensive medical education.

Long hours gaining experience and

developing specialized skills. And a

lifetime of dedication, awareness

and compassion. That’s not only our

profession, it’s our calling.

nursesknow.ona.org

For the love of healing.

hospital news 2016 april edition

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