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Information Technology Vital for Global Healthcare Improvements Aptly recognized as Toronto’s “Urban Angel,” St. Michael’s Hospital is heading towards the future of healthcare. Through a powerful information technology initiative, the visionary Canadian care center is transforming clinical practice across the continuum of care. by Laina Minervino


CARE CONTINUUM OF CARE “The future of healthcare relies on our ability to utilize technology to understand disease earlier, develop the best treatment plans, improve clinical workflow, and decrease costs – and ultimately help patients enjoy longer and healthier lives,” said Prof. Dr. Erich Reinhardt, President and CEO, Siemens Medical Solutions. As connectivity and interoperability continue to drive healthcare discussions around the globe, solutions that help link physicians with the whole patient story throughout the healthcare continuum are essential.

Global Partners Driving Change The key to transforming healthcare through information technology lies in how well healthcare systems and technology solution providers work together. More than 2,700 hospitals around the globe have moved into the electronic healthcare age using Siemens equipment, including 30 in Canada. As in the United States, the Canadian government has mandated IT to drive healthcare forward. As a result, the government has formed the Canada Health Infoway, an independent, publicly funded organization to make strategic advancements in the electronic health record (EHR) projects that can be replicated throughout the country.1 More and more Canadian hospitals are turning to healthcare IT, and one hospital – St. Michael’s Hospital in Toronto, Ontario – is taking a thoughtful and measured approach to ensure the introduction of new technology is about much more than simply automating existing paper systems. Helping them through this process is a partnership with Siemens.

The Urban Angel and Project Gemini St. Michael’s Hospital (SMH) is a 600bed facility located in downtown Toronto. The facility provides primary and secondary care, serves as a downtown trauma center, and is a leading teaching facility fully affiliated with the University of Toronto. Its dedication to treating and protecting the city’s vulnerable has earned SMH its reputation as the “Urban Angel.” The healthcare environment in which SMH is thriving is undergoing many changes. Ontario is in the midst of a three-year, province-wide health system transformation, and new provincial privacy legislation governing the collection, use, and disclosure of personal health information – Personal Health Information Protection Act – came into effect in November 2004. “Canada has made significant advances in healthcare IT in the past two or three years,” said Jeffrey Lozon, chief executive officer of St. Michael’s Hospital. “Infoway, the provinces, and healthcare organizations have invested significant resources in EHRs. Everyone is watching what we do.” And, SMH hopes to do a lot. In 2002, the executive team shaped an extensive information management plan and establishing an internal EHR emerged as a key corporate priority. The project was named “Project Gemini” to reflect the hospital’s vision of “twinning” the transformation of clinical practice with technology.

»Our clinical vision for transformation is about much more than simply automating our existing paper system. It is about designing a patient-centered, best practice framework.« Anne Trafford, chief information officer, SMH

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»The future of healthcare relies on our Project Gemini Redefines ability to utilize technology to under- Care Lozon recalls that Project Gemini started stand disease earlier, develop the best with four specific goals: • improving patient care treatment plans, improve clinical • improving the working life of SMH staff workflow and decrease costs – and • connecting with other employees ultimately help patients enjoy longer and and outside professionals • improving efficiencies throughout healthier lives.« the hospital Prof. Dr. Erich Reinhardt, President and CEO, Siemens Medical Solutions

“We were behind the times with respect to the whole world of computerized information,” said John King, executive vice president, chief administrative officer, SMH. “We were very paper-based and needed a strategic plan to move forward.” “With Project Gemini, we were looking to implement best-of-breed ideas and solutions that would link the entire patient care system,” King added.

To achieve these goals, SMH charted a course to implement a system that would build and present a coherent patient story (record) across the continuum of care, empower interdisciplinary care and provide quick access to relevant data at the point of care to all 3,500 clinicians practicing at SMH. “Our clinical vision for transformation is about much more than simply automating our existing paper system,” said Anne Trafford, chief information officer, SMH. “It is about designing a patientcentered, best practice framework.” To achieve this vision, SMH went to the market and decided on the Siemens solution. “Soarian® was the only product with embedded analytics and a workflow engine. We needed to change the

St. Michael’s executive team underscores information technology’s vital role in achieving the hospital’s vision for improved patient safety and care. (left to right: John King, chief administration officer; Jeffrey Lozon, chief executive officer, and Anne Trafford, chief information officer.

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Envisioning a Connected Health System: Siemens Shapes Tomorrow’s Care While St. Michael’s in Toronto has a clear vision for moving towards an electronic health record (EHR) and incorporating healthcare information technology (IT) solutions into the continuum of care, Siemens Medical Solutions also has a vision for helping healthcare providers around the globe achieve integrated care. As the first major diagnostic technology vendor to provide a comprehensive portfolio of integrated imaging and IT solutions, Siemens knows first-hand the power of transforming care. Siemens journey started more than five years ago and was propelled by the acquisition of Shared Medical Systems in 2000 as a strategic move that merged Siemens imaging expertise with a company with established leadership in healthcare IT. Since launching Soarian® in 2001 – the core element of its IT strategy – Siemens remains the only vendor to develop a new, Web-based, workflow-driven health information system (HIS). More than 100 healthcare facilities are live on Soarian modules. According to Dr. Sami Atiya, senior vice president at Siemens Medical, Soarian is a workflow system that manages the execution of processes to reduce handoffs, enable concurrent activities, and automate routine work, resulting in higher productivity, increased throughput, and optimal outcomes. One of the first steps in integrating imaging and IT was the creation of syngo®, an intuitive user interface that bridges all imaging hardware with a common look and feel. More than 40,000 licenses have been sold for solutions from Siemens enhanced with syngo. Siemens has expanded the successful syngo image management platform, including integrated radiology information systems (RIS) and picture archiving and communication systems (PACS), with unprecedented linkages to Soarian. This brings together all Siemens software into a single instrument to support patient care. “Siemens understood the importance of integrating imaging and IT workflow early on, embarking upon a trendsetting strategy,” said Tom Miller, president, healthcare IT division, Siemens Medical Solutions. “With the syngo Suite and Soarian we are driving the future of healthcare by helping to advance accurate, quick diagnoses and early disease detection.” The combination of syngo and Soarian within any healthcare environment provides the foundation for an EHR that goes across boundaries or information silos to assist with workflow concerns and drive clinical benefits. Such a free flow of information leads to treatment that is not limited to a hospital or doctor’s office, collaboration and communications that are streamlined across departments and disciplines, and outcomes that are focused on improving patient care.

process of how we did things and work with technology for better outcomes and measurement,” King said. “Siemens and SMH have a true partnership,” added Trafford. “Siemens is an active member of our strategic alliance council.” Ultimately, the workflow technology within the hospital will help bridge the silos and enhance the interprofessional culture. “Electronic systems will allow care teams to work together,

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not in silos, to plan the patient’s care,” said Trafford.

Seeing IT Benefits The first phase of Project Gemini – a Web-based tool that allows clinicians to view patient information – went live 18 months ago. To date, the hospital has introduced Soarian Clinical Access, a radiology information system (RIS), and a new pharmacy man-

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CARE CONTINUUM OF CARE agement system. And, SMH saw immediate success with the implementation of the picture archival and communications system (PACS). “We went from a traditional film environment to filmless in about 10 days,” said Trafford. King echoed: “One of the major benefits of phase one was the instant access to images. Our clinicians no longer had to wait to review critical patient tests and more than one professional can view the images at a time. This has been a huge advancement for us.” A more recent success was seen in SMH’s Fracture Clinic when the department went live with electronic scheduling. “The team adapted quickly and won’t go back to paper processes,” said Trafford. While this is only the first of many steps Project Gemini will take on the

road to hospital-wide use of the scheduling application, this quick win prompted requests from other clinics hoping to automate their patient scheduling practices.

A Journey’s Lessons Even with successful implementations, the process to complete IT integration is a continual journey. SMH has only laid the foundation for this multi-year project, and like many other healthcare organizations, learned many lessons along the way. Despite its challenges, SMH has successfully positioned itself for the implementation of more complex applications such as order entry and automated clinical documentation. “Phase one made us realize how complex this was and made us set more realistic expectations,” explained King. “We weren’t totally naïve, but we now have a

Toronto’s “Urban Angel,” St. Michael’s Hospital is recognized as a leader in global health and information technology initiatives. Photo courtesy of St. Michael’s Hospital

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CARE CONTINUUM OF CARE better understanding of just how complex this process is.” Trafford added: “Our initial implementation was very IT driven and the clinical side couldn’t see the benefits. We now know what the clinicians need to get on board with the change. We are able to plan better for later phases and we now have significant clinical engagement. “ As SMH learned, the implementation of healthcare IT solutions dramatically changes the infrastructure of any healthcare organization. King and Trafford believe it is essential that organizations understand the impact on the personnel in both patientfocused and non-patient focused roles. “This is a big change,” said King. “There are and will continue to be mixed reactions among the staff. However, there are also huge advancements and benefits throughout the hospital. It’s about managing expectations throughout the entire process.” Expectation management is also essential because technology can be temperamental and infrastructure changes don’t happen over night. “These things take time, and I’m not sure it can be done faster,” explained Lozon. “Even if hospitals or governments throw more money at IT, these things take time and the change management effort is considerable.” “This is a whole new world for many people in this industry and at St. Michael’s,” added King. “It is important to take the transition slow and realize that implementation is very complex. You also need to remember that you are dealing with people and everyone adjusts to change differently. The key is to never lose site of the goal to improve patient safety. “

Staying the Course

Beulah Hibbert, film library clerk at St. Michael’s, copies a patient’s test images onto a CD using Siemens PACS archive technology. Photo courtesy of St. Michael’s Hospital

“We believe very strongly in seeing Project Gemini through to the end,” said King. “We are anxious to implement advanced technologies, but don’t want to lose sight of our mission and our special hands-on approach. Ultimately, the technology will enhance how we serve our mission by helping us make better bedside decisions.” When asked what SMH will look like five years from now, the goal is still clear: “St. Michael’s will look quite different. We will see all of the components of our integrated solution in place for better patient care,” said Lozon. 1

Dorrel, Linda, et al. “Name Game: Canada’s Blueprint for a Nationwide Master Person Index.” Journal of AHIMA 75, no.9 (October 2004): 40-42.

»Soarian was the only product with embedded analytics and a workflow engine. We needed to change the process of how we did things and work with technology for better outcomes and measurement.«

The whole new world holds much potential for SMH and Canada.

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John King, executive vice president, chief administrative officer, SMH

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Medical Solutions IT Edition February 2006