State-of-the-Art Ambulatory Care Unit Design Helps
A "smart" way to enhance mental health care focus in this issue
Canada’s Health Care Newspaper february 2013
Volume 26 Issue 2
Facilities Management and Design/Health Technology/ Greening Health Care:
Innovative and efficient health-care design, the greening of health-care, and facility management. An update on the impact of information technology on health-care delivery including electronic healthcare records. Trends, issues and achievements in the field of Clinical Informatics.
Inside Ethics...............................................................5 Patient Safety................................................13 Legal Update.................................................18 Nuring Pulse.................................................24 From the CEO's desk����������������������������������� 25 Careers��������������������������������������������������������� 27
State-of-the-Art Pharmacy System Increases Patient Safety By Patti Enright
n November, Providence Healthcare became the first hospital in Canada to implement the BeaconTM Inventory Management System from TCGRx, a new automatic medication dispenser, for its new on-site retail pharmacy. “When we first spoke about opening a retail pharmacy for our patients, staff and the surrounding community, we needed to be space conscious. We also wanted a system that would be quick to use and user friendly to ensure more time for customer service,” explains James Lam, Director of Clinical Services and Organizational Health. “We chose this system because it offered comprehensive automated medication inventory management for patient safety and efficiency.” Through the use of a touchscreen display and a cordless scanner, the system locates medication using light activation technology. Bright LEDs identify the correct drawer for picking or stocking medications and numeric displays specify the correct row and slot position within the storage area. Pharmacy staff use bar code technology to scan each order, helping to ensure the right medication is dispensed for the right patient – an impressive feature for an organization serving a diverse population.
Pharmacist Sean Chai-Chong and pharmacy technician Ben Choi scan medications into a new electronic inventory management system in Providence Healthcare’s retail pharmacy. Through its hospital, Providence offers inpatient and outpatient rehabilitation to adults of all ages, as well as palliative care. As an active community partner and resource for the people of Toronto’s east end, Providence offers clinics to promote recovery and well-being, caregiver support, an adult day program for people with dementia and long-term care for 288 residents. The retail
pharmacy will be available to support the organization’s 8,000 patients and their families as well as Providence’s 1,400 staff and volunteers. “With this system, we can develop the ideal inventory for our customers by tracking what and how often we are dispensing as well as what is expiring on our shelves so that we have a better idea of what we can keep in stock,” says Sean Chai-Chong, Pharmacy
Manager for Providence’s retail pharmacy. “Plus, like the majority of hospitals, we have a very compact space to work in. This system allows us to maximize our workspace through high density storage.” From inventory control to accuracy in dispensing to improved workflow efficiencies, Providence is able to provide a small, yet fully stocked pharmacy for its patients, clients and surrounding community.
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“Human errors are reduced significantly compared with traditional pharmacies,” adds Lam. “It allows us to free up time for our pharmacist and technician so they have more time to spend one-on-one with patients.” Patti Enright is the Corporate Communications Manager for Providence Healthcare.
Hospital News, FEBRUARY 2013
Focus: Facilities Management and Design/Health Technology/Greening Health Care
eCare strategy a priority at St. Joseph’s Health Centre By Lauren Pelley
t. Joseph’s Health Centre is taking the steps to enhance patient care through innovation, as plans move ahead as part of our eCare strategy for the implementation of a fully comprehensive electronic health record by November 2013. Our eCare initiative has the capacity to be “truly transformational” for our organization and for patients, explains Mark Vimr, Executive VicePresident of Clinical Programs and Chief Nursing Executive. “We’re at a very exciting time with eCare, given all the work we’ve done over the past three years, and the recent decision made by our Board to commit to a revised plan that sees us going live later this year,” Vimr says. Electronic health records provide a safe way for health care providers to store and access patient health information – and the launch of these records through eCare will result in a secure paperless system here at St. Joseph’s. Our eCare initiative is part of a province-wide push from the Ministry of Health for electronic health records and reflects our goal of Putting Patients First by ensuring the safest care. Over the past three years, there have been some significant developments in our eCare strategy. “About a year ago, we fully upgraded the system in our Emergency Department and the current version of the Allscripts software we’re using for our electronic health record, so that we would be in a good position to build the next steps,” explains Vimr. “We called that Phase 1 of the electronic health record journey.” That first phase helped build the infrastructure for eCare, allowing us to gear up for our November launch. Where we are now is the
A St. Joe's staff member looks at electronic patient information in our Emergency Department. Through St. Joe's eCare strategy, a fully comprehensive electronic health record will be implemented for patients in November 2013. second phase – a realignment of our original strategy, which involves a closer look at the logistics of using electronic health records. In order to achieve our goal that means implementation of CPOE (computerized provider order entry), physician documentation and full in-patient clinical and inter-professional documentation. According to Stephen Banyai, Chief Information Officer at St. Joseph’s, the eCare strategy will be fully integrated. That means everything – including prescriptions, lab results and diagnostic imaging such as x-rays or MRIs – will be in one consolidated patient record available to all clinicians within our organization. “After November, the patient experience here will change. At that time, when someone comes into the hospital, the information that is collected up-front will be available to all appropriate care providers at St. Joe’s, throughout their entire journey,” explains Banyai. This will result in a streamlined process that will no lon-
ger include repeated questions about patient details, such as allergies and medications, as a patient moves through different hospital units. “Electronic health records allow you to put in certain checks and balances automatically,” notes Vimr. “So that when certain medications are ordered that may counteract other medications, we can program red flags that will automatically pop up.” The entire operation will become faster and more efficient, Vimr adds. “But first and foremost, the quality of care that we give is going to be much safer.” Some patients here are already witnessing first-hand the power of electronic health records. Foreign Exam Management went live late last year, and now allows clinicians at St. Joseph’s to access patient scans from within the GTA West Diagnostic Imaging Repository (DI-r) – a shared regional bank of diagnostic imaging results. “We now have the capability to store and view foreign studies that are relevant to
exams being performed at St. Joe’s,” explains Cam Hyginus, Technical Lead with the GTA West DI-r team at St. Joseph’s. For example, if a patient here at the Health Centre is scheduled for a scan – such as an MRI or x-ray – then clinicians are able to access any previous scans the patient has had at other hospitals within the GTA West DI-r. This allows clinicians to compare results and ensure they are provided with a full picture of the patient’s history to inform the appropriate treatment. It also has the added benefit of reducing radiation on patients, since repeated scans will be less frequent thanks to easier access to past results. This new capability of being able to share images and results among the various hospitals a patient is likely to visit is a direct result of the Health Centre being connected to the DI-r and ultimately translates into improved and safer care for that patient. While diagnostic imaging is only a small fraction of the work we do here at St. Joseph’s, it does provide an
example of the great potential for improved care thanks to electronic health records. Achieving something similar on a hospital-wide scale is, of course, a much larger task. “In a project of this size, we have many major milestones,” says Banyai. “We are in the process now of identifying which devices will be used by health care providers,” adds Vimr. The eCare team at St. Joseph’s is looking at all the options: Smartphones, tablets, computers on wheels and workstations. Phase 2 also involves determining how many devices are needed and where they would be more effective within the Health Centre. “As well, we’re doing a lot of work establishing the pharmacy database,” Vimr says. “All the drugs we use at St. Joseph’s have to go in that database so that physicians can access the information.” Staff members that provide direct patient care will begin training in August 2013 for the new electronic health record. A pilot unit will be selected for a trial run of the new system, in order to work out any remaining issues and obtain important feedback from our clinicians. Vimr says St. Joseph’s is also working to put protocols in place so that if our electronic system is ever unavailable or off-line, we would be able to revert back to a paper-based system. With all of the system upgrades, training and preparation over the last three years, the Health Centre is confident that the launch of the electronic health record will be a seamless transition from a paper-based environment to electronic documentation. “eCare is our number one priority right now,” he says. “I feel very confident that we have the expertise, leaders, physicians and staff engagement that we need to make this truly successful – and I look forward to seeing the outcome of all our hard work.” Lauren Pelley is a Junior Associate at St. Joseph's Health Centre in Toronto.
Do you know a nurse who has gone above and beyond the call of duty? Now is your chance to acknowledge and recognize the nursing heroes in your facility or community.
Hospital News will once again salute nursing heroes through our annual National Nursing Week contest. Nominate a nurse and share your story so that we can highlight the exceptional work that our nurses are doing and how they touch our lives. Stories/letters can be submitted by patients or patients’ family members, colleagues or managers. Please submit by April 19th and make sure that your entry contains the following information: | Full name of the nurse | Facility where he/she worked at the time | Your contact information | Your nursing hero story Please email submissions to firstname.lastname@example.org
NATIONAL NURSING WEEK – MAY 6TH - 12TH
Hospital News, FEBRUARY 2013
Focus: Facilities Management and Design/Health Technology/Greening Health Care
St Joseph’s Hospital: A new look for a new era of care By Laura Janecka
t. Joseph’s Hospital in London, Ontario is getting a make-over – peeling back the old layers to reveal a brand new modern look. The next time you visit the hospital, you’ll be greeted by a sleek, new look, and a new era in health care. Since August 2011 when ground broke for the last phase of restructuring, renovations have been underway to the interior and exterior of the hospital. Inside, the former birthing centre has been transformed into 42, 000 square feet of purpose-built space for St. Joseph’s internationally recognized ambulatory and chronic disease care programs and services. Outside, at the corner of Grosvenor and Wellington streets, new windows and metal paneling have replaced the deteriorating brick walls, improving the building’s energy efficiency and giving it a new face-lift. At the corner of Richmond and Grosvenor streets, meanwhile, the outdated building (Zone A) is being taken down and in its place a new accessible Grosvenor entrance, as well as plenty of green space and an outdoor garden featuring a “living-wall” of green foliage, will be constructed. This last phase of restructuring, known as Milestone 2, Phase 3, is helping St. Joseph’s redefine what it means to be a hospital. Specializing in minimally invasive, same-day and shortstay surgery, and ambulatory (outpatient) clinic treatment of complex medical and chronic disease, interdisciplinary teams at St. Joseph’s Hospital provide comprehensive assessment, diagnosis, disease prevention and management strategies, and follow up care to help patients reach optimal health and well-being. In the new central outpatient area clinics for asthma, general respirology, chronic pain, cardiovascular investigation and pulmonary function are now located in close proximity to each other to provide patients with coordi-
Artist rendering of the new building at the corner of Grosvenor and Richmond streets (via architects Tillmann Ruth Robinson) Getting there from here In addition to the move of several clinics and support services, entrances and other areas of the hospital will close for safety purposes during this last phase of construction at St. Joseph’s Hospital. To make the journey to your next appointment a success, below is a list of closures and helpful navigation tips. • St. Joseph’s Hospital Chapel: For safekeeping, the historic chapel closed on Sept. 20 and is being carefully preserved during construction. It will reopen in early 2015. Alternate spaces for prayer and reflection are available. Details are available through spiritual care at 519 646-6100 ext. 66029 • Tunnel: The tunnel from the Grosvenor Street parking garage to St. Joseph’s Hospital closed on Oct. 1 and will reopen in early 2015. However, the portion of the tunnel from the parking garage to Mount Hope Centre for Long Term Care remains open. • Entrance 1: The entrance on Grosvenor Street closest to Richmond Street is now
closed. Please use Entrance 2 on Grosvenor Street near the Urgent Care Centre, or Entrance 4 or 5 on Cheapside Street. • Accessible parking: Accessible parking is available in both the Grosvenor and Cheapside street parking garages. With the tunnel closure, those requiring easy access to the hospital should use the parking garage located on Cheapside Street or use the drop off circles at Grosvenor Entrance 2 or Cheapside Entrance 4. For more information about accessible parking, meter parking and public transit visit sjhc.london.on.ca/directions/st-josephs-hospital • Turn by turn directions: For printable, turn-by-turn directions to all programs and services at St. Joseph’s Hospital, visit sjhc.london. on.ca/directions/st-josephshospital
nated and integrated services to meet individual needs. As part of acute care restructuring in London, two renowned programs joined St. Joseph’s. The Cardiac Rehabilitation
and Secondary Prevention Program and Allergy and Immunology Program moved from London Health Sciences Centre (LHSC) to St. Joseph’s Hospital, as well infectious
Laura Janecka is a Communication Assistant at St. Joseph's Health Care London.
diseases clinics merged with the infectious diseases care program at St. Joseph’s, further strengthening St. Joseph’s role in ambulatory medicine. “This last step in restructuring is a culmination of much effort, energy and dedication to create spaces that will enhance the patient experience at St. Joseph’s Hospital,” says Karen Perkin, Vice President, Acute and Ambulatory, Professional Practice and Chief Nurse Executive. “The goal is streamlined, convenient, comprehensive care. Individuals can come here to be tested, diagnosed, treated and given the right tools to manage their health needs. Restructuring is also providing us with dedicated space to continue as leaders in teaching and research. Exciting milestones are happening right here at St. Joseph’s that are improving care and outcomes.” In addition to the new outpatient space, renovations are now complete in other areas of St. Joseph’s Hospital. Programs and services that have recently moved into these brand new spaces are the Regional Sexual Assault and Domestic Violence Treatment Centre, Prescription Shop (pharmacy) and the outpatient clinic of the Osteoporosis and Bone Disease Program known as the 3M Osteoporosis Clinic. While St. Joseph’s continues to be progressive in meet-
ing the population’s growing need for ambulatory care for complex and chronic diseases, the past remains an important part of what St. Joseph’s is today: a hospital built on compassionate care. The history of St. Joseph’s — founded by the industrious and pioneering Sisters of St. Joseph — plays an elemental role in the redesign of many of the new spaces and the preservation of monumental trees, statues and cornerstones. “The restructuring is as much about staying current according to accessibility and building code standards as it is to preserving and reusing our resources to pay homage to the past while being efficient,” says Dave Crockett, integrated Vice President Facilities Management. “We’ve worked with the architects to come up with an interesting design to bridge the old with the new, which you will be able to see with the fusion of old bricks and stone with the new glassed-in entrance and a garden growing out of the old stone foundation walls.” The Chapel at St. Joseph’s Hospital, which was built in 1915, will be preserved and when the new building is erected a better view of the chapel’s intricate stained glass windows will be seen from Richmond Street. The last phase of restructuring is set to be complete in early 2015. For more information about St. Joseph’s Hospital restructuring visit http://www.sjhc. london.on.ca/stjosephshospitalrestructuring Laura Janecka works in Communication and Public Affairs at St. Joseph’s Health Care London. Renowned for compassionate care, St. Joseph’s Health Care London is one of the best academic health care organizations in Canada dedicated to helping people live to their fullest by minimizing the effects of injury, disease and disability through excellence in care, teaching and research.
REGISTERED NURSES: EXPLORE ALL THAT NIAGARA HEALTH HAS TO OFFER Excitement is in the air at Niagara Health. Whether you’re an experienced Nurse, or a recent graduate looking to gain primary nursing experience, this is a great time to join Niagara Health System – the major provider of acute care in Niagara Region. Our new St. Catharines site opens March 2013, with Centres of Excellence for Women and Babies and Mental Health, and new regional cardiac and cancer programs. As a result, we offer a wide variety of practice settings and plenty of opportunities to carry out interesting and challenging work. Discover a supportive team environment and great quality of life in Niagara. To explore our opportunities, visit our website. Apply online or send your resume to email@example.com.
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Hospital News, FEBRUARY 2013
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Getting smart about healthcare technology
t may not be just the winter blahs." That’s what my family doctor said when I described my symptoms of feeling low energy and, well, kind of blah. Off I went, requisition in hand, to my local lab to have my blood drawn and tested for a number of illnesses and malfunctioning body systems that might account for my mid-winter fatigue. I was delighted to discover I could actually book my appointment at my lab online and avoid lineups, which is especially important if you require a time-sensitive test. Thanks to my doc’s relatively new ability to receive lab results electronically, the next afternoon she was on the phone reassuring me that my thyroid was functioning well, my red blood cells were iron rich and that my B12 was on the low side. That’s just one small example of how electronic health records can streamline the system, eliminate a massive paper trail and deliver accurate information to your entire health-care team. Some of you may remember that when cell phones first appeared on the scene they were not to be used in hospitals, and then banned in restricted areas and now virtually everyone walks around the hospital hallways with a smart phone. And now health care providers are using this technology to help their patients get “smarter” about a number of health-care issues. In this issue we highlight one facility which uses smart phones to help patients with mental health issues commu-
nicate with their community health care provider upon discharge. The ease of this system helps bridge a gap which exists for many patients and provides fast and reliable access to health records and may help to prevent re-admission to treatment, homelessness, and possibly suicides. Mt. Sinai uses an app where patients can measure their blood pressure at home and receive immediate feedback from their smartphone about how to stay on track and informing them of any concerns. This could be a great tool for the six million Canadians currently living with high blood pressure. Baycrest Health Sciences has developed a mobile tablet app that allows palliative patients to report their discomfort symptoms, such as pain, nausea, drowsiness, anxiety and appetite, directly into their electronic health record that the doctor and healthcare team see. These amazingly simple uses of technology are literally putting health care back into patients’ hands. Telehealth has been around for some time in Canada to provide free, confidential telephone service and access to health advice or general health information from a Registered Nurse. Now Telehome Care expands on that concept. Each day, the patient uses special equipment to check blood pressure, weight, heart rate and pulse and answer simple questions about their health, all in the privacy of their own home. These daily submissions are then reviewed by
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Monthly Focus: Pain Control/Rheumatology/ Complementary Health/ Health Promotion:
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Pain management interventions. Developments in the management of rheumatic diseases. Advancements in complementary treatment approaches to various diseases and conditions. Innovative health promotion programs that focus on disease prevention.
Geriatric medicine and aging-related health issues. Innovative approaches to home care and palliative care delivery. Care in rural and remote settings: enablers, barriers and approaches.
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their Nurse Coordinator who provides feedback and support and contacts their primary health care provider when needed. Toronto’s new Humber River Hospital plans to open its doors in 2015 to their new state-of-the-art, patientcentred model of care. Set to be North America’s first fully digital hospital, the facility will implement a Managed Equipment Services solution to enhance all aspects of quality care delivery: efficiency, accuracy, reliability and safety. These advancements are all exciting and promise to lead the way to a better, more efficient health care system. However, let’s not overlook the importance of the human touch in the midst of all of these technologies. I noticed when I first moved from Toronto to a smaller city, the little thrill I got every time I ordered a book from my local public library. Every time my book was available, a very pleasant human being would call me up on the phone to let me know, and sometimes even offer me a mini book review on the spot. Just recently, this service was replaced by a computerized message and I felt somehow like I had lost a friend. That left me wondering… if instead of the voice of my family doc on the phone, there had been a computerized message from some medical android would I have felt the same? I know that health care professionals’ time is at a premium but we still cannot overlook the extreme importance of the human touch in all of our encounters, but most especially when it comes to our health and wellbeing. Julie Abelsohn, Acting Editor
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Hospital News, FEBRUARY 2013
Are there limits to a patient’s autonomy in making health care decisions? By Mojisola Adurogbangba
his is a question healthcare professionals have to answer almost every day. As they work with patients and families who are making healthcare decisions, the goal is to move care in the right direction. How much control should patients have over their healthcare choices? Isn’t the answer obvious? The most intuitive answer would be ‘as much control as possible.’ Why would a patient not want to have control over his or her healthcare decisions? When might a patient not be able to fully control their care choices? The ethical principle of autonomy, which has many definitions, is highly valued in personal healthcare decisionmaking. Autonomy should be considered when it has features which relate to people, self determination or self governance, all of which are relevant to making healthcare decisions. Two concepts will assist in answering our question. First, to be autonomous (literally a self-lawmaker), an individual must have adequate knowledge to explore and examine all options relevant to the healthcare decision that needs to be made. This specialized knowledge is beyond the scope of most patients, so they must rely on healthcare professionals to present them with the information they lack (often in a simplified version). Patients may be quite knowledgeable about their illness, but they usually do not know the whole story. Even a physician who becomes a patient may lose objectivity about specific details of treatment. It is the obligation of the healthcare professional who is proposing treatment to provide the relevant information that is needed to enable the patient to make an informed decision. Second, the patient is often in an impaired state that makes fully deliberative decision-making difficult at best. The patient could be in pain, emotionally traumatized or in some way not up to making a fully unemotional, rational decision. The ability to give informed consent may be impaired by illness, denial and multiple factors. In such instances, care must be taken that teams do not revert to the old standard of deeming a patient incapable if they do not agree with their health team’s plan of care. The
team is obligated to facilitate a patient’s decision-making and involvement in medical treatment, enhancing their dignity. Concisely, the healthcare team should always invite and encourage the patient’s participation. Now, getting to the extent of autonomy: autonomy is limited when its exercise causes harm to someone else or may harm the patient. When harm to others is sufficiently grave, it overrides the principle of autonomy. In some cases, the team may not be able to fully respect autonomous decisions. Furthermore, autonomy is limited when its exercise violates the physician’s/healthcare team’s medical conscience. For example, if a patient wants antibiotics for a viral infection or renal dialysis for urinary incontinence, the physician will refuse because anti-
biotics don’t fight viruses and dialysis doesn’t treat incontinence. At the same time, there are potentially negative consequences for these treatments. Sometimes, if a patient makes a decision that causes moral distress within the team, it might be necessary to determine whether the patient appreciates the extent or full implications of their decision. While it is quite correct to say that in some circumstances, other considerations take precedence over the wishes of individuals (for instance, if a person has ‘irrational’ desires or if they will cause avoidable harm to others), autonomy should be thought of more broadly. Patient wellbeing and autonomy go hand-inhand. Autonomy should not necessarily be seen as ‘patient control of decision-making,’ but as a clinical reality which consists of education, conver-
sation and concern for patient wellbeing. It is helpful for healthcare professionals to think of autonomy, not as a disembodied principle or as something that is entirely lost if a right to choose is denied, but rather as a matter of the degree to which it is honoured, aimed at providing respectful patient care. The implication is that once information relevant to treatment is made available and the patient is deemed capable of making treatment decisions, then the healthcare professionals proposing treatment should not prevent the patient’s choice unless respecting the wishes would cause harm to others, or seriously undermine the patient’s wellbeing. Fundamentally, autonomy is the pivotal healthcare notion. Consideration for patient autonomy (in the
broadest sense) must always be the starting point for interventions that seek to enhance patients’ dignity. Beyond this, the issues must be resolved using appropriate moral reasoning, clear communication, comprehensive assessment of the situation, respect empathy and personal judgement. References: ¡¡ Medical Ethics (2000) by Michael Boylan. ¡¡ Ethics -The Heart of Health Care (2009) by David Seedhouse. Moji Adurogbangba is the Bioethicist at The Scarborough Hospital, a member of the Regional Bioethics Group- Hamilton and a member of the Canadian Bioethics Society.
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Hospital News, FEBRUARY 2013
Focus: Facilities Management and Design/Health Technology/Greening Health Care
Technology supports new research aimed at easing healthcare’s challenges By Shannon O’Connor
he healthcare industry is experiencing fundamental transformation… and as tumultuous as the current environment is, it is expected to become even more complex over the next several years. Data overload is a problem as well as a potential problem solver. New medical devices, the increased use of sensors, and patient monitoring systems are contributing to an increase in data. Medical information is doubling every five years; and data managed by hospitals and ambulatory providers is expected to quadruple from 2010 to 2015. Harnessing that data, consolidating, integrating and transforming it into meaningful information represents an important tool healthcare practitioners and researchers can use as they struggle with how to offer better care to more people at less cost. Making sure that data becomes the problem solver is one of the goals of the new IBM Canada Research and Development Centre (CRDC). The CRDC is part of a public/ private collaboration between IBM, the governments of Canada and Ontario, and a consortium of seven universities: McMaster University, Queen’s University, University of Ontario Institute of Technology, University of Ottawa, University of Toronto, University of Waterloo, and Western University. The CRDC offers Canadian
researchers an unprecedented opportunity to solve some of the world’s biggest challenges – by giving them access to an advanced high performance infrastructure that includes the most powerful supercomputer in Canada and some of the most advanced analytics software available today. “To have this leg-up at this critical juncture is really exciting,” says Mark Daley, an associate professor of Computer Science and Biology at Western University. Daley is using the centre’s capabilities to further his
Institute, Western University Millions of people in Canada are affected by neurological disorders, and the impact of brain disorders on the economy is in the billions. Daley’s research brings together scientists from neuroimaging, neuroscience and high-performance computing. By studying dynamic networks in realtime, faster, more accurate diagnoses, better outcomes, and optimal use of expensive scanner time can be achieved. Dynamically adapted brain scanning allows the test to be stopped, tuned and
are of paramount importance. With insulin infusion pumps now programmable through wireless connections, a major security risk exists. Wassyng's team is focused on developing methods for building safety and security into the software of insulin pumps. The team is working in collaboration with the FDA to identify and predict the ways in which an insulin pump may overdose or underdose a user, and then mitigating those risks. 3. Privacy and Security in Personal Health Information
By studying dynamic networks in realtime, faster, more accurate diagnoses, better outcomes, and optimal use of expensive scanner time can be achieved. research in neuroscience and modeling the brain. Other projects focus on software to certify the safety of insulin pumps, anonymizing confidential medical information to improve treatment, and giving ICU physicians in remote locations access to advanced decision support tools. Here are details on some of those healthcare projects. 1. Real-time Graph Dynamics from Scanning Measurements Led by Dr. Mark Daley, Associate Professor, Computer Science and Biology; Principal Investigator, Brain and Mind
adjusted while it is underway. Neural functional connectivity networks have been shown to be diagnostic indicators for several brain disorders, including autism, schizophrenia, Alzheimer’s, and ADHD. 2. Certification of Safety and Security in SoftwareIntensive Medical Devices Led by Dr. Alan Wassyng, Associate Professor, Department of Computing and Software, McMaster University and Director, McMaster Centre for Software Certification Thousands of deaths involving infusion pumps are reported in North America every year. As with most medical devices and health information systems, concerns related to safety and reliability
Led by Dr. Stan Matwin, Distinguished University Professor, EECS, University of Ottawa A multi-disciplinary University of Ottawa team (Computer Science, Management and Medicine) is working to develop new methods for private and secure handing of personal health information. While effective security methods exist, they focus mainly on protecting the two-party data exchanges from intrusion of third parties. The University of Ottawa's project will examine how to facilitate information flow between different players in the healthcare ecosystem. Health information must flow seamlessly across health professionals, providers and
researchers. However, existing legal and regulatory frameworks impose constraints on how information can be shared, and emphasize data privacy as a patient right. Matwin’s goal is to develop and prototype a mechanism for sharing information while respecting privacy of the patient. 4. Online Health Analytics through Cloud Computing for Improved Critical Care Led by Dr. Carolyn McGregor, Canada Research Chair in Health Informatics, University of Ontario Institute of Technology Critical care units are one of the most costly areas within hospitals, accounting for 15.9 per cent of inpatient direct expenses but only 8.1 per cent of inpatient days. Due to Canada’s geography, many critically ill patients in rural and remote communities have minimal access to critical care services. McGregor’s research proposes to establish a computing infrastructure for critical care online health informatics. The “Artemis Project” will use real-time analytics to analyze massive streams of physiological data from patients in remote areas to detect life-threatening conditions before they are apparent to the clinician. This builds on her ongoing work analyzing data generated from premature infants in a neonatal intensive care setting, which was first implemented at The Hospital for Sick Children in Toronto in August 2009. Shannon O’Connor is Director at IBM Canada Research and Development Centre.
Laughter is STILL the best medicine.....
Hospital News, FEBRUARY 2013
Focus: Facilities Management and Design/Health Technology/Greening Health Care
Baycrest’s mobile tablet app enables palliative patients to report symptoms directly into their medical chart By Kelly Connelly
aycrest Health Sciences has developed a mobile tablet app that allows palliative patients to report their discomfort symptoms, such as pain, nausea, drowsiness, anxiety and appetite, directly into their electronic health record that the doctor and healthcare team see. The app is a high tech version of the gold standard Edmonton Symptom Assessment Scale (ESAS) and it was created to replace the time-consuming, traditional paper-based reporting that required the patient to rank their symptoms on paper and then a nurse to input vthe data into the patient’s medical chart. The Baycrest innovation would have gone unheralded had it not been for Paul Christopher Webster, an investigative reporter and documentary film director who has written extensively on the state of e-health progress in Canada and around the world for major medical journals. He was preparing an in-depth story on Canada’s challenges with e-health
for The Globe’s Report on Business magazine when he was tipped about the Baycrest project. Webster met with IT specialists and interprofessional clinicians at the health campus and talked with palliative patient Helmut Braun who was trying out the mobile tablet app. Webster quickly realized that he not only had a story scoop but was witnessing what could be a first – a patient writing information into their own electronic
health record. Webster was also witnessing the power of mobile technologies to connect the doctor’s brain to the patient’s pain much more quickly. It was Dr. John Hamalka, chief information officer of the Harvard Medical School and the Beth Israel Deaconess Medical Center, who articulated this catchphrase in a keynote address at a Vancouver eHealth conference, which Webster reported on for a 2012 CMAJ article.
“The future of e-health, it appears, will be driven by consumer-friendly innovations such as the tablet...used at Baycrest,” wrote Webster in his ROB story. In a blog posted last fall on the Ontario Ministry of Economic Development and Innovation’s website, Terrie Tucker, Baycrest’s executive director of eHealth and chief information officer, described the mobile app project as no less than “radical innovation that occurs when clinicians
and informatics experts come together to solve a problem and focus on what’s best for the patient and the workflow of clinicians.” The project was not mandated by a provincial or federal healthcare strategy or the recipient of special funding, she explained. “It was simply a solution to a problem that arose at the grassroots level on a hospital unit and was solved at this level. It came about from a desired outcome to reduce duplicate data entry and manual calculations and enable patients to actively participate in providing information on their own assessments of their wellbeing.” Tucker also noted that the app development wasn’t an easy solution. It involved multiple systems (proprietary EHR, SQL database e-forms and a scripting solution); courage to let patients in the post-acute, palliative care setting record their symptoms on a tablet; and clinicians who would not just support the project, but champion it. Kelly Connelly is Senior Media Officer, Baycrest Health Sciences.
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Hospital News, FEBRUARY 2013
Focus: Facilities Management and Design/Health Technology/Greening Health Care
Hospitals, Dashboards, and Savings By Stephen P. Ashkin
ccording to a report by the Natural Resources Canada Office of Energy Efficiency, Canadian hospitals were consuming nearly 52 million gigajoule (a unit of energy often referred to as GJ) annually by 2003. This is an amount equal to the average annual consumption of approximately 450,000 Canadian households. It is also equivalent to the amount of energy used by all the private dwellings in a large metropolitan area the size of Ottawa-Gatineau. The study also found that this “energy intensity” was significantly higher than the amount of energy consumed by universities and colleges. The report stated that, “The high energy intensity of hospitals is probably due to their nearly constant use of numerous types of medical equipment, as well as lighting.” Further, the reported estimated that the energy consumption of Canadian hospitals produces nearly 2.8
million tons of greenhouse gas emissions annually. This is equivalent to the average annual emissions of approximately 814,000 compact cars or 533,000 sport utility vehicles. (See Sidebar: Reasons for High Energy Use in Canadian Hospitals.) This high energy usage is likely to also have high costs for Canada’s healthcare facilities. As in other areas of the world, the cost of energy (along with water and other consumables*) has been rising in Canada in recent years, and is expected to continue to do so. However, healthcare system managers—who are now putting greater emphasis on sustainability and cost reductions than ever before—will be glad to know that if proper steps are taken, significant energy usage reductions are possible. But we must not put the cart before the horse. Before any sustainability measures can be implemented, it is necessary to obtain performance data. This includes how much energy, water, and other consumables are cur-
rently being used, along with how much waste the facility is generating. This information is essential to the success of any sustainability initiative, as well as to cutting costs. This is where a relatively new technology known as “sustainability dashboards” can help. Dashboards are systems used to track, measure, and monitor sustainability across an array of indicators. These systems are called dashboards because they often look similar to automobile dashboards, offering information on a variety of metrics in a graphic, quick, and easy-tounderstand format. Some of the newest and most advanced systems are Web based, which means they can be operated on any computer without the need for special hardware or software programs. This also makes them cost effective, since the service is essentially rented. Using Dashboards The first dashboard-type systems date back to the mid1980s. At that time they were not used to measure and monitor the use of natural resourc-
Reasons for High Energy Use in Canadian Hospitals Studies have indicated that Canadian hospitals use more energy than hospitals in Europe and the U.S. According to Caddett Energy Efficiency, an organization that works with the International Energy Agency (IEA) to promote the international exchange of information on energy-efficient technologies, the consumption of energy in Canadian hospitals can be as much as 2.5 times higher than in European and U.S. hospitals. While there are many reasons for this, two important factors were noted in the study. One is that Canadian hospitals are, on average, smaller than those in Europe and the U.S. Their higher energy consumption could also be due to the colder climate found in many parts of Canada. es. Instead, they were used by business executives as a quick and easy way to verify current sales figures, check cash flow, monitor investments, etc. While the ways these systems are used can vary, entering data is usually the first step. A good place to start is with “low-hanging fruit,” which generally includes energy and water consumption (the amounts used and their costs). In some cases, this information must be entered
manually, but it can often be downloaded directly into the dashboard from the utility company in question. Either way, it is important for managers to gather information for at least a year or more to help form an informational benchmark. There can be peaks and valleys in, for instance, water and energy consumption. Getting data over a prolonged Continues on page 26
Infrastructure Ontario delivers green health care projects By Terence D. Foran
ne of Infrastructure Ontario’s (IO) mandates is to deliver complex, health care projects on time and on budget. A key highlight of this mandate is to ensure these projects are sustainable. So what does sustainable or ‘green’ health care
development mean? For the New Oakville Hospital, under construction as a design-build-financemaintain project, part of being sustainable means targeting the Canada Green Building Council’s Leadership Energy and Environmental Design (LEED®) Silver designation. The Hospital’s LEED®
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Rendering of the New Oakville Hospital. Silver goal includes a number of green endeavours. Construction waste will be recycled and/or reused, diverting 75 per cent of typical construction waste from landfill. Low emitting materials for adhesives and sealants, paints and coatings and carpets will reduce off-gassing, enhance indoor air quality and eliminate the unpleasant ‘new car smell’ common to new construction. The use of highly efficient plumbing fixtures including low-flow toilets, faucets and showers will reduce indoor water use by 30 per cent.
Another IO project, Bridgepoint Health shares similar sustainability goals. Storm water run-off from the hospital’s roof will be collected and used to irrigate the native species landscaping. Reflective roofing materials and double-glazed windows will minimize solar heat gain. Also, strategic use of windows will enhance daytime lighting for staff and patients and reduce energy consumption. These sustainability initiatives are only a sample of the green features included in IO’s health care facilities. By applying a design-build-
finance-maintain approach to develop health care projects, IO has allowed architects, constructors and facilities management companies to integrate on one team. This integrated approach ensures a consortium shares a common goal – to develop a sustainable, durable health care facility both in the short- and longterm. For more information on IO and its sustainable projects visit, www.infrastructureontario.ca Terence D. Foran is Project Communications Advisor for Infrastructure Ontario.
Hospital News, FEBRUARY 2013
Focus: Facilities Management and Design/Health Technology/Greening Health Care
Runnymede Healthcare Centre Leading the Way in Facilities Management By Sabrina Jeria
unnymede Healthcare Centre received an overall score of 96 per cent in a rigorous audit assessing the hospital’s commitment to high quality standards and performance in the delivery of support services, such as housekeeping and laundry. The audit was the final phase in a four-month implementation of the Healthcare Compass Service Framework (CSF), a standard operating platform for best practices in hospital support services that was piloted by Compass Group in Canada in 2011. The audit was performed in October 2012 by Crothall Healthcare (a division of Compass Group Canada), an organization that provides environmental and laundry services at the hospital. Canada’s healthcare industry is always evolving, and as a result, being aware of leading practices and implementing them is a top priority at Runnymede. This was the driving force behind implementing the CSF at the hospital after Compass joined the team in June 2012. The completion of this process made Runnymede the first new business to utilize the CSF in Compass Group Global support services, and the country’s second CSFcertified hospital. Compass Group originally developed the CSF in an effort to enhance patient safety and quality of service, important principles that align with those of Runnymede Healthcare Centre. Accessed online, the CSF software platform compiles best practices in client management, operations management, service control and operational standard procedures from around the world. The online tool outlines how services should be provided and the outcomes to measure for success and benchmarking. Through quarterly snapshot audits, Runnymede stays up-to-date on staff training in the areas of health and safety and infection control. For instance, environmental services staff at the hospital recently completed a series of Provincial Infectious Disease Advisory Council (PIDAC) training sessions, covering a range of topics including hand hygiene, disinfection and sterilization methods. The CSF is a global blueprint for the consistent and efficient delivery of multiple support services, and ensures replicable success at both the
(left to right) Mike Murray, Regional VP, Crothall Canada (a division of Compass Group Canada), Bernice Acheampong, Support Services Manager, Runnymede Healthcare Centre, Wayne Close, District Manager, Crothall Canada and Corinne Wong, Chief Operating Officer, Runnymede Healthcare Centre receive a certificate for successfully completing the CSF compliance requirements. local and global levels in a cost-effective manner. It also facilitates knowledge sharing, making it possible to capture innovations in healthcare from across the globe, while promoting transparency and mutual agreement on best practices. “The CSF is a world class best practice,” says Mike Murray, Regional Vice President, Crothall Healthcare. “Our global community of practice experts continuously revise and improve our delivery process. The Healthcare Knowledge Library (HKL) section of the platform allows our managers to share and access the knowledge and experiences of our global healthcare sites. With this
knowledge and the rigorous service delivery and service management structures, we consistently deliver on commitments and expectations for our clients. In just four months, Runnymede’s Bernice Acheampong, Environmental Services Manager, along with the support of Crothall Canada’s Wayne Close, District Manager and Canada CSF Deployment Lead were able to have Runnymede Healthcare Centre completely certified with an impressive score of 96%.” The CSF audit highlighted particular areas where Runnymede excels, including managing change effectively across the organization and strengthening internal pro-
cesses to ensure appropriate personnel respond to and monitor situations to satisfactory completion. This focus on operational excellence once again demonstrates the hospital’s long-standing commitment to progress and continuous improvement. “The transition to and implementation of the CSF at Runnymede has greatly contributed to the quality of support services at the hospital,” says Corinne Wong, Chief Operating Officer, Runnymede Healthcare Centre. “The framework allows us to tailor our response systems to the patient population and our available resources and staff, which assists with the management of quality control and accountability. Building an
infrastructure that’s based on a strong culture of enhancing our operational processes and improving quality means that our staff can continue to provide prompt and reliable care to patients in a safe environment.” Support services play a vital role in creating a nurturing and safe environment for patients, families, staff and volunteers within every healthcare organization. Environmental and laundry services are an essential part of this, and Runnymede staff are trained in effective environmental cleaning and disinfection methods to assist the interprofessional team in controlling the spread of healthcare associated infections (HAIs). The protocols and policies that the support services staff follow at Runnymede are compliant with a number of relevant agencies, including the Ministry of Health and Long-Term Care, Canadian Standards Association, Centre for Disease Control, Canadian Association of Environmental Management and the Provincial Infectious Disease Advisory Committee. Having the CSF in place demonstrates Runnymede’s commitment to high quality standards and performance. Runnymede Healthcare Centre’s mandate is to continue to raise the standard of quality care as the hospital continues to grow and expand. The CSF supports that mandate and enables the hospital to enhance care processes with patient safety as a fundamental and essential attribute of quality healthcare. Sabrina Jeria is a Communications Associate at Runnymede Healthcare Centre.
News, FEBRUARY 2013 www.hospitalnews.com 10 Hospital Focus: Facilities Management and Design/Health Technology/Greening Health Care
Jenny’s Story: A lesson in how health self-management empowers Canadians with chronic health By Dipti Purbhoo
Chances are someone you know is living with at least one chronic health condition. In Canada alone there are close to 20-million individuals with a chronic condition; many whom require ongoing attention and care to manage their health. Some of these affected Canadians can easily access care and support services but others avoid the hospital or don’t have the means or mobility to seek medical care, including some of Canada’s 5-million seniors, half of whom live independently. Fortunately, there is an alternative when one can’t or doesn’t want to go to the doctor’s office or hospital. A growing number of seniors in Ontario are taking advantage of new technology to help them manage their health in the comfort of their own home. What is Telehomecare? Managed by the Ontario Telemedicine Network (OTN) and funded by the Ministry of Health and Long-Term Care,
Telehomecare is offered free of charge to clients of the Toronto Central Community Care Access Centre (CCAC) and other CCACs throughout the province. The Toronto Central CCAC helps individuals stay in their home longer by coordinating care in the community and providing care in the home, like the use of Telehomecare. Telehomecare supports people living with chronic health conditions to self-manage their care in their own homes with the assistance of a Telehomecare Nurse Coordinator who remotely monitors a patient’s health and provides regular health coaching. Each day, the patient uses special equipment to check blood pressure, weight, heart rate and pulse and answers simple questions about their health. The Telehomecare Nurse Coordinator reviews these daily submissions and regularly connects with the primary care provider to talk about the patient’s progress. To-date the Toronto Central CCAC has supported more than 300,000 seniors
to stay in their homes independently using a variety of in-home services including Telehomecare. Ninety-one year old Jenny is a just one example of the excellent and timely care clients can receive without leaving home. Jenny’s Story There aren’t many people who are 91 years old who are as impressive as Jenny. Jenny lives alone and manages her life extremely well with some assistance from the Toronto Central CCAC. She has lived in the same Toronto apartment for 42 years and has a great network of family and friends in her neighbourhood. Fiercely independent, Jenny loves living on her own and like many seniors has dismissed her doctor’s suggestion that she move in with family. Despite having some health problems, such as chronic heart failure, Jenny enjoys a good quality of life by eating well and being active. Realizing that “visiting the doctor is getting harder,” Jenny decided to explore health care options
that would allow her to maintain her independence, like Telehomecare. Like some seniors when confronted with technology, Jenny was initially apprehensive about participating in the Telehomecare program, “I didn’t even have a computer in my home,” Jenny remarked. But after some help from the Telehomecare team Jenny is now able to check herself five days a week. “It’s so simple and it takes less than five minutes each day!” she added. At one point while enrolled in the Telehomecare program, Jenny started to feel unwell. She became extremely short of breath, fatigued and was unable to go on her regular walks. Tracking her vital signs, her Telehomecare Nurse Coordinator was concerned about Jenny’s symptoms and low pulse rates and contacted Jenny’s health care providers, including her heart specialist, and advocated for Jenny to be seen and suggested that her pacemaker needed to be re-assessed. Soon after getting the attention she needed, Jenny’s pulse returned to normal and she began feeling like her regular self, going out to community events and resuming her walking. “I felt like someone had lifted something off me. (Telehomecare) is a
very good thing and really wonderful for me,” she said. For the Toronto Central CCAC empowering seniors like Jenny with tools to monitor their health conditions at home is crucial as it provides a sense of independence and allows individuals to healthy at home for longer. As well, active monitoring – like in Jenny’s case – can prevent a major health episode and save the health system thousands by eliminating EMS calls and emergency room visits. Telehomecare offers an excellent patient care and experience. If you or someone you know suffers from chronic heart failure or chronic obstructive pulmonary disease, Telehomecare is an option to explore. Contact Toronto Central CCAC at 416-217-3841 for more information. About Toronto Central CCAC: We are homecare. We help people find their way through Ontario’s health care system; help them understand their health care options and help connect them to community-based healthcare and local resources. Dipti Purbhoo is Senior Director, Client Services at Toronto Central CCAC.
Hospital News, FEBRUARY 2013
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News, FEBRUARY 2013 www.hospitalnews.com 12 Hospital Focus: Facilities Management and Design/Health Technology/Greening Health Care
A "smart" way to enhance mental health care By James Bullbrook
hen Walter Osoka first began experiencing mental health challenges in the late 1980s, cell phones were a novelty and reaching a care provider outside of a scheduled appointment was not common practice. Now a mental health advocate, he has seen firsthand the challenge for some mental health outpatient clients who are discharged from hospital treatment to communicate regularly with their community-based care provider. “A lot of mental health care time is wasted on traveling and waiting,” says Walter, who adds that many clients don’t have a phone or a car, or any easy way to keep in contact which puts them at risk for serious outcomes when they are in need of immediate care. Another challenge for many is that health records are not centralized or easily accessed at a time of crisis. “The most common cause of death among people with psychotic or mood disorders is suicide,” says Dr. Cheryl Forchuk, lead project researcher and assistant director at Lawson Health Research Institute, the health research institute of London Health Sciences Centre and St. Joseph’s Health Care London. “That is why maintaining communication between cli-
as well as tools—developed in consultation with a care provider—to help continue their recovery. “With this technology, clients can now simply send their care providers a secure text message saying, ‘this is what’s going on right now.’ As care providers, we will be much better able to help and intervene earlier,” says Dr. Forchuk. This two-way point of contact between clients and caregivers will give individuals diagnosed with a mental illness a greater role in managing their own care. Clients The new smart phone app helps clients and caregivers work together to improve care will work with their care providers to use the SMART once they re-enter the community. record to develop a personal ent and community-based care cell phones, the team devised their health and produce better care plan, including prompts providers, and fast and relia solution to develop and eval- health outcomes. and reminders for appointThe pilot is providing 400 able access to health records, uate a mental health system ments and activities. It even community-based mental is essential to preventing rethat takes advantage of new has a mood monitor and health clients with an iPhone admission to treatment, homesmartphone technology. exercise tracker—all availloaded with a custom-designed able at their fingertips from lessness, and worse outcomes.” Walter has been workapp that gives them access Two years ago, Dr. Forchuk ing with Dr. Forchuk and the the iPhone. “It’s empowering to the new Lawson SMART and Lawson’s Mental Health team to pilot a new two-year, people to participate more record. The tool leverages Group held a retreat to coltwo-phase project. It was offiactively in their own care,” TELUS health space®, powlaboratively look for answers cially launched on October says Dr. Forchuk. 12, 2012, at an event attended ered by Microsoft® Health to these challenges. The team The SMART record also Vault® – a secure online included researchers, clinicians, by Deb Matthews, Ontario’s ensures that everyone who Minister of Health and Longconsumer health platform, needs access to a client’s and clients themselves - all certified by Canada Health Term Care, as well as leaders health information – the cliworking to come up with better from project partners, Canada Infoway – that allows patients ents themselves, as well as and more creative solutions, not Health Infoway and TELUS to collect, manage and share their formal and informal only to help clients better comHealth. Both organizations their health information. network of caregivers – have it municate with care providers, are committed to supporting Stored securely online, this when they need it. And there but also to give them tools that initiatives that develop and record includes their personal are potential benefits beyond help them play a more active implement innovative mobile health information (i.e. treatrole in their own care. improved outcomes for the electronic health technology ment history and a list of med- client. It points the way to a Recognizing the mobility ications and care providers), and increasing functionality of to help Canadians manage whole new model of care that may relieve stresses on the system and deliver significant cost savings at the same time. Lawson “SMART” record The “SMART” record houses personal health information, giving mental health clients ready access to their treatment history, medications, crisis and discharge plans, and care providers over the years. The pilot project is currently testing and refining the tools available on the “SMART” record, which all helps continue their recovery in the community. For example, the mood tracker allows them to determine their mood at any given time (on a scale of one to seven) and share that number with their care provider. By setting prompts and reminders, patients can be reminded about upcoming appointments, when to take medications, or even when to exercise. The iPhones provided in this pilot project are password protected and the “SMART” record is a web-based app so even if the phone is lost, there are no patient confidentiality issues.
James Bullbrook is Manager of External Relations and Communications at Lawson Health Research Institute.
Patient Safety 13
Hospital News, FEBRUARY 2013
Solutions to problems that have already been solved By Hugh MacLeod
echnology has had a profound impact on the quality of healthcare in Canada and around the world. Not only does it allow for better care to be delivered at the bedside, it also has the ability to bring healthcare providers together in ways that would have been impossible a decade ago. Thanks to Electronic Medical Records (EMR), which are in various stages of implementation across the country, a patient’s care providers, regardless of where they’re located, are able to instantly access and work from the most up to date information. Advancements in information technology make these types of systems a reality. With respect to patient safety, wouldn’t it great if there was a tool that could provide us with instant access to lessons learned following a patient safety incident in other organizations? Wouldn’t it be great if we could share what we’ve learned from our own patient safety incidents so that others may prevent similar incidents from happening in their organizations? When it comes to patient safety, it’s important to learn from our mistakes and share them with others. The advancement of Health IT makes this possible on a global scale. There is no reason that a harmful incident suffered by one patient should ever happen to another. Regardless of jurisdiction, we are all committed to making patient care safer. Organizations across Canada and around the world are doing a great job in analysing and learning from their incidents. Sharing that learning is so important in order to really improve patient safety. This is where Global Patient Safety Alerts comes in - a onestop searchable database where you can find information on patient safety alerts, advisories and recommendations. You’re able to share your own learning, but you’re also able to learn from others. With Global Patient Safety Alerts, you can start telling each other what happened in your organization, what you learned from it, what you did to make your patients safer and what you can recommend to other organizations who may find themselves in a similar situation. For instance, if you go to www.globalpatientsafetyalerts.
com and search for “infection”, you will find 40 alerts and 207 recommendations
Recognized by the World Health Organization and its member countries, Global
When it comes to patient safety, it’s important to learn from our mistakes and share them with others. from 12 organizations who have agreed to share their info with you. Instant access to this type of information isn’t found anywhere else on the web.
Patient Safety Alerts contains more than 684 alerts and 3,400 recommendations from 23 contributing organizations around the world, and the
numbers are growing. You can also learn about how your organization can contribute to improving patient safety beyond the walls on your institutions by sharing your own alerts and recommendations with others. There are many who are struggling with similar incidents and Global Patient Safety Alerts allows us to leverage the power of information technology for the greater good and to ensure that no one
is stuck without a solution to a problem others have already solved, and that no patient has to needlessly suffer as a result. We need to work together and learn from each other if we’re going to make a difference. This technology is vital to bringing all of us together and allowing us to share this valuable information freely. Hugh MacLeod is CEO of the Patient Safety Institute.
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News, FEBRUARY 2013 www.hospitalnews.com 14 Hospital Focus: Facilities Management and Design/Health Technology/Greening Health Care
Mount Sinai’s Dr. Sandy Logan and colleagues first in Canada to show improved blood pressure control in diabetics, via smart phones By Leslie O’Leary
or the six million Canadians living with high blood pressure, a new smartphone application has the potential to put the power back in the patients’ hands. Dr. Alexander Logan, a nephrologist at Mount Sinai Hospital, together with Dr. Joseph Cafazzo from the University Health Network’s Centre for Global eHealth Innovation, have developed an app where patients can measure their blood pressure at home and receive immediate feedback from their smartphone about how to stay on track and informing them of any concerns. The telemonitoring system automatically delivers selfmeasured blood pressure readings and a progress note to patients via their smart phones after each blood pressure measurement. It also keeps a digital record of all readings, creates messages based on all stored information, sends progress reports to healthcare providers, and reminds
patients to follow their measurement schedule. Current home blood pressure monitoring models require a physician or healthcare team member to review the patients’ data and contact the patient for any adjustments to treatment. This approach is cumbersome and costly, and messaging lacks timeliness. The study published in the July issue of Hypertension found that in the randomized controlled trial, 51 per cent of the patients who received progress notes and coaching messages on their phones achieved their target blood pressure levels, versus only 31% of control patients. And the blood pressure improvements were obtained with no additional medications or visits to physicians, thereby relieving undue burden to the health-care system. “Home blood pressure telemonitoring with self-care support not only alleviates stress for health-care providers, but it empowers patients to take charge and become more involved in their own care,” said Dr. Logan. “What
Mount Sinai’s Dr. Sandy Logan and colleagues help patients improve blood pressure control in diabetes via smart phones. we’ve learned is that home blood pressure monitoring systems are not helpful with-
out that linkage to a support system. That is where this system is different—we are eliminating the need for constant visits to the doctor while still providing support to our patients.” Another innovative aspect of the self-care blood pressure telemonitoring system
is its use of smart phone and Bluetooth technology. Several other mobile applications available to smart phone users can monitor blood pressure, but require patients to manually enter their information—a daunting task for patients who are not technologically savvy. Also, results are sent to their physicians for review and feedback, meaning that clinicians are still taking a lead role in providing support for blood pressure monitoring, even without patient visits. “Often, calls from patients about blood pressure readings and results are given to health-care assistants to review, adding time and cost to our health-care system,” said Dr. Logan. “Patients now have easy access to informed care at anytime from anywhere. Harnessing this power has the potential to radically change the way healthcare will be delivered to patients with chronic illnesses. Here, the system empowers patients to make informed decisions about their own health.” The study was funded by The Heart and Stroke Foundation of Ontario. Leslie O’Leary is a Senior Specialist in Media Relations and Public Affairs at Mt. Sinai Hospital.
What is worth knowing in clinical practice? Infoway and partners launch education campaign on national electronic record plan and clinical benefits By: Maureen Charlebois
Canada-wide initiative is underway to create a network of interconnected electronic health systems aimed at providing residents of Canada and their health care providers with timely, appropriate and secure access to the right information when and where they enter into the health care system. Led by Canada Health Infoway (Infoway), along with the provinces and territories, this initiative means that health care professionals will have more timely access to the most up-to-date information to make the best possible patient care decisions. While many clinicians are already working with various
point-of-care information and communication technology systems (ICTs), research has revealed that nurses, pharmacists, and physicians across Canada have a mixed understanding of the benefits to their practice and of the local and national plans to connect point-of-care systems. Once aware, they want to know more. In response, a collaborative multistep process was undertaken to develop the Knowing is Better than Not Knowing clinician education campaign (CEC). The CEC’s objective is to create awareness and understanding of the key benefits of interconnected ICTs for clinicians and the initiaContinues on page 26
Focus: Facilities Management and Design/Health Technology/Greening Health Care 15 Hospital News, FEBRUARY 2013
State-of-the-Art Ambulatory Care Unit Design Helps Prevent the Spread of Airborne Diseases By Akilah Dressekie
n 2011, the completion of a massive redevelopment project at Rouge Valley Ajax and Pickering (RVAP) introduced 140,000 square feet of new and renovated space to the hospital campus. Boasting a state-of-the-art design, new equipment, a larger emergency department, and new, complex continuing care, and ambulatory care units (ACU), among other features, the project was a welcome addition to the community’s growing population. But it is the design benefits of the ACU that are being applauded after being put to the test recently when measles was discovered in the community. The ACU runs about 10 different clinics, and houses five negative pressure rooms, which are used to prevent the spread of airborne diseases, such as tuberculosis and measles. Its dedicated ground-level entrance allows it to be completely separate from the rest of the hospital. “This clinic played a key role in preventing a possible measles outbreak in the community through strong collaboration with Rouge Valley’s infection prevention and control team and Durham Public Health,” explains Amber Curry, manager of the RVAP ambulatory care unit. Measles is a highly contagious, airborne virus that is spread when infected individuals cough or sneeze. When it was realized that many might have been exposed to the airborne virus, Durham Public Health and Rouge Valley worked together to identify and contact staff members and members of the public who may have come into contact with the infected individual. Those exposed were asked to come to the hospital to receive preventative treatment. Each of them was directed to enter the hospital through the ACU’s separate entrance. The entrance is normally closed, but was activated to contain potential cases of measles, minimizing exposure to the rest of the hospital. “The layout of the unit makes it very effective, as it helps to prevent possible exposure to other patients in the hospital,” explains Curry. “Because it was designed to be self-contained, and has its own entrance and waiting room, it can be closed off from the rest of the hospital.” It took one afternoon for a team of infection control practitioners, physicians,
The unique design and layout of Rouge Valley Ajax and Pickering's Ambulatory Care Unit and its negative pressure rooms allow this space to help contain airborne viruses during an outbreak. nurses, managers, ACU staff and clinical practice leaders working together to triage and treat patients in the clinic. Each patient was given a mask to wear, was triaged and
ing to infection control protocol, before it was re-opened for regular use. How negative pressure rooms work A negative pressure room
system that generates negative pressure, allowing air to flow into the isolation room, without allowing the contaminated air to escape into the surrounding area. Air naturally
A negative pressure room is an isolation technique often used in hospitals, and is used to prevent contamination into the hallway or between rooms. brought into a negative pressure room to receive care. In all, between 15 to 20 patients and staff members were treated and released. The unit was subsequently cleaned accord-
is an isolation technique often used in hospitals, and is used to prevent contamination into the hallway or between rooms. The rooms are equipped with a ventilation
flows from areas with higher pressure to areas with lower pressure. This technique is often used to isolate patients with contagious airborne diseases.
Design of RVAP Ambulatory Care Unit At RVAP, the ACU also features a separate entrance and parking area that can be used during an outbreak. Those affected can enter the ACU directly through its separate entrance, helping to contain airborne diseases and prevent them from spreading throughout the hospital. Once the door of the negative pressure room is shut, a switch activating the negative pressure feature is turned on. If the door is left open too long, an alarm will sound. “These rooms have a higher airflow rate exchange. Every hour the air in these rooms changes at least nine times,” explains Ed Carroll, manager, capital projects. “It’s like you’re washing the room out with air. In a negative pressure room this occurs more times than it would in a regular room. This is necessary in preventing the transmission of airborne diseases.” Negative pressure rooms can also be found within Rouge Valley’s specialty inpatient, emergency, and diagnostic imaging areas. However, the RVAP ACU is one of the few units at Rouge Valley designed to be self-contained from the rest of the hospital; a key feature that helped to minimize the spread of measles. Akilah Dressekie is a Senior Communications Specialist at Rouge Valley Health System.
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News, FEBRUARY 2013 www.hospitalnews.com 16 Hospital Focus: Facilities Management and Design/Health Technology/Greening Health Care
Runnymede Healthcare Centre Goes Green By Sabrina Jeria
ospitals consume significant amounts of both renewable and non-renewable resources, like water and energy. With over 200 hospitals in Ontario, daily operations have a tremendous impact on the ecological health of the community. In an effort to increase corporate sustainability and reduce environmental impact, Runnymede Healthcare Centre has implemented a number of green initiatives in the past year. In April 2012, Runnymede became one of 24 members of Greening Health Care, an innovative program in Ontario that supports healthcare facilities working together to lower energy costs and raise environmental performance, while maintaining and improving patient care. Since joining the program, numerous operational changes have been made to the 180,000 square foot, 200bed facility, with environmental sustainability in mind. In a bid to conserve water and reduce the use of natural gas at the hospital, repairs were made to the hot water heating system and pressures were adjusted on the steam system. Fan system schedules were reviewed and adapted to
(left to right) Bernice Acheampong, Manager Support Services, Runnymede Healthcare Centre, Wayne Close, District Manager, Crothall Canada, Corinne Wong, Chief Operating Officer, Runnymede Healthcare Centre, Connie Dejak, President & CEO, Runnymede Healthcare Centre, Mike Murray, Regional VP, Crothall Canada, Stewart Dankner, Director Support Services, Runnymede Healthcare Centre celebrate going green. align with occupancy times in both offices and patient rooms, ensuring fans are not being overworked cooling empty rooms, and space temperatures were increased from 13°C to 18°C to save gas. To continue managing
energy use, Runnymede solicited a partnership with a Toronto Hydro Roving Energy Manager to brainstorm ongoing solutions to reducing energy consumption. Further, the hospital reached out to its other vendors and suppliers
for suggestions of additional ways to green the facility and reduce costs. So far, Runnymede has made significant progress, lowering its use of gas by 14.5% over an 8 month period from the previous year, resulting in a savings of nearly $30,000 and 181 tonnes of greenhouse gas (GHG) emissions. However, the senior leadership team at Runnymede Healthcare Centre appreciate that environmental sustainability requires more than just operational changes; it depends on a collective effort from staff, volunteers, patients and their families to ensure ongoing success. As a result, the hospital launched a new recycling program in November 2012, Runnymede Recycles, in collaboration with Crothall Healthcare (a division of Compass Group Canada), an organization that provides housekeeping and laundry services at the hospital. Under the leadership of Corinne Wong, Chief Operating Officer, the program is led by Stewart Dankner, Director of Support Services and Bernice Acheampong, Manager of Environmental and Linen Services, and focuses on environmental sustainability and giving back to the community. To promote Runnymede Recycles and encourage onsite participation, recycling stations were placed on every floor of the hospital and in the cafeteria, and monthly recycling tips are sent out to staff with inspiration for new ways to go green at work. “Quality, sustainability and accountability are fundamental
principles at Runnymede and I believe the key to our current and ongoing success,” say Connie Dejak, President and Chief Executive Officer at Runnymede Healthcare Centre. “As a result, we are committed to developing and implementing corporate initiatives that align with these principles and further our achievements in these areas. Green initiatives, like Runnymede Recycles, highlight our dedication to reducing our collective carbon footprint, further demonstrating our commitment to environmental protection, social responsibility and the health and well-being of our community.” Staff at the hospital have also assembled a Green Committee—comprised of members from a range of departments, including facilities, environmental services, clinical, food services and communications. The committee’s role is to drive change within the organization through leadership, assess performance and track the hospital’s progress in reducing, reusing and recycling. The committee also manages the launch of upcoming environmentally-friendly initiatives, which include a new organic waste program and a community cleanup event. Other notable changes that have been made at the hospital include planting perennials in the therapy gardens and courtyards to increase sustainability, replacing patio furniture with locally-sourced, Canadian-made aluminum furniture and switching to microfiber mops to cut the use of chemicals by 92 per cent. Runnymede also partakes in ongoing waste, energy and biohazard audits, and consolidates and recycles electronic waste, such as batteries and fluorescent light bulbs, in order to divert these items from landfills. Further, 77 per cent of hospital staff utilizes public transportation to travel to work. With the Government of Canada attributing 25 per cent of the country’s GHG emissions to the transportation sector alone, this is a positive trend in the hospital’s workforce. Runnymede Healthcare Centre recognizes the impact of the healthcare industry on the environment and the community. As leaders in environmental sustainability, the hospital is wholly committed to continuing to reduce its carbon footprint through reducing, reusing and recycling. Sabrina Jeria is a Communications Associate at Runnymede Healthcare Centre.
Focus: Facilities Management and Design/Health Technology/Greening Health Care 17 Hospital News, FEBRUARY 2013
New Humber River to implement innovative MES agreement By: Sarah Quadri Magnotta
nnovation and excellence is at the heart of Toronto’s new Humber River Hospital (HRH). Set to be North America’s first fully digital hospital when it opens in 2015, this state-ofthe-art, patient-centred model of care is already proving its commitment to quality and safe care through the design and construction of its new building; awards and recognition for leadership and innovation and a unique multi-year technology and service agreement that’s the ‘first of its kind’ in Canada and beyond. "We are excited to be the first hospital in North America to implement a Managed Equipment Services (MES) solution to enhance all aspects of quality care delivery: efficiency, accuracy, reliability and safety,” said Barb Collins, HRH Chief Operating Officer and Redevelopment Project Lead. “This solution will help us to further enhance the quality patient care we currently provide. Our patients will benefit from the latest technology to assist in diagnosis and treatment and our physicians will receive faster results, reducing wait times,” she added. “Humber River’s access to the latest in medical equipment will improve the overall quality and safety of care.” What is an MES agreement? It’s a flexible and tailored technology and service agreement to provide long term, sustainable access to innovative medical equipment and services. According to Collins, the MES model is widely used outside Canada and has proved to be successful in a number of countries including the U.K., Germany, Spain and Australia. Last October, Humber River and GE Healthcare announced their 15-year MES agreement that will ensure Humber River’s equipment remains on the leading edge. Under this new agreement, GE Healthcare will manage the ongoing acquisition, installation and replacement of medical technology for Humber River and provide maintenance services – for the duration of the agreement – on over 1300 pieces of equipment in the Hospital’s Diagnostic Imaging, Surgical and Emergency Room Departments. "GE Healthcare is proud to collaborate with Humber River Hospital on this 'first of its kind' innovative technol-
ogy and service agreement in North America,” said Peter Robertson, Vice President and General Manager, GE Healthcare. “This Managed Equipment Services Program represents a new and improved way for the public and private sectors to work together; providing Canadians with better access to high quality care with cutting edge technology that demonstrates real cost savings to the healthcare system,” he added. “With the many challenges confronting Canadian healthcare, this type of public, private sector agreement is a great example of how we can work together to better meet our future healthcare challenges.” Part of that working together involves the close collaboration between HRH, GE Healthcare and Plenary Health Care Partnerships (the consortium building the new hospital), and includes the formation and function of various committees, team-building sessions and consistent communications. GE Healthcare is also providing equipment information and planning guides to assist the Hospital’s architects and engineers in designing rooms and spaces in the new hospital. “With this model in place, our care providers can focus on patients and spend more time at the bedside, leaving the upkeep of equipment to GE Healthcare,” noted Collins. “As part of the agreement, GE will also ensure that Humber River staff is trained on the equipment when necessary. This ‘win-win’ situation will also save Humber River approximately $20-25 million over the fifteen-year term. Savings from this solution will be reinvested directly back into HRH patient care programs. When asked why Humber River chose to purse an MES solution, Collins said the answer is simple: “We wanted to prevent technology obsolescence. With a 15-year agreement in place, we are confident that many years from now we will continue to run a hightech facility that maintains the same quality patient care, equipment and services as the day we opened,” said Collins. “We will still be on the leading edge and we will still have a plan and a partner that is helping us to achieve quality and safe care at all times.” Sarah Quadri Magnotta is a Senior Writer/ Communications Specialist at Humber River Hospital.
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News, FEBRUARY 2013 18 Hospital Legal Update
What hospitals and hospital workers need to know about the Employment Standards Act, 2000 By Melanie Warner
he Employment Standards Act, 2000 (“ESA”) is the primary piece of legislation governing Ontario’s workplaces. It establishes minimum standards with respect to hours of work, overtime, vacation, public holidays, wages, leaves of absence, layoffs, terminations, severance, and other work-related issues. The Ontario Ministry of Labour administers the ESA through various education and enforcement campaigns, including publishing information to help employers and employees understand their rights and obligations, conducting proactive workplace inspections, investigation possible violations of the ESA, resolving employee complaints, and enforcing the ESA. In this article, I discuss some key issues of interest recently to hospitals and those who work in hospitals. How does the ESA apply to hospitals and hospital employees? Most employers in Ontario, including hospitals, are covered by the ESA. However, certain types of workers are exempt from the application of the ESA, or are subject to special rules. For example, the ESA does not apply to anyone who performs services as an independent contractor, for any entity. In addition: • Unlike employees in
other establishments, hospital employees can be required to work on a public holiday (so long as the hospital provides a substitute day off with pay). • Duly qualified practitioners of chiropody, chiropractic, dentistry, massage therapy, medicine, optometry, pharmacy, physiotherapy and psychology, and students training for these professions, are exempt from most protections in the ESA, except those protections pertaining to notice of termination and severance pay. So, for example, there is no limit on the number of hours they can be required to work, they are not entitled to overtime pay, they are not entitled to vacations with pay, and they are not entitled to public holidays. • The above-noted practitioners and students, and other professionals listed under Schedule 1 of the Regulated Health Professions Act, 1991 (including audiologists, dieticians, medical radiation technologists, medical laboratory technologists, opticians, midwives, nurses, occupational therapists, respiratory therapists and speech language therapists) are subject to special rules regarding leaves of absence. In particular, these individuals may not take personal emergency leave if doing so “would constitute an act of professional misconduct or a dereliction of professional duty”. (The personal emergency leave provisions would otherwise allow
employees to take up to ten days off, without pay, in each calendar year due to their own personal illness or the illness, death, medical emergency or other urgent matter concerning a close relative.) Casual employees Hospitals typically employ a number of casual (also sometimes called relief, or elect-to-work) employees, particularly in the nursing field. Historically, casual employees were exempt from the entitlement to paid public holidays, and were not entitled to notice of termination or severance pay. However, in recent years the ESA has been amended such that casual employees now enjoy all of the same protections as regular employees. As of January 2, 2009, casual employees are entitled to paid public holidays, and as of November 6, 2009, casual employees are entitled to receive notice of termination (or pay in lieu thereof) and severance pay (if the standard qualifying conditions are met). Hours of work refresher The ESA provides that most employees cannot be required to work more than eight hours in a day (or the number of hours in an established, regular work day that may be longer than eight hours in a day) and 48 hours in a week. There are some exceptions: an employee can agree in writing to work up to a specified number of hours in excess of the daily
maximum, and an employee can work up to a specified number of hours in excess of the weekly maximum if he or she agrees to do so in writing and the employer obtains approval from the Director of Employment Standards. Overtime pay refresher The hours of work rules in the ESA should not be confused with the overtime pay rules. The ESA provides that eligible employees are entitled to overtime pay equal to one and one-half times their regular rate of pay for all hours worked beyond 44 in a week. If the employer agrees, and employee may take time off in lieu of overtime pay. In addition, employers and employees can agree to overage hours of work over two or more weeks for the purpose of determining one’s entitlement to overtime pay. Hours of work and overtime pay exemptions Employees are exempt from the hours of work protections, and are not eligible for overtime pay, if their work “is supervisory or managerial in character” and, to the extent they perform any non-supervisory or non-managerial tasks, they do so only on an “irregular or exceptional basis”. The supervisor/manager exemption is much narrower than is commonly assumed. The fact that a contract of employment or job description states that an employee is a supervisor or manager, or the fact
that an employee is paid an annual salary rather than an hourly rate, is not determinative. The actual functions of the person must be assessed. Supervisory/managerial work typically involves the supervision of employees, but other managerial functions could include hiring and firing employees, responsibility for making substantial purchases, financial control and budgeting, production planning, and other tasks that include the regular exercise of independent discretion and judgment in management affairs. A 2012 class action certification decision emphasizes the importance of assessing each employee’s duties individually to determine whether he or she is exempt from overtime pay and hours of work protections. In that case, groups of analysts, investment advisors and associate investment advisors at CIBC World Markets claimed that they were owed overtime pay because they were improperly classified as supervisors/managers and treated as exempt from the overtime pay requirement. The employees argued that their positions were not supervisory or managerial because they did not have decision-making authority, or any employees reporting to them. The Ontario Superior Court of Justice refused to certify the lawsuit as a class action because there was not sufficient commonality between the employees and their job functions to hold that they were all entitled to overtime pay, or not. The Court held that there had to be an individual assessment of each employee's particular circumstances, and the similarity of job titles, or certain words within job titles, was not sufficient commonality. Conclusion The ESA is a complex and nuanced piece of legislation, outlining numerous rights and obligations affecting hospitals and those who work in them. In all cases, the legislation itself should be consulted, but this article provides an overview of some of the most pressing or recent topics of interest.
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Melanie Warner is a Partner in the Toronto office of Borden Ladner Gervais LLP and regional leader of the Labour and Employment Group. Melanie can be reached at 416.367.6679 or email@example.com
Focus: Facilities Management and Design/Health Technology/Greening Health Care 19 Hospital News, FEBRUARY 2013
Nursing and Medical Peer Leadership in Electronic Medical Record Adoption
By Jennifer Hartford There is no denying that health care and technology are coming together in amazing ways. In my 15 yr nursing career, I have seen paper “SOAP” notes turn into spreadsheets, and notepads into personal digital assistants (PDAs). The information technology (IT) world and the health care world do not always marry together in perfect harmony. In fact, many would argue that it never happens that way. After all, we are talking about a very concrete and rather impersonal IT field coming together with a very people centered and dynamic health care system. Most of us have heard about provincial plans for a seamlessly integrated Electronic Health Record (EHR) system. Although we are years away from achieving that, Ontario has made great strides in implementing stepping stones towards that goal. Nursing, as a driving force and key group of stakeholders, has embarked on a unique collaborative initiative. This initiative is one that combines the resources of OntarioMD and the Registered Nurses’ Association of Ontario (RNAO) in a Peer to Peer Network project. This project will facilitate the marriage of IT and healthcare in clinic settings.
OntarioMD was established by the Ontario Medical Association and the Ministry of Health and Long-Term Care to manage the EMR Adoption Program, which funds and assists physicians to acquire, implement and adopt IT. The RNAO is the provincial nursing association. The RNAO has been leading many projects and peer programs with regards to supporting nurses to adapt and champion eHealth initiatives across the province. The strengths of both these influential entities will be harnessed in this new project. The purpose of this initiative, in collaboration with eHealth Ontario and the Ministry of Health and LongTerm Care, is to expand and enhance the OntarioMD Peer Leader Programs and the RNAO eHealth network to assist in the engagement and use of Electronic Medical Records (EMRs) in Medical Offices and Nurse Practitioner Led Clinics. The target professionals in this project include physicians (primary care and specialty), family practice nurses, and Nurse Practitioners. To clarify, an EMR is the electronic charting software used to collect and store data at point of care. The EHR refers to a bank of complete client data that can be accessed across a variety of settings.The EMRs in indi-
vidual settings will eventually be used to link information in creation of the provincial EHR system. Healthcare consumers enter the system at many points of entry – either through an unplanned visit to an emergency/urgent care centre or a planned visit for primary health care services. With the expected increase in primary health care services and the adoption of EMRs supported by Canada Health
the following objectives. The peer leader team with continue building awareness and achieve a state of readiness to enable EMR implementation (pre-implementation) in primary health care settings including family practice clinics and NPLCs. The team will accelerate EMR adoption by linking experienced physicians, family practice nurses, nurse practitioners, and clinic managers with their colleagues to support and mentor
This initiative is one that combines the resources of OntarioMD and the Registered Nurses’ Association of Ontario (RNAO) in a Peer to Peer Network project. Infoway’s EMR funded investment project, mentoring of Physicians, Nurse Practitioners, Nurses, Clinic Managers and other members of the care team by peer leaders will help ensure clinicians are better prepared to adopt and use EMR in practice. This team of peer leaders will also assist health care teams in using EMR systems to their maximal potential. Building upon the key successes and lessons learned from both previous Peer Leader Programs, this collaborative initiative will achieve
in the use and integration of EMR into the practice setting and other required change management support. The peers will develop tools and support services that contribute to the use and optimization of the EMR to achieve clinical value and promote clinical quality standards, decision support and optimization of use. Peer Leaders will also work with practice settings and Practice Advisors in developing mitigation strategies to improve targeted areas of EMR maturity within the practice, including cod-
ing, chronic disease management, practice management improvements, etc. The total Peer Leaders engaged will consist of 30 MDs (including one Senior Peer Leader), 14 clinic managers and 22 Registered Nurses and Nurse Practitioners (myself as Senior Peer Leader). The potential impact of the project will focus on inter-professional practice at the clinic level where nurses and physicians both consider the impact of EMR adoption on their practice. The project will enhance the professional practice of office nurses by increasing adoption of EMR in clinical settings, as well as focus on sustained and enhanced use. Peer leaders will have the added potential to champion the EMR adoption plan to patients. There is great benefit to patients and professionals alike in consistent use of EMR systems. Eventually, a provincial EHR would mean that the correct healthcare data and information could be accessed at the right time no matter where and when the client presents to the healthcare system in Ontario. While still in the early stages, this project has huge impact potential and opportunity to be at the forefront of major improvements to the provincial healthcare system. For more information, please contact the RNAO or OntarioMD. Jennifer Hartford RN(EC) MScN is a Primary Health Care Nurse Practitioner at the Barrie and Community Family Health Team and is Senior Peer Leader, RNAO/ OntarioMD Peer Leader Initiative firstname.lastname@example.org
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News, FEBRUARY 2013 www.hospitalnews.com 20 Hospital Focus: Facilities Management and Design/Health Technology/Greening Health Care
Southlake Acknowledged at Provincial and National Levels for Quality and Innovation Submitted by Kate Porretta
outhlake Regional Health Centre in Newmarket, Ontario, has been recognized with two recent awards for its outstanding dedication to quality, and its leadership in implementing innovative technology for the benefit of its patients and the overall healthcare system. “Within a period of two days, the Hospital received two very distinct but equally meaningful awards,” said Dr. Dave Williams, Southlake President and CEO. “I truly believe that our recent successes can be attributed to a strong corporate culture, unsurpassed commitment to continuous improvement, and the exceptional work of an entire team of more than 4000 people who are working together with a common vision.” Southlake received a goldlevel Quality Healthcare Workplace Award, designed by the Ontario Hospital Association (OHA), Ministry of Health and Long-Term Care, and HealthForceOntario to encourage self-evaluation, learning, and improvement
The recipients of the COACH award include from left to right: Ron Dunn - VP Information Solutions, Integrated Healthcare Solutions, McKesson Canada; Steve Lawrence - Senior Client Executive, Integrated Healthcare Solutions, McKesson Canada; Helena Hutton, Vice President, Emergency, ICU, Medicine, Quality & Surgical Programs, Southlake Regional Health Centre; Judy Dewsbury, Manager Patient Access, Southlake Regional Health Centre; Brenda MacNeil, Clinical Application Specialist, Southlake Regional Health Centre; Gary Ryan, Chief Operating Officer, Southlake Regional Health Centre; Sue Grills, Project Manager, Southlake Regional Health Centre ;Diane Salois-Swallow, Chief Information Officer, Southlake Regional Health Centre ; Dr. Dave Williams, President and CEO, Southlake Regional Health Centre and Mike Krga - Implementation Manager, Integrated Healthcare Solutions, McKesson Canada
when it comes to healthy workplaces. The Hospital was also acknowledged by COACH: Canada’s Health Informatics
Association, as the 2012 recipient of the national Innovation in the Adoption of Health Informatics Award. Created to acknowledge a
technology project that has been successfully integrated into the health system at the community or regional level, Southlake was recognized for
its McKesson Performance Visibility Project, an innovative initiative that improves patient flow, quality of care, and transparency across the organization. Through the project, secure electronic boards are in use in all patient care areas, providing all members of the healthcare team with important information, such as: the location of patients and their estimated time of discharge, a given patient’s risk of falling, and whether or not a patient has been on precautions. To date, the initiative has achieved tremendous outcomes for patients, including a reduction in the time it takes to admit a patient who has come into the Emergency Department, the elimination of almost 1000 minutes of daily phone time related to patient assignments, and a reduction in falls. Kate Porretta is in Corporate Communications at Southlake Regional Health Centre.
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Focus: Facilities Management and Design/Health Technology/Greening Health Care 21 Hospital News, FEBRUARY 2013
Providence Manor demonstrates care and efficiency in “Code Green” emergency evacuation exercise By Chonglu Huang
hether it’s an overheating electrical device, a worn out wire or a stove left unattended – a fire can occur from many unforeseen circumstances. That is why it is extremely important to be aware of your surroundings and know how to respond. At Providence Care’s longterm care facility Providence Manor in Kingston, the Incident Management Planning Committee takes the lead in making sure that the home is safe and that everyone is well-informed of all safety procedures. On November 1, 2012, Providence Manor conducted a mock “Code Green” (evacuation) exercise involving frontline staff, security personnel and students who role-played as residents. The organizers of the exercise also invited observers from the Kingston Fire Department, and representatives of the residents and their families. Everyone gave their full support to the initiative. Most notable were several residents of a third floor wing at Providence Manor, who
Providence Care's mock scenario uses Med Sleds to simulate an emergency evacuation of non-ambulatory residents.
graciously lent their rooms to the exercise. This allowed the mock scenario to be as true to real life as possible. “When it comes to fires, there have been a lot of things
for me over my lifetime,” said Raymond Feeley, one of the residents. “I had the loss of a home and a business from fire. It had serious effects – we lost everything. It sure is very
dangerous and thus it is very important to be prepared.” “You have to know where the doors are and know where to go and respond immediately,” added another resident, Joyce Dudley. “I support this exercise because I want to know that, should anything happen, there are procedures in place.” The mock scenario played out as a fire (Code Red) in a resident’s room on the third floor that spreads beyond the area and requires an evacuation (Code Green) of that wing. Over 20 local high school students from LaSalle Secondary School in Kingston participated in the exercise by acting as residents. Some even dyed their hair grey to help them get into character. During the exercise, they roleplayed as ambulatory, semiambulatory or non-ambulatory residents so that various evacuation procedures and devices can be tested. One of the devices tested were newly-purchased Med Sleds – these are designed exclusively for emergency situations during which clinical staff need to move patients or residents who are unable to walk. For Providence Manor’s
evacuation exercise, Med Sleds were used to move eight non-ambulatory residents – played by students – horizontally (into adjacent wings) and vertically (down several flights of stairs). Exceeding expectations, the nursing staff at Providence Manor took just 12 minutes to move all 24 residents (ranging from ambulatory to nonambulatory) out of the area of the mock fire – a tremendous achievement. “This certainly proved to me how valuable these Med Sleds will be should such an emergency actually occur,” said Jordan Pike, Coordinator of Emergency Management and one of the organizers of the exercise. “One of the best outcomes from the exercise was seeing the timeline involved with an evacuation of this. The observers and I were thoroughly impressed with how quickly the staff worked to get everyone in danger out of the hazard area.” Chonglu Huang is a Communications Officer and Digital Media Specialist at Providence Care.
News, FEBRUARY 2013 www.hospitalnews.com 22 Hospital Focus: Facilities Management and Design/Health Technology/Greening Health Care
SickKids helps to launch regional image repository By Karina Dahlin
ospitals in Ontario are moving forward with electronic patient records that can be shared among institutions. At The Hospital for Sick Children (SickKids), information technology staff has been busy helping to launch the various features of a complex initiative that will increase the effectiveness of the health care system. The GTA West Diagnostic Imaging Repository project (GTA West DI-r) is a shared regional repository, built around solutions provided by the company CGI as the systems integrator. It will provide clinicians with access to all patients’ diagnostic imaging results, including CT scans, ultrasounds, MRIs and x-rays from health care facilities in the GTA West region. The GTA West DI-r project involves 19 organizations, accounting for 35 sites across five LHINs (Mississauga Halton, Central West, Toronto Central, Central and North Simcoe Muskoka). EHealth Ontario and Canada Health Infoway provide funding and strategic direction for the project.
Fatima Lima-Simao, a manager in digital imaging at SickKids, works with the new system. The month of December saw two new milestones at SickKids. First, the GTA DI-r FEM (Foreign Exam Management) went live. The system is integrated with the SickKids PACS (Picture Archiving and Communication System). As a result, recent scans of patients at Holland Bloorview Kids Rehabilitation Hospital and SickKids will
be available on the GTA West DI-r, and can be reviewed by health-care professionals electronically. Secondly, SickKids began piloting the GTA West DI-r web-based viewer application within its Emergency department. This marks the first clinical go-live for the project, and SickKids became the first site to complete the full clini-
national nursing week 8th Annual Supplement
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cal deployment strategy. Next, the viewer will be deployed in critical care areas across the hospital. With the viewer, clinicians can access diagnostic imaging records from the organizations that are currently publishing to the GTA West DI-r. If clinicians are working on their hospital’s secure network, they will no longer require access
to their local PACS to review the images. The new process saves a great deal of time and removes technical obstacles that sometimes arise when hospitals share DVDs of diagnostic images. “We are excited to play such an active role in shaping the future of Ontario’s health care,” says Daniela CrivianuGaita, Vice-President and Chief Information Officer at SickKids. “Hospitals have found a new way to work together, and patients will benefit.” The two projects – the launch of the Foreign Exam Management system and the GTA West DI-r web viewer – complete more than 12 months of intense work. The launch also marks the success of the ongoing collaboration between SickKids and Holland Bloorview which saw the integration of images into the SickKids PACS in December 2011 and the start of publishing images and reports to GTA West DI-r in July 2012. Karina Dahlin is a member of the SickKids Department of Communications & Public Affairs.
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News, FEBRUARY 2013 24 Hospital Nursing Pulse
By Melissa Di Costanzo
urses have a unique role to play in the lives of patients diagnosed with cancer. In the November/December 2012 issue of Registered Nurse Journal, the flagship publication of the Registered Nurses’ Association of Ontario (RNAO), Melissa Di Costanzo looks at the experiences and views of several nurses from different vantage points. This excerpt looks at two of those nurses. Morgan Lincoln is advocating for environmental policies that will have widespread consequences for all Ontarians. Grace Bradish works directly with patients in palliative care. They are among the thousands of RNs who are doing amazing things to help those dealing with this pervasive chronic disease. Morgan Lincoln knows the devastating effects cancer can have on a family. Her aunt passed away from leukemia at the age of five. Her grandfather died of a brain tumour when she was 10. And in 2009, Lincoln’s mother learned she had breast cancer. After her mother’s diagnosis, Lincoln began her nursing degree at the University of Toronto. She had an interest in environmental health and noticed cancer prevention programs focused on maintaining a healthy, smoke-free lifestyle. Early screening was also offered as a pre-emptive tool. While these messages
are important, they “generally eclipse environmental factors, such as air pollution, or toxins in consumer products,” says the Toronto native and president-elect of RNAO’s Ontario Nurses for the Environment Interest Group (ONEIG). According to the Canadian Cancer Society, harmful – or potentially harmful – substances include: non-stick cookware, arsenic in drinking water, pesticides and radon. Environmental risks include: radio frequency fields and medical radiation. Lincoln believes stronger regulations around carcinogens need to be created and enforced at the federal, provincial and municipal levels. Nurses, with their holistic view of health, are in a strong position to advocate for cancer prevention politically, she says. In fact, ongoing political activity by RNs will keep these environmental risks top-of-mind for policy makers, she adds. The majority of work ONEIG is currently focused on aims to do just that. Three ONEIG resolutions – all linked to cancer prevention – were passed at RNAO’s 2012 annual general meeting. The group has urged RNAO to support policy that will: reduce vehicle idling, including drive-through emissions; ban the mining, processing, use and export of all forms of asbestos; and reduce the risk of exposure to carbon monoxide and nitrogen diox-
ide due to emissions from ice resurfacers in arenas. ONEIG is pushing for these changes so Canadians can breathe easier, but its work is not limited to these resolutions. In the fall, the group organized a Greening Health Care event, where sustainability initiatives in place at Toronto’s University Health Network were discussed. RNAO and the Canadian Nurses Association have also passed ONEIG resolutions related to the amount of lead children are exposed to. Lincoln says few people realize how closely their health and the environment are linked, which is what drives her involvement with ONEIG. “They’re inextricable,” she says, suggesting peoples’ lack of understanding may relate to the lapse in time between exposure and the onset of disease. Breathing air polluted by diesel exhaust, which has been labeled a carcinogen by the International Agency for Research on Cancer, is exposure, but some people may not be diagnosed with cancer until years later, she explains. “We can touch a stove and see a blister or burn right away. This is like constantly touching a hot stove, or being in a toxic soup, but not seeing the effects until way down the line.” In the fall of 2011, Lincoln was completing a placement in oncology at Toronto’s Princess Margaret Hospital. One day, she learned two people on the unit had been diagnosed with mesothelioma – a rare cancer primarily caused by asbestos exposure. She was surprised to hear that two patients were living with the same uncommon cancer. When it comes to cancer prevention, this is “a warning for what’s potentially to come if we don’t get serious (about protecting our environment).” Grace Bradish has provided care for hundreds of patients over her 35-year nursing career. Few have had the impact on her that Rob Fazakerley and his wife, Jen, have. “I tell my patients on a daily basis: my job is to help you find joy in living today, because I can’t tell you what’s coming tomorrow,” she says. “Jen and Rob really lived that (philosophy).” Bradish was the homevisiting nurse practitioner at London’s South West Community Care Access Centre assigned to Rob’s care
Morgan Lincoln believes nurses are in a strong position to lobby politicians for better cancer prevention. when he was diagnosed with terminal pancreatic cancer in August 2009. He was only 46. She’s also the co-author of a new book called Just Stay, a novel about Rob and Jen’s last months together. After his diagnosis, Bradish met numerous times with Rob, his wife, and spiritual care specialist Helen Butlin-Battler to discuss Rob’s care. When the London NP was not available to meet in person, or if Jen had an urgent question, she exchanged emails with the couple. Often criticized as an impersonal way to communicate, Bradish says emailing is a fast, effective method that can be used to supplement in-person client care. Jen asked Bradish for clinical advice – many times via email – right up until Rob’s passing in September 2010. “She would email me with a question: ‘Is this normal?’ ‘What should I do?’” recalls Bradish. “I could respond almost instantly…and she could choose when to open (the message).” Bradish even learned of Rob’s death via email because she was out of town at the time. The message, she admits, was tough to comprehend. “I warn families about this: that regardless of how much they’re anticipating…that final breath, that absence of pulse carries an element of shock and surprise that one can never anticipate,” she says. “(When Rob died) I felt that.” A few months later, Bradish gathered together 300+ emails she had exchanged with the couple
and Butlin-Battler. She sent them to Jen, and talked to her about the wealth of her experience. It could be beneficial to other patients, families and health providers, she said. Discussions ensued, and the idea for Just Stay was born. For two years after Rob’s death, Bradish, Butlin-Battler and Jen collaborated on the book. All three were firsttime authors, and the writing experience, Bradish says, was very powerful. The book, which, in part, is a reflection of Bradish’s approach as a palliative care nurse, was released in September 2012. Bradish hopes it gives readers “confidence that, despite a (loved one’s) departure…there will remain a significant presence with those whom they loved.” For health-care providers, her wish is that the book “releases them from the awkwardness that we all experience in having these very difficult conversations with people. We are so afraid to use the “d” word, and yet, death is what makes life so terribly precious.” Melissa Di Costanzo is staff writer at RNAO. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve. Not a member? Visit www.RNAO.ca to join, and take full advantage of our member benefits.
Hospital News, FEBRUARY 2013
From the CEO’s Desk
Innovation by PFA By Andrée G. Robichaud
t Thunder Bay Regional Health Sciences Centre (TBRHSC), patients are first. Most hospitals would say the same. In fact, this one touted that claim for years. Then, in early 2009, we adopted the Patient and Family Centred Care (PFCC) model of care and learned what it really meant to put patients first. We now know that outcomes tend to be much better when patients are engaged and involved in their own healthcare. Within 18 months of starting the PFCC journey, TBRHSC improved inpatient satisfaction scores by 6.8% to 21.6% in all eight dimensions of care as reported by National Research Corporation (NRC) Picker™. It did not happen overnight, nor without effort. Innovative strategies, including an organizationwide pledge, encouraged staff at all levels to understand and buy into the PFCC model. Creative approaches were applied to engage patients and family members who had experiences with us and involve them as Patient Family Advisors (PFAs). PFAs are central to the PFCC model of care. They call upon their own experiences to help guide improvements in all areas of care. Inspired activities helped to persuade staff to embrace PFA input, including large group planning sessions with staff, managers and PFAs. Once the value of the PFAs was realized, the PFCC model spread its wings. We did extremely well. In fact, Thunder Bay Regional Health Sciences Centre is the first and only hospital to receive a Leading Practice designation in PFCC from Accreditation Canada. To become leaders in PFCC, we had to be innovative. And because of PFCC, we continue to be innovative.
Innovation inspires innovation PFAs sit on every decisionmaking committee, providing invaluable insights into how efficiently our academic health sciences centre operates today and how to make improvements for tomorrow. Over 90 PFAs ranging in age from eight to 85 have been integrated into everything we do, including staff hiring, senior management and board quality committees, education, strategic planning and program/ service councils. Each program and service at TBRHSC has a responsibility to partner with patients and families in the development of annual action plans, ensuring their needs and values are considered in the delivery of care and services. As a result, innovative ideas to improve and advance patient care happen almost every day. PFAs bring with them new perspectives and they challenge us to approach patient care in completely different ways. And the results are very well received. Family Tour Nights is one of many examples of PFCC initiatives making experiences at TBRHSC better for patients and families. Our Health Sciences Centre serves 1,100 paediatric patients who require surgery every year. PFAs partnered with us to bridge the gap between what we thought our paediatric surgical patients and families needed and what they actually needed. “One of the worst feelings in the world is handing your child to a stranger, listening to them cry, as they are taken away and the OR doors close,” said one of our PFAs. We cannot change the fact that children need surgery, but we can change the process to create a better experience. PFAs applied their first-hand experiences with the surgical journey to identify how it could be improved. Now, the families of paediatric surgical patients are
invited to take part in an organized group tour of the Operating Room (OR) before their scheduled surgeries. The tour takes the child and family on the entire surgical journey, from the admitting process to returning to their room after surgery. Nurses from the OR guide the families to the paediatric unit to visit the playroom and the area where they will wait until the young patient takes a ride to the OR in a little red wagon (another stress-reducing initiative, this one recommended by our youngest PFA who was just nine years of age at the time). Once in the OR holding room, everyone changes into OR attire, and the children are given their very own OR scrubs to take home. The children can walk or ride on a stretcher into the operating theatre, where they and their parents are entertained by an interactive puppet who explains, with the help of surgical team members, all of the machines and noises in the room, as well as all that will take place when they come in for their surgeries. The tour gives the children an opportunity to play with flavoured oxygen masks, finger probes, “sticky pads”, and other equipment. After the show, the children ride to the recovery room to see where mom and dad will be waiting for them after surgery. The tour ends with snacks and playtime with the other children. When asked what they liked best, tour participants listed the puppet show, ride, and pictures taken of the whole family “dressed up” (the parents particularly enjoy this as well). Learning what was behind the closed doors of the Operating Room helped dramatically to reduce the anxiety for both the child and parent and has improved the patient and family experience. The Family Tour Night has had immediate and significant improvements in our patients’
Andrée G. Robichaud and families’ experience of care. The Family Tour Night clearly demonstrates that innovation often comes in many forms. As healthcare professionals, we tend to consider innovation in terms of technological advancement and medical research break-throughs. These are, of course, important areas of focus that enable all of us to deliver more effective and efficient care. However, it’s also important to recognize that innovation at the grass roots level can result in profound improvements that effect better patient outcomes. This sort of success generates momentum. Hearing the perspectives of patients and family members has been enormously beneficial. So much so that it inspired yet another simple yet effective innovation – the sharing of patient stories as a way to open all council meetings. The Senior Management Council, for example, begins with the telling of a recent patient experience. The group reflects on the story and discusses whether or not the activities and decisions around the care were patient and
family centred, and how they could be more so. We focus on learning and improvement. We focus on the care the patient the received, as opposed to the people who delivered it. This sharing of patient stories sets the tone for the meeting. Whether we are dealing with budgets, policies or procedures, we never forget why we are together: to deliver a better experience and better outcomes for our patients and families. Together, PFAs, healthcare professionals and employees collaborate to identify inspired new ideas. They build on their achievements and those of their colleagues. They are encouraged to think outside the box to find creative solutions. Their innovative strategies continue to change the way healthcare is delivered at Thunder Bay Regional Health Sciences Centre, truly Patient and Family Centred. We are becoming healthy together. Andrée G. Robichaud is President & CEO of Thunder Bay Regional Health Sciences Centre.
Preparing health care facilities for climate change and extreme weather By Dylan Dingwell
limate change and natural disaster preparedness are topics of growing interest and concern for health care facilities in Canada. These are two of the most critical areas in which facility planning and management need to take into account how a health care facility
relates to its external environment. Last October, Hurricane Sandy provided a stern test of emergency management and recovery capabilities for health services on the Atlantic coastline. One notable success story of facility preparedness that emerged after the storm was the use of combined heat and power (CHP)/
cogeneration systems, which offer environmental benefits through greater energy efficiency, by several New England and New York hospitals. Though the local power grid was battered by Sandy, South Oaks nursing home and hospital in Long Island was able to pre-emptively disconnect from the grid and rely on CHP to provide power until
the utility had time to recover. Paul Cheliak, Director of Market Development at the Canadian Gas Association suggests that one of the often overlooked benefits of CHP is that these systems offer customers greater reliability – something important to institutions like hospitals. "While the energy efficiency and payback numbers of CHP are
improving with new technology and low natural gas market prices, it is the underground natural gas pipeline infrastructure and the corresponding resiliency of the technology that offers added reassurance for consumers during critical times of need". Though most of Canada Continues on page 26
News, FEBRUARY 2013 www.hospitalnews.com 26 Hospital Focus: Facilities Management and Design/Health Technology/Greening Health Care
Hospitals, Dashboards, and Savings
Continued from page 8 period allows the system to identify these peaks and valleys while also producing the averages necessary to create benchmarks. Once sustainability initiatives are implemented, dashboard systems can monitor their progress. For instance, say showerhead aerators (which are quite inexpensive) are installed in all patient rooms over a 30-day period. A month or two after their installation, managers can use a dashboard system to see if water consumption and related costs have declined from the original benchmark. A few months later, the system can tell administrators whether this trend has continued and, if so, if it has lowered the average water consumption of the facility overall, producing a cost savings. As other sustainability strategies are implemented, dashboard systems can be used to measure their impact. According to Practice Greenhealth (a nonprofit membership organization for the healthcare sector that helps its members to become Greener and more sustainable), using dashboard systems not only helps its members track environmental performance data, but also helps them to: • Gauge the organization’s carbon footprint by tracking greenhouse gas emissions • View and compare data for an entire facility, different areas of a facility, or multiple facilities • Evaluate a facility’s environmental impact compared to that of other healthcare facilities • Identify costs and cost trends for various consumables • Improve financial performance • Report progress to all staff members and promote sustainability goals Additionally, dashboard systems can help promote recycling programs and be used to track the cleaning
products purchased and used in a facility. This information can be especially helpful if the goal is to increase the number of Green or environmentally preferable cleaning products selected over conventional products. Creating a Culture of Sustainability All organizations, including healthcare organizations, have a culture. This is a common way of thinking and doing things that everyone in the organization recognizes and hopefully identifies with. A culture of sustainability usually starts with policies, procedures, and employee guidelines designed to promote efficiency and cost savings. As organizations begin using dashboard systems and making changes that improve sustainability and reduce operational costs, most employees get on the “sustainability bandwagon.” In other words, a culture of sustainability emerges in which everyone is on the lookout for new opportunities to operate more efficiently and sustainably. This type of culture tends to build on itself, resulting in improved environmental performance over time. Stephen P. Ashkin is President of The Ashkin Group, a consulting firm specializing in Greening the cleaning industry, and CEO of Sustainability Tool LLC, which makes an electronic dashboard that allows organizations to measure and report on their sustainability efforts. He is also coauthor of both The Business of Green Cleaning and Green Cleaning for Dummies. *Consumables can refer to a variety of items other than water and energy (whether electricity or gas), including fuel used by facility vehicles, paper products, ink cartridges and toner, and cleaning products.
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Preparing health care facilities for climate change and extreme weather Continued from page 25 was spared the brunt of Hurricane Sandy, such extreme weather events are neither a distant memory nor an unrealistic expectation for many regions of Canada. Individual weather events have a complex network of causes, with climate change having a major impact on weather trends, as the Intergovernmental Panel on Climate Change (IPCC) warns: "a changing climate leads to changes in the frequency, intensity, spatial extent, duration and timing of extreme weather and climate events, and can result in unprecedented extreme weather and climate events." The effects of climate change extend beyond the possibilities of extreme
weather. For example, the anticipated rise in overall and peak heat levels not only have population health ramifications, but also present a serious challenge for facilities, which has contributed to the growing popularity of passive cooling technologies from basic exterior shades to green and cool roofs. All aspects of operations, from power and water consumption to food procurement are increasingly taking environmental trends into consideration. The Canadian Coalition for Green Health Care and our partners are working with funding from the Nova Scotia Climate Change Adaptation Fund, to develop a tool to measure the resiliency of health care facilities in Canada to the effects of climate change. The project is
based on a three-part definition of resiliency, which takes into account not only health systems' ability to withstand disasters and return to normal levels of functioning (resistance and recovery), but also their ability to learn from and adapt to climate effects. The Resiliency tool should be available to facilities nationwide in 2013. The Canadian Coalition for Green Health Care is Canada’s premier integrated green health care resource network; a national voice and catalyst for environmental change. www.greenhealthcare.ca Dylan Dingwell is Project Coordinator at the Canadian Coalition for Green Health Care.
What is worth knowing in clinical practice? Infoway and partners launch education campaign on national electronic record plan and clinical benefits Continued from page 14 tive underway in Canada to accelerate adoption of these systems. As a result, a series of educational resources illustrating the clinical value and progress of ICTs for health were developed based on the areas identified by the clinicians. “Having a variety of options to address the range of learning needs from those who are less familiar with using ICT in practice to those more experienced with these technologies is helpful. The clinical examples also help to illustrate the progress made to date and what is possible going forward,” says Pamela Thorsteinsson, Director Professional Practice, Fraser Health, British Columbia. In addition to two animated videos, there will be five videos illustrating the identified clinical benefit areas: 1. Timely access to information 2. Decision support and workflow 3. Collaboration and communication 4. Improved efficiency and avoided duplication 5. Information management and education Achieving clinical value through the use of ICTs in professional practice means more than just the transfer of
paper to electronic records. It’s a process that requires effective change management support and active clinician involvement from project design to implementation with a focus on providing the best care possible while addressing clinical needs and workflows. “It is critical that we, as clinicians, are aware of progress achieved provincially and nationally to support clinical best practice. That is why these resources are so important,” according to Dr. Peter Rossos, Chief Medical Information Officer for Toronto’s University Health Network and Shared Information Management Services (SIMS) Partnership in Toronto. “When clinicians see how electronic systems are improving the practices of their colleagues across the country, they can consider the benefits that similar systems can bring to their own practices and contribute back by sharing their own ideas and experiences.” Canadian health care professionals are expecting to hear from their peers about this initiative and partners across the country are picking up the cause. Ms. Thorsteinsson and Dr. Rossos are part of this growing community of Clinical Champions who are reaching out to their
colleagues to speak about the benefits of using electronic systems in clinical practice and what it can mean for the patients and the care providers. To date more than 40 national and provincial organizations as well as 25 individual clinical champions have committed to incorporate the educational resources within their existing programs and channels. The available CEC resources were developed and extensively tested with front line health care professionals to ensure they met learning interests and that the messages were delivered in a meaningful way. Designed to be easily shared between peers, supporting documents also include a customizable PowerPoint presentation, template article, orientation guide, and Frequently Asked Questions (FAQs). Find out why clinical leaders across Canada believe that Knowing is better than not knowing. Visit www.knowingisbetter.ca to explore the resources and find out how you can join the community of Clinical Champions. Maureen Charlebois is Canada Health Infoway’s Chief Nursing Executive & Group Director, Clinical Adoption.
March 2013 Issue: February 26, 2013
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