Inside: From the CEO’s Desk | Evidence Matters | Safe Medication | Ethics | Careers
April 2018 Editi ion Edition
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Contents April 2018 Edition
IN THIS ISSUE:
Students solve EHR challenge
15 ▲C Cover story: t Bringing art into medicine
▲ E-Health supplement
19 ▲ Nominate your nursing hero
Editor’s Note ....................4 In brief .............................6 From the CEO’s desk .....34 Evidence matters ...........36 Nursing pulse ................39 Safe medication ............41 Ethics ............................ 44 Product S potlight ............46
▲ Communicate with patients like it’s 2018
Ethics of e-health
▲ Students watch surgery in real-time
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Nursing Hero before it’s too late! he deadline to nominate your nursing hero is fast approaching. If you have been impacted by a nurse who has gone above and beyond, please send me your story by April 10th. Winners will have their stories shared in our 13th annual Nursing Week supplement as well as receive a cash prize. All nominees will have their names published in the supplement as well. So often nurses go above and beyond without the expectation of recognition or reward; this is
your chance to say thank-you. Don’t miss out on this opportunity to recognize the outstanding work of a nurse. Nominations can be made by patients, their families, managers, colleagues etc. All you need to do is email me the name of the nurse, the facility they work at and a story including examples of your nursing hero going above and beyond. Please email your nomination to me at H firstname.lastname@example.org by April 10th. ■
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ADVISORY BOARD Cindy Woods,
Senior Communications Officer The Scarborough Hospital,
RN, PHD, CHE VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences
Publicist Health-Care Communications
President Brainstorm Communications & Creations
Bobbi Greenberg, Health care communications
Sarah Quadri Magnotta, Health care communications
Dr. Cory Ross,
Kristie Jones Editor, Hospital News
B.A., MS.C., DC, CSM (OXON), MBA, CHE Dean, Health Sciences and Community Services, George Brown College, Toronto, ON
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Monthly Focus: Surgical Procedures/Pain Management/ Palliative Care/Oncology: Non-invasive surgery, plastic surgery, orthopedic surgery and new surgical techniques including organ donation and transplantation procedures. New approaches to pain management and palliative care delivery. Approaches to cancer diagnosis and treatment.
Monthly Focus: Personalized Medicine/Volunteers and Fundraising/Health Promotion: Developments in the field of personalized medicine. Innovative approaches to fundraising and the role of volunteers in healthcare. Programs designed to promote wellness and prevent disease including public health initiatives, screening and hospital initiatives.
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Men and women have
opposite genetic changes in depression
en and women with major depressive disorder have opposite changes in the same genes, according to a new study by researchers at the Centre for Addiction and Mental Health (CAMH) and the University of Pittsburgh. Published in Biological Psychiatry, the findings reveal significant biological differences, and suggest that men and women may need different types of treatment for depression. It’s the first time these opposing molecular changes in men and women have been identified. “These findings confirm the absolute necessity of doing parallel studies in men and women and of reassessing what we’ve
WOMEN ARE TWICE AS LIKELY TO BE DIAGNOSED WITH DEPRESSION, AND TEND TO REPORT GREATER ILLNESS SEVERITY, MORE SYMPTOMS AND DIFFERENT TYPES OF SYMPTOMS THAN MEN taken for granted – depression is not just depression,” says Dr. Etienne Sibille, senior author of the study and Chair of the Campbell Family Mental Health Research Institute at CAMH. There are obvious differences in depression between men and women – women are twice as likely to be diagnosed with depression, and tend to report greater illness severity,
more symptoms and different types of symptoms than men. Yet, says lead author Dr. Marianne Seney, Assistant Professor of Psychiatry at the University of Pittsburgh, “While researchers have been examining the brains of depressed subjects for decades, many of these studies included only men.” As one example of how the illness is different, a less
common form of depression that involves weight gain and sleep disturbances, called hypersomnia, is three times more likely in women than in men. Another example is among people with depression who experience a co-occurring mental illness. In women, depression typically occurs alongside anxiety disorders, while men are more likely to report co-occurring substance use problems. In the new study, the researchers analyzed genes in the postmortem brain tissue of 26 men and 24 women with major depressive disorder, and in a comparison group of men and women without depression. Specifically, the team investigated gene expression levels, which indicate how Continued on page 7
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Continued from page 6 much protein a gene is producing. Most of the affected genes – more than 1,500 in total – showed changes either only in men, or only in women. However, the majority of genes that were altered in both men and women were changed in opposite directions. Women had increased expression of genes affecting synapse function, whereas men had decreased expression of the same genes. (Synapses are the connection sites where chemical signals pass from one nerve cell, or neuron, to another.) Women had reduced expression of genes affecting immune function, whereas men had increased expression of these genes. Additionally, the researchers then examined the same genes in another group of individuals, which confirmed the same findings. Because the study examined postmortem brain tissue, it’s unclear when these molecular changes occur. But the findings support that depression at the molecular level is differH ent in men and women. ■
New standards help both health care professionals and patients manage opioid use n response to Ontario’s opioid crisis, Health Quality Ontario released three standards outlining what quality care looks like where opioid use is concerned. Called quality standards, they offer direction to healthcare providers and patients on when to use opioids – and the non-opioid treatments to consider first – for people with acute pain (due to things like a broken bone or surgery) or chronic pain (commonly caused by arthritis or lower back pain). The third standard outlines how to treat people with an opioid use disorder or addiction. There were 1,053 opioid-related deaths in Ontario from January to October 2017, compared with 694 during the same time period in 2016. People with opioid addiction have a mortality rate of 10 times more than the general population.
Almost all Ontarians accumulate multiple chronic conditions over their lifetime he study published in the journal Health Affairs, examined more than 1.6 million deaths that were registered in Ontario from 1994 to 2013, and linked each to health administrative data from Ontario’s single payer healthcare system. The 18 chronic conditions the researchers identified were acute myocardial infarction, asthma, cancer, cardiac arrhythmia, chronic coronary syndrome, chronic obstructive pulmonary disorder, congestive heart failure, Crohn’s disease or colitis, dementia, diabetes, hypertension, mood disorder, osteo- and other arthritis, osteoporosis, other mental health disorder, renal failure, rheumatoid arthritis and stroke. The study showed that almost all Ontarians accumulate multiple
chronic conditions over their lifetime. The total number of chronic conditions that Ontarians died with increased over time. In 1994, about one quarter (24.6 per cent) of Ontarians died with five or more chronic conditions, this increased to two thirds of all Ontario deaths (65.7 per cent) in 2013. The researchers found that the types of chronic conditions that Ontarians accumulated varied by socioeconomic groups. Individuals that lived in materially deprived neighbourhoods were more likely to die with chronic obstructive pulmonary disease (COPD), mental health disorders and diabetes. While cancer and dementia at time of death were more common among individuals that lived in high income neighbourH hoods. ■
Data recently released in two Health Quality Ontario reports also shows that nearly two million people in Ontario fill prescriptions for opioids every year – translating into one in every seven Ontarians, or 14 per cent of the province’s population – and more than 40,000 Ontarians were newly started on high doses of prescription opioids in 2016. This, despite evidence that those who receive prescription opioids at higher than recommended doses are several times more likely to suffer an overdose or become addicted compared to those on lower doses. Quality standards outline what high-quality care looks like for conditions where there are large variations in how care is delivered, or where gaps in access to care exist – like with conditions where opioids are being prescribed. They are based on the best available evidence and are developed in consultation with experts and patients with lived experience. They also include recommendations on proven supports that healthcare professionals can use to address gaps and barriers to care. “There are many options available to healthcare providers to improve
the health of people in pain, making it challenging to know what the best plan of action should be,” says Joshua Tepper, president and CEO, Health Quality Ontario. “Opioids play an important role in managing pain, but we also need to minimize the harm that can be caused from these medications, including the symptoms that come with addiction, opioid overdoses and death. In addition, we need to help patients who have an opioid use disorder and offer them evidence-based care. The quality standards will ensure patients with acute pain, chronic pain and an opioid disorder receive the highest quality of care. They have the potential to save a lot of lives and prevent enormous suffering.” The quality standards also offer guidance to healthcare professionals on how to not suddenly discontinue prescription opioids so patients do not turn to street sources. These standards of care will be put into action through coordinated efforts with a number of healthcare organizations who are providing healthcare providers with customized data, tools and additional supports to help them help H patients manage their pain. ■
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Communicating with patients like it’s 2018 By Tara Kiran echnology has revolutionized how we live, play and work. We don’t think twice about using an app to make a restaurant reservation, tracking a parcel’s expected delivery date online or chatting with an on-line agent to answer questions about a product we want to purchase. In many ways, technology has also revolutionized medicine. We have developed new drugs, designed new devices and surgical techniques and have a larger and more precise range of imaging options to help diagnose problems. But when it comes to how healthcare organizations communicate with patients, we are still practicing as if it’s 1980. Most clinics only book appointments by phone, often with long waits on hold. Family doctor and specialists communicate by fax. Patients usually have no way to track the status of their referral. Appointment bookings are often conveyed to patients via mailed letter, sometimes by phone, but seldom by email or text message. There are, of course, practices that have managed to integrate technology into their workflow. But these are exceptions. According to recent international surveys, only six per cent of Canadians reported viewing health information such as tests or laboratory results online. Four per cent said they emailed their regular practitioner with a question. And only one in 10 physicians reported offering patients the option of making appointments online. Our patients deserve better. For the last few years, our Family Health Team has been working with patients to understand how we can improve the care we provide. We do regular surveys, involve patients in specific initiatives and have even held a day-long event to get detailed feedback on improving the typical clinic visit. The feedback has been consistent. Patients are grateful for the compassionate, comprehensive care we
deliver. But they have also given us thoughtful suggestions for doing even better. Specifically, they have told us over and over again that we need to improve how we use technology to communicate with them. First, our patients have told us they want to be able to book appointments on-line. Second, they want to be able to track the status of their test and specialist referrals the way we can track the delivery status of a package on-line. Third, they want to be able to access their own records, particularly their test results, on-line. The views of our patients are consistent with those of Canadians more broadly. Most Canadians want these electronic communication options but few receive them. Research shows that being able to access their own records is empowering for patients and improves communication with their health team. So, what’s the hold up? Some say, medical culture needs to change. But, in our case, physicians and staff are ready to try something
new. Our clinicians told us that better use of technology for appointment booking and test result communication would make things more efficient for them too. Is it a lack of innovation? Not really. For the most part, the technological solutions have been developed. For us, the trouble is integrating these technologies into our workflow. Meeting our patient recommendations would mean engaging with three separate vendors, purchasing their solutions and incorporating them into our existing system. We already use an electronic medical record. Our appointment calendars are electronic. Our lab tests come in electronic format. Yet the software we use does not enable on-line booking or two-way secure messaging with patients. The software doesn’t allow patients to access their records or view the status of their referrals. Online booking, secure messaging and the ability for patients to track their referrals and access their own
records should be mandatory built-in functions in all electronic medical records. Almost three-quarters of Canadian physicians use electronic medical records. Having these functions standardly available within electronic medical records – without having to negotiate or pay for add-ons – would help us advance patient communication into the twenty-first century. We need political leadership to move us forward. Quebec is leading the way and recently pledged that patients in their province will soon have access to their medical records through a password-protected portal. Some Canadian hospitals already offer this, but they are the minority. There are, of course, many factors influencing technology adoption in healthcare, from how we pay doctors to privacy rules governing health information. But making it easier for interested practices to integrate e-communication in their workflow is one way to help us H move forward. ■
Tara Kiran is an expert adviser with EvidenceNetwork.ca, a family physician and researcher in the Department of Family and Community Medicine, St. Michael’s Hospital, University of Toronto, and an adjunct scientist at the Institute for Clinical Evaluative Sciences. 8 HOSPITAL NEWS APRIL 2018
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Medical 3D printing is turning physicians into artists By Kathryn Young he patient – a wounded ed soldier – had a severe faacial deformity, and Dr. Frank Rybicki found it psychologically difficult to prepare re himself to meet him. “My medical training helped me respond to his sensory defects: sight, ht, sound, smell and taste,” explained ed Dr. Rybicki, who helped found the he 3D printing lab and program at The Th he University of Ottawa and The Ottawa aw wa Hospital. “However, when people lee meet each other, we connect with th h their faces and recognize each other er later by their face. I felt both meddically responsible and challenged too help artfully repair this soldier’s damamm aged face.” In an article published in The Lann-cet in February, Dr. Rybicki discussed ed how, in the mid-20th century, plastic ic surgery options were limited. But tooday, 3D-printed patient-matched immplants can help restore function. For or this soldier, Dr. Rybicki was able to help restore his functions (of chewing, g, swallowing, breathing and speaking) as well as his form – his appearance. “We can now digitally change anattomy and then design and create new w anatomical parts for injured patients, helping transform their lives,” says Dr. Rybicki, who has taught innovative medical technologies to a generation of physicians, and is considered a father of medical 3D printing. “3D printing helps change how these patients perceive themselves, and how others perceive them.” At the same time, he explained in The Lancet, 3D printing is also transforming how doctors perceive themselves. As more hospitals set up 3D printing labs, as at The Ottawa Hospital, the field has begun to weave technology and art together. “When I trained in the 1990s as a physician-scientist and academic radiologist, I studied theories and methods with a technical, as opposed to
10 HOSPITAL NEWS APRIL 2018
(Above and opposite) 3D printers can print a wide variety of body parts.
MEDICAL 3D PRINTING TING IIS SAF FORM ORM O OF FA ART BECAUSE EXPERTS CAN USE RADIOLOGY EQUIPMENT TO DIGITALLY CHANGE THE PATIENT’S ANATOMY, AND THEN CREATE A NEW PHYSICAL VERSION OF THE PATIENT an artistic, focus. I looked for ways to scan patients faster and more precisely – methods that are still important,” he says. “But 20 years later, I’ve discovered that the creativity that comes with 3D printing has led to it becoming an art form in medicine, with ‘physician-artists’ working in a new studio – the hospital.” Medical 3D printing is a form of art because experts can use radiology equipment to digitally change the patient’s anatomy, and then create a
new physical version of the patient. As physician-artists do this work, they bring new skill sets into hospitals, such as computer-aided design. They have inherent artistic license as they design, produce, clean and present 3D medical models. “As a physician-artist, I know when a design is ‘just right’,” he says. “I will think, or openly exclaim, ‘Don’t touch it anymore. lt’s done. lt’s beautiful.’” For years, companies have produced medical models using their wider re-
sources and greater expertise in design sou and manufacturing. They are, however, bound by industry manufacturing standards. stan By contrast, when a 3D-printed B part is created for personalized medical care, physicians have artistic as well as medical license and a responwel sibility to treat patients safely. As this sibi sib field grows, Dr. Rybicki says, there fi aare concerns that physician-artists have too few boundaries imposed h on n them. ““Think of how, in representing the human hum m body, an artist can distort proportions for emphasis or to evoke a por rt feeling,” he pointed out in The Lancet feel l article. “To what extent does such ararti i tistic tist ti freedom shape the work of physician-artists specializing in 3D printsici ia ing?? How do they resolve the tension ing between artistic endeavor and clinical bet tw need?” nee e Through his own work, Dr. RybicT has identified three key constraints ki h k that generate a healthy balance between 3D printing as an art form vertwe sus 3D printing as an emerging, materializing medical technology. riali 1. Challenges in designing a mod1 el iintended to replicate a patient’s anatomy. For example, in oncology, ana physical models of patients with lung phy tumours close to the clavicle and the upper rib cage must be accurately designed to include critical, adjacent vessels, nerves and bones. The 3D model often provides information that is otherwise unavailable, to help the physician determine whether or not the tumour is operable. In another example, 3D models are required for surgery in babies with complex congenital heart defects, and the physician-artist must decide which cardiac details to include in the model design. Surgeons must have models that are as anatomically accurate as possible, so their artistic license is constrained. 2. When the physician-artist must alter the patient’s anatomy. ln planning a facial reconstruction after a disfiguring injury, for example, the www.hospitalnews.com
COVER Through his work with the 3D Printing Lab at The Ottawa Hospital, Dr. Frank Rybicki (right) has discovered that the creativity required for 3D printing has led to it becoming an art form in medicine. He has worked closely with Dr. Adnan Sheikh (left), Medical Director of 3D Printing, who is holding a 3D-printed pelvis used to plan hip replacement surgery. Photo by Mark Holleron
physician-artist has competing challenges and priorities: the patient’s need to chew, salivate and breathe; how repairable the tissues are; and the desire to restore the face based on ‘before’ photographs. To meet these challenges, the physician-artist must integrate medical data to improve form and function for the patient’s existing anatomy but within specified limits. 3. Choosing the patients who can benefit the most from 3D printing, given the costs of operating a lab within a hospital. “Just because a physician-artist can make a model doesn’t mean that doing so is a best use of resources,” says Dr. Rybicki. For patients with specific conditions – such as in areas of oncology and orthopaedics – the evidence is showing that 3D printing could save time and money and improve clinical outcomes. However, evidence based guidelines for appropriate use need to be developed. Dr. Rybicki is now charting a course for 3D printing to be reimbursed, so that the technology can be brought to patient care in a more structured, unified way. The challenge is medical, and artistic. “One layer at a time, one patient at a time, and one hospital at a time, 3D printing is inching medicine closer to personalization,” says Dr. Rybicki. “The act of creating 3D models and implants palpably brings art to medicine. The tension between artistic license and clinical constraints will continue to establish an equilibrium state in which 3D printing in hospitals enhances the quality of care we deliver and improves H patients’ quality of life.” ■ Kathryn Young is the Publications Officer at The Ottawa Hospital. www.hospitalnews.com
APRIL 2018 HOSPITAL NEWS 11
Our Panel of Medical Laboratory Professionals
Carolyn McCarville, MLT Chief Technologist QEH Department of Laboratory Medicine, PE
Bernie Hartung, MLT Laboratory Manager Grey Bruce Health Services, ON
Hansika Deepak, MLA Technician III, Surgical Pathology University Health Network (UHN), ON
Heather Autio, MLT, ART Site Supervisor Abbotsford Regional Hospital and Cancer Centre, BC
Deanna R Danskin, BSc, MLT Microbiology Quality Resource Technologist & Biosafety Officer Northern Health Authority, BC
We Complete the Picture edical laboratory professionals are an integral part of patient care. They provide critical information that completes your whole health care picture. We asked a panel of medical laboratory professionals from across Canada to share their thoughts on the laboratory’s role in health care.
abnormal a laboratory result, the longer it takes to validate and confirm that result. While a normal complete blood count (CBC) may be available within a few minutes, a result with a very high white count and abnormal differential requires significantly more technologist intervention and time to produce the result, sometimes up to 10 times longer than a normal result.
1. WHAT’S A MISCONCEPTION ABOUT THE LAB YOU WOULD LIKE TO DISPEL?
2. WHAT HAVE YOU SEEN IN THE LAB OVER THE PAST FEW YEARS THAT HAS HAD THE GREATEST IMPACT ON PATIENT CARE?
Carolyn: Medical laboratory professionals are not just “button-pushers.” Contrary to what is portrayed in popular television, you don’t just push a button and receive a valid laboratory result in seconds! While it is true that advances in technology have made some analyses very user-friendly in that we can achieve a high throughput of testing without much intervention, there is still so much more involved that requires a human touch and brain, like troubleshooting and result interpretation. Heather: The biggest misconception is that all test results take the same amount of time to produce. Often, we hear that there is a “delay in lab results and the patient is really sick.” The more 12 HOSPITAL NEWS APRIL 2018
Carolyn: The Choosing Wisely Canada campaign successfully brought test utilization to the forefront of issues in healthcare, reducing unnecessary laboratory tests that not only consume time and resources but could potentially lead to patient stress or harm rather than improving outcomes. Deanna: In microbiology the recent accessibility of good quality, rapid technologies such as molecular assays and MALDI-TOF, have improved both turn-around times and quality for identification of infectious organisms. Outside of the lab, I’ve noticed a move towards more collaborative, interdisciplinary conversations, especially involving pharmacy and infection control
practitioners regarding antimicrobial stewardship, which provides better service to patients.
3. WHERE DO YOU SEE THE FUTURE OF THE PROFESSION? Hansika: It is a misnomer that technology will eventually negate the need for technicians and technologists in the lab. As technology becomes a more vital part of the lab setting, our scope of practice and job duties will shift. The medical laboratory assistant (MLA) role is diversifying in different provinces across Canada. Heather: Laboratory professionals will become a more integrated part of the health care team. Historically, and even at this point in time, the laboratory is seen as a support service to provide care and, in the future I think there will be more consultation with laboratory professionals as part of the team.
4. WHAT IS ONE THING THAT YOU WOULD LIKE PEOPLE TO KNOW ABOUT YOUR JOB? Bernie: Lab tests are needed at all hours of the day. In our small rural communities, there is always a dedicated lab professional able to perform those tests needed to help reach the proper diagnosis.
Deanna: Medical laboratories, and the technologists who work there, are required to follow strict accreditation standards. In BC, our accreditation body is administered by the College of Physicians and Surgeons of BC, which in turn draws many of its standards from international bodies, such as ISO (international organization for standardization).
5. WHAT IS THE MOST REWARDING ASPECT OF WORKING IN THE LAB? Bernie: Remembering that there is a patient at the end of everything I do. Hansika: I have the privilege of contributing directly to patient care knowing that what I do behind the scene helps save lives. Carolyn: I always go home at the end of the day with a sense of accomplishment knowing that I made a difference in a patient’s health care journey. Heather: Knowing that a caring and considerate medical laboratory professional at the time of collection can help alleviate the fear many patients endure while facing an uncertain diagnosis. Deanna: The satisfaction of solving real problems that directly or indirectly help patients. www.hospitalnews.com
Empowering or isolating? Addressing common myths about digital health By Shelagh Maloney or Nancy, trips to the hospital or walk-in-clinic were a regular part of life, and because of her chronic obstructive pulmonary disease (COPD), she would wind up in one or the other at least once a month. A telehomecare program changed that, enabling Nancy to track her vitals and, with the help of her healthcare provider who monitored her remotely, take action to address changes in her condition before they escalated into the need for a trip to the hospital or clinic. For Canadians like Nancy, digital health has meant a better quality of life. For others, however, digital health raises the spectre of governments and insurance companies looking at their health records or confusion about why a patient would ever want to access anything so complicated as a lab result, which surely only doctors can understand. And telehomecare programs that have reduced hospital visits for patients like Nancy? They have some Canadians worrying about a cold and impersonal future in which patients no longer see healthcare providers in face-to-face visits. As with any significant change, the transformation taking place as a result of digital health has raised some concerns – some based in fact, and some not – about what digital health means for Canadians, clinicians and the health system. Is digital health only for the young and tech savvy? Will doctors’ offices be inundated with phone calls from confused or anxious patients who have online access to their lab results? Will digital health marginalize populations who don’t have online access? Lack of understanding is a barrier to adoption, which is why, to dispel these and other myths, Infoway launched a digital health myth busting campaign.
We identified several misconceptions we’ve encountered over the years through our outreach efforts and used research conducted by Infoway with researchers from across Canada, as well as international studies, to address the misconceptions with facts. In total, Infoway addressed 17 myths on a wide range of topics, such as virtual visits, lab results, privacy, e-booking and patient portals. One myth we explored was the value of patients being able to access their lab results online, a digital health service some Canadians believe is pointless because they think the results will be too complicated for patients to understand. Infoway drew on research to set the record straight. In fact, 76 per cent of patients who first saw their lab results online were confident they understood the results. And 93 per cent of patients who accessed their lab results online said they had more informed discussions with their
doctor. Additionally, patients with one or more chronic conditions were less likely to report being anxious. Clinicians also had reservations related to patient access to lab results, fearing it would mean an increase in calls from worried or anxious patients. In fact, our research found patients who have access to their lab results online are less likely to call their physicians while waiting for results. They’re also less likely to have an unwarranted in-person visit related to their results. Another myth examined the concern that digital health is only for the young and tech savvy. In fact, Canadians, including seniors, are very connected, and digital health offers important opportunities for advancing care for seniors like Nancy through programs such as telehomecare. In a study in which the average age of respondents was 75 to 84 years, 98.3 per cent of telehomecare patients were satisfied with the program. It’s easy to
understand why. Studies confirm patients with chronic conditions such as COPD or congestive heart failure who are enrolled in telehomecare programs have 35 to 63 per cent fewer trips to the emergency room and 44 to 85 per cent fewer hospitalizations. The myth-busting campaign provided an opportunity for Canadians and clinicians to share their experiences with digital health, with their stories further demonstrating that digital health solutions are being used in Canada and people are benefiting as a result. Some Canadians, initially skeptical about the value of digital health solutions such as online access to their lab results, even changed their minds after hearing from others whose family members were better able to manage their condition thanks to having access to their results. To learn more about the value of digital health and to view all 17 myths, visit www.infoH way-inforoute.ca/myths. ■
Shelagh Maloney is Vice President, Consumer Health, Communications and Evaluation Services, Canada Health Infoway. 14 HOSPITAL NEWS APRIL 2018
Co-op students interact with new digital healthcare technology that they helped launch as part of the Dovetale project at St. Joseph’s Hospital
Hospital turns to students to solve electronic health records challenge By Kari Pasick-St t. Joseph’s Healthcare Hamilton hired an army of 58 co-op students for the Fall 2017 term, 35 of which were hired from the University of Waterloo to help launch the Dovetale project, a new digital infrastructure for patient care at St. Joe’s. The project is a fully integrated, safe and secure information solution that will place all of a patient’s information in one location. Patients will only need to tell their full story once, and all caregivers will see that same information. This move will make St. Joe’s a fully electronic hospital, one of only eight in Canada with this level of technology today. Currently, a single visit to the hospital could result in over 180 pieces of paper, creating a potential for error and inefficiencies. Dr. David Higgins, President of St. Joe’s, says that it’s time to move from pen and paper to the digital age. “The pace of healthcare, the info we need to care for patients,
is really significant,” says Dr. Higgins. “A patient may be on 12 or 13 medications, have different needs, and even one error, even moving from one location to another, is a profound source of risk.” Ross Johnston, executive director of co-operative education at Waterloo, says that hiring 35 co-op students in a single term may be unusual, but support from fellow co-op students can actually help them be confident and successful in their roles. He is in awe of the work that has been accomplished with the Dovetale project. “It’s incredible, the courage shown by St. Joe’s to take this leap toward becoming a fully digital hospital,” says Johnston. “We are so proud that our students have had the opportunity to make such an impact on this project.” When St. Joe’s officially flipped the switch to a digital state on December 2, 2017, co-op students were an integral asset to its success, taking on the challenge of helping provide 24-hour
support in the six weeks following the launch, some shifts were staffed by coop students. Tara Coxon, chief information officer at St. Joe’s (and a Waterloo Science and Business grad), isn’t surprised that the students are so adapt-
able. A strong proponent of the co-op experience, she knew that bringing in a large co-op team would get the job done. Her message to the students: “We would not be here without you,” says Coxon. “You are an integral part H of our team. You are key.” ■
Kari Pasick-St is the Strategic Communications Manager at UWaterloo’s Co-operative Education and Career Action Centre.
Apps for Health & FHIR North Conference Explore • Engage • Innovate April 25 & 26 | Mohawk College, Fennell Campus Register now! Visit appsandfhir.mohawkcollege.ca
APRIL 2018 HOSPITAL NEWS 15
Grade 10 students from Bill Hogarth Secondary School recently had the unique chance to watch colorectal surgery and ask the surgeon, Dr. Shady Ashamalla, questions in real time.
Photos by Kevin Van Paassen/Sunnybrook Health Sciences Centre.
Students watch colon cancer surgery in real time at Sunnybrook By Alexis Dobranowski arch was Colorectal Cancer Awareness Month. To raise awareness about prevention and screening, Grade 10 students were recently invited to research colorectal cancer and develop a video or graphic, and were given a unique opportunity at Sunnybrook Health Sciences Centre in return. In a pilot project with Bill Hogarth Secondary School, all students who entered the competition were invited to Sunnybrook to view colorectal cancer surgery (a minimally invasive colon resection) live via video hook up with Dr. Shady Ashamalla, renowned surgeon and educator. Dr. Ashamalla explained what he was doing each step of the way, and answered students’ questions in real time. “The surgery wasn’t actually as gross as I thought it would be,” says Grade 10 student Madeleine Dupuis. “We could see the surgeon’s tools so close up. It was neat to see how the surgeons work inside such a small space in the body – they pump air into the stomach to create more room to work.”
Dr. Shady Ashamalla
“It was really amazing to watch the surgery step by step,” says Sierra Wild, age 15. “At one point I had a question about if the patient would feel any pain, and I was able to ask the surgeon right away.” Sierra said she was also surprised to learn that making healthy lifestyle choices not only reduces the risk of getting cancer, it also can impact the
outcome of your surgery when treated. Colorectal cancer is a malignant tumour that starts in the cells of the colon or rectum. Malignant means it is a cancerous tumour that can grow and spread. This cancer is highly treatable if caught early. “As a leader in cancer care and in education, Sunnybrook is continually looking for ways to engage our
community, including high school students,” Dr. Ashamalla says. “This project allowed us to raise awareness about colon cancer prevention, and hopefully turn these students into junior experts on the topic. My hope is they go home and tell their parents and others about the importance of positive lifestyle changes and colorectal cancer screening.” Dr. Ashamalla said giving the students an opportunity to see surgery and visit other areas of the hospital, like the Simulation Centre, Anatomic Pathology, and several research labs, would hopefully spur an interest in science, technology, engineering or math careers. Casey Daleman, Bill Hogarth Secondary School head of science, agrees. “This was an amazing experience for our students to see surgery, talk to a surgeon as well as other healthcare professionals at the hospital,” she says. “And it was a great opportunity for students to learn about careers in the health and wellness sector and get an introduction to the Specialist High H Skills Major (SHSM) program.” ■
Alexis Dobranowski works in communications at Sunnybrook Health Sciences Centre. 16 HOSPITAL NEWS APRIL 2018
Seeing the future By Erin Lynch and Megan Brydon he IWK Health Centre is the paediatric and women’s tertiary care facility for the Maritime Provinces. This requires a tremendous amount of health information sharing with stakeholders, neighbouring provinces, as well as with healthcare collaborators involved in care provision. Historically, a request for sharing of imaging health information would require data to be burned to a CD/DVD and couriered to an outside facility, with unknown delay in care delivery. Now, the requests can be processed and transmitted 24 hours a day, 365 days a year to referring facilities, or uploaded into the local system. The key player in this facilitation is the Picture Archiving and Communication System team in Diagnostic Imaging at the IWK. They oversee the imaging informatics aspect of health records for Radiology, Ophthalmology, Dentistry, Ambulatory Gynecology, Laparoscopic Gynecology, Fetal Assessment Clinic and Cardiology. These images are stored in a centralized provincial database with built-in redundancy and catastrophic failure mechanisms in place. Enterprise solutions exist, but they are expensive and not currently available to Nova Scotia. In the meantime, the conventional PACS system is being used to manage and store non-conventional images.
Facilitated by the in-house development of an image request database, a notification is generated and the images can then be sent electronically. Building on existing Secure File Transfer Protocol service of the Nova Scotia Health Authority, the IWK PACS applications specialists have facilitated timely, reliable imaging health information-sharing across Canada, the United States, Europe and as far away as Australia. The Nova Scotia PACS system is directly linked, meaning images aren’t required to be packaged, but can directly transmit to Prince Edward Island, New Brunswick, and Newfoundland. This direct Atlantic interconnectivity across provinces is very unique around the world, and something the IWK uses every single day. Being a fairly small hospital has allowed the innovative and adaptable two-person PACS department to build relationships and trust with outside facilities, troubleshoot and adapt to the evolving requirements in the changing networked healthcare delivery environment. This has also been the case in using existing infrastructure to support diagnostic image archival in the eHealth record, beyond the traditional confines of Radiology. As enterprise imaging becomes more readily available for integration, these connections move away from being a novel idea, to the expectation for complete patient re-
Images such as fetal MRIs are sharable across the healthcare team in preparation for care & intervention cords, access and care. While locally enterprise imaging is still a ways into the future, the application specialists at the IWK have established a system to accommodate the growing imaging informatics needs of the healthcare team in the provision of truly collaborative care. The IWK has incorporated women’s laparoscopic gynecology operating room media, Dentistry (both radiographic and oral photos), Ophthalmology, Fetal Assessment Clinic and Ambulatory Gynecology imaging into PACS. Having these five departments fully integrated in the PACS environment allows the IWK to round out the imaging aspect of health records, be-
yond traditional radiology (xray, CT, MRI etc) and allows the care team to access and share a variety of images related to the patient care that they didn’t have access to as recently as even three years ago. On the horizon, Gastro Intestinal endoscopy is moving towards storing their images on PACS, as well as external images for Orthopaedics. These imaging health information processes have streamlined not only the turn-around time for sharing and collaborating, but also significantly reduced the timeline of imaging critical healthcare decisions for Oncology, Orthopaedics, Genetics, Surgery, H Emergency Medicine and more. ■
Erin Lynch is the Communications Specialist and Megan Brydon is the PACS Applications & Imaging Informatics Specialist at IWK Health Centre.
APRIL 2018 HOSPITAL NEWS 17
Three little words Using text messages to support adherence By Amy Noise n developed countries, only half of people with chronic illnesses take their medications as prescribed, and this number can be even lower for people with low health literacy skills, poor social supports or unstable housing. But what if supporting adherence could be as simple as asking ‘How are you?’ In 2005, when Dr. Richard Lester and his team were starting an HIV treatment program in Kenya, the vast majority of his patients were starting treatment for the very first time. Not only that, they were spread out over a huge geographic area, with many in rural and remote parts of the country. The team knew adherence was going to be an issue, and needed to find a low-cost way to support patients to take their medicine, and take it correctly. “We started by brainstorming with clinicians and patients and quickly found out that patients don’t want to be reminded to take their medication, they want to feel supported,” says Lester, an associate professor in UBC’s Division of Infectious Diseases. “Adherence is about more than just remembering to take your pills, it’s about the other priorities in your life – addictions, childcare, mental health – and how you balance all of these factors”. The result was WelTel, a weekly automated text messaging service that makes use of widespread cell phone access in Kenya to simply ask ‘Mambo?’ (‘How are you?’ in Kiswahili). According to Lester, a friendly ‘How are you?’ works because it isn’t
How are you?
“I’VE LEARNED TO TAKE MY MEDS EVERY DAY IN THE LAST SIX MONTHS. AND IT’S A LOT TO DO WITH BEING ABLE TO TALK ABOUT IT, THROUGH THE TEXTING. THEY LET ME KNOW THAT THE SYMPTOMS WOULD GO AWAY, OR JUST TO HANG IN THERE AND KEEP ON TRYING. THERE’S JUST SOMEBODY ELSE THERE FOR ME” –OAK TREE CLIENT intrusive but it opens the door to support if and when it is needed, without raising suspicion or sharing confidential information. Halfway around the world, at BC Women’s Hospital’s Oak Tree Clinic for women and children living with HIV/AIDS across BC, outreach nurs-
es use similar weekly text messages to stay in touch with vulnerable patients. “The texts help build a bond between patient and nurse. Even though the first message is automated, patients know that there is a person at the other end who is there to help them,” says Dr. Melanie Murray an infectious dis-
ease physician based at Oak Tree. “It gives users the opportunity to ask for the support they need, whether that is ‘I need to reschedule my appointment’ or ‘I have nothing to eat’.” This ability to identify who needs support in real-time allows monitoring nurses to identify and address problems related to treatment, or societal barriers to adherence, before they escalate into crises. If a patient develops a side effect, their nurse can provide advice by phone or text, or triage them as appropriate, helping the patient stay adherent and out of hospital in-between scheduled appointments. “The great thing about text messaging is that with relatively simple technology we can offer support to a large patient population and make better use of in-person visits,” says Lester. “Initially, we focused on HIV and tuberculosis, but this approach can be applied globally for almost any condition.” Read more about Dr. Lester’s work in Spark: Everyday tech for better care (www.msfhr.org/spark/06/). Spark is a digital magazine produced by the Michael Smith Foundation for Health Research (MSFHR), British Columbia’s health research funding agency. In 2014 Lester received an MSFHR Scholar award to investigate how WelTel, originally developed in Kenya, could support those living with HIV and tuberculosis in British Columbia. MSFHR currently supports Dr. Richard Lester via a 2017 Innovation to Commercialization award for the development of smart-text-analytic-tools to analyse natural language H text data. ■
Amy Noise is a Communications Specialist at the Michael Smith Foundation for Health Research.
18 HOSPITAL NEWS APRIL 2018
May 27â€“3 0, 20 18
SPECIAL SHOW GUIDE
Conference Celebrate Grow and Inspire Bold Action in Digital Health s Canadaâ€™s largest national digital health event, the e-Health Conference and Tradeshow brings together passionate individuals from across the country to learn from leading digital health professionals and innovators from Canada and around the world. The conference offers top-quality learning and opportunities to network with organizations and people
20 HOSPITAL NEWS APRIL 2018
that value quality health information and effective integrated system solutions. Now in its 18th year, there is no shortage of activities to partake in and attendees can look forward to special events such as the Showcase, and Hackathon, and network with old and new colleagues. This yearâ€™s event will bte held in Vancouver, British Columbia at the brand new JW Marriott Parq Vancouver, from May 27 to May 30.
Connect with a 7b@;u;m|hbm7o= 1omvѴঞm]|;-lĺ
);-u;-ruo=;vvbom-Ѵv;ub1;vCul=o1v;7om|_;mbt;m;;7v o=|_;_;-Ѵ|_1-u;ķvo1b-Ѵv;ub1;v-m7Ѵb=;v1b;m1;vv;1|ouvĺ Please visit us at Booth #210 gevityinc.com
Conference Program With more than 250 presenters, e-Health 2018 offers an abundance of education and learning opportunities for all attendees. In addition to plenary sessions and presentations, this year introduces Rapid Fire – a live, interactive presentation format that will feature presenters, who will have three minutes to present their ideas. The result will be an engaging, fast-paced session covering a variety of topics. Here is a selection of some of the planned sessions – created from the hundreds of abstracts submitted from across Canada and internationally.
MONDAY, MAY 28 4:00 P.M.–5:00 P.M.
TUESDAY, MAY 29 8:30 P.M.–9:30 P.M.
OS08 – Patients as True Partners in Care • 4:00pm – Addressing the Opioid Crisis with Technology – Doug Malcolm, MAXIMUS Canada, CA; Natalie Borden, Nova Scotia Department of Health and Wellness, CA • 4:15pm – The Critical Yet “Not So Glamourous” Trusted Citizen Identity – Sunny Kumar, Canada Health Infoway, CA • 4:30pm – Mustimuhw Citizen Health Portal – National Expansion Project – Karl Mallory, Mallory Consulting Ltd., CA • 4:45pm – Innovation Through Predictive Analytics in the NonProfit Sector – Don McIntosh, Sierra Systems Group Ltd, CA
Plenary Session Big Ideas, Building from the Ground Up This panel will spotlight healthcare start-ups new to the digital health industry. Key topics to be discussed include: How they came up with the idea; how the fundraising process worked, who supported them, and the challenges they encountered; how they entered the market and impediments they faced; what SOLUTIONS they think are feasible in the short and medium term; and how they can partner with others to succeed. It will also touch on how procurement, funding models or other innovation approaches can be used to actually foster young Canadian companies to thrive in this market.
OS09 – Changing the HealthCare Delivery Landscape • 4:00pm – Addressing the Opioid Crisis with Technology – Doug Malcolm, MAXIMUS Canada, CA; Natalie Borden, Nova Scotia Department of Health and Wellness, CA • 4:15pm – The Critical Yet “Not So Glamourous” Trusted Citizen Identity – Sunny Kumar, Canada Health Infoway, CA • 4:30pm – Mustimuhw Citizen Health Portal – National Expansion Project – Karl Mallory, Mallory Consulting Ltd., CA • 4:45pm – Innovation Through Predictive Analytics in the NonProfit Sector – Don McIntosh, Sierra Systems Group Ltd, CA 22 HOSPITAL NEWS APRIL 2018
TUESDAY, MAY 29 1:00 P.M.–2:00 P.M. OS22 – Digital Health Big Data: Promises and Possibilities • 1:00pm – Applying Data Analytics to Understand Prevalence of Adverse Drug Reactions – Syed Sibte Raza Abidi, Dalhousie University, CA • 1:15pm – Barriers to Testing Mitigated by an Online STI Testing Service – Devon Haag, BC Centre for Disease Control, CA • 1:30pm – Health Data Integration to Enable System-Wide Palliative Care Analytics – Jason Schwartz, Cancer Care Ontario, CA • 1:45pm – Knowledge Management for Research to inform Policy and Practice – Ezrah Tonui, National AIDS Control Council, KE
WEDNESDAY, MAY 30 10:30 A.M.–12:00 P.M. OS27 – Disrupting Technology into the Next Decade • Distributed Consent Management by Blockchain – Edward Brown, Memorial University, CA • Deep Learning Techniques to Improve Patient Care with Neural Networks – Dan Connors, Allscripts Analytics, US • The Power of Patient/Provider Messaging: From Human to AI – Anne Weiler, Wellpepper Inc, USA
• Iris Scanners as an Identification Tool for Individuals Experiencing Homelessness. – Cheryl Forchuk, Parkwood Institute, CA • Using Blockchain To Enable Informed Patient Consent For Research – Bruce McManus, PROOF Centre of Excellence, CA • Improving Management of Long Stay Patients with Machine Learning Prediction – Patrick Tan, Fraser Health Authority, CA OS28 – Bringing Mental Health to the Forefront • Development of Mental Health Reporting Framework – Rebecca Comrie, Centre for Addiction and Mental Health, CA • Physician Adoption of Standardized Order Sets and Electronic Order Entry – Ileen Gladding, Trillium Health Partners, CA • Global Experiences in Building Cognitive Digital Health Systems – Dan Gordon, IBM Canada, CA • Telemedicine and Its Growing Usage – Sanjiv Gulati, MCSCS, CA • Building an E-Mental Health Toolbox: An Implementation Toolkit for Clinicians – Megan Schellenberg, Mental Health Commission of Canada, CA • Insights to Impact: Helping Organizations Use Data for Business Improvements – Behnaz Shirazi, Centre for Addiction and Mental Health, CA
Opening Ceremony Penny Rae, Chief Information Officer, Alberta Health Services and Josh Blair, TELUS Health and TELUS Business Solutions West and Chair, TELUS International will host this year’s opening ceremony keynote address. The session, titled Grand Debate: Systemic Transformation versus Incremental Change – Canadian Digital Health for the Future will examine strategies, approach, challenges and lessons learned on the journey to connected care. It will also look at public/private sector relationships and how to foster innovation in a public-sector market and debate large scale province-wide implementations vs small scale implementations in a provocative and informative debate style format. The session be challenged by the innovation theory of small scale community implementations as trials to build and learn from.
Meet the Speakers
Josh Blair Executive Vice-President, TELUS Health and TELUS Business Solutions West and Chair, TELUS International Josh oversees TELUS Health and Payment Solutions, a Canadian leader in electronic medical and health records, consumer health services, and benefits and pharmacy management solutions. In addition, Josh has oversight of TELUS Employer Solutions, a leading provider of innovative human resources, talent management and wellness solutions. He also oversees TELUS’ customer experience, product marketing and Internet of Things (IoT) teams focused on business clients nationally, in addition to business sales and customer marketing in Western Canada. As well, Josh is the Chair of the Board for TELUS International, the global arm of TELUS that is led by President and CEO, Jeffrey Puritt. TELUS International’s approximately 30,000 team members across North America, Central America, Asia and Europe, provide contact centre, business processing and information technology solutions to major corporate clients worldwide. Josh also serves as TELUS’ Chief Corporate Officer, supporting the company’s Board on selected activities and priming relationships with many of TELUS’ external stakeholders. In addition, he oversees TELUS Ventures, a team dedicated to investing in promising start-up companies with innovative technology solutions that can help TELUS operate more effectively www.hospitalnews.com
and succeed in the marketplace. As a strong supporter of TELUS’ commitment to give where we live, he also serves on the Board of Directors for the Sandbox Project and the Board of Advisors for the Cures for Kids Foundation as well as being Vice-chair of the TELUS Vancouver Community Board. Josh is a professional engineer and his 23-year career at TELUS started after he graduated with distinction from the University of Victoria’s Electrical Engineering program. In 2015, he received a Distinguished Alumni Award from the University of Victoria in recognition of his professional achievements and community contributions. Josh is also a graduate of the Executive Program at Queen’s School of Business.
to deliver results by aligning IT and business goals with a focus on three strategic themes: strengthening the foundation, optimizing operations and transforming care Prior to that role, she was the Senior Vice President Capital Management, responsible for the physical infrastructure that supports Alberta’s health care system. Also, a professional engineer, Penny has held senior leadership roles in both the public and private sectors.
CLOSING KEYNOTE ADDRESS Nova Browning Rutherford will be closing the Conference with the Lunch Closing Keynote Address. Nova is a motivational speaker and TV/Radio personality who masterfully weaves life lessons gathered from her career in Hollywood to deliver instantly relatable presentations. She helps to spark a renewed sense of confidence
Nova Browning Rutherford, TV/Radio Personality and empowerment over one’s own life. Look forward to leaving walking away with a fresh appreciation for the past, a bold affirmation of your power to transform your current experience, and effective tools to manifest dreams H into future success. ■
Penny Rae Chief Information Office, Alberta Health Services Over the last five years, Penny Rae has been leading the Information Technology department at Alberta Health Services (AHS), as the Chief Information Officer (CIO). Penny is part of a triad that leads the Connect Care Program, a clinical transformation underpinned by an integrated clinical information system. As CIO, Penny oversees the AHS IT department, sets direction and coordinates IT service delivery across the province. She has built a team APRIL 2018 HOSPITAL NEWS 23
Social Events + Wellness Programs
Hacking Health 2018 ccording to the Public Health Agency of Canada, three out of five Canadians aged 20 and older have a chronic disease. That is why this year, Hacking Health is partnering with the e-Health Conference on a #patientsincluded hackathon set to tackle the pressing healthcare issue of chronic disease management. Participants will work hand-in-hand with patients and clinician experts, building innovative software solutions focused on prevention, home care, and community care. The challenge will kick-off on Sunday, May 27th, where the lead-
ers of selected projects will give short pitches explaining the healthcare problems they seek to solve. Teams will then spend the next day and a half designing, building, testing, validating and tuning their prototypes in preparation for the demo competition, working with mentors to refine and improve their solutions. Once the hacking is complete, the teams will present to conference delegates and be evaluated by an expert panel of judges on May 29th. Awards will be presented shortly after to the H winners. ■
Hackers corner “My experience at the hackathon at e-Health 2017 was very memorable for the sheer fact that I got to meet and work with some brilliant and creative minds. I’m really glad the theme of the hackathon was on mental health in the workspace, a topic that receives so little attention yet affects so many Canadians. It was exciting to get to be in the centre of all the action too, though at times also distracting! The final presentations were fun to watch and there was great
Andy Tran energy. Seeing the solutions that other people came up with was inspiring, and that’s a feeling I carried with me long afterwards.” Andy Tran is a front-end developer, entrepreneur, and Hacking Health enthusiast. He began his career in health policy, but through his research in innovative health technologies, he became interested in coding in order to bring his ideas to life.
Want to participate? Registration is open now! Sign up today in the Hacking Health section of the e-Health Conference website. 26 HOSPITAL NEWS APRIL 2018
In addition to learning, e-Health offers many opportunities to mix and mingle with peers – in both formal social settings, as well as activity-based programs. The social events include the Welcome Reception, the e-Health Happy Hour, the Pre-Gala reception and Canadian Health Informatics Award (CHIA) Gala. Networking breaks are also weaved into the Conference program to make sure everyone has an opportunity to mingle with peers and make new connections. For those interested in physical activity, there will be Morning Yoga and Kickboxing sessions. The full social and wellness program information is available on the e-Health Conference website.
Before the official start of the conference, delegates are invited to get a head start at the Sunday Symposium which is designed to enrich the 2018 conference experience. This year’s theme is Patient Engagement: Taking it to the Next Level. Patients have a unique perspective as key stakeholders in the health system and engaging them leads to better health outcomes. From 12:00 p.m. until 4:00 p.m., attendees can engage in discussion with patients and health leaders about best practices in patient engagement efforts, pitfalls to avoid and ways to accelerate progress.
PATIENTS INCLUDED For the first time, this year’s conference is an accredited Patients Included event. This means that the e-Health Conference is committed to incorporating the experience of patients as experts in living with their conditions while ensuring they are neither excluded nor exploited. As part of this commitment, patient advisors were involved in program planning and patient speakers have been invited to be a part of this year’s program curriculum.
CHIA GALA Every year, the conference hosts the Canadian Health Informatics Awards (CHIA) Gala, where participants can dust off their fancy frocks for a special evening dedicated to celebrating and rewarding excellence in the digital health community. These awards pay tribute to individuals, projects, teams and companies. Categories include: • Clinician Leadership • Corporate Citizenship • Emerging Leader in Health Informatics • Canadian Telehealth • Innovation in the Adoption of Health Informatics • Leadership in the Field of Health Informatics • Project Team: Implementation • Project Team: Innovation & Care Delivery • Project Team: Patient Care Innovation • Steven Huesing Scholarship Taking place on Monday, May 28 from 6:15 p.m. to 10:00 p.m., the evening will start with a reception followed by dinner and the awards presentation.
Julie Kim is hosting this year’s gala. She is a two-time Canadian Comedy Award nominated stand-up comedian who has performed extensively across North America. She believes that laughter is the best medicine (except in life-threatening emergency situations), and that humour is the shortest distance between two people (if you’re not being literal about space
and time). Julie is also a professor at multiple Canadian universities, educating students about health care and health information technology. She has also been a health care consultant, facilitator, and technology advisor for priority health care transformation initiatives across Canada. Tickets to the CHIA Gala can be purchased through conference registration.
Julie Kim, CHIA Gala Host
Together with their Partners, the Canadian Health Information Management Association (CHIMA) announces two new educational opportunities and upcoming advanced certifications
School of Health Information Science Graduate certiﬁcate program in Health Terminology Standards
CHIMA-Accredited Begins Fall 2018 - Applications open until May 1st.
Coding Specialist Program The only advanced certiﬁcate for HIM Professionals
The program is intended to help meet national and international needs for best practices in controlled terminologies in the health industry. One-year, part-time, online program with a 2.5-day on-campus workshop. The Program is accredited by CHIMA.Future graduates eligible to apply for CHIMA terminology certiﬁcation.
Fully online and ﬂexible - complete in 6-12 months Expert coding faculty
Enrol and start anytime! https://www.uvic.ca/hsd/hinf/graduate/certiﬁcate/index.php
chalearning.ca/csp APRIL 2018 HOSPITAL NEWS 27
6 Ways to Improve Hospital Performance by PetalMD
Healthcare managers are under a lot of pressure to improve hospital performance and they sometimes have a hard time finding the right way to do it. After nearly 10 years of collaborating with physicians and healthcare facility managers, PetalMD shares solutions they have devised to help many hospitals streamline their processes and reduce operational costs.
Ensure Optimal Distribution of Physician Shifts
Physician time is precious. The best way to optimize physician shift distribution is to create schedules with a solution that uses specialized algorithms. These algorithms themselves take into account a multitude of factors, such as on-call coverage, equity in distribution, vacation time, personal preferences, subspecialties, etc. Although doctors’ schedules are extremely complex, there is virtually no case that cannot be addressed by a specialized solution.
Streamline Communications with On-Call Physicians
Studies have shown that 1 in 7 ‘pager’ alerts are sent to the wrong on-call physician.1 To reduce errors and unnecessary round trips that affect the day-to-day efficiency of administrative staff and physicians, it is important to have a single, up-to-date, real-time on-call list. This contact list should be synchronized in real-time with the physician schedules of each department, and should be accessible from staff mobile devices.
1 2 3
Spyglass Consulting Group, Point of Care Communications for Nursing 2014 Canada Health Infoway, Exploring the Value, Benefits and Common Concerns of e-Booking Raytheon and Websense, 2015 Industry Drill-Down Report
Automate Tasks Related to Patient Appointment Management
According to a study conducted by Canada Health Infoway, the average time it takes to make an appointment over the phone is 2.7 minutes.2 For a hospital that processes 100,000 phone appointments annually, this represents approximately 4,500 hours per year. This repetitive task could be automated by offering patients the option to manage their appointments online. Automated reminders could even be received by email or text message.
Limit the Number of Communication Channels
The larger the number of communication tools being used, the more steps there are in the communication process and this increases the risks of errors. For example, a simple schedule can be 1) communicated by fax, 2) updated in an Excel file, 3) converted to PDF to be printed, 4) consulted in a specific physical place and 5) used to reach a doctor… on his pager. Healthcare managers can equip their organization with a single platform that allows for multiple concurrent communication processes, thanks to automatic updates.
Leverage Predictive Analytics
Insufficient staffing can have a major impact on patient health and hospital performance. Based on the number of appointments and admissions that have taken place in the past, it is possible to predict traffic over a period of time. Thanks to these forecasts, staff can be more prepared and provide better healthcare services. Obviously, to take advantage of predictive analytics, hospitals need a system that collects and centralizes medical offerings and patient demand.
Secure Hospital Data
A 2015 study found that hospitals are three times more likely to experience data breaches than other industries, and 4.5Â times more likely to be targeted by ransomware.3 To eliminate the risk of information leakage, hospital staff should have access to a secure messaging platform directly on their smartphones. This way, each communication is encrypted to make the data unusable by anyone outside the system.
How Can PetalMD Help Hospital Managers and Physicians? PetalMD offers solutions that meet the challenges above, including a scheduling management software for physicians, real-time on-call lists, online appointment booking portals and secure messaging.
For more information, visit www.petalmd.com or call a specialized advisor at 1 888 949-8601.
Meet the Attendees ATTENDEES AT THE E-HEALTH CONFERENCE VARY- FROM CIOS, CLINICIANS, HEALTH AUTHORITIES, EMERGING PROFESSIONALS, STUDENTS –AND MANY MORE! HERE IS WHAT PAST ATTENDEES HAVE TO SAY ABOUT THE CONFERENCE:
Heather Thiessen – Patient and Family Advisor
Naima Salemohamed – Senior Business Analyst This year I will be attending my third e-Health conference and you may be wondering why again, because it gets better every year and the wealth of knowledge imparted is invaluable. Our industry is constantly evolving and there are always new learnings. These learning’s benefit current projects and help with future ones. My favourite part of the e-Health conference is the people and the networking that happens. Every year I connect with old friends and meet plenty of new friends. The benefit of all these connections especially for young professionals is in building a reliable network. Our world is based around technology and as we continue to work together we can continue to make changes to help our patients. I hope you will attend this year’s e-Health conference and hope to meet with you. Challenge yourself to meet and exchange contacts with at least 10 new people and to learning 5 new ideas.
30 HOSPITAL NEWS APRIL 2018
My experience at e-Health 2017 was enlightening. The one overarching reason is that the voice of patients and families were front and centre and woven throughout all that was showcased. It’s just the way they do it!
The benefit of attending the conference this year? Well, of course, is all the different things to listen and learn about. I guarantee when you leave you’ll be not only inspired but also motivated to keep digging deeper to find solutions to digital health issues and connect with some pretty amazing health information communities such as CIHI. I am also pretty sure you will learn a thing or two from an engaged patient or family member present at the Conference. Patients and families are the missing links in healthcare and e-Health 2018 recognizes this and ensures our voice is present.
Andre Pires – Product Manager The e-Health conference is truly the epicenter for everything e-Health related in Canada. For me, it was the first conference I attended that got me interested in the field. It is where I have made some of my strongest connections in the industry and secured valuable partnerships for my organization. It encompasses many aspects of the industry allowing for the brightest minds to come together, learn from one another, and advance the e-Health agenda for the benefit of the entire Canadian healthcare system.
A New Venue Location The city offers plenty of fine dining and shopping, but it is also an excellent place for more outdoor pursuits such as hiking, golfing, boating, and surfing.
JW Marriott Parq Vancouver is located in the city’s exciting urban entertainment and resort complex, Parq Vancouver. The JW Martiott Parq Vancouver is rising against a backdrop of majestic coastal mountains on Canada’s pristine pacific coast and will deliver understated luxury and quiet sophistication. About Vancouver The City of Vancouver is a highly diverse and multicultural city with people from all around the world. It is a popular tourist destination and
SEE YOU AT E-HEALTH 2018!
has been regarded as one of the most outstanding convention cities in the world.
Don’t miss this year’s must attend event showcasing the success stories, products, new ideas, and amazing people leading the way on Canada’s digital health journey. Visit our website at www.e-healthH conference.com. ■
Register Now to Save! REGISTER EARLY TO TAKE ADVANTAGE OF REDUCED RATES Registration Types
Regular Registration Final Call/Onsite Registration (March 1 – April 19, 2018) (April 20, 2018 – Onsite) Full Registration $1,200.00 $1,400.00 Student* $325.00 $475.00 One Day Registration $595.00 $745.00 Tradeshow Only $360.00 $360.00 Sunday Pre-Conference Session (Includes Lunch) $95.00 $95.00 More information can be found in the Registration section of the e-Health website. www.hospitalnews.com
Strategies and tools to enhance performance and patient safety he Canadian Patient Safety Institute is now offering an exciting new program to enhance patient safety through improved teamwork and communication. TeamSTEPPS™ is the acronym for Team Strategies and Tools to Enhance Performance and Patient Safety. It is a teamwork system originally developed jointly by the Department of Defense (DoD) and the
Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety. As part of its efforts to enhance a patient safety culture under the SHIFT to Safety platform, the Canadian Patient Safety Institute has adopted and adapted the program and is now making TeamSTEPPS Canada™ available to the Canadian healthcare field.
TeamSTEPPS has been shown to improve safety and transform culture in healthcare through the promotion of teachable, learnable skills that lead to better teamwork, communication, leadership, situation monitoring, and mutual support within and among teams. These core skills lead to important team outcomes, such as enabling the team to adapt to changing situations, achieve compatible shared
TeamSTEPPS Framework Triangle model Performance
32 HOSPITAL NEWS APRIL 2018
ent Care Team
mental models among team members, and maintain a stronger orientation toward teamwork. The Canadian Patient Safety Institute has been working with Canadian and international partners to cultivate the growing network of TeamSTEPPS early adopters, and to develop capacity across the country in support of better teamwork and communication for patient safety. The TeamSTEPPS Canada™ program is delivered in a train-the-trainer model, where Master Trainers are certified to teach the program to others. The program is designed for providers, leaders and patients alike, from a variety of healthcare settings, including acute, primary, long-term and ambulatory care fields. The Canadian Patient Safety Institute has partnered with the Health Quality Council of Alberta (HQCA), as a TeamSTEPPS Canada™ Regional Training Centre, to deliver the TeamSTEPPS Canada™ Master Trainer program. The Master Trainer program includes a comprehensive set of ready-to-use materials and a training curriculum to integrate teamwork principles into a variety of healthcare settings. The inaugural two-day TeamSTEPPS Master Trainer program will be offered in Calgary, May 8 and 9, 2018. The HQCA plans to deliver programs at various locations throughout Alberta quarterly. To register, visit www.hqca.ca “TeamSTEPPS is a good conduit for standardization, sharing, and creating a common vision for safe care between all organizations,” says Rhonda Pouliet, Lead, Collaborative Learning & Education, HQCA and a TeamSTEPPS Master Trainer. “The Health Quality Council of Alberta is pleased to collaborate with the Canadian Patient Safety Institute and come on board as a Regional Training Centre for the TeamSTEPPS Canada™ program. It is an exciting opportunity and we have people throughout the province chomping at the bit to get started on their TeamSTEPPS training!” www.hospitalnews.com
TEAMSTEPPS™M HAS BEEN SHOWN TO IMPROVE SAFETY AND TRANSFORM CULTURE IN HEALTHCARE THROUGH THE PROMOTION OF TEACHABLE, LEARNABLE SKILLS THAT LEAD TO BETTER TEAMWORK, COMMUNICATION, LEADERSHIP, SITUATION MONITORING, AND MUTUAL SUPPORT WITHIN AND AMONG TEAMS The Canadian Patient Safety Institute has also partnered with the Atlantic Health Quality and Patient Safety Council to offer a TeamSTEPPS Canada training session in Halifax, in April 2018. Module 1: Introduction – provides an overview of Master Training, TeamSTEPPS, and the science of team performance. Module 2: Team Structure – defines a team and its members, including patients and their families, and describes a multi-team system, which is important in planning a TeamSTEPPS implementation. Module 3: Communication – provides tools and strategies for communi-
cating effectively through standardized information exchange strategies such as SBAR, check-back, call-out, and handoff. Module 4: Leading Teams – identifies the activities conducted to effectively lead teams and the tools that support these activities, such as briefs, huddles, and debriefs. Module 5: Situation Monitoring – describes the importance of team members gaining or maintaining an accurate awareness or understanding of the situation in which the team is functioning, and outcomes of situation monitoring, including a shared mental model among team members. Module 6: Mutual Support – describes approaches for providing mutu-
al support, or “backup behavior,” that allows teams to become self-correcting, distribute workload effectively, provide effective feedback, and manage conflict. Module 7: Summary: Pulling It All Together – provides an opportunity for participants to review and apply the TeamSTEPPS tools and strategies learned through the course. Module 8: Change Management – provides information about organizational change through Kotter’s Eight Steps of Change. Module 9: Coaching – describes coaching, how to coach, and the role of coaching in implementing TeamSTEPPS.
Module 10: Measurement – provides information about evaluating the success of your TeamSTEPPS implementation, including available assessment tools and resources. Module 11: Implementation Workshop – serves as a capstone to the course by allowing you and your team members to think through your implementation plans and strategies. Module 12: Teachback opportunity – provides participants an opportunity to plan and teach a module from the Fundamentals course. For more information on TeamSTEPPS Canada™, visit www.teamH stepps-canada.ca ■
This article was provided by the Canadian Patient Safety Institute.
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FROM THE CEO’S DESK
The first ever Canadian Hospital Command Centre By Barbara Collins s North America’s first digital hospital, we are in a privileged position to push the envelope when it comes to embracing innovative technology. The technology we have in place has enabled us to accelerate many care processes, improve information sharing and allow patients control over their environment, all of which improve patient care and outcomes. Now, with the launch of our Command Centre in November 2017, we are able to integrate cutting-edge technology, insight-rich data and human expertise to create an innovative system that is contributing to delivery of an excellent patient experience. Similar to airports, hospitals depend on the smooth operation of a number of moving parts. Our emergency department alone receives approximately 130,000 visits each year, and the impact of this high volume is felt by staff, physicians and support services in departments across the hospital. All acute care hospitals experience these pressures, both expected and unexpected. However, airports have air traffic control to support their operations and manage high traffic volumes, while hospitals have not traditionally had such support. Our groundbreaking Command Centre fills that gap. Developed in partnership with GE Healthcare, it is a focal point of our strategy to deal with the pressures we face. As the first of its kind in Canada, and only the second in the world, the Command Centre features powerful analytical and predictive tools to help us improve patient care and flow through the hospital. It also provides physicians and staff with more real-time information and solutions to developing crises, allowing them to focus their efforts and time on delivering excellent patient care. At the hub of the Command Centre are large-scale screens displaying
(l-r) John Flannery, Chairman and CEO, General Electric, Barbara Collins, President and CEO, Humber River Hospital and Roy Scaini, Board Chair, Humber River Hospital Foundation. real-time data and predictive insight. The data is mined from multiple hospital systems – such as bed management and digital communications systems – and processed through algorithms so that it is displayed to a cross-departmental team in a meaningful way that allows them to take action. For example, if the system alerts Command Centre staff that the only activity standing in the way of a patient being discharged from a high-demand unit is an imaging exam, staff are able to coordinate care teams to prioritize the exam, expedite the discharge and accelerate the bed clean. These actions are each taken by a different team, but are orchestrated by Command Centre staff enabled by real-time information that makes delays and risks visible, often before they happen. The cross-departmental nature of the Command Centre team is critical to its success. Decision-makers from each department are concentrated in a single space, improving their ability to
communicate with one another. The team is able to react quickly to make decisions and empowered to take action to avoid developing crises. The data from the Command Centre also gives the team a predictive view of hospital resources and supports. With a hospital-wide view of the demand for beds, porters, housekeeping and other support services over the 48 hours that lie ahead, the team is able to take proactive action to prevent bottlenecks and delays altogether. This predictive potential is a particularly exciting aspect of the Command Centre’s function. Although still in its early days, the Command Centre is already improving the hospital’s processes, as the team is able allocate resources in real time and proactively manage potential issues before they become serious. It is also improving the ability of our physicians and staff to deliver excellent care at the highest levels that our patients deserve. When the flu season brought
its usual peaks in demand for urgent care, the Command Centre was able to provide better support to care teams, prioritizing activities to improve patient care and manage the increased capacity in a more streamlined and integrated way. The Command Centre is a work in progress, and we will be continuing to build on the existing system to add new capabilities, such as monitoring quality of care and clinical data of patients. With these features and the existing improvements to patient flow, we anticipate that over the next few months, the Command Centre will enable an increase in capacity equivalent to opening a small community hospital within our walls. There is still more we can do to improve reliability and safety of care and improve outcomes for our patients. At Humber River Hospital, we view the Command Centre as a focal point in our vision to deliver innovative and H compassionate care to our patients. ■
Barbara Collins is the President and CEO, Humber River Hospital. 34 HOSPITAL NEWS APRIL 2018
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Optimal strategies for the diagnosis of
pulmonary embolism By Sarah Garland he diagnostic approach for pulmonary embolism (PE), a condition referred to as “The Great Masquerader,” is controversial. PE has earned its moniker because it is difficult to recognize and has symptoms that vary from patient to patient. Diagnosing it typically requires multiple steps, and the approach used can differ according to the resources at hand (e.g., staff to operate the machines and interpret the results). So let’s explore this – what exactly is PE, what do you do if you suspect a patient has PE, and what does the evidence say? PE occurs when a blood clot, usually originating from the leg, travels and lodges in the arteries of the lung. However, the signs and symptoms of pulmonary embolism – shortness of breath, feeling faint, chest pain, and
36 HOSPITAL NEWS APRIL 2018
cough – are not specific to only PE and could be attributed to many different conditions. This is part of the reason why PE can be difficult to diagnose, and determining the best strategy for diagnosis is so varied and complex. But it is also important that PE be diagnosed quickly, as the condition is a major cause of emergency hospitalization and, if left untreated, can be fatal in up to 30 per cent of patients. The approach to diagnosing PE requires multiple steps, and the results of each test or exam helps determine the need for further testing. The initial step may be an assessment to determine the likelihood that a person has PE. Tests to help assess the likelihood or risk of a patient having PE are often referred to as clinical prediction rules; these provide a set of clinical criteria that can help determine if further test-
ing is needed. Examples of these tests include the Wells rule, the Geneva score, and the revised Geneva score. Patients assessed to have a high probability of PE may proceed directly to diagnostic imaging, while patients with low probability may undergo further testing. These additional tests include Pulmonary Embolism Rule-Out Criteria, also known as PERC, or D-dimer testing (a lab test that looks for indications in the blood that a patient has a blood clot). Based on the results of these tests, a patient may be referred for confirmation testing or be considered unlikely to have a PE and not require any further testing. Patients who are deemed at high risk of PE following an initial assessment with a clinical prediction rule, or based on unstable presentation, usually undergo diagnostic imaging to confirm
the disease. Previously, conventional pulmonary angiography had been considered the gold standard for PE imaging, but due to its invasive nature (i.e., it requires right heart catheterization), it has been overtaken by alternative imaging modalities. Less invasive methods for imaging include computed tomography pulmonary angiography (CTPA), magnetic resonance pulmonary angiography (MRPA), ventilation-perfusion (V/Q) scanning planar scintigraphy, V/Q single-photon emission computed tomography (SPECT) or V/Q SPECT-CT, positron emission tomography–CT (PET-CT), and thoracic ultrasound. There are strengths and limitations to each of these modalities, and which one is appropriate may depend on several factors. Examples of these factors include the availability of the technology, the www.hospitalnews.com
EVIDENCE MATTERS expertise and choice of the healthcare provider, contraindications (e.g., pregnancy or allergy to the contract dye used in CT), and considerations of radiation dose associated with the various modalities. Not all modalities are widely available or in routine clinical use in Canada. This may be due to a lack of availability or expertise, or due to practical considerations such as the increased time required and the complexity of performing the exam. To help address the challenges associated with diagnosing adults with suspected PE, CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – conducted an evidence review of the various diagnostic approaches. The CADTH project assessed the diagnostic test accuracy, clinical utility, safety, cost-effectiveness, patient experiences and perspectives, implementation issues, ethical issues, and environmental impact. An expert
TESTS TO HELP ASSESS THE LIKELIHOOD OR RISK OF A PATIENT HAVING PE ARE OFTEN REFERRED TO AS CLINICAL PREDICTION RULES; THESE PROVIDE A SET OF CLINICAL CRITERIA THAT CAN HELP DETERMINE IF FURTHER TESTING IS NEEDED panel, the Health Technology Expert Review Panel (HTERP), reviewed the evidence and developed recommendations. Based on the evidence review, three key recommendations by HTERP emerged. These recommendations highlight different approaches for different patient populations; however, the use of the two-tiered model of the Wells rule is recommended as a first step for any adult with a suspected PE. Subsequent tests may be performed as necessary, and the need for diagnostic imaging is assessed after these tests. For the general population, the rec-
ommended pathway is two-tier Wells, followed by D-dimer if appropriate, and followed by CTPA if necessary. For the pregnant population, two-tier Wells followed by PERC and D-dimer testing (if appropriate) is recommended, followed by leg ultrasound and, if necessary, computed tomography pulmonary angiography. However, where there is a heightened concern about radiation exposure, and where the clinical situation allows, it would also be reasonable for the clinician and patient to undertake a shared decision-making process to select between CTPA and VQSPECT as the final step
in the diagnostic pathway. Among patients for whom CT is strongly contraindicated, HTERP recommends two-tier Wells followed by D-dimer testing, followed by VQ-SPECT and, if necessary, leg ultrasound. It should also be noted, in addition to patient characteristics, the available resources influence the choice of diagnostic imaging modality. To help determine availability of imaging machines, CADTH’s Canadian Medical Imaging Inventory was referenced and considered when developing the recommendations. PE is recognized as a complex, nuanced condition, and the diagnostic approach will vary according to many contextual issues. There are different options and approaches when it comes to diagnosing PE, and CADTH evidence can help guide those decisions. To learn more about our project on diagnosing PE, visit www.cadth.ca/PE or speak to a CADTH Liaison Officer H in your region. ■
Sarah Garland is a Knowledge Mobilization Officer at CADTH and focuses on the diagnosis of pulmonary embolism.
APRIL 2018 HOSPITAL NEWS 37
Leveraging technology to transform the patient experience By Carla Wintersgill utbreak season can be hard on patients whose family members are too sick to visit. But thanks to some creative use of technology at Runnymede Healthcare Centre, patients can still connect face-to-face with their families via video calling. Arranging Skype and Facetime calls for patients during outbreak is just one of the ways Runnymede is transforming the patient experience by leveraging technology to enhance the hospital’s patient-centred care.
RUNNYMEDE HAS ALSO ADOPTED A FORMALIZED VIDEO STORYTELLING PROCESS AS A MEANS OF IMPROVING QUALITY THROUGH MEMORABLE STAFF EDUCATION “We are always looking for innovations in support of excellent patient care,” says Sharleen Ahmed, vice president of quality, strategy and clinical programs. “Using technology has enabled us to transform the way we work to enhance customer service and satisfaction at the hospital.” Facilitating instant family and patient feedback is part of that customer service approach. As part of Runnymede’s commitment to ongoing quality improvement, the hospital is introducing real-time patient experience survey kiosks throughout the facility. Real-time data collection enables Runnymede to gather ongoing feedback from patients and families on an hourly, daily or weekly basis so the hospital can constantly enhance the
Thanks to some creative use of technology at Runnymede Healthcare Centre, patients can still connect face-to-face with their families via video calling. patient experience. It also offers the ability to measure patient satisfaction immediately and on an ongoing basis, as well as providing an opportunity for patients and visitors to provide feedback in a continuous, user friendly and accessible way. The system allows comments on service and care to be sent immediately to responsible departments so they can be addressed in a timely manner. While the survey responses are completely anonymous, patients and family members can choose to self-identify through a video testimonial feature on the survey.
Runnymede has also adopted a formalized video storytelling process as a means of improving quality through memorable staff education. Personal storytelling serves to make concepts real and helps crystallize policy thinking by putting real faces to the standards of care. In its guide to using storytelling in healthcare improvement, The Health Foundation, a UK-based healthcare charity, notes that stories of real-life events are used because they are more memorable than data or lengthy manuals, are an established way for board members to focus discussions on qual-
ity and patient experience, and speak strongly to frontline staff, who are often the most motivated by their individual interactions with patients. Finally, the hospital is partnering with OpenLab, a design and innovation centre at the University Health Network to embark on its first ever research project to bring immersive virtual reality (VR) to patients at Runnymede. OpenLab’s pilot project, VRx, explores and evaluates the potential benefits of using VR with various patient populations. The VRx prototype is a series of short, immersive 360 degree films designed to provide a calming experience for participating patients. Exposing patients to VR could elicit buried memories that have been previously forgotten, and may also offer a virtual vehicle that can move patients beyond the walls of the hospital or confines of a bed. At Runnymede, the activation and communications departments will be collaborating with OpenLab to use the immersive VR technology with patients at the hospital and then evaluate any benefits that are observed. “We’re very excited to have the opportunity to participate in this leading edge research project at Runnymede,” says Julie Hiroz, director, communications at Runnymede. “Implementing new patient-centred initiatives that help enhance the patient experience is a key priority for everyone at the hospital, and we are hopeful that this new research partnership with OpenLab will have a variety of benefits for our patients.” As Runnymede moves forward with its first research project, it is cementing its position as a healthcare leader and demonstrating an ongoing commitment to its patients by leveraging new technologies that will heighten their experience at the hospital and raise the H bar on the quality of care. ■
Carla Wintersgill is a Communications Specialist at Runnymede Healthcare Centre. 38 HOSPITAL NEWS APRIL 2018
Talking about the hard stuff
RN helps colleagues, families and communities have tough conversations about death with kids. By Alicia Saunders eath and grief can be intense topics of discussion for anyone, but they can be especially challenging conversations to have with children. Whether it’s a family member or friend, breaking the news about death to a child, or helping a child through the grieving process can be difficult, even for professionals. Andrea Warnick, an RN, registered psychotherapist and thanatologist (someone who studies the sociology and psychology of death), says there are some great resources that can help professionals support patients or clients dealing with loss. In fact, there is a lot of research around grief and death in regard to children, particularly when it comes to cancer. Warnick, who has more than 20 years of experience supporting children, families and communities through the grieving process, says there are many misconceptions she’s often trying to dispel. For instance, it’s important, she says, to allow children to be at the bedside of a dying relative. If a child wants to be there, it can help them to understand what is going on. Literature also supports the idea that children do better with honest and early information about a loved one’s death. Early information allows kids
KIDSGRIEF.CA, A COMPANION TO MYGRIEF.CA, PROVIDES ONLINE SUPPORT AND RESOURCES SPECIFICALLY AIMED AT HELPING CHILDREN to have a more realistic perception of death and the dying process, rather than letting their imaginations run wild thinking about what could be happening. Warnick says there’s never a point at which it’s too early to talk about an illness or dying with children, but there’s certainly a point at which it’s too late. If children feel there’s a secret that’s been kept from them, they can start to struggle with trust issues that are a complicating factor when dealing with grief. Death is an issue that everyone will deal with at some point in their life, but most nurses are not properly educated on how to talk about it with children. Despite her focus on palliative care during her education, Warnick says she did not have a chance to develop skills specific to discussions of death with children when she was first starting out. It was never taught in the classroom, she says. And having worked in a number of positions in nursing at different hospitals, Warnick has found many other health
professionals also feel ill-equipped or helpless when it comes to dealing with this difficult issue. “I realized that social workers had no training in this, and the chaplains had no training in this, and the physicians were terrified of having that conversation with children,” Warnick says. It isn’t surprising, she adds, since Western society, especially in North America, doesn’t like talking about death in general, let alone in conversation with children. In an effort to raise awareness and answer questions about this issue, Warnick recently helped launch a website that she hopes will make the discussion easier – for health providers, families and friends alike. KidsGrief.ca, a companion to MyGrief.ca, provides online support and resources specifically aimed at helping children. The website was developed by the Canadian Virtual Hospice with support from a number of other organizations, and funding from the Canadian Internet Registra-
tion Authority and Hope & Cope, an organization that helps people cope with cancer. Warnick says KidsGrief.ca touches on many of the concerns she has helped her colleagues address in Q&A sessions and webinars she’s hosted as an educator and consultant on the topic. She has been hosting a monthly webinar with Canadian Virtual Hospice since June 2016, and says the website came out of a need to do more to help people feel better equipped to have tough conversations with kids. The site features an ‘Ask a Professional’ link, where parents, professionals or volunteers can send messages directly to Warnick and other professionals for advice and feedback. It also provides details on the monthly KidsGrief webinars at which people can ask questions, share information and voice concerns. When it comes to death, Warnick says nurses are on the front line, often helping patients during the vulnerable hour (2 a.m.) when the hard questions are asked and therapists are often off the clock. She hopes this new website, which launched in November 2017, will not only provide support to nurses, but also be a resource they can give H to families trying to cope. ■
Alicia Saunders is communications assistant for RNAO, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. This article was originally published in the January/February 2018 issue of Registered Nurse Journal, the bi-monthly publication of the Registered Nurses’ Association of Ontario (RNAO). www.hospitalnews.com
APRIL 2018 HOSPITAL NEWS 39
Taking control of chronic illness with technology By Carla Peacock iving with a chronic illness like Chronic Obstructive Pulmonary Disease (COPD) used to mean frequent visits to the emergency department and long hospital stays resulting from acute flare-ups. But thanks to new vital signs monitoring technology, patients can monitor the status of their condition daily to help identify and prevent potential emergency situations.
THE CONNECTED HEALTH KIT ALLOWS PATIENTS TO MEASURE AND RECORD THEIR OWN VITAL SIGNS
Markham Stouffville Hospital, (MSH) in partnership with Women’s College Hospital (WCH), Closing the Gap Healthcare, and Cloud Diagnostics Canada (Cloud Dx) developed a comprehensive self-management program that includes a connected health kit and personalized action plan for COPD patients. They can use this program to be more knowledgeable about their disease and recognize when they require additional interventions. This will shorten the impact of a flare-up and reduce the impact that it has on their recovery and quality of life.
The connected health kit allows patients to measure and record their own vital signs and quantify their breathing capacity using blood pressure, oxygen saturation and COPD assessment scores. When patient specific predetermined thresholds are met, automated notifications are sent to the patient and a healthcare provider. Using a tablet or other wireless devices accompanied with a patient specific action plan, patients are better able to self-manage their condition at home and avoid crises moments. “I used to guess about when I should worry about my symptoms. But now that has changed, by recording my own vital signs, I know what’s going on and if I need to take my additional medication to avoid flare-ups,” says John Grabiec of Stouffville, who has been living with COPD for over 20 years. Grabiec has found the Cloud DX technology has been easy to use. It has reduced his visits to the hospital and given him peace of mind that his care team is monitoring his symptoms as well. “We know more about our patients’ symptoms and we can prevent serious flare-ups so that they don’t have to come into the hospital,” says Sheery Tse, Respiratory Therapist. “With this technology, patients work with care providers to keep themselves healthy and living independently.” In addition, WCH is leading a research study to investigate the effectiveness of this technology by comparing the current standard of care to both a technology enabled self-monitoring program and a technology
MSH patient John Grabiec demonstrates technology to track his vital signs with respiratory therapist Sheery Tse. enabled combined self- and remote monitoring program for this patient population. The effectiveness of this program will be measured by examining patients’ self-management skills, quality of life, COPD knowledge and respiratory symptoms. Secondary outcomes include tracking ED visits, hospital admissions, and length of stay for COPD patients. “The study is in its early stages but we have already seen great success with our rapid pilot project. One of our patients reported avoiding a visit to the emergency department by monitoring their vitals and following their action plan over a long weekend when the clinic was closed,” says Katrina Engel, Respiratory Therapist and Clinical project Specialist at MSH. This technology was made possible with funding from Ontario’s Health Technologies Fund (HTF). The fund is administered by Ontario Centres of Excellence (OCE) on behalf of the
Office of the Chief Health Innovation Strategist (OCHIS), and is a part of the OCHIS mandate to strengthen Ontario’s health innovation ecosystem. This project is one of 12 MSH SmartCare innovations that the MSH Transformation Office has launched in the past year. Combined, these projects have impacted the lives of over 1,300 people. For MSH, ‘SmartCare’ describes innovations and tools that support a culture of innovation. It’s about providing care to patients in a way that is more efficient, more convenient, better coordinated, and smarter. Partnerships have been essential in developing this culture of innovation, and achieving success. MSH has been fortunate in building great partnerships to explore new innovative healthcare delivery models that achieve better outcomes, better experience, and greater efficiency for our H patients, staff, and physicians. ■
Carla Peacock is a Senior Communications Specialist at Markham Stouffville Hospital. 40 HOSPITAL NEWS APRIL 2018
The second victim: Supporting healthcare providers involved in medication errors By Lindsay Yoo and Mengdi Fei n clinically complex healthcare settings, adverse events and medication errors can occur despite the best intentions of healthcare professionals. There are usually two victims that are affected after these events: The “first victim”, who refers to the patients and their family, and the “second victim”, who is the involved healthcare provider who experience emotional distress following an adverse event that results in patient harm. It is estimated that almost 50 per cent of all healthcare providers are a second victim at least once in their pro-
fessional career. Following the medical/ medication error, the second victims often experience a range of distressing emotions, such as guilt, isolation, and anxiety. This emotional burden can linger for a long time, with a few going on to suffer long-term consequences that are similar to post-traumatic stress disorder.
STAGES OF RECOVERY OF THE SECOND VICTIM The second victims go through a recovery trajectory discussed below (Figure 1).
SUPPORTING SECOND VICTIMS The supporting system for second victim should be consistent with the “5 Rights of Second Victims”, particularly when reviewing events and addressing staff: • Treatment that is just • Respect • Understanding and compassion • Supportive care • Transparency and opportunity to contribute One way for second victims to overcome the guilt after an adverse event is through confession; however, this is
Figure 1 – Stages of Recovery of the Second Victim
Chaos & Accident Response
• Discover how the adverse event occurred • Confusion, clinically distracted • “How did that happen?”; ”Why did that happen?”
• Understand what transpired • Revaluate situation, feelings of isolation • “What did I miss?”; “What should I have done differently?”
• Restore professional credibility among peers and supervisors • Fear of rejection from colleagues • “How can I ever be trusted again?”; “What will others think of me?”
• Provide effective accounts of the event • Fear of losing license and employment • “Will I lose my license or job as a result of this incident?”
Obtain Emotional First Aid
• Safely communicate feelings regarding the event • Seek emotional help but concerned about privacy • “Who can I trust to talk about this case?”; “Where can I go to for help?”
often not available or discouraged by risk managers and lawyers. Even when adverse events are discussed within formal sessions, there is little focus on the emotional impact of the individual involved. To address this gap, the emotional health of the second victims needs to be taken into consideration in incident analysis and review process. Furthermore, organizations are encouraged to create blame-free environments or “safe spaces” for second victims to: • Share their experiences and transfer knowledge regarding medication incidents; • Discuss coping strategies; and • Make recommendations to prevent similar errors. The goals of most second victims are reconciliation and closure, which are best achieved through disclosure. By sharing and storytelling, the second victims can release their emotions and gain insight from the incident. In addition, colleagues or “buddies” can offer social and emotional support to assist the second victims during this healing process. For individuals who consider themselves as second victims and wish to seek help, the Government of Canada Employee Assistance Program (EAP) provides confidential and professional counselling.
TO ERR IS HUMAN Healthcare providers are humans. Humans are not perfect. Second victims should be not neglected; they should be acknowledged and provided with support to help recover from the aftermath of the error and to ultimately reach the “thriving” stage H (Figure 1). ■
• Dropping out - Changing professional role • Surviving - Identifying ways to cope; “doing okay” but never return to baseline performance levels • Thriving - Gain insight and make a positive impact on future events
Lindsay Yoo is a Medication Safety Analyst at the Institute for Safe Medication Practices Canada (ISMP Canada); Mengdi Fei is a PharmD Student at the Leslie Dan Faculty of Pharmacy, University of Toronto; Certina Ho is a Project Lead at ISMP Canada. www.hospitalnews.com
APRIL 2018 HOSPITAL NEWS 41
Giving patients the right information, at the right time, on a mobile device By Allison Johnson hen Matthew Kaufman’s mother returned to her hospital room after emergency hip surgery, he says they were both feeling scared and anxious about what would happen next. They had plenty of questions, but did not want to trouble nurses while they were busy caring for other patients. After downloading Windsor Regional Hospital’s new WRH MY CARE JOURNEY APP, Kaufman says he learned all about his mother’s fractured hip, what to expect while she was in the hospital, where she would go next, and how to prepare for her eventual return home. “That immediately made us feel more at ease and in control,” Kaufman says. “It was such a relief and it answered questions we didn’t even know we had!”
THE WRH MY CARE JOURNEY APP ALLEVIATES THAT FEAR BY PROVIDING ANSWERS FOR PATIENTS IN AN EASY TO USE FORMAT THAT IS AVAILABLE TO THEM AT ANY TIME The new WRH MY CARE JOURNEY APP helps patients and loved ones know what to expect during their treatments, so they can play a more active role in their recoveries and prepare for a safe discharge. “In focus groups, patients told us the scariest part of being in the hospital is fear of the unknown. They also said that sometimes after receiving a life-altering diagnosis, they don’t fully hear, understand or appreciate what their care provider is saying,” says Karen McCullough, Windsor Regional
Windsor Regional Hospital’s app ambassadors promoting the app to patients and colleagues at the hospital. Hospital Chief Operating Officer and Chief Nursing Executive. “The WRH MY CARE JOURNEY APP alleviates that fear by providing answers for patients in an easy to use format that is available to them at any time.” The app uses a diagnosis-specific timeline and interactive push notifications to keep users informed while they are in the hospital, and after they leave. It includes photos, videos and easy to understand language to let patients know: • What they can expect in the hospital (length of stay, possible tests, medication, members of their care team); • How they can participate in their treatment and recovery (diet, physical activity, etc.); • Detailed information about certain conditions (COPD, heart failure, hip fracture, etc.); • Helpful information for their visitors (parking, food, wifi password); and
• Ways they can prepare for next steps in their journeys (follow up appointments, equipment for their homes, etc.). The mobile tool is part of a larger initiative to standardize care at Windsor Regional Hospital and improve communication between patients and their care teams. It was designed by a multidisciplinary team including physicians, nurses, allied health professionals, quality improvement experts, communication specialists and patients. “Having patients at the table helped us understand what information they felt they needed for a safe recovery. With that, we programed the app with relevant content that anticipates patients’ questions and addresses their concerns,” says McCullough. For those not comfortable using a mobile app, the information is also provided in brochures given to patients when they are admitted and on
the hospital’s website where it is also available French, Arabic, Spanish and Italian. The app also has useful information for family members and loved ones. Whether they are providing care at the bedside or live out town, friends and family members can download the app, and instantly become part of their loved one’s journey. Kaufman says even though his mother does not use a smartphone, the WRH MY CARE JOURNEY APP played an important role in helping her get better. “Once she found out I had the app and could look things up, she would ask me questions all the time. It put her at ease and me as well. I could go home and relax without worrying,” he says. “If I had questions I could look them up at any point in time.” The WRH MY CARE JOURNEY APP is free to download and available in the App Store and H Google Play. ■
Allison Johnson is manager, communications at Windsor Regional Hospital. 42 HOSPITAL NEWS APRIL 2018
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Considering the ethics of e-health: Telemedicine, telehealth and telesitting By Andria Bianchi ealthcare delivery is rappidly changing, and techhnological advances are re diminishing barriers to receiving care. Some current practices that respond to healthcare needs are telemedicine, telehealth, and telesitting. These practices are often defined under the umbrella term “e-health”, and they enable individuals to receive guidance, care, and d attention, irrespective of a person’s n’s geography or institutional boundaries. s. Most of Canada’s population and nd healthcare organizations exist in urrban cities, making it difficult for peoople from other parts of our country to access adequate healthcare services; s; this is especially the case when it comes to accessing specialized healthhcare facilities, such as teaching and nd research institutions, hospitals focussing on cancer or paediatric care, etc. c. An inability to access care based on geographical constraints is an ethical al problem from the perspective of access and equity.
THE USE OF TECHNOLOGY IN HEALTHCARE CAN BE A POSITIVE STEP FORWARD TO DECREASING HEALTHCARE DISPARITIES ACROSS CANADA Technological advances can help to address some of these inequities, and there have been several novel approaches to providing care in just the last few decades. Telemedicine is a type of medical practice where a clinician is at least one of the participants involved in an interaction via technology. For instance, a clinic that offers
pain and symptom management services over the telephone or computer would be classified as telemedicine. Telehealth is any platform offering health h l h information i f i and d support that h does not necessarily involve a clinician (e.g. facebook support groups for people diagnosed with certain illnesses, websites about healthcare treatments, etc.). Telesitting is when a patient is monitored through a virtual sitter system by a patient care technician – the technician can virtually observe patients through the system. Technology in healthcare is constantly advancing, and there are many ethical benefits that justify the continued and increasing use of e-health. The primary benefit, which I alluded to above, is providing equitable access to care. Another benefit is that remote and home care services are typically less costly than in-person/in-hospital services; requiring patients and clinicians to travel for (potentially unnecessary) in-person care is costly for all parties involved. Any savings that result from providing care via technology could be allocated to other healthcare priori-
ties, potentially resulting in a greater benefit for a larger number of people. Finally, technological services h l i l healthcare h lh i give patients more autonomy to take control of their health and receive timely support. In addition to examining these benefits, we must also consider some of the arising ethical vulnerabilities. One of these considerations is whether e-health services “promote rationality and efficiency at the expense of values traditionally at the heart of caregiving.” If building in-person relationships with clinicians in an intimate setting represents what healthcare should be like, then e-health poses a potential problem. Furthermore, most types of telemedicine prevent clinicians from gauging a person’s body language and facial expressions, which may be relevant to understanding a patient’s concerns, comprehension of information, etc. Also, while e-health services offer people the opportunity to access information and support from wherever they are located, it is possible that people from certain cul-
tural communities may hold different perspectives about how healthcare services ought Reh to bbe provided. id d R latedly, information exchange may be challenging for people who speak a different primary language than their clinician. Giving people the opportunity to access care is important, but if the quality of care being offered is sporadic across populations, then this needs to be thoughtfully addressed. The use of technology in healthcare can be a positive step forward to decreasing healthcare disparities across Canada. Providing equitable access to care through technology is compatible with patient-centred care and it may allow us to allocate resources in other beneficial ways. Upon implementing e-health services, however, we ought to ensure that we try to mitigate possible vulnerabilities. Offering services that maintain a high quality of care, consulting with relevant stakeholder groups, and taking different perspectives into account, will help to ensure that the benefits of e-health outweigh H potential risks. ■
Andria Bianchi is a Bioethicist at the University Health Network, a PhD Candidate at the University of Waterloo, and a board member of the Canadian Bioethics Society. 44 HOSPITAL NEWS APRIL 2018
NEWS A telehealth program could increase access to expert knowledge and information after a stroke.
Putting a stroke coach in every patient’s corner fter a stroke, prevention of another is key. Prevention starts with a healthy lifestyle, yet many patients lack access to knowledge and experts that can help them make the right healthy living choices. Enter the Stroke Coach – a telehealth program to guide patients towards a healthy recovery and away from bad habits that could increase their risk of another stroke. Led by Vancouver Coastal Health Research Institute (VCHRI) researchers Brodie Sakakibara and Janice Eng, the Stroke Coach connects stroke survivors with healthy living experts over the phone from the comfort of their home. Over 50 per cent of stroke survivors do not return to driving after their stroke, which can lead to difficulty accessing specialized care at a hospital or clinic. In addition, many recovery programs do not involve the in-depth follow-ups and personalized advice that are part and parcel of Stroke Coach, leaving patients to manage their health and wellbeing on their own. “We spend a lot of time rehabilitating our patients, but we don’t yet have a formal protocol to help patients understand how to prevent another stroke,” says Eng, who is leading the Stroke Coach study. Eng became aware of the need for an easy-to-access program when working with colleagues in rural areas, and discovering that some parts of BC have minimal rehabilitation services. Many individuals experience high levels of distress after a stroke, or have
difficulty getting their lives back to normal. Stroke Coach puts patients in regular communication with a healthy living expert who keeps track of their recovery and health behaviours, regardless of how far the patient is from the nearest hospital. “We want to help our patients get on the path to recovery. This means helping them manage chronic disease, get enough physical activity, improve their diet and manage stress. Ultimately, we hope we can improve the quality of their lives.” In 2013, over 405,000 people in Canada had experienced the effects of a stroke. The risk of stroke increases with age, and the recurrence of stroke is estimated to be 13 per cent within one year of the first stroke and 2533 per cent after five years. Lifestyle management has been shown to decrease that risk. The protocol being tested by Eng and Sakakibara builds on evidence-based research into the success of lifestyle coaching. However, Stroke Coach is unique in that it provides lifestyle coaching, self-monitoring and a self-management manual for stroke patients that empowers them to better manage their health after a stroke. The Stroke Coach study is open to stroke survivors from across BC. Participants receive seven telephone lifestyle coaching sessions over the course of six months. During the 30- to 60-minute sessions, a trained lifestyle coach shares information with patients about how to self-manage and monitor their health using a self-monitoring kit that includes blood pressure and activity monitors.
This article was submitted by Vancouver Coastal Health Research Institute. www.hospitalnews.com
Brodie Sakakibara is a postdoctoral research fellow with the Department of Physical Therapy at UBC and Faculty of Health Sciences at Simon Fraser University. If their results are positive, Sakakibara believes the protocol could have ap-
plications for managing other diseases. “The next step would be to identify where in the healthcare system this program should be implemented. It is not going to replace services currently provided, but it could be an add-on to H improve patient care and recovery.” ■
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SIGNA™ Premier gradient technology. The SuperG graGE Healthcare is proud to andient coil introduces outstanding pernounce SIGNA™ Premier, a new wide formance and superb stability, which is bore 3.0T magnetic resonance imaging designed to deliver the performance of (MRI) system, is now available for sale ultra-high-performance, research-class in Canada. SIGNA Premier is the re60 centimeter MRI system in a 70 censult of a four-year collaboration with timeter bore. the National Football League (NFL) The RF technology of SIGNA Preand research institutions around the mier provides 146 independent receivworld working to design new imaging er channels that allow the simultanetools, particularly to aid researchers ous acquisition of patient data from in the detection of biomarkers for the multiple high channel-density surface potential diagnosis of mild Traumatic coils for faster scanning, higher image Brain Injury. SIGNA Premier delivers quality, and overall enhanced clinical a new level of clinical performance performance*. with additional research-focused caAdditionally, SIGNA Premier can pabilities, especially for neurology and perform a routine fast brain examinaoncology research. tion in under five minutes by leverag“We’re excited to be the first in ing HyperSense, a new speed scanning Canada to bring this premium widetool, delivering up to eight times faster bore 3T technology to our patients,” scanning*, which is part of the Hypersaid Dr. Gallix, chair of Diagnostic Works application suite. Radiology at McGill University Health SIGNA Premier is the most recent Centre in Montreal, Quebec. “We addition to GE Healthcare’s MRI look forward to using this cutting-edge portfolio, including SIGNA Archiimaging technology to advance our tect, a 3.0T MRI system, and SIGNA practice and to help us in our goal to Artist, a 1.5T system, both premideliver great care to our patients.” um wide bore scanners designed to SIGNA Premier features: GE increase productivity and improve Healthcare’s latest, short-bore, diagnostic confidence for clinicians. high-homogeneity 3.0T superconThese new MRI systems feature ductive magnet; the most powerful the new SIGNAWorks applications gradient system GE Healthcare has portfolio and the SIGNAWorks Inever developed for a wide bore 3.0T novation application suite delivering system; and a new, digital RF transmit beyond the standard productivity and and receive architecture. Clinical and clinical capabilities. The Architect research applications benefit from this and Artist are supported by both an high-performance hardware as well advanced 96channel and 128channel as machine learning software that inRF architectures and cutting-edge cludes cloud analytics. SIGNA Premier H applications. ■ is powered by the innovative SuperG *As compared to GE Healthcare’s previous generation MR systems. 46 HOSPITAL NEWS APRIL 2018
Philips Azurion Philips Azurion is the next-generation in image-guided therapy (IGT) systems. IGT specifically refers to the use of any form of medical imaging to plan, perform, and evaluate surgical procedures and therapeutic interventions. Azurion features many unique ergonomically designed features, including its user interface, which can contribute to faster training of new staff and make it easier to rotate existing staff. An Azurion workflow study was performed in the interventional radiology department at St. Antonius Hospital in the Netherlands. The study demonstrated time savings for almost all aspects of their interventional procedures – including a 25% reduction in planned cases finishing late. The key finding of the study was that the efficiencies gained by using Azurion allowed for one more patient to be treated per day.1 With Azurion, clinicians have full table-side control of all applications in the interventional lab. The Touch Screen Module Pro feature reduces the need to “break sterility” during procedures. The FlexVision Pro and FlexSpot features allow for all needed information to be accessed from any work area. These technologies help optimize workflow and help clinicians to work more efficiently, consistently, and confidently. What is exciting about Azurion is ConnectOS, a unique real-time
multi-workspot technology. ConnectOS was designed specifically by Philips for the Azurion interventional platform. It allows for the integration of real-time information from all technologies connected to the Azurion. Clinicians can now customize their workflow to maximize efficiency. By using different user-focused work spots they can view, control, and run multiple applications independently, without interrupting each other’s work. The ability to pre-program settings and layouts can help minimize preparation errors and procedure time. Clinicians within a team can simultaneously complete different tasks within procedures and different service teams can easily work in the same lab with the settings that work best for them. The Azurion is available with a range of detector sizes and Philips unique ClarityIQ technology. It produces high-quality images at ultra-low radiation exposure. The Azurion is designed to support all types of interventional and surgical imaging applications. The flexibility of the Azurion makes it an ideal platform not only for todays image guided therapy procedures, but also for the procedures of the future. 1Results are specific to the institution where they were obtained and may not reflect the results H achievable at other institutions. ■ www.hospitalnews.com
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Focus: Health Care Transformation, eHealth, Mobile Health and Medical Imaging. Special eHealth Conference Supplement.