Therapeutic ICT

A couple of years ago, my family had an encounter with ‘big medicine’...transplant medicine to be precise. It was a challenging experience for all of us, but fortunately, one with a happy ending. It brought us face-to-face with just how rapid the progress of medical science and technology is; the procedure that pre-occupied us wasn’t even a possibility 10 years ago. Through it all, we acquired a profound respect for the Canadian healthcare system, the ingenuity of healthcare professionals and the vital role that ICT plays in patient care.

On the technology front, what impressed me most was not the battery of diagnostic machinery or the beeping light show performance of an ICU. It was a relatively simple application of social networking technology that helped address one of the biggest side-effects of a major procedure: fear. The University Health Network, like many modern hospitals operates a Care Pages service for patients. Care Pages disseminates information regarding preparation for surgery, post-surgical care and other aspects of treatment.

It also provides a networking space for a patient to register and post their own updates about their progress through diagnosis, surgery and post-op. It is a brilliant way to keep in touch with far-flung family and friends as the surgery date approaches. And it is a profoundly effective tool for sharing information, optimism, encouragement and—certainly in our case—joy.

Modern medicine runs on ICT, and much of it is hugely complex, but this simple application of everyday web-based tools had a huge impact on our whole experience. And while it doesn't show up on a chart, I know it accelerated the healing process and contributed to a positive outcome. If simple tools like this can have this impact, imagine what the really sophisticated stuff can do. This tantalizing possibility is what keeps so many ICT companies and professionals focused on applications for healthcare. We’re pleased to share a few of their stories in the current issue of ITAC Online.

ICT's Community-Eye View on H1N1

Jay Mercer, Ottawa family physician and CMA representative

Amidst the considerable, and constant, media buzz about the H1N1 flu pandemic, one story that has gone unreported is the fact that a number of key players in Canadian health care—including health ICT vendors, the Canadian Medical Association (CMA) and the Public Health Agency of Canada—are testing a surveillance system that will form an important part of an electronic medical record (EMR). To get the full story, we talked to Dr. Jay Mercer, an Ottawa family physician and the CMA’s representative on the project.

ITAC: How is this new surveillance tool working in relation to the H1N1 pandemic?

Dr. Jay Mercer: What we are doing is working with EMR vendors across the country to build into their existing products a reporting capability that will allow them to help out with influenza surveillance. The vendors are building templates and reporting tools into the software they already have deployed with their customers.

So someone comes into your clinic with a suspected case of the flu, and you log a report in the patient’s electronic record. What happens next?

What happens is that a report is compiled and sent to the Canadian Network for Public Health Intelligence server in Winnipeg every night. The folks at the Public Health Agency can grab that and get a better understanding of what is going on in the community. In addition to that, they also report back to the physicians on what they are seeing. So, are they going to get mostly kids, or is it older folks, etc.? Basically, what happens is the physicians become reporters, but in addition to that, they benefit from the Public Health Agency’s epidemiologists, as well.

So if you are the doctor who is reporting this and you are getting these stats back, what do you do with them?

As a physician, it helps you to be more vigilant in your practice. As we get more sites online, what eventually will occur is that you will be able to understand what is happening not just in your practice but you will also see what is happening in the community around you. For example, if I was only seeing kids with influenza and yet most of the other practices in my area were seeing mostly women in their late thirties, then I might be alerted that perhaps I am missing something and I need to look a little bit more carefully.

Is the feedback ongoing, no matter what you are reporting? For example, you don’t file a report for five days because no one is presenting with flu symptoms at your clinic; do you still get a report back?

That is the plan, but currently we don’t have enough sites online to generate that degree of reporting. Eventually, though, that is exactly what we plan to do. Even the fact that a site is not seeing any patients with influenza is very important information. For example, if a site was seeing no cases but had a very large number of patients vaccinated against the flu, it might tell us that the current vaccine was effective, and that would be important for the doctor to know.

Is this something that was designed specifically for this pandemic?

Although it is being deployed to help out with this pandemic, it really isn’t restricted to H1N1; it can be used for influenza reporting throughout the year and it doesn’t really depend upon which type. Partly, what we are trying to do is to show the value of the primary care physicians as a frontline resource in public health surveillance. We also want to show the power of the EMR vendor as a partner in getting these sorts of things done. The vendors are really important partners in this.

What are the roles of each of the partners?

The CMA basically sponsored the project; they provided my time to work on developing functional specifications and do a lot of the co-ordination. ITAC helped to launch the project and is the glue that holds it together.  It has been a recruiter and a vehicle to communicate with the EMR vendors on an ongoing basis. The Public Health Agency provided the back-end technology and also the epidemiology resources. We’ve also seen several EMR vendors step up to the plate and get really engaged with this project. They have done some pretty sophisticated work to make this happen. What is also striking is the depth of knowledge in these companies. During the course of this project I am running into CIOs who can talk about the role of the EMR in epidemiology at a level that surprises me and would also probably surprise a lot of people in the public health arena.

In future terms, what does this point towards in terms of the potential power of eHealth?

It tells us that when we’ve got alignment between all the various players it is very easy to obtain very highly relevant data from the primary care providers. Public health can do great things with the data, but getting the data requires the EMR vendors to be seen as vital partners; they have deployed the software that is used during the patient encounter and supported the software with the clinician in the field.

ITAC Health Diagnoses Software Licensing

Gary Folker, Managing Director, Business Development of xwave Healthcare

As part of the evolution toward a national electronic medical record (EMR), patient-management software is now considered a medical device and therefore is subject to compulsory licensing. As a result, on August 31, 2009, Health Canada notified vendors of an imminent transition to two classes of licence. Under the federal government’s proposed framework, software used only for archiving or viewing patient information or images will be considered a Class I device. Class II will encompass any software used to acquire, manipulate, analyze or edit primary data; generate, images; record measurements; graph or flag results; and perform calculations.

The impact of this framework is significant, prompting ITAC Health in October to establish a Working Group to represent vendor interests to Health Canada. To better understand the scope of the issue, we talked to Gary Folker, Managing Director, Business Development of xwave Healthcare and chair of the Working Group.

ITAC: Could you give us an overview of the issue, particularly from the industry’s point of view?

Gary Folker: I think it’s important to note that the Health Canada ruling is actually enforcing regulations that were already in place; the ruling has simply modified some of the guidelines around patient-management software. The fact of the matter is that much of the patient-management software currently available would qualify as a Class II medical device, thus requiring heightened certification on the part of vendors. While the industry supports the goal of the ruling — enhanced patient safety — we also recognize that it would result in significant change: In order to comply with the new regulations, many of our member-companies would need to obtain ISO certification.

From the perspective of ITAC Health, what are the potential ramifications for Canadian technology companies?

First, there is the process of becoming ISO-certified; this has a significant cost attached to it. Our member companies are now asking questions about the process: How do we proceed with it? What does it involve? It should be noted, too, that a number of provinces already have similar specifications in place; many companies have had to comply with these, and now are facing the prospect of added governance at the federal level. The result being that we may need to look at how some of these costs could be more evenly distributed in the marketplace, so that vendors are not bearing the brunt of them. 

The second key ramification relates to the federal ruling’s one-year transition time, which gives companies 12 months to become compliant in accordance with software reclassification.

Simply put, this timeframe is probably not sufficient.

Consequently, when I, along with Dr. Jay Mercer, who represents the Canadian Medical Association on our Working Group and Brendan Seaton from ITAC Health, met with Health Canada, we did two things: We asked for a review of the transition time, and we expressed our concern that, given the number of questions arising from the ruling, it might in effect ‘shut down’ the industry for a period of time, because end-users—physicians, for example—could essentially sit back and ‘see what happens’. This would be detrimental in any industry, and more so in the EMR world where technology adoption traditionally has been slow and we have been working hard to accelerate it.

What has Health Canada’s response been to your position?

Health Canada has been very responsive and receptive to our feedback. They currently are reviewing the issue of transition time, and we’ve been told we should see an amendment to the August 31st ruling by the end of November. With regard to inhibiting industry growth and user adoption, the agency also expressed concern and indicated that it in no way wanted the ruling to negatively impact the industry’s overall well-being. We are now waiting to see what the amendment will say.

Is this a relatively new role for ITAC to take with Health Canada?

ITAC Health has over 120 members, with several in the category of EMR vendors. Naturally, therefore, when the ruling came out, the organization seriously considered the regulatory impact on members. The fact alone that they had so many questions prompted ITAC Health to take a leadership position on this. I think it has filled that position well and is working to provide the industry with as much information and guidance as possible.

In conclusion, both from your position in ITAC Health and also from an xwave perspective, what’s the bigger picture? How are you hoping to position the industry as an influencer of evolution of Canada’s e-health?

I think ITAC Health should be serving as a voice for our industry, and I believe it’s well-suited to fill that role, whether it be in discussions with Health Canada or with some of the provincial agencies that sit on our working groups and have a vested interested in what our members do. I think this kind of leadership is vital to the health of our industry, and so far, ITAC Health is proving itself an effective industry advocate.

Board Member Profile: Meet Michael Green

Michael Green, President and CEO, Agfa HealthCare Inc., North America Region

As President and CEO of Agfa HealthCare Inc., North America Region, Michael Green helps steer a company that has been a pioneer in health care ICT since the early 1990s. A member of the Belgium-based Agfa-Gevaert Group, Agfa HealthCare is a leading provider of IT-enabled clinical workflow and diagnostic image management solutions, as well as systems for capturing and processing images in hospitals and health care facilities. The company operates in more than 100 countries. In addition, Green is currently serving as Chair of ITAC Health, Canada’s only health ICT vendor association.

A native of Britain with a background in clinical biochemistry, Green joined Agfa in 1985 and moved to Canada in 2001 to become head of Agfa’s Americas Informatics division and lead Agfa HealthCare’s Global Marketing group.

ITAC:  In January, Agfa HealthCare received $29.6 million from the Ontario government to expand your R&D activities in Waterloo. What is the scope of the projects that the company is pursuing in Ontario?

Michael Green:One thing we are working on are the next versions of a Picture Archiving and Communication Systems (PACS) solution which is called IMPAX™, and currently we are on IMPAX Version 6.4. Next year we launch Version 6.5, and so it is really the continued development of that product base to keep it up to date. In addition to that, we are working on some new eHealth infrastructure systems. One of those is a viewer, a kind of enterprise viewer that we call XERO, which can be used across the enterprise for physicians to look at the electronic medical record and all the different content that they need—images and everything else that comes into the electronic record.

So that would integrate images with the other data in the electronic medical record?

That’s right. It could be PDF files, it could be cardiology information; all kinds of formats, and the nice thing about it is that this particular viewer can be used out in the community, by family physicians and so on, as well.

So if I am going to see my doctor and I am in the examination room, if he is calling up my electronic record on his terminal, he can access images as well?

Yes, that is the idea; anything, all kinds of information that you might want to call up from the electronic health record, you could use this product and they just link together all the different legacy systems that the hospitals is using. Another area is called IDC (IMPAX Data Centre) which is a kind of a vendor-neutral archive software to facilitate storage of all the different information related to the clinical health record.

Looking toward the longer term, what is your vision for how Agfa HealthCare will evolve in Canada and what that might mean for the continued evolution of eHealth in Canada?

The way we see it is that we started off really very much focusing on the medical X-ray, the diagnostic imaging area, and I think that technology now is quite mature. Also, from Canadian point of view, nearly all the hospitals in regions now have digital imaging and X-rays. The areas that we are now focusing on are, on one hand clinical content—so cardiology, orthopaedics and pathology, all those kinds of clinical areas are targets so that we can help to build the content of the electronic health record. On the other hand, we are looking at tools like IDC, XERO and other tools that help with the infrastructure for viewing, sharing and storing those images. That is how we are trying to work. So I would say that actually it is moving into the electronic health record area, and in a broader sense, into the clinical information domain.

The press release in January at the time of the Ontario grant made reference to partnerships. Will your major investment here in Ontario have significant impact on other health care ICT suppliers?

I think it could. One thing we are doing is setting up what we call the Agfa Institute, where we are going to put all of the R&D corporations under that institute, and some of the initiatives that are come out of that are academic partnerships. We have a relationship with the University of Waterloo, where we sponsor a chair in health informatics. We are working to look at the different research projects around that. We are also working with other universities: the University of Laval in Quebec, Dalhousie in Nova Scotia and some others. We are very keen on increasing our academic relationships. And then we are doing other activities to try and stimulate new ideas. We have a competition at the moment where we are inviting students to submit their ideas and inventions, innovations and so on. It is something we ran last year and I think again a part of that is an effort for us to help, from recruitment point of view, to try and stimulate recruitment into the health care ICT business. 

Will the work done in Ontario have an impact on Agfa HealthCare’s activities in other parts of the world?

The centre in Waterloo is really our global centre of excellence for PACS, diagnostic imaging PACS, and also for cardiology and eHealth. The products developed there are sold worldwide. The technical support provided at Waterloo is also a global service. Apart from that, we have also moved some additional service resources into Waterloo, such as our North American Region call centre, which was based in New Jersey. We are in the process of expanding that and moving it up to Waterloo.

Shifting the focus to ITAC Health, what are the key objectives you see over the coming couple of years?

I think one of the objectives must be to raise the profile of the eHealth industry within different stakeholders in Canada. Other than that, I think there is definitely an opportunity for ITAC to work with partners like Canada Health Infoway and raise the profile of eHealth, and what that can contribute to patient care in terms of efficiency, safety and issues like that. In view of some of the negative publicity that has gone around lately in connection with Ontario’s eHealth issues, there is definitely a need to re-market the eHealth industry to the public and show them the benefits that eHealth definitely does bring to the patient care. Over and above that, we need to attract people to come into eHealth as a career path. For members, the other area is lobbying on behalf of the industry. ITAC is a great forum to bring that together. The other area is the regulatory area. We have seen recently with Health Canada’s regulatory requirements for medical information systems that that type of regulatory environment is probably going to increase. The trade association can play a role in helping to co-ordinate that.

How well positioned do you think that Canada’s health ICT sector is to influence change as eHealth evolves in Canada?

I think we are pretty well positioned to do that. I think it is a fairly significant industry, and I think we are in a good position to influence elected representatives and have a voice. I think what we certainly need to do is to have some good stories and case studies that demonstrate the positive impact of eHealth.

How important it is for ITAC Health to be working in concert with the Canadian Medical Association and other partners?

I think again that is certainly a good role for the trade association to form links with organizations like we mentioned—Canada Health Infoway, other professional associations and colleges and so on—where ITAC can be a voice of the industry and provide a lot of benefit to all the members, independent of what product areas they are working in.

The Canadian Medical Association has been very outspoken in its criticism of Canada’s adoption rate of eHealth. From your position, what is going to have to change, and are we indeed at a critical junction in our development of electronic health care?

In some respects, Canada is viewed as a leader globally because Canada Health Infoway has successfully promoted an agenda. I think many countries are envious of that, but on the other hand there is a danger that we could lose a bit of momentum. I think a big challenge is going to be to demonstrate the value for the money and also the patient care benefit that eHealth can bring.

ITAC Events

December Events

For a full event listing, and to register for ITAC events, go to: http://www.itac.ca/events