INSIDE:

CPOE across PEIBefore implementing CPOE at all ofits hospitals, the province of PEIdid extensive planning, particularlyin the area of order sets. Page 4

Innovation powerhouseIn recent years, Sunnybrook HealthSciences, in Toronto, has built ex-tensive laboratories capable of tak-ing ideas from concept to proto-type. The facilities include a GMP

room that’s ultra clean and canproduce devices that can be safelyinserted into the body.Page 6

Danielle Martin’s viewsHigh-profile physician executiveDanielle Martin, who has battledpoliticians in the US Senate, re-cently spoke about Canadian med-ical care and technology at aToronto event.Page 8

Robots rule?Thanks to the rapid rate of techno-logical progress, some experts be-lieve that robots will be able to

conduct surgeries as well as hu-mans. Three Canadian leaders inthe field of surgical robotics de-bated this possibility, and what itmeans for physicians and patients,at the recent OCE Discovery con-ference, in Toronto.Page 5

BY JERRY ZEIDENBERG

Hamilton Health Sciences hasgone live with a system that au-tomatically feeds data from over400 vital sign monitors into the

electronic medical records of patients.HHS, which comprises seven hospitals

and over 1,100 beds, plans to soon add an-other 200 monitors to the system.

The hospital corporation created the in-tegrated system in less than three months byusing a software solution from Iatric Sys-tems, of Boxford, Mass. It went live in Janu-ary of this year.

Mark Farrow, vice president and CIO atHHS, explained that the Iatric system is atechnological platform that’s capable of in-tegrating any type of device with the hospi-tal’s electronic health records, including

smart pumps and ventilators, both wiredand wireless.

The plan at HHS is to use the Iatric Sys-tems platform to tie together many types ofdevices, so they feed data directly into theelectronic records of patients.

“Whenever you can re-use a platform forother purposes, you’re ahead,” noting that fi-

nancial pressures are forcing all hospitals towork smarter and to seek more bang for thebuck when installing new systems.

The vital sign monitors that were recentlyintegrated are located in the hospitals’ ICUs,CCUs and Neonatal Unit. Among other ben-

efits, it means that nurses in these units nolonger need to spend time scribbling notesonto scraps of paper and transcribing theminto computer workstations.

Moreover, the flow of data between devicesand the Meditech EHR system is two-way,with ADT data being pushed to the devices.

That reduces the need for clinicians toenter patient data into the monitors at thepoint of care, saving time and reducing thechance of error.

Significantly, the investment in theIatric Systems solution has enabled a quan-tum leap in analytics usage and patientsafety at HHS.

The platform in conjunction with IatricsVisual Flowsheet, is capable of powering thehospital’s Hamilton Early Warning Score(HEWS), which uses real-time information

HHS connects vital signs monitors to its EHR

CONTINUED ON PAGE 2

A new project at the Peter Munk Cardiac Centre, in Toronto, is using two high-powered CT scanners from Toshiba as a way of speedingthe transfer of imaging innovations to patients receiving clinical care. Pictured are project leaders Dr. Narinder Paul, Dr. Barry Rubin andDr. Lawrence White, and Jens Dettmann, General Manager of Toshiba of Canada’s Medical Systems Division. SEE STORY ON PAGE 10.

Cutting-edge imaging will reach patients sooner

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FEATURE REPORT: DIRECTORY OF HEALTHCARE I.T. SUPPLIERS – PAGE 16

CANADA’S MAGAZINE FOR MANAGERS AND USERS OF INFORMATION SYSTEMS IN HEALTHCARE VOL. 20, NO. 5 JUNE/JULY 2015

SPECIAL REPORT:

IMAGINGPAGE 10

The new solution has enabled aquantum leap in analytics andpatient safety at the hospital.

from devices such as blood pressure cuffsand EMRs to predict which patients are atrisk of a medical emergency. When this oc-curs, the appropriate clinicians can bealerted, enabling them to provide care be-fore it is too late.

“You can predict, for example, a respi-ratory issue or a severe infection ahead oftime,” said Farrow, adding that the HEWSsolution makes use of predictive analytics.

“It’s not good enough to import yourdata four hours later, and to see that yourpatient is getting into trouble. And that, bythe way, the patient had a cardiac arrest or‘code blue’ which could have been pre-vented if the response team had beenalerted.”

The HEWS team has produced an algo-rithm made up of seven different vitalsigns. The system scores patients on thewards, continuously and in real-time.

“It has translated into real-world im-provements,” said Farrow. “We’ve seen areduction in code blues and unplannedICU admissions. It is now unusual to hearcode blue called at the General site.”

Jeff McGeath, senior vice president ofsoftware solutions at Iatric Systems, notedthat HHS has created a visual interface forHEWS that will allow members of the crit-ical care response team (called the RACEteam) to easily monitor the status of criti-cal care patients.

He explained that analytics have evolvedin recent times through three phases, andthat HHS is now developing solutions forthe third and most useful phase.

The first type of analytics is ‘descriptive’and consists of simple reporting, he said.The second consists of predictive analytics– systems that can forecast what is likely tohappen. And the third phase is prescrip-tive; it not only predicts but also makesrecommendations. “It’s where you’re alsoprescribing a course of action,” saidMcGeath.

Farrow noted, “That’s what we’re tryingto get to.”

The potential benefits of such systemsare enormous, as they will enable care-givers to prepare for incidents before theyoccur, and to use ‘best evidence’ databasesto take effective actions.

An additional facet of the Iatric Systems

platform is its benefit to biomedical engi-neers and clinical informatics specialists.The integration of medical monitors anddevices allows them to remotely diagnoseand repair the hundreds of devices spreadacross the seven HHS sites.

Indeed, it was the need to maintain afleet of monitors that spurred HHS to im-plement Iatric Systems in the first place.

That’s because last year, Philips Medicalannounced it would stop supporting the

vital signs integration engine used at HHSat the end of 2014. To keep its monitorscommunicating with the EHR, Farrow andhis team had to find a support solution.

They found it in the form of the IatricSystems platform, and were able to con-nect the Philips monitors to the new so-lution in less than ninety days. Next,HHS is looking to add their SpaceLabsmonitors and potentially Welch Allyn de-vices to the platform.

Other devices, such as smart pumpsand ventilators, will also be connected.“We needed a solution that was multi-ven-dor, and multi-modality,” said Farrow.“And we found it.”

Interestingly, the Iatric Systems soft-ware server solution cost only about$60,000. That investment will form thecornerstone of a system that ties togetherall medical devices in the organization andintegrates them with the hospital’s elec-tronic medical records.

It is also a key element of the HEWSdrive in analytics and patient safety.

And of course, it is enabling engineersand clinical informatics specialists to keepclose tabs on the functioning of the devicesand interfaces.

All in all, it’s performing a lot of work.As Farrow says, the ability to accomplishall of these tasks on one platform is havinga significant impact on the hospital. “It’s avery big deal,” says Farrow.

CONTINUED FROM PAGE 1

Hamilton Health Sciences ties data from vital signs monitors to EHRs

Art DirectorWalter Caniparoliart@canhealth.com

Art AssistantJoanne Jubasjoanne@canhealth.com

CirculationMarla Singermarla@canhealth.com

Publisher & EditorJerry Zeidenbergjerryz@canhealth.com

Office ManagerNeil Zeidenbergneilz@canhealth.com

Address all correspondence to Canadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9 Canada. Telephone: (905) 709-2330.Fax: (905) 709-2258. Internet: www.canhealth.com. E-mail: info2@canhealth.com. Canadian Healthcare Technology will publish eight issues in 2015. Featureschedule and advertising kits available upon request. Canadian Healthcare Technology is sent free of charge to physicians and managers in hospitals, clinicsand nursing homes. All others: $67.80 per year ($60 + $7.80 HST). Registration number 899059430 RT. ©2015 by Canadian Healthcare Technology. Thecontent of Canadian Healthcare Technology is subject to copyright. Reproduction in whole or in part without prior written permission is strictly prohibited.Send all requests for permission to Jerry Zeidenberg, Publisher. Publications Mail Agreement No. 40018238. Return undeliverable Canadian addresses toCanadian Healthcare Technology, 1118 Centre Street, Suite 207, Thornhill ON L4J 7R9. E-mail: jerryz@canhealth.com. ISSN 1486-7133.

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

Volume 20, Number 5 June/July 2015

Contributing EditorsDr. Alan Brookstonealanbrookstone@shaw.ca

Dianne Danieldianne.daniel@cogeco.ca

Richard Irving, PhDrirving@schulich.yorku.ca

Rosie Lombardirosielombardi@hotmail.com

Andy Shawandy56@telus.net

Mark Farrow, VP/CIO at Hamilton Health Sciences.

2 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y J U N E / J U LY 2 0 1 5 h t t p : / / w w w . c a n h e a l t h . c o m

IN THE SEPTEMBER EDITION of Cana-dian Healthcare Technology, we lookat different approaches to interoper-ability. While some organizations haveimplemented integration engines, oth-ers are scrapping old systems and stan-dardizing on a single solution. Still,there are many niche systems, and pa-per will continue to come through thedoors of healthcare providers. WillVendor Neutral Archives, with enter-prise document management abilities,save the day? We profile current andupcoming solutions.

In addition, in the September issueCanadian Healthcare Technology willinclude a feature on Privacy and Secu-rity Issues in Healthcare, with a lookat how hospitals are coping with em-ployees who share passwords. Thistechnique is seen as a time-saver byclinicians and staff, but it causes trou-ble for managers who are trying tokeep a lid on security and must beable to conduct audits.

Coming in September:Feature on integration

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

BY ROSIE LOMBARDI

Ahospital that runs an electronichealth record (EHR) platformwithout a computerized physician

order entry (CPOE) system is only half-pregnant. It isn’t a truly electronic system

until the thousands of paper order entriesthat flow around the hospital outside theEHR system are incorporated into it.

In 2010, Prince Edward Island’s HealthMinistry made it a priority to implementCPOE systems across the province’s sevenhospitals after they’d implemented their

Cerner Millennium EHR platform. Theproject was completed in 2014, and haseliminated almost all of the acute-care pa-per orders generated in the past. More im-portantly, diagnostics and medication or-ders have been speeded up considerably,and there is now an electronic mechanism

for preventing and tracking medication er-rors and other potential problems.

“Implementing CPOE is the tippingpoint, because ordering is such a funda-mental aspect of care delivery,” explainsLiam Whitty, CIO at Health PEI. “Everydecision a doctor makes triggers one ormore orders. Without CPOE, an EHR isjust a paper-based system supported withsome electronic tools.”

But implementing CPOE is tricky busi-ness, precisely because orders are an inte-gral part of the hospital’s workflow. “It’slike changing out the engine of a car whileyou’re driving it. When you’re switchingover from paper to electronic, you don’twant to lose any orders. You have to main-tain your care delivery,” says Whitty.

Some hospitals have made headlinesbecause they had to revert back to paperorders after their CPOE implementationswent very wrong, he adds.

To minimize risk, Health PEI devised amulti-pronged strategy to tackle severalpotential failure points.

Before they even touched the technol-ogy, the multi-disciplinary project teamworked out paper versions of order sets forcommon conditions, like congestive heartfailure, by collecting all the orders typicallyinvolved in treatment. Then they workedout how this data would flow throughCPOE to catch bottlenecks and glitches.“We did a lot of testing ahead of time so itwould be safer to go live,” says Whitty.

Once they were satisfied with the work-flow, the team began what it calls its‘rolling rollout’ implementations, switch-ing on their Cerner Millennium CPOEmodules one by one at each of the Island’sseven hospitals. CPOE is embedded inMillennium’s platform and requires licens-ing and configuration to switch on – butthe change management challenges thatensue can be intense.

To ensure a smooth transition withknowledgeable staff, Health PEI created aprovincial support team. “We don’t havethe extra people or funds that larger juris-dictions have, so we pulled together a teamfrom all seven hospitals. When we wentlive at hospital number one, people fromhospitals two through seven helped withthe planning and go-live support.”

Another prong of the strategy was go-ing electronic with orders by type. “Asthere are so many different types of orders– diagnostic imaging (DI), laboratory or-ders, medication orders, and so on – webroke the project up into two parts to al-low the different types to be done inphases. For example, in phase one we onlyhad lab, DI and consult orders.”

Whitty says it’s best to tackle simplerorders before inputting the more compli-cated ones. “We got some of the easier oneslike lab and DI out of the way first, thendid the harder ones like medication ordersonce we were a bit more robust.”

Doing it by category makes managingpaper orders and electronic orders concur-rently during the transition easier, he adds.“Once you turn on lab orders, for example,the lab stops taking paper orders and thatstream of paper disappears. However, thepharmacy would still be taking paper med-ication orders. So essentially you’ll have

Prince Edward Island’s ‘rolling’ rollout creates provincial CPOE system

CONTINUED ON PAGE 6

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h t t p : / / w w w . c a n h e a l t h . c o m4 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y J U N E / J U LY 2 0 1 5

BY JERRY ZEIDENBERG

TORONTO – The day will comewhen robots will performprostatectomies, liver and kid-ney surgeries and more, withbetter results than living and

breathing surgeons, says Dr. ChristopherSchlacta, director of CSTAR at LondonHealth Sciences and a leading authorityon surgical robotics.

“Will robots become better surgeonsthan us?” he asked. “I’m sure that willhappen.

Dr. Schlacta participated in a discussionabout surgical robotics and tele-surgery atthe OCE Discovery Conference, held atthe Metro Toronto Convention Centre inMay. The gathering was combination con-ference and trade show for start-ups andtechnological innovators, sponsored by thegovernment of Ontario.

For his part, Dr. Schlacta conducted thefirst single-port robotic surgery in Canada,when in 2013 he removed the gall bladderof a patient through one tiny hole in thebelly button. Traditionally, robotic surgeryrequires four incisions for the catheterscarrying instruments, lights and cameras.

He explained that a ‘perfect surgery’could conceivably be monitored andrecorded by cameras and sensors, and thedata could be uploaded to a computer-dri-ven surgical robot. The machine wouldthen be able to repeat the optimal surgerypretty much on its own, time after time.

With a robot, quipped Dr. Schlacta,“You’re never getting a surgeon with ahangover or with marriage problems.”

However, one of Dr. Schlacta’s inter-locutors strongly disagreed. Dr. MehranAnvari asserted that a robot can often be oftremendous help, but will never performas well as the best surgeons. “Robots won’tremove the need for surgeons,” he said,“just as calculators didn’t eliminate ac-countants and bookkeepers.”

Instead, he said, robots can improve theperformance of an unskilled or inexperi-

enced surgeon. “We know that in everyhospital, there are good and not so goodsurgeons. And if it’s my daughter whoneeds an operation, we know who to go toand who to avoid.”

Dr. Anvari is a professor of surgery atMcMaster University, and CEO of theCentre for Surgical Invention and Innova-tion, in Hamilton.

“A surgical robot can turn a poor per-former into a high-level performer,” headded.

Dr. Anvari has been working with surgi-cal robots for the past 25 years. His centreis developing its own medical robots, in-cluding the Image Guided Automated Ro-bot (IGAR), a device that works in con-junction with an MRI scanner to help sur-geons conduct more accurate breast canceroperations. It is currently in trials andawaiting regulatory approvals in theUnited States. Some $30 million has beeninvested in IGAR.

He also conducted the world’s first com-

plete tele-surgery, in 2003, when he per-formed surgery on a patient in North Baywhile in Hamilton, 400 kilometers away.

Tele-surgery can also benefit from ro-botics, he said, as human surgeons havedifficulty adjusting to latency – the delaysin images that are transmitted overtelecommunication lines – while comput-ers and robots can easily make the neces-sary adjustments.

While robotics and tele-surgery can de-liver top-tier medical skills to remote re-gions that are often without the services ofan experienced surgeon, most rural andisolated areas haven’t benefited, as thetechnology is expensive.

Surgical robots like Intuitive Surgical’sda Vinci, the leading system on the mar-ket today, require multi-million dollar in-vestments in equipment and specializedtraining.

Governments and health regions acrossCanada have been loath to make these in-vestments when pressed 12 different ways

for funding for nurses, long-term care,home care and other needs, not to men-tion deteriorating buildings.

Still, the prices of surgical robots are onthe verge of falling, while the technol-

ogy becomes even more adept.Toronto-based Titan Medical hasbeen developing a surgical robotthat will sell for only $800,000 –less than half the cost of a da Vincisystem. It will also provide the

surgeon with unsurpassed flexibil-ity while conducting operations, due

to the invention of a new, snake-liketechnology that enables a single entrypoint while carrying all of the camerasand high dexterity instruments that

are needed.The SPORT robot enables ‘single port’

surgeries, meaning that only one small inci-sion needs to be made. Titan’s founders be-lieve it is a major improvement over othersystems on the market, as it offers muchbetter flexibility and superior imaging.

“We developed a very flexible arm, withseven plus one degrees of freedom,” saidDr. Reiza Rayman, president of Titan Med-ical. Moreover, the single port system car-ries not one but two cameras for extra-pre-cise imaging.

“This 3-D view allows for more accuratesurgeries,” said Dr. Rayman, explaining thatpoor imaging in other systems has led toless than ideal outcomes in some cases.

Prototypes of Titan’s SPORT robot willsoon be available, and testing on humansis expected to begin in 2016. The system isscheduled to be commercially available bymid-2017.

Not only is the device less expensivethan other surgical robots, but it will alsohave a smaller footprint, allowing it to bemoved from one OR to another or to am-bulatory settings.

All three speakers agreed that majortechnological changes and cost reductionswill have a huge impact on the medicalsector, with surgical robots entering theoperating room like never before.

Innovators produce headband to detect and monitor epilepsy seizures

TORONTO – A start-up companycalled Avertus has produced theworld’s first ‘Holter monitor forthe brain’, a headband that

monitors brain waves and is capable ofdetecting the onset of epileptic seizures.

The novel device is made up of inter-locking pieces, each containing a sensorand small circuit board, enabling all pro-cessing to occur right in the headbanditself. Bluetooth is used to transmit datato a nearby personal computer or tablet,which can keep an automated logbook.

The headband can be fashionablyhidden by a hat, so a person could wearit all day without feeling conspicuous.

“Today, people with epilepsy keep di-aries to log their seizures. But they canhave cluster seizures at night, and by themorning they may have forgotten allabout them,” said Ron Gonzalez, PhD,the president of Avertus.

The Avertus headband can automati-

cally chart epileptic events and alert pa-tients and family members to the start ofa seizure. That can provide a great mea-sure of safety and security to patientsand their loved ones; it can also helpwith medication dosing and the dataneeded by researchers to produce bettertreatments in the future.

Gonzalez said the Avertus SmartHeadset represents a breakthrough inmeasuring brain waves in a portable de-vice that can be used by consumers. Thecompany has filed six patents and hashad three issued.

Avertus showed its technology at theOCE Discovery conference, an annualmeeting that brings together Ontario in-novators in various areas, includinghealthcare, and connects them with gov-ernment and private sources of funding, aswell as other organizations that are seekingto commercialize new technologies.

For its part, Avertus is seeking to fur-

ther develop and commercialize technol-ogy that was created by Dr. Berj Bar-dakjian, an electrical engineering profes-sor at the University of Toronto, andthrough a later partnership with Dr. Pe-ter Carlen, a neurologist at the Univer-sity Health Network.

The company is being run by fourPhDs, including Gonzalez, and operatesin close collaboration with ZBx Corp., aToronto-based biomedical company.

Gonzalez said the two-year-old com-pany first looked for an existing headsetthat was sensitive enough for its pur-poses, but couldn’t find one. By neces-

sity, Avertus decided to create its own.They came up with an original de-

sign. “All the parts are 3D printed,” saidMirna Guirgis, PhD, a biomedical engi-neer who is part of the Avertus team.“It’s modular, and if one piece breaks,you simply replace that one part, not theentire headset.”

It is also adjustable, comfortably fit-ting adults and children by adding or re-placing pieces. Avertus has received$350,000 from public sources, and hasattracted close to $500,000 in privatefunding. Recently, it received an orderfor $100,000 worth of devices from anout-of-province customer. The headsetwill undergo clinical testing this summerat the Toronto Western Hospital, part ofthe University Health Network. Guirgissaid in the future, sensors and algo-rithms could be developed to monitorother conditions such as sleep apnea, de-pression and Alzheimer’s.

The Avertus Smart Headsetcan automatically chartepileptic events and alertpatients and family members.

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

Experts forecast future of surgical robotics at Discovery conference

Pictured (l to r): Dr. Reiza Rayman; Dr. Mehran Anvari; Gillian Sheldon, Ontario Centres of Excellence; mod-erator Dr. Fayaz Quereshy, minimally invasive surgeon with the UHN; and Dr. Christopher Schlacta.

h t t p : / / w w w . c a n h e a l t h . c o m J U N E / J U LY 2 0 1 5 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y 5

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

BY JERRY ZEIDENBERG

TORONTO – An advanced labo-ratory is at the heart of Sunny-brook Research Institute’s suc-cess in converting ideas aboutimage-guided therapeutic de-

vices into real-world products and solu-tions. “It’s unique in Canada and possiblyin the world,” commented Kevin Hamil-ton, director, strategic research programsat SRI. “No one else has an integrated fa-cility like this.”

The 10,000 square foot lab sits at thetop of a seven-storey tower, and containseverything from machinist’s lathes to 3Dprinters and a current Good Manufactur-ing Practices (GMP) centre, an ultra-cleanfacility for producing devices that can beinserted into the body.

Called the Device Development Labo-ratory, “It’s got anything you’d need tobuild a device or product,” said Hamilton,who noted the lab can quickly turn an ideainto a prototype, ready for testing.

What’s more, the lab has a core ofskilled developers who work closely withscientists and clinicians.

“We have many clinician-scientists whocome up with ideas and want to turn theminto products, to benefit patients,” saidHamilton. “Some of them have createdcompanies, and work here to produceprototypes.”

At the same time, he noted that repre-sentatives from private companies are of-ten visiting, as they’re meeting with scien-tists, developers and clinicians as part ofthe commercialization process.

“We can churn out prototypes in days,as opposed to the weeks this process usu-ally takes,” said Anthony Chau, a machinistat the Device Development Lab. Chau alsohas training in electronics.

He observed that rapid prototyping ofmedical devices can be done at the DDL

not only because the machine tools and fa-cilities needed are all in one place, but be-cause talented people with a wide varietyof skills are working together.

“SRI combines all the skills that areneeded,” said Chau.

Sunnybrook Research Institute has be-come a powerhouse in the creation andcommercialization of image-guided de-vices for researchers and clinicians. In re-cent years, the organization has formedpartnerships with more than 18 private-sector companies and has refined 23 im-age-guided technologies, some of whichare now being sold internationally.

A $74.6 million award, the largest grantin the hospital’s history, was announced in2008 by the Canada Foundation for Inno-vation’s (CFI) Research Hospital Fund,and was used to establish the Centre forResearch in Image-Guided Therapeutics.

In 2012, the government of Canada’sFedDev Ontario provided funding of $6.9million, which was used to help commer-cialize promising technologies.

And in April of this year, FedDev On-tario strengthened the image-guided med-ical device cluster at SRI with a $20 mil-lion grant, a sum that will lead to morethan $40 million in total investmentsthrough matching contributions from in-dustry partners.

The money will be used to spur thecommercialization of 28 different tech-nologies, through collaborations withpartners that include up to 28 businessesand four other universities – Western Uni-versity, University of Toronto, Queen’sUniversity, and Ryerson University.

Hamilton explained the new moneywill largely be used to attract skilled peopleneeded to further develop promising tech-nologies and help bring them to market. Ifthe lab and panoply of equipment are atthe heart of the SRI, people are still thebrains that come up with the ideas and

bring them to fruition. “It’s all about thepeople,” said Hamilton.

Many of the technologies developed atthe centre involve the use of ultrasound orMRI, two of the dominant imagingmodalities used today. SRI has MRI scan-ners from GE and Philips, and will soonadd one from Siemens, the third majormaker of MRI technology. Hamilton notesthat will help researchers and developers,who like to ensure their solutions are com-patible with all of the leading brands.

Some of the technologies and companiesthat have been spun out of research at SRI,and that will be further developed, include:

• Calavera Surgical Design Inc., whichhas developed patent-pending technologyand methods to help surgeons create cus-tom patient-specific implants in the oper-ating room using a compressive mold sys-tem. This technology will be marketed astwo products: a kit for skull and face im-plants and a kit for eye socket implants.

The technology is also suitable for otherapplications such as forming surgicalguides and templates.

• Focused Ultrasound (FUS) Instru-ments, spun out of research done in the labof Dr. Kullervo Hynynen, director of Phys-ical Sciences at SRI, is developing a novelfocused ultrasound phased-array systemthat allows noninvasive and precise deliv-ery of ultrasound through tissue withoutmechanical motion.

• Harmonic Medical Inc. is developingthree novel clinical beta-prototype focusedultrasound systems for noninvasive surgeryand precise delivery of energy to ablate tis-sues deep in the body. The unique featuresof different anatomical targets are used todesign, construct and test devices for thetreatment of uterine fibroids, back pain andvascular diseases.

• Innovere Medical Inc. is a start-up com-pany established by researchers Drs. KevanAnderson and Garry Liu, working in thelab of Dr. Graham Wright, director of theSchulich Heart Research Program at SRI.Together, they invented a wireless headsetsystem to facilitate audio communicationbetween clinicians and research teamsworking inside a noisy magnetic resonanceimaging (MRI) scanner suite and the adja-cent console room.

• PathCore Inc. is a startup company inToronto that was created in 2011 by Dr.Anne Martel, a senior scientist in the OdetteCancer Research Program at SRI, andDanoush Hosseinzadeh, a former SRI re-search engineer.

The company is creating an integratedplatform capable of storing and servingwhole-slide histopathology images foranalysis of tumour burden, tissue damage,and other pathological features. It is also thefirst software company in the world to offera DICOM (digital imaging and communi-cations in medicine) compliant server fordigital pathology.

Hamilton observed that SRI is advancingpatient care in hospitals, including Sunny-brook, through its innovation, and is alsocreating economic benefits through its re-search activities. “We’ve created 14 spinoffsin the last 12 years, and all are alive,” he said.A few have been sold to larger companies,but the manufacturing facilities have re-mained in the Toronto area.

Anthony Chau (right) demonstrates new technology to Kevin Hamilton at the Device Development Lab.

Sunnybrook Research Institute is a commercialization powerhouse

paper and electronic side-by-side – butit’s for completely different categories.”

In addition, Health PEI broke up or-der entering into two phases by staffcategory. “In the first phase, it waslargely nursing staff entering orders intothe system on behalf of doctors, whowere still using paper orders. That al-lowed them to learn the system andwork out the bugs.

“In phase two, the physicians starteddoing electronic orders themselves, buttheir trained colleagues could providesupport. It’s really much less risky tohave the nursing staff go first.”

Once CPOE is fully implemented ina hospital, order processing is speededup considerably. “Orders are enteredelectronically right off the bat at thepoint of care, and they go instantly towherever they’re supposed to go,” saysWhitty. “The hospital workings be-come less about pushing paper aroundthe system and much more about ful-filling needs. You get faster diagnoses

and more responsive care.”In addition, the CPOE now issues au-

tomated alerts that notify clinicians ofimportant information, from supportingsafer medication administration to high-lighting overdue patient care activities.

Whitty says getting hard numbersabout time savings is difficult, as there’s noaccurate pre-CPOE baseline for processingpaper orders at most hospitals. “Also, be-cause we phased it in gradually, we didn’t

have a particular go-live date to measurebefore and after. And there was no systemto track medication errors before. ”

However, Health PEI has been able tomeasure some aspects. “We’ve been ableto take an hour off the delivery time fornon-stat antibiotic orders. We’ve also seena 34 percent improvement in medicationreconciliation at our largest hospital.”

Whitty says he would recommend

PEI’s phased, gradual approach by ordertype and staff category to other hospi-tals planning their CPOE implementa-tions, as there were virtually no glitchesin PEI’s rollout. “PEI is a small place, soeverything gets reported on in ournewspapers. But our CPOE implemen-tation didn’t make the news at all.”

The PEI CPOE project team won the2014 Canadian Health InformaticsAward for its efforts. “This is a tribute tothe people behind the technology,” saysJim Shave, president of Cerner Canada.“Cerner’s partnership with Health PEIhas helped establish a robust EHR sys-tem for the residents of PEI.”

There’s a positive trend afoot as moreand more hospitals are going live withCPOE systems, adds Shave. “Over thepast two years, we’ve gone live withCPOE at more than 30 sites, represent-ing more than 13,000 clinical end-usersacross Cerner sites in Canada. When weget to this level of automation, then wecan start to set our sights on more com-plex areas like population health man-agement. I can’t wait for us to be in aposition to use the data we’re collectingto advance healthcare in new ways.”

“We’ve seen a 34 percentimprovement in medicationreconcilation at our largesthospital.”

PEI’s rolloutCONTINUED FROM PAGE 4

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

BY TERESA PITMAN

The problem is not that we don’thave enough data, it’s that wedon’t always know what to dowith the abundance of data we

have. Michael Quinn, one of the facilita-tors of McMaster University’s Centre forContinuing Education Health Informatics(HI) diploma program, hopes to help solvethat problem.

Health Informatics as a field focuses onunderstanding how healthcare data can beextracted, understood and used to analyze,assess, predict and plan in a wide variety ofsituations.

Quinn’s had a 25-year career usinghealth information built on a Master’s inHealthcare Administration. Like other fa-cilitators in the program, he approacheshis subject matter with both theory andpractical experience. He teaches HealthInformation Systems and Data Analysis,one of eight courses required for thediploma.

“There’s a tremendous market forhealthcare professionals with informaticsknowledge,” Quinn says. He points out

that while peopletend to focus onhospitals when theythink of the health-care industry, it ismuch broader – andthe need for an un-derstanding ofhealth informatics isvital in many areas. One particularlyvaluable aspect ofthis diploma, Quinn

says, is that it is geared towards the Cana-dian healthcare system, with its variationsfrom province to province. “I describetools and techniques that the students canthen decide if they want to put into theirprofessional toolbox. I don’t give a how-toone-size-fits-all methodology because itsimply will not translate to every situationand every context.”

Over nine weeks, students are asked towatch nine recorded modules, completesome readings and join their classmates –who may be spread out across Canada – inweekly discussions. They’ll also completeindividual and group assignments. Havingmost of the coursework online gives thosewho are working full-time more flexibility.

While most of the students who enrollin the Health Informatics diploma pro-gram work in healthcare or informationtechnology, future graduate (summer2015) Yvan Foster’s experience shows thatthose working in related fields also findbenefits. The Quebec City resident has abackground in electrical engineering andhas worked for IBM since 1985. He’s cur-rently a business development managerwho focuses on solutions for the health-care and life sciences industries.

“I hoped this program would help mesee from the perspective of the person whouses the technology I am selling,” he says.“I’ve been really pleased with the results.Healthcare is a very complex business. Asan IBM representative, I understood partof what customers would do with our pro-grams, but not all. I feel that now I under-

stand their challenges, and I’m equipped tobe a better consultant.”

He was pleased to be able to apply whathe learned right away. “One thing I learnedis that in any HI project, success is due 20percent to the technology, and 80 percent tothe planning and people involved. I’m work-

ing with a customer right now to make surehe has the right people in place, as well as theappropriate technological solutions.”

Foster says, “There’s really been a needfor people who understand the business ofhealthcare and also how to leverage thetechnology and data to improve healthcare

services. It’s great to see that McMaster hasbuilt this curriculum to meet that need.”

For more information regarding McMaster’sHealth Informatics and Health InformationManagement diploma programs, please visitMcMasterCCE.ca/health.

McMaster Healthcare IT diploma provides tools for improving care delivery

Michael Quinn VNA

For more information, please contact your sales representative at 1 888 882 8898christieinnomed.com

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

BY ANDY SHAW

TORONTO – Dr. Danielle Martin is afamily physician and innovativevice-president at Women’s College

Hospital, whose firm grasp and defence ofMedicare, Canada’s beloved universal

healthcare system, famously won her theday at an inquisition-like U.S. Senate com-mittee hearing in Washington last year.

Dr. Martin recently made a convincingcase back home in Toronto that to fix ourstill admirable but admittedly flawedMedicare system, it’s high time our health-

care leaders stopped grasping at straws. We need, she says, to reduce wait times

and improve outcomes with technologicalinnovation certainly but also with bold,necessarily risky, non-techie approaches –like making all prescriptions in Canada free.

Dr Martin, charming and approachable

despite such strongly held views, got achance to air them at the second in a seriesof Distinguished Speaker Series hosted byTelus Health, this one over lunch at thedowntown Toronto Region Board ofTrade offices.

There, another executive with a goodgrasp of Canadian healthcare and its trou-bles, Janet Da Silva, the Board of Trade’spresident and CEO, set the scene for the over100 luncheon guests who paid to hear Dr.Martin’s talk and her subsequent discussionwith Paul Lepage, Telus Health’s president.

“Our healthcare system doesn’t comecheap, and our costs are rising,” said thewell-informed Ms. Da Silva, a former West-ern University dean of the Ivey Asia businessschool in China. “According to the OECD(Organization for Economic Co-operationand Development, in Paris ), Canada hasone of the most expensive universal health-care systems in the world. And in 2011, a TDBank economics report estimated that by2030 our healthcare costs could well rise tobe 80 percent of provincial spending!”

Da Silva further pointed out that a re-cent report from the Ontario Health Inno-vation Council (ohic.ca) made clear that ifwe are to create more sustainable health-care, we rather desperately need to inno-vate new ways of doing things and conse-quently abandon the old.

Such as costly, unneeded, dangeroustests.

Dr. Martin, early in her after-lunch talk,told the story of a world-ranked athlete sheknew who followed a private clinic’s rec-ommendation that he undergo a stress testand a follow-up angiogram “just in case”something was truly wrong: “The an-giogram confirmed he was not sufferingfrom heart disease, but not before he suf-fered a stroke on the table. This athlete willnever play his beloved sport again becausehe is paralyzed on one side of his body, asa direct result of a completely unnecessaryand inappropriate medical test.”

Dr. Martin went on to say that manyCanadians are harmed every year by im-proper, wasteful or harmful tests and pre-scriptions, naming mammography foryoung women, PSA testing for men not atrisk, colonoscopy after five years instead of10, among the leading culprits.

Also, such errant testing, she pointedout, lengthen an already over-long queueof people who truly need the tests.

In order to get better hold of such dys-function in our healthcare system, Dr. Mar-tin says the Canadian medical communitytogether with its patients need to undergo afundamental cultural change. And encour-agingly, there’s already a movement tobring that about underway in Canada.

“It’s called the Choosing Wisely cam-paign which is a physician-led attempt toget doctors and patients talking more to-gether about things they both need toquestion,” said Dr. Martin. “When that oc-curs, two good things happen: the patientsusually end up healthier; and resources arefreed up for others who truly need them.”

Beyond earnest discussion, Dr. Martinbelieves that all innovations aimed at giv-ing Canada a stronger handle on itshealthcare, be they cultural or technical,should leverage what she terms the“Medicare Advantage”. “We have one

Prominent physician urges her colleagues to use technology wisely

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8 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y J U N E / J U LY 2 0 1 5

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

health insurance plan for all, making wide-spread innovation relatively easy to imple-ment. So we can make changes at low ad-ministrative costs.

“Our costs our impressively low by com-parison,” Dr. Martin told her audience overafter-lunch coffee. “Administration ac-counts for 31 percent of healthcare expen-diture in the United States, for example, butin our public insurance plans in Canada,administration costs are just 1.3 percent.”

So it hasn’t cost all that much to makesome sweeping changes by applying theMedicare Advantage in coming to gripswith a long-standing bugaboo in Cana-dian healthcare – wait times for surgery.Dr. Martin finds the innovations Ontariohas made in reducing those times encour-aging for both her as a physician and forher patients.

Ten years ago when she first started prac-ticing, even if Dr. Martin referred a knee-re-placement patient to an orthopaedic sur-geon she knew well, the patient might stilljust go on wait list and have nothing done

while the surgeon,say, went off to vaca-tion for the month ofAugust. “Ontario has sinceintroduced Central-ized Intake and As-sessment centresacross the province,”said Dr. Martin, “sonow if I refer a pa-tient with late stageosteoarthritis of the

knee, that patient is seen within a week ortwo, first by an advanced practice nurseand then a physiotherapist.”

In the course of those encounters, re-ports Dr. Martin, the two caregivers edu-cate the patients about their disease;demonstrate exercises to improve pre-op-erative strength, give weight-loss advice,and use an evidence-based checklist to de-termine whether surgery is actually re-quired. If it is, then the patient can book anappointment with a surgeon of theirchoosing, or wait for the next available one.

“The Intake Centres are good examplesof the evidence-based cultural shift in thehealthcare system I have been saying weneed to make,” said Dr. Martin. “It’s a shiftthat moves us away from thinking of thesurgeon as the personal owner of referralbases and wait lists – to one that puts ac-cess for patients first.”

For Dr. Martin, the first among all pa-tients needing a change are those payingfor their own prescriptions.

“Canada is the only developed countrywith universal health insurance that does-n’t include prescription drugs,” Dr. Martinpointed out. “The result is many Canadi-ans do not take the medication they need,simply because they can’t afford to.”

The well-known upshot is that ne-glected medications often lead to more se-rious and thus far more costly patient carefor both public and private health insur-ance schemes to bear.

“The need to expand our public insur-ance plans to include coverage of med-ically necessary prescription medicine isabsolutely clear,” said Dr. Martin, addingthat it would save tax-payer dollars as wellas stimulate the economy.

A study Dr. Martin co-authored andwas published in the Canadian Medical

Association Journal showed that imple-menting universal drug coverage wouldsave private sector health insurers withdrug coverage plans for their employees awhopping $8.2 billion annually. “Thinkhow much more competitive our indus-tries could be without that burden,” shesaid at the Telus luncheon.

This notion, said Dr. Martin, of a uni-versal drug Pharmacare, is, as she termed

it, a good news story about opportunity:“It turns out that innovations we need inour system don’t require that we turn ourbacks on our healthcare values, nor dothey require a lot more money.”

But they could do with much more helpfrom technology.

Just how much help, became clearer af-ter Dr. Martin’s formal address in an infor-mal on-stage chat with Telus Health Presi-

dent Lepage. Here’s a synopsis of much ofthat conversation:

Lepage: As a practising physician Dr. Mar-tin, I am wondering what you are gainingfrom technology generally and from theelectronic medical record in particular?

Dr. Martin: Well Paul, it’s a matter ofstages. The first stage that technology has

© 2015 Cerner Corporation

Health PEI is the single health authority for the Canadian province of Prince Edward Island and recently implemented CPOE, using Cerner’s integrated solutions. This moves Health PEI closer to their vision of “One Island health system supporting improved health for Islanders.” They are enhancing the patient experience, improving the health of islanders and reducing cost.

With Cerner’s CPOE• 89% of pharmacy orders placed electronically within one month

• 90.4% of pharmacy orders placed electronically within five months

• 34% increase in completion rate of reconciling patient medications

To find out how Cerner can help you streamline workflows, increase communication, speed up implementation and improve patient safety, visit cerner.com/cpoeincanada.

Health PEI

Earns 2014 Project TeamImplementation Award

With the implementation of CPOE, PEI hospitals are

among the top in Canada in terms of EHR adoption.

This allows us to deliver high quality care and

improve patient safety for those we serve.

Liam WhittyChief Information Officer

Dr. Danielle Martin

CONTINUED ON PAGE 10

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M E D I C A L I M A G I N G

BY ANDY SHAW

Dr. Narinder Paul, like Noah,has faith that two are moreproductive than one. Espe-cially if they are a pair ofToshiba’s Aquilion ONE Vi-

sion Edition volume CT scanners, workingside by side.

Dr. Paul, a British-educated radiologistand internationally recognized expert inimage optimization and dosage reduction,is the head of cardiothoracic imaging atToronto General Hospital (TGH), a cor-nerstone of the larger University HealthNetwork (UHN) and the multi-hospitalJoint Department of Medical Imaging.

As such, in April Dr. Paul was front-and-centre at TGH’s Peter Munk CardiacCentre for the launch of a joint, multi-yearJDMI and Toshiba of Canada project fea-turing two identical Vision Edition scan-ners, operated from one control room.

This first-ever arrangement gives thePeter Munk Cardiac Centre the uniqueability to expedite transferring what oneCT is storing as research-proven protocolsfor imaging procedures to the other CT foruse by clinicians caring for actual patients.

So why the need for two CT scanners?“Typically, you have separate scanners

for doing research and clinical work,” saysDr. Paul. “And so often those scanners aredifferent machines. Maybe one is olderthan the other, or they’re from differentmanufacturers. Likely they are also in dif-ferent parts of the hospital, each with theirown control room, and for sure each withdifferent ways of handling protocols.

“So if you identify a procedure or pro-tocol for research subjects that might beapplied to actual clinical patients, there’s alot of effort involved in translating thoseprotocols from the research scanner to theclinical scanner. It might take days or evenweeks to work the differences out andtransfer the new protocols over.

“But now, with our identical twin scan-ners, if the new imaging practice protocol inthe research scanner does not need to bepeer reviewed, then we can make the trans-fer from it to the clinical scanner and put itto work on patients in the hands of our tech-nicians and clinicians – almost instantly.”

As Dr. Paul further points out, even if anew protocol coming out of research needsto be properly reported in medical jour-nals and thus peer reviewed, a process itselfthat can take months to complete; once itdoes get the nod, the new protocol can beput into action on the front lines of health-care with the same swiftness.

Either way, the new integrated two-CTset-up enables quicker bench to bedsidetreatment.

With more and better imaging practicescoming out of research being appliedsooner, clinicians will be able to see the de-tailed images of the bone, blood vessel, andtissue conditions they seek to understandand treat. From that better knowledge,care givers should be able to map out bet-ter, more effective treatment plans.

What may also come of all this, is yetbetter scanning machines, especially fromToshiba.

“We have partnerships like this one inToronto, and we work closely with the tech-nical people and caregivers who actually usethe scanners because it shortens our cycle ofinnovation,” says Jens Dettmann, Toshiba ofCanada General Manager and Vice-Presi-dent, Medical Systems Division. “The part-nerships give us a faster feedback loop toour engineers back in Japan.”

Toshiba’s research and developmentwork with UHN stretches back a goodnumber of years; one previous project in-cluded multidisciplinary teams workingon the fusion of imaging technologies. ThePeter Munk Centre clinicians involved inthat project have in turn influenced the de-sign of Toshiba scanners in significantways with their feedback, reports Dr. Paul.

But do the results of working with two$3 million dollar scanners have meaningfor other parts of the country?

“Very much so,” says Dr. Paul. “What weare developing here is a model that otherscan emulate, regardless of the machinesthey are using. By pairing two compatiblemachines, you can bring research and con-sequent treatment together sooner.”

What they likely won’t be able to emu-late quite is how low they can go, in termsof smaller radiation dosages patients areexposed to during a CT scan. First there’sthe Vision Editions’ gantry speed of justbarely over a quarter of a second to makeone rotation, and yet still capture a highlydetailed image in that one eye-blink turn.

“So with that gantry speed and the veryhigh sensitivity of the scanners, what we cando now with our research scanner is to keepdialing down the dosage just to the pointwhere it is at its lowest possible to get thekind of detail clinicians need for a particularexamination,” says Dr. Paul. “Then we can

put that lower setting into a new protocoland instantly transfer it over to the clinicalscanner for use with patients that same day.”

Not without willing hands to help,however. “I can’t emphasize enough howimportant the nurses, the radiologicaltechnologists, and others who use thesemachines every day are to the innovationand partnership process as a whole,” saysDr. Paul. “Without their knowledge andconstant feedback on the protocols we maydevelop, the partnership and its benefits toall its partners simply wouldn’t work.”

Besides Dr. Paul’s efforts to make thisworld-first bench to bedside partnershipwork, are other UHN project veterans, in-cluding Dr. Barry Rubin, the Peter MunkCardiac Centre’s Medical Director, and Dr.Larry White, the Radiologist-in-Chief forthe UHN’s Joint Department of MedicalImaging. The team embraces over 600staff, 75 radiologists and 80 resident fel-lows, the largest speciality grouping of anykind in Canada.

Twin CT project accelerates translation of imaging R&D into practice

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Imaging and surgical leaders from the University Health Network and Toshiba Canada at the twin CT launch.

taken us to is getting our record keepingoff paper and into the computer.

The second stage or level we need toget to is getting our systems to talk toeach other, and we’re not there yet. Forexample, I am in a family medicineclinic at Women’s College on one elec-tronic medical record, but the rest of thehospital just across the street is on a dif-ferent EMR. The one we have is moreappropriate to what we do in the clinicand the one in the hospital is more ap-propriate to their needs. So, if I want tosee what happened to my patient in thegastroenterology clinic across the street,I need to laboriously exit my EMR andthen log into theirs – and that is absurd.

Once we get systems talking to eachother, the third level up is to use IT to driveimprovement in population health – but Idon’t think any healthcare system in theworld has figured out how to do that yet.

Lepage: Speaking of IT, the balance of

power seems to be shifting to the cellphone-toting patient. How does that af-fect the physician, would you say?

Dr. Martin: That’s a tricky issue. But whatI find helpful is to look at it as part of theshift from doing healthcare things for thepatient to doing things with the patient.Remember that patients are their owncare provider 99.999 percent of the time.But if you give them stuff they don’t use,can’t understand, or doesn’t fit into theirworld, you’re not going to be much helpto them. However, we are seeing a shiftfrom traditional care in two forms: in onethe patient sees the provider then goeshome to use technology and managethemselves independently; in the other,both patient and provider stay in someform of two-way electronic communica-tion. So there’s a lot of research going onright now, to see which works best.

Lepage: That raises questions about ac-cess to the records and about who ownsthem, as well as the transparency andopenness of the whole caregiver-patientrecord-producing process.

Dr. Martin: I am all for openness and

transparency, but I do think it is sort ofsad that we feel this need to declare topeople that they actually own the infor-mation about their own health. Also, pa-tients need access to more than just theirown health data. We need transparencyfor them at the physician level too, aboutthe quality of their physician’s individualwork, about their physicians’ incomes –

who is paying them, and how much theirphysicians are taking from industry in thework they do on behalf of businesses.

Lepage: So we can’t just think abouthealthcare if we are going to solve itsproblems, can we?

Dr. Martin: That’s what I think is so ex-citing about healthcare today, especiallywhen you start trying to solve the manyproblems connected with high-end

users, like those who have chronic dis-eases. Many of them are socially andeconomically challenged, so they are notonly sick, but usually have multiple chal-lenges extending well beyond the med-ical sphere. That means, unless you aresolving problems with their housing say,or unless you are thinking about theirmental health, or wrestling with theirlanguage issues, you are not going tomove the yardsticks on populationhealth very much.

Indeed in our healthcare universe,where you have so many moving partslike we have in chronic disease and somany other variables that are particularto one individual, it’s enough to makeyour head burst. It’s so hard to knowwhat to even try, exactly.

But what we’ve learned at Women’sHospital, in what we call our VirtualClinic, is to think of “rapid cycle” devel-opment. That means we try something,evaluate it, often fail, but learn from it,and try again, kill that one if necessaryand try something different, kill it againif needed, and just keep moving on tothe next one until something works.

Aided by technology, there isa shift from doing things forthe patient to doing thingswith the patient.

Danielle MartinCONTINUED FROM PAGE 9

BY NURALLAH RAHIM

TORONTO – Seeking greater insightinto the time and financial costs ofits surgeries and procedures, TheScarborough Hospital(TSH) re-

cently went through a vendor investigationand RFP process. It chose a perioperativeinformation system for scheduling anddocumenting all phases of care.

Even though TSH operated with anelectronic health record (EHR), providersstill documented surgical cases on paper, alaborous process with a heightened risk forinaccuracies.

The new solution integrates with ourMeditech EHR system, so data entry is au-tomated. This helps TSH’s nursing staffwork more efficiently and safely. Anothermandatory feature for us was the system’sdata-analytics capabilities needed to de-liver actionable intelligence to improveOR utilization, turnover times and otherefficiencies.

Since implementation, our hospital hasseen improved surgical and endoscopy

suite utilization andnurse staffing as-signments thanks tothe new insight wenow have intohigher-performingphysicians andproviders.Prior to the imple-mentation of thenew perioperativeinformation system,Surgical Informa-

tion Systems (SIS), generating a report thatpresented procedure times and costs byphysician, pre-admission productivity bynurse, or patient recovery times by nursewas a time-consuming process. In part,this was because data was not consolidatedin one system across the enterprise.

With disparate systems, communicationwas also less efficient, often requiring thepatient to answer the same medical historyand status questions several times duringthe pre-admission, surgery and recoveryperiods. This repetitive data entry wouldnegatively impact the patient’s experience,increase administrative work for providersand introduce the risk for data errors.

Following the requirements of ourLHIN, TSH investigated eight perioperativeinformation systems and created a requestfor proposal (RFP) for selected vendors.Among other qualifications, the RFP listedthe required clinical and financial capabili-ties for eligible systems.

For example, one of the major require-ments was integration with our organiza-tion’s other information systems. Eligibletechnology also needed to automaticallycapture certain data and generate enter-prise-wide and granular reports thatwould help us understand cost and utiliza-tion trends.

Although implementation took placeonly a year ago, the addition of the periop-erative information system at TSH has al-ready improved the efficiency of our surgi-cal services. For example, prior to the SISimplementation, utilization in the en-doscopy suites was at 66 percent, turnovertimes were between 10 and 12 minutes and

providers had completed their schedulesby 1:30 p.m.

After analyzing the data to identify howproviders could better schedule their pro-cedures and improve their productivity,the hospital saw the following results: Uti-lization rate grew to 85 percent; turnover

times dropped to five minutes between pa-tients; and billable time was extended to aslate as 3:30 p.m.

The analytics have also helped withstaffing efficiencies. For example, we wereable to create a report showing whichnurses complete more surgery assessments

in a day to ensure that they are continuallyassigned those duties and re-assign otherclinicians with lower productivity metrics.

Nurallah Rahim, RN, BScN, MHA, is Direc-tor of Surgical Services at the ScarboroughHospital in Toronto.

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Nurallah Rahim

BY DR . VIKRUM MALHOTRA

The Canadian healthcare system is one ofmany systems going through a transi-tion from traditional hospital-basedcare to home-based patient-centric careand eventually to the “doctorless” pa-tient. We have heard in previous years

about the concept of bringing the care to the home,but much of this is still in the introductory phase andtele-homecare is still not reimbursed in Canada.

We have also heard of the promises of the transitionto home-based care, but now our communities want toknow what stage we are in and where we are headed.

Here is the update. We were bound as physiciansand patients by expensive technologies, lack ofcloud-based health networks, and poor legislativesupport to reimburse these services.

Due to the costs incurred, hospitals and clinicswere created formally in the 16th and 17th century tocentralize resources and deliver care. We saw this be-come formalized across the world as a form of deliv-ering care. We are beginning to see the transitionback to the patients’ homes for care delivery as tech-nology improves, costs reduce, and positive health-care outcomes are proven.

As our Canadian population ages, we are forced toput this in the forefront as costs of care will increasealong with our wait times and overburdening ourhealthcare resources. There has been a large focus onsolutions and healthcare economics. Currently, thereis a large debate with the Ontario Medical Associa-tion and the Ontario government who are cuttingcosts by limiting this care.

The voice of the OMA has been strong in opposi-tion and has created an agenda around the conceptof “Care not Cuts” over the last year. The politicallandscape has also changed with telemedicine premi-ums enabling sustainable clinician tele-visits via the

Ontario Telemedicine Network. The government isholding the reins on its widespread use after seeingthe disruptors create an over-utilization problem ofhealthcare resources.

Now, think about that for a second. We used theseservices so frequently that our costs of utilization ex-penses skyrocketed and the British Columbia govern-ment, with a fixed amount of resources, expressedpublic concern regarding its use by companies likeMedeo, a Vancouver-based teleconferencing provider.

In the United States, Medicare introduced reim-bursement codes 99490 and 99091 to reimburse re-

mote patient monitoring to facilitate collection andinterpretation of health data as they are transition-ing to Obamacare where fixed sums of moneyare used to reimburse care. The insurance com-panies have backed this form of care deliverybecause it is cost effective and shown positivehealth outcomes in different pathologies.

Beginning January 1, 2015, Medicare be-gan reimbursing physicians for non-face-to-face care coordination services furnished toMedicare beneficiaries with multiple chronicconditions. For payment, chronic caremanagement services must be fur-nished, with at least 20 minutes

of clinical staff time directed by a physician or otherqualified health care professional, per calendarmonth, with the following required elements:

• Multiple (two or more) chronic conditions ex-pected to last at least 12 months, or until the death ofthe patient

• Chronic conditions place the patient at significantrisk of death, acute exacerbation/decompensation, orfunctional decline

• Comprehensive care plan established, imple-mented, revised, or monitored.

This allows for early detection, fewer readmis-sions, and less costly readmissions. The United Stateshas implemented Medicare codes 99490 and 99091as a method of creating more sustainable personal-ized healthcare platforms as Obamacare is beingtransitioned through 2016.

In summary, the transition to personal medicinehas changed as implantables/wearables have becomesmaller, cheaper, cloud-based and more integrated intoour day to day living. We are starting to see the begin-

ning of the second generation of remote patientmonitoring where “dumb” data collected by

biosensors is being turned into “smart” datafor interpretation and clinical decision sup-port for doctors. Ontario has one of thelargest telehealth networks in the worldand has become the focus of attention forour delivery model success through our

novel approach to care networking. We are now at a point where we should sup-

port this shift in the paradigm to tele-homecare and telemedicine visits. Per-

sonalized medicine will representthe advancement of our

healthcare in the next 20years and bring large-scaleaccess to healthcare whileimproving costs.

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Earlier this year, the Medicare began reimbursing physicians for non-face-to-face services.

While the U.S. moves ahead on reimbursing telehealth, Canada dithers

Dr. Vikrum Malhotra is a US-trained cardiologist at Advan-tageCare Physicians. He is alsoan entrepreneur and investor.

When you compare the Canadian digitalhealth landscape to the American one,it’s almost as if Canada is in an entirelydifferent universe.

Theorems in eHealth? Is there a canonical basis for what we do?

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

BY DOMINIC COVVEY

Those with math backgroundswill know that ‘canonical’means the simplest or stan-

dard form of a rule or equation. Italso means the authorized, recog-nized and accepted or undisputedform of something. ‘Canonical basis’is used herein to mean ‘recognized,accepted and simple’.

In April 2009, Chuck Friedman,renowned Health Informaticsteacher and researcher, published ‘A“Fundamental Theorem” of Biomed-ical Informatics’ in the Journal of theAmerican Medical Informatics Asso-ciation. Math wonks know that theword ‘theorem’ represents a state-ment validated by a proof.

Chuck’s “Fundamental Theorem”

is not at that level of sophistication.It is, rather, an assertion in which weall believe and whose validity isbased on real-world experience.Chuck expressed his FundamentalTheorem in the form of an inequal-ity (to paraphrase): a human to-gether with an information systemresource is greater (or better) than ahuman on its own.

Some studies and even clinicaltrials indicate that this might be avalid statement, although manydon’t and the magnitude of ‘greaterthan’ or ‘better than’ is still elusive.

Nonetheless, this is a tenet of ourfield. Chuck also points out thatthere are corollaries to the theoremincluding that “informatics is moreabout people than technology” andthat the information system “re-

source must offer something that theperson does not already know”.

Most eHealth professionals’might react that such a basic state-ment is underwhelming and say, “sowhat?” Of course, the math types

will simplyridicule astatement likethis as beingfundamentallyunprovableand trivial.But, there maybe great valuein examiningour field by as-serting andeven debating

basic ideas and then building onthem to create a structure of knowl-

edge that we can all accept and use.Let’s take a shot at that.

Let’s consider building up a set ofassertions (‘theorems’ is a bit toopompous) about our field with whichwe can all agree. These assertions mayhelp us to better understand and bet-ter explain what we do and what weare trying to accomplish.

Over the next few articles, we willput forward key assertions that wecan organize into a useful body ofknowledge. Moreover, we challengereaders to offer theirs. These asser-tions can be very basic, but must bedemonstrated to have validity and tobe commonly accepted by our con-frères. Let’s start!

Assertion 0 – HUMAN LIMITA-TIONS: There is a need to supplement

Dominic Covvey

CONTINUED ON PAGE 14

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V I E W P O I N T

BY MAHMOOD QASMI

The proliferation of smartphoneshas opened up multiple avenuesfor home healthcare manage-ment for consumers. In the last

three years, the newer generation of smart-phones and tablets have provided a plat-form for physical activity trackers and di-etary intake monitors, but more impor-tantly, they have allowed rudimentary dataacquisition for physiological indicators.

For instance, the S Health app fromSamsung makes use of Light EmittingDiodes (LED) and infrared (IR) sensorspackaged with Galaxy S5/S6 smartphonesto indirectly estimate the user’s heart rateand blood oxygen saturation level.

Similarly, the Apple Health app uses theiPhone’s camera as an optical sensor for es-timation of heart rate. Interestingly, read-ings from such apps produce results com-

parable with con-ventional empiricalmethods used inmedical practice. While sophisticatedmedical-grade in-struments providefar more accurateand detailed analy-ses, consumer-gradesmartphones couldin fact use special-ized instrumenta-

tion “add-ons” to give users direct access tosimilar functionality in the next few years.

Basic blood pressure monitoring add-ons such as the Wireless Sphygmomanome-ter from Withings Inc. and stand-alone appssuch as Instant Blood Pressure from AuralifeLabs Inc. have already found their way intothe marketplace. Soon, smartphones andtablets could be capable of using such exten-sions for monitoring and reporting PersonalHealth Information (PHI).

However, transfer and access of PHI be-tween patients and medical practitionerscan have a whole different set of opportuni-ties and risks. While PHI security standardsdo not apply to fitness related apps, they docome into play when allowing medicalpractitioners and patients to communicatewith each other on health matters.

The challenge is further compounded bysignificant fragmentation within healthcareinformation technology standards due tovarying compliance requirements fromcountry to country. For instance, it is ratherdifficult to have a unified protocol to con-currently comply with the Canadian Per-sonal Health Information Protection Act(PHIPA) and the US Health InsurancePortability and Accountability Act (HIPAA).

PHIPA focuses on objectives and em-phasizes the reasonability of methods toprotect PHI against loss or unauthorizeddisclosure and subsequent copying, modifi-cation, or disposal. On the contrary, HIPAAtends to directly describe safeguards forhealth information including access con-trols, workstation/device security measuresand authentication parameters.

As such, cross-compliance even withina North American context is far from triv-ial. Further still, the complexity can in-crease several fold when concurrently sat-isfying the European Data Protection Act

(DPA.) It can only be imagined what oper-ational and technological challenges couldbe faced by OEMs and developers whenaiming for global healthcare compliance.

They do however present new niche op-portunities for OEMs, third party develop-ers and Service Providers (SPs) to adapt

their technology and infrastructure for re-motely managing and sharing PHI be-tween clinical practitioners and patients.

Service providers will need to warrantthat adequate communication and servicesecurity is in place to comply with applica-ble healthcare regulations.

Mahmood Qasmi, BEng, MASc, MBA, PMP,is a Manager with the SR&ED AdvisoryGroup at BDO Canada. He has more than tenyears of progressive experience in engineering,product development and consulting withparticular focus on Research and Develop-ment in the Telecommunications industry.

Use of smartphones in healthcare will soon face regulatory hurdles

Mahmood Qasmi

A portal that providessecure exchangeof information

Easily implemented, web-based connectivityamong patients and alltheir healthcare providers

For a demo visitwww.relayhealth.ca/demo

www.mckesson.ca

h t t p : / / w w w . c a n h e a l t h . c o m J U N E / J U LY 2 0 1 5 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y 1 3

V I E W P O I N T

BY ZAYNA KHAYAT

Wearable technology ismoving quickly from acutting-edge quirk to aneveryday item, and thishas huge implications

for how we understand our own health –and how we can misunderstand it and howto know the difference.

A smart watch that can access yourheartbeat, health records and Internetmedical websites all at once can be a valu-able tool or a path toward misinformationand an incorrect self-diagnosis. Medicalinfo-tech can empower both healthy peo-ple and patients or it can confuse and leadto quack remedies.

This is a challenge, but it’s also an op-portunity to modernize our healthcaresystem, and a potentially massive opportu-nity for the tech firms that can make thishappen. In addition to looking cool, wear-able devices can let people become CEOsof their own healthcare.

According to BCC Research, global rev-enues for wearable healthcare devices havealready reached more than $1.1 billion ayear. The investor community is noticing.In Ontario, the number of ventures in the“advanced health sector” grew by 21 percent over the last two years, according toresearch by Innovation Data PartnershipOntario. Little surprise, over 400 industryexecutives and investors descended toToronto this month to attend Health-Kick2015, Canada’s largest showcase ofearly-stage health startups.

Governments, eager to rein in costs, arenoticing too. For example, the Ontariogovernment, which put the brakes on

provincial healthcare spending in its Aprilbudget, at the same time announced it’screating a new $20 million fund to helpboost homegrown health technology.

The province also announced it’s ap-pointing a new Chief Health InnovationStrategist to encourage health-related ITdevelopment and use in Ontario. TheToronto Region Board of Trade is also set-ting up a new consortium called TO-Health! to promote the region as a centrefor tech-related health innovation.

Technology can bring cost efficiencies aswell as improve effectiveness of the healthsystem. It lets individuals focus on theirown health and medical needs without thetime-consuming and costly step of havingto book a doctor’s appointment or visit aclinic or hospital for non-emergencies.

A Toronto-based company calledLeague, for example, developed by one ofthe co-founders of e-book company Kobo,will let people access and share their ownhealth records securely with the teams ofhealthcare practitioners they designate – ashortcut around the more cumbersome al-ternative of requisitioning records throughthe province wide e-health system.

A Waterloo, Ont. health startup, MedellaHealth, pitched its high-tech contact lenses

at a Dragon’s Den-style health-related in-vestors’ conference at Toronto’s MaRS Dis-covery District in May. Medella’s lenses mea-sure glucose levels in the eye. This could be aboon for early treatment of diabetes, replac-

ing the pinprick testthat requires drawingblood.Right now one infour Canadian hasdiabetes or its pre-cursors – a numberpredicted to rise toone in three by 2020and cost Canada’seconomy $16 billiona year in conven-tional treatment.

An app that deals with chronic painfrom a company called ManagingLife letspeople better communicate their pain withdoctors. The app allows doctors to go backin time and look for changes in a patient’spain levels and response to medication.Not only can this help in the short term,but the information can be used to create aplan that looks at longer-term health goals.

Yet another startup, Toronto-basedSeamlessMD has developed a platform thatlets surgeons monitor patients remotely af-

ter surgery. Patients can also use the app toprepare for surgery and care for themselvesafter by following post-care instructionsand sending updates to doctors and nurses.

Toronto East General Hospital testedthe platform in a trial involving thoracicsurgery patients, and found patients re-ported less anxiety over surgery instruc-tions and fewer cancellations.

Fewer unnecessary post-op calls andreadmissions frees up resources for otherswho need treatment and care; remote mon-itoring also helps 6.3 million Canadianswho live in rural areas and can’t easily travelback and forth from the hospital or clinic.

Ontario’s government took a lot of heatover many years for huge cost overrunsand delays in moving to electronic healthrecords. But maybe moving from filingcabinets to e-health is simply a clumsy yetnecessary first step in a revolution.

Portable, wearable health tech – whichsome observers still consider to be fash-ion accessories – may actually be the gate-ways to the way we take care of ourselvesin the future.

Zayna Khayat is the Lead of the health prac-tice of MaRS Discovery District and directorof MaRS EXCITE.

Wearable healthcare devices: the next frontier for Canadian startups

human (individual and group) thoughtand work processes to deliver betterhealth care. We have much evidence thathumans need help, given our history of

inadequate or failed diagnoses and thera-peutic interventions.

Assertion 1 – HEALTH INFORMATICSOFFERS HELP: Health Informatics is a bodyof knowledge, skills and experiences thatunderpins activities in eHealth. eHealth

has a formal, if not scientific, basis. It isnot just doing things. It is doing thingsthat have been demonstrated to be appro-priate, correct, usable and productive ofdesired effects.

Assertion 2: – UNDERSTANDING PROB-LEMS FIRST: The fundamental contributionof Health Informatics (and its practice byeHealth professionals) is the understandingof problems related to human health andthe health system. This means that what weare really about is observation, listening,studying, understanding or, more broadly,thinking. For us to be successful, the veryfirst thing we must do is to get our mindsaround problems, challenges, deficiencies,etc. that make health care and the healthsystem less than optimal. In other words,our focus must first be on understanding.

Assertion 3 – SOLUTIONS BASED ON UN-DERSTOOD PROBLEMS: The understandingof problems is a continuing and progres-sively deepening process that practitionersattempt to address by various evolving solu-tions, often based on technology. Here werecognize that the complexity of health andthe health system means that we will grad-ually approach comprehensive and persis-tent solutions as our understanding evolves.Initial uses of technology may be spotty andtheir effectiveness relatively weak, but wecontinue the process of understanding andevolving solutions through time.

We will continue this in the next article.Meanwhile, please start thinking aboutand sending your contributions. For now,many thanks to Dr. Tom Rosenal for read-ing and commenting on the manuscriptfor this article.

Dominic Covvey is President, National Insti-tutes of Health Informatics, and an AdjunctProfessor at the University of Waterloo.

McMaster Centre for Continuing Education

Centre for Continuing Education | McMaster University | 905-525-9140 ext. 24321 | mcmastercce.ca

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Where health and information technology intersect: mcmaster-health.ca or speak to one of our advisors today at 905-525-9140 ext. 24321 or 1-800-463-6223.

Zayna Khayat

CONTINUED FROM PAGE 12

Covvey: Is there a canonical basis for what we do?

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Annual directory of leading healthcareinformation-technology suppliers

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ABELMed Inc.3310 South Service RoadBurlington ON L7N 3M6T: 800-267-ABEL (2235) F: 866-337-5558E-mail: Info@abelhealthgroup.comContact: Angela SpinksWeb: www.abelmed.comABELMed Inc., a Microsoft Gold CertifiedPartner, is a leading provider of outstandingclinical/practice management systems.ABELMed EHR-EMR/PM v12 is userfriendly, fully-integrated EMR/PM softwareand is OntarioMD EMR 4.1A Funding Eli-gible (local solution).

Agfa HealthCare2-5975 Falbourne StreetMississauga ON L5R 3V8T: 877-753-2432 F: 416-240-7359E-mail: salesinfo@agfa.comContact: Lisa ShonikerWeb: www.agfahealthcare.comAgfa HealthCare delivers proven enterpriseand department imaging informatics to ad-vance improved efficiencies and the safetyof care. Agfa HealthCare is committed toopen standards and interoperability and of-fers a full range of workflow-centric imag-ing solutions, from classic X-ray film to Di-rect Radiography, and advanced Imaging In-formatics/Clinical IT.

AlayaCare4950 Yonge Street, Suite 2110Toronto ON M2N 6K1T: 1-855-858-5214 F: 1-855-858-5214E-mail: sales@alayacare.comContact: Brady MurphyWeb: www.alayacare.comAlayaCare provides home health care agencieswith an end to end solution suite built on thelatest technology and offered on a secure Soft-ware as a Service platform. The AlayaCare so-lution suite includes Remote Patient Monitor-ing, Scheduling, Time and Attendance, Billing,Electronic Clinical Documentation, and more.

Allscripts13888 Wireless Way, Suite 110Richmond BC V6V 0A3T: 604-273-4900E-mail: canada@allscripts.comContact: Jennifer MacGregorWeb: www.allscripts.comAllscripts is a leader in healthcare informa-tion technology solutions that advance clini-cal and operational results. Our innovativesolutions connect people, places and dataacross an Open, connected Community ofHealth. Allscripts provides a full suite ofclinical, operational, population health man-agement and patient engagement solutions.

AMD Global Telemedicine321 Billerica RoadChelmsford MA 01824 USAT: 1-978-937-9021 F: 978-937-5249E-mail: kdostie@amdtelemedicine.comContact: Keri DostieWeb: www.amdtelemedicine.comAMD Global Telemedicine is the pioneer ofTelemedicine Encounter Management Solu-tions that enable healthcare providers to con-nect clinical patients with remote specialists.As telemedicine is evolving into mainstreamcare, AMD provides our customers withtelemedicine solutions that integrate seam-lessly into their existing infrastructures sothey can deliver patient-focused care. Prod-ucts include telemedicine software, mobilecarts/cases, and medical devices.

Austco Communication Systems60 Granton Drive, Unit 6Richmond Hill ON L4B 2N6T: 905-731-1830 F: 905-731-1816E-mail: info@austco.caContact: Aaron RoslerWeb: www.austco.comAustco is a world leader in the highly spe-cialized field of electronic communicationsfor the healthcare and long-term care envi-ronments. Specifically, we design and manu-facture a family of dedicated microprocessorEmergency Call Management Systems forthe Hospital (TACERA) and long-term care(CallGuard) markets.

B Sharp Technologies23 Lesmill Road, Suite 404North York ON M3B 3P6T: 416-445-7162 F: 416-445-2341E-mail: rhianac@bsharp.comContact: Peter BurgessWeb: www.bsharp.comB Sharp Technologies contributes to ahealthier world by developing and deploy-ing “B Care” electronic documentation andclient case management solutions forhealthcare, social services, and communitycare. These solutions unlock the value ofdata to support informed decision-making.Innovation, Flexibility, and Responsivenessmake up the heart of each installation.

BlackBerry2200 University Avenue EWaterloo ON N2K 0A7T: 519-888-7465 F: 519-888-7884E-mail: salesatblackberrycanada@blackberry.comWeb: www.blackberry.com/healthcareBlackBerry enables secure real-time connec-tions across the full continuum of care.BlackBerry’s security backbone supports so-lutions to manage all devices, collaborateand share, reduce risk, meet regulatorycompliance, enable mobile workers, andprovide secure access to health systems.Contact BlackBerry today to meet the mo-bile needs of your healthcare organization.

Canon Canada Inc.6390 Dixie RoadMississauga ON L5T 1P7T: 905-795-1111 F: 905-795-2022E-mail: Medical_Systems@canada.canon.comWeb: www.canon.ca/medicalCanon Canada’s Medical Systems Divisionoffers diagnostic products for hospitals, clin-ics, optometry, ophthalmology and veterinar-ian practices across the country. The widerange of digital imaging products includesgeneral digital radiography systems, wirelessDR panels, portable X-ray systems, retrofitsto existing analog and CR equipment, as wellas ophthalmic retinal imaging cameras.

Caredove1 Yonge Street, Suite 1801Toronto ON M5E 1W7T: 705-795-6813 F: 1-866-430-8903E-mail: jeff@caredove.comContact: Jeff DoleweerdWeb: www.caredove.comCaredove’s e-Referral platform helps clini-cians book their patients into local health andcommunity services. Networks of communityhealth organizations use Caredove to improveaccess to their services and smooth patienttransitions, quickly, easily and securely.

Carestream Health Canada Company8800 Dufferin Street, Suite 201Vaughan ON L4K 0C5T: 1-866-792-5011 F: 416-665-0595E-mail: info-canada@carestream.comWeb: www.carestream.comCarestream Health is a worldwide providerof dental and medical imaging systems andhealthcare IT solutions. We offer flexible so-lutions that can be tailored to your facility’sneeds and budget. Accelerate and evolve yourdigital transition with advanced RIS/PACS,clinical data archiving, wireless DR solutionsand more – all designed to improve work-flow, staff productivity and the quality of pa-tient care, while reducing your costs.

Centre for Imaging TechnologyCommercializationSuite 130, 100 Collip CircleLondon ON N6G 4X8T: 519-858-5013 F: 519-931-5719E-mail: info@cimtec-canada.caContact: Darlene PrattWeb: http://www.cimtecimaging.com/CIMTEC helps researchers, startups andsmall to medium-sized companies translatemedical imaging innovations into commer-cial products. CIMTEC builds and testsclinical prototypes in the broad areas of 3Dvisualization, image analysis and mecha-tronics design. We offer clinical testing andbusiness development services including in-tellectual property and regulatory assess-ments, market research, opportunity evalua-tions, and business plan advice.

h t t p : / / w w w . c a n h e a l t h . c o m1 6 C A N A D I A N H E A L T H C A R E T E C H N O L O G Y J U N E / J U LY 2 0 1 5

Cerner CanadaTrillium Executive Center 675 Cochrane Drive East Tower, 6th FloorMarkham ON L3R 0B8T: 1-905-530-2434 F: 1-905-530-2434E-mail: cernercanada@cerner.comWeb: www.cerner.caCerner’s mission is to contribute to the systemicimprovement of health care delivery and thehealth of communities. We are transforminghealth care by eliminating error, variance andwaste for health care providers and consumersaround the world. Our solutions optimizeprocesses for health care organizations rangingfrom single-doctor practices to entire countries,for the pharmaceutical and medical device indus-tries, and for the field of health care as a whole.

Dell155 Gordon Baker Road, Suite 501North York ON M2H 3N5T: 1-800-WWW.DELL (1-800-999-3355) F: 416-758-2313E-mail: john_g_armstrong@dell.comContact: John ArmstrongWeb: www.dell.caDell listens to customers and delivers innovativetechnology and services that give them the powerto do more. As the leading provider of healthcareIT services in the world, Dell helps healthcare or-ganizations harness the power of information.

Educredu Corp.157 Adelaide Street W, Suite 308Toronto ON M5H 4E7E-mail: contact@educredu.comWeb: www.educredu.comEducredu is a Software-as-a-Service (SaaS) com-pany catering to the needs of professionals whomaintain credentials, as well as those of educa-tional events and accreditors.

Ergotron1181 Trapp RoadEagan MN 55122 USAT: 1-800-888-8458 F: 651-365-5615E-mail: customercareeagan@ergotron.comWeb: http://www.ergotron.com/Ergotron’s wide portfolio of healthcare carts, ITmounting and mobility products include all thefeatures that nurses ask for, and all the conve-niences and dependability that IT requires.

Evident6600 Wall StreetMobile AL 36695 USAT: 800-711-2774 F: 877-866-4706E-mail: bob.magonigal@evident.comContact: Bob Magonigal, Director Sales – CanadaWeb: www.evident.comEvident is a leading provider of Hospital andClinical Information Systems solutions and sup-port ideally suited to Canadian healthcare. To-gether with our customers, we’re taking the nextstep to secure the future of healthcare.

GE Healthcare2300 Meadowvale BlvdMississauga ON L5N 5P9T: 905-567-2110 F: 905-567-2135E-mail: hcitcan.info@ge.comWeb: www.gehealthcare.comGE Healthcare provides transformational medicaltechnologies and services to meet the demand forincreased access, enhanced quality and more af-fordable healthcare around the world. From med-ical imaging, software & IT, patient monitoringand diagnostics to performance improvement so-lutions, GE Healthcare helps medical profession-als deliver great healthcare to their patients.

Globestar Systems Inc.7 Kodiak CrescentToronto ON M3J 3E5T: 416-636-2282 F: 416-635-1711E-mail: info@connexall.comContact: presales@connexall.comWeb: www.connexall.comConnexall is a leading international provider of ahospital-wide interoperability engine that em-powers disconnected people, tasks and devicesacross the care continuum. Its capabilities act as abackbone for enterprise workflow, facilitating thecritical exchange of actionable health informationat the moment it matters.

Health Information Technology Services (HITS)293 Wellington Street N, Suite 133Hamilton ON L8L 8E7T: 905-521-2100 x49997 F: 905-521-5006E-mail: info@HITS-IT.caContact: Kareem ToniWeb: www.HITS-IT.caHITS is an information technology consultingservice provided by the Information & Commu-nication Technologies team at Hamilton HealthSciences. Our team helps healthcare organizationstransform the capacity and functionality of theirinformation technology.

Healthmark8827 Henri-Bourassa OuestMontreal QC H4S 1P7T: 800-665-5492 F: 514-336-7111E-mail: info@healthmark.caWeb: www.healthmark.caHealthmark is a Canadian Healthcare ProductsDistributor since 1980 offering products and au-tomation for packaging and dispensing of unitdose Oral and IV medications.

Honeywell Life Care Solutions3400 Intertech BlvdBrookefield WI 53045 USAT: 262-309-0661 F: 262-364-2891E-mail: erin.conley@honeywell.comContact: Erin ConleyWeb: www.honeywelllifecare.comHoneywell Life Care Solutions provides digitalhealth technologies for healthcare systems, payors,employers, home health agencies, and individuals.Our remote patient monitoring and clinically-dri-ven self management solutions help individualsactively contribute to their own care through easyto use software and devices, providing greater in-sight for their care providers.

IBM Canada Ltd.3600 Steeles Avenue EMarkham ON L3R 9Z7T: 905-316-5000 F: 905-316-2535E-mail: bburk@ca.ibm.comContact: Barry Burk, Vice President, HealthcareWeb: www.ibm.com/healthcare/caIBM is working with clients across Canada tobuild a sustainable healthcare system that can de-liver better patient care and outcomes. Along withour partners, IBM brings together deep expertisein managing and integrating solutions which areredefining value and success. Together we arehelping to build a smarter healthcare industry.

Imprivata10 Maguire RoadLexington MA 02421 USAT: 1-781-674-2700 F: 1-781-674-2700E-mail: sales@imprivata.comContact: Michelle LiroWeb: www.imprivata.comImprivata®, the healthcare IT security company, isa leading provider of authentication and accessmanagement solutions that deliver fast, secure NoClick Access® EMRs, other clinical applications,and virtual desktops at the point of care to im-prove provider productivity for better focus onthe patient experience.

Innovative Imaging Technologies Inc.1713 St-Patrick, Suite 101Montreal QC H3K 3G9T: 514-223-1717E-mail: info@iitreacts.comWeb: www.iitreacts.comIIT’s unique Reacts collaborative platform is de-signed for highly secured telemedicine, trainingand supervision via computers/mobile devices. Itprovides caregivers with an intuitive way to inter-act with colleagues and patients, integratingmulti-stream HD videoconferencing.

Intelerad Medical Systems895 de la Gauchetiere W, Suite 400Montreal QC H3B 4G1T: 905-639-9582 F: 514-931-4653E-mail: sales@intelerad.comContact: Rob ElichWeb: www.intelerad.comIntelerad® is a leader in distributed radiology,providing medical imaging solutions and servicesfor hospitals, radiology groups, imaging centres,and teleradiology businesses. Renowned for theirinnovative features and functionality, Inteleradsolutions increase productivity and streamlineworkflow by overcoming technical barriers in dis-tributed and complex environments.

Intelliware Development Inc.200 Adelaide Street W, Suite 100Toronto ON M5H 1W7T: 416-360-7320 F: 416-762-9001E-mail: joe.kevens@intelliware.comWeb: http://www.intelliware.com/industries/healthcare/#allThe Healthcare practice of Intelliware, a Toronto-based provider of custom software development,specializes in systems integration, product devel-opment and outsourced custom software devel-opment.

InterSystems CorporationOne Memorial DriveCambridge MA 02142 USAT: 617-621-0600 F: 617-551-2100Contact: Market DevelopmentWeb: www.intersystems.com/HealthShareInterSystems HealthShare® is a health informaticsplatform and family of solutions that enable in-teroperability across multiple systems and dataformats, making it possible to capture, share, un-derstand, and act on large volumes of structuredand unstructured health information. The plat-form is used by private hospitals and health sys-tems, public health information exchanges, andentire nations to achieve more coordinated, moreconnected care. InterSystems CACHÉ® is theworld’s most widely used database system inhealthcare applications.

Iron Mountain Canada195 Summerlea RoadBrampton ON L6T 4P6T: 905-792-7099E-mail: helen.lan@ironmountain.comWeb: www.ironmountain.caIron Mountain, a leading provider of storage andinformation management services, with theirHealth Information Management Solution deliv-ers a suite of specialized storage, digitization andaccess capabilities tailored to help organizationstake a holistic approach to managing informationthroughout its lifecycle, ensuring data integrity,security and privacy at every stage.

Lanier Healthcare Canada980 Adelaide Street S, Unit 36London ON N6E 1R3T: 519-649-4880 F: 519-649-2562E-mail: cwelbourn@lhcc.caContact: Mr. Chris WelbournWeb: lhcc.caLanier (LHCC) specializes in the art of documen-tation. We can create the written word from manydifferent methodologies such as: speech recogni-tion, templates or narrative dictation. The 2ndgeneration of speech, unlocks patient informationin narrative reports and provides Trends in realtime. Improve patient outcomes and the qualityof reports.

Lexmark Healthcare125 Commerce Valley Drive W, Suite 600Markham ON L3T 7W4T: 416-986-3347 F: 1-913-495-8800E-mail: Heidi.Brown@lexmark.comContact: Heidi BrownWeb: www.lexmark.com/healthcareLexmark Healthcare delivers a complete patientrecord within the core applications you use today.Lexmark healthcare content management com-bines industry-leading technology including ven-dor neutral archive, enterprise viewing, documentmanagement and image connectivity. With Lex-mark Healthcare technology, you can make moreinformed decisions, future-proof your businessand maximize your technology investments. Visitus at www.lexmark.com/healthcare

McKesson Canada4705 DobrinVille-St-Laurent QC H4R 2P7T: 514-832-8295 F: 514-832-8274E-mail: inquiries@mckesson.caWeb: www.mckesson.caMcKesson Canada empowers healthcare throughsupply, technology, business and clinical solutionsthat enable manufacturers, pharmacies and insti-tutions to improve the quality, safety and cost ofpatient care. Solutions include drug distribution,enterprise performance management, EMR con-nectivity, image management, pharmacy automa-tion, teletriage, adherence and chronic diseasemanagement.

MediSolution110 Cremazie Blvd, 10th FloorMontreal QC H2P 1B9T: 905-673-4000 x4115 F: 905-673-3114E-mail: michael.conn@medisolution.comContact: Michael ConnWeb: www.medisolution.comMediSolution, a wholly-owned subsidiary of Har-ris Computer Systems, is a leading informationtechnology company, providing ERP software, so-lutions and services to healthcare and service sec-tor customers across North America.

Medworxx121 Richmond Street W, Suite 700Toronto ON M5H 2K1T: 416-642-1278 F: 416-847-0037E-mail: info@medworxx.comContact: Niels ToftingWeb: www.medworxx.comMedworxx provides solutions for Patient Flowand Compliance and Education.

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Merge Healthcare6303 Airport Road, Suite 500Mississauga ON L4V 1R8T: 1-800-724-5970 F: 1-905-364-8100E-mail: steve.schudlo@merge.comContact: Steve SchudloWeb: www.merge.comMerge is a leading provider of innovative enter-prise imaging, interoperability and clinical solu-tions that seek to advance healthcare. Merge’s en-terprise and cloud-based technologies for imageintensive specialties provide access to any image,anywhere, any time. Merge also provides clinicaltrials software and intelligent analytics solutions.For more information, visit merge.com and fol-low us @MergeHealthcare.

Microsoft Canada Inc.1950 Meadowvale BlvdMississauga ON L5N 8L9T: 905-568-0434 F: 905-568-1527E-mail: peter.jones@microsoft.comContact: Peter JonesWeb: www.microsoft.caMicrosoft and its partners empower health orga-nizations to improve collaboration, speed accessto actionable information, and gain useful and ac-tionable insights supporting better decisions.

Novari Health1473 John Counter Blvd, Suite 401Kingston ON K7M 8Z6T: 613-531-3008E-mail: jsinclair@novarihealth.comContact: John SinclairWeb: novarihealth.comeReferral, eBooking, Central Intake, Wait Times, WaitList Management, Surgical Bookings, and more...

Nuance CommunicationsOne Wayside RoadBurlington MA 01803 USAT: 888-471-3453 or 781-565-5000 F: 866-402-6384E-mail: Benjamin.Hebb@nuance.comContact: Benjamin HebbWeb: www.nuance.comNUANCE diagnostic solutions are powering anenhanced approach to clinical documentation,driving quality outcomes. PowerScribe® 360 is acritical component within the radiology workflowand a trusted solution enabling quality, efficient,structured yet personalized reporting.

OnBase by Hyland28500 Clemens RoadWestlake OH 44145 USAT: 1-440-788-5558E-mail: pj.carter@hyland.comWeb: www.onbase.comOnBase is a flexible enterprise content manage-ment (ECM) solution that helps healthcare organi-zations complete patient records, eliminate reim-bursement delays and enhance business processes.Tailored for departments and comprehensive forthe enterprise, OnBase gives you what you need to-day and evolves with you over time whether de-ployed via mobile, cloud or on-premises.

Orion Health120 Adelaide Street W, Suite 1010Toronto ON M5H 1T1T: 647-980-3617E-mail: karen.ewing@orionhealth.comWeb: www.orionhealth.comOrion Health is an award-winning populationhealth management company with proven experi-ence delivering eHealth solutions for healthcarefacilities, organizations and regions. Our productsinclude Clinical & Patient Portals, eReferral solu-tions, and integration tools delivered through ourRhapsody® Integration Engine.

PetalMD350 Blvd Charest E, Bur 300Québec QC G1K 3H5T: 888-949-8601 F: 888-949-8601E-mail: info@petalmd.comContact: Daniel BulotaWeb: www.petalmd.comPetalMD is a networking application featuringproductivity tools for healthcare professionals.Save time scheduling and collaborating. Whereever you are, anytime, on any device.

Philips Healthcare281 Hillmount RoadMarkham ON L6C 2S3E-mail: Darran.Fischer@Philips.comWeb: www.philips.com/healthcarePhilips is one of the world’s leading technologycompanies, driven by innovative solutions de-signed to improve patient outcomes, provide bet-ter value and expand access to care. Philips goal isto improve the lives of 3 billion people a year by2025 by creating innovations across the healthcontinuum from healthy living and prevention,through diagnosis, treatment, recovery andhomecare. www.philips.ca/healthcare

QuadraMed110, Cremazie Blvd W, 10th floorMontreal QC H2P 1B9T: 703-709-2455 F: 1-855-872-7430E-mail: GBujold@QuadraMed.comContact: Guy BujoldWeb: www.QuadraMed.comQuadraMed® is a leading provider of award-win-ning healthcare software and services that improvethe safety, quality, and efficiency of patient care.Founded in 1993, QuadraMed provides proven,flexible solutions that help make our clients suc-cessful by streamlining processes, increasing pro-ductivity, and driving positive clinical outcomes.Behind QuadraMed’s products and services is astaff of professionals who support clients at morethan 1,200 healthcare provider facilities acrossNorth America, Europe and Saudi Arabia.

Red Hat Inc.90 Eglinton Avenue E, Suite 502Toronto ON M4P 2Y3T: 888-733-4281 F: 416-482-6299E-mail: fsemaan@redhat.comWeb: http://redhat.comRed Hat provides the only fully open technologystack in addition to award-winning support, con-sulting, and training offerings. And with a fullyopen stack, you’re not locked in. You’re not limitedto a vendor’s vision of your future. Our core tech-nology products provide the capabilities needed todeploy a complete, high-performing IT infrastruc-ture that is flexible, scalable, and secure. Using ourcore products as a foundation, Red Hat’s open hy-brid cloud vision drives the our cloud capabilities.Our award-winning consulting and training offer-ings and certifications help customers fully utilizethe value of their subscriptions.

Rubbermaid Healthcare586 Argus RoadOakville ON L6J 3J3T: 416-460-5365 F: 289-291-5805E-mail: joe.teodoro@rubbermaidmedical.comContact: Joe TeodoroWeb: www.rubbermaidhealthcare.comPoint of care computer and medication mobileand wall mounted workstations. RubbermaidHealthcare, increasing the capacity to care.

Siemens Canada Limited1577 North Service Road E, 2nd FloorOakville ON L6H 0H6T: 905-465-8000 F: 905-465-8162E-mail: customeradvocate.ca@siemens.comWeb: www.siemens.ca/healthcareSiemens Healthcare is one of the world’s largestsuppliers to the healthcare industry and a trend-setter in medical imaging, laboratory diagnosticsand medical information technology. Siemens of-fers its customers products and solutions for theentire range of patient care from a single source –from prevention and early detection to diagnosis,and on to treatment and aftercare. By optimizingclinical workflows for the most common diseases,Siemens also makes healthcare faster, better andmore cost-effective.

SIMMS161 Eglinton Avenue E, Suite 701Toronto ON M4P 1J5T: 416-663-0200 F: 416-663-0020E-mail: Tamara@oursimms.comContact: Tamara GoochWeb: www.mysimms.comThe SIMMS Enterprise is a cloud based inte-grated PACS & RIS, ideal for small, medium andlarge size, single or multiple site IndependentHealth Facilities.

Speech Processing Solutions Canada Inc.140 Allstate Parkway, Suite 301Markham ON L3R 5Y8T: 877-773-3242E-mail: info.na@speech.comWeb: www.philips.com/dictationFor more than 50 years, Speech Processing Solu-tions is the driving force in delivering excellence inPhilips dictation and voice technologies. We con-stantly reinvent the world of digital dictation withground-breaking products such as the PhilipsSpeechMike Premium, the Philips Digital PocketMemo or Philips SpeechLive and Mobile DictationApps helping professionals to be productive.

Spok6850 Versar Center, Suite 420Springfield VA 22151 USAT: 1-800-611-8488E-mail: paige.hancock@spok.comContact: Paige HancockWeb: www.spok.comSpok is a leader in critical communications forhealthcare, public safety, and other industries. Wedeliver smart, reliable solutions to help protectpeople around the globe. .

Talk 2 Me Technology Inc.255 Dundas Street E, PO Box 82089Waterdown ON L0R 2M0T: 866-554-8877 F: 866-554-8833E-mail: info@talk2me.comContact: Charles MarriottWeb: www.talk2me.comCanada’s leading provider of professional dicta-tion, transcription and speech recognition solu-tions. Mobile, Cloud and Desktop solutions fromDragon, Philips & Olympus Dictation providerssince 1946!

TELUS Health1000 de Serigny Street, Office 600Longueuil QC J4K 5B1T: 1-866-363-7447 F: 450-928-6344Contact: http://www.telushealth.co/sales/Web: www.telushealth.coTELUS Health is a leader in telehomecare, elec-tronic medical and health records, consumerhealth, benefits management, and pharmacymanagement.

Terra Nova100 Elizabeth AveSt. Johns NL A1B 1S1T: 888-600-4178 F: 888-600-4178E-mail: adoster@terranovatrans.comContact: Maria FrenchWeb: www.terranovatrans.comTerra Nova specializes in clinical documentationsolutions for hospitals, medical clinics and physi-cian practices.

Toshiba of Canada LimitedMedical Systems Division75 Tiverton CourtMarkham ON L3R 4M8T: 905-470-3500 F: 905-470-3489E-mail: ToshibaMedical@toshiba.caWeb: www.toshiba-medical.caToshiba Medical Systems provides patient-focusedimaging technologies, including CT, Cath & EPLabs, X-Ray, Ultrasound, MRI and Multi-Modal-ity Thin Client Work Station solutions. Advancedservice solutions range from single-room cover-age to complete asset management programs.

Wellsoft Corporation27 World’s Fair DriveSomerset NJ 08873 USAT: 800-597-9909 F: 732-507-7199E-mail: wellsoft@wellsoft.comContact: Denise HelfandWeb: www.wellsoft.comWellsoft, developer and provider of the industry-leading EDIS since 1988 is consistently ranked #1in KLAS user surveys of EDIS time and again.

Wolters Kluwer | UpToDate230 Third AvenueWaltham MA 02451 USAT: 781-392-2000 F: 781-642-8890E-mail: enterprise@uptodate.comContact: Michele ConnorsWeb: www.uptodate.com/homeUpToDate®, part of Wolters Kluwer, is an evi-dence-based, physician-authored clinical decisionsupport resource used by over 1 million cliniciansworldwide. UpToDate’s world-renowned authors,editors and peer reviewers use a rigorous editorialprocess to synthesize the most recent medical in-formation into evidence-based recommendationsclinicians trust to make correct point-of-care de-cisions.

Zonare Medical Systems, a Mindray CompanyB20c Beaver AvenueBeaverton ON L0K 1A0T: 1-866-966-2730 F: 1-705-426-1554E-mail: info@zonare.caContact: Vince ArsenaultWeb: www.zonare.com, www.mindray.comZonare Medical Systems is a wholly owned sub-sidiary of Mindray Medical International(NYSE:MR) which is one of the leading globalproviders of medical devices and solutions. ZonareCanada offers a complete array of ultrasound so-lutions from hand-carried to cart-based systemsfor point-of-care ultrasound, general imaging andcardiology. Zonare joins Mindray in its commit-ment of providing exceptional “healthcare withinreach” through the company’s award winning nextgeneration Zone Sonography technology.

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© 2015 InterSystems Corporation. All rights reserved. InterSystems and HealthShare are registered trademarks of InterSystems Corporation. 2-15 Patient1CaHeTe

Using InterSystems HealthShare®, the Rhode Island Quality Institute’s health information exchange, CurrentCare, is helping everyone get the results they need. Patients are getting the safe quality care they need to feel better. Doctors and nurses are getting the information they need, when, where, and how they need it, to make the best care decisions.

“Aggregated and normalized patient data”? That’s one of many HealthShare capabilities for solving your toughest healthcare IT challenges.

Read a case study on Rhode Island Quality Institute and CurrentCare at InterSystems.com/Patient1W

“The comprehensive patient recordwe’re building with HealthShare is giving providers across the state the information they need to deliver thebest care.”

Laura Adams, President & CEO

Rhode Island Quality Institute

HealthShare transforms care by sharing health information

“Aggregated and normalized patient data?”

Frank just feels better.

A HealthShare Success Story: Rhode Island Quality Institute

Toshiba wishes to thank all of the

conference attendees for making the

2015 International CT Symposium

a wonderful success.

COMPUTED TOMOGRAPHY AT THE HEART OF INTEGRATED DIAGNOSTIC IMAGING

www.Toshiba-Medical.ca

Copyright © 2015 Toshiba of Canada Limited.

Dr. Frank Rybicki

The Ottawa Hospital

Lecture Topic: Face Transplant

Imaging with Wide Area

Detector CT

Dr. Donatella Tampieri

Montreal Neurological Institute

Lecture Topic: Multidetector

CTA in the Management of

Hemorrhagic Stroke

Dr. Russell Bull

Royal Bournemouth Hospital

Lecture Topic: AIDR 3D

Enhanced with the PUREViSION

Detector

Dr. Daniel Podberesky

Nemours Children’s Health System

Lecture Topic: Pediatric

Imaging

Dr. Patrik Rogalla

University Health Network

Lecture Topic: Dual-Energy

Imaging

Mme. Katia Kirpa

Montreal Neurological Institute

Lecture Topic: Protocols

and Techniques using

320 Multislice Scanner in

Cerebrovascular Disease

Dr. Almudena Perez

Montreal Neurological Institute

Lecture Topic: Applications

of Multidetector CT in other

Cerebro-vascular Diseases

Mr. Nagi Sharoubim

Radiation Protection and Quality Control

Lecture Topic: The Physics

of CT from the Dose

Perspective

Prof. Alain Blum

C.H.U. Central Hospital

Lecture Topic: 4D MSK

Imaging - Movement Analysis

and SEMAR

Dr. Dimitris Mitsouras

Harvard Medical School Brigham & Women’s Hospital

Lecture Topic: The Emergence

of CT Angiogram to Lesion

Hemodynamic Significance

Dr. Catherine Legault

Montreal Neurological Institute

Lecture Topic: Clinical

approach to Stroke: Ischemic

and Hemorrhagic Stroke

Dr. Marcus Chen

National Heart, Lung and Blood Institution

Lecture Topic: Cardiac Imaging

with Coronary Subtraction

Dr. Narinder Paul

University Health Network

Lecture Topics: Cardiac CT –

The New Frontier,

CT Lung Perfusion –

Techniques and Applications

Dr. Maria Cortes

Montreal Neurological Institute

Lecture Topic: Multidetector

CT in the Management Acute

Ischemic Stroke

A special thank you to all of our conference speakers. Their dedication to the field and knowledge they shared was insightful

and will help us all achieve our goals to provide the best possible care for our patients. The details of the scientific sessions

will be available soon on the conference web site (www.toshiba-medical.ca).