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How Canadian eHealth Initiatives are Changing the Face of Healthcare: Success Stories

Office of Health and the Information Highway, Health Canada
August 2002

Canadians are enjoying improved health care services as a result of the innovative use of information and communication technologies (ICTs) to deliver care to patients. Projects ranging from the small scale implementation of electronic health records in physician offices, to large initiatives that are bringing telehealth services to thousands of patients, are occurring across the country.

In some cases, these projects are carried out in isolation. Some involve multiple government organizations, hospitals and other partners. In every case there are lessons to be learned and shared within the ICT sector and health care community.

Attached you will find success stories about the implementation of ICTs in health. These stories were written for a general audience to explain how these projects improve health care services, and to share just a few of the many initiatives currently underway. We encourage you to distribute these success stories to your colleagues and other interested parties.

As Health Canada's focal point for ICTs in health, the Office of Health and the Information Highway would like to invite you to share your success stories with us so we can continue to collect information on the ongoing developments in the field. See also OHIH's Information and Communications Technologies in Health Initiatives Database which contains information on other initiatives.

If you would like additional information on these stories or on Health Canada's role in the developing Canadian health infostructure, please don't hesitate to contact us.

Atlantic Canada
Central Canada
National
Northern Canada
- Bridging the Gap: IIU Network (NU)
Western Canada

Success Stories From Atlantic Canada

Four in One: Health Infostructure Atlantic

Reaching consensus between four Canadian provinces on any issue is a great accomplishment. Keeping them together to deliver a shared vision of health information technology is cause for real celebration.

"There's no question that this is a unique model of collaboration and cooperation," says Brenda Ryan, Project Coordinator for Health Infostructure Atlantic (HIA), which was formed in 1999 to work on health information technology strategies for Nova Scotia, New Brunswick, Newfoundland and Labrador and Prince Edward Island. The project is also supported by funding from Health Canada.

HIA came together at the direction of the provinces' premiers, and developed an agenda that includes their first round of projects: a Common Client Registry to store data from health care consumers; Community-based Care Management systems; and Tele-i4, a project to install digital x-ray technology equipment and connect provincial networks so that images can be shared across Atlantic Canada to support clinical care.

While the individual initiatives are innovative in terms of enhancing patient care and supporting service delivery, the real innovation may be in a structure that respects individual provincial priorities and maintains alignment with the federal, provincial and territorial health infostructure vision.

"The HIA steering committee works on the basis of consensus. Our goal is to develop a common vision for the health information technology that we want to deploy, develop and implement common standards of interoperability, and hold each other accountable for achieving our shared vision."

"Not only are there many levels at work, but there are many players as well. Each province is a distinct legal entity with its own priorities. Each health ministry and government has its own structures and processes for approvals. It is a challenge to keep all the ducks lined up."

A challenge, but not insurmountable.

Driving the project is the recognition that the region can have more impact on federal and provincial strategies if it speaks with one voice.

"We have to build and draw on the expertise throughout Atlantic Canada. We can accomplish a lot on our own but can accomplish much more by working together."

Among those goals is the creation of an electronic health record that will take advantage of the efficiencies of shared resources and capacity.

"Working together we can improve health care delivery for Atlantic Canadians."

Creating a Paper-Free Zone: Central East Health Care Institutions Board (NF)

Anyone who doesn't believe that the province of Newfoundland and Labrador is defined by weather and geography has likely never been on Fogo Island with a winter storm closing in.

That was the reality facing a 70-year-old woman on a recent Friday afternoon. She'd fallen, and the emergency room physician at the 14-bed Fogo Island Hospital suspected a broken shoulder. His options: race her to Gander via ferry and road, or keep her for observation and risk having to summon an air ambulance during a stormy weekend.

Fortunately, the Central East Health Care Institutions Board (CEHCIB) - which includes both the Fogo Island Hospital and Gander's James Paton Memorial Hospital - has one of the most advanced electronic health record (EHR) networks in the country. One element of the network is Newfoundland and Labrador's only Picturing Archiving and Communication System (PACS). All diagnostic imaging can be shared electronically throughout the region, reducing the turnaround time from 10 days to 1 day for radiology reports from regional locations such as Twillingate, Brookfield and Fogo Island.

On the Friday in question, the Fogo Island doctor scanned the woman's injury and was sharing the image with an orthopedic surgeon at James Paton within three minutes. A decision was made and the woman was transported to Gander for surgery before the storm shut down the island.

"There's no question about it," agrees David Lewis, Chief Executive Officer for Central East Health Care Institutions Board. "PACS helps physicians make better decisions and results in better patient care."

There are many benefits," states Dr. Joe Tumilty, Chief of Staff. "We have better access to clinical information and we have better utilization of our resources because of the reduction in duplicate procedures."

Doctors within the CEHCIB can now check on a patient's progress from their home or office by logging into a secure database. A record locator function tells them what forms require their electronic signature and which charts are incomplete. All the information can be customized to fit individual preferences.

"The doctor now has the resources to arrive at the hospital completely up to date."

Once on the nursing unit of James Paton Memorial Hospital, the physician wheels a laptop computer to the patient's bedside. Using the electronic chart, the physician can enter notes, view lab work, medication or physiotherapy, or view PACS images using the wireless unit's 12-inch screen.

"One of the real advantages beyond speeding up function and flow is the ability to provide patient education at the bedside. The doctor can share x-rays or test results with the patient right there."

Sean Bailey, Director of Information Systems for CEHCIB stated the next steps in the implementation of the system include wireless connectivity between all the facilities in the CEHCIB, the introduction of hand-held wireless devices for doctors, physician order entry and the rollout of a region-wide videoconferencing system.

"One of the secrets of our success has been that we won't put anything in place if we can't support it. But we've stuck to our vision of providing exceptional patient care over the past 11 years, and we're now at the point where we can really begin to take advantage of what we've built."

Laying the Pipe for Health Information: Newfoundland and Labrador

While some advances in health technology bring immediate and obvious benefits, some lower profile projects do not dazzle immediately, but are laying the groundwork for a revolution in health care.

Such a project is being undertaken in Newfoundland and Labrador. According to project leader Mike Barron, "what we're doing now, the patient identification phase, is an enabler that will allow the tracking and eventual consolidation of patient records across the whole provincial system."

Through communications technology, the province will ultimately have the ability to trace patients' records, what tests they've had performed, and what medications they have been prescribed. Mr. Barron says at present, a move from a hospital in one region to another in the next town can mean that sometimes painful and invasive tests are repeated, because the records are not available to the new hospital.

The new patient identifier system will show health care providers whether or not a patient has had previous treatment in another health facility in the province. At this stage of the project, a doctor will still have to call to retrieve that information, but at least they are signalled that the information exists. Mr. Barron foresees a future phase of the project that will allow doctors in hospitals and other facilities to access that information electronically as soon as the patient's name is entered.

Creating this health information network will not require a costly new repository of information. Mr. Barron says all that is required is to link up existing databases.

"It's like a bank," he explains, "when you go to a bank out of town, or a cash machine, they retrieve your financial information from wherever it's stored. Our system will do the same thing with your medical information."

Mr. Barron says a key building block for the system, the patient identifier, is now in place, and it will be followed by information on lab tests and prescriptions by 2004.

He believes the Newfoundland and Labrador project is not just paving the way for sharing health information in the province, but ultimately for sharing information across the whole country.

Improving Planning for Cancer Care: Newfoundland Cancer Treatment and Research Foundation

When the Newfoundland Cancer Treatment and Research Foundation is planning what resource requirements for the coming and future years, it looks to the cancer registry, it needs for the coming year, it looks at its cancer registry. This central database tracks over 200 cancer diagnoses, which occur in the population over the previous year. Bertha Paulse ,CEO of the Newfoundland Cancer Treatment and Research Foundation, says the registry is particularly useful for tracking the incidence of the "big four"; breast, lung, prostate and colorectal cancers.

The only problem with the registry is that it is not up to date, because it's a manual process that relies on clerical staff to transcribe information that is mailed out to them. "It may be six months before it gets into our cancer registry," says Ms. Paulse. "So that by the time you look at it and analyse it, the information is old." She says the information lag can be as long as six months, which weakens the registry as a tool for effectively allocating resources where they are needed.

That is where the new cancer pathology network will help. It will link in all the cancer information from the seven pathology labs in hospitals through Newfoundland and Labrador into a central database

Ms. Paulse says the data collected by the new network will add layers of information that are not currently available. Data on treatment outcomes from such treatments as radiation, chemotherapy, and surgery will help evaluate the effectiveness of those treatments for different forms of cancer.

The network will also allow health workers to examine the lag time between a specimen being taken from a patient, and the review and interpretation of that specimen by a specialist.

A major benefit is that the pathology network will help the treatment centre to make faster decisions about the priority for a patient's treatment. With the present system, it takes some time for an analysis of the severity of a patient's cancer, and the corresponding urgency of their treatment. According to Ms. Paulse, "I would say it will probably reduce your immediate lag time by three to four weeks."

The network is presently being piloted with one pathology site. Ms. Paulse hopes to have all seven on line by the end of September 2002.

Telemedicine Melts Northern Labrador's Isolation: Health Labrador Corporation (NS)

When you live in one of the communities huddled along the Labrador coast, a simple thing like a cut on the finger can turn into a long, painful and expensive ordeal. The twelve small communities are strung out across an area about the size of the British Isles. They are only connected to the outside world by air, so if a cut becomes infected, and the nurse in charge at the small community clinic is concerned that it may get worse, a patient could be forced to take a medevac flight to the local centre of Goose Bay.

Despite the best efforts of medical staff, the trip can be a painful and traumatic experience, with the patient ending up far from family and friends. That is why Marge Learning remembers the story she was told recently about how the man from the northern community was saved such a trip. Instead of being bundled onto a plane, the man's infected finger was held up in front of a camera at the northern community clinic. The doctor in Goose Bay, several hundred kilometres away, looked at the finger and decided that the nurse could simply treat it with antibiotics available to her.

Ms. Learning is the Assistant Executive Director of Administrative Services at Health Labrador Corporation, which provides health services to the northern Labrador communities. She says the corporation is in the process of connecting all twelve communities with a videoconferencing system that will allow all of the community clinics to be connected with the hospital in Goose Bay. That hospital, in turn, is connected to the larger hospital in St. John's, allowing access to a wide range of specialists.

Being able to diagnose and treat patients in their home communities adds up to big cost-savings in Labrador, bigger than in most parts of the country, because of the high costs of air travel. Another cost saving in this project is that the network carrying the medical video images will also be used by the provincial Departments of Justice and Education. The cameras for the other applications will be in community buildings, while the medical camera will be at the community clinics.

Ms. Learning says another major advantage of the Labrador project will be to reach out to the one or two nurses who run each clinic. "In our remote areas we didn't even have the luxury of having Internet connectivity with our community clinics so it's allowed that to happen. So as far as communication goes, it's greatly improved to our remote sites, and that of course enables them to feel more supported and connected to the organization and not as isolated." Ms. Learning says nurses can use the video link to take training programs, as well as using it for clinical purposes. She says the new connection is expected to be an important factor in recruiting and retaining nurses, which is always a challenge.

For now, the link will provide audio and video. Ms. Learning says Health Labrador Corporation hopes to expand it later, to allow more diagnostic tools to be added.

Nova Scotians Net Gain: DoctorsNS.com (NS)

Life in the Information Age would be easier if we could simply expand our memories by inserting a card, the same way we upgrade our computers. In health care, the flood of information available is particularly challenging.

"The average doctor needs about two million facts at their fingertips," says Dr. David Zitnick, Director of Medical Informatics at Dalhousie University. "To provide the best care, doctors need access to as much knowledge as possible; not just what's inside their heads."

For Nova Scotia physicians and their patients, DoctorsNS.com is a gateway to a wealth of information, ranging from health promotion news to extensive medical libraries. The site gives more than 1,900 members of the Medical Society of Nova Scotia -- Canada's oldest -- access to a well-stocked electronic bookshelf.

Penny Logan, the site's librarian, believes it levels the field for the province's doctors. "A large number of members don't work out of a university or major hospital. Our electronic bookshelf gives them quick and easy access to 500 full-text journals and 40 textbooks."

Also online is DXplain™ -- a decision-support service that uses a set of clinical findings to produce a ranked list of diagnoses that might explain a patient's symptoms -- and the MD Consult database of medical publications.

"These types of tools can help reduce the time to a great diagnosis," says Zitnick.

Both the members-only and public parts of DoctorsNS.com also have information about topics like palliative care, the risks associated with smoking and news items related to health promotion. The general public can use the site to locate a doctor in their area, while physicians can identify practice opportunities in the province.

"The site is designed to be the one source you need for issues and current thinking on health care," says Zitnick. "For example, it provides a link to the Romanow Commission on the Future of Health Care in Canada so Nova Scotians can have input and follow the issue."

"As we move into the future of electronic patient records, we see this type of site becoming a place where doctors and their patients can collaborate on managing health issues."

Last Wish: Telehospice (PEI)

The dying man knew it was his final Christmas, and among those he wanted to remember with a gift was someone he'd met only twice.

To John Martin of the West Prince Health Authority (WPHA) in Prince Edward Island, the story speaks volumes about the power of his region's TeleHospice project. The man was one of several dozen people in the Alberton area who have been remotely linked to a nurse through the project since 1999. Using a regular phone connection, the nurse monitored his vital signs and offered comfort. Although they almost never dealt face to face, she became a trusted and welcome source of support in his final days - the embodiment of palliative care.

Situated in the province's richest potato-growing region and serving a largely rural population of 15,000, the WPHA has built a strong core of expertise about palliative care, says Martin. With nurses in short supply, it was a natural move to adopt an electronic model of home care that is both fast to implement and efficient to use.

"Because the system uses regular phone lines, we can set up the equipment and provide the initial visit in one day."

Depending on the client's needs, the unit can be equipped to measure blood pressure, weight and pulse. The remote nurse can monitor the client's heart using the same stereophonic stethoscope that's used onboard the space shuttle. Soon, an electrocardiogram monitor will also be available.

The system's efficiency became clear in surveys conducted before and after its implementation. With the system in place, the WPHA recorded a 76 percent decrease in days that dying clients were hospitalized. There was a 20 percent reduction in emergency room visits and 15 percent fewer doctor's office appointments.

Some individual cases show results that are even more impressive.

Martin recounts the story of an elderly single woman who lived in her own home.

"In the year prior to going into the program she had frequent long hospital stays. Once she had a unit in her house her admissions dropped by 80 percent. For people like her, a lot of it is just loneliness. This was a sociable person, and she missed the daily contact in her life. TeleHospice gave that back to her, to the extent that a lot of her online exchanges with the nurse were personal rather than strictly medical."

In its third year, the system has now expanded its client base to include those suffering from chronic depression, diabetes, cardiac problems and congestive lung disease. The WPHA is running at its capacity with 16 units installed in the field, and it's receiving close attention from health authorities throughout the province. A proposal is being prepared to roll it out to other areas with the assistance of various sponsors.

"There's lots of enthusiasm," says Martin. "As a service option to home care clients this can make a major difference."

If not the difference between life and death, at least the difference of death with dignity.

Raising awareness about cervical cancer screening: Teleoncology (NB)

Dr. Réjean Savoie was recently disturbed to discover a 17-year-old patient with advanced cervical cancer. "We shouldn't be seeing this in 2002," he says.

And yet, the statistics indicate that Dr. Savoie's young patient is among the majority of New Brunswick women who do not have regular Pap tests to screen for what is the world's second most common form of cancer.

Only 39 percent of women in New Brunswick have Pap tests, and in some parts of the province the number is as low as one in five. Statistics Canada reports that only two-thirds of women in New Brunswick have had a Pap test in the past several years.

"These are disturbing statistics," says Dr. Savoie, who is a gyn-oncologist and medical director for the Teleoncology project, led by the Beauséjour Regional Health Authority, the largest provider of Francophone health care services in Atlantic Canada. Other partners include the New Brunswick Department of Health and Welfare, the Université de Moncton, three other regional health authorities (Campbellton, Bathurst, and Miramichi) and the Big Cove Health Centre.

These percentages are upsetting, not only because they are so low, but because cervical cancer is one of the forms of the disease that can be arrested successfully if diagnosed early. Regular Pap tests are the key.

According to Teleoncology project manager Suzanne Robichaud, focus groups yielded a number of reasons why New Brunswickers avoid systematic screening: they do not have a family doctor or would prefer the tests are performed by a female doctor, they are shy, tests are not offered on a regular basis, and many lack knowledge about the risks of cervical cancer.

Dr. Savoie hopes that the new, multi-faceted project will help reverse the trend in his province by introducing an efficient and comprehensive screening system. The project's goals include increasing awareness and Pap test participation, improving follow-up with those tested, eliminating unnecessary screening, and ultimately, reducing the incidence of cervical cancer and deaths from the disease.

Computer Among the components the project introduces are: a health promotion campaign (including a video in the Mi'kmaq language); screening clinics in Miramichi, Bathurst, Campbellton and Beauséjour; training for health care professionals; and a central database with test results of women who have been screened.

Creation of this database will not only lead to an automatic call-back system, it will help track trends throughout the province so future efforts can be targeted to areas where women are most at risk.

In addition, the project will allow gyn-oncologists and gynecologists to consult remotely about the treatment of cervical cancer patients, using secure electronic files that include multi-media capabilities.

For physicians like Dr. Savoie, the hope is that fewer New Brunswick women will be afflicted with this preventable cancer.

This project is one of 29 funded through the Canada Health Infostructure Partnerships Program, managed by the Office of Health and the Information Highway.

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Success Stories From Central Canada

Consistency in the Community: Community Care Connects! (ON)

A province as large and diverse as Ontario presents unique challenges to community health providers. With 43 main offices and over 200 branch offices, the province's Community Care Access Centres (CCACs) deliver outreach, referral and placement services in both urban and remote settings. Providing consistent levels of service -- from Etobicoke to Cochrane -- relies heavily on information management.

Since 1999, Community Care Connects! (C3) has worked to ensure that all CCACs have access to the same level of technology. This will enable a common set of computer software to be implemented for all CCACs over the next few years. However, the current technology has already resulted in better service to clients and improved productivity.

C3 Senior Project Manager Patrick Allen points to several ways the new system is working.

"Previously, team members at a CCAC had to share one computer, so there was often a wait to enter client data into the system. C3 provided computers for every team member. This not only increases productivity, but also changes the way that case managers work with their clients.

"Let's say a senior in Toronto is considering entering a long-term care facility near his or her family in Sarnia. The case manager at the Toronto CCAC can enter the Information & Referral computer system, which uses a search engine very similar to Yahoo! or Google to display a list of facilities and, together with the client or the entire family, go through what's available. It's much more collaborative."

The system also addresses short-term mobility issues.

"Before C3, a client's health records had to move with them on paper. So, if a CCAC client moved from Toronto to cottage country for the summer, all that paper had to follow them there and back. Now, a child being discharged from hospital in Toronto can be sent home to Rainy River with services prearranged and information on equipment, medication and supplies sent electronically to the CCAC ahead of the child's arrival back home."

All CCACs can access a secure network to send client information and files as e-mail attachments between their offices. The backbone of the system is a managed virtual private network, implemented by The Government of Ontario's Smart Systems for Health (SSH). This is a secure Internet-compatible network that provides Internet access and a secure e-mail facility.

The system also enables desktop faxing, so CCAC staff can securely send material to external service providers, such as long-term care homes, occupational therapists, or family physicians letting them know the services their client is receiving.

In CCACs, where some case managers work primarily outside the office, the network provides access to the CCAC server which offers integrated electronic messaging, so they can sign on from a remote location, collect voice messages or e-mail, check their case load and download files.

"In the future, this network will help form a provincial database to allow information sharing between all care providers and facilities," says Allen, who estimates that the project is about 20 percent of the way to its goal.

"We have the technical infrastructure in place, and now we're working with CCAC staff to help them re-engineer the way they do their business, using a common set of software."

"What we're seeing is significant organizational change that will introduce consistency in assessment and treatment right across the Ontario Health Care System for Community Care clients."

Health Technology with Heart: Regionally Accessible Secure Cardiac Health Records (ON)

The University of Ottawa Heart Institute is planning to make the administration of heart complaints run much more smoothly, with the introduction of a new program that enables secure access to cardiac health records to health professionals throughout the Ottawa region.

The Institute is using the Internet to transfer patient health records, and to involve local doctors in follow-up care for heart patients.

About 1.5 million people in Eastern Ontario and Western Quebec use the Heart Institute as a referral centre.

Doctor Tim Cheung speaks for the Institute. He says the new program will take over from the old system of local doctors mailing health records to the heart specialists.

"Often you don't get that information," says Dr, Cheung, "because when they assemble the charts and mail them, there are dribs and drabs of information coming from a variety of areas, and when it comes to the office we can miss a lot of information. And by the time the patient arrives at the Heart Institute to see the cardiologist, we have to redo everything. The patient will probably have to spend another day in Ottawa, it's a complicated and time consuming process."

Using the Internet to track health records will not only get over that old problem of missing files, it is also expected to save on return visits after patients are discharged from the Heart Institute.

"Say you've just had bypass surgery," says Dr. Cheung, "traditionally, you'd have to come back to the heart institute for a follow-up examination about two weeks after your discharge. With the new system, your local doctor can send us your chest x-rays on the Internet, and our specialists can make sure you're healing properly without making you take a long trip to Ottawa."

The cuts on travel not only save the patient time and stress, they also save money. Dr. Cheung estimates that every trip not taken saves about $600 in health care costs. More importantly, says Dr. Cheung, people can get the care they need in their own communities from family doctors they know and trust, while benefiting from specialist expertise. "The whole idea is to bring the specialty to the community," he says, "rather than bringing the patient to the specialty."

The program officially starts in May 2002, with ten hospitals and one clinic taking part. If all goes as planned, the remaining 23 hospitals and clinics will also be linked in after a review at the end of the year.

Connecting for Health: Eastern Ontario Telehealth Network (ON)

A man in his thirties recently arrived at the Pembroke General Hospital with pains in his neck, chest, and shoulder. He was examined and admitted to the intensive care unit. Medical staff recommended that he be referred to a cardiac specialist from the University of Ottawa Heart Institute.

In the past, that would have meant scheduling an appointment for the patient, a potentially lengthy wait in the hospital, and a long trip to the specialist in Ottawa.

On this occasion, the patient only had to wait a day. Using videoconferencing technology, the patient was "seen" remotely by the specialist, who sat in an office hundreds of kilometres away. As a result, the specialist was able to immediately order a Catscan and other tests, which saved the patient time in the diagnostic process. He was also able to determine that the patient's condition was stable, which allowed the patient to return home until a face-to-face consultation could be scheduled with the specialist.

This quick telehealth consultation set the patient's mind at rest sooner and saved him the inconvenience of having to stay in hospital for an extended period, while freeing up valuable hospital resources for other, more critical patients.

This is one of the early success stories of a system that has grown into the Eastern Ontario Telehealth Network (EOTN). With the help of some funding from Health Canada, the network links 16 rural and community hospitals in the region with three consulting sites - the Children's Hospital of Eastern Ontario (CHEO), SCO Health Service, and the University of Ottawa Heart Institute - offering a variety of consultation and education services along the continuum of care, from paediatric to palliative care. It is hoped that this 18-month implementation project will eventually expand its menu of services as partners learn to incorporate telehealth technology into how they deliver and receive health care and ultimately, improve the overall effectiveness of the healthcare system.

The telehealth network was built on a successful pilot program between the University of Ottawa Heart Institute and the Pembroke General Hospital. This specialized telecommunications network allows for the electronic transfer of audio and video information through various peripherals such as cameras, stethoscopes, and other medical devices.

Kathy Crone is the project manager of EOTN. She says that the goal of the project is to facilitate equal access to health care. "We want to break down the distance barrier, to ensure that your access to quality health care is not dependent on where you live."

The network is also being used to enhance the skills of medical staff and other health care professionals in the rural and community hospitals. Through EOTN, they can participate in educational activities such as taking part in the "grand rounds," where a specialist presents an interesting medical case and helps colleagues understand the diagnosis and treatment of that patient.

Changing Habits Through eLearning: eCare (ON)

Few things in life are harder than changing lifelong habits, yet that's what a disease like diabetes demands.

Learning how to manage the disease can be an enormous hurdle to living with it successfully. Failure to follow dietary restrictions or take prescribed medication can lead to serious consequences, including heart disease, blindness, kidney failure or amputation.

St. Elizabeth Health Care's eCare concept began by using Internet technology to help diabetics clear the disease-management hurdle. Better yet, the "anywhere, anytime" system can be customized to the specific needs of each individual.

In one instance, it was a young executive who had recently been diagnosed. A classic 'type-A' personality, he used the eCare service to learn about the disease and how to manage it while maintaining his customary hectic schedule, and peppered the online experts with e-mail questions each evening.

The system meets the needs of more than just those who have recently joined the ranks of the 1.6 million Canadian diabetics.

Another example is a middle-aged woman who was a long-term diabetic. When she began to have problems controlling her blood-sugar level, her doctor recommended a re-education program. But the waiting list is often long for these programs, particularly if you work during the day, so the woman was an ideal candidate for eCare. She completed the re-education program on her own time over two days and the flexibility of the program allowed her to focus on the key issue of blood-sugar control. In addition, the monitoring and trending feature allowed her to continue to keep a close watch on blood-sugar fluctuations and adjust her habits to have better control over her condition. As well, she was able to send this information to her health team and ask them questions. The online support provided a convenient way for her to obtain the information she needed to manage her diabetes.

"This has really improved the clinical outcome for the people who have used eCare," says Shirlee Sharkey, President and CEO of Saint Elizabeth Health Care, a Canadian not-for-profit organization. "It means fewer direct visits and individuals feel very comfortable using the program to help them adjust to the challenges of a chronic disease. It is important to note that people of all ages, including seniors, are welcoming the solution. They are particularly pleased that it helps in taking some of the mystery out of health care.."

eCare was the first generation of what has now evolved to a suite of online health-care services that includes modules such as cardiac care, pain and symptom management and asthma/respiratory care. "We believe the newest addition to this suite, a module for family caregivers, is perhaps the most meaningful. It helps people to be more comfortable and confident in the care they provide, and to maintain their own health and well-being while doing so."

Saint Elizabeth Health Care also has a set of clinical services that complement the modules by supporting health providers with interactive learning packages, an electronic reference library and a virtual exchange involving experts as well as peers.

"These programs are the result of many years of thinking about how Saint Elizabeth Health Care could reach out to people and augment the care and education that's been available in the past. They are a realization of our vision to help people have the supports (tools/information and care) they need in a responsive, customized way, so that they can have greater control of their condition and their relationship with their health providers."

Taking the hospital to the people: Sunnybrook and Women's College Health Sciences Centre (ON)

Sam Marafioti is Vice-President of eHealth at a major teaching hospital in Toronto, the Sunnybrook and Women's College Health Sciences Centre. A few months back, he was also an anxious son, waiting in emergency with his mother, who had slipped into a coma. The staff in emergency had no information about the medications she was on. They turned to her son to see if he might know...

Mr. Marafioti tells this story to illustrate how communications technology could help improve care for patients that use his hospital, or any hospital. Had the staff in emergency that night had access to an electronic history of patients' medications, they could have looked up the comatose woman's information on a computer and avoided the possibly faulty knowledge or incomplete recollections of relatives . This type of electronic record of medication and allergies is one of the technology initiatives being championed by Sunnybrook and Women's.

Another way communications technology is helping improving patient care within Sunnybrook and Women's hospital walls is through "filmless" x-rays which capture the picture in digital format. This means that a doctor can show a patient and their family what is revealed by an x-ray, through a bedside monitor. Nobody has to be moved to a specialised viewing site and everybody can see it at once. What's more, any authorised person involved in treatment of a patient has ready access to the x-ray through Sunnybrook and Women's electronic patient record system accessible from computers across all patient areas of the hospital.

In future, Mr Marafioti hopes to enable the secure sharing of digital x-rays and other patient health information with patients' doctors in their communities too. This will lead to a two-way flow of electronic information, to and from hospitals and other health care facilities, as the patient's information follows them wherever they go. And he believes communications technology can help reach that goal.

Sunnybrook and Women's is also the hub for the NORTH Network, a telehealth network that services Northern Ontario. Fifty-eight hospital sites in smaller communities are linked by digital cameras and other equipment to the main hospital site in Toronto. This allows specialists in areas such as dermatology, orthopaedics, and mental health to "see" patients sitting in a consultation room hundreds of kilometres away. Mr. Marafioti tells of a senior doctor cheerfully announcing one day, "I'm going to see patients in Kirkland Lake, Pickerel Lake, and Timmins - and I'll be back in my office by noon!" Patients value not having to travel far distances and for long periods of time for brief consultation or follow-up visits. The ultimate goal for Mr. Marafioti is access to quality care, regardless of where a patient lives.

"Technology in and of itself does not lead to results," he says. "But it is a key enabler, it has the opportunity to transform health care. We're at the cusp of a new system, now we must move it forward."

Northern Connections: NORTH Network improves healthcare across Ontario (ON)

It's just past midnight as the jangling phone rouses a Toronto neurologist, alerting him to a crisis 300 kilometres away. An elderly woman has passed out in North Bay, Ont., a possible victim of stroke. Within minutes, the neurologist can see the patient on his home computer screen, examine digital images of her brain, and advise the local emergency physician on the best course of treatment.

"The neurologist can look at this information and use it to see whether the patient would be a candidate for clot-busting drugs," explains Dr. Ed Brown, an emergency doctor overseeing this futuristic new application called Tele-stroke. "The objective is to ensure that potential stroke patients, even in faraway parts of the province, can be seen by specialists within three hours." Tele-stroke is the first emergency telehealth service and the newest member of a family of telehealth applications that form part of the Northern Ontario Remote Telecommunications Health (NORTH) Network, an ambitious project that uses technology to bring medical services to First Nations communities, small villages and rural and remote areas.

"What we have is probably the most advanced network of its kind in the world," says Brown, the project's executive director.

While Tele-stroke is still in its pilot stage, the network's other elements have become well established since the network began in 1998. Administered from Sunnybrook and Women's College Health Sciences Centre in Toronto, the NORTH Network now treats more than 300 patients a month and is growing quickly. It offers medical services in about 40 specialities, such as eye and skin care, orthopedic surgery and psychiatry.

The program's goal is to eliminate distance as a barrier to care for people outside major urban centres. Mid-sized cities such as Timmins, Thunder Bay, Sudbury and North Bay also benefit: While establishing them as referral centres for more remote towns, the network also connects them with leading specialists in big hospitals like the Hospital for Sick Children and Sunnybrook & Women's Health and Science Centre.

Linking more than 75 sites in Central and Northern Ontario, the network knits together dozens of institutions, partners such as the Northern Academic Health Science Network and Keewaytinook Okimakanak Tribal Council, and funding sources, including $8.5 million under the Canada Health Infostructure Partnerships Program.

Supported locally by a medical director and a telehealth co-ordinator, NORTH Network sites boast a range of sophisticated tools that are used to collect information about patients and send it to a referral centre for assessment over secure Internet protocol links. For instance, digital instruments monitor heart and breath sounds, peek into ears and throats, capture X-ray and camera images, and take close-ups of the retina of the eye. Video-conferencing technology also allows people to see and talk to each other.

In addition to patient care, the technology helps health professionals toiling in remote areas. Video-conferencing, for instance, allows rural doctors to consult with specialists or participate in continuing education.

"We have huge under-serviced areas in Ontario, with terrible shortages of physicians," Brown notes. "We want people to go up there, and then to stay, and we know that this kind of training and support improves recruitment and retention up North." Brown says patients have also embraced telehealth technology, because they can be treated in their own communities.

"People love the fact that they can get their care at home, and not have to go on a major pilgrimage. It saves time, money and hardship, and avoids a lot of driving through dangerous conditions."

Montreal shows MOXXI: Researchers find better ways to prescribe medications (PQ)

As the consultation draws to a close, the family doctor whips out a pocket-sized computer and begins to tap on the touch-sensitive screen. But this Montreal physician is not scheduling a meeting or checking her e-mail; she's helping her patient get the best possible pharmaceutical therapy.

The colourful little device is part of an "integrated electronic drug management and prescription system" being developed in an innovative research project called MOXXI. The goal, explains project manager Mélodie Faucher, is to make the prescribing, dispensing and use of medications safer and more effective. "At the end of the day, we're after better health outcomes for patients."

MOXXI, which stands for Medical Office of the 21st century, has been operating on the city's West Island since December 2002 with a $2.3-million grant under the Canada Health Infostructure Partnerships Program.

Drug interactions and the inappropriate use of medications take a huge human and economic toll. Adverse drug reactions are believed to cause up to 27 percent of hospitalizations in North America. "There is also the problem caused by illegible prescriptions," Faucher adds, noting some patients may be dispensed incorrect drugs or dosages.

To address these problems, MOXXI, under the direction of chief investigator Dr. Robyn Tamblyn, is equipping up to 40 primary care physicians with "personal digitial assistants." Known as iPAQs, these handheld computers are linked to several dozen community-based pharmacies over a secure wireless network with the data housed at the McGill University Health Centre.

The devices, loaded with software created by MOXXI in consultation with doctors and pharmacists, display constantly updated details on drugs - their uses, interactions and costs. The iPAQs also display the medical histories of patients who have consented to participate in the project, including visits to emergency rooms, hospitalizations, medical services and all medications, no matter who prescribed them.

By combining information on the patient's medical history and potential drug effects, there's less chance a new medication will react badly with other drugs the patient is taking, Faucher says. The doctor can type a prescription right onto the iPAQ. The device posts an alert if there's a chance the selected drug may cause a dangerous reaction in the patient.

The patient gets a paper copy of the prescription while an electronic version is sent to a pharmacy. This eliminates the problem of illegible prescriptions. With the details stored on the pharmacy's computer, it is also easier to change, renew or stop medications. Faucher says the doctors participating MOXXI are pleased with the system's informative and user-friendly features. "We want them to use it and we want other physicians eventually to use it too."

There are also impressive benefits for patients, Faucher says, because the best available information on medications is integrated with more complete patient histories. But MOXXI is, first and foremost, a research project. The 15 main investigators, including university researchers and clinicians, want to make sure that the apparent benefits are actually backed by measurable results - from fewer hospitalizations to better patient health.

Continuous Care: Laval's integrated health information system puts doctors and patients in the driver's seat (PQ)

In Laval, Que., family physicians can now navigate through the health care information system , thanks to an innovative new system linking general practitioners with community clinics, hospitals, diagnostic centres and home care services.

"For patients, the continuum of health care services, in a medical clinic for example, CMV (clinique médicale virtuelle) can be a way," observes Jean Fratelli, who is spearheading a part of the new Système d'information du réseau intégré de Laval, or SI-RIL. "When they get through to the end, we don't want them just dropping off into the void. We want to be sure they know where to go next, and that their progress is being closely monitored by their own doctors."

Modern health care is delivered at so many sites that it's easy for patients to feel lost and discouraged. For example, a person who has just had hip-replacement surgery may need a lengthy sequence of rehabilitative services, home care, and follow-up laboratory and clinical visits. SI-RIL is a computerized information system designed to co-ordinate care across these many sites (SI-PRSA, système d'information de la programmation régionale des services ambulatoires). It smoothes and simplifies the process for patients, while keeping their family doctors informed of their progress.

This translates into better patient care, notes project director Yolaine Lapointe. "The whole thing is designed to ensure the physician has the best and latest information, which enriches the quality of the clinical experience for the patient."

Greater co-ordination also leads to speedier service, Jean Fratelli adds. This reduces nerve-racking waits for patients, while increasing the productivity and the quality of the health care system. "On an individual level, it may not sound like much," he says. "But across a population of 350,000, we can achieve tremendous efficiencies in terms of reduced waiting lists and lower demand on emergency room services."

Supported by $5.5 million in funds under the Canada Health Infostructure Partnerships Program, SI-RIL is a unique project with many layers. A key element was the expansion of a health-care information network, originally designed for hospitals and institutions, to encompass community health and CLSC and medical clinics in Laval (Quebec).

For more than 100 family practitioners associated with these health centres, this new connection means secure access to electronic information about their patients.

Another new feature, known as "request and result," enables family doctors to order lab tests and receive the resulting reports online. This dramatically speeds the process, often to the profound relief of patients. It also decreases the chances that information is lost. The electronic test results form the basis of an electronic health record.

Thanks to SI-RIL, it's also easier for family doctors to plot an appropriate course of treatment for many conditions. The project has developed 85 protocols mapping out the best clinical path to pursue for specific diagnoses. As patients migrate through the process, the network advises the next service provider to expect their arrival.

"SI-RIL aims to reassure every patient, even those with chronic conditions and a frequent need for services, about the quality and the continuity of their care," the project director, Yolaine Lapointe says.

Shared Information Improves Cancer Care: Regional Clinical Oncology Information Highway Project (PQ)

No matter how they are couched, three words -- "You have cancer" -- invariably introduce turmoil, fear and uncertainty into a life. A positive diagnosis puts each cancer patient into the hands of a health care team trained to fulfill specific roles to ensure effective treatment.

For the first-time cancer patient, of course, it's all new. There is baffling terminology to understand, tests and therapies to submit to. Few events in life are as stressful.

A pilot project conducted by the regional health authority of central Quebec and two district hospitals is using digital technology to share information and improve the experience of cancer patients through faster decision-making and decentralized care.

Under the leadership of the Centre hospitalier régional de Trois-Rivières, with collaboration from the Régie régionale de la santé et des services sociaux de la Mauricie et du Centre-du-Québec, the Centre hospitalier du Centre-de-la-Mauricie, the private firm Médisolution and Health Canada, the Regional Clinical Oncology Information Highway Project (RCOIHP) will create a secure electronic health records system that combines data from doctors, hospitals, labs and other community-based services.

Introduced initially for breast cancer patients, the RCOIHP delivers four key benefits: collaborative care management; a systematic framework for faster decision-making; an integrated appointment management system that allows patients to make fewer visits for tests and treatment; and improved records management.

Project manager Yves Desaulniers explains that cancer patients in the central part of Quebec usually are diagnosed in one of the local hospitals and then go to the regional centre in Trois-Rivières for treatment. An integrated electronic health record will allow follow-up appointments to be scheduled at the local hospital. He believes that the new tool will provide more thorough and personalized care for patients.

"The new system will lessen the burden on the patient at a very trying period in her life," he says. "She will know that, regardless of who in the health care network she is seeing, that caregiver has access to her latest electronic file. She doesn't have to worry about the transfer of information from one hospital to the other. Nothing will get missed."

"As well, in one phone call, a patient can make all the necessary arrangements for appointments and tests prescribed by her doctor."

Laboratory results will be sent automatically to the electronic file, eliminating much of the anxiety that comes with waiting for test outcomes.

The project is scheduled to run until June 2003, and Desaulniers says plans are to expand it beyond breast cancer patients once the system is fully operational.

Psychiatry at a Distance: Project Outreach (ON)

Mental health problems such as mood disorders and related issues like substance abuse and suicide know no geographical boundaries. In rural areas, mental health conditions can go untreated, and may, in fact, be exacerbated by isolation.

Telepsychiatry is a natural outgrowth of technology that extends broadband or dial-up videoconferencing to areas that lie outside urban centres. As such, it's also a natural area of expansion for the Hamilton-based St. Joseph's Health Care System, which grew out of the 130-year tradition of caring developed by the founding Sisters of St. Joseph of Hamilton.

Early needs assessment and a cost benefit analysis have demonstrated strategic reasons for an expansion of the network to include connectivity between tertiary care centers and scheduled hospitals to provide not only initial consultations between a care giver and client, but follow-up visits for ongoing care and treatment.

Bringing telepsychiatry services to 40 rural and remote communities -- including 20 First Nations communities -- Project Outreach intends to build on the organization's mission of integrated care for body, mind and spirit.

The project started by creating a video link between residents of under-serviced parts of southwestern Ontario and mental health specialists. It also provides printed materials on mental health and related problems, such as depression and domestic violence.

In addition to partnerships with medical facilities that include those at the Departments of Psychiatry at the University of Western Ontario, McMaster University, University of Ottawa and the University of Toronto, and staff psychiatrists in Hamilton, London, Toronto and Ottawa, Project Outreach uses the resources of the economic development corporation of the Chippewa of the Thames First Nation. It also receives funding from Health Canada.

Reflecting the long-standing shortage of mental health providers working in Aboriginal and other rural and remote communities, Project Outreach is designed to assist those communities take responsibility for mental health services. One major benefit of this approach is the development of local support for residents who would traditionally have to be hospitalized in the city, away from the supportive care of their families.

The project also aims to provide services that reflect the cultural beliefs and practices of the First Nations communities within the network.

To support the clinical, technical and administrative development of the project a secure Psychiatric Outreach Information System will form a database of patient records that will be integrated with a more comprehensive electronic health record.

While Project Outreach will concentrate initially on providing telepsychiatry, plans are in place to expand it to meet other medical needs, including diabetic care and education.

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National Success Stories

Opening the Door to Information: Canadian Health Network (Health Canada)

Despite the dubious nature of many things found on the Internet, people continue to search the Web for answers to health concerns. Over the past decade, Canadians have increasingly asked for access to health information that was both reliable and Canadian.

Funded by Health Canada and committed to providing "health information you can trust", the bilingual Canadian Health Network (CHN) meets both criteria.

Launched in November, 1999, CHN provides links to more than 11,000 Canadian Web-based resources, with in-depth information on 26 key health topics and population groups. The data is catalogued by subject area and can be located through a variety of easy-to-use search options.

"Our goal is to provide reliable health promotion and disease prevention information through one doorway," says Executive Director Susan Margles. "We want to be the first choice for Canadians seeking helpful e-based health information they can trust."

The key to CHN's effectiveness is what lies beyond that door: a core group of collaborators comprised of Canada's major non-profit health organizations. These affiliates -- including the Canadian Cancer Society and the Dietitians of Canada -- select high-quality resources in their specific topic areas and work with other organizations to identify relevant resources for CHN.

Content on CHN focuses on how to stay healthy and prevent disease and injury, but there is also information on societal health issues such as violence prevention, environmental health and workplace safety.

Nutrition is the single most popular subject area, according to respondents to an online survey, with diabetes, fitness and health, and issues related to seniors rounding out the top four.

CHN users -- who are predominantly female, between 35 and 54, across Canada -- give high marks to the service.

The network has more than doubled its audience over the past two years, and Ms. Margles says more feature articles and an improved search engine will attract more users.

Giving Power to the People First Nations and Inuit Health Information System (Health Canada)

"Knowledge," wrote author Alvin Toffler, "is the most democratic source of power." In that regard, the First Nations and Inuit Health Information System (FNIHIS) is well suited as a vehicle to promote self-determination among Canada's Aboriginal communities.

One of two electronic health care service delivery systems established by Health Canada for First Nations and Inuit communities, FNIHIS is designed to be a primary care electronic health record. By providing online access to health information for case management, program planning and health assessment, FNIHIS allows the communities to assume control of their own health programs.

At the end of 2001, FNIHIS was available to 342 communities, with full implementation planned to reach 566 sites by 2005.

Among the communities linked to FNIHIS are Big Cove, a Mi'kmag reserve 60 kilometres north of Moncton, New Brunswick, and some two dozen Ojibway and Cree communities under the administration of the Sioux Lookout First Nations Health Authority (SLFNHA) in Northwestern Ontario.

In Big Cove, where a central health centre treats about 10,000 patients each year, Health Director Claudia Simon believes that FNIHIS helps meet the goal of giving people more control over their own health. She says the system benefits both health care providers and clients by providing a comprehensive and integrated information and retrieval framework. FNIHIS improves record keeping and makes diagnoses more reliable. Reports are more accurate, and scheduling follow-up appointments is easier.

"Delivering professional services to our client base is what we're all about," says Simon. "(With FNIHIS) our teamwork has improved and our productivity is up, since we can now plan more accurately and serve our clients more effectively."

In the large area administered by the SLFNHA, FNIHIS is combined with a tuberculosis control program to help local chiefs and their tribal councils evaluate programs and plans. Data flows into the system from sources including hospitals, community health facilities, correctional facilities, schools, social agencies and provincial health units, and reports can be generated in formats that give local officials the information they need to create a health profile of their clients.

In the view of SLFNHA officials, the system is a means of ensuring that "community data makes its way back home."

FNIHIS currently encompasses 12 sub-systems that deal with health subjects including immunization, tests/exams, medication allergy and adverse reactions, abuse, public health education and mortality. Enhancements to the system will allow community health providers like those in Big Cove and Sioux Lookout to address additional health priorities like addictions, home and community care, and diabetes.

Getting the Jump on Disease: Global Public Health Intelligence Network (Health Canada/World Health Organization)

Ebola, HIV, West Nile Virus. The rise of deadly infectious diseases is a frightening spectre in this era of increased human mobility.

But, it's not just new diseases that pose a threat; the rapid adaptation of micro-organisms and the evolution of anti-microbial resistance have given new life to diseases thought to be eradicated or, at least, held in check. Yellow fever, malaria and cholera have all made reappearances in the West after decades of inactivity.

In the past decade, the World Health Organization (WHO) has placed a growing emphasis on developing surveillance systems to signal a warning about the spread of disease in the hope of heading off a major occurrence.

In industrialized countries, where communicable disease mortality has decreased significantly over the past century, the concern is preventing diseases from entering and causing an outbreak or re-emergence. In developing nations, the concern is detecting communicable disease outbreaks early and arresting their mortality, spread and potential impact on trade and tourism.

One of the tools used is a Canadian development called the Global Public Health Intelligence Network (GPHIN), the result of collaboration between WHO and Health Canada.

GPHIN uses the same principle as Google and other Internet-based search engines to 'crawl' through databases and Web sites looking for local news articles about disease outbreaks.

"It's a simple concept, and perhaps that's why no one thought of it earlier," says Health Canada's Dr. Greg Sherman. "GPHIN looks for informal sources of information which it extracts for analysis by subject matter experts."

Relevant information goes into a database, to which WHO, the United States Centers for Disease Control and Prevention, and the United States Armed Forces Medical Intelligence Center subscribe.

In use by WHO since 1998, GPHIN is now the organization's leading indicator of disease occurrences around the world.

"Right now, GPHIN is providing about 70 percent of the global intelligence on communicable diseases," says Sherman.

Its effectiveness stands to get even better as further improvements are made to the Web crawling technology that parses news articles for key language.

Giving Public Health a Sense of Place: Spatial Public Health Information Network Exchange (Health Canada)

Tracking epidemiological situations - whether they are an outbreak of a disease or a water purity issue like Walkerton - can be like solving a crime. Fitting the "clues" together is critical.

"The classic epidemiology triad is person, time and place," says Dr. Greg Sherman, Director of Infostructure Development for Health Canada. "Unfortunately, place has never been very well addressed."

Not until the advent of the Spatial Public Health Information Network Exchange (SPHINX), that is. Using geographic information systems (GIS) technology, SPHINX can help health officials make better diagnoses and more informed decisions.

"It's a groundbreaking spatial tool for frontline workers in a field where time is always of the essence," says Sherman.

Jointly developed, beginning in 1995, by Health Canada and the Province of Alberta, SPHINX is now in use by all of Alberta's regional health units and is under the sole control of the province.

The power of GIS lies in the ability of computer software to generate graphical representations of various situations using massive sets of data, including census information, geographical features and the location of buildings, roads and other physical infrastructure features. GIS allows health workers to examine and analyze health effects and environmental determinants by layering on maps that represent such elements as population demographics, political and administrative boundaries or various environmental factors.

"When you need to interpret information quickly it's important that you can examine the situation in a way that makes sense to you, and SPHINX allows people to visualize things in a very intelligible fashion. So, not only is the information available faster, it's more meaningful.

"Most health situations can be expressed as a relationship between a person, their lifestyle and the environment in which they live. Looking at those elements allows you to track causal relationships and predict risk, and the more information you have - including different ways of looking at the information - the faster you can understand a situation. SPHINX gives the practitioner a much great understanding of place in the relationship."

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Success Stories From Northern Canada

Bridging the Gap: IIU Network (NU)

When you're young, fitting in is everything. No one wants to stand out from the crowd, least of all because of unusual appearance.

Imagine then, the plight of a young girl living in the remote hamlet of Cape Dorset, on Baffin Island, rendered bald by alopecia. Social workers weren't surprised she was 'acting out'. Funds were available to pay for a wig, but not to fly the girl and an escort to a southern wigmaker for consultation and fittings.

Fortunately, a new telehealth project that reaches more than half of Nunavut's population has made these kinds of services much more accessible in the remote regions of Canada's North. Using Anik-F1 satellite technology, the girl was able to discuss her needs with a wigmaker in Ottawa. When the finished product arrived in Cape Dorset, it was a perfect fit.

The case illustrates the flexibility the Ikajuruti Inungnik Ungasiktumi (IIU) Network will bring to the 15 sites it will reach by April 2003.

"This is a Nunavut-driven project," says spokesperson Tina McKinnon. "Each community has its own unique needs. We learned a lot of lessons during the planning process and applied them to the strategy for IIU."

The range of services offered includes telepsychiatry, teleradiology, dermatology, cardiology and prenatal counseling. The profile of each community will help determine where the emphasis is placed.

Three telehealth coordinators work with the communities to develop procedures and train local health personnel to use the equipment.

"What IIU gives these local health workers is another tool," says McKinnon. "Access to care is an issue for Nunavummiut and for many Canadians living in remote and rural areas. Our goal is to is augment the resources these people already have and bridge the gap between health care in the North and South."

One other benefit of IIU, she adds, is the feeling of collegiality it brings to Arctic health care providers.

"It fosters interaction by putting them online with a doctor at the Children's Hospital of Eastern Ontario or elsewhere. Now, a caregiver in the one of our remote communities can discuss modes of treatment with a practitioner just as though they were in the same room." After the 15 sites are up and running, the program will be evaluated in preparation for the possible expansion of the network to the balance of the communities in other parts of Nunavut.

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Success Stories From Western Canada

Cure for the Common Mistake: Alberta's Seniors Drug Profile

The Alberta senior citizen had gone too far this time in his belligerent behaviour, so far that he was in danger of losing his place at the seniors' residence. And he may well have lost his place, if it were not for the curiosity of a home care nurse, and Alberta's Seniors Drug Profile.

Staff at the seniors residence told the nurse that the senior had been prescribed drugs to help curb his aggressive behaviour, and for a time they had worked. Staff assumed the effect must have worn off. The nurse asked the senior if it was okay for her to access his record of past medications. The electronic record showed that indeed the man had a prescription, but hadn't filled it for some time. When asked about that by the nurse, the man told her that when he asked for his "nerve pills" at his regular pharmacy, the pharmacist refused to give him any. Another look at the electronic record revealed the problem. The first time the man had filled his prescription he had gone to a different pharmacy, so of course his regular pharmacy had no record of the prescription.

After the nurse explained what had happened, the prescription was transferred and filled. The senior's behaviour improved, and he didn't have to leave the residence.

That's only one of the stories of how the Seniors Drug Profile has helped people since its inception in 1999. Doug Stich, program coordinator for the Pharmaceutical Information Network, knows many more such stories. "People will say 'I'm on a pink pill for my heart' or 'I'm on a pink pill for my kidneys'" says Mr. Stich. "That's not accurate enough to help diagnose whether the medication may be having side effects, or to identify possible conflicts between different types of medication." The problem is particularly marked among seniors, he adds, although the reason the program is presently limited to seniors is because they are the only clearly defined group covered by the province's drug benefit plan.

The Seniors Drug Profile, run by Alberta's Department of Health and Wellness, takes the guesswork out of prescribing medications for seniors who agree to be part of the program. The electronic record includes information on what was prescribed and when, which pharmacy filled the prescription, and the prescribing doctor. As a further privacy safeguard, it can only be accessed with the consent of the patient.

Medications are a crucial aspect of therapy, says Mr Stich. "If you go to an emergency room, if you're in a hospital or in almost any kind of medical setting, the first question you'll be asked is 'what medications are you on?' All too often, people are either unable to answer that question, or are unable to answer it accurately."

Mr. Stich says there are now 3,600 health care professionals using the program, generating about 60,000 information requests a year.

Regional Emergency Department Information System (Alberta)

Frenetically paced, intense and unpredictable -- emergency department medicine demands the best from those who practise it. Critical, life-affecting decisions must be made throughout every shift, and information-sharing is essential to ensure that those who need assistance most get it first.

The concept of triage is one of the oldest in medicine, and the fluidity the concept enforces on an emergency department, or ED, presents one of the biggest organizational challenges. The status of life on the ward is only as current as last ambulance arrival, and everything can change, literally, in a heartbeat.

In the Calgary Health Region, a new electronic triage and patient status/tracking system has altered the way information is shared in the ED's of four hospitals -- three adult facilities and a children's institution -- that serve a population of more than one million.

"Traditionally, all the information about the state of the ED has been displayed on a whiteboard at the triage nurse's station," says Kim Jessen, a 15-year veteran nurse. "It registered the patient's name, their presenting complaints, their current priority and physician assignments."

The new Regional Emergency Department Information System (REDIS) decentralizes that information to computers located throughout the ED and adds significant new features and functionality.

"Now, authorized people in the ED can see more information," says Duane Martin, the REDIS IT Project Manager. "They see each patient's full complaint in detail, comments that have been added, vital signs and medication that has been given. Icons allow staff to get an instantaneous view of the situation. It's a significant improvement in communication between the caregivers."

"The triage nurse can see the entire situation on the ward -- which rooms are occupied and how many people are waiting to be seen -- and each physician can see the status of their patients and who they need to see next."

"Perhaps best of all is the way the system reflects the fluidity of the ED. When a new patient is given priority, the system automatically bumps everyone else, reshuffles the complete presentation and is visible throughout the whole department."

The fact that the new system so accurately reflects life in the ED is no accident; rather, it's the reflection of the intensive planning the REDIS team applied to the project.

"I basically lived in the ED for three months," says Joanne Bouma RN MN, whose job it was to determine how the supplied software needed to be customized to deliver superb results. "The system had to fit the business perfectly. You can't do enough preparation for a transition like this. We involved the ED staff in every step of the planning, and it paid off: some staff reported they felt they more were productive using the new system during their very first shift."

The implementation team has trained over 800 personnel to use the system, and a user group is in place to provide feedback and suggest improvements.

"Every previous system that has been introduced in my 15 years in the ED has meant that staff has had to change the way they work," says Jessen. "This system was completely adapted to us."

In addition to providing more information on the ward, REDIS will introduce significant efficiencies in the preparation of reports, and will allow administrators to study trends and allocate resources more effectively.

Future enhancements to REDIS will include lab and diagnostic imaging results reporting, order entry for tests, improved communication with Family Physicians and information from the system will be added to a larger database of patient information.

Shrinking the Wide West: Alberta Telehealth

How Telehealth Stopped the Teasing

In Northern Alberta, there's a community called Fort Chipewyan, an old fur-trading post that is now home to a few hundred people. In terms of travel, it's hardly more accessible now than it was in the old fur trading days. But a lack of roads has not stopped the hand of modern medical technology from reaching in and making a difference to the life of one little girl.

To respect her privacy, we can't name her, but for the sake of convenience, we'll call her Linda.

Linda had a problem, not a life-threatening problem, but a spirit-crushing problem. When she began to talk, Linda developed a very pronounced lisp. By the time she hit school, Linda had not grown out of the lisp. Every day, in school, the teasing would start about Linda's speech impediment.

Her parents could not afford to send her hundreds of kilometres away for speech therapy, and the specialty is not offered locally. That's where Alberta's new telehealth program came in. The program started in 1998 with provincial money and $14 million from an anonymous donor. It provides video-conferencing links for diagnosis and treatment, and for health training and administration.

For Linda, the link was a lifeline. She was given six speech therapy sessions by videoconference, and they were successful in decreasing the lisp. Dr. Trevor Cradduck, a spokesperson for Alberta Telehealth, picks up the story. "I was told by a nurse in the community that several days after the therapy, the little girl ran up and told her how nice it was not to be teased at school any more. Apparently, after that, the girl's grades went up, and she just generally got more self-confidence."

That's just one example of the thousands of times that Telehealth has overcome Alberta's vast distances to make a difference. Dr. Cradduck says a common use of the system is for ultrasound scans for expectant mothers. Diagnostic tools such as ultrasound can plug in to the system, allowing a specialist hundreds of kilometres away to check on the health of mother and baby. That saves the mother, and often another family member, from having to take a day off work to travel to a larger centre.

The system is now growing by leaps and bounds. Dr. Cradduck expects there will be 200 sites linked in by the end of the year, up from the current 75. Linda's home community, Fort Chipewyan was a pilot site for First Nations communities. They were so impressed with the results, that a total of 23 first nations sites are slated to be connected to the Telehealth system by the end of 2002.

Finding Help Fast in Alberta: informCalgary

Everybody knows the problem - you know what you need but you have no idea of where to go to find it. Following a hunch, you phone one agency only to find out that the receptionist has never heard of the service and doesn't know where you should go next, but you might try this number...and so begins an endless round of referrals from one agency to the next, until finally you get connected with the service you were looking for.

This process is bad enough, but when it is a more urgent health or social service need, the situation can be desperate. It occurred to some people in Calgary that a web site and web-based service directory might be the ideal tools for cutting through some of this clutter, giving people a single place to go for information on health and social services. The "informcalgary" directory now lists thousands of services offered by both government and non-government organizations.

Sharon Nettleton, Project Manager at the Calgary Health Region, says the collaborative project between the City of Calgary and the Health Region has benefited both organizations, and most importantly the city's residents. "By doing this together the information is much more extensive and comprehensive. Because it's on-line we're better able to keep the information current. There's less duplication and a greater awareness and interest in our community of going 'on-line' to find information," says Ms. Nettleton.

One of the features of the site is its sophisticated search engine that helps people narrow down what they're looking for in a variety of ways. As Ms. Nettleton explains, you can search for services by the usual keyword method, but also by location, hours of operation, language, and accessibility. This enables people to find the service that's best for them.

According to Ms. Nettleton, about 65% of Calgarians have access to the Internet, and looking for health information is one of the most common uses, so the site is definitely filling a need. Another part of the project is designed to bring the directory to those who don't have access to the Internet. It plans to put computer access in places such as homeless shelters, and to offer access to the directory by phone. Nettleton says the idea is to create access for those people most at risk.

Ms. Nettleton says the Calgary team wants to bring the advantages of the system to others. Already it has shared the architecture with Ontario's Ministry of Health and Long-Term Care for use among its 42 Community Care Access Centres. "Trying to create the connectivity that enables people to access information locally, provincially, and nationally has always been part of our vision" she says. There is great interest from other communities in Alberta, and outside the province. The Calgary partners are working closely with an organization called "Inform Canada" to create a national information system, linking similar information systems and services across the country. To get a glimpse of that future right now, look up the Calgary site at www.informcalgary.org.

Cutting through the billing clutter: Teleplan Upgrade Project (BC)

Billing can be a sore point for doctors, especially when there are delays in payment or queries on bills they submit. A new web-based billing system in BC is now in place to help soothe that sore point.

The Teleplan Upgrade Project is spearheaded by the BC Ministry of Health. Rob Holloway, senior business consultant for the ministry's Medical Service Plan, says the project is "to find a way out of a twelve year old system." The current system worked very well over the years, allowing doctors at 4,000 sites across BC to submit their billing information electronically, at a rate of six to seven million claims every month.

Mr. Holloway says difficulties have been arising because the original communications software that ran the system is having problems adapting to the variety of new computer operating systems. "A doctor with a brand new computer who's never known DOS in their life is faced with us saying, you've got to make a DOS icon, you've got to install this DOS software, then you have to do a little marriage of the modem card and the comm port, what interrupt do you want to use...You're talking to someone who's trained medically, computers are not their bailiwick, they just want to get their job done."

It had got to the point where the technology was getting in the way, says Mr. Holloway, "Our job was to get the technology out of the way."

The solution was to put the whole system on the internet, an option that wasn't available 12 years ago. That means the age or operating system of a doctor's computer doesn't matter, as long as it is capable of connecting to the internet. It also means that if the doctor's computer is hooked up to one of the new high speed connections, it can process all of the billing information much faster than was previously possible.

Short of a complete revolution in computer technology, Mr. Holloway says the new web-based system should be able to handle any advances that computer and software designers throw at it. "This means we're no longer dependent on third parties," he says. "It doesn't matter what system doctors are using, they can quickly get access to the billing information they need."

In at the deep end - creating an electronic information pool: Integrated Community Health Information System (BC)

Imagine you are a doctor trying to put together a picture of previous treatment your patient has received. Now imagine how difficult that would be if all the records of previous treatments were in different languages.

That is the problem faced by Brian Shorter, Chief Information Officer for the Vancouver Island Health Authority. Only, the different languages he has to decode and disentangle are different technologies and software used by different former health authorities on the Island. Embedded within the tangle of information are patient records that could be used by doctors to better diagnose and treat people.

The health authority now has what Mr. Shorter describes as a partial electronic record in a central system. He says they are currently in a pilot mode, driving the information out to doctors. "It's not just patient information," he adds. "It's knowledge-based information. The physician will not only be told what the current lab test results are for a patient, but if that lab test was influenced by pharmaceuticals. We drive out a complete pharmaceutical knowledge base to the provider."

Mr Shorter says patients should begin to notice that their community health nurses and physicians seem better informed about the patients' care history. He says they should also be able to escape the irritation of having to fill out multiple forms.

"Maybe the biggest thing they would notice is not being asked to give the same old demographic information to each therapist, nurse, physician, meals on wheels workers and so on - so they should notice a dramatic reduction in some of the senseless administrative overhead to the care process."

Despite only being in the early stages of implementation, the project is already beginning to pay off. Mr Shorter says a person was recently admitted to an emergency room, obviously in intense difficulties. The patient's first language wasn't English - all that could be got from them was a name. By putting that name into the system, it was discovered that the person had been in another emergency room a week earlier, and a diagnosis was speedily made, without subjecting the patient to a battery of tests.

A full electronic health record is estimated to take another three and half years. In the mean time, the health authority is pushing the information out to even more of the people who could use it to help their clients; not just doctors, but also home care nurses, staff at community health centre, even to street social workers. As Mr. Shorter explains the health authority's vision, "Wherever the consumer comes into contact with the health-care system, we need to be there to ensure the providers have the information."

Online Delivery makes Training more Accessible throughout the Province: Paramedic Training Network (BC)

Surveys show that most employees value continuous job-related training more than almost any other factor, including compensation. For paramedics, job-based learning isn't just a perk; it's a necessity.

In British Columbia, that fact has been an expensive reality, as paramedics from around the province had to travel to Vancouver for ongoing skills advancement and re-certification every five years.

Now, the Paramedic Training Network (PTN) operated by the Justice Institute of British Columbia is keeping paramedics on the job and in their communities with a combination of on-line courses and practical training that's available at some 15 locations throughout the province.

"The online training we provide gives each paramedic more control over their own learning experience," says PTN program director Glenn Hocking. "They can choose their own course dates, do their online training at any time of the day and create their own training plan."

In addition to the on-line independent study, paramedics can attend traditional classroom sessions, which are held at local facilities, take clinical training through a placement in a regional hospital, and get hands-on training by working in an ambulance under the supervision of a preceptor.

"Our goal with the on-line independent study was to reduced the need for face-to-face classroom work by about 40 percent."

The programs are designed with interactive components, which allow participants to exchange information with trainers. Courses include a combination of exercises, assignments, readings and multimedia presentations designed to promote critical thinking in crisis situations.

The courses offered cover a gamut of paramedic skills, ranging from basic cardiac and trauma protocols, drug administration and IV maintenance.

In addition to the expected increase in skill levels among the province's paramedics, the PTN has yielded some other bonuses, says Hocking.

"Doing clinical training placements in regional institutions has allowed paramedics to build closer ties within their own medical communities."

What's more, the new approach to training has resulted in improved life skills such as typing, computer skills, and enhanced research capabilities.

Women and Children First: BC Telehealth network improves maternal and child health care across the province (BC)

British Columbia is using new telehealth technology to improve care for children and their families in under-serviced areas of the province. Through Telehealth technology patients receive timely access to health care services that would not otherwise be possible. For example, a pregnant woman that has a possible problem identified on her fetal ultrasound image can seek the opinion of a perinatologist (a specialist in managing high-risk pregnancies) and not have to travel 600 or more miles for that consultation.

"British Columbia is a large and diverse province with a significant rural and remote population where access to clinical services can be expensive and time consuming for patients and their families," explains David Babiuk, who oversees the Provincial Health Services Authority's BC Telehealth program. "Telehealth applications can improve their access to quality care, while allowing them to remain in their home communities."

BC Telehealth is a secure electronic network that lets specialists at three Vancouver hospitals and a pediatric hospice conduct virtual consultations with patients in 12 communities, from Invermere and Fernie in the southeast to Prince Rupert and Kitimat in the northwest. The system uses real-time two-way videoconferencing technology, along with an assortment of accessories. For instance, a Vancouver specialist can examine an injury by directing the health worker in the distant community to use a hand-held camera to deliver a close-up image of an injury.

Telehealth co-ordinator Valerie Ashworth says the technology can help ease patients' suffering and anxiety by letting them stay in the familiar surroundings of home. She tells the story of a pregnant woman from a remote northern community, whose blood tests hinted at problems with her developing fetus.

"The indications were that she might be in a difficult situation, facing some very tough decisions," Ashworth recalls. "She had to consult quickly with a medical geneticist." The telehealth consultation was arranged with a specialist at Vancouver's Children's and Women's Health Centre, who was able to counsel the woman and her family about the meaning of the blood screen and the consequences for the pregnancy.

The physician observed that, by sparing the woman an eight-hour drive to the big city, "she was more relaxed in her home environment and better able to receive and process complex information, and make her decision," Ashworth says.

The BC Telehealth network, supported by $3 million from the Canada Health Infostructure Partnerships Program, was launched in the Fall of 2001 and is still evolving.

Most applications so far relate to maternal fetal and pediatric medicine. These include obstetrics, nutrition counseling, oncology, neonatology, the care of newborns, cardiology, medical genetics, child development and rehabilitation. Videoconferencing with Canuck Place Hospice also helps families and health professionals care for dying children in their own communities or by allowing children in the hospice to talk to family back home.

Vancouver General Hospital is using the same videoconferencing technology to treat emergency and trauma patients in Cranbrook and Terrace and as a distance learning tool, it allows doctors and nurses in rural and remote communities to tap into the expertise housed at the University of British Columbia's medical school.

Telehealth consultations are especially useful for follow-up consultations, Babiuk says. Extensive travel for a brief medical visit costs time, money and personal inconvenience. It can also be dangerous, he says, recounting the story of a man killed in a car accident on the way to a routine follow-up appointment.

"The physician never really got over that," he says.

X-Ray Vision: Tele-imaging network improves diagnostics in Central British Columbia and Yukon (BC)

The little boy from Williams Lake, B.C. was in pain and unable to move his arm, but the local doctor couldn't see a fracture. With the press of a button, a digital X-ray image of the arm was flashed to Kamloops, where specialists were able to spot a hairline fracture that put a bone out of alignment.

"The child came down here that afternoon and the orthopedist operated on him right away to correct the displacement," recalls Dr. Jim Bilbey, the chief radiologist at the Royal Inland Hospital in Kamloops. Without the computerized image and long-distance consultation, the five-year-old would have been sent home while his condition worsened.

"We saved him at least two or three extra days of pain," Bilbey says, "and he had a much better outcome."

The case underscores the value of a leading-edge distance imaging system that now spans a dozen sites in Central British Columbia and Whitehorse. Known as the Central BC-Yukon Telemedicine Initiative, it is supported with $2.5 million in Canada Health Infostructure Partnerships Program funding.

The system allows for the collection, in digital format, of a range of image types, including X-rays, and ultrasound, CT and MRI scans. These pictures become part of the patient's electronic health record, accessible to doctors with a mere mouse click.

The scans can also be instantly transmitted over a secure network, which links sites as small as Lytton (population 345) to a referral hospital in Kamloops. There, doctors can call the images up, share them simultaneously with physicians in other locales, or store them in computerized archives.

Project manager Roy Southby notes that the technology saves on the cost of X-ray films and developing chemicals - a boon for the environment as well. It also comes with useful add-ons, such as the ability to measure and magnify an ailing part, or render a three-dimensional image.

"Röntgen invented the X-ray in 1895, and nothing changed in the field until just the last few years. Now we're finally moving into the digital age," he says.

For Bilbey, the system spells improved patient care. Even in remote areas, patients are able to get speedy specialist attention - without the need to leave their communities. Moreover, he says, the superior image quality and handy enhancement functions improve the accuracy of diagnoses.

Digital imaging is a perk for doctors as well. "It makes radiology very interesting," Bilbey says. "Radiologists tend to like that high-tech stuff, like cross-sectional imaging. We see it as a major advance on the technological side."

Expansion plans for the network are already underway. General practitioners, like their hospital-based counterparts, will be given access to the images. The network will also grow to include other health regions in the interior of British Columbia, as well as other diagnostic procedures such as mammography.

Health technology erasing provincial barriers: Provider Registry (Western Health Information Collabortive)

It is a relatively small western Canadian project on health information technology, but it has the potential to have huge implications for the future delivery of health care across the country. The project is officially known as the Western Health Information Collaborative (WHIC) Provider Registry Project.

Provider Registry is being led by the BC Ministry of Health Services. Chris Schrader is the Project Director. He says the project is currently building an electronic registry of doctors and other health care providers across the four western provinces. This information will be standardized, so that each province can share the data electronically across provincial boundaries. Mr Schrader says it is a first step to creating a complete electronic health record (EHR), one that will provide information to authorized personnel regarding doctors and patients, diagnoses and treatments, allowing future encounters between a patient and the health care system to be simpler and more efficient.

While Mr. Schrader is enthusiastic about the end point of the project, he's even more excited about the route taken to get there. "There's a whole other benefit from this project - it's the first project of its kind in Canada that I'm aware of where multiple provinces are working together to create one common application to be shared. That to me is huge; we're pioneering all sorts of concepts around collaboration. What's interesting is how we're erasing provincial borders to act as one."

The registry of health care providers already hints at some of the possibilities for future co-operation. Although he stresses that there are no firm plans in this direction, Mr. Schrader says it is possible that the registry could lead to such things as the sharing of specialist services between jurisdictions. Also, the Provider Registry contains a unique identifier for providers which will be useful in other disciplines such as health human resource planning.

Apart from its future potential, the project is already laying essential groundwork for the rest of the collaborative venture to create a complete electronic health record. "It enables the Electronic Health Record to take shape," explains Mr. Schrader. "You can't go out and buy a fleet of trucks unless you've got the highways to drive them on. Now there's not a whole lot of glory in building highways, but somebody's got to do it, and it's got to be in place so you can drive these new trucks down the road."

The four provinces involved in the project are meeting to agree on the next steps for the EHR. They will focus next on standardizing an electronic process for ordering and receiving lab tests.

And while this initiative is so far limited to the western provinces, Mr. Schrader travelled across the country last year, talking to other provinces about the benefits of joining together to create fundamental pieces needed for the electronic health record.

Technology makes sense of mental health: SYNAPSE (BC)

The person who jumped off an Edmonton parkade, it was later discovered, had been seen by various mental health agencies about 20 times in the previous weeks. Each time was like a new visit. The health professionals involved had no idea that this was a chronic case headed toward tragedy.

A new tool developed in British Columbia is helping to ensure that cases such as the Edmonton suicide are becoming more rare. Developed over the past 2 years, the "SYNAPSE multi-jurisdictional mental health information system" is a lengthy term for a simple idea. The system allows the sharing of mental health records among authorized clinicians in hospitals, community mental health centres, and residential facilities, both within and between health regions.

Project Director Mike Nusbaum explains how it works. "Say a patient in need of mental health treatment comes in. If I'm an authorized health care professional with the system available, I just log on and start searching for the person. There are many ways to search, by name, by health care number. Even if I only have one name, and I think the person looks about 40 years old, I can enter "Bob, about 40", and the system will search for a match. If I find this person has "touched" the mental health system before, I can look at previous clinical data to help treat the person, then document the treatment I've given, which will then help the next person who encounters this patient."

The SYNAPSE system enables better, more targeted treatment for mental health, and allows better use of mental health resources, says Mr. Nusbaum. Because records are shared, an inpatient in a psychiatric unit of a hospital can also participate in a program offered at a community health centre nearby, and all the clinicians involved in the treatment of that person can monitor the patient's progress. We call this the "virtual team" approach, says Mr. Nusbaum.

Information entered into the SYNAPSE system is targeted primarily for direct care of mental health patients and clients, but can also be used for management purposes. Health care managers can track what sort of problems people are coming in with, where they're going for treatment, and what types of treatments are given. That allows them to see trends and allocate resources more efficiently.

Mr. Nusbaum says another major objective of the system is the standardization of data, technology, and security policies, which would enable a jurisdiction in one part of the country to understand and use patient information from another jurisdiction.

At the moment, the SYNAPSE system is in place in a number of health regions in British Columbia, but Mr. Nusbaum says there is currently interest from five other provinces. His ultimate vision is to see a system of standards for mental health care that covers the whole country, providing more effective, more responsive, and more efficient care.

Overcoming Isolation: MB Telehealth Network

Canada's vast size always hits home when you realize there are communities well south of the Arctic where isolation is a fact of life. Manitoba's Leaf Rapids is a prime example.

A mining community northwest of Thompson, Leaf Rapids has no reliable landline telephone service and depends on satellite access. Seeking medical assistance can be costly and time-consuming since specialized -- and sometimes basic -- medical care is only available in large centres such as Winnipeg, where 70 percent of the province's specialists practise.

Proximity to the capital doesn't always make a difference.

Although Berens River is closer to Winnipeg the remote First Nations community can be reached only by plane or by winter roads. Diabetes is a major health issue, and inhabitants rely on resources outside their community for information about the disease. The community has also faced challenges acquiring and retaining local medical staff, forcing people there to rely more heavily on the ability to access external resources.

Faced with these realities, the advent of a new network to deliver telehealth services and distance medical learning via broadband videoconferencing amounts to a revolution.

Under the leadership of the Winnipeg Regional Health Authority in conjunction with a number of partners, the MBTelehealth Network will bring telemedicine to 20 remote communities, including seven in the extreme north.

"All the communities will get videoconferencing as the basic service," says Yvonne Hopper, Senior Business Analyst for Manitoba Health's Information Services. "From there, the specific services that are provided will be tailored according to a needs assessment developed by the community in conjunction with MBTelehealth."

Among those services identified by various communities are counseling for Fetal Alcohol Syndrome and pediatric care, diabetic self-management, dermatology, mental health and diagnostic imaging. Sixteen sites were in place in early 2002, with completion of the installation scheduled for March 2003.

"The various site managers are very excited about this, and it promises to bring added benefits to the community such as creating and maintaining skilled jobs."

To ensure the project's long-term benefits, a telemedicine centre of excellence will be established to develop policy guidelines, oversee clinical and technical training programs and evaluate the project.

Partnering On the Prairies: Brandon Regional Health Authority

Community cooperation has been an important part of life in Manitoba since the province's founding. Today, a new type of cooperation - between as many as five regions and several types of care facilities - in the southwest corner of the Keystone Province is changing the way health care is delivered.

The unique approach to partnerships followed by the Brandon Regional Health Authority (RHA) was cited when its integrated health information network won in the inaugural Smart Winnipeg Awards competition. The award highlighted the project's ability to reach out to those outside its own backyard. "The Brandon Regional Health Centre must be constantly aware that its partners and clients are beyond the regional boundaries," stated the award citation.

"Partnering is definitely an important factor in what we've accomplished to this point," says Brian Schoonbaert, Brandon RHA's Vice-President of Finance and Information Systems.

While Brandon itself has one 320-bed hospital and a population of about 50,000, the Brandon RHA encompasses more than 120,000 people in and around the communities of Souris, Carberry, Minnedosa and Neepawa.

"A lot of our clients come from out of town," says Schoonbaert, "so it's very important for us to find ways to reduce travel and cut down on the duplication of tests that often occurs when a patient deals with more than one facility. Integration is extremely important to us and information is the real driver in this project."

Already in place are: an integrated lab system; central patient scheduling; diagnostic imaging; automated patient record system; and admission, discharge, transfer/central patient index. Planned for implementation by 2004 are more systems, including: electronic charting; automated medication distribution; and picturing archiving and communication.

"One of the real benefits of building this type of electronic health record is that it gives you much complete patient data to work with. In the future, caregivers will be able to slice and dice the information as they need it. Traditionally, there has been very little ambulatory care information on patient charts. We're moving toward a system that follows Manitobans from womb to tomb."

"What we're doing is building a better tool that will help caregivers do their job more efficiently and with fewer errors. The result will be shorter hospital stays for patients and improved safety throughout the system."

Prescription for Safety: Drug Programs Information Network (MB)

It's a scenario that concerns many people with senior relatives: adverse drug reactions from mixing medications.

While there's little that can be done to prevent people of any age from self-medicating, the pharmacist is the first line of defense against use of prescribed drugs that will offset each other or lead to health complications.

Among other benefits, Manitoba's Drug Programs Information Network (DPIN) gives pharmacists at 300 stores throughout the province the background they need to advise customers about potential dangers. Administered by the province, and voluntary for both pharmacists and residents, DPIN gives the pharmacist immediate access to a customer's history of prescription drug use. Customers simply provide a nine-digit personal health identification number when they submit their prescription.

"This clearly enhances the professional practice of the pharmacist," says Olaf Koester, Director of Manitoba's Provincial Drug Programs. "In the past some Pharmacists have provided this kind of advice based on their own knowledge of the customer, but the DPIN formalizes it and improves the efficiency of the whole system."

In addition to helping prevent dangerous drug mixtures, the DPIN introduces significant efficiencies into the system of drug claim adjudication and payment.

"All claims were handled manually before this network was implemented, and claimants had to pay up front and await a cheque. Now, all the adjustments are made online, which eliminates a huge administrative burden for us. We've been able to transfer staff to other functions."

The DPIN also adds another layer of protection against prescription drug abuse and fraud.

A related system - DPIN-ER - connects the emergency rooms of 81 hospitals, allowing ER personnel to access the drug history of those in the DPIN database. When a patient seeks treatment or is being admitted, authorized staff can use the database to collect background information that can help them make informed decisions.

Developing doctor-friendly technology: Integrated Provider Solutions (SK)

Doctor Bill Haver's fascination with the medical potential of computer technology began in the mid 1980's, when he was trying to decipher a colleague's medical charts. "One of our initial motivations was to be able to read a chart," says Dr. Haver. "Just to understand the information that was there, and not some hieroglyphics and abbreviations provided by the previous physician."

From that desire to develop an electronic system for medical charts, Dr. Haver has become one of the chief practitioners of using computers to help doctors do their job better and more efficiently. Since the mid 1980's, all of the physicians in Dr. Haver's Saskatoon practice have kept their medical charts on computers. What's more, they have phased in computer use in other aspects of the practice too. Correspondence, billing, scheduling, even ordering and receiving lab tests is all done by computer.

To accomplish all of this requires not just the hardware, the computers and assorted other equipment, but also appropriate software. Doctor Haver has not only been an enthusiastic consumer of such software, he has also helped software companies design the programs to make them more useful for physicians.

One reason that Dr. Haver has become so involved is that he sees increasing computer use by doctors as one of the ways out of the current health care crunch. "I've been doing some work with Health Canada and with the different provincial organizations as well as the medical associations, trying to show what can be done. It certainly has some advantages in the area of patient care, as well as in the physician management aspect, because it provides some efficiencies for doctors. These are pretty tough times in the medical world, everybody's looking to save money."

Dr. Haver recognises that it can be a challenge for both doctors and patients to accept the new technology. He says one of the biggest concerns is confidentiality, people worried that their records will end up in the wrong hands. That's why the systems Dr. Haver uses, and those that he's helping to design, emphasise security as well as efficiency.

Although he is already in the forefront of using computers in his practice, Doctor Haver is not content to rest there. He is currently helping to develop a project called the "doctor's desktop". The idea is that when doctors sign on to the system, they will automatically have access to the latest information on drugs and clinical advances that are pertinent to the patients they will be seeing that day. "It's fascinating," he enthuses. "Every time I think I have a handle on what computer technology is capable of doing, somebody changes the rules."

It's comforting to know that when the rules change, a practicing doctor will have had a hand in changing them.

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How Canadian eHealth Initiatives are Changing the Face of Healthcare: Success Stories

Table of Contents

Success Stories From Atlantic Canada

Four in One: Health Infostructure Atlantic

Creating a Paper-Free Zone: Central East Health Care Institutions Board (NF)

Laying the Pipe for Health Information: Newfoundland and Labrador

Improving Planning for Cancer Care: Newfoundland Cancer Treatment and Research Foundation

Telemedicine Melts Northern Labrador's Isolation: Health Labrador Corporation (NS)

Nova Scotians Net Gain: DoctorsNS.com (NS)

Last Wish: Telehospice (PEI)

Raising awareness about cervical cancer screening: Teleoncology (NB)

Success Stories From Central Canada

Consistency in the Community: Community Care Connects! (ON)

Health Technology with Heart: Regionally Accessible Secure Cardiac Health Records (ON)

Connecting for Health: Eastern Ontario Telehealth Network (ON)

Changing Habits Through eLearning: eCare (ON)

Taking the hospital to the people: Sunnybrook and Women's College Health Sciences Centre (ON)

Northern Connections: NORTH Network improves healthcare across Ontario (ON)

Montreal shows MOXXI: Researchers find better ways to prescribe medications (PQ)

Continuous Care: Laval's integrated health information system puts doctors and patients in the driver's seat (PQ)

Shared Information Improves Cancer Care: Regional Clinical Oncology Information Highway Project (PQ)

Psychiatry at a Distance: Project Outreach (ON)

National Success Stories

Opening the Door to Information: Canadian Health Network (Health Canada)

Giving Power to the People First Nations and Inuit Health Information System (Health Canada)

Getting the Jump on Disease: Global Public Health Intelligence Network (Health Canada/World Health Organization)

Giving Public Health a Sense of Place: Spatial Public Health Information Network Exchange (Health Canada)

Success Stories From Northern Canada

Bridging the Gap: IIU Network (NU)

Success Stories From Western Canada

Cure for the Common Mistake: Alberta's Seniors Drug Profile

Regional Emergency Department Information System (Alberta)

Shrinking the Wide West: Alberta Telehealth

How Telehealth Stopped the Teasing

Finding Help Fast in Alberta: informCalgary

Cutting through the billing clutter: Teleplan Upgrade Project (BC)

In at the deep end - creating an electronic information pool: Integrated Community Health Information System (BC)

Online Delivery makes Training more Accessible throughout the Province: Paramedic Training Network (BC)

Women and Children First: BC Telehealth network improves maternal and child health care across the province (BC)

X-Ray Vision: Tele-imaging network improves diagnostics in Central British Columbia and Yukon (BC)

Health technology erasing provincial barriers: Provider Registry (Western Health Information Collabortive)

Technology makes sense of mental health: SYNAPSE (BC)

Overcoming Isolation: MB Telehealth Network

Partnering On the Prairies: Brandon Regional Health Authority

Prescription for Safety: Drug Programs Information Network (MB)

Developing doctor-friendly technology: Integrated Provider Solutions (SK)