Hospital News 2016 June Edition by Hospital News

Using MRIs to predict kidney failure

Transforming shoulder care

FOCUS IN THIS ISSUE

HEALTH CARE TRANSFORMATION/ EHEALTH/MOBILE HEALTH/ MEDICAL IMAGING

www.hospitalnews.com JUNE 2016 EDITION | VOLUME 29 | ISSUE 6

Programs and initiatives that are transforming care and contributing to an effective, accountable and sustainable system. Innovations in electronic/digital process in healthcare, including mHealth (health applications on mobile devices). A look at medical imaging techniques for diagnosis, treatment and prevention of diseases.

INSIDE From the CEO’s desk ......................... 10 Nursing Pulse ..................................... 14 Legal Update ......................................15 Evidence Matters ...............................20 Safe Medication .................................22 Careers ...............................................23

There’s an

APP for that: Mobile health apps are changing healthcare. But are they effective? Private? Safe? Should we care? Story on page 16

1-866-768-1477

Focus

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

2 Photo courtesy of the UHN

1 A unit team participating in daily discharge rounds, where the team identifies patients leaving within 48 hours to make sure they are ready to go. 2 Georgeta Savu, nurse manager, University Health Network, works closely with her front line staff to reduce wait times for patients.

Lessons from the auto industry By Michael Ronchka urns outs an auto manufacturer has a thing or two to teach Canada’s largest teaching hospital. That’s why Toronto’s University Health Network (UHN) is taking a lesson from Toyota and designing patient care using a Lean management system. The approach provides employees with a systematic method for continuously improving the way an organization runs, by first standardizing processes and then making small, incremental changes in order to reach important goals. Decisions are based on data, and both errors and waste are reduced by making processes easy for staff to follow correctly. When a problem occurs, the root cause is identified before a solution is implemented. “Toyota has one of the most advanced process improvement cultures in the world,” says Brenda Kenefick, Director, Lean Process Improvement, UHN. “While people often tell me that treating sick people is very different from manufacturing cars, we can learn a lot from Toyota about how to create a culture where we achieve specific goals by teaching every single staff member how to identify problems, and develop effective solutions.” Such improvements are necessary for healthcare organizations to be able to meet the demands of an aging population while increasing the quality of care without substantial additional funding. The following examples from UHN show what can be achieved with a continuous improvement culture – safety improves, wait times shrink and patients go home sooner.

Improving safety

It was a moment three-and-a-half years in the making. The team on a spinal unit at Toronto Western Hospital (TWH) recently celebrated 60 days without a single patient developing a pressure ulcer. It’s a first for the team, and for UHN. And it’s particularly impressive given the limited mobility of the spinal injury patients the unit treats. Pressure ulcers occur when the skin breaks down due to prolonged immobility. HOSPITAL NEWS JUNE 2016

They are painful and notoriously difficult to heal once they develop. They are also preventable. “We work very hard to be preventative and proactive,” Rosemary Ritchie, the former nurse manager, now retired, says in explaining how her team reached this milestone. “We discuss every patient that comes on to our unit during our daily huddles. “If they are deemed at risk of developing a pressure ulcer, a fall or a urinary tract infection, we flag them on our risk board and act immediately by involving other team members or employing the necessary equipment to prevent harm.”

It turns out the best way to solve big, complex problems like wait times is to work with the people doing the job to solve the small, simple problems. The team also realized that to prevent pressure ulcers they needed to better educate patients and families on what happens if they don’t turn, or move. Patients can be totally dependent on others for their movement, and may not always want to mobilize. Educating them on why it is important to roll over or move to a chair helps the team blend their comfort and safety.

Reducing wait times

Some patients at Toronto Rehab are now getting in the door much earlier. And when it comes to rehabilitation, how soon a patient starts may affect their recovery. You might think reducing wait times comes at a cost – more infrastructure, more staff, more hours. But it turns out the best way to solve big, complex problems like wait times is to work with the people doing the job to solve the small, simple problems. By doing that, the Stroke Outpatient Rehab Clinic reduced its wait time from 15 days to six. Clinic patients need to see up to three clinicians in one day, three days a week, for at least four weeks. It’s a scheduling

challenge that the team used to manage by meeting once a week to find a way to fit in all their new patients. By finding a new way to schedule the team can now come up with appointments as soon as the referral is received. “You have to be adaptable,” says Georgeta Savu, manager, Stroke Rehab Outpatient Rehab Clinic, Toronto Rehab. “In order to make any changes work, you’ve got to be prepared to measure them, evaluate and make changes when necessary. “Most importantly the team knows their goal, and came up with the solutions themselves. It’s a significant change and one that was achieved by the team.”

Streamlining discharge

The longer a patient spends in a hospital, the more time they spend at risk of a fall, a medication incident or acquiring an infection. That’s why hospitals need to discharge people as soon as they are ready to go – getting them to the right place at the right time. One unit at the Peter Munk Cardiac Centre (PMCC) has done just that. “We’re not doing this to create more bed space,” says Jeanne Elgie-Watson, nurse manager, PMCC. “In our effort to become a high-reliability organization, we need to look at reducing length of stay as a fundamental part of improving patient safety.” Patients on her cardiovascular surgery unit are heading home with or without support, on average, just over a full day earlier than they were three months prior. That’s a 16 per cent reduction in length of stay, down to 6.1 days from 7.3 in just 12 weeks. “We achieved that by smoothing out the barriers to timely discharge,” says Jeanne. “The work started with help from the Lean Process Improvement team in our Rapid Improvement Event and it’s continued every day since in our huddles.” While the team made numerous minor changes to the discharge process, much of the improvement stems from three major changes: • Ensuring test results are ready in time to discharge the patient.

• Continuous communication of an upto-date discharge plan to the patient and their family. • Daily huddles implemented by the clinical team to discuss process problems and discharge rounds so as to identify patients who will be ready for discharge within 48 hours. “The medical team usually needs the results from morning blood tests and echocardiograms before discharging anyone,” says Jeanne. “The night shift now draws blood by 6 a.m. for patients we’re planning to discharge that day. “By starting the process earlier, we get results back in time to make decisions.” After surgery most patients need family support to safely transition back home. The team communicates the estimated discharge date to the family two days in advance, giving them some time to make arrangements for transportation and home care. The engine driving these improvements has two components. The first part is the team’s daily huddle where they address process problems, and the second part is their new discharge rounds. At 1:30 p.m. every day, the entire team gathers for 15 minutes to identify any patients who will be ready for discharge in the next 48 hours and discuss their individual needs or outstanding tests. The unit’s target length of stay is six days. When they beat it, they celebrate as a team. When they meet it, they record it as a success on their performance board. When a patient is discharged on day seven or later, they find out why. Often a delayed discharge is because the patient required more medical care. If the delay was due to a problem with the discharge process the team is reluctant to simplify; they dig into the root cause and address it. “Everyone knows our goal, and we work together to achieve it,” says Helen Zhang, a Nurse Practitioner at PMCC. “Whenever a patient is ready to go home H by day six after surgery, we cheer.” ■ Michael Ronchka is a Communications Associate at University Health Network. www.hospitalnews.com

In Brief

Transplants:

Canadians facing delayed access to

innovative Three life-saving performed every day medicines Last year in Ontario, 1,173 patients on the transplant wait list were given a second chance at life because of the generosity of organ donors and their families. For the second year in a row, Trillium Gift of Life Network reports a record number of deceased organ donors and patients who received a life-saving transplant. Between April 1, 2015 and March 31, 2016, 296 deceased organ donors gave

the gift of life, an increase of nine per cent over last year (and a 61 per cent increase over 10 years). More than 2,200 tissue donors enhanced the lives of thousands through the gift of corneas, skin, bone and heart valves, up 16 per cent from 2014/15. “Another record year in Ontario confirms that improvements to the donation and transplant system are taking hold,

and translating to more lives saved,” says Ronnie Gavsie, President and CEO of Trillium Gift of Life Network. “We are making progress towards our goal: to ensure that donation is an integral part of quality end-of-life care and that when donation is possible, every family is given the opportunity to save lives.” Also, in 2015/16, over 340,000 Ontarians registered as donors, the highest number ever recorded in one year. By age of consent, 20-29 year olds continue to be most likely to register (22 per cent), compared to all other age groups. “Ontario’s record donation and transplant results should give hope to the 1,600 people who wait for that second chance at life,” says Dr. Eric Hoskins, Ontario’s Minister of Health and Long Term Care. “All of us can help make a difference. Register to be an organ donor at www.BeADonor.ca and talk to your family about your wishes. This act could one day save up to eight lives.”

Quick facts:

•Today, Ontario’s registration rate is 29 per cent (or 3.5 million people) •Registration rates by community are available at www.BeADonor.ca/scoreboard •Everyone is a potential organ and tissue donor. To date, the oldest Canadian organ donor was 92 and the oldest tissue H donor was over 100. ■

Taking seniors off antipsychotics shows dramatic improvement in care The Canadian Foundation for Healthcare Improvement (CFHI) recently released dramatic results from a bold pan-Canadian initiative reducing the inappropriate use of antipsychotic medication among seniors in long term care (LTC) – fewer falls, less aggressive behaviours and resistance to care, and an improved quality of life for residents and their families. From 2014-2015, CFHI worked with 56 LTC homes that agreed to take senior residents off any antipsychotics that weren’t appropriately prescribed. “Antipsychotics are often used in patients with dementia to curb resistance to care and other challenging behaviours,” says Stephen Samis, Vice President, Programs, CFHI. “But they provide limited benefit and can cause serious harm and complications from overuse – especially falls, which ultimately lead to unnecessary visits to the emergency room. With this initiative to reduce use, LTC providers report improved care for residents and a better culture at their facilities. Most important, family members say they now have their loved ones back.” After only one year, early results from a sample of 416 residents from the facilities showed: www.hospitalnews.com

•54 per cent of residents had antipsychotics discontinued or significantly reduced (18 per cent reduced; 36 per cent complete eliminations). •Among these residents: – Falls decreased by 20 per cent – Verbally abusive behaviour decreased by 33 per cent – Physically abusive behaviour decreased by 28 per cent – Socially inappropriate behaviour decreased by 26 per cent – Resistance to care decreased by 22 per cent “A major concern of removing the antipsychotic medication was the potential of increasingly aggressive behaviour. Aggression is what typically triggers the use of antipsychotics in the first place. Our initiative not only showed a notable decrease, it took that issue off the table,” says Samis. Recent studies show that more than one-in-four (27.5 per cent) seniors in Canadian long term care facilities is on antipsychotic medication without a diagnosis of psychosis. If the results of the CFHI initiative were scaled up nationally, over the first five years an estimated:

• 35,000 LTC residents per year would have their antipsychotics reduced or discontinued. • 25 million antipsychotic prescriptions would be avoided altogether • 91,000 falls would be prevented • 19,000 ER visits would be prevented (an eight per cent decline) • 7000 hospitalizations would be prevented (an eight per cent decline) “CFHI projections also show $194 million saved in direct healthcare costs – even after the costs of implementing the program are taken into account,” says Samis. CFHI is calling for: • Long term care homes and provincialterritorial governments to step up efforts to change the culture of over-medicating seniors with dementia, and increase access to alternate behavioural support programs. • Healthcare providers to take better patient histories, conduct more regular medications reviews and work as care teams with family members. • Frontline staff in LTCs to tailor services – including music, pet or recreation therapy that replace strong medications – to support quality of care and quality of H life for residents. ■

Canadians face wait times of about 449 days in order to get access to new, potentially lifesaving medicines in public drug plans, according to a new IMS Health Canada Inc. report commissioned by Innovative Medicines Canada. The 2016 Access to New Medicines in Public Drug Plans: Canada and Comparable Countries analyzed reimbursement for new medicines in provincial drug plans comprising at least 80 per cent of the eligible national drug plan population. The report finds Canada’s public drug plans are seriously lagging compared to other similar OECD nations. “Compared to similar countries, Canadian patients have access to fewer new medicines and also face long delays for the drugs that are covered under public drug plans,” says Brett Skinner, Executive Director, Health and Economic Policy, Innovative Medicines Canada. Canadians who rely on public drug plans are facing more than a year’s delay to access new, potentially lifesaving treatments. This report shines the light on why access to medicines in Canada needs to be improved – patients must come first. • In Canada, 59 per cent of cancer medicines were covered in public drug plans, ranking Canada in 17th place of 20 countries. • Canadian public drug plans placed reimbursement conditions on 90 per cent of new medicines, ranking Canada 17th of 20 countries. • In Canada, only 23 per cent of new biologic medicines were reimbursed in public drug plans, putting Canada in 19th place of 20 countries. Innovative Medicines Canada is the national voice of Canada’s innovative pharmaceutical industry. We advocate for policies that enable the discovery, development and commercialization of innovative medicines and vaccines that improve the lives of all Canadians. We support our members’ commitment to being valued partners in the H Canadian healthcare system. ■

PD WORKSHOPS • Phlebotomy • Injections • ECG • OSMT MLA/T exam prep • Urinalysis CALL ABOUT OUR DIPLOMA PROGRAMS Classes Starting Monthly

3025 Hurontario St, Mississauga, ON

905-361-2380

1830 Bank Street, Ottawa, ON

613-722-7811

www.algonquinacademy.com JUNE 2016 HOSPITAL NEWS

Guest Editorial

UPCOMING DEADLINES JULY 2016 ISSUE EDITORIAL JUNE 10 ADVERTISING: DISPLAY JUNE 24 CAREER JUNE 28 MONTHLY FOCUS: Cardiovascular Care/Respirology/ Diabetes/Complementary Health:

Developments in the prevention and treatment of vascular disease. Advances in treatment for various respiratory disorders. Prevention, treatment and long-term management of diabetes and other endocrine disorders. Examination of complementary treatment approaches to various illnesses.

AUGUST 2016 ISSUE EDITORIAL JULY 11 ADVERTISING: DISPLAY JULY 22 CAREER JULY 24 MONTHLY FOCUS: Pediatrics/Ambulatory Care/ Neurology/Hospital-based Social Work: Pediatric programs and developments in the treatment of paediatric disorders including autism. Specialized programs offered on an outpatient basis. Developments in the treatment of neurodegenerative disorders traumatic brain injury and tumours. Social work programs helping patients and families address the impact + ANNUAL PEDIATRIC SUPPLEMENT

THANKS TO OUR ADVERTISERS

Hospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News.

A LEGACY THAT WILL KNOW NO BORDERS

LEAVE A GIFT IN YOUR WILL TO MSF Help us provide medical assistance wherever the need is greatest by remembering Médecins Sans Frontières/ Doctors Without Borders with a gift in your will. For information, contact Emily Harris: 1-800-982-7903 or emily.harris@msf.org msf.ca/mylegacy

Why American doctors are calling for

Canadian-style medicare

And how Canada risks losing the health advantage it has By Karen Palmer

n a dramatic show of physician support for deep healthcare reform in the U.S, more than 2,200 physician leaders have signed a “Physician’s Proposal” calling for sweeping change. The proposal, published May 5 2016 in the American Journal of Public Health, calls for the creation of a publicly-financed, single-payer, national health program to cover all Americans for all medically necessary care. If that sounds familiar, it should. These American doctors are calling for Canadian-style medicare. They want a decisive break from the expensive and inefficient private insurance industry at the heart of the U.S. healthcare system. How ironic that at the same time U.S. physicians are calling for a single-payer health system like ours, Canada is in the midst of a legal battle threatening to pave the way for a multi-payer system resembling what has failed Americans. What’s at stake? A trial about to begin in British Columbia threatens to make the Canada Health Act unenforceable. The Canada Health Act is federal legislation that guides our healthcare system. It strongly discourages private payment for medically necessary hospital and physician services covered under our publiclyfunded medicare plans. This includes outof-pocket payments in the form of extra billing or other user charges. Legislation in most provinces further prohibits private insurance that duplicates what is already covered under provincial plans. If patients are billed for medically necessary hospital and physician care, the federal government is mandated to withhold an equivalent amount from federal cash transfers to provinces or territories violating the Act. At least that’s what supposed to happen. Unfortunately, the last decade saw a proliferation of extra billing in several provinces, and few instances of government clawing back fiscal transfers. Perhaps, things will change. Minister Philpott recently stated that the government will

ADVISORY BOARD Cindy Woods,

Senior Communications Officer The Scarborough Hospital,

Barb Mildon,

RN, PHD, CHE , CCHN(C) VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189

www.hospitalnews.com

EDITOR

KRISTIE JONES

editor@hospitalnews.com ADVERTISING REPRESENTATIVE

DENISE HODGSON denise@hospitalnews.com PUBLISHER

STEFAN DREESEN CREATIVE DIRECTOR

LAUREN REID-SACHS SENIOR GRAPHIC DESIGNER

JOHANNAH LORENZO facebook.com/HospitalNews

HOSPITAL NEWS JUNE 2016

“absolutely uphold the Canada Health Act.” In BC’s upcoming trial, the plaintiffs – including two for-profit investor-owned facilities, Cambie Surgery Centre and the Specialist Referral Clinic – are attempting to have the court strike down limits on private payment. They support the creation of a constitutionally protected right for physicians to bill patients, either outof-pocket or through private insurance, for medically necessary care, while also billing the public plan.

The outcome of this trial could be that those who can pay for care would jump the queue, drawing doctors and other resources out of the public system. In other words, the plaintiffs want to undo our elegantly simple single payer system for hospital and physician care, creating instead a multi-payer system like the U.S. If their constitutional challenge is successful, the door will swing wide open in BC – and across Canada – for insurers to sell what will amount to “private queue jumping insurance” for those who can afford it, potentially harming the rest of us who can’t. The outcome of this trial could be that those who can pay for care would jump the queue, drawing doctors and other resources out of the public system. Those who can’t pay would likely wait longer. Rather than a solution for wait times, private payment in the Canadian context would make them worse. Global evidence shows that private insurance does not reduce public system wait times. The Achilles’ heel of health care in several European countries, such as Sweden, has been long waiting times for diagnosis and treatment in several areas, despite some private insurance. After Aus-

Helen Reilly,

Publicist Health-Care Communications

Jane Adams,

President Brainstorm Communications & Creations

GRAPHIC DESIGNERS

ANGEL EVANGELISTA CAROLINE PAPINEAU NICK MCGRAW RENATA VALZ JEFF CHARD ARUN PRASHAD ALICESA LAROCQUE KATHLEEN WALKER STEPHANIE GIAMMARCO BILLING AND RECEIVABLES

MATTHEW PICCOTTI PHIL GIAMMARCO

Karen Palmer is an advisor with EvidenceNetwork.ca, and Adjunct Professor in the Faculty of Health Sciences at Simon Fraser University.

Bobbi Greenberg,

Health care communications

Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross,

B.A., MS.C., DC, CSM (OXON), MBA, CHE Dean, Health Sciences and Community Services, George Brown College, Toronto, ON

Akilah Dressekie,

Ontario Hospital Association

David Brazeau

Director, Public Affairs, Community Relations and Telecommunications Rouge Valley Health System

tralia introduced private insurance to save the government money, those with private insurance have faster access to elective surgery than those without. Divisions in equitable access to care is one of the biggest challenges now facing countries that have adopted multi-payer systems. Multi-payer systems are administratively complex and expensive, explaining why the U.S. health insurance industry spends about 18 per cent of its health care dollars on billing and insurance-related administration for its many private plans, compared to just two per cent in Canada for our streamlined single payer insurance plans. Hospital administrative costs are lowest in Canada and Scotland – both single payer systems – and highest in the US, the Netherlands, and the UK – all multi-payer systems. For all of its warts in how we deliver healthcare in Canada, the way in which we pay for care – a single public payer in each province or territory – avoids the high administrative costs of multi-payer systems. Abundant evidence shows private insurance is at the root of what ails the U.S. system. Dr. Marcia Angell, co-author of the Physicians’ Proposal, Harvard Medical School faculty, and former editor-inchief of the New England Journal of Medicine, sums it up: “We can no longer afford to waste the vast resources we do on the administrative costs, executive salaries, and profiteering of the private insurance system.” A Canadian-style single payer financing system would save the U.S. about $500 billion annually. Meanwhile, in Canada, abandoning our single payer health care system for a U.S.-style multi-payer system would be the worst possible outcome for Canadians. Let’s hope the evidence convinces the H judge. The trial begins September 2016. ■

ASSOCIATE PARTNERS:

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@hospitalnews.com Canadian Publications mail sales product agreement number 40065412.

www.hospitalnews.com

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Focus

Improving patient care by

connecting medical records By Leela Holliman

hen patients sit in front of a clinician, whether in a hospital Emergency Department (ED), an urgent care centre or a community practice, they may already have received care from dozens of other physicians, specialists and care providers. To fully understand the patient’s medical condition and to offer the best and most timely care, that physician ideally wants to know what all of those other clinicians know. He or she needs the patient’s medical information. But patients rarely travel with their medical data, which means that the attending physician may have to spend time phoning around to other institutions, seeking the patient’s latest lab results or medical images, or even their medication history. Without this data, the physician may be forced to send the patient for duplicate and potentially unnecessary tests, or unknowingly begin treatment that may conflict with the patient’s current care. More than just an inconvenience and burden to everyone involved, the lack of a patient’s medical data may significantly compromise his or her care. Recognizing this concern, Markham Stouffville Hospital (MSH) recently implemented an electronic health information sharing platform known as Connecting GTA (cGTA). Part of eHealth Ontario’s larger Connecting Ontario initiative, cGTA integrates electronic health records through a centralized database. “By seamlessly and securely linking through our hospital information system, our clinicians have ready access to a provincial patient data repository,” explains MSH CIO Lewis Hooper. “Such access allows our clinicians to view information critical to our patients and their care.” The system also limits the burden on patients who may already be overwhelmed by their current medical concern, particularly in an emergency situation where the patient may not have had time to bring their records from home. Or in situations where patients may be experiencing cognitive impairments or language barriers that further complicate already challenging conversations. MSH is part of the first expansion wave of cGTA participants, the earlyadopter phase linking 40 healthcare service organizations including 11 hospitals, which are already sharing patient data and populating the repository. MSH was the first hospital to link to cGTA with a new version of a prominent hospital information system, which presented the organization a unique obstacle to overcome. This meant that MSH needed to work with the systems’ designers to create an entirely new way to link the two resources while maintaining important features such as single-sign-on. The one-click, or single-sign-on, system design allows clinicians to access the cGTA repository without having to open a second portal, further streamlining access to vital patient information. As well, the restriction to a single log-in improves

www.hospitalnews.com

Dr. Lee accessing patient data from cGTA with a colleague to ensure they have the information they need to support the care plan. the system’s security, helping to ensure that personal medical information is only seen by those authorized to view it. “We’re already seeing the benefits of the new system,” says General Internal Medicine Lead Dr. Allan Yee. “The rapid access to a patient’s previous care from connected organizations, and lab results from across the province gives us the information we need to support medical decision-making. This is health data sharing at a level that provides us access when and where we need it the most.” For example, ED physician Dr. Sonia Sabir lauds the ability to see clinical lab results from facilities throughout Ontario, thinking of one case where her next

More than just an inconvenience and burden to everyone involved, the lack of a patient’s medical data may significantly compromise his or her care. treatment decision hinged on knowing how well the patient’s kidneys were functioning. “The cGTA viewer allowed me to easily compare lab results from different hospitals to see that there was no

worsening of the patient’s renal function over time,” she says. The MSH implementation has also shown benefits from quite unexpected directions. Kris Bayley, an ED nurse, recounted an incident involving a patient who was new to MSH and was presenting with suspicious behaviour. Checking cGTA for the patient’s medical history, she found more than 20 visits to various facilities in the region, all within the last few months. Just by looking at the patient’s ADT (admission-discharge-transfer) information, the nurse realized that the numerous visits suggested drug-seeking behaviour by the patient, and she was able to act accordingly. As MSH was the first hospital to link cGTA to the new version of the hospital information system, the design solution will be shared with other institutions using the same vendor as cGTA rolls out across the province and with early adopter organizations as they upgrade to the same version. As for MSH itself, the organization has begun the next phase of populating the cGTA repository with patient data. This completes the information loop and further strengthens cGTA and enhances the quality of patient care for all participating organizations. “We want to be sure we contribute information quickly,” offers Hooper. “It’s great that we can view the data from cGTA, but it is just as important that we add whatever data we have to ensure opH timal care to all patients in Ontario.” ■ Leela Holliman is a Project Manager at Markham Stouffville Hospital and led the implementation of ConnectingGTA.

JUNE 2016 HOSPITAL NEWS

Focus

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Using MRIs to predict kidney failure By Geoff Koehler ne in every two patients diagnosed with kidney failure will not be alive in three years. “The major reason that kidneys fail is scarring,” says Dr. Darren Yuen, a nephrologist with St. Michael’s Hospital. “If we could figure out who has a lot of scarring, we could better predict which patients are most likely to develop kidney failure and treat these patients more aggressively.” Scarring is irreversible and can cause ongoing kidney injury that eventually leads to kidney failure. Regardless of whether a patient has diabetes, high blood pressure or another condition affecting the kidney, all these diseases can cause scarring, which ultimately can lead to organ failure. Needle biopsy is the current “gold standard” diagnostic test for assessing kidney scarring. A long needle is injected into the kidney and a sample – about the size of a mechanical pencil’s tip – is removed from the organ. “The problem with biopsy is that such a small sample means even after patients undergo this painful test, we still don’t know what most of the kidney looks like,” says Dr. Yuen, who is also a scientist in the hospital’s Keenan Research Centre for Biomedical Science. “The sample may show no scarring, but the rest of the organ may be severely scarred. We have no way

Drs. Kirpalani and Yuen shared their translational research project with donors at the St. Michael’s Foundation’s Angels’ Den event. The pair was runner up and awarded $80,000 from the foundation’s Translational Innovation Fund. of knowing and so clinicians are hesitant to subject patients to a test that provides limited information and has risks such as internal bleeding.” Dr. Yuen teamed up with Medical Imaging specialists Dr. Anish Kirpalani and Dr. General Leung to apply and study a specific magnetic resonance imaging test – called an elastogram – and its ability to detect scarring in transplanted kidneys. If their new MRI technique is able to quickly and clearly tell the difference between mild and severe kidney scarring, it may prove particularly helpful for kidney transplant patients. “In the first year after surgery, patients with transplanted kidneys generally do very well,” says Dr. Yuen. “Their long-term prognosis, however, is unfortunately not as good.” Ten years after transplantation, up to 60 per cent of patient’s kidneys have some degree of scarring that can cause kidney failure. “We’ve begun using MRI to measure a transplant kidney’s stiffness,” says Dr.

Kirpalani, a radiologist and director of St. Michael’s MRI Research Centre. “Stiffness is an early sign of scarring, and this has been shown with MRI in organs other than the kidney. Healthy tissue is more flexible whereas scar tissue is more rigid.” The team has begun studies to evaluate whether MRI can measure kidney scarring in patients more safely and accurately than biopsy. Unlike biopsy, the MRI test does not require needles or injections and MRI can analyze the whole organ for scarring, rather than just the small biopsy sample. “We’ve already tested this technique in more kidney transplant patients than anywhere else in the world,” says Dr. Kirpalani. “If we’re able to detect scarring more safely and accurately than a needle biopsy, we may be able to better guide how kidney transplant patients are treated early on and improve their H long-term outcomes.” ■ Geoff Koehler works in communications at St. Michael’s Hospital.

Photo courtesy of Dr. Kirpalani and Dr. Leung, St. Michael’s MRI Research Centre

The top two images compare mild and severe scarring using conventional MRI technique. The bottom two images contrast mild and severe kidney scarring with the new MRI technique being tested in transplanted kidneys at St. Michael’s.

Hospital Professionals. We Care For You.

joinopseu.org HOSPITAL NEWS JUNE 2016

organizing@opseu.org

844-677-3848 (OPSEU 4 U)

facebook.com/joinopseu www.hospitalnews.com

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Focus

Cancer support in the palm of your hand By Alaina Cyr & Matt Turczyn he Princess Margaret Cancer Centre recently launched a free app which helps guide patients and families throughout the cancer treatment process, from diagnosis through to after treatment. Many people find themselves feeling overwhelmed following a cancer diagnosis. The stress of not knowing what happens next, what questions to ask, or where to find help can lead patients to feel out of control. The Princess Margaret Cancer Journey app was designed to give patients a place to start.

The Princess Margaret Cancer Centre recently launched a free app which helps guide patients and families throughout the cancer treatment process, from diagnosis through to after treatment. Since 2011, the Princess Margaret has provided patients with a comprehensive, patient-focused cancer guide in the form of the My Cancer Journey Personal Guide Book, a three-ring binder full of helpful materials developed by the Patient & Family Education program in consultation with patients and clinicians. The My Can-

www.hospitalnews.com

cer Journey Personal Guide Book aims to develop patients’ self-management skills and self-efficacy through the provision of timely information, leading to improved clinical outcomes. With the booming popularity of mobile apps, the Patient & Family Education program worked with Princess Margaret’s Web & Digital Innovation team to adapt the Guide Book into a downloadable app, giving patients more choice for accessing this information. By adapting the trustworthy health information from the Guide Book and leveraging the strengths of mobile

technology, the Cancer Journey app provides a convenient, portable complement to the binder. Like the Guide Book, the Cancer Journey app is organized by the different phases of the cancer experience, providing information such as articles on what patients can expect at each phase of the cancer journey, examples of questions they may want to ask their healthcare team, and descriptions of services available at the Princess Margaret and in the community. The Cancer Journey app also allows patients to take notes, write down questions they’d

like to ask their healthcare team, and keep track of their doctor’s contact information. The mobile adaptation enhances the Guide Book by providing additional features that benefit patients. Patients with visual impairments or limited English proficiency can use Apple’s VoiceOver or Google’s TalkBack text-to-speech technologies to listen to information rather than read. Patients can view websites with more details or call services at the tap of a button. The app provides instantaneous access to the latest and most up-to-date brochures, physician and services details, and health information as Princess Margaret information databases are updated. The Princess Margaret offers quality educational materials in multiple media formats to provide patients with options to learn the information they want and need in ways that meet their learning preferences. Helping patients become active participants in their care leads to improved feelings of control and ultimately increases their quality of life. The app was made possible by the Zas and Stella Ruth Feitelson Patient Education Fund at The Princess Margaret Cancer Foundation. Download the free app by searching for “Princess Margaret Cancer Journey” in H Google Play or the Apple App Store. ■ Alaina Cyr & Matt Turczyn are members of the Princess Margaret Web & Digital Innovation Team.

JUNE 2016 HOSPITAL NEWS

Focus

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Transforming shoulder care By Jennifer R. Collins and Farah Nabi

magine not being able to work or run your business, or that you are a grandparent who cannot push their grandchild

on a swing. Imagine not being able to sleep through the night, or that you are a paramedic who cannot lift a stretcher. Every year, over 30,000 people in the Central East Local Health Integration Network (Central East LHIN) visit their primary care provider (PCP) because of shoulder pain. Shoulder pain is second only to low back pain in terms of disability and costs. Patients often experience 12 to 18 months of unresolved pain and discomfort before being referred on to an orthopaedic surgeon. During this time, many patients remain without a concise diagnosis, while receiving unnecessary diagnostic tests, ineffective medication and physiotherapy, only to return to their PCP several times before being referred on to a specialist. Remarkably, only one in twenty-five shoulder complaints result in surgery. The majority of issues can be solved through non-surgical interventions that do not automatically require a surgeon’s attention. In Ontario, lengthy wait times to see an orthopaedic surgeon persist in many LHINs, and thus it is not surprising that about 40 per cent of the shoulder patients in the Central East LHIN receive their shoulder care outside of their region. With this in mind, Rouge Valley Health System has developed a novel specialty care program. Designed and led by Rouge Valley’s own shoulder surgeons, The Shoulder Centre is transforming the way shoulder pain is treated: redefining and shortening the patient journey, increasing the ease and access to consistent and quality care, as well as addressing system inefficiencies that challenge health service sustainability.

“For primary care providers, determining the next course of action for a patient who comes to them with shoulder pain can be difficult and frustrating,” says Dr. Stephen Gallay, Division Head of Orthopaedics at the Rouge Valley Ajax and Pickering hospital campus and one of the founders of The Shoulder Centre. “They often order diagnostic tests (including costly MRIs) and try multiple treatments, all in the effort to return the patient to a pain-free state. The patient is then referred to a shoulder surgeon – sometimes three to twelve months after their first appointment with their PCP – and often without having received a concise diagnosis.”

Every year, over 30,000 people in the Central East Local Health Integration Network (Central East LHIN) visit their primary care provider (PCP) because of shoulder pain. In contrast, The Shoulder Centre’s new model of care immediately connects the PCP and their patient with the right shoulder specialist. To do this, the Centre developed a new intelligent e-referral tool to guide the PCP through a more succinct assessment of their patient’s shoulder pain at the time of the patient encounter. The referral tool generates a report that is triaged to establish which member of the Centre’s multidisciplinary shoulder specialist team will take charge of the patient’s care. Only then are evidence-based diagnostics used (if needed) to determine the appropriate and most effective treatments, which could mean anything from a cortisone injection performed by a physician assistant or sports medicine physician,

EMERGENCY LOANS FOR HOMEOWNERS! WE REPRESENT OVER 400 LENDERS

Manny provides 1st, 2nd and 3rd mortgages even with:

• Horrible Credit • Bankruptcy • Unemployed • Power of Sale • Mortgage Arrears • Property Tax Arrears • Self-Employed • Pension & Disability

Does your bank offer payments THIS LOW? Mortgage Amount

Monthly Payment

Bi-Weekly Payment

$200,000 $220,000 $240,000 $260,000 $280,000 $300,000 $320,000 $340,000 $360,000 $380,000

$677.03 $744.73 $812.44 $880.14 $947.84 $1,015.55 $1,083.25 $1,150.95 $1,218.65 $1,286.36

$312.33 $343.56 $374.79 $406.02 $437.26 $468.49 $499.72 $530.95 $562.19 $593.42

$400,000 $1354.06 $624.65 As of February 16, 2016, OAC - Based on 5 Year Term & 35 Years Amortization

Licence # 12079 Mortgage Agent Manny Johar

Rates from

2.10%!

Amortization up to

35 Years!

“My husband lost his job. We fell behind on our mortgage. The bank was seizing our home. I still can’t believe that you gave us an emergency mortgage with no proof of income. You saved our home & gave us extra cash to get by until he finds another job. Thanks Expert Mortgage!” C.S.

Call Manny 7 DAYS A WEEK

1.888.646.7596 or www.MannyJohar.ca Ask him about COMMERCIAL – FARM – CONSTRUCTION loans!

Manny Johar is Ontario’s mortgage SUPERSTAR! HOSPITAL NEWS JUNE 2016

Orthopedic surgeon Dr. Joel Lobo performs an assessment on Sharon Graves at Rouge Valley Ajax and Pickering hospital campus in Ajax. In just its first three months, Dr. Lobo and The Shoulder Centre’s team have shortened patients’ wait times to between 2-3 weeks to see a shoulder specialist, and demonstrated significant cost savings to the healthcare system. to a customized exercise program crafted by a physiotherapist, to surgery booked with an orthopaedic surgeon. Relying on a team rather than on an individual to provide care means the patient is seen sooner. And that means the patient will be pain-free faster. Just in its first three months, The Shoulder Centre’s team has shortened patients’ wait times to between two to three weeks, and demonstrated significant cost savings to the healthcare system. “We’re really excited that we’ve been able to add a physician assistant [PA] to our team. We’ve trained her to provide exemplary shoulder care to many of our nonsurgical shoulder patients so they don’t have to wait to see one of the surgeons. From a system perspective, the PA is delivering the same quality of care for a particular problem within her scope of practice at a fraction (approximately 25 per cent) of the usual cost that would be charged to OHIP if one of the surgeons treated the patient,” explains Gallay. “We’ve also projected that with patients being referred directly to The Shoulder Centre, we can reduce the number of MRI tests by twothirds… that also leads to significant system savings especially when an MRI is priced at $500-$800 a test.” The next step for the Centre is to empower and educate local PCPs and other allied health providers with shoulder knowledge. Thus the Centre will no longer be just a physical space that patients must travel to, but rather the hub of a specialty care community comprising of information and expertise that can be found throughout the network. Patients can then stay close to home, but still be confident that they are receiving consistent and quality shoulder care. “The goal of this model of care is for the patient to easily and quickly reach the right care at the right time, and to also make it efficient and sustainable. We’re starting with transforming shoulder care,

Question & Answer Q. How many patients in Ontario’s Central East LHIN go to their family doctor for shoulder complaints? A. Approximately 30,000 per year Q. Has The Shoulder Centre reduced the average wait time for specialized services? A. Yes! Lengthy wait times have been shortened to 2-4 weeks. Q. How many patients with a shoulder complaint require surgery? A. Only approximately 4-5 per cent Q. What is the effect on the health care system of The Shoulder Centre reducing the number of unnecessary diagnostic tests being ordered? A. If the patient is managed by the new Shoulder Care Community, The Shoulder Centre is projecting that it can reduce the number of MRI tests ordered by two-thirds, consequently saving the health care system $500-$800 per test but recognize that this model is transferable to other areas in health care,” concluded Gallay. For more information about The Shoulder Centre located at Rouge Valley Health System as well as to download the referral H form, visit www.theshouldercentre.ca. ■ Jennifer R. Collins is a Special Projects Officer at Rouge Valley Health System Foundation And Farah Nabi, is Interim Manager of Outpatient Orthopaedics, Rouge Valley Health System. www.hospitalnews.com

Focus

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

New service offers faster assessment for

cancer patients with urgent symptoms By Debbie Silva t is not uncommon for cancer patients undergoing treatment to experience side effects or sometimes painful complications that need to be addressed in an urgent manner. The Regional Cancer Centre at Trillium Health Partners developed a new program to address this and improve patient care.

The REACT clinic revolves around the patient experience. It provides a quick response to our patient’s concerns... The REACT: Rapid Evaluation and Assessment of Cancer Treatment clinic was designed as a patient-centred service offering patients undergoing cancer treatment at Trillium Health Partners’ Credit Valley Hospital site a more timely option for assessing their urgent symptoms and sideeffects from treatment within 30 days of their last treatment. Ted Goodwin was in the midst of undergoing his first round of chemotherapy treatments when he developed a severe pain in his back and began to feel unwell.

He knew something was wrong and that he needed immediate help with his symptoms. “It was like a two-by-four was shoved in my back,” described Ted, 54. Unbeknownst to him, his lungs were filling up with fluid. Ted placed a call to his primary care nurse at Trillium Health Partners’ Carlo Fidani Regional Cancer Centre, who directed him to the REACT clinic. Upon his arrival, he was assessed by the REACT oncology nurse and treated a few hours later by a general practitioner specializing in oncology. “I felt so relieved,” says Ted. “I received great care and they took care of my immediate needs in an efficient and timely manner. It left me with peace of mind that I was in good hands.” When a patient calls the REACT clinic they are immediately connected with an oncology nurse who will assess the patient’s condition and recommend next steps, with help from a general practitioner specializing in oncology and the medical and radiation oncology team at Trillium Health Partners’ Carlo Fidani Regional Cancer Centre. “Our patients undergoing cancer treatment can experience such side-effects as fever, nausea, vomiting and diarrhea. For support, many wait until their next scheduled appointment or visit the emergency

REACT Oncology Nurse, Andrea Finlayson, in the REACT clinic. department. We knew that we could provide them with an option to better suit their specific needs,” says Dr. Katherine Enright, Medical Oncologist, Trillium Health Partners, and Regional Lead, Systemic Treatment Quality, Mississauga Halton Central West Regional Cancer Program. “The REACT clinic revolves around the patient experience. It provides a quick response to our patient’s concerns, helps them to manage their urgent symptoms, and can help them avoid an emergency department visit.” In 2014-15, the bustling Carlo Fidani Regional Cancer Centre and Oncology Program at Trillium Health Partners welcomed over 141,000 patient visits from across the Mississauga Halton and Central West regions. By offering the REACT clinic to its patients that currently receive cancer treatment at Credit Valley Hospi-

tal, Trillium Health Partners has provided faster and more convenient access to services that address their most urgent needs. “With REACT, our patients receiving cancer treatment now have more timely access to high-quality specialized care for their urgent symptoms,” says Sarah Banbury, Program Director, Oncology Services, Trillium Health Partners, and Regional Director, Mississauga Halton Central West Regional Cancer Program. “Ultimately, this can improve their quality of life and contribute to better outcomes in their care and treatment plan.” For more information please visit www. trilliumhealthpartners.ca/patientservices/ H cancerservices ■ Debbie Silva is a Communications Advisor at the Mississauga Halton Central West Regional Cancer Program.

cce

McMaster Centre for Continuing Education Discover. Possible. www.mcmastercce.ca

McMaster is a leader in healthcare education. When employers see McMaster University on

The McMaster CCE courses transcended my expectations.

my resume, they know I have the knowledge and

Almost immediately after taking the program, I was

skills. McMaster is the only program that offers

granted my professional certiﬁcation as an addiction

the Health Information Management diploma at

counsellor. On top of that, I was offered a supervisory

the university level.

position with my current employer.

Nusrat Farhana, Graduate, Health Information Management Diploma Program

Mike Hughes, McMaster CCE Addiction Caseworker Diploma graduate, CACCF, Team Lead, Reconnect Mental Health Services

WATCH NUSRAT’S STORY: www.mcmastercce.ca/nusrat

WATCH MIKE’S STORY: www.mcmastercce.ca/mike

Health Information Management & Health Informatics Diploma programs

Addiction Education Diploma or Certiﬁcate

100% online

Apply by July 15 for September start

APPLY NOW

Study online or in person Apply anytime, courses start monthly

www.mcmaster-health.ca

Centre for Continuing Education | McMaster University | Hamilton, Ontario | 1-800-465-6223 | mcmastercce.ca www.hospitalnews.com

JUNE 2016 HOSPITAL NEWS

10 From the CEO's Desk

Connecting2care

for children and families By Julia Hanigsberg his year Holland Bloorview Kids Rehabilitation Hospital is celebrating an important milestone in our 117 year history – 10 years in our new state-of-the-art, accessible, child-friendly facility recognized by the International Academy for Design and Health as “an inspirational building… which speaks to a child’s right to participate in our society.”

Kids and youth and their families actively partner with their care teams at the hospital to set their own goals and plan their transition to home and community. We have come a long way since 1899 to become the largest rehabilitation hospital in Canada focused on improving the lives of kids and youth with disabilities. Over the generations, we’ve had many name chang-

HOSPITAL NEWS JUNE 2016

es, locations and even amalgamated two organizations. Some of our former names you might recognize, others, however wellintentioned during their time, reflect outdated language: From the original facility called the Home for Incurable Children to the Ontario Crippled Children’s Centre, Bloorview Children’s Hospital, the Hugh MacMillan Medical Centre to our current facility, named following a generous donation by the Holland Family. Those name changes mark an evolution in the history of childhood disability and child health. Where we once saw “incurable,” we now see possibility. Kids and youth and their families actively partner with their care teams at the hospital to set their own goals and plan their transition to home and community. In addition to exceptional care, we are helping bridge the gap to adulthood with work experience programs like “Youth@ Work” for the specific readiness skills needed for employment. We are constantly looking at new opportunities such as a recent robot building pilot program with FIRST Robotics Canada, which brings the inspiration of science, technology and teamwork to kids who may often require

Julia Hanigsberg technology for their activities of daily living. And supported by our generous donors, we have embarked on an ambitious three-year program to establish excellence in building the pathway to adulthood for kids and youth with disabilities. Of course there is much further to go. The kids and youth we serve and their families with whom we co-create great care, have unlimited ambitions for recovery, capability, long-term health and inclusion in society. Research is a big part of the way they will achieve these aspirations.

Through our world-class research institute we are expanding the reach of technology to create a future when every child regardless of ability is able to communicate. Our team is advancing our understanding and treatment of pain in children with cerebral palsy and helping to disseminate that knowledge through downloadable toolkits available to clinicians across the globe. We are also making important strides in autism research in early intervention, clinician capacity building, technologies including anxiety monitoring, pharmacological approaches, and understanding autism to help improve the lives of children with autism and other neurodevelopmental conditions. And our work in participation and inclusion is paving the way for a brighter future by identifying how to build resilience and improve service delivery for kids and youth and their families, as well as identifying barriers and the evidence to eradicate them. Through novel programs such as advanced simulation development, advocacy, and a “family as faculty” philosophy including a home visit program for medical and other health disciplines students, the Holland Bloorview Teaching and Learning Institute in partnership with our client and family integrated care team is giving the next generation of clinicians the tools they will need to help improve the quality of life for those we serve. We have been engaging kids and youth and their families for years and developed a system-leading framework in 2011 through which we partner at all levels and for all major decisions in the organization. That’s why as important as 10 years in a building feels, we listen when our families remind us that they want health care excellence that isn’t confined within our bricks and mortar. Continued on page 22 www.hospitalnews.com

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Focus 11

Physician launches mobile-friendly guide to emergency contraception options By Magdalena Stec mergency contraception, also known as EC, is a woman’s last opportunity to prevent a pregnancy after unprotected sex or a problem with contraception. Although there are three choices of EC available, most women only know about one – a pill that is available over the counter, but is actually the least effective of the three methods.

Whatsnextforme.ca was developed using the most up-to-date evidence available, and designed based on feedback from young women to provide user-friendly, easy-tounderstand information. That’s why a team of healthcare providers and researchers led by Dr. Sheila Dunn, Women’s College Hospital (WCH) physician, recently launched whatsnextforme.ca – a mobile-friendly guide to all emergency contraception options available to women. “After years of working in reproductive health and emergency contraception, I noticed how often women need back-up birth control and how many don’t know

www.hospitalnews.com

what their options are. We developed whatsnextforme.ca to bridge this gap and provide women who need emergency contraception with information about all their options, so that they can make an informed choice that is right for them,” says Dr. Dunn, project lead and research director of the Family Practice Health Centre at WCH. Whatsnextforme.ca was developed using the most up-to-date evidence

available, and designed based on feedback from young women to provide userfriendly, easy-to-understand information. Although it’s primarily aimed at women between 18 and 30 years old, anyone who’s sexually active can benefit from the information. “Most women know about Plan B pill, which is actually the least effective especially if there is a delay in getting emergency contraception or if a woman weighs

more than 75 kg. There are more choices out there that women don’t know about but may be better suited for them,” says Dr. Dunn. One such option is the copper IUD. It’s the most effective EC method and can also be left in place to provide highly effective ongoing contraception. However, even if a woman wanted to get an IUD, she might have difficulty getting one because few doctors or nurse practitioners insert them. To help women figure out where they need to go to get emergency contraception, including clinics that insert emergency IUDs, the website includes a handy clinic finder for local sexual health clinics that provide emergency contraception consultation services. The clinic finder is currently limited to Toronto, with the possibility of expanding in the future. The website was developed by a group of healthcare providers and researchers based at Women’s College Hospital including Dr. Sheila Dunn, Dr. Payal Agarwal, Dilzayn Panjwani, pharmacist researcher Lisa McCarthy and WCH’s Bay Centre for Birth Control team.Visit whatsnextforme. H ca to learn more. ■ Magdalena Stec is a Marketing and Communications Specialist Strategic Communications Women’s College Hospital.

JUNE 2016 HOSPITAL NEWS

12 Focus

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

ADVANCE PATIENT CARE WITH MOBILE HEALTHCARE TECHNOLOGY. WE GET IT. $%8 DB IQ

HP ElitePad Healthcare Tablet Delivering the highest patient experience 4UBSUJOH BU

$1649.00

Imagine equipping your healthcare organization with the mobility needed to work more efficiently and enhance the patient FYQFSJFODF .BLF SFBM UJNF EFDJTJPOT BU ZPVS QBUJFOUT CFETJEFT ,FFQ QBUJFOU EBUB DPOGJEFOUJBM "OE BDDFTT UIF JOGPSNBUJPO ZPV OFFE GSPN XIFSFWFS ZPV BSF 5IF )1 &MJUF1BE )FBMUIDBSF 5BCMFU TVQQMJFT mobility and capability in a thin, light mobile solution designed specifically for clinical settings.

$%8 DB MFOPWP

Lenovo IdeaPadÂŽ Miix 700 4FBNMFTTMZ $POOFDUFE $BSF

-FOPWP *EFB1BEÂĽ .JJY HJWFT IFBMUI QSPWJEFST BOE TUBGG UPPMT to create better clinical workflows, from patient room to beyond hospital walls.

4UBSUJOH BU

XXX DEX DB TVSGBDF

$1149.00

8JUI B EFUBDIBCMF LFZCPBSE "DUJWF 1FO BOE #VJMU JO 51. FODSZQUJPO UP QSPUFDU TFOTJUJWF QBUJFOU EBUB UIF .JJY JT B reliable solution for anywhere care.

Surface Pro 4

5SBOTGPSN & )FBMUI CZ FRVJQQJOH ZPVS IFBMUIDBSF QSPGFTTJPOBMT XJUI UIF VMUSB MJHIU BOE QPSUBCMF 4VSGBDF 1SP 4VSGBDF BEBQUT UP UIF XBZ QIZTJDJBOT XPSL 4P JOTUFBE PG KVHHMJOH UXP EFWJDFT UIFZ SF FNQPXFSFE CZ B TJOHMF device that delivers the power of a laptop and the mobility of a tabletâ&#x20AC;&#x201D;so they can focus on patients, make rounds more productive, and improve PWFSBMM DBSF "DDFTT BMM QBUJFOU EBUB BOE IFBMUIDBSF TPGUXBSF BU POF QPJOU PG DBSF 4VSGBDF DPNQMJFT XJUI DSJUJDBM IPTQJUBM JOGFDUJPO DPOUSPM QSBDUJDFT BT JU DBO CF TBOJUJ[FE XJUI NBOZ TUBOEBSE IPTQJUBM EJTJOGFDUBOUT -POH CBUUFSZ MJGF BOE UIF CSJMMJBOUMZ EFTJHOFE 4VSGBDF 1FO BMMPX ZPV UP DBQUVSF SFBM UJNF QBUJFOU EBUB ,FFQ QBUJFOU EBUB TFDVSF XJUI #JU MPDLFS 51. BOE TFDVSF #PPU

&OBCMJOH RVBMJUZ DBSF BOE NPCJMF healthcare with a single device 4UBSUJOH BU

$1179.00

ENHANCING QUALITY OF CARE AND PATIENT SATISFACTION Healthcare institutions need a trusted partner that understands how to optimize point-of-care technology to improve quality of care and meet patient safety goals. CDW Canadaâ&#x20AC;&#x2122;s knowledgeable experts leverage our strategic technology partnerships to deliver comprehensive bedside solutions including mobile and stationary devices, displays, and accessories. We help healthcare facilities select, configure, implement and support flexible solutions to maintain their technology investment well into the future.

INFORMATION TECHNOLOGY PLAYS A KEY ROLE * 5 QSPWJEFT UIF EBUB VTFE JO QBUJFOU TBUJTGBDUJPO measurement and feedback to: t &OBCMF DMJOJDJBOT UP EFMJWFS JNQSPWFE QBUJFOU DBSF t 4USFBNMJOF DPNNVOJDBUJPOT BOE JNQSPWF TUBGG FGGJDJFODZ t &NQPXFS DBSFHJWFST XJUI JOGPSNBUJPO BU UIF QPJOU PG DBSF 4PVSDF )551 #-0( .0%"--*$ $0. ."3,&5*/( )041*5"-4 *.1307& 1"5*&/5 4"54*'"$5*0/

IMPROVE PATIENT 4"'&5: 8*5) 10*/5Ë&#x2C6;0'Ë&#x2C6; CARE TECHNOLOGY t 5BJMPS QBUJFOU SPPN UFDIOPMPHZ UP DMJOJDJBO OFFET JO UFSNT of screen size, portability and data input options t .BLF TVSF UIF EFWJDFT ZPV JOUSPEVDF GJU SBUIFS UIBO impede, the existing workflow t &EVDBUF TUBGG PO IPX UFDIOPMPHZ JNQSPWFT TBGFUZ supports better patient outcomes and meets meaningful use objectives t &OTVSF UIF UFDIOPMPHZ TFBNMFTTMZ JOUFHSBUFT XJUI ZPVS current systems

4VSGBDF 1FO DPNFT XJUI 4VSGBDF #PPL BOE 4VSGBDF 1SP BOE TPME TFQBSBUFMZ XJUI 4VSGBDF ÂŞ $%8 --$ $%8 ÂĽ BOE 1&01-& 8)0 (&5 *5 Â&#x2122;BSF USBEFNBSLT PG $%8 --$ "MM PUIFS USBEFNBSLT BOE SFHJTUFSFE USBEFNBSLT BSF UIF TPMF QSPQFSUZ PG UIFJS SFTQFDUJWF PXOFST

HOSPITAL NEWS JUNE 2016

www.hospitalnews.com

Focus 13

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

$%8 DB FSHPUSPO

Ergotron StyleViewÂŽ Tablet Cart, SV10 &YQBOE UIF 3FBDI PG $BSF &%$

8"4 /08

$1110.00

$%8 DB FQTPO

Epson WorkForce DS-40 Colour Portable Scanner Wireless portable scanner for smartphones, tablets, computers and more $%8

$199.99

$%8 DB MPHJUFDI

Logitech GROUP Video Conferencing System with Logitech Expansion Microphones $%8

$1749.99 .BOZ IFBMUI DBSF GBDJMJUJFT BSF CFHJOOJOH UP adapt online health care systems which connect physicians and other medical specialists to patients and their caregivers via â&#x20AC;&#x153;telemedicineâ&#x20AC;?

5IF OJNCMF 47 FGGPSUMFTTMZ NPWFT UP UIF QPJOU PG OFFE using a versatile interface to accommodate almost any tablet. Its patented lift engine easily adjusts the platform and screen to exactly the right height for whatever task is BU IBOE "TTFNCMFE JO UIF 64" CZ "OUISP UIJT DBSU JT GVMMZ 5"" DPNQMJBOU

t 8JSFMFTTMZ TDBO UP TNBSUQIPOFT UBCMFUT .BDT BOE 1$T t -JHIUXFJHIU BOE USBWFM GSJFOEMZ Â&#x2030; XFJHIT MC CBUUFSZ PS 64# QPXFSFE t 4DBO EJSFDUMZ UP QPQVMBS DMPVE TFSWJDFT Â&#x2030; TDBO UP (PPHMF Drive and more t $SFBUF FEJUBCMF UFYU BOE TFBSDIBCMF 1%'T Â&#x2030; 0$3 BOE EPD management suite included t $POOFDU UP EPDVNFOU NBOBHFNFOU TPGUXBSF Â&#x2030; 58"*/ driver supported

WJEFPDPOGFSFODFT .FEJDBM QSPGFTTJPOBMT DBO EJBHOPTF BOE initiate treatment without having the patient make a trip UP UIF FNFSHFODZ SPPN PS UIF EPDUPS T PGGJDF 7PJDF BOE WJEFPDPOGFSFODJOH FRVJQNFOU GSPN -PHJUFDI BSF FTTFOUJBM components of providing that capability, both effectively and FDPOPNJDBMMZ 5IF -PHJUFDI (SPVQ WJEFP DPOGFSFODJOH TZTUFN is the newest addition to a line of robust video conferencing solutions that are easy to use, work with leading software applications, and allow for a customizable setup.

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

The People â&#x20AC;&#x201C; 5FDIOPMPHZ FYQFSUT and dedicated healthcare account managers serve as your resource for cutting-edge knowledge on the MBUFTU PGGFSJOHT GPS IFBMUIDBSF * 5

The Products â&#x20AC;&#x201C; Unparalleled access to more healthcare products from more manufacturers means you obtain the technology solutions that meet your exact needs.

The Plan â&#x20AC;&#x201C; 4QFDJBMJ[FE TFSWJDFT BOE support options help create and sustain your technology solution over the long term.

CDW.ca/healthcare | 800.493.7651 www.hospitalnews.com

JUNE 2016 HOSPITAL NEWS

14 Nursing Pulse

Nurses release recommendations to ensure patients come first By Marion Zych

he Registered Nurses’ Association of Ontario (RNAO) says government reforms that are expected to radically change the way health services are delivered in the province won’t succeed unless they include a comprehensive health human resources (HHR) strategy. To inform the conversation on how that strategy might look, representatives of RNAO were at Queen’s Park on May 9 – the first day of National Nursing Week 2016 – to release a report that outlines what must happen if Health Minister Eric Hoskins wants to achieve his goal of putting patients first – an initiative RNAO supports. Mind the safety gap in health system transformation: Reclaiming the role of the RN takes an extensive look at recent trends in nursing employment and sheds light on how the minister’s priorities to improve the system are completely at odds with the reality of how nursing human resources are deployed today. RNAO says developing a comprehensive and well-thought-out interprofessional HHR plan is a must for any major health system transformation, which is why it is the report’s first recommendation. “Given that nurses make up the largest share of regulated health professionals in the province, we are advancing the HHR agenda by issuing this report,” says RNAO President Carol Timmings, adding that “nurses play a central role in delivering health services, and statistical trends in nursing skill mix and organizational models of care delivery don’t bode well for patient safety and health outcomes.” “How can we drive the important changes outlined in the health minister’s Patients First report without the fuel to make these changes happen?” asks Timmings. “It makes no sense that at a time when patient acuity is increasing in hospitals and in the community sector, RNs are being replaced by less qualified personnel.” RNAO is urging the minister of health and the Local Health Integration Networks (LHIN) to issue an immediate moratorium on the replacement of RNs, a trend associated with increased morbidity and mortality. “RNs are being replaced simply to cut costs, but this practice flies in the face of well-documented evidence that shows employing more RNs actually costs less. This is because a higher proportion of RNs results in lower complication rates, and fewer hospital re-admissions,” says Timmings. And yet, data shows that between 2005 and 2010, the ratio of RNs to diplomaprepared registered practical nurses (RPN) was 3:1. By 2015, the ratio had shockingly dropped to 2.28:1. In fact, Ontario has the second-worst RN-to-population ratio in Canada. RNAO CEO Doris Grinspun says “these statistics must trigger alarm bells, because if the government’s goal is to shorten lengths of stay in hospital and re-orient the system towards greater community care, a large influx of RNs is needed to respond to rising acuity levels, especially those of hospital patients deemed the sickest of the sick.” That’s why RNAO is calling on the ministry to mandate an all-RN nursing workforce in acute care, teaching, HOSPITAL NEWS JUNE 2016

and cancer care hospitals within two years, and in large community hospitals within five years. Given that acuity will continue to increase in home care and long-term care, the report also includes recommendations for these sectors. For example, RNAO welcomes the health minister’s promise to move more care into the community. But as patients are discharged from hospital earlier and with more complex care needs, the report recommends every first home care visit be conducted by an RN. The association says the minister’s vision of a more person- and family-centred system also needs to take full advantage of the expertise and authority of nurse practitioners (NP). To that end, RNAO’s report includes specific recommendations aimed at removing all barriers that handcuff NPs’ ability to fully care for Ontarians, including those who reside in long-term care homes. Changes in nursing skill mix are not the only concern highlighted in RNAO’s report. The way nurses are increasingly being forced to deliver care is another troubling trend. Grinspun says more and more hos-

“If we are going to shake up the system, we must make sure that it’s set up to succeed.”

pitals are resorting to functional or teambased organizational models of nursing care delivery that result in fragmented care where no one is in charge of the comprehensive care needs of the patient. These models, in which patient care is broken down into a series of tasks that are delegated to various members of the nursing team, have huge implications in terms of quality of care and safety, says Grinspun. “Imagine being a patient or family member and not knowing who your nurse is.” She says some hospitals are relying on these models to meet bottom line pressures. “Not only are they ineffective, there is no continuity of care. They are the fur-

thest thing from putting the patient first,” says Grinspun. RNAO’s report recommends that hospitals use primary nursing as the most effective model, where one nurse is in charge and takes full responsibility for planning and delivering all of the care needs of a patient throughout their stay. Grinspun says RNAO applauds Minister Hoskins for his desire to revamp the health system. “If we are going to shake up the system, we must make sure that it’s set up to succeed,” she says, adding the most important element in the delivery of health services is front line staff. “Those who provide care day-in and day-out are the ones who will help us deliver the necessary changes Ontarians have been waiting for, and we will do our part to ensure their experiences and health outcomes are the best.” To read the report, and the full list of eight recommendations proposed by H RNAO, visit RNAO.ca/mindthesafetyga ■ Marion Zych is director of communications for the Registered Nurses’ Association of Ontario (RNAO)

A link to the community: Medical Imaging provides hotline to primary care By Jamie Louie ommunity-based primary care providers often face challenges accessing and navigating hospital-based imaging for their patients. The Medical Imaging Call Centre, a partnership between Women’s College Hospital (WCH) and the Joint Department of Medical Imaging (JDMI), is a direct point of contact for primary care providers in the community to access medical imaging expertise. Staffed by a dedicated team of administrative professionals and on-call radiologists, the call centre’s mission is to improve integration with primary care by providing navigational and consultative support in realtime during patient visits. While supporting Women’s College Family Practice Health Centre (FPHC), the Medical Imaging Call Centre is also part of WCH’s primary care strategy, aiming to make hospital services more accessible to community-based providers. “The patients truly benefit from such a tremendous service,” says Dr. Dominic Li, family physician in Toronto and frequent user of the call centre service for the last three years. “With direct access to such specialized imaging expertise, patients can be assured that they are receiving the appropriate information about their health without having to visit the emergency department.” Established in 2008, this service was originally available to hospital clinicians at WCH, University Health Network and Mount Sinai Hospital. In 2014, with the Ministry of Health

The Medical Imaging Call Centre team. and Long-term Care’s support, the call centre was expanded as a pilot and enhanced to support community physicians to evaluate the benefits to patients and referring physicians. Results showed a decline in emergency department visits, increased appropriateness of imaging by facilitating clinician-clinician conversations between radiology and primary care. “Creating an innovative, user-friendly call centre illustrates that primary care providers value conversations with medical imaging specialists,” says Dr. Heidi Schmidt, medical imaging site director, WCH. “This initiative serves as an opportunity to develop partnerships with primary care, elicit feedback, and tailor medical imaging services to their needs.” Primary care feedback received through the call centre allows the JDMI and WCH to make improvements to the medical imaging services they provide. Designed to prevent unnecessary emergency department visits and improve the

appropriateness of ordered imaging tests, WCH and the call centre offer access to urgent imaging and expedited reports, real-time radiology consultations and navigational support. Prior to its expansion, community-based providers did not have a direct link to any of these services. Patients requiring urgent investigations were often sent to over-crowded emergency departments to expedite imaging. The Medical Imaging Call Centre currently provides its service to more than 120 family health practitioners in the GTA. For more information please contact Corwin Burton, medical imaging manager, WCH at 416-323-6082 or Corwin. H Burton@wchospital.ca. ■ Jamie Louie is Communications Coordinator, Joint Department of Medical Imaging, Mount Sinai Hospital, University Health Network, Women’s College Hospital. www.hospitalnews.com

Legal Update 15

Internal decisions may be subject to review by the courts By Paula Trattner and Aislinn Reid he recent decision of the Ontario Divisional Court in Asa et al. v. University Health Network is an important reminder to hospitals that their internal decisions may be subject to review by the courts, and that decision making processes by their committees must be fair and decisions themselves reasonable. This is well known in the context of medical staff who hold hospital privileges but Asa takes this message beyond that context. In Asa, a number of renowned endocrine oncology researchers applied to the Divisional Court for judicial review of a decision of the CEO of the University Health Network (the “Hospital”) to temporarily suspend the researchers’ activities as a result of findings of research misconduct. The decision was made following an inquiry, investigation and internal appeal which were all carried out in accordance with the Hospital’s research policy, with the initial formal investigation having been carried out by an investigation committee. In their application for judicial review, the researchers asked the Court to void the decision and direct that it be reconsidered at an oral hearing. In response, the Hospital argued that the decision of the Hospital’s CEO was not a decision which could be reviewed by the Court. The Hospital alternatively argued

www.hospitalnews.com

that if judicial review of the decision was available, the decision was reasonable and it was made according to a fair process. The Court determined that the decision could be judicially reviewed because it had a serious effect on public rights or interests. The following were key considerations for the Court in determining that the decision was reviewable:

Decisions of hospital committess must be fair and reasonable. • the decision concerned the researchers’ ability to continue to perform cancer research which affects the medical protocols used to treat cancer in Ontario; • the decision concerned one of the Hospital’s core functions – the establishment and operation of research facilities and maintenance of programs for cancer research; • the Hospital is a public hospital governed by the Public Hospitals Act; and • the research policy under which the decision was made was mandated by three government agencies. Having found that the decision was ap-

propriate for judicial review, the Court considered whether the decision itself was made fairly and was reasonable. The Court found that the process by which the decision was made was fair and that an oral hearing was not required. Although there was no prescribed process for the inquiry, investigation and appeal, the Court noted the following in finding that the process that the Hospital had followed was fair: • the researchers were advised of the nature and scope of the allegations; • the researchers were advised when the allegations were expanded; • the researchers engaged the investigative committee and participated fully in the investigation, including by making oral and written submissions; • the researchers were assisted by legal counsel; • the researchers commented on the draft report; and • the researchers were notiﬁed of the final report, appealed the Decision and made appeal submissions and reply submissions. The Court ultimately found that the Decision was reasonable in part: the CEO’s decision to uphold the investigative committee’s finding of research misconduct in the form of material non-compliance with the research policy was reasonable. However, the findings of research misconduct

in the form of falsification and fabrication were unreasonable because they were not supported by the evidence. The suspension of the researchers’ activities was remitted for reconsideration by the Hospital in light of the Court’s findings. When conducting internal investigations and making decisions that affect medical staff and other hospital staff, hospitals should be aware that their internal investigative processes and decision making may be subject to the external scrutiny and review by a court even if the process and decision is not an exercise of a statutory power of decision. While the level of procedural fairness that a hospital should extend in the context of an investigation or decision will vary with the nature of the investigation and/or decision, hospitals should at a minimum provide parties who are subject to an investigation or potential decision with: (1) full disclosure of allegations; (2) an opportunity to participate in any investigation (including by being interviewed and making submissions); (3) an opportunity to be represented by legal counsel; and (4) notice of a decision with H comprehensive reasons for the decision. ■ Paula Trattner is a Partner and Aislinn Reid is an Associate in the Toronto office of law firm Osler, Hoskin & Harcourt LLP.

JUNE 2016 HOSPITAL NEWS

16 Focus

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Cover story

There’s an app for that

There are more than 165,000 mobile health apps and they are changing how patients and hospitals engage with the health system. But are they effective? Private? Safe? And who cares? By Yvan Marston eady or not, hospitals, healthcare providers and patients are seeing mobile health (mHealth) apps move into almost every aspect of care delivery. From operating room scheduling on your phone and patient information questionnaires on iPads to automatic medication reminders for the chronically ill, wherever information needs to flow, apps are filling the system gaps.

A 2013 study commissioned by Canada Health Infoway found most Canadians recognized the importance of leveraging digital health tools and capabilities. Mom & Baby To Be app from Niagara Region Public Health offers interactive prenatal guides. The University Health Network’s (UHN) BANT app is downloaded around the world by patients with diabetes to graph and trend blood glucose data. Albertans can use the province’s health services app to plan care and even check emergency department wait times in Edmonton, Calgary and Red Deer. The effect it is having on care delivery is encouraging and profound. And it marks a fundamental shift in how patients are engaging in their healthcare. But not all apps are created equally. As the number of apps dedicated to health reaches over 165,000, questions arise over their effectiveness and safety, not to mention issues of privacy over apps gathering patient information.

Mobile ubiquity

Still, the sheer ubiquity of mobile devices (two thirds of Canadians own a smartphone and almost half own a tablet) is pushing the innovation agenda forward under a momentum of demand, driven as much by consumers as by health professionals. Then there’s the push to digital health. A 2013 study commissioned by Canada Health Infoway found most Canadians recognized the importance of leveraging digital health tools and capabilities. Although the study didn’t ask specifically about mHealth, 89 per cent said they felt it was important that they personally take full advantage of digital health capabilities. HOSPITAL NEWS JUNE 2016

There’s little data on how Canadians are using mHealth apps, in part because apps cross operating systems and geographic borders, but there are some trends on usage as reported by developers. According to the Connecticut-based IMS Institute for Healthcare Informatics, of all the mHealth apps on the Apple iOS and Google platforms in 2015, twothirds were wellness related apps like MyFitnessPal, serving to track exercise and count calories. These come mainly from app developers and their accuracy and effectiveness is ultimately judged by marketplace reviewers. But there’s another 24 per cent that are focused on disease and treatment management, and only two per cent deemed specific to health care providers.

The chronically ill market

Apps are collecting important amounts of data from the chronically ill. IMS says an evidence base for mHealth app use is emerging from studies of type II diabetes, multiple sclerosis and Parkinson’s disease, cardiovascular health and obesity. It also found that in the last two years the number of clinical trials using mHealth apps more than doubled. As might be expected, the trials focused mostly on the treatment and prevention of disease in seniors. A 2015 study from German firm research2guidance on mHealth app developer economics explains that the focus on chronic diseases comes from the high cost of treating those patients and that if apps can help to change behaviours, they have the potential to reduce these costs. “In most cases, this is still an unfulfilled promise, as most of the apps are failing to retain their users for even a few weeks,” it reported.

From app to medical device In Canada, mHealth apps are not specifically addressed in regulation but any smartphone or tablet enabled to function as a medical device is considered subject to the Medical Devices Regulations. What makes it a medical device depends on such things as its intended use. If it calculates a drug dosing regimen, for example, it’s a device. Apps that help with administrative functions like appointment scheduling, or with education, like a disease guide, are not likely to fall under the legislative definition of medical device. While the U.S. Food and Drug Administration also sees apps as a matter of medical device versus not a medical device, it isn’t a simple determination. As a proactive measure, all the apps developed (six to date) at the University Health Network’s Centre for Global eHealth Innovation were submitted to Health Canada to determine whether they fell into medical device categories, notes Melanie Yeung, a manager with the Centre. “But there aren’t a lot of app developers that have even considered submitting to regulators because many don’t know that this is a practice for medical device manufacturers,” she says. Even if they aren’t considered medical al and health provider devices, most hospital apps follow a process..

executive director for AHS’s web communications. “While the AHS mobile app was developed by a third-party, it was started as an internal project to share emergency department wait times with Albertans in Calgary, Edmonton and Red Deer.” In Toronto, UHN’s Centre for Global eHealth Innovation works closely with clinical teams developing apps using input from specific stakeholders. The group started developing apps for ‘dumb’ Nokia phones almost 15 years ago and uses a traditional academic approach to vet the work. Its products are put through randomized control trials (RCTs) similar to what is required for new drugs, explains Yeung. It is peer reviewed and the UHN’s IT governance committee and medical engineering evaluate the app, examining the development team’s quality management process before the final product can be posted to an app store. “RCTs are the academic gold standard, but it takes years to do. We’re looking at how we can evaluate health apps differently, the way Google and others in the consumer space test product,” says Yeung. Continued on page 19

Apps and development elopment

In Alberta, the requests quests for mobile app development come from rom internal teams at Alberta Health Services ices (AHS) who want to share information on rather than from external developers. “These have been n less frequently at the facility-level than han at a team or project level,” says ys Kass Rafih,

How do you know a particular ? process or task is right for an app? Alberta Health Services asks submissions for mobile health apps to consider a number of things, among them: • What is the size and specificity of the intended audience of the app? • Does an app actually improve the end-user experience? • Does this need to be an app or would some other medium m be better suited? • Would anyone actually use this? There should be a demonstrable purpose for it to be an app, and the audience ce should be broad enough (or specific enough) that the resources dedicated to building it are justified. “But these are just the start of a conversation with the various us stakeholders,” says Kass Rafih, executive director of web communications for Alberta Health Services. “We don’t maintain a rigid list of requirements before an app is considered.” www.hospitalnews.com

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Focus 17

Medical privacy and security By Michael Checkley

hile the digital age has enabled many to take charge of their health, it has also put their privacy in an increasingly precarious situation leaving many practitioners and patients to wonder just how vulnerable private medical histories have become with the increasing digitization of records, also known as Electronic Medical Records (EMR). Technology offers a wide range of possibilities for improving healthcare, including streamlined monitoring of patient progress, easy access to healthcare professionals, and hospital efficiency. If you’re one of the thousands of healthcare organizations on the verge of making the transition from paper to pixel, there are many factors to consider.

has all the information you currently hold, and that it is securely handled. 4. Elect a system administrator – every organization should have a System Administrator, who has the responsibility to ensure the best possible security measures are taken with respect to the set-up, audit, back up, configuration and user training. 5. Ensure all staff sign an agreement – create an Information Managers agreement that outlines every user’s responsibility to only access the data they need to perform their obligations. Avoid sharing

passwords, always lock screens and monitor and review all employee activity. It’s important to communicate that actions will be tracked through audit logs and reviewed regularly.

What your patients need to know

Digitization represents an important change for patients. With digital tools, patients can take a more active, participatory role in their healthcare and wellness decision-making. Digitized consumers are

more engaged, and can more effectively take part in their health destiny. Patients should always be made cognizant of the risks associated with online medical records and virtual care, but they should welcome technology advancements. Digital healthcare is improving access to health treatments and providers, and improving the efficiency of the H patient-doctor relationship. ■ Michael Checkley is President and CEO of QHR Technologies Inc.

The driving force behind the digitization of the healthcare industry

We all want information faster and with as little effort as possible. As technology progresses, so do the expectations of users. This is driving innovation in access to digital health records, and along with this is a continued concern over privacy and security. If technology makes information easier for users to access, does that make them more exposed compared to their paper predecessors? We tend to believe that paper records are “secure” due to the fact that they are physically hard to access. But, in reality, paper records are far from secure; there are no passwords or audit trails, and no way to know if something was seen, copied, or removed. These shortcomings are the very reason records are being digitized. EMRs can easily be stored behind firewalls with password-protected access. All logins are tracked, including audit trails of what was seen, changed, or deleted. The capabilities of EMR systems are not the core issue, as they can be used in a very secure way. Not all of these systems are used properly, which is primarily where the exposure comes into play.

What healthcare practitioners need to know

As the adoption of digitized health care becomes more widespread, action will need to be implemented by doctors, hospitals, and ultimately the legislators who create and approve health care policies. Here are some things to consider for your EMR: 1. Have your data professionally hosted – locking a server in the office is a temporary solution, but offers nowhere near the security that a professionally managed data centre has, with manned front entrances 24/7, redundant power, Internet, and backups. 2. Check your audit logs – on a daily or weekly basis, scan through summary level audit reports looking for anomalies. Things like users who are accessing more records than normal, or have experienced too many failed login attempts can raise red flags. 3. Backups are essential – if you already have your vendor host your system, then this is likely already done for you. If not, ensure that the data backed up is encrypted and that the device you back up on to www.hospitalnews.com

There is hope for a better tomorrow. Thomson, Rogers is dedicated to getting accident victims the compensation and support they deserve.

YOUR ADVANTAGE, in

and out of the courtroom.

TF: 1.888.223.0448 T: 416.868.3100 www.thomsonrogers.com JUNE 2016 HOSPITAL NEWS

18 Focus

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Transitioning to family and patient–centred care By Jenny Read

emptville District Hospital (KDH) has launched an innovative campaign to help transition from providing patient-focused care to partnering with patients for Patient and Family Centred Care. Dubbed “The Patient Experience Starts Here”, the campaign is generating excitement in the Eastern Ontario hospital and surrounding communities as well as other healthcare organizations. It was designed to encourage all KDH staff, physicians, and volunteers to internalize the principle that each one makes a vital contribution to the patient experience. “I’m proud of the team here at KDH that took a new and creative approach to what I believe is a mission critical initiative for all healthcare organizations,” says the hospital’s CEO, Frank Vassallo. “The Patient Experience Starts Here” campaign is a key component of KDH’s patient and family engagement strategy, which was developed as a roadmap to achieve Patient and Family Centred Care in its fullest form.” Patient and Family Centred Care is a model of service delivery that is transforming healthcare both nationally and internationally. It shifts providers from doing something for or to a patient to partnering with the patient, both in the care setting and in the planning, design, delivery, evaluation and improvement of health services. The benefits of Patient and Family Centred Care are well documented: increased quality of care, enhanced patient safety, higher patient satisfaction, and a welcome spinoff – higher staff satisfaction. In addition to providing these benefits, Patient and Family Centred Care is now mandated by the provincial government and our federal accreditation body: For 2016 surveys, Accreditation Canada has

HOSPITAL NEWS JUNE 2016

Kelli Cumming works in Kemptville District Hospital’s Health Records department. added more than 350 new criteria that set out best practices for the delivery of Patient and Family Centred Care. With its next Accreditation scheduled for November 2016, KDH set ambitious goals in the fall of 2015 for implementing the Patient and Family Centred Care model: high levels of engagement with patients and families, both during episodes of care and at decision making tables, starting immediately. In February 2016, the hospital’s Board of Directors embraced the patient and family engagement strategy developed jointly by

KDH’s Quality and Patient Relations departments, and identified Patient and Family Centred Care as a guiding principle for the organization. As outlined in the strategy, “The Patient Experience Starts Here” campaign addresses the challenge of encouraging frontline staff to make the shift from the patient-focused care that KDH is known for to partnering with patients in the care setting. Lana LeClair, KDH’s VP Corporate Affairs, explains: “Although we knew that in many instances our healthcare providers were already taking a partnership approach, we needed all staff to be more deliberate about partnering with patients to ensure the approach was consistent across the organization. In fact, we recognized that it would require a cultural shift to make Patient and Family Centred Care a daily reality at KDH.” The delivery of Patient and Family Centred Care in its fullest form results in an exceptional experience for every patient. LeClair’s team realized that to achieve the cultural shift, each KDH staff member, physician and volunteer would need to internalize the fact that she or he makes an important contribution to the patient experience. The team came up with the slogan, “The Patient Experience Starts Here”, and developed promotional materials to launch the campaign: eye-catching buttons for each staff member to wear and an Owner’s Guide explaining the campaign, along with posters of a variety of staff, physicians and volunteers performing their individual roles in the hospital. The Owner’s Guide pays homage to the great work KDH is already doing, describes the rationale for Patient and Family Centred Care, and contains key messages for

staff as well as a workbook section where individuals can make a personal attestation of how they contribute to the patient experience. The guide’s most important message is that delivering an exemplary patient experience is not the work of frontline staff alone. “Everybody who works, volunteers, or provides services here has the opportunity and responsibility to make Patient and Family Centred Care a reality at KDH,” the guide declares. The campaign slogan and its accompanying materials were unveiled at a wellattended kickoff event held at the hospital in early March. The event featured guest presenters associated with Kingston General Hospital (KGH), a national leader in Patient and Family Centred Care: Eleanor Rivoire and Marla Rosen. Rivoire is the former Executive Vice President and Chief Nurse Executive at KGH and a thought leader in the area of Patient and Family Centred Care. She is also an Accreditation Canada surveyor/educator and on the Faculty of the Canadian Foundation for Healthcare Improvement. Marla Rosen is a patient experience advisor at KGH who has been actively involved with the patient and family advisory council there, as well as with the KGH Oncology Program and Regional Oncology Council. Rivoire and Rosen shared their experiences with Patient and Family Centred Care and provided inspiration as to how transformative the model can be. Following the kickoff, Rivoire shared her impressions of the event: “It was wonderful to participate in the launch of the KDH “The Patient Experience Starts Here” campaign, and to experience the engagement, enthusiasm, and energy of all who were present – including the patient advisors. Continued on page 19 www.hospitalnews.com

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Focus 19

Family and centred care Continued from page 18

The KDH team is clearly resolved to partner with patients in providing Patient and Family Centred Care, with confidence that this will lead to even better patient outcomes, an improved work environment for staff and better organizational performance. It is going to be exciting, over the months to come, to see and hear how this commitment builds on their already strong commitment to excellence in patient care.”

The benefits of Patient and Family Centred Care are well documented: increased quality of care, enhanced patient safety, higher patient satisfaction, and a welcome spinoff – higher staff satisfaction. Feedback from staff on the campaign has been very positive as well. “I found the posters of staff really resonated with me,” says one staff member. “They made me realize that whatever we do at KDH – whether we care for patients, keep the building at a comfortable temperature, or prepare healthy meals – we all do something important.” Other staff have reported that their “The Patient Experience Starts Here” buttons are conversation-starters out in the community. “The clerk at the cash was admiring my button and asked me what it

www.hospitalnews.com

was all about,” a staff member said. “After I explained, she responded that it sounded like a great campaign and we must be excited about it. She added how rare that is and wished us the best.” Following the successful launch of the campaign, notes LeClair, work continues on the implementation of the patient and family engagement strategy. Ongoing ef-

forts include education for staff on involving patients and families as equal partners in their care. On the organizational side, the hospital is currently working with a small group of patient and family advisors and preparing to recruit more, with the ultimate goal of having the patient voice at every table where a decision is being made that will materially impact the

patient experience. “We are so excited to start seeing the benefits – to patients, staff, and the organization as a whole – of our commitment to Patient and Family CenH tred Care,” said LeClair. ■ Jenny Read is a Communications/ Patient Relations Officer at Kemptville District Hospital.

There’s an app for that Continued from page 16

Ensuring patient safety

At issue, of course, is the fear that an app may compromise patient safety. In 2013, the University of Pittsburgh studied four apps designed to diagnose skin lesions using a smartphone’s camera. It found three of the apps incorrectly classified 30 per cent or more of melanomas as “unconcerning.” Much of what is moderating the proliferation of apps in hospital administration and in disease treatment and management categories is the scientific rigour and governance applied by health providers and medical device manufacturers behind them. But clinical trials and peer reviews take time. “By then, consumers have moved on,” says Dr. Puneet Seth, a Toronto-based hospitalist and CMO of InputHealth, whose software is used on iPads in over two dozen hospitals and providers across Canada to collect and analyze patientcentered data.

“Clinical utility is a big piece. That’s where a lot of these apps fail,” says Dr. Seth. He’s beginning to see a demand for clinical research to re-examine the process for digital health. One that maintains the depth and precision of these studies while enabling a faster workflow. Regulation and peer reviewed development is one thing, but with over 1,100 apps for diabetes alone, for example, the number of mHealth choices providers and patients face is a problem in itself.

Prescribing apps

The Canadian Medical Association released guiding principles on apps last year, and many hospitals offer guidelines to choosing an app, as well, some third-party platforms have appeared that evaluate and rate mHealth apps for health providers. But determining the suitability of an app for a particular patient comes down to being a shared responsibility between doctor and patient.

Seth sees a strong parallel between prescribing an app and prescribing over-thecounter medication. “You don’t prescribe a specific brand of cold medication. Instead you give them an idea of what might work for them, who is making the medication, what is it used for and then going back and reviewing how it is being used by the patient,” he explains. It may also be helpful to think of it as another shift in the information revolution. Google has yielded a more informed class of patient: many have come to understand what a trusted source looks like from among the thousands of hits a disease search can yield. Apps fall into a similar eco-system where a great number of choices yield only a handful of trustworthy contenders. Until a more robust means of rating mHealth is developed, providers and patients will have to share H the responsibility. ■ Yvan Marston is a freelance writer in Toronto.

JUNE 2016 HOSPITAL NEWS

20 Evidence Matters

Online curriculum designed to support homecare workers in providing care to seniors By Magdalena Stec

Medical imaging in Canada By Kasia Kaluzny

ne of the things that makes hospitals stand out is that many of them are home to impressive medical imaging scanners. If you visit a Canadian hospital, you might find a computed tomography (CT) machine, a magnetic resonance imaging (MRI) machine, or a single-photon emission tomography (SPECT) machine. In some places you might even find advanced machines that combine imaging modalities, such as hybrid positron emission tomography (PET) and CT (called PET-CT for short). These medical imaging technologies can be used for diagnosing and monitoring a range of diseases and conditions, from cancer to internal injuries. They can also be used to guide surgeries and other treatments. As the technology advances, so too do the uses. But taking a step back, how does medical imaging look in Canada as a whole? Are the technologies available where they are needed? We recently conducted a large inventory – the Canadian Medical Imaging Inventory – to find out where medical imaging equipment is located and how it’s being used. The inventory revealed that most imaging machines are located in hospitals in major urban areas, where the population is highest. The regions with the greatest number of machines were Ontario, Quebec, British Columbia, and Alberta. The less populated provinces and territories have fewer machines, with the lowest numbers in the Northwest Territories, Yukon, Nunavut, and Prince Edward Island (PEI). The other east coast provinces – Nova Scotia, New Brunswick, and Newfoundland and Labrador – as well as Manitoba and Saskatchewan, were in the middle with a relatively moderate number of machines. Interestingly, when counting the number of imaging machines per population, some of the less populated regions actually have a greater number of CT and MRI scanners per number of people, but the population is geographically dispersed so the machines may still be difficult for patients to access. We created the inventory using a survey that captured information on six imaging modalities (CT, MRI, SPECT, PET-CT, PET-MRI, SPECT-CT); it did not look at

HOSPITAL NEWS JUNE 2016

technologies such as ultrasound and x-ray. It includes results from a total of 374 facilities in Canada; however, not all medical imaging facilities responded to the survey. Although the information is not entirely complete, the inventory provides us with the best and most current view of the landscape of medical imaging in Canada. It’s an important foundational piece – a key starting point for making decisions about how these technologies are used and managed. Most (90%) of the facilities that responded are publicly funded. Most were hospitals, but tertiary care centres, freestanding facilities, and community hospitals also participated. Not all of their machines are stationary – some of the MRI machines identified by the inventory are mobile, meaning they move from one facility to the next based on agreements. All medical imaging equipment eventually needs to be replaced as a result of wear and tear, technological progress, and changes in clinical practice and population needs. The inventory provides a “lay of the Snapshot of findings from the Canadian Medical Imaging Inventory • Overall, Canada has seen a growth over the last three years in the number of medical imaging machines installed and operated. • Most medical imaging scanners are used for clinical purposes; a small portion of the time they are used for research. • CT is the most widespread imaging modality in Canada, with the highest number of machines (538 total) followed closely by MRI (340 total) and then the nuclear imaging modalities. • The least common modality is PET-MRI (2 total; research use only), but it is also the newest specialty imaging modality and its clinical use is expected to grow. • Hybrid modalities such as PET-CT have replaced single modality PET scanners.

land” and it can be used as a resource to guide decisions on purchasing new machines, decommissioning old ones, and managing how they are used and shared. For example, in the territories and in PEI, where some modalities are absent, patients might need to travel to another province to obtain the type of imaging scan they need. Partnerships across provinces and territories could make the patients’ experience easier. CADTH is also exploring other issues in medical imaging. We recently published an Environmental Scan report that looks at the criteria and processes used across Canada to identify, prioritize, and fund the replacement or upgrade of medical imaging equipment. The report found that most provinces have processes in place, they use mechanisms to minimize costs (e.g., by working with purchasing groups), and they have contingency funds set aside for unexpected needs. Many of the decisions – about prioritization and funding – are made at the regional or local level. In Alberta, Manitoba, Nova Scotia, Quebec, and PEI, funding decisions are made at the provincial level. CADTH has also conducted several reviews of the evidence for specific medical imaging uses, including a recent review of low-dose CT for lung cancer screening, and a recent review of the safety and guidelines related to ionizing radiation in pregnant women. What’s next? Based on feedback we’re hearing from clinicians, radiology groups, and other stakeholders, it’s clear there is a need for evidence to inform decisions on optimal use of medical imaging. This will be a key area for CADTH project work, now and in the coming years. Medical imaging is a complex field, and there is much to be studied and done to help achieve a sustainable medical system where all Canadians, no matter where they live, have access to appropriate, safe, quality medical imaging services. To read more about the findings of the inventory and other related CADTH reports, visit our medical imaging evidence bundle: www.cadth.ca/imaging. Kasia Kaluzny is a Knowledge Mobilization Officer at CADTH.

omen’s College Hospital’s (WCH) Centre for Ambulatory Care Education (CACE) is thrilled to announce the launch of CACE Homecare Curriculum – a first of its kind evidence-informed online curriculum designed to support a variety of homecare workers in providing care to seniors experiencing delirium, dementia, or depression. Launched in March of this year, cacehome.ca is a free, mobile-friendly website featuring a virtual home-based homecare curriculum that uses teaching and learning tools based within three different patient cases set in representative Canadian households. It’s primarily aimed at personal support workers, nurses and rehabilitation professionals but is also relevant to all healthcare disciplines. The CACE Homecare Curriculum features realistic situations which address many of the nuances that are important when visiting a client’s home, such as assessing risks in the client’s environment, and respecting the client’s wishes.

Some of the features include:

• Assessments and teaching tools designed to improve learning • Learning objectives relevant to members of different professions • Individual or team-based learning modes, allowing team members to work together or individually • Learners who ﬁnish all three modules in the curriculum are given a certificate of completion The curriculum, which has been reviewed by a team of experienced homecare workers and healthcare professionals including personal support workers, places an emphasis on interdisciplinary care for a client, and highlights the roles and responsibilities of allied healthcare professionals. This project was created by CACE at WCH and the University of Toronto, in collaboration with multiple partner agencies, including St. Michael’s Hospital, VHA Home Healthcare, Ryerson University, Fanshawe and George Brown Colleges, and through the support of the Ministry of Health and Long-Term Care, and SIM-one. For more information visit cacehome.ca or contact Nicole Woods, CACE director, at nicole.woods@wchospital.ca or cace@ H wchospital.ca. ■ Magdalena Stec is a Marketing and Communications Specialist | Strategic Communications Women’s College Hospital www.hospitalnews.com

Focus 21

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Educational & Industry Events To list your event, send information to “events@hospitalnews.com”. We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “advertising@hospitalnews.com”

Q June 2, 2016 Diagnosis – Strategies & Decisions A Diagnosis of the Digital health Agenda in Canada Webinar Website: http://www.nihi.ca

World’s first ultra-high frequency ultrasound By Aruna Adhya

taff in today’s hospitals are fortunate to have a wide range of medical imaging platforms available to them. Of these, ultrasound is the most portable, cost-effective and safe imaging solution. However, clinical ultrasound to date, operates at frequencies that have been too low to produce good image quality for visualizing small anatomy. To overcome this challenge, FUJIFILM VisualSonics, based in Toronto, ON, recently introduced the new Vevo MD (FDA cleared, Health Canada pending). The new Vevo MD is the world’s first Ultra High Frequency Ultrasound Imaging System available for the clinical market. FUJIFILM VisualSonics specializes in developing ultrasound technology that has been scaled to much higher frequencies, up to 70 MHz in fact, which results in incredible, high resolution images within the first three cm of the body.

VisualSonics was founded in 1999 by medical physicist Dr. Stuart Foster, a Senior Scientist at Sunnybrook Research Institute The Vevo MD was designed specifically to play a role in a range of clinical applications where greater image resolution is highly desired. For example, when an anesthesiologist needs to place a line to prep small children for surgery, she may have a tough time placing a line. Often times, the line is almost as large as the vein itself in young children and infants. There are often multiple missed attempts that result in great discomfort for patients and families before the line is placed properly. Imaging the area, using the Vevo MD in this case, could greatly improve accuracy in line placement saving a lot of time and distress for everyone involved. FUJIFILM VisualSonics sees great potential for their new Vevo MD product across a wide range of clinical applications including neonatology, vascular, musculoskeletal, dermatology and other small parts that are within the first few centimetres of the body. The launch of this new product is an exciting development for an organization www.hospitalnews.com

that was once a start-up launched out of Sunnybrook Health Sciences Centre in Toronto. VisualSonics was founded in 1999 by medical physicist Dr. Stuart Foster, a Senior Scientist at Sunnybrook Research Institute, who had been involved in the development of high-frequency ultrasonic systems since 1983. The company’s intellectual property was based on research supported by the Canadian Institutes of Health Research (CIHR), Ontario Research and Development Challenge Fund (ORDCF), the Terry Fox Foundation, and venture capital investment, with infrastructure support from the Canada Foundation for Innovation and Ontario Research Fund. Originally, Dr. Stuart Foster and his team started using this technology in preclinical research, in small animal models of human disease (e.g. mice or rat models of cancer and cardiovascular disease). By using high frequency ultrasound, researchers were able to study their live animals in real-time, longitudinally, and with no issues of safety or side effects. “From the inception of the company, we always envisioned that the technology would eventually find a home in human clinical applications and it is exciting that that day has finally arrived,” says Dr. Foster. In June of 2010, VisualSonics was acquired by SonoSite, Inc. (based in Bothell, US), a leader in hand-carried and mountable ultrasound, and impedance cardiography equipment. Sonosite, Inc., was then subsequently acquired by Fujifilm Holdings in December of 2011. Today, after 15 years of success in preclinical research, FUJIFILM VisualSonics is bringing the innovative Ultra High Frequency Ultrasound to the clinical market. “We are confident that Vevo MD is the kind of progressive tool that health care providers around the world will find to be of value for a wide array of applications as well as still unexplored areas.” says Andrew Needles, director of marketing at FUJIFILM VisualSonics. “The challenge is getting the word out that this new product exists and to try and get it into the hands of those that can really expand on its uses.” For more information visit: www. H vevomd.com ■ Aruna Adhya is the Marketing Manager at FUJIFILM VisualSonics, Inc

Q June 5–8, 2016 eHealth Conference Vancouver, BC Website: www.e-healthconference.com Q June 5–7, 2016 Annual OACCAC Conference Westin Harbour Castle Hotel, Toronto Website: www.oaccac.com Q June 6–7, 2016 National Health Leadership Conference Westin Ottawa, Ottawa Website: www.nhlc-cnls.ca Q June 8-9, 2016 Association of Ontario Health Centres – Conference 2016 Sheraton parkway Toronto North, Richmond Hill Website: http://www.aohc.org Q June 15-17, 2016 Canadian Association of Neuroscience Nurses (CANN) WK $QQXDO *HQHUDO 0HHWLQJ DQG 6FLHQWLÀF 6HVVLRQV Double Tree Hilton, London Website: http://cann.ca Q July 7 -8, 2016 eLearning Alliance of Canadian Hospitals Toronto, Ontario Website: www.eachconference.ca Q July 7-8, 2016 World Conference on Disaster Management International Centre, Toronto Website: www.wcdm.org Q September 20-21, 2016 Patient Experience Summit Toronto, Ontario Website: www.patientexperiencesummit.com Q September 28, 29 & 30, 2016 Mental Health For All Conference Hilton, Toronto Website: www.conference.cmha.ca Q October 16, 2016 Sustainable Compassion Training Workshop Emmanuel College, University of Toronto Website: https://bit.ly/ECABSI Q October 30-November2, 2016 Critical Care Canada Forum Toronto, Ontario Website: www.criticalcarecanada.com Q November 7-9, 2016 HealthAchieve Toronto, Ontario Website: www.healthachieve.com To see even more healthcare industry events, please visit our website www.hospitalnews.com/events JUNE 2016 HOSPITAL NEWS

22 Safe Medication

Medication incidents that could have been prevented at the prescribing stage By Jim Kong, Kacy Park, and Certina Ho ystems-based vulnerabilities are reflected in the volume and type of medication errors, and anonymous reporting demonstrates a commitment to an open culture of sharing and quality improvement by healthcare professionals. For a patient, a medication error can range from a near-miss to patient death, with varying degrees of severity in between. The prescribing stage represents the patient’s first contact within the medication-use process and is an important milestone in helping to guide patients to positive outcomes and better health. Thus, to be able to definitively address medication incidents and prevent patient harm, ISMP Canada conducted a multi-incident analysis focusing on the prescribing stage of the medicationuse process to highlight potential areas for improvement. Incidents were retrieved from ISMP Canada’s Community Pharmacy Incident Reporting (CPhIR) program from the period between January 2010 and April 2015. Inclusion criteria included all levels

of harm to patients with the exception of “No Error”. The decision to exclude data from hospital reporting programs allowed ISMP Canada to gain an understanding of the more broad prescribing landscape of the community setting, which expands our exposure to medication errors in a non-formulary-limited prescribing environment. A total of two main themes and seven subthemes were identified by this analysis.

Therapeutic Plan Error

Therapeutic plan error refers to medication incidents that occurred during the prescribing stage as a result of any therapeutic oversight of a patient’s pharmacotherapy plan. The four subthemes that fall under this category include Incorrect Dose, Medication Discrepancy, Allergy, and Drug-Drug Interactions. A prescriber’s intentions are not always clearly outlined, and there is a lack of a standardized format for prescribers to confirm recommendations or aspects regarding dose appropriateness. These issues highlight the need for a readily-available, compre-

Table 1. Recommendations to prevent Therapeutic Plan Errors

Recommendations

Subtheme

Contributing Factors

Incorrect Dose

Lack of process to confirm recommendations or therapy appropriateness

Use standardized order sets Increase access to therapeutic information resources Patient education on signs and symptoms of over/under-dosing of medications

Lack of appropriate clinical decision support system Alert fatigue Lack of relevant patient information

Implement user-friendly clinical decision support system Check-point barriers for highrisk alerts Utilize mandatory data entry fields when gathering information from patients Conduct Best Possible Mediation History (BPMH) during initial interaction with patients Involvement of patients and caregivers to ensure compliance of medication therapy

Medication Discrepancy Allergy Drug-Drug Interactions

hensive medical information platform for healthcare professionals to refer to when prescribing medications. Any gap in patient medication history knowledge lends itself to mistakes being made at all stages of the medication-use process, with the prescribing stage acting as the initial onset for this cascading effect. Recommendations based on the hierarchy of effectiveness and best medication practices are outlined in Table 1.

Therapeutic Plan Execution Error

The second main theme of this multi-incident analysis was therapeutic medication plan execution error which refers to mediation incidents that occurred due to the technical aspects of the prescribing stage. This includes subthemes such as Incomplete Prescription, Illegible Writing, and Wrong Patient. With the multitude of drug products on the current market, there is an increased need for vigilance when providing prescriptions to patients. Although the technical aspects of a prescription are

often overlooked as minor issues, occurrences still have the potential to cause severe patient harm. The implementation of computerized physician order entry (CPOE) systems remains a powerful tool to help prescribers prevent medication errors. Recommendations based on the hierarchy of effectiveness and best medication practices are outlined in Table 2. Prescribers currently have more pointof-care tools or resources at their disposal than ever before and the opportunities to mitigate patient harm are vast. The proper use of clinical decision support systems and order entry sets can help overcome the therapeutic and technical limitations of prescribing, helping prescribers achieve their desired and optimal patient H outcome ■ Jim Kong is a Consultant Pharmacist at the Institute for Safe Medication Practices Canada (ISMP Canada); Kacy Park is a PharmD Student at the School of Pharmacy, University of Waterloo; and Certina Ho is a Project Lead at ISMP Canada.

Table 2. Recommendations to prevent Therapeutic Plan Execution Errors

Subtheme

Contributing Factors

Incomplete Prescription

Lack of forcing functions/ reminders for data entry fields

Utilize CPOE systems with mandatory prescription fields* Utilize pre-printed order sets Independent double checks Staff education regarding mandatory prescription data entry fields

Lack of process to ensure prescription legibility Lack of process to confirm patient identity

Utilize CPOE systems* Incorporate process for ensuring prescription legibility before providing prescription to patient Alerts for similar patient profiles Utilize two separate patient identifiers at each stage of the medication-use process

Illegible Writing Wrong Patient

Recommendations

*CPOE systems may introduce other safety challenges in the medication use process. Therefore, always assess the risks versus benefits of using a new system in the workplace/workflow before widespread implementation.

From the CEO’s desk Continued from page 10 That’s why we implemented, in partnership with Canada Health Infoway and kids and their families, our connect2care portal that brings health records (as well as appointments and secure messaging with clinicians) to mobile devices and laptops. Physical space still matters: Our building isn’t meant to feel like a hospital. Thirty-three art pieces around the building create interest and inspiration. ScreenPlay, an interactive waiting room activity for kids of all abilities created by our research institute, turns waiting for

a clinic appointment into anxiety reduction, physical activity and intellectual stimulation…oh and fun! With a storied history behind us, Holland Bloorview is continuing a journey of healthcare transformation as we partner and lead to advance the most integrated, high-quality care for children and youth with disability and rehabilitation needs H and their families. ■ Julia Hanigsberg is President and CEO of Holland Bloorview Kids Rehabilitation Hospital.

After 117 years, Holland Bloorview Kids Rehabilitation Hospital is continuing a journey of health care transformation as we partner and lead to advance the most integrated, high-quality care for children and youth with disability and rehabilitation needs and their families. HOSPITAL NEWS JUNE 2016

www.hospitalnews.com

Focus 23

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Careers

Driven by technology

Evolving from a paper-only system By Dr. Eric Irvine orking in the Emergency Department (ED) at Brantford General Hospital during the 1990s meant trying to track patients throughout their visit using paper charts that ended up being piled up on the corner of the nursing desk. At that time, we did not have defined triage. Those who were sickest were seen first and the restâ&#x20AC;Ś simply waited. We did not collect data on wait times and, as a result, we generally had no idea of the length of time some patients were waiting to be seen. Charts were sometimes lost or misplaced. Patients waited longer than necessary and were very frustrated. Our ability to try to plan for change was hampered by our lack of data or any effective way to monitor what was happening. As healthcare progressed and technology evolved, we realized that the pile of charts sitting on a desk could lead to patients being missed or worse â&#x20AC;&#x201C; forgotten. It was commonplace for an Emergency Physician (EP) to leave a shift and not pass along information about a patient still being worked on simply because the chart was out of sight. As our department became busier, we realized the need for a far more organized approach. This led us to develop a card system with a wood cardholder. Each patient would have a 3â&#x20AC;? x 5â&#x20AC;? card made out with their individual patient sticker applied. The cards were then placed in a wooden holder which had a specific spot for each patientâ&#x20AC;&#x2122;s bed or stretcher. The EP would use a colour marker and check off those that they had seen. We were able to keep track of charts in a more organized manner, as well as track patients using the cards more efficiently. Unfortunately, with triage becoming part of our world, cards for new incoming patients were placed ahead of others due to a variety of reasons. Ultimately, we ended up with a cluster of cards with cards overflowing from the top and bottom of the holder. Patients continued to be â&#x20AC;&#x153;lostâ&#x20AC;? within our department at times and often seen well out of sequence. Patients remained frustrated. Planning change proved to be very difficult as we still did not have effective means of collecting any useful data regarding how the patient flow worked within our department beyond manually checking for times. Manual checks were too timeintensive and never happened. ED patient trackers â&#x20AC;&#x201C; electronic tracking boards â&#x20AC;&#x201C; started to become more popular around 2005. We were a few years behind the wave of change, but we did eventually catch up. We examined a variety of different tracking boards and decided on Picis ED PulseCheck as it worked well and was available immediately. www.hospitalnews.com

The technology has made an amazing difference in how we are able to work. The tracker organized all patients within the department by room, physician, or Canadian Triage Acuity Scale (CTAS). It tallies data for all of our wait times and allows us to see the patient times in a live format. Also â&#x20AC;&#x201C; and just as important â&#x20AC;&#x201C; it allows us to see when investigations are complete. It enables nurses to send messages to the EPs without wasting time to come find us. It has allowed us to create different work areas for different providers maximizing the efficiencies of those staff without constantly having to go to one central area to ask â&#x20AC;&#x153;who should be seen next?â&#x20AC;?

As healthcare progressed and technology evolved, we realized that the pile of charts sitting on a desk could lead to patients being missed or worse â&#x20AC;&#x201C; forgotten. Our ED has grown from approximately 105 patients per day to over 145 per day in just five yearsâ&#x20AC;&#x2122; time. We have gone from length of stay for lower acuity patients of over six hours to under four and for the sickest patients from over eight hours to under seven for their encounter to be finished. Wait times to be seen have gone from over 4.5 hours (90th percentile) to 3.5, even with the significant increase in volume. Most of this change is, to a large degree, because we can now simply look at any screen within the department and immediately identify who is next to be seen, whoâ&#x20AC;&#x2122;s tests are finished, notes from the nurses to come reassess, and best of all, we are able to narrow the scope of view of the list to those that we are involved with. We can focus on our individual work without getting lost in the overall picture of the department. We no longer have to look at a board covered with 3â&#x20AC;? x 5â&#x20AC;? cards and wonder if some are lost. We no longer have to walk to one central area to check all that needs to be checked. We are able to reduce the waste of walking and focus on patients. Although wait times certainly are not the only way to measure a department, they certainly do lead to patient satisfacH tion. â&#x2013; Dr. Eric Irvine is Episodic Care Value Stream Medical Lead and Chief of Emergency Department at Brant Community Healthcare System.

VIEW CAREER ADS AT:

DEADLINE FOR JULY 2016 ISSUE: JUNE 28, 2016

www.hospitalnews.com CHIEF NURSING OFFICER

To advertise please contact

Denise Hodgson

denise@hospitalnews.com 905-532-2600 ext. 2237

If four-season outdoor activity in Northwestern Ontario intrigues you; if the serenity of mirror-like water on a cool, spring-fed lake broken by the splash of a laker, walleye, northern or bass excites you; or if a paddle through pristine Quetico Wilderness Park relaxes and inspires youâ&#x20AC;Ś and you want to work where you playâ&#x20AC;Ś we invite you to apply your exceptional proven nursing and leadership skills at the accredited 41-bed Atikokan General Hospital in the capacity of Chief Nursing Officer. For details on required job qualifications and responsibilities on Reference #2016-31,

visit aghospital.on.ca/careers

Stroke signs and symptoms

The importance of physical activity

Caregiver SOS â&#x20AC;&#x201C; Communication

June 2016 www.homeandlongtermcare.ca

Young caregivers See page 9

To advertise please contact DENISE HODGSON denise@hospitalnews.com 905.532.2600 ext. 2237

Every time our phone rings, we have the opportunity to make a difference to the callerâ&#x20AC;&#x2122;s well-being. For this reason, Registered Nurses are a vital role in Sykes Assistance Services Corporationâ&#x20AC;&#x2122;s Telehealth Division.

FULL TIME / UNILINGUAL AND BILINGUAL

WORK-FROM-HOME REGISTERED NURSES )F YOU ARE PASSIONATE ABOUT HEALTH AND ENJOY A FAST PACED PATIENT CENTRED APPROACH JOIN US TO PROVIDE CLINICAL CARE TO HELP PEOPLE MAKE HEALTH DECISIONS (ELP CALLERS NAVIGATE THE HEALTH SYSTEM AND MAKE INFORMED DECISIONS USING YOUR CRITICAL THINKING WHILE EMPLOYING CLINICAL GUIDELINES THAT ARE CONSIDERED THE @GOLD STANDARD WITHIN THE INDUSTRY !S A NURSE COMBINE YOUR TRIAGE ABILITY WITH PHONE CHAT AND WEB APPLICATIONS TO HELP PEOPLE ONE PATIENT AT A TIME

Help others. Make a difference. Be proud

REQUIREMENTS:

s $IPLOMA OR "ACHELOR IN .URSING s 2EGISTERED AND IN GOOD STANDING WITH THE #./ s YEARS OF EXPERIENCE INCLUDING YEAR OF ACUTE CARE ENVIRONMENT s 3HIFT SCHEDULES REQUIRE BOTH WEEKENDS NIGHTS s #OMPUTER PROFICIENT WITH ACCESS TO HIGH SPEED INTERNET CONNECTION s -UST HAVE TELEPHONE LANDLINE PRIOR TO START s !BLE TO COMPLY WITH 7ORK &ROM (OME PRIVACY AND SECURITY REQUIREMENTS

7E BELIEVE YOU SHOULD BE REWARDED FOR THE IMPORTANT WORK YOU DO &OR THAT REASON YOU LL RECEIVE A COMPETITIVE TOTAL COMPENSATION PACKAGE WHEN YOU JOIN OUR TEAM

APPLY ONLINE: www.nursecareerscanada.com

JUNE 2016 HOSPITAL NEWS

24 Focus

HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING

Thank You to Our Valued Clients! Thank you for choosing PSHSA for your JHSC Training, we have donated $20,000 to Threads of Life & Parachute. March 1 – June 30, PSHSA will Donate $20 per person enrolled in Certification Part 1 or Certification Part 2 JHSC Training to these same 2 charities! Take advantage of our $700 bundled offer for both Certification 1 & 2 together, and PSHSA will donate $40. Call 1-877-250-7444 or visit pshsa.ca/jhsc to register.

Threads of Life helps families of workplace tragedy along their journey of healing by providing family support programs & services. threadsoﬂife.ca

Parachute, a national charity dedicated to injury prevention, will direct PSHSA donations to programs for keeping children safe at home & at play. parachutecanada.org

Train with PSHSA & help us reach our charitable goal! Regional & Onsite

CERT 1

3 Day Training

$439 per person

CERT 2

2 Day Training

$339 per person

#supportsafety HOSPITAL NEWS JUNE 2016

•

pshsa.ca/jhsc www.hospitalnews.com