Hospital News November 2019 by Hospital News

Inside: From the CEO’s Desk | Evidence Matters | Ethics | Careers | SPECIAL FOCUS: MEDTECH

November 2019 Edition

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Is the Ford government listening? Year one has seen the Doug Ford Conservatives cut too much, too quickly, without meaningful consultation. Premier Ford says heâ&#x20AC;&#x2122;s listening now. Actions speak louder than words. If Doug Ford is serious about ending hallway care in Ontarioâ&#x20AC;&#x2122;s hospitals, nurses and health-care professionals need to be heard. Tell your MPP, the Health Minister, and Doug Ford that open dialogue with front-line nurses is vital to successful health-care reform.

Contents November 2019 Edition

IN THIS ISSUE:

Combining AI, machine learning and professional expertise

27 ▲ Cover story: The best healthcare is value-based

▲ Canadian first establishes central venous access

COLUMNS Editor’s Note ....................4 In brief .............................6

▲ Safe opioid use

▲ A one-two punch in rehabilitation success

Evidence matters .............8 From the CEO’s desk .....20 Ethics .............................32 Doctors without Borders .. 34 Long-term care ...............38

▲M MedTech dT h Supplement

21 www.hospitalnews.com

Video conference technology helps connect patients

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Medically assisted dying ruling denies important safeguard for persons with disabilities All lives, including the lives of vulnerable persons with disabilities, must be valued

Editor

Kristie Jones

editor@hospitalnews.com Advertising Representatives

Denise Hodgson

denise@hospitalnews.com Publisher

Stefan Dreesen

stefan@hospitalnews.com Accounting Inquiries

accountingteam@mediaclassified.ca Circulation Inquiries

info@hospitalnews.com Director of Print Media

Lauren Reid-Sachs

Senior Graphic Designer

Johannah Lorenzo

By Robert Lattanzio n September 11, 2019 the Quebec Superior Court struck down the requirement that death be reasonably foreseeable in order for someone to meet the legal criteria to qualify for medical assistance in dying. The Court’s decision was the result of a legal challenge brought by Mr. Truchon and Ms. Gladu. Both are persons who have physical disabilities and degenerative diseases and who wished to die with medical assistance but did not qualify because neither of their deaths were reasonably foreseeable. In defending the constitutionality of the reasonably foreseeable requirement, the Attorney General of Canada argued that the requirement was necessary to prevent per-

sons with disabilities from being induced or coerced into receiving medical assistance in dying because of stereotypes that their quality of life was poor or their lives were not worth living. This is consistent with the United Nations Committee on the Rights of Persons with Disabilities, which in 2017 and 2019, asked Canada to ensure that safeguards were strictly enforced so that no person with a disability was subjected to external pressure. In this sense, the requirement for death to be reasonably foreseeable was a crucial safeguard. It ensured that physicians assisted people to die only when their deaths were reasonably near, not when physicians, families or society erroneously decided that a person was “too disabled” to live a good life. Continued on page 17

Robert Lattanzio is the Executive Director at ARCH Disability Law Centre. He received law degrees from McGill University in 2003. He has advocated for disability rights at all levels of court, made law reform submissions to governments, and written extensively on equality and human rights from a disability perspective.

ADVISORY BOARD Barb Mildon,

RN, PHD, CHE VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

Helen Reilly,

Publicist Health-Care Communications

Jane Adams,

President Brainstorm Communications & Creations

Bobbi Greenberg, Health care communications

Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross, B.A., MS.C., DC, CSM (OXON), MBA, CHE Vice President, Academic George Brown College, Toronto, ON

ASSOCIATE PARTNERS:

UPCOMING DEADLINES DECEMBER 2019 ISSUE

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EDITORIAL: November 12 ADVERTISING: Display – November 22 | Careers – November 26

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Monthly Focus: Year in Review/Future of Healthcare/Accreditation/Hospital Performance Indicators: Overview of advancements and trends in healthcare in 2018 and a look ahead at trends and advancements in health care for 2019. An examination of how hospitals are improving the quality of services through accreditation. Overview of health system performance based on hospitals performance indicators.

Monthly Focus: Professional Development/Continuing Medical Education (CME)/ Human Resources: Continuing Medical Education (CME) for healthcare professionals. The use of simulation in training. Human resource programs implemented to manage stress in the workplace and attract and retain healthcare staff. Health and safety issues for healthcare professionals. Quality work environment initiatives and outcomes.

+ Special Focus: Radiology

+ Professional Development Supplement THANKS TO OUR ADVERTISERS Hospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News.

4 HOSPITAL NEWS NOVEMBER 2019

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@ hospitalnews.com Canadian Publications mail sales product agreement number 42578518.

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NEWS

Canadian first establishes central venous access from the inside-out By Roger Boyle ometimes it takes looking at a situation differently to find simpler and safer approaches to patient care. This is evident for the Joint Department of Medical Imaging’s (JDMI) Interventional Radiology Team, who earlier this month, made the University Health Network (UHN) the first centre in Canada to establish central venous access (CVA) using an Inside-Out Catheter System. “Traditionally, when we try to get into veins we puncture from the outside-in – from the skin into the vein,” says JDMI’s Dr. Dheeraj Rajan, Lead Interventional Radiologist for the procedure. “This novel approach is actually coming from the inside of a blocked, inaccessible vein and puncturing out. “It creates another option for patients which they didn’t have before.” This new approach, meant for patients with chronically occluded or blocked veins, is an alternative to vascular bypass surgery, and used when all other procedures for central venous access have been exhausted. It works by manually inserting a device through the femoral vein in a patient’s thigh and navigating it up past the heart, into the occluded venous segment. The device is then pushed through the occlusion internally, and a needle within the device is advanced out through the skin. With the needle then providing a direct path through the occluded vein, a central venous access device can be inserted. The Canadian-first procedure, performed in conjunction with Peter Munk Cardiac Centre Vascular Surgeon, Dr. George Oreopoulos, came about following multiple failed venous access attempts for UHN patient, Kira Whitehead, who, due to past surgical complications, has ongoing needs for intravenous fluids and medications. “I’ve been through over 20 PICC lines, two ports, and two Hickman’s, all of which have failed at some point,” says Kira. “I have potential for a long

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Photo credit: UHN

Dr. Dheeraj Rajan navigates the central venous access device through the patient’s femoral artery, past the heart and through the occluded vein using x-ray images on the monitor ahead. life-span ahead, and not being able to access any of my upper veins is a serious concern.” At just 43 years old, and having already dealt with a number of serious illnesses, including bowel obstruction, C. difficile and kidney failure, Kira was willing to explore every option available to her. “Everyone’s there when you’re critically ill, and then they all sort of just disappear,” she says. “So for Dr. Rajan and Dr. Oreopoulos to undertake this, means a great deal to me. “I’ve had a lot of promises, and very few people have meant what they promised to do.” The procedure, performed with a special case-based approval from JDMI/UHN, was completed successfully on Oct. 4 at Toronto General Hospital, and Kira can now receive fluids and medications through a highflow central venous port. “It’s rare that patients get to this situation,” says Dr. Rajan. “We can usually open up blocked veins from the

outside-in with traditional methods, but in Kira all of that failed – multiple times at multiple institutions.

“We want to extend her lifespan as long as possible and this gives us an opH tion we didn’t have before.” ■

Roger Boyle is Communications Specialist at University Health Network.

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IN BRIEF

Campaign launched to improve quality of life for people with severe dementia campaign launched on National Seniors Day and the International Day of Older Persons aims to improve quality of life for people with severe dementia who live in long-term care by sharing best approaches for evaluating and managing pain in these residents. “Pain is under-assessed and under-treated in long-term care because people with severe dementia have limited ability to communicate what they are feeling,” says Dr. Thomas Hadjistavropoulos, who holds a Research Chair in Aging and Health at the University of Regina in Saskatchewan. Under-recognized pain can have serious consequences. Pain in dementia can lead to agitation and aggression. When these types of behaviours are misattributed to a psychiatric problem, people are often given psychotropic rather than analgesic medications, says Dr. Hadjistavropoulos. Research has shown that psychotropic medications may increase the risk of earlier death in these individuals, he says. To raise awareness, he created a social media campaign in collaboration with national and provincial

organizations as well as older adults, caregivers and health-care professionals. #SeePainMoreClearly includes a video and a website with information and resources, such as a pain checklist for seniors with limited ability to communicate, developed by Dr. Hadjistavropoulos’s team. Dr. Hadjistavropoulos says he took the unorthodox step of launching a grassroots campaign because he wanted to go directly to health professionals, family caregivers, people with dementia and the general public. Typically, he says, it takes many years to disseminate research findings in a way that they become part of widespread practice. “We want to share evidenced-based practices now to optimize the quality and frequency of pain assessments. Overworked frontline staff want to do the best for their patients but are constrained by limited resources. Moreover, there’s a clear need for continuing pain education for staff to make sure everyone is familiar with the newest methods.” The website also has links to resources for families and patients. Filmed with actors in Regina, the video depicts a scene involving health

professionals and a long-term care resident living with dementia. It is based on Dr. Hadjistavropoulos’s research and work in applied health psychology. The video campaign is supported by AGE-WELL and the Alzheimer Society of Saskatchewan. The Canadian Association on Gerontology and the Chronic Pain Network are partners in the campaign as well. Dr. Hadjistavropoulos points to studies that indicate that people living with severe Alzheimer’s are less likely to receive an analgesic medication than older adults in general. “We aim to address under-recognized pain and, in turn, this will mean improved quality of life for long-term care residents, fewer incidents of agitated behaviour and lower stress levels for hard-working staff and for families.” As part of his work with the AGEWELL network, Dr. Hadjistavropoulos co-leads a research team that is developing technology-based solutions to improve pain management in long-term care residents who are living with dementia. This includes knowledge mobilization efforts using H social media. ■

Canadian physicians support national licensure and increased use of technology to improve health care access ew data released by the Canadian Medical Association (CMA) shows overwhelming support for national physician licensure. The findings, from the 2019 CMA Physician Workforce Survey, reveal that nine in 10 physicians support national licensure and three quarters agree it will improve access to care for Canadians. Nearly 7,000 physicians responded to the survey and provided input on the realities of their practice – from the potential impact of technology to working hours and patient care. “Physicians are prepared to embrace technology to alleviate the strain on our health care system,” says Dr. Sandy Buchman, CMA president. “The potential that technology, such as virtual care, can offer to increase access to care is obvious and it’s time to put

6 HOSPITAL NEWS NOVEMBER 2019

this technology to work, for all our benefit.” Under current rules in most jurisdictions, physicians must currently be licensed in the jurisdiction where the patient they are treating resides. In order to provide care for patients in other jurisdictions, they must secure an additional license or licenses, a costly and time-consuming process that can impact access to care. Among the report’s key findings:

NATIONAL LICENSURE: • Nine in 10 (91%) physicians support the implementation of national licensure that would enable them to practise in all Canadian jurisdictions. • Three quarters (74%) agree that a national physician license would improve access to care for Canadians. • 62% found that the overall complex-

ity of the process to obtain a license was a significant obstacle to practising in another jurisdiction. • The length of the process (58%) and the cost of getting licensed in another province/territory (53%) were other key obstacles.

ACCESS TO TECHNOLOGY: • More and more physicians are now reporting the use of technology in their practices, including increased online access to lab test and diagnostic results (87%), and lists of medications taken by patients (72%). 63% are ordering lab and diagnostic tests electronically. • One in five patients (22%) are now able to view their health records online. • More patients than ever are also able H to book appointments online (13%). ■

Biased views

of obesity leave Canadians unsupported at work and in the doctor’s office ealthcare professionals, employers and people living with obesity disagree on how the disease develops, how to manage it and who owns responsibility for treatment, according to a new assessment. The Awareness, Care, and Treatment in Obesity Management (ACTION) Study surveyed attitudes toward obesity in 2,000 individuals living with it, 395 physicians and allied health professionals who manage it, and 150 employers who provide private health benefits. Results were published in the journal Clinical Obesity in October 2019. Obesity Canada highlights five key conclusions from the ACTION study conducted and provides recommendations for each of the three surveyed groups on how to change attitudes and improve access to obesity care: • 94% of healthcare providers (HCPs) think that obesity is a serious chronic disease on par with stroke, depression and others, yet many believe diet (63%) and exercise (50%) are effective treatments. • 72% of HCPs said they discussed weight management in their interactions with people with obesity (PwO), but only 50% of PwO said their HCPs had done so. • Even though 82% of PwO said they are actively trying to manage it, 72% of HCPs and 65% of employers believe that PwO are not motivated to manage their disease. • 47% of employers believe that weight is within employees’ control; 63% believe PwO can manage their weight if they set their mind to it. • 77% of employers thought their wellness programs contributed to successful weight management significantly/a lot, while only 32% of PwO agreed. Obesity Canada’s recommendations include: Healthcare professionals: • Embrace recent research supporting obesity’s complex etiology and heterogeneity. • Learn more about current, evidence-based approaches to treating obesity as a chronic disease using available treatments (new Clinical Practice Guidelines will be available H in 2020). ■

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IN BRIEF

Canadians with Inflammatory conditions sought for two surveys wo of Canada’s leading patient groups, the Gastrointestinal Society and the Canadian Society of Intestinal Research (CSIR), are calling on patients with inflammatory bowel disease (IBD) to participate in a survey to help them identify what’s missing in their care. They are also asking Canadian patients with any inflammatory condition who take biologic/biosimilar medication to provide their opinions.

ducted in 2018, but this time is open to IBD patients worldwide in order to collect a larger and more diverse body of information about the IBD patient community. Participants must have been diagnosed with any type of IBD (Crohn’s disease, ulcerative colitis, ulcerative proctitis, microscopic colitis, etc.).

INFLAMMATORY BOWEL DISEASE

USE OF BIOLOGIC/ BIOSIMILAR MEDICATIONS FOR INFLAMMATORY DISEASES

The first survey, IBD Patients: What’s Missing in Your Care?, seeks to learn more about IBD patients’ experiences and their outlook in current management. The survey, which is available in English and French, follows a similar questionnaire con-

The second survey, the Canadian Biosimilar Medication Experience, explores the experiences and outlook of Canadian patients who use biologic/ biosimilar medications to treat inflammatory bowel disease (Crohn’s disease or ulcerative colitis), as well as other

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GASTROINTESTINAL CONDITIONS AFFECT AS MANY AS SIXTY PERCENT OF THE POPULATION. inflammation causing diseases such as diabetes, rheumatoid arthritis, cancer, osteoporosis, psoriasis, HIV, multiple sclerosis, or growth deficiencies. This is following up on a survey conducted in 2015. “Healthcare is an ever-changing space of innovation and variation,” says Gail Attara, president and CEO, Gastrointestinal Society. “As the Canadian leaders in providing trusted, evidence-based information on all areas of the gastrointestinal tract, the GI

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Society and the CSIR seek to balance health policy with real world evidence and ensure that the patient voice is the prime focus. That’s why we urge all individuals who are living with IBD to participate in our global survey and Canadian patients with inflammatory conditions of any kind to complete the biosimilar survey.” Data gathered from both surveys will be used anonymously and in aggregate to shape future programming and to inform discussions with community members, healthcare professionals, and health policy decision-makers. “Gastrointestinal conditions affect as many as sixty percent of the population at some point in their lives,” added Attara, “and the GI Society has a vast collection of trusted, medically-sound information covering topics from gum to bum on badgut.org.” ■ H

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EVIDENCE MATTERS

Innovations in healthcare: 3-D printing and bioprinting By Dr. Brit Cooper-Jones here may be many people who have heard of 3-D printing and/or bioprinting – but for others, these may be new concepts. Yet there is thought that they could change the field of health care in substantial ways in years to come. To start off with, what exactly is 3-D printing? Or bioprinting, for that matter? 3-D printing is defined as an additive manufacturing process – that is, a process by which 3-D objects are created, layer by layer, from raw materials guided by a digital file. Put simply – and applied to a health care context – this could mean “printing” a wide range of 3-D objects, including anatomic models to aid in visualizing and planning complex surgical interventions, custom tools and guides for surgery, personalized or patient-specific medical devices at the point-of-care, devices or supplies on-site as needed, 3-D printed drug delivery systems, and much more. Bioprinting is a technique that combines living cells (e.g., stem cells) and supportive biomaterials (e.g., scaffolds on which cells can grow) into “bioinks,” which are then printed into pre-specified, computer-generated designs, with the goal of having these cells eventually mature to form specific tissues. One of the objectives of bioprinting research and design (and of the field of regenerative medicine more broadly) is to potentially one day be able to generate full organs for transplant, though this is still in early stages. So how might 3-D printing and/ or bioprinting impact actual patient care in the immediate or near future? To gain a greater understanding of the current state of the research, CADTH conducted a Horizon Scan that looked at current and emerging

uses of 3-D printing and bioprinting that have the potential to impact health care. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures to find out what the evidence says. CADTH’s report An Overview of Clinical Applications of 3-D Printing and Bioprinting provides a synopsis of emerging innovations of this type across a variety of specialty areas and stages of development. The clinical areas where the research on 3-D printing has advanced the furthest are dentistry and oral and maxillofacial surgery, as well as orthopedics and the musculoskeletal system. For example, studies have reported improvements in surgical accuracy and decreases in operating time with the use of surgical guides and 3-D models to help with anatomic visualization. There is also the possibility of

creating dental and surgical devices via 3-D printing, such as orthodontic devices, dental crowns, dentures, and implants for orthopedic arthroplasty. And these are only some of the potential applications of 3-D printing in these fields. Overall, however, the evidence is still limited for direct patient-specific outcomes and longer-term outcomes. In addition, little is known about the cost-effectiveness of various 3-D printing innovations compared with the current standard of care. These factors, in addition to regulatory, technical, and other considerations, will all need to be taken into account before 3-D printing is adopted more widely into routine clinical practice. Another potential application of 3-D printing in health care is to create custom medical devices such as prosthetics and orthotics. In theory, these devices could be uniquely tailored to

each patient, accounting for individual variances and thus offering a form of personalized medicine. However, the types of study designs that would be best suited to evaluate customized devices, as well as regulatory concerns with the potential shift to a decentralized manufacturing process (i.e., at the hospital or clinic level), are only some of the additional factors that will need to be considered as the research continues to move forward. With regard to bioprinting, the current research is still in the early stages, consisting primarily of in vitro experimentation and conceptual exploration. However, there is hope of one day using bioprinting to generate full organs, help with joint repair and replacement surgeries, and move away from animal testing (and toward testing with 3-D cell cultures instead), to give some examples. In closing, the fields of 3-D printing and bioprinting are exciting and highly active areas of research, with the potential to transform the delivery of health care in years to come. At the time of CADTH’s Horizon Scan, over 100 clinical trials of clinical applications of 3-D printing were registered as in progress or recruiting in the International Clinical Trials Registry Platform and ClinicalTrials.gov. Looking beyond the current state of 3-D printing, 4-D printing – an approach that adds a dimension of transformation or adaptation of the device over time in response to specific parameters – may offer additional advantages in the medical field as smart implants, tools, and devices become more common. If you’d like to learn more about CADTH or this Horizon Scan, visit www.cadth.ca. You can also follow us on Twitter @CADTH_ACMTS or speak to a CADTH Liaison Officer in H your region. ■

Dr. Brit Cooper-Jones, MD is a Knowledge Mobilization Officer at CADTH. 8 HOSPITAL NEWS NOVEMBER 2019

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New web-based app launches shift filling into the digital age;

enhances employee morale and the patient experience By Julie Adams n the past, if Liz Caterer, staff scheduler at Stevenson Memorial Hospital (SMH) needed to fill a shift she pulled out her long list of clinicians and settled in for an hour or two of making calls â&#x20AC;&#x201C; now she just ShiftLinks it. With the click of a button, Caterer can fill vacant shifts â&#x20AC;&#x201C; saving her about two hours a day while simultaneously helping to enhance both staff morale and the patient care experience. â&#x20AC;&#x153;I co-ordinate the staffing for nursing across the hospital,â&#x20AC;? says Caterer. â&#x20AC;&#x153;Depending on which department is short, I may have to call up to 25 people to fill one or multiple shifts per department, per day. Now I simply create a shift profile that can be segmented by time, employee status and department or location, and boom, the shift is posted.â&#x20AC;? An innovative, cloud-based web and mobile application, ShiftLink helps organizations to eliminate the time, cost and frustration typically associated with the arduous process of filling vacant shifts. Once the software is implemented, staff download the free app directly to their smartphone, tablet or desktop computer to receive notifications about available shifts. â&#x20AC;&#x153;We offer a unique technology platform that enables managers to communicate shift opportunities to frontline staff in mere seconds,â&#x20AC;? says Richard Bicknell, president, ShiftLink. â&#x20AC;&#x153;Managers donâ&#x20AC;&#x2122;t have to spend hours on the phone and staff no longer have to worry about missing a shift due to a missed call or unchecked voicemail â&#x20AC;&#x201C; they simply get a notification through the app.â&#x20AC;? This innovative technology has streamlined the shift-filling process from multiple disjointed steps to three

0DQDJHUV DQG IURQWOLQH VWDII DW 6WHYHQVRQ 0HPRULDO +RVSLWDO FDQ HDVLO\ Ă&#x20AC;OO DQG UHVSRQG WR YDFDQW VKLIWV YLD WKH QHZ FORXG EDVHG DSS 6KLIW/LQN 7KLV LQQRYDWLYH WHFKQRORJ\ KDV ODXQFKHG WKH DUGXRXV SURFHVV RI Ă&#x20AC;OOLQJ VKLIWV LQWR WKH GLJLWDO ZRUOG simple actions: create a shift profile, hit send and approve the most appropriate employee based on seniority or fair shift distribution. Shifts are only sent to staff with matching profiles and a customized timeframe in which to respond. Responses are filtered back to the manager listed by seniority to help maintain effective labour-relations. â&#x20AC;&#x153;The experience of scheduling â&#x20AC;&#x201C; not only for the hospital, but for our clinicians from a personal perspective â&#x20AC;&#x201C; has improved,â&#x20AC;? says Carrie Jeffreys, Vice-President of Clinical Services and Chief Nursing Executive at SMH. â&#x20AC;&#x153;It helps to make life more predictable in a business that runs 24/7, and by making the process easier, we are not running short which has a major impact on patient care.â&#x20AC;? Paul Schaedlich, Manager, Environmental Services, at Markham Stouffville Hospital has had a similar experience.

â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s great to be able to notify the entire seniority list in one shot,â&#x20AC;? says Schaedlich. â&#x20AC;&#x153;Not only do staff have more time to respond to a shift, but also more time to get ready and get to work. Since implementing ShiftLink things have become a lot easier.â&#x20AC;? In the past, Schaedlich spent 15 to 45 minutes filling just one vacant shift from his 120-person staff. Now he fills four or five shifts concurrently via the online platform while engaging in other operational work. Since launching in 2017, ShiftLink has helped its clients reduce time spent on the phone by 75 per cent equating to an annual average savings of about $400,000 in productivity alone, not to mention the savings associated with overtime and agency costs. With an average of four people responding per post, hospitals are provided greater choice of available and interested staff, thus avoid-

ing the need to pay overtime or fill the shift through an external staffing agency, saving tens of thousands of dollars each year. This is vital for an industry that provides acute medical care to thousands of Ontarians every day and is under constant strain to produce both cost and time efficiencies. At SMH, Jeffreys says the hospital had already been looking at the dated and wasteful process of filling shifts. â&#x20AC;&#x153;We wanted to eliminate some of the re-work because itâ&#x20AC;&#x2122;s a waste of time for the system and for the person, and we value peopleâ&#x20AC;&#x2122;s time.â&#x20AC;? What she, and her team, discovered was more than a pile of inefficiencies; there wasnâ&#x20AC;&#x2122;t a mechanism in place to capture data and see where the process was breaking down. â&#x20AC;&#x153;ShiftLink captures all the data we need,â&#x20AC;? says Jeffreys. â&#x20AC;&#x153;We have a dashboard that allows staff, management and leadership to see whatâ&#x20AC;&#x2122;s going on. This has led to more informed conversations about scheduling â&#x20AC;&#x201C; how it functions and abides by union rules and how our process can be further improved.â&#x20AC;? In addition to its convenience and simplicity, the app also features custom screens for staff and management, the ability to list staff responses in order of seniority, a history log to help manage shift-related grievances and support investigations, unlimited administrative accounts, and the ability to capture trend data for future staff and budget planning. Ultimately, scheduling, which is a known pain point for most hospitals and shift-related industries, is now easier for shift schedulers and staff, leading to a more relaxed and positive work culture. â&#x20AC;&#x153;When you have happy staff, you H have happy patients,â&#x20AC;? says Jeffreys. Q

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NOVEMBER 2019 HOSPITAL NEWS 9

NEWS

Working to support Canada’s national efforts to safe opioid use By Anthony Danial and Tamara Milicevic providers, stored safely and taken as prescribed. This is especially important for post-operative clients whose opioids have been titrated and stabilized before the start of weekend passes. The safety guide, written in client-friendly language and reviewed by Holland Bloorview’s health literacy team, also highlights some common side effects and who best to speak to at the hospital regarding questions or concerns. The Health Canada mandatory information handout still accompanies each of the Holland Bloorview-created safety guides.

anada is in the midst of a national opioid crisis. It is a public health emergency that crosses cultural, socioeconomic, age and gender barriers. Management of this has been multipronged from federal and provincial actions, to regulatory bodies, hospitals, and community-driven initiatives. In 2018, Holland Bloorview Kids Rehabilitation Hospital decided to take action to provide client and family-friendly information that explained some of the potential realities of these medications to align with Canada’s national initiative. The hospital’s “Opioid medication safety guide” has been instrumental in supporting clinicians with Health Canada’s regulatory changes around dispensing these medications.

HEALTH CANADA REQUIRED PRACTICE CHANGE In an effort to provide greater caution regarding opioid use, Canada’s Food and Drug Regulations were amended in October 2018. This meant that a warning sticker and patient information handout had to be provided to patients at the time of sale in community pharmacies, with all prescription opioids. However, opioids provided during hospitalizations, under the supervision of a prescriber, are exempt from this requirement. Rehabilitation hospitals fall somewhere in between. Patients are admitted to the hospital, but often are encouraged to go home on weekend passes. When they do, the inpatient pharmacy provides all of the required medications for their time at home, including opioids. As part of a multimodal approach to pain management, opioids are used in conjunction with non-medication strategies such as physiotherapy and

Health Canada’s patient information handout (left) and Holland Bloorview’s family-friendly opioid medication safety guide. psychological strategies supported by child-life and therapeutic recreation specialists. An example of this approach can be seen through Holland Bloorview’s Get Up and Go program, in partnership with The Hospital for Sick Children, for persistent pediatric pain. For the inpatient population, opioids are most commonly used post operatively after orthopedic surgery to help with pain management during the rehabilitation process. When stable and safe to go home for weekend passes, clients at Holland Bloorview are provided with their regular medications, including pain management medications if needed.

CONNECTING THE SYSTEM THROUGH COLLABORATION Holland Bloorview was purposely mindful about how to incorporate the

warning sticker and Health Canada patient information handout into its practice. “Our aim was to balance safe and effective opioid use with the new regulations,” says Nathan Ho, director of pharmacy services at Holland Bloorview. “We knew that for our specialized pediatric population, the sticker and handout had to be accompanied by education and a very tailored message.” By forming an interdisciplinary working group of pharmacists, prescribers, nurses, clinical managers and collaborative practice leads, the hospital created a client and family-friendly opioid medication safety guide. The colourful, one-page tip sheet helps contextualize the Health Canada messaging for its pediatric clients and sends the message that opioids can be used safely to help manage pain when monitored by health care

MEDICATION MANAGEMENT REQUIRES HAVING IMPORTANT CONVERSATIONS The opioid medication safety guide is now incorporated into a standard process at Holland Bloorview where the client’s nurse reviews the safety guide and Health Canada handout, along with all of the medications that are being sent for the weekend. Also, as part of regular patient follow up and care, the pharmacists on the inpatient units use the opioid medication safety guide to provide education to families. And on the orthopedic post-operative rehab unit, opioids are regularly discussed with families on admission, reassessed and doses adjusted and weaned prior to discharge. “The opioid safety guide has proved to be a useful communication tool, a conversation starting point and a resource for patients and families,” says Sarah Rumbolt, clinical resource leader at Holland Bloorview. “It helps families understand how opioids can be taken safely to support their child’s H rehabilitation.” ■

Anthony Danial is a collaborative practice leader and Tamara Milicevic is a clinical pharmacy coordinator at Holland Bloorview Kids Rehabilitation Hospital. 10 HOSPITAL NEWS NOVEMBER 2019

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A one-two punch in rehabilitation success By Fred DeVries

ou might do a double-take when you see Diane Jamieson, 78, donning her boxing gloves to throw a

double jab. After undergoing surgery for a broken hip, Diane arrived at St. Joseph’s Health Care London’s Parkwood Institute as an inpatient to continue her rehab regime. Even though her mobility was improving, she was discouraged by her pace of recovery. “I thought this was it. I broke my hip, I have Parkinson’s disease, and I’m not going back home. I’d have to move into long-term care when I leave Parkwood Institute,” recalls Diane. One day, Danielle Sinclair, a physiotherapist at Parkwood Institute, noticed boxing gloves hanging from Diane’s walker. “I asked her about it,” says Danielle, “thinking it was unusual to see a patient carrying boxing gloves around.” What Danielle learned was how Diane adopted non-contact box-

ing as part of her fitness routine to help with Parkinson’s disease – and how much she loved to box. That was a knockout moment for Danielle. Why not include boxing as part of Diane’s rehab program? She enlisted the help of avid boxer and St. Joseph’s volunteer Greg Overend. Together with Diane, they built a unique therapy program adding the movement, balance and coordination of boxing – all of which can build mobility and strength – into her rehab. “Working with what patients love and connecting with their interests motivates them,” says Danielle. “And it helps to move therapy and recovery along because they are more engaged, more interested in seeing progress.” After several weeks as an inpatient, Diane had progressed so much she moved back home – not into longterm care. A complete turnaround from what she thought would happen. Now as an outpatient at the Geriatric Day Hospital at Parkwood Insti-

tute, Diane continues to strap on her gloves to ‘go a few rounds’ with Greg. “The Parkwood Institute staff truly listen to what is working and not working for me,” she says. “My care isn’t based on their assumptions. They attend to my specific needs, like adding boxing to my rehab. I really appreciate how they’ve gone out of their way to make my treatment my own. We all want to have our own voice – not just in healing but in this world.” For Danielle, seeing Diane’s progress is gratifying. “Had I not noticed and asked about her boxing gloves, I’m not sure I would have known about her love of boxing or how it would make such a big difference to her success in rehab,” says Danielle. “Listening to what matters to patients and finding the one thing that inspires them to be involved in their rehab – that can really improve their life.” Diane agrees. “Being able to box was a great morale boost for me. It has H brought me many smiles.” ■

Parkwood Institute outpatient Diane Jamieson puts on a pair of boxing gloves as part of her unique rehabilitation program at St. Joseph’s to improve her mobility and strength after undergoing surgery for a broken hip.

Fred DeVries works as a Communication Consultant with St. Joseph’s Health Care London.

Expanded orthopaedic care model aims to dramatically reduce wait times for patients By Julie Dowdie t’s a scenario that happens in doctors’ offices every day. A patient who has waited months – often over a year – to see an orthopaedic surgeon finally has their appointment and is told surgery is not the right treatment. Their wait begins again to see a specialist like a physiotherapist. Or, if they are referred for surgery, another frustratingly long wait is before them as they continue to deal with debilitating and often unbearable joint or lower back pain.

However, a comprehensive new model at Markham Stouffville Hospital (MSH) is aiming to reduce these months-long waits to simply weeks. MSH is the first hospital in Ontario to provide orthopaedic care under the Ministry of Health’s rapid access centre (RAC) model to people with hip and knee, lower back/spine, shoulder, and foot and ankle joint issues. MSH, along with several other Ontario hospitals, have been providing hip and knee and lower back and spine care under the RAC model since 2006. MSH is the first hospital in Ontario to add foot

and ankle, and shoulder care to cover all four major orthopaedic areas. “The RAC model is a game-changer for orthopaedic patients,” says Dr. J. Stephen McMahon, an orthopaedic surgeon at MSH and the York Region surgeon lead for the musculoskeletal hip and knee program. Dr. McMahon explains that patients are able to have quick consultations – usually within two weeks after a referral is received from their family physician – with a skilled advance practice physiotherapist who can assess if they are a candidate for surgery.

If surgery is the right option, their procedure is usually scheduled within two months. And if surgery is not the best treatment, the patient also can be quickly referred to another practitioner, such as a physiotherapist or sports medicine physician. MSH orthopaedic surgeon Dr. David Santone, who heads up the RAC foot and ankle clinic, adds that “under the RAC model, surgeons like myself will be seeing only the most appropriate, pre-selected patients, avoiding needless appointments and saving our healthcare system valuable dollars.” Continued on page 14

12 HOSPITAL NEWS NOVEMBER 2019

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Orthopaedic care

Continued from page 12 Glyn James describes the care he received at MSH to replace his left hip in 2018 as “unbelievable.” Following a consultation with Dr. McMahon in the summer of 2018 that confirmed the need for surgery, the now 57-year-old paramedic with Toronto Paramedic Services made the decision to wait until early 2019 for his surgery based on his work schedule. But as his mobility lessened and his pain increased, Glyn was able to take advantage of an opening and have his surgery that fall. In addition to the short wait time, Glyn benefitted from Dr. McMahon using what’s known as the ‘direct superior approach’ for his hip-replacement. This leading-edge procedure allows for a faster recovery time with less pain.

MSH orthopaedic surgeon Dr. David Santone examines a patient in the foot and ankle clinic

“I had my right hip replaced in 2016 at another hospital and I was in agony for more than six weeks during my recovery following the surgery,” Glyn explains. “With my hip replacement at MSH, it was like night and day. I was able to get up two hours after the surgery, I was home the next day and back at the gym in less than a week.” “We’re incredibly proud of the care we’ve been able to provide to our orthopaedic patients and we’re looking forward to serving even more people under our newly expanded model; helping them to get back to a life without joint or lower back pain,” says Dr. McMahon. For more information on the RAC model at MSH, visit www.msh.on.ca/ H ortho. ■

Julie Dowdie is a Senior Communications Specialist at Markham Stouffville Hospital.

Cuddle Cot provides bereaved families more time with babies after loss By Selma Al-Samarrai

new device at St. Joseph’s Health Centre is being offered to families coping with a stillbirth or neona-

tal loss. At least seven families have used the Cuddle Cot since its arrival to St. Joseph’s Family Birthing Centre (FBC) earlier this year. It is a bassinet attached to a cooling mechanism that’s designed to preserve the baby’s body to allow families to spend a bit more time with them. “When we lose adults, depending on how long they’ve been in this world, we have experiences, memories and mementos with them that help us remain connected to them even when they’re gone,” explains Luisa Guerrera, patient care manager at the FBC. “But when babies pass away, they have such a short life that families don’t have the benefit of that time and experience, and that’s where the Cuddle Cot offers some comfort.”

The Cuddle Cot provides families the opportunity to spend time with their baby, take photographs, invite visitors and loved ones to meet them and say their goodbyes, all while the cooling mechanism is preserving the body’s integrity. “When we can support families to spend more time with their baby and to build a community of witness, we’re punctuating the existence of their baby in the world,” explains Guerrera.

Depending on the family’s preference, most will spend up to 24 hours with their baby in the Cuddle Cot. Lindsey Peacocke is a registered nurse and full time lactation consultant for the Women and Children’s Program at St. Joseph’s. On multiple occasions, she has visited mothers and families who were spending time with their babies in the Cuddle Cot. “In my experience watching families with the Cuddle Cot, I find that it’s a

lot more approachable for families and a lot less medical. They’re comfortable taking the baby out of it, taking photos of the baby in it and inviting visitors to come see the baby,” explains Peacocke. Peacocke meets with new mothers in her role as lactation consultant because she finds that breast care generally is not attended to after a stillbirth or neonatal loss. Her role involves talking to the mothers about breast care, donating milk and associated concerns. “The Cuddle Cot was born out of good-quality bereavement care. It keeps families together for an extended time while also preserving the integrity of the newborn,” explains Guerrera, who adds that the Clinical Engineering team at St. Joseph’s has been instrumental in providing support with the Cuddle Cot as FBC staff learn to use it. The Cuddle Cot was funded by the St. Joseph’s Health Centre H Foundation ■

Selma Al-Samarrai works in communications at Unity Health. 14 HOSPITAL NEWS NOVEMBER 2019

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Virtual care at hand. This ensures the most positive experience for both the patient and the care provider. “The people I have seen by way of virtual visits have benefitted from my services and, had we not had this option, they probably wouldn’t have received any services,” Dr. Cockell says.

By Christine Lyon here are many reasons a patient might be unable to make an in-person appointment with their health care provider, but the rise of virtual visit technology is removing barriers by allowing patients to stay home and use a laptop, or other electronic device, to see their care provider in real time via video chat. Expanding the use of virtual visits is just one of the ways Providence Health Care is embracing digital health and committing to patient-centred care. Secure virtual visit platforms such as Skype for Business have been implemented at more than 15 outpatient clinics across the organization, giving patients a convenient alternative for appointments that don’t require a physical exam.

NOT WITHOUT CHALLENGES

Dr. Sarah Cockell, a psychologist in the Heart Centre at St. Paul’s Hospital, started offering virtual visits about a year ago.

THE FLEXIBILITY AND EASE OF SCHEDULING THAT VIRTUAL VISIT TECHNOLOGY PROVIDES MEANS QUICKER TURNAROUND IN TERMS OF PATIENT MANAGEMENT.

‘PATIENTS HAVE REALLY LOVED IT’ Cardiac electrophysiologist Dr. Zachary Laksman has been doing virtual visits for several years. As Director of the St. Paul’s Hospital Atrial Fibrillation Clinic and the B.C. Inherited Arrhythmia Program, his patients live all over the province. For many, the time and expense required to travel to Vancouver to see him is prohibitive. With virtual visit technology, he can coordinate and review tests with his patients in the comfort of their own homes. “People are inviting the physician and the clinical team into their living room and just having a discussion,” Dr. Laksman says. “Patients have really loved it. They’re very comfortable in their home, their kids are around, they don’t have to go out of their way. It’s really worked for them.” Because he specializes in an inherited heart rhythm condition, he often needs to see families together. This is far easier to coordinate when video conferencing is an option. Meanwhile, the flexibility and ease of scheduling

that virtual visit technology provides means quicker turnaround in terms of patient management. “Patients often delay medical care because their life is too busy. So when we need to follow up on test results or communicate more frequently when things are happening fast, that care doesn’t get delayed by trying to make in-person appointments around their schedule,” Dr. Laksman says.

TIP: TREAT A VIRTUAL VISIT LIKE AN INPERSON VISIT Dr. Sarah Cockell, a psychologist in the Heart Centre at St. Paul’s Hospital, started offering virtual visits about a year ago. The technology has allowed her to provide uninterrupted care to patients who aren’t able to see her in person due to mobility issues, long distance, or feeling unwell after surgery. “It provides that flexibility so when people are just going about life – be it a vacation, be it a sudden move, be it

work that doesn’t allow them to take time off – the video option suits them quite well,” she says. “In addition, a virtual visit saves patients money that would be spent on gas, parking or public transportation.” When it comes to psychological services, a virtual visit can’t replace the human connection that’s established when sitting face-to-face. For that reason, Dr. Cockell prefers to see new patients in person at least once before offering the virtual option in order to build that important foundation. She prefers video-enabled virtual visits over phone conversations, she explains, because seeing the patient on her computer screen allows her to read facial expressions and body language, resulting in better communication. While virtual visits are often more convenient for the patient, Dr. Cockell says it’s important patients treat the appointment the same way they would an in-person visit. That means being on time, finding a quiet place free of distractions, and focusing on the task

Virtual visits have been taking place at Providence for several years now. Initially patients were required to go to a telehealth room in their community for the appointment. “While this system works for many, and still exists, several of the hospital outpatient clinics wanted to make it easier for their patients to connect virtually,” says Margot Wilson, Corporate Director of Shared Care and Virtual Health at Providence. That demand prompted the Virtual Health Team to explore options for connecting directly to the patient’s home. As with any new initiative, there are challenges. Not all patients or health care providers are comfortable with new technology. Plus, it’s a lot of work to ensure the online connection is solid and the cameras and microphones are working on both ends. These are all things that are being addressed as the initiative expands and new opportunities arise. At the same time, different virtual visit platforms are also being trialled to make it easier to connect with patients in their homes. “New technologies are emerging on a constant basis,” Wilson says. “At the same time, patients are requesting timely and convenient care closer to home. While there will always be a need for face-to-face visits, we’re committed to expanding the use of virtual visits as we position ourselves as a modern, patient-centred health care provider.” For more information about virtual visits at Providence, email virtualvisH its@providencehealth.bc.ca. ■

Christine Lyon works on the Communications team at Providence Health Care in British Columbia. 16 HOSPITAL NEWS NOVEMBER 2019

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Medically assisted dying

Partnership Conference

Continued from page 4

THE FUNDAMENTAL FLAW WITH THIS CONCLUSION IS THAT THE SAFEGUARD REQUIREMENT FOR DEATH TO BE REASONABLY FORESEEABLE DOES NOT NEGATE DECISION MAKING AUTONOMY. It was a safeguard that spoke to the inherent worth of every life, including the lives of persons with disabilities. The Court rejected this argument. Instead, it found that the requirement for death to be reasonably foreseeable perpetuated a different stereotype, namely that persons with physical disabilities cannot exercise their autonomy or consent to medical assistance in dying. The fundamental flaw with this conclusion is that the safeguard requirement for death to be reasonably foreseeable does not negate decision making autonomy. To the contrary, this requirement permitted persons with physical disabilities, like other Canadians, to exercise their free and informed consent to medical assistance in dying, providing that consent was given at the right time, within the carefully crafted safeguard. Pervasive stereotypes that persons with physical disabilities cannot exercise their capacity to make decisions continue to exist. However, striking down a safeguard such as this does not address or prevent this ongoing ableism. One of the issues the Quebec court grappled with was whether the requirement for death to be reasonably foreseeable violated section 15 of the Canadian Charter of Rights and Freedoms. Section 15 is the equality rights provision. It guarantees the right to equal protection and equal benefit of the law without discrimination. But what does equal treatment mean? The Supreme Court of Canada has long rejected formal equality and has instead upheld substantive equality. Equal treatment does not mean the same treatment. Depending on the circumstances, different treatment may www.hospitalnews.com

actually be necessary in order to combat discrimination. Substantive equality is a legal principle that describes equality of opportunity and in some cases equality of outcome. Substantive equality recognizes the particular needs and circumstances of a disadvantaged group, including historical and present-day prejudice, stereotypes and disadvantage. It requires implementing measures that respond to these factors and avoiding measures that perpetuate such disadvantage. The requirement for death to be reasonably foreseeable was a safeguard intended to promote substantive equality for vulnerable persons with disabilities. By legally limiting physician assisted death only to situations where death was reasonably foreseeable, the law sent a message that all lives, including the lives of vulnerable persons with disabilities, are valued. In this way, the safeguard eschewed historical and present-day prejudice and ableism which devalue the lives of persons with disabilities. Without this safeguard, will we slowly slip towards “normalizing” physician assisted death for persons with disabilities whose lives are challenging, who have significant care requirements, and who do not have sufficient supports in the community to meet their needs? The Quebec court did not think so. But there are a number of reports of this having already happened in communities across Canada. The Attorney General of Canada has until October 11, 2019 to appeal the Quebec court’s decision -- and appeal it must. The legal, social and ethical issues raised by this case are far too fundamental to allow the deH bate to end now. ■

.. . NOVEMBER 2019 HOSPITAL NEWS 17

NEWS

Virtual reality video games

make rehab fun for younger patients

By Amber Daugherty patient makes it to their appointment a little early. They consider a quick bathroom break or grabbing a coffee but worry about stepping away. What if their name is called while they’re briefly gone? This is not an unfamiliar scenario for many people accessing health care. Appointments run over, people are called away for emergencies and often, there’s little sense of how long a wait will be. A team at St. Michael’s Hospital is working to change that with a tool called MySMH. Patients at St. Michael’s diabetes clinic can now get text notifications after they check in for their appointment letting them know what their estimated wait time is and if they have time to leave and come back. “MySMH is helping improve patients’ experience because it’s putting the time back in their hands,” says Lexie Brand, Project Manager, “and also increasing transparency. Health care is not always on time so this lets them know what the situation is and decide what they’d like to do. It gives them control.” The text messages are tied to a system used by the clinic’s staff that shows every patient scheduled to be seen that day and whether they’ve registered, are with a physician, need to schedule their next appointment or have left. As an added bonus, MySMH helps make life more efficient for the clinical team. “It allows us to track everyone,” says Miriam Sarpong, a clerical assistant and booking clerk in the Continued on page 19

By Vivian Sum xperts commonly advise that the best exercise is exercise you enjoy doing – that way you’ll keep doing it. The same holds true for rehabilitation exercise, especially when it comes to younger patients. Vancouver Coastal Health Research Institute scientists recently tested gaming devices equipped with immersive virtual reality (VR) technology to see if they motivated teenage patients with cerebral palsy to improve their motor learning. Initial results show VR was well received by patients and was successful in improving outcomes, making it worth pursuing further. Biomedical engineer Leia Shum designed the study under the guidance of Dr. Machiel Van der Loos, an associate professor in the department of mechanical engineering and associate faculty of the school of biomedical engineering at the University British Columbia. “Error augmentation is a way of putting a visual weight on things,” explains Shum. “In real-life these patients don’t have an accurate perception of how they move. With virtual reality we can manipulate what they see. We make it more obvious which body part needs to work harder so their brain will correct the movement.” Shum incorporated two-handed tasks into the games – such as carrying a tray or laying out food items – and then visually increased the distance the weaker limb had to reach, triggering the brain to move the weaker limb as much as the stronger limb. “Even if a person thinks they are moving both arms equally,” says Shum. “We can manipulate the image to show them they are not, in an effort to trigger their brain to change that movement.” While the study was small, Van der Loos says it accomplished a lot. In just one session of so-called exergames, participants with cerebral palsy improved their ability to reach with their weaker limb. “We established that this intervention has great potential.

Respecting patients’ time

In the study sessions, participants wear special headsets and play VR games. The research team made use of a technique called error augmentation to boost movement of participants’ weaker limbs.

IN JUST ONE SESSION OF SO-CALLED EXERGAMES, PARTICIPANTS WITH CEREBRAL PALSY IMPROVED THEIR ABILITY TO REACH WITH THEIR WEAKER LIMB. People with hemiparesis (paralysis affecting one side of the body, or partial paralysis) can essentially retrain their brain using virtual reality.” Van der Loos says because the VR software and hardware in the study are commercially available, it could be used in the home setting. This would improve both patient outcomes and access. “Typically, people need way more exercise therapy and practice than their health care plan will allow for. Having a fun, low-cost robotics tool you can use at home will enable people to practice and meet goals that are motivated more by the activity itself than by it being something they have to do.” Shum says another huge advantage is that with the VR games, therapists can quantitatively control stimuli and set more concrete goals, even by phone or Skype check-ins. “In the clinic, physiotherapists can only give verbal cues; using VR we can give patients an exact number

as to how far away they are and how much they need to move. This can be incredibly motivating, as they can see and measure their progress in real time.” However, Shum stresses that athome use of VR exergames is meant to complement, not replace physiotherapy and clinical visits. As such, there’s no reason the VR technology can’t be used with older people, including seniors. “Once someone is trained in how to set it up, it is fairly straightforward to use. Seniors often enjoy the gaming aspect too.” Shum notes some senior centres already use VR games to motivate and encourage residents to be more physically active. Both Shum and Van der Loos note that VR therapy has potential to be used in a wider range of motor disorder rehabilitation, including stroke recovery. They are hoping longer-term studies, with more particiH pants, can be done in the future. ■

Vivian Sum works in communications at Vancouver Coastal Health Research Institute 18 HOSPITAL NEWS NOVEMBER 2019

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Video conference technology helps connect patients to care providers By Elaina Raponi

magine being able to speak with your doctor at the click of a button. Sounds far-fetched, right? Not

anymore. A pilot project with the stroke rehabilitation team at Providence Care Hospital has stroke patients “going digital” for care conversations. Using the Ontario Telemedicine Network’s (OTN) eVisit technology, patients are able to connect with care providers from the comfort of their home or from a local health care centre. “eVisit uses two-way video conferencing and is designed to increase access to family doctors, specialists, and other health care providers,” said Chris MacLean, Project Manager with Providence Care. “It’s changing the landscape of how we provide care.” Just ask Laurie Bolan. The 74-yearold had a stroke in August, and after spending a few weeks at Kingston Health Sciences Centre’s Kingston General Hospital (KGH) site, was transferred to Providence Care Hospital to continue her rehabilitation journey. This involves having follow-up appointments with a Stroke Neurologist in the Stroke Prevention Clinic at KGH. When approached by her care team to ask whether she was interested in participating in an eVisit, Bolan jumped at the opportunity. On the day of her appointment, Bolan was able to speak with Stroke Neurologist Dr. Ramana Appireddy over the computer.

patients’ time diabetes clinic. “Before, we would have to go and knock on doors if we had a question. This way, I can see if a physician is with someone and make sure I’m not disturbing them.” Joan Honeyford is a patient who recently consented to receiving text messages with MySMH. In her first

Pilot project at Providence Care Hospital has stroke patients ‘going digital’ for care conversations.

“The use of eVisit is a transformative change to the way we practice ambulatory health care,” said Dr. Appireddy. “This is a huge step forward. Using eVisit we are able to meet the needs of patients wherever they are,” added Lori Kimmet, Inpatient Program Manager. “It was just like FaceTime or WhatsApp,” laughed Bolan. “And it allowed me to stay in the comfort of my room.” And while the technology is considered a time-saving and convenient option for patients, the benefits are more far-reaching. “Using eVisit has the potential to reduce interruptions to our patients’ ongoing stroke rehabilitation by limiting missed therapy sessions due to transfer and travel time, while facilitating timely access to important medical follow up appointments,” explained Dr. Benjamin Ritsma, Clinical Director of Stroke Rehabilitation at Providence Care Hospital. “We see this as an opportunity to build upon the model of patient-centered care we have at Kingston Health

Continued from page 18 visit receiving texts, she said she’s already seeing the benefit. “I’ve been at other facilities where the surgeon was called for an emergency and I had to wait for two hours,” said Honeyford. “If you could know you’d be waiting, it would make life a H little ■

Sciences Centre and Providence Care.” And without the stress of arranging transportation and worrying that they will miss therapy, patients can focus on what matters – getting better. “By bringing the care to the patient we are maximizing the amount of

therapy the patient receives,” added MacLean. “That’s why they’re here; to receive the care and therapy they need so that they can return home.” Both MacLean and Dr. Ritsma agreed that eVisit not only makes it easier for the patient, but also for family members who want to be a part of those important care conversations. Bolan was joined by her husband and brother for her eVisit. When asked how the appointment went, Bolan said, “It was like I was there in person. It was fantastic.” While the use of eVisit is still being piloted, the hope is to eventually expand the service to other patient populations at Providence Care Hospital. “I’d recommend it to anybody,” said Bolan. ■H

Elaina Raponi is a Communications Officer at Providence Care

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NOVEMBER 2019 HOSPITAL NEWS 19

FROM THE CEO’S DESK

Leadership in volatile, uncertain, complex and ambiguous times

By Dr. Tim Rutledge he acronym “VUCA” was coined in the 1980s to describe conditions or situations that are characterized by volatility, uncertainty, complexity and ambiguity. Initially used in military education, it has taken root in literature on leadership and business strategy over the past two decades. Formal training and 25 years of practice in emergency medicine have helped to prepare me for VUCA conditions. However, my first immersive experience with a fully VUCA environment was the SARS outbreak in 2003. During that time, I was the Chief of the Emergency Department and Chair of the Medical Advisory Committee at North York General Hospital, which was at the epicentre of the outbreak. It was the most intense period in my 35-year career in health care. Health care professionals scrambled as we tried to understand and contain this new, highly contagious and potentially deadly illness. Decisions were being made, then modified, sometimes hourly. New policies and protocols were developed in response to frequently changing directives from the Ministry of Health. The transformation of our care environments was surreal. Many of the experiences, emotions and learnings from the SARS outbreak are indelibly etched in my mind. What helped get us through that unprecedented crisis was ample two-way communication, trust, courage, being true to our values, and focusing on what was most important – the respect we had for each other and our patients. Health care in Canada is becoming an increasingly VUCA world with the convergence of a number of factors. Escalating costs, economic concerns, growth and aging all present urgent imperatives to find solutions to sus-

GOOD LEADERSHIP IS EXTREMELY IMPORTANT DURING VUCA TIMES. WITHOUT IT, ORGANIZATIONS ARE AT HIGH RISK.

Dr. Tim Rutledge is the President and CEO of Unity Health Toronto Leadership in VUCA times tain our system. The expectations of patients and families are continually evolving with increasing consumer expectations and the democratization of medicine. Innovations, new technologies and advanced analytics are being developed at an exponential rate. In Ontario, we are currently entering into the biggest health care system transformation in most of our careers, with the plan to dismantle Local Health Integration Networks and to create more local integrated delivery models referred to as Ontario Health Teams. As the President and CEO of Unity Health Toronto, I have been involved with the integration of three Catholic hospitals: St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare. A little over two years into our official integration, I’m sure our staff feel there are elements of VUCA to contend with as we grow together and align our priorities, policies and procedures to meet the challenges we face in health care today and into the future. Good leadership is extremely important during VUCA times. Without

it, organizations are at high risk. One tendency is to adopt a highly cautious approach. However, too much risk aversion in a VUCA environment can lead to organizations being left behind, and possibly even becoming irrelevant. In VUCA conditions, people can become very anxious and unsure of what to do. It is important for leaders in these situations to communicate well with staff to help them make sense of what is going on. Meaningful engagement of staff in developing strategies to navigate challenges can build trust and lead to greater success. It is also essential in these times for organizations to be well grounded in their mission and values, and to be laser focused on their vision – the lighthouse across the stormy sea. It is worthwhile breaking down VUCA into its components. VUCA conflates four types of challenges that can call for distinct approaches. As examples, volatility may require strategies to increase organizational resilience, uncertainly often calls for gathering lots of information, and complexity and ambiguity can be

approached with hypothesis generation and testing, for example, with Plan–Do–Study–Act cycles. Above all, leaders should embrace VUCA conditions and look for the opportunities presented by them. They have a Darwinian nature in that they drive innovation. Those that are able to thoughtfully and skillfully navigate VUCA storms will succeed, be stronger, and even thrive. As we enter into a VUCA world in health care in Ontario, I’m excited about the future. We have recently launched our strategic plan at Unity Health Toronto. Well aligned with the province’s plan for health care transformation, our vision statement is: The Best Care Experiences. Created Together. Grounded in the meaning and purpose in our work, we look forward to collaborating with our system partners, breaking down silos in our system, learning from leaders in other sectors, and partnering with those we serve – our patients, families and our communities. Together we will embrace the challenges ahead and create a better, more integrated and H sustainable health care system. ■

Dr. Tim Rutledge is the President and CEO of Unity Health Toronto, the Catholic health network consisting of St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare 20 HOSPITAL NEWS NOVEMBER 2019

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SPECIAL FOCUS

MEDICAL TECHNOLOGY MAKING A DIFFERENCE

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NOVEMBER 2019 HOSPITAL NEWS 21

MEDTECH 2019

Sixth annual

MedTech supplement n behalf of Medtech Canada, we’re very pleased to once again be a part of the Hospital News annual Medical Technology supplement. As the association representing the medical technology industry in Canada, this is a valuable opportunity to share perspectives on enablers of innovation and highlights of how technological innovation is transforming health care. Some readers may know our association from our previous name – MEDEC (Medical Devices Canada). Earlier this year we underwent a rebranding process, renaming our association to Medtech Canada. Our new name and its accompanying brand identity reflect the ever-evolving nature of the medical technology industry, which

is contributing to enabling the digitization of health care, providing more connected care and providing opportunities for more patient-centred care in community settings. As health care systems in Canada are increasingly focused on achieving more digital and patient-centred approaches to care, the medtech industry is there to provide safe and effective technologies and solutions that can make significant contributions to achieving these goals and enabling patients to live the lives they want to live. The work of our association has adapted in lockstep with these changes, working collaboratively with our health system partners towards improving patient care and our new brand identity reflects this.

At Abbott, we’re committed to helping people live their best possible life through the power of health. For more than 125 years, we’ve brought new products and technologies to the world – in medical devices, nutrition, diagnostics, and branded generic pharmaceuticals – that create more possibilities for more people at all stages of life. Today, 99,000 of us are working to help people live not just longer, but better, in the more than 150 countries we serve.

22 HOSPITAL NEWS NOVEMBER 2019

Brian Lewis President and CEO, Medtech Canada Medical technologies are a vital part of every facet of health care including ever-advancing cardiovascular devices, orthopaedic implants and diagnostic imaging equipment, which are just a few examples of this broad and patient-focused industry. Medtech Canada is a member-driven association, with committees focused on subsector-specific issues, as well as broader, industry-wide topics in areas such as promoting strategic procurement and funding reforms, regulatory affairs and championing the Canadian medical technology eco-system. Our association also brings together a variety of stakeholders through such avenues as our Hospital to Community Collaborative, which seeks to enable the important shift to community-based care and LabCanDx, a coalition from the laboratory medicine community (including health care providers, government, and industry) who seeks to ensure that laboratory

medicine continues to be recognized and supported as a patient-focused, integral and evolving component of healthcare. The medical technology industry has a very important role to play in enabling value-based health care (VBHC) and we are working closely with our partners to advance this shift, which will enhance patient outcomes and contribute to the sustainability of our publicly-funded health care system. We’re pleased to have included in this supplement a story that explores the current status of VBHC in Canada, barriers to its adoption and optimism for its future. We’re pleased that this edition of Hospital News is being distributed at Canada Health Infoway’s 2019 Partnership Conference. Medtech Canada is a proud sponsor of the conference and a participating organization of Canada Health Infoway’s ACCESS 2022 initiative, which seeks to enable Canadians to have access to their health information and digitally-enabled solutions to better manage their care. We’re also very pleased to use this opportunity to spread the word about The Medtech Conference (the largest medical technology focused conference in North America), which is taking place in Toronto on October 5-7, 2020. This is the first time the conference is being hosted outside the US and is a testament to Canada’s innovation ecosystem. Be sure to “Save the Date” to be a part of this tremendous conference. As 2019 nears its end, we’re looking forward to 2020 and continuing our efforts with our health system partners to enhance the quality of patient care, improve patient access to health care, and help enable the sustainability of H our health care system. ■ Brian Lewis President and CEO, Medtech Canada

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Pulmonary vein potentials seen with Advisor™ HD Grid Mapping Catheter, Sensor Enabled™, not captured on standard mapping catheter

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CAUTION: This product is intended for use by or under the direction of a physician. Prior to use, reference the Instructions for Use, inside the product carton (when available) or at manuals.sjm.com or eifu.abbottvascular.com for more detailed information on Indications, Contraindications, Warnings, Precautions and Adverse Events. United States — Required Safety Information Indications: The Advisor™ HD Grid Mapping Catheter, Sensor Enabled™, is indicated for multiple electrode electrophysiological mapping of cardiac structures in the heart, i.e., recording or stimulation only. This catheter is intended to obtain electrograms in the atrial and ventricular regions of the heart. Contraindications: The catheter is contraindicated for patients with prosthetic valves and patients with left atrial thrombus or myxoma, or interatrial baffle or patch via transseptal approach. This device should not be used with patients with active systemic infections. The catheter is contraindicated in patients who cannot be anticoagulated or infused with heparinized saline. Warnings: Cardiac

catheterization procedures present the potential for significant x-ray exposure, which can result in acute radiation injury as well as increased risk for somatic and genetic effects, to both patients and laboratory staff due to the x-ray beam intensity and duration of the fluoroscopic imaging. Careful consideration must therefore be given for the use of this catheter in pregnant women. Catheter entrapment within the heart or blood vessels is a possible complication of electrophysiology procedures. Vascular perforation or dissection is an inherent risk of any electrode placement. Careful catheter manipulation must be performed in order to avoid device component damage, thromboembolism, cerebrovascular accident, cardiac damage, perforation, pericardial effusion, or tamponade. Risks associated with electrical stimulation may include, but are not limited to, the induction of arrhythmias, such as atrial fibrillation (AF), ventricular tachycardia (VT) requiring cardioversion, and ventricular fibrillation (VF). Catheter materials are not compatible with magnetic resonance imaging (MRI). Precautions: Maintain an activated clotting time (ACT) of greater than 300 seconds at all times during use of the catheter. This includes when the catheter is used in the right side of the heart. To prevent entanglement with concomitantly used

catheters, use care when using the catheter in the proximity of the other catheters. Maintain constant irrigation to prevent coagulation on the distal paddle. Inspect irrigation tubing for obstructions, such as kinks and air bubbles. If irrigation is interrupted, remove the catheter from the patient and inspect the catheter. Ensure that the irrigation ports are patent and flush the catheter prior to re-insertion. Always straighten the catheter before insertion or withdrawal. Do not use if the catheter appears damaged, kinked, or if there is difficulty in deflecting the distal section to achieve the desired curve. Do not use if the catheter does not hold its curve and/or if any of the irrigation ports are blocked. Catheter advancement must be performed under fluoroscopic guidance to minimize the risk of cardiac damage, perforation, or tamponade. ™ Indicates a trademark of the Abbott group of companies. © 2019 Abbott. All Rights Reserved. 31672-SJM-ADV-0319-0072 Item approved for global use.

The best healthcare is value-based By Timothy Wilson he term Value-Based Healthcare (VBHC) was first made popular by authors Michael Porter and Elizabeth Teisberg in their ground-breaking work, Redefining Healthcare. In that book, which was published in 2006, the authors defined value as “the health outcomes achieved per dollar of cost compared to peers,” making clear that “financial results are an outcome, not the goal in and of itself.” As a concept, VBHC is both uncontroversial and easy to comprehend, but as a practical remedy it gets complex fast. Isolated funding silos, cultural resistance, activity – and service-based payments, the lack of actionable data – among many other factors – make VBHC a difficult nut to crack. That said, the ideal place to start with VBHC initiatives, in Canada and elsewhere, is in the hospitals, as they’re touched by so many parts of the system, while also facing serious challenges. “When looking at VBHC, hospitals represent the biggest opportunity, as they’re the biggest cost to the system,” says Dr. Jason Sutherland, Professor in the Centre for Health Services and Policy Research (CHSPR) in the

UBC Faculty of Medicine. “At present, about 10 per cent to 15 per cent of hospital beds are filled with patients who can’t be discharged due to lack of community support.” In the above example, it’s easy to see how value – both in terms of health outcomes and cost – could be increased if a service were bundled to include short-term care at home. In Ontario, this is exactly what’s happening at St. Joseph’s Healthcare Hamilton’s Integrated Comprehensive Care Demonstration Project (ICCP), which was the first in Ontario to pioneer a bundled care model. “St. Joes is a good place to promote VBHC, because we’re a teaching hospital that also has a homecare business,” says Melissa Farrell, President at St. Joseph’s Healthcare Hamilton. “This way, we can create an integrated practice unit across the two organizations.” Since 2015, St. Josephs Healthcare Hamilton has been joined by five other cross-provider teams in Ontario, all of which are piloting bundled models for patients who require short-term care at home after leaving hospital. This can apply to a range of clinical pathways, but is most easily implemented with

scheduled events such as cardiac surgeries and hip and knee replacements. Having a care model that crosses organizations is a big step forward, with St. Joseph’s also having had success in chronic care, such as congestive heart failure and chronic obstructive pulmonary disease. “It can look like you’re saving money when people are discharged without support, but those costs are just shifted into the community or return as a re-admission” says Farrell. “A bundled care model allows us to look beyond the walls of the hospital. That visibility is critical. From an integrated care perspective, the only way that VBHC works is with shared data – you need to track and monitor outcomes collectively.” This view is echoed by the Canadian Foundation for Healthcare Improvement (CFHI). In a report published last year, the CHFI noted the importance of identifying and measuring health outcomes for individuals and groups, and of tracking spending across full care pathways. The CFHI was clear that for VBHC to be realized, health care providers need to commit to deep engagement and collaboration, and to be ready to

participate in a process that is both data and evidence-intensive. In that regard, Canada still has some work to do. “Within the Ottawa Hospital, we have developed a data infrastructure, but in our current model in Canada, every hospital is its own entity,” says Dr. Alan Forster, Vice-President, Innovation, and Quality at The Ottawa Hospital. “As a result, access to data is a fundamental problem. We need to distribute our resources to deliver the best care, with a population perspective for all outcomes. Hospitals are ready to participate, because we carry a lot of risk, and are motivated to effect change.” That change can come in many forms. Bundled payments, as in the Ontario example, are a popular component of VBHC, because they can be implemented in a limited way, without disrupting the larger system. Value-based procurement initiatives for medical devices are also starting to take hold across the country, with organizations adopting purchasing practices that take into account the ongoing health of a patient, and the total cost to the system, as opposed to only addressing one-time hospital costs. Continued on page 26

24 HOSPITAL NEWS NOVEMBER 2019

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THEY SAY PROBLEMS ARE JUST OPPORTUNITIES IN DISGUISE

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MEDTECH 2019

Cover story Continued from page 24 â&#x20AC;&#x153;In most cases, current procurement approaches and siloed funding models in Canada still treat medical technologies as commodities which has contributed to Canada being a poor adopter of high-value innovations,â&#x20AC;? says Brian Lewis, President and CEO of Medtech Canada. â&#x20AC;&#x153;Given the substantial patient benefits and savings to the broader health care system that many technologies can provide, we continue to strongly advocate for VBHC and are pleased that itâ&#x20AC;&#x2122;s making headway here since it can enable the shift to new models of care and provides opportunities for high-value technologies to be recognized and adopted.â&#x20AC;? But without the right data, and unless the system is designed to respond to the right incentives, large-scale implementation of VBHC remains a challenge. â&#x20AC;&#x153;In Canada, we donâ&#x20AC;&#x2122;t have good ways of attributing cost to interventions, hospitalization or medical concerns,â&#x20AC;? says Dr. Sutherland from UBC. â&#x20AC;&#x153;We know the price of new drugs, of a

new technology or medical device, but overall â&#x20AC;&#x201C; with some narrow exceptions â&#x20AC;&#x201C; weâ&#x20AC;&#x2122;re not good at measuring costs.â&#x20AC;? By necessity, thatâ&#x20AC;&#x2122;s changing. Manitoba is moving forward with implementing a fully integrated value analysis program, which the province says will advance best practices through alignment with value-based procurement models. As with other provinces, Manitoba is reaching out to health care supply chain leaders, and procurement and value analysis specialists, to ensure that the right decisions get made, because at present tying procurement to outcomes remains comparatively rare. â&#x20AC;&#x153;In Canada, we need better data on outcomes and on cost at the population level, with clear lines of communication, and visibility,â&#x20AC;? says Dr. Forster from The Ottawa Hospital. â&#x20AC;&#x153;I canâ&#x20AC;&#x2122;t think of a successful industry that spends as much as we do and doesnâ&#x20AC;&#x2122;t have robust measures of impact.â&#x20AC;? There is an opportunity here to get creative, as in one innovative ap-

The SonoSite Solution for )MÇ˝ GYPX 5IVMTLIVEP IV Insertion The SonoSite Solution is designed to be a collaboration between SonoSite and you. The objective is to provide a VIEH] QEHI FYX LMKLP] QSHMÇť EFPI ERH WGEPEFPI GPMRMGEP TEXL[E] XS MQTVSZI WYGGIWW VEXI SJ HMÇ˝ GYPX 5IVMTLIVEP IV Insertions and reduce the need for CVCs. through the aid of point-of care ultrasound. As part of your FUJIFILM SonoSite, Inc. product purchase, FUJIFILM SonoSite, Inc. makes SonoSite Solutions available to you. The program is rooted in quality improvement science and includes a Resource Center that can help guide your practice through an entire improvement cycle. The available tools and resources are organized in a 5PER )S XYH] &GX 5) & G]GPI JSVQEX 8LI VIWYPX MW E self-guided, quality improvement project that will help MRGVIEWI WYGGIWW VEXI SJ 5.:W MQTVSZI TEXMIRX WEXMWJEGXMSR and eliminate the need for unnecessary CVCs. For more information on Â&#x2030;Ä&#x161;ĂĽĆ?Â&#x201E;Ĺ&#x2021;ÄťĹ&#x2021;Â&#x201E;Ä&#x17E;Ć&#x2019;ĂĽĆ?Â&#x201E;Ĺ&#x2021;ÄŽĆŁĆ&#x2019;Ä&#x17E;Ĺ&#x2021;ÄťĆ?ĂźĹ&#x2021;ĹšĆ?%Ä&#x17E;Ăž Ć?Ć?Ă?ĆŁÄŽĆ&#x2019;Ć? Peripheral IV Insertion GSRXEGX +YNMÇť PQ SRS MXI EX 1-425-951-1200 or e-mail /EGOMI LIVFWX%JYNMÇť PQ GSQ.

26 HOSPITAL NEWS NOVEMBER 2019

â&#x20AC;&#x153;I CANâ&#x20AC;&#x2122;T THINK OF A SUCCESSFUL INDUSTRY THAT SPENDS AS MUCH AS WE DO AND DOESNâ&#x20AC;&#x2122;T HAVE ROBUST MEASURES OF IMPACT.â&#x20AC;? proach supported by Public Health Agency of Canada, the Heart and Stroke Foundation, and the MaRS Centre for Impact Investing, in which social impact bonds support a threeyear community hypertension prevention initiative. Another example is New Brunswickâ&#x20AC;&#x2122;s Primary Health Care Integration Project, which embraces a risk/gain-sharing model to improve coordination and collaboration among services provided outside of hospitals. â&#x20AC;&#x153;The amazing thing about bundled payment for integrated care, as well as risk/reward models, is that they create shared incentives for quality and remove the walls around providers,â&#x20AC;? says Farrell. â&#x20AC;&#x153;People are now discussing how the entire continuum of care is paid for. Theyâ&#x20AC;&#x2122;re talking about the best way to structure payment and reward in order to deliver the best care in a cost effective manner. This has been difficult to do in the traditional siloed payment models.â&#x20AC;? When looking at the examples across Canada, it is critical to note that VBHC is not acting as a Trojan horse for private health care. Not only is VBHC not a threat to Canadaâ&#x20AC;&#x2122;s public health system, it may be that the Canadian system offers some advantages that are unavailable elsewhere. â&#x20AC;&#x153;One major benefit of the Canada Health Act, and the provincial and territorial delivery of healthcare, is that Canada delivers more equitable access to services, technology, and drugs, than do many other countries,â&#x20AC;? says Dr. Sutherland from UBC. â&#x20AC;&#x153;With VBHC, we could realize very substantial gains in effectiveness and value. Without changing how much we pay in taxes, we could still do much better.â&#x20AC;? Central to Sutherlandâ&#x20AC;&#x2122;s observation is the fact that, in a Canadian context, VBHC involves the ability to repeat success across jurisdictions. Though there are differences in how

provinces deliver care, there is no reason that what works in one province canâ&#x20AC;&#x2122;t work in another. One challenge is that, though stakeholders in Canada are aware of the importance of VBHC, not many are taking a leadership role. â&#x20AC;&#x153;When my colleagues and I attend conferences for the International Consortium of Health Outcomes Measurement [e.g. ICHOM], the Canadian presence is not substantial,â&#x20AC;? says David Barrett, Executive Director, Ivey International Centre for Health Innovation. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s clear that Europe is much further along in the VBHC movement, with countries like Sweden and the Netherlands taking the lead.â&#x20AC;? That may not seem like good news for Canada, but itâ&#x20AC;&#x2122;s not as bad as it sounds. Canada, like most countries, remains in an emergent phase, despite the fact that, according to CHFI, seven in 10 Canadian health leaders claim their organization is acting on a commitment to VBHC. In truth, all nations struggle to measure and implement VBHC. â&#x20AC;&#x153;We all agree we want better value in our healthcare system, but how do you measure health?â&#x20AC;? says Dr. Sutherland from UBC. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s a challenging question. We might want to assess someoneâ&#x20AC;&#x2122;s overall functional status. That could include mental health or physical pain, which is often ignored.â&#x20AC;? Since the publication of Redefining Healthcare, the bookâ&#x20AC;&#x2122;s fundamental message has held strong, resulting in increased awareness of the legitimacy of VBHC around the world and leading to Canadian initiatives such as bundled payments and procuring for longer-term value. Change is afoot, and the digital transformation of the entire health care system will make it easier for us measure the larger value, and to re-think how we organize and pay for health services. Ultimately, that should help us attain the real H goal: better health care for everyone. â&#x2013;

Timothy Wilson is a research analyst and business/technology journalist with a special interest in healthcare.t www.hospitalnews.com

MEDTECH 2019

Combining AI, machine learning and professional expertise By Arielle Zomer ur healthcare landscape is changing. Every day, hospitals in Canada and around the world face more and more challenges – a spike in the number of patients in distress against a backdrop of increasing work pressures and fewer resources. It is also a known concern that patients who visit any hospital can be at risk of adverse outcomes, or adverse events. In fact, according to data from the Canadian Patient Safety Institute and the Canadian Institute for Health Information, one in 18 hospital stays involved at least one harmful event. According to re-

search in CMAJ (Canadian Medical Association Journal), the costs of experiencing hospital harm amounted to more than $1 billion in Ontario in fiscal year 2015-16. At Humber River Hospital, patient safety and high reliability healthcare are key priorities. We looked at these incidents across the healthcare system and how these issues could be addressed. We needed a solution that could make a big systemic difference in improving the patient experience – not only in our hospital, but in hospitals around the world. We asked our physicians and staff what would make the biggest difference in helping to

LAST MONTH, HUMBER RIVER HOSPITAL LAUNCHED THE WORLD’S FIRST CLINICAL ANALYTIC APPLICATIONS OR ‘TILES’ INSIDE OF A HOSPITAL COMMAND CENTRE BRINGING A NEW STANDARD OF PATIENT-CENTRED QUALITY HEALTHCARE TO ONTARIO, AND THE WORLD. support them in providing better and safer care to patients. And they gave us 350+ ideas. We turned those ideas into action. Last month, Humber River Hospital launched the world’s first clinical

analytic applications or ‘tiles’ inside of a hospital command centre bringing a new standard of patient-centred quality healthcare to Ontario, and the world. Continued on page 28

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Galen BT, Southern WN. Ultrasound-Guided Peripheral Intravenous Catheters to Reduce Central Venous Catheter Use on the Inpatient Medical Ward. Quality Management in Healthcare. 2018 Jan/Mar;27(1):30-32. https://www.ncbi.nlm.nih.gov/pubmed/29280905. Accessed September 30, 2019. Ultrasound-guided vascular access program saves St. Joseph’s $3.5 million https://www.beckershospitalreview.com/quality/ultrasound-guided-vascular-access-program-saves-st-joseph-s-3-5-million.html. Accessed April 1, 2019.

SONOSITE, and the SONOSITE logo are trademarks and registered trademarks of FUJIFILM SonoSite, Inc. in various jurisdictions. FUJIFILM is a trademark and registered trademark of FUJIFILM Corporation in various jurisdictions. All other trademarks are the property of their respective owners. Copyright © 2019 FUJIFILM SonoSite, Inc. All rights reserved. Subject to change. MKT03427 10/19

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NOVEMBER 2019 HOSPITAL NEWS 27

MEDTECH 2019

Combining AI Continued from page 25 These new clinical applications or analytic ‘tiles’ are displayed on largescreen monitors in the Hospital’s Command Centre, with key items alerted immediately to the staff or physician’s dashboard. The ‘tiles’ integrate standardized early warning systems, predictive analytics, real-time information from multiple digital systems, and professional expertise to provide an added layer of protection for patients with conditions that make them more vulnerable to risks of adverse events, or adverse outcomes. Through this process, clinical staff can be alerted to a changing patient’s condition even sooner, so that they can intervene to keep that patient on track and advancing towards becoming healthy. “This evolution in our technology-rich Command Centre marks a significant step in our pursuit of high reliability healthcare. Humber River Hospital is the first in the world to build such analytics and deploy them alongside clearly defined procedures, with the hospital’s Command Centre

L-R: Jhanvi Solanki, Dr. Susan Tory and Jane Casey in Humber River Hospital’s Command Centre as a back-stop. We want what’s best for our patients and this just enhances our ability to revolutionize that experience and deliver even higher quality care,” says Barbara Collins, President and CEO of HRH.

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Humber River Hospital’s vision for high reliability healthcare is clearly manifested in our clinical analytic tiles. For instance, the Mother and Baby tile alerts our front-line staff and physicians in the Obstetrical Unit and the Clinical Expediter in the Command Centre when an expectant mother or newborn is at elevated obstetrical risk, which our hospital staff developed when we were designing these tiles. The goal of the Mother and Baby tile is to support patients in the Labour and Delivery Unit and in the Newborn Intensive Care Unit (NICU) and to reduce unpredicted rates of illness. Similarly, the new Risk of Harm tile is designed to help reduce the likelihood of adverse events for patients who are at an elevated risk of harm, such as sepsis or an infection. The Delays in Care tile includes a number of items based on the Registered Nurses’ Association of Ontario (RNAO) best practice guidelines related to falls risk intervention, wound and skin management, pain management and delirium. A seniors’ care tile focused on mobility, dietary intake early ambulation and medications causing risk is of particular focus on preventing deterioration that often accompanies hospitalization for this vulnerable population. “Staff immediately saw the benefits to patients and it empowered them to

continuously improve and streamline our clinical and digital processes where it could add even greater value to patients,” adds Collins. Since the launch of its Command Centre, Generation One, HRH has unlocked inpatient capacity equivalent to 35 additional beds, eliminated hallway medicine and reduced Emergency Department wait times, despite experiencing eight per cent growth in ED volume during this same period. Our new quality tiles, referred to as Generation Two, show how we can harness the power of clinical data and innovative technology to transform the delivery of healthcare, not only for Humber River’s patients, but for patients across Ontario and around the world. As a leader in the digital transformation of care delivery, we are making our methodology available to hospitals around the world because the only way for healthcare to continuously improve is to build on each other’s successes. The launch of these four new analytic tiles in the HRH Command Centre marks a major milestone in the hospital’s multi-generational roll-out. The next phase will introduce additional Command Centre functionality, with analytics designed to further integrate the hospital with the community it serves, so that more patients can reH ceive care at home. ■

Arielle Zomer is Manager of Public Affairs at Humber River Hospital. www.hospitalnews.com

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MEDTECH 2019

Heart pump helps patient live to see grandchildren By Taresh Mistry ina Amaral cherishes the two young granddaughters she never would have met, had it not been for the tiny device in her heart that keeps her alive. The Toronto woman had difficulty believing she’d live long enough to become a grandmother. Her doubt was justifiable – she had nearly died on several occasions over the years since she was diagnosed with Cardiomyopathy in her early forties. But this past summer, as Amaral marked her ninth year living with a Left Ventricular Assist Device (LVAD) – a record length of time in Canada for a patient with an LVAD system – she also celebrated the birth of two granddaughters less than two months apart. “It’s been a challenge, but I’m still here, you know, as long the good Lord wants me to be,” she says. “I told my doctors I wanted to stay alive long enough to see my first grandchild, and now I have two beautiful granddaughters. My blessings outnumber my challenges.” Amaral is among approximately one million Canadians currently living with heart failure, who have a mean survival rate of just over two years. Amaral’s heart problems began in middle age when she was a busy mother of four daughters and grew progressively worse until she was identified as a heart transplant candidate. Initially, she relied on a variety of medications to treat her illness and improve blood flow, but nearly a decade ago her medical team decided more medicine alone was not going to keep her heart working. She also experienced several additional health complications which ruled out a potentially life-saving heart transplant. The cardiology team at Toronto General Hospital and surgeon Dr. Vivek Rao implanted an LVAD in Amaral’s heart – a Medtronic Heart-

Lina Amaral with her grandchildren. Ware HVAD System – which has allowed her to beat the odds for the past nine years. “I didn’t think I would make it this far. It’s a big blessing,” Amaral says. The HVAD System features the world’s smallest, commercially available, centrifugal flow pump. Weighing only 160 grams, the system’s continuous flow pump is 30 per cent thinner and has 38 per cent less volume than other centrifugal-flow devices. Earlier this year, Health Canada authorized the HVAD System as destination therapy for patients like Amaral with advanced heart failure who are not candidates for heart transplants. Many patients with end-stage heart failure have other medical conditions or health histories that make them ineligible for a heart transplant. The HVAD System is also available as a bridge to heart transplant in eligible patients.

Health Canada also authorized a less-invasive implant procedure for the HeartWare HVAD Pump, making it the only LVAD licenced in Canada for implant via thoracotomy. The procedure involves a small, lateral incision between the patient’s ribs on the left side of the chest instead of the traditional median sternotomy procedure, which requires more-invasive surgery to divide the sternum. Thoracotomy has been clinically shown to reduce the average length of recovery in hospital and higher patient satisfaction. Now that funding in Ontario has been made available to implant the HVAD System in destination patients as well as those awaiting heart transplants, Dr. Rao has said he hopes to see more patients benefit from the technology. Dr. Rao and his team currently implant approximately 30 of the devices

annually, but they’ve set a target to increase that number to 90 implants annually in three years. “Patients with heart failure who are not transplant candidates typically only have one or two years to live,” says Dr. Rao. “But those who get ventricular assist devices can get their life back and can remain active. They’re not restricted by heart failure anymore.” Amaral is making the most of her new lease on life and enjoying every minute with her growing family. “Be thankful every day that you wake up, that’s my philosophy,” she says. “If you’re alive in the morning and get to go to sleep in a cozy bed at night, you should be grateful.” Worldwide, more than 18,000 patients have received the HVAD System since it was first approved in EuH rope in 2009. ■

Taresh Mistry is the Marketing Manager for Mechanical Circulatory Support & Heart Failure Solutions at Medtronic Canada. 30 HOSPITAL NEWS NOVEMBER 2019

www.hospitalnews.com

MEDTECH 2019

The MedTech Conference coming to Canada for the first time

SAVE THE DATE

TORONTO OCTOBER 5–7, 2020 METRO TORONTO CONVENTION CENTRE | TORONTO, ONTARIO

he Advanced Medical Technology Association (AdvaMed), Medtech Canada’s counterpart association in the United States, is bringing its annual MedTech Conference to the Metro Toronto Convention Centre from October 5-7, 2020. With this decision, organizers have chosen Canada to be the first host country for the conference outside the United States.

The MedTech Conference, which is the largest medical technology-focused conference in North America, attracts more than 3,000 attendees from around the world each year for three days of educational programming, patient stories, technology showcases, networking opportunities and more. AdvaMed’s decision to bring the conference to Canada was based on multiple factors, but a significant im-

THE ADVANCED MEDICAL TECHNOLOGY ASSOCIATION IS BRINGING ITS ANNUAL MEDTECH CONFERENCE TO THE METRO TORONTO CONVENTION CENTRE FROM OCTOBER 5-7, 2020.

Patients share their stories at the Patient Pavilion at The Medtech Conference. Source: The Medtech Conference.

www.hospitalnews.com

petus is Canada’s strong medical technology innovation environment. The 2019 edition of the conference recently took place in Boston and with over 300 participants, the Canadian delegation was the largest of all in attendance – building tremendous momentum for 2020 in Toronto. The delegation included dignitaries such as Pierre Fitzgibbon, Quebec’s Minister of the Economy and Innovation; Nina Tangri, Ontario’s Parliamentary Assistant to the Minister Economic Development, Job Creation and Trade; Michael Thompson, Deputy Mayor of Toronto; and Patrick Brown, Mayor of Brampton. “Canada is becoming more and more of a medtech power each year,” says Scott Whitaker, president and CEO, AdvaMed. “We look forward to working with our local partners to showcase Toronto’s booming health technology ecosystem at The MedTech Conference in 2020.” “Bringing the Medtech Conference to Toronto presents an opportunity for

all of us and also all of you–clinicians, medical researchers, research scientists, business leaders, entrepreneurs, academics – all to come together and have important conversations about the future of medical science and how to advance this sector,” says Toronto Mayor John Tory in a video address to conference attendees. AdvaMed will partner with Medtech Canada to ensure that the conference reflects and highlights the local Canadian medtech community, which is home to more than 1,500 medical technology companies. “We’re very pleased that the largest medical technology-focused conference in North America has chosen Toronto to be its first host city outside the United States,” says Brian Lewis, President and CEO, Medtech Canada. “Great things are happening in the Canadian medtech marketplace, and we look forward to working closely with AdvaMed and The MedTech Conference planning team to contribute to H this world-class event.” ■

NOVEMBER 2019 HOSPITAL NEWS 31

ETHICS

Money for value:

Exploring the differences between compensation and honoraria By Dolly Menna-Dack ith evidence that supports the engagement of health system users, the changing expectations of pan-Canadian regulatory and granting agencies, a new role in the healthcare system has emerged – the Patient Partner. Across health and research systems Patient Partners are a recognized as important stakeholders and collaborators in co-design. The Multidimensional Framework for Patient and Family Engagement in Health and Health care, developed by Carmen et al outlines the levels of engagement: Direct, Organizational, Systems and the continuum of engagement: Consultation, Involvement, all the way to Partnership and Shared Leadership.

While there might be varying degrees of active patient partnership at the local level, it is widely accepted as a best practice. Take for example the change to Accreditation Canada’s standards, released in 2016. The new standards reflect an explicit change that highlights that patient engagement is an expectation for health care across Canada. The primary qualification of a Patient Partner is in having experience of being a individual who has received care/ participated in research themselves, or has acted as caregiver to an individual engaging in one or both of these activities. Requirements or qualifications beyond this are often determined at the local level where Patient

32 HOSPITAL NEWS NOVEMBER 2019

Partners with particular experiences in health care or research may be sought, organizational training provided, education sessions delivered, and registration in a patient partnership program may also be necessary aspects of the role. Compensation has become a hot topic in the world of patient partnership. There are well known groups and institutions that can be looked to for guidance on this. In Ontario, The Change Foundation has created a tool, Should Money Come into it? to aid in decision-making around whether a Patient Partner should be paid, and in the United Kingdom, INVOLVE, funded by National Institute for Health Research, has many resources to support

those wanting to include Partners who are paid in aspects of research projects. It is also clear from the literature that there is a belief and recommendation that Patient Partners should not be spending their own money in order to participate in partnership activities. The recommendations range from covering “typical” costs like parking and providing refreshments all the way to covering costs which include things like child care, and personal support assistants to remove barriers to participation. There are many papers devoted to why Patient Partners should be compensated, suggestions for how, and how much. One paper, authored exclusively by a group of such individuwww.hospitalnews.com

ETHICS als entitled, Patient partner compensation in research and health care: the patient perspective on why and how focuses on why compensation is important. The need to explore payments and other barrier-removal offerings is clearly important when working with patient partners, however after reading this and so many other papers, as well as working closely with Patient Partners, I cannot help but wonder if compensation is just not the right word for recognizing the work of Patient Partners. Compensation has two important dictionary definitions; firstly it “typically refers to money awarded to someone as a recompense for loss, injury or suffering,” and it is also understood to mean the money received by an employee as a salary or wage. Frankly neither of these definitions seem appropriate when attempting to recognize or value a Patient Partner’s contributions. Although a clear line can be drawn between the desire to ensure that Patient Partners

THE NEED TO EXPLORE PAYMENTS AND OTHER BARRIER-REMOVAL OFFERINGS IS CLEARLY IMPORTANT WHEN WORKING WITH PATIENT PARTNERS. are not out-of-pocket for expenses related to their own participation in health care and research collaborations, it is not in this vein that “compensation” is generally understood. Instead, authors like Richards, et al (2018) believe that there is a difference between a Patient Partner receiving an “expense payment” and a “compensation” payment. And if compensation is typically viewed as a recompense for loss or suffering, are we suggesting that we are hoping to compensate Patient Partners for sharing “their expertise (which is) often based on very personal, sometimes emotional stories and experiences” (Change Foundation, 2019)? It does not seem possible that

we could ever be in the position to suggest that recompense is needed, nor could we ever understand what could be appropriate to offer or provide; it is beyond the scope of the partnership between system collaborators and Patient Partners. Patient Partners function in volunteer roles, not as staff receiving a regular salary. Therefore the term compensation adds another layer of confusion to the realm of Lived Experience Roles because there are a number of paid roles in the system. While possibly less well known, these roles seek to embed individuals with lived experience as regular team members, like CAMH’s Peer Support Worker and Holland Bloorview Kids Rehabilitation Hospi-

tal’s Youth Facilitators. These regular staff roles, along with funded Patient Advisor roles clearly offer compensation – a salary or wage – the way other traditional roles in the system do. If we start from the premise that volunteer Patient Partners are necessary stakeholders that bring invaluable insights to the co-design process, then we must continue the conversation of how to offer cover out-of-pocket expenses and how to talk about demonstrating the value of the Patient Partners. A term that is already in use for this use for this purpose and utilized broadly in society is “honoraria.” The strength in the term honoraria is that it is openly acknowledging that the amount of money provided is not reflective of the value of the work that has been done, but rather viewed as a way to say thank you (Ryerson University, 2019). This simpler term carries an important message to Patient Partners: your lived experience contributions are invaluable, and we thank H you. ■

Dolly Menna-Dack, MHSc is a Clinical Bioethicist at Holland Bloorview Kids Rehabilitation Hospital.

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DOCTORS WITHOUT BORDERS

By Angela Prisovsky ou’ve got to adapt,” my colleague Joseph said matter-of-factly as I felt the panic levels rise in my stomach. I was furiously swatting black flies from my face and struggling to pitch my tattered tent in the dark as I watched my colleagues set up their tents with ease. After watching my failed attempts, Joseph helped me pitch my tent. I tried to fall asleep with pervading thoughts that I was in way over my head. We had arrived in Loya, a remote village on the banks of the Lomami river in the Democratic Republic of Congo, just as the sun was setting. It was our second day of travel by pirogue, a traditional canoe, under the unforgiving sun. We were on our way to a village called Yahisuli, another full day’s travel south on the Lomami river. Yahisuli and its surrounding areas had been hit by a measles outbreak and our objective was to set up health centers to treat the children who had already been affected, to support local staff and to lessen the impact and spread of the disease by conducting a mass vaccination campaign. Although it gets significantly less media coverage than Ebola, the measles epidemic in the DRC is arguably just as damaging. With more than 1,500 officially recorded measles-related deaths in the first five months of 2019, the current outbreak is one of the deadliest the country has ever seen. It is a disease that affects the young and can cause complications such as diarrhea, pneumonia and encephalitis in those five years and younger. I worked with a team called “PUC” or Pool d’urgence Congo, an emergency team with a mix of medical and logistical experts that respond rapidly to infectious disease outbreaks anywhere in the country. The team travels by any available means to reach the site of an outbreak: By dirt bike, land cruiser, plane, pirogue or by foot. This was my first assignment with Doctors Without Borders/Médecins Sans Frontières (MSF) but I had previously volunteered in a pediatrics hospital in northern Laos. While in the DRC, I had the opportunity to take part in two measles vaccination campaigns, in the provinces of Tshopo and Sud-Ubangi.

“

34 HOSPITAL NEWS NOVEMBER 2019

www.hospitalnews.com

DOCTORS WITHOUT BORDERS

Combatting one of the world’s most deadly measles outbreaks A pharmacist by profession, I have worked in a variety of settings a mental health facility, an outpatient hospital and a community pharmacy. I’ve dreamed of working for MSF since pharmacy school and it was pretty surreal for me to be able to be in the field in such an intense context. My main objective with the PUC was to manage the supply, and assure the quality, of medicines and all medical supplies while in the field. I learned quickly that in order to live and work with the PUC, you have to be flexible and at times creative. As you can probably imagine, maintaining the temperature of medications can become complicated when you are travelling hundreds of kilome-

ALTHOUGH IT GETS SIGNIFICANTLY LESS MEDIA COVERAGE THAN EBOLA, THE MEASLES EPIDEMIC IN THE DRC IS ARGUABLY JUST AS DAMAGING. tres and have only a tent to house your supplies. I was also responsible for order management. In a community pharmacy, you can expect a medication order to be delivered the day after you place it. In the field, it may take weeks to receive a medical order. This requires consumption and epidemiological data analysis to avoid stock

outs and to ensure a steady supply of medication. This especially becomes critical when taking into account key antibiotics in the midst of a measles outbreak. As a pharmacist with the emergency team, I also took on a logistical role. I learned how to transport and conserve vaccines and how to track temperatures using different indicators. In addition to medical

staff, as a pharmacist you collaborate closely with logistical and supply staff to ensure the smooth continuation of the intervention. It was amazing to see firsthand the emergency machine in action, working tirelessly to quell an epidemic that has already taken such a toll on a country that has suffered so much. The PUC became more than just my colleagues; they became my family. Any difficulties or challenges I faced during interventions just became shared experiences. There is a resilience that lies within the PUC and I hope that I built up some of that resilience within me during my short time H on the team, too. ■

Angela Prisovsky is a pharmacist from Kitchener, Ontario

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podcast.csmls.org www.hospitalnews.com

NOVEMBER 2019 HOSPITAL NEWS 35

NEWS

#ConquerSilence

to improve medication safety By Virginia Flintoft ConquerSilence is a campaign led by the Canadian Patient Safety Institute to catch mistakes before they happen. We want people in Canada to know that if something looks wrong, feels wrong, or is wrong – they need to speak up. One in three Canadians has suffered from preventable healthcare harm, and yet collectively most people are unaware that the problem exists. This is a silent epidemic. The silence forms a barrier between patients and provid-

ers, between colleagues in healthcare facilities, between administrators in different regions, and between the public and policymakers. If we do nothing, 1.2 million Canadians will die from preventable patient harm in the next 30 years. We can battle systemic silence in our efforts to reduce patient harm together. In Canada, harmful incidents associated with medications are among the most frequent cause of patient safety incidents. The 5 Questions to Ask About Your Medications is one tool that healthcare providers are using to help patients and advocates speak up. The Canadian

IN CANADA, HARMFUL INCIDENTS ASSOCIATED WITH MEDICATIONS ARE AMONG THE MOST FREQUENT CAUSE OF PATIENT SAFETY INCIDENTS. Patient Safety Institute teamed up with the Institute for Safe Medication Practices Canada, Patients for Patient Safety Canada, the Canadian Pharmacists Association, and the Canadian Society for Hospital Pharmacists to create a list of top questions to help patients and their caregivers have a conversation about

medications with their healthcare provider. When care providers change, doses change, or medications change, those are signals to speak up and ask questions. The 5 Questions tool is available in 25 different languages. In early 2019, the Canadian Patient Safety Institute launched an 18-month

Canada Health Infoway’s journey into technology By Mario Voltolina hen Canada Health Infoway (Infoway) was established in 2001, some people thought digitizing our health system would be easy, and fast, completed in about a decade. Others, like those of us who are in the technology field, knew it would be hard, and we would never be finished because there will always be new technologies that can be adapted to benefit health care. At Infoway, we have embraced these challenges and evolved over the years. Many of you will know that about three years ago Infoway established PrescribeIT®, Canada’s national e-prescribing service. You may also know that more recently we embarked on an initiative called ACCESS Gateway, a technology service that enables data sharing and the delivery of digital health services to Canadians. What you might not know is how we got to this point, and where we intend to go next. I’ll talk about that journey at the 2019 Infoway Partnership Conference, taking place in Ottawa from November 12-13, and I hope you’ll join me. This year’s conference also has a great line-up of distinguished national and

international speakers, including: Dr. Simon Eccles, Deputy CEO and Chief Clinical Information Officer of NHSX, the unit that is leading digital health strategy for England’s National Health Service; Ry Moran, Director of the National Centre for Truth and Reconciliation; Holly Witteman, Associate Professor in the Department of Family and Emergency Medicine at Université Laval in Quebec City; Dr. Jeffrey Turnbull, Medical Director of Ottawa Inner City Health Inc.; and Alexandre Le Bouthillier, Co-Founder of Imagia. I don’t want to give everything away before my presentation, but you can expect to hear about some of the lesser-known technologies and associated services Infoway has built and operated over the years. For example, we have provided national leadership in interoperability standards. We’re the National Release Centre for several messaging and vocabulary standards that ensure that health information is standardized and shareable. We also operate InfoCentral, an online community platform that enables collaboration among clinicians, digital health representatives, vendors, developers and others. The platform also provides convenient access to resourc-

es, such as interoperability specifications and APIs, that enable developers to implement interfaces to health information systems faster and more efficiently. In addition, we developed and operate Terminology Gateway, where users can browse and download terminology content, subset data and code systems. Over the years, Infoway has built software as well as collaboration tools, developer tools and standards tools. For example, Infoway Message Builder abstracts the complexity of HL7v3 messages and greatly simplifies the work of developers when implementing them. And Infoway HL7 Explorer is a powerful browser that makes it easier and more efficient to locate details and information about HL7 v3 structures, vocabulary and references. With PrescribeIT®, we decided to establish the service on a platform that is run by a technology partner. ACCESS Gateway will be a shared platform, developed by Infoway and partners, with services exposed via a large number of digital health applications and providers. The objective is to have a single focal point for health data, instead of islands of data across the country. The goal is to provide

Canadians with secure access to their health information to digitally-enable health services. Identity, access and consent are the first components we’re working on for ACCESS Gateway. During my talk at Partnership, I’ll walk through a demonstration of how identity management would work on a phone and computer, and I’ll talk about where we’re going next with the Gateway. Infoway’s journey into technology has been interesting and exciting. Many of you have been a part of that journey, and we look forward to working with you on the next leg. Infoway’s journey has always involved close collaboration and true partnerships with all of our stakeholders – Canadians, clinicians, governments, industry and innovators – and that will continue. By working together, we will realize our collective vision of providing Canadians with secure access to their health information anytime, anywhere, from the device of their choice. To see the full program for the 2019 Infoway Partnership Conference, go to https://bit.ly/2II2iRr and to register, go to https://bit.ly/2wd8g5M. I look forH ward to seeing you there! ■

By Mario Voltolina is the Chief Technology Officer and Executive Vice President, Product Engineering & Operations, Canada Health Infoway. 36 HOSPITAL NEWS NOVEMBER 2019

www.hospitalnews.com

NEWS Safety Improvement Project to address medication safety at transitions of care for frail, elderly populations. Five teams are participating in the collaborative, two from ambulatory care and three from acute inpatient care settings, including: British Columbia First Nations Health Authority (Klemtu, BC); Cancer Care Manitoba; the University Health Network (Toronto, ON); Niagara Health System (St. Catharine’s site); and Middlesex-London Health Unit (Strathroy Hospital site). Each team is approaching their safety improvement project differently, with the common goal of reducing harm. The teams have developed aim statements, are implementing interventions, and monitoring data to assess their progress in achieving their goals. The process is guided by a quality improvement/knowledge translation learning design. The teams will report back on their projects and share their learnings in April 2020. To date, the work has resulted in system changes to improve patient

Mike Cass presenting on the World Health Organization Med Safety Challenge at a Medication Safety at Transitions of Care Safety Improvement Project learning session. flow and standardized medication reviews. Medication reconciliation practices are being incorporated into the improvement projects. Some innovative changes are being introduced, such as pharmacists doing routine

follow-up with patients for up to three months, and fabric bags for medications and supplements given to every patient so that a medication review can be completed with the hospital pharmacist. The 5 Questions tool is

also being used by providers as an education tool to help patients speak up about their medications. For more information or to speak up for medication safety, visit www.conH quersilence.ca ■

Virginia Flintoft, Senior Project Manager, Canadian Patient Safety Institute leads the Medication Safety at Transitions of Care Safety Improvement Project.

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LONG-TERM CARE NEWS

The future of healthy aging By Rebecca Ihilchik he Canadian population is aging faster now than at any time in our history. The latest estimates suggest that nearly 750,000 Canadians are currently living with dementia, and that number is expected to double in the next 20 years. Technology will play a crucial role in the way we understand and treat dementia, and effective innovations will make all the difference in the quality of life of older adults, their families, and caregivers. The Centre for Aging + Brain Health Innovation (CABHI), powered by Baycrest, enables and accelerates the testing of promising solutions in real-world care settings, to the benefit of all of us as we age. Over the past four and a half years, CABHI has funded more than 210 projects from across Ontario, Canada, and around the world, and validated them in more than 100 care sites across North America. In addition to financial support and clinical validation, CABHI provides innovators with acceleration services and access to its global networks of partners, including distribution channels and science and business advisors. Below, we spotlight five CABHI-supported innovations that are on their way to improving the quality of life of older adults worldwide.

SMART BED SHEET The people most at risk of bedsores (also called pressure ulcers) are those with limited ability to change positions or those who spend most of their time in a bed or chair – namely, older adults. Startup Curiato is tackling the issue with their innovative skin-data platform that collects patient data from a bedsheet with built-in sensors, so bedsores and other pressure injuries can be accurately predicted and prevented. The system works with existing hospital beds and uses artificial intelligence (AI) to analyze and deliver data to care teams in real-time using a digital interface.

With CABHI’s support, Curiato is testing their solution with individuals living with dementia in long-term and acute care institutions. The goal is to help frontline medical teams prioritize procedures and increase the quality of life for those at risk of pressure injuries.

DIGITAL PHYSICAL THERAPY PLATFORM With the rising number of older adults in Canada and the ever-increasing need for physical therapy and rehabilitation, there is a persistent gap in access to treatment. To overcome this barrier, Portuguese startup SWORD Health has created a digital platform that enables older adults to perform their physical therapy independently at home, under the remote watch of a clinical team. With support from CABHI, SWORD Health is validating their innovation in collaboration with CBI Health Group, the largest provider of community healthcare services in Canada.

DAILY SUPPORT FOR OLDER ADULTS LIVING WITH DEMENTIA DataDay is a user-friendly app that provides daily support, reminders, and monitoring to individuals living with early dementia or mild cognitive impairment. Audio, text, and visual prompts remind users to carry out tasks and activities like preparing meals or taking medications, providing greater independence for those living at home. The app can also help older adults and their families spot the earliest signs of change, and allow clinical teams to assess individuals remotely. Monitoring helps caregivers and clinicians proactively identify any emerging issues, and thereby prevent avoidable hospitalization or trips to the emergency room. DataDay was co-created with people living with dementia by Dr. Arlene Astell at Ontario Shores Centre for Mental Health Sciences (now at UHN).

ElliQ is a social robot that aims to reduce social isolation and loneliness amongst older adults by providing companionship, enrichment and support.

CABHI PROVIDES INNOVATORS WITH ACCELERATION SERVICES AND ACCESS TO ITS GLOBAL NETWORKS OF PARTNERS, INCLUDING DISTRIBUTION CHANNELS AND SCIENCE AND BUSINESS ADVISORS. A HOSPITAL BED FOR THE 21ST CENTURY Norwegian company Ably Medical is using state-of-the-art sensor technology and machine learning to develop and test the Ably Bed, a bed that actively assists nurses and works to protect patients at risk for falls and pressure ulcers. With CABHI support, Ably Medical is testing and evaluating the bed at four Ontario hospitals: Hamilton Health Sciences, West Park Health Centre, Southlake Regional Health Sciences, and Mackenzie Health.

SOCIAL ROBOT COMPANION ElliQ is a social robot that aims to reduce social isolation and loneliness

amongst older adults by providing companionship, enrichment and support. ElliQ acts both as an assistant – by providing reminders of calendar appointments, receiving and sending messages, displaying photos from family and friends – and as a companion, by acknowledging the older adult when they enter a room, wishing them good morning, greeting them when they come home, and more. CABHI helped broker a relationship between Intuition Robotics, the company behind ElliQ, and two independent living homes to test the extent to which ElliQ can decrease feelings of loneliness and isolation in seniors. The clinical validation testing is currently underway. H Learn more at www.cabhi.com. ■

Rebecca Ihilchik is the Senior Communications Specialist at the Centre for Aging + Brain Health Innovation. t 38 HOSPITAL NEWS NOVEMBER 2019

www.hospitalnews.com

LONG-TERM CARE NEWS

Snacks in long-term care By Dale Mayerson and Karen Thompson nacks are an important component of the resident nutrition program in longterm care (LTC). They provide increased nutrients and fluids, and are especially important for residents who do not eat full meals in the dining room.

WHY SNACKS? For residents with small appetites, snacks help to avoid hunger between meals. Many elderly people are easily fatigued and experience early satiety related to delayed gastric emptying. Both of these factors suggest a need for small,

more frequent meals allowing residents to take their snacks as they are able. The plan of “six small meals a day” helps to keep residents well nourished.

PLANNING SNACKS Every resident in LTC should be offered between-meal snacks according to the policies of the home and standards of the province. Snacks are considered part of the meal cycle, which is usually three or four weeks long, and should be planned at the same time as the meals. In this way, snacks complement the meals, optimize variety and avoid repetition. For example,

if cheese is served at breakfast, the evening snack should not be a cheese sandwich. Residents Council reviews the menu after it has been developed. If the home has a food committee, the committee is likely involved in helping to plan the menus.as well The usual snack plan includes a mid-morning drink, a 2 PM snack and a drink, and an 8 PM snack and a drink. Snack menus should include well liked nutrient dense foods and beverages. Items that include protein, vitamins and minerals help residents to maintain their health and weight. Increased meat portions, extra cheese, peanut

butter, and yogurt will all increase protein and can be easily added between meals. Other nutritious foods are milk, milkshakes, cookies, muffins, ice cream, puddings, fruit, cheese and crackers, and sandwiches. Eggnogs should not be homemade, since raw eggs are not considered safe due to risk of salmonella. Commercial eggnogs have been pasteurized and are safe to use. Seniors lose their ability to recognize thirst so drinks should be offered to residents frequently. For snack times, pitchers of juice, water, milk and/or hot beverages should be offered. Continued on page 40

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LONG-TERM CARE NEWS

Snacks

Continued from page 41 Some residents enjoy warm milk or decaffeinated coffee before bedtime. Adequate fluid intake can save residents from increased suffering and staff from increased work. This is especially important during hot weather conditions when residents are at increased risk. Popsicles and freezies should be available and offered frequently in hot weather to keep residents well hydrated. Foods and drinks served at snack times need to be provided for all diet types and all textures. For example, cookies and sandwiches can both be pureed

for residents who require a pureed texture. Recipes are available for all texture-modified foods on the snack menu. Portion sizes are planned and servers reference current lists outlining specific dietary needs of each resident for all diets and texture modifications. Written procedures will guide staff on how to manage snacks for a resident who is napping or away at the time of snack delivery. Nutritional supplements may also be served at snack time as ordered according to resident’s individual needs. Residents receiving a nutrition supplement should be offered a snack in addition to their supplement unless otherwise indicated in their plan of care. Staff will report if residents are refusing snacks so that changes can be made according to the resident’s individual needs and wishes.

SERVING SNACKS Similar to dining, snack time is an opportunity to encourage social

interaction. Snacks may be served from a central location or passed from room to room according to the needs of the residents. Staff provide assistance to those residents who require help in taking their food/fluids and should monitor and document consumption for all residents. Staff records each resident’s intake at snacks just as they do for residents at meal times. Serving staff must also understand and practice the principles of proper food handling for the snack service. Sandwiches and dairy products should not be left sitting at room temperature for later consumption but should be stored in a refrigerator until the resident is ready for them.

24 HOUR AVAILABILITY Food supplies are available for nursing staff to distribute for night emergencies and resident snack requests. A home policy should support the 24 hour

availability of food and fluid to ensure that incidents of diabetic hypoglycemia and overnight hunger can be managed. Residents with dementia may wake up during the night and should have access to nutrient rich snacks. A pantry stocked with food items and a kettle, toaster and/or microwave help staff to provide a quick snack to residents at any time of the day or night. Since LTC homes have a limited food budget, most of the spending for meal planning goes towards the meals, focusing on appetizing protein items and tempting desserts. There is consideration, however, towards improving snack quality to include foods that provide vitamins and minerals that may be lacking in meals, especially for those who don’t eat well or who can’t eat a lot at any given time. The snack menu cycle is planned for attractive presentation, variety and to enhance the overall fluid and H nutrient intake. ■

Dale Mayerson, BSc, RD, CDE, and Karen Thompson, BA Sc, RD are Registered Dietitians with extensive experience in Long-term care. They are coauthors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians in Canada.

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LONG-TERM CARE NEWS

Peer-to-Peer Clinical Team

provides greater meaning for virtual care By Sarah Quadri ary Curtis is delivering extraordinary, virtual, patient care. At the same time, she’s also educating and supporting her peers on the frontline – empowering them with the knowledge and skills to be their best – every day. For Curtis, a long time, Registered Nurse on the Clinical Practice Resource Team (CPRT) at SE Health – a national, not-for-profit, social enterprise – a care model like the one she’s enabling is bridging the gap from hospital to home, complementing the exceptional ‘home care’ SE Health is known for, and enhancing patient care at every turn. “Our Clinical Practice Resource Team is a one-of-a-kind model that allows us to optimize the scope of practice and promote quality, personalized care,”

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BY TELEPHONE AND USING INCREASINGLY NEW, DIGITAL COMMUNICATIONS, THE TEAM OF HIGHLY SPECIALIZED REGISTERED NURSES PROVIDES DIRECT CLINICAL SUPPORT, 24/7. says Kaiyan Fu, SE Health Vice President, Professional Practice and Quality. “Since we started this Team several years ago, it’s become an increasingly useful resource for visiting nurses in the field and supports our already outstanding patient care at home,” added Fu. “It’s also a diverse team and includes nurses in a wide variety of specialties – from paediatric to palliative – and a Clinical Practice Coach.” By telephone and using increasingly new, digital communications, the team of highly specialized Registered Nurses provides direct clinical support, 24/7, 365 days a year, to SE

Health frontline staff in communities across Ontario. Nurses call in or message the CPRT to inquire about a specific patient they are working with or a process for which they need more information. Questions range from medication management, to sharing expertise on intravenous pain pumps, to applying specific policies and procedures. The virtual team and the on-site care provider access the same digital platform to view a patient’s medical history and work together to find the best care solution. “Frontline workers feel more confident when they have this kind of sup-

port and encouragement,” says Curtis. “I was a visiting nurse for 14 years and time management was a struggle for me. Having the support of the CPRT is great, especially in difficult situations.” The CPRT helps SE Health’s Service Delivery Centres by providing ‘just in time’ clinical education, critical problem solving, and consultation to front line staff. They also help to support the patient and their loved ones through the best possible end of life experiences and other difficult circumstances. “As part of referrals, we sometimes learn that a child is being discharged with a tracheal tube,” says Maria Teresa Salazar, SE Health Registered Nurse and Manager, CPRT. “We need to move quickly and mobilize our team; making sure that a paediatric nurse is available and that the clinical practice coach and supervisor are ready to go. Continued on page 42

NOVEMBER 2019 HOSPITAL NEWS 41

The SE Health Clinical Practice Resource Team (CPRT) is complementing SE Health’s exceptional care at home and taking virtual care to new heights, focusing on patience outcomes and experience and enhancing patient care at every turn.

Peer-to-Peer Clinical Team Continued from page 41 Collaboration is key and within a short time we can personalize the care for the patient and ensure they have the best possible resources. Having the support of a virtual team keeps everything moving and complements the ongoing excellence of our home care program.” As a leader in best practices for living and aging well at home, SE Health takes pride in its use of digital technology that enables the CPRT to serve numerous community partners and programs by promoting collaboration that puts the patients at the forefront. Some of these partners include prominent health care centres where

SE Health collaborates with in-hospital teams that enable frontline workers to enhance patient care, ensuring

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42 HOSPITAL NEWS NOVEMBER 2019

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a seamless transition for patients from hospital to home. “When patients are discharged from the hospital, they are given a discharge kit that includes a tablet, armed with software that allows us to collect information about their health status when we aren’t there,” says Salazar. “They fill out questionnaires about their symptoms and use a bluetooth-enabled blood pressure cuff to record their vitals. When the visiting nurse arrives, they deliver the exceptional SE Health ‘home care’ experience but can also call in to the CPRT if they have questions or need additional support.” SE Health is also practicing clinician-to-clinician support outside of the CPRT. At a Hamilton-area health care centre, SE Health utilizes video conferencing between physiotherapists (in hospital) and physiotherapy assistants who are in a patient’s home. “Virtual care is the cornerstone of our commitment to digital health; and looking for better ways to provide care is part of our DNA,” says Arslan Idrees, SE Health’s Digital Transformation Officer. “The key question that we continue to ask ourselves daily: how can we enhance people-centered care that we have been

delivering for over 110 years? By using digital as a foundation and focusing on state-of-the-art technology,” he adds. “Virtual care is about sharing the right information at the right time and enhancing the ability of all members in the circle of care (including patients and their caregivers) to make better decisions.” With better outcomes as the focus, SE Health hopes to expand the CPRT to include other services: “We are on an upward growth trajectory to build around our existing virtual care service,” adds Idrees. “We are looking forward to introducing numerous new digitally enabled services to meet and exceed the care needs across the country.” For Curtis, delivering exceptional care matters; and working with a team to maximize the use of technology ensures that SE Health remains focused on patient outcomes and experience. “With our CPRT and beyond, we are providing a unique care experience at SE Health and making the transition from hospital to home easier for patients and their families. I love my job,” says Curtis. “We are also supporting our frontline staff which fosters a wonderful culture of teamwork. EveryH one benefits.” ■

Sarah Quadri is Head of Communications at SE Health. www.hospitalnews.com

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Improving communication between people with Parkinson’s and health professionals

By Anne Marie Gabriel ealthcare professionals committed to clear and compassionate communication can make a meaningful difference to their patients. When people with Parkinson’s know what healthcare professionals recommend and why, they can anticipate what to expect; they are better prepared to navigate the system, ask the right questions, and make the best personal choices. Parkinson Canada launched the ACT on Time® campaign to improve the quality of life of people with Parkinson’s disease and to help hospital and care facility staff to understand Parkinson’s better. When managing Parkinson’s symptoms, people with the disease need to get their medication on time, at home, in an emergency room, or in a long-term care facility. It’s imperative that strict medication regimes be followed; this could mean administering medication at a different time from the usual preset rounds in various healthcare settings. When people with Parkinson’s don’t get their medication on time, every time, Parkinson’s symptoms can become uncontrolled; people can be-

PARKINSON CANADA LAUNCHED THE ACT ON TIME® CAMPAIGN TO IMPROVE THE QUALITY OF LIFE OF PEOPLE WITH PARKINSON’S DISEASE AND TO HELP HOSPITAL AND CARE FACILITY STAFF TO UNDERSTAND PARKINSON’S BETTER.

come very ill and can take longer to recuperate. If people with Parkinson’s get medication on time, this will: • shorten hospital stays • reduce the need for readmission after discharge from hospital • reduce the burden on individuals, families, hospital and care facility staff. The ACT on Time program includes the informative Managing my Parkinson’s in a Healthcare Setting which includes information on drug interactions, planning for hospital stays and a diary to summarize visits with specialists. The Medical Alert Card contains emergency contact information, current medications taken and medications to avoid. To view the various components of this program online contact education@parkinson.ca.

A DAY IN THE LIFE… “I’m living with Parkinson’s. I’m 59 years young, and I never saw it coming. Not that long ago, I was a registered nurse, working in home care at a local health agency. I truly loved my job. I loved being able to support others in their time of need. I was living a full life,” says Hélène Deutsch, M.Sc., a clinical nurse living in Montreal and diagnosed with Parkinson’s disease in 2016. Hélène was working extended days as a clinical nurse, just to get through all of her nursing tasks. She noticed that she was slowing down, but was not sure why. The slowness was becoming a true impediment and she delegated tasks that required fine motor skills, like taking blood, giving injections and wound care.

The tremors in her left hand started. Soon, she was dragging her left leg and then the tremors were constant, affecting her balance as well. Her family doctor, colleagues and friends all suspected Parkinson’s and that diagnosis was confirmed in 2016. The challenge, even for a clinical nurse like Hélène, is that there is no test to confirm a diagnosis of Parkinson’s – and, there is no cure. Hélène reached out to Parkinson Canada’s information and referral services shortly after her diagnosis. At a time when she was filled with uncertainty and fear, Parkinson Canada connected her with resources that helped her cope with her disease and plan for her new life. She has hosted information sessions about the first signs, diagnosis, motor and non-motor symptoms, as well as management strategies, including medication therapies and complementary care options. “Volunteering helps me continue to be of service in my community. I use my nursing background working with support groups, teaching ’Parkinson’s Disease 101’ sessions for newly diagnosed patients and their care partners, and ’Parkinson’s Disease 201’ sessions

Anne Marie Gabriel works in communications at Parkinson Canada. 44 HOSPITAL NEWS NOVEMBER 2019

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CAREERS

for nursing students and other health professionals to demystify Parkinsonâ&#x20AC;&#x2122;s for them,â&#x20AC;? adds HĂŠlĂ¨ne. â&#x20AC;&#x153;And Iâ&#x20AC;&#x2122;m certain that one day, research will unlock the key to cure this disease. â&#x20AC;&#x2122; Parkinson Canada is committed to research and is a founding partner of the Canadian Open Parkinson Network (C-OPN), a new collaboration designed to foster knowledge sharing and increase the pace of Parkinsonâ&#x20AC;&#x2122;s research. The network will give researchers access to unprecedented data and will support large scale, multidisciplinary projects that would not be possible at a single research site. C-OPN will officially launch in March 2020. Through the Parkinson Canada National Research Program, Canadaâ&#x20AC;&#x2122;s best and brightest scientists can develop new medications and treatments that will improve the quality of life for people like HĂŠlĂ¨ne who are living with Parkinsonâ&#x20AC;&#x2122;s.

Parkinson Canadaâ&#x20AC;&#x2122;s Canadian Guideline for Parkinson Disease, 2nd Edition, was published in the Canadian Medical Association Journal (CMAJ) in September 2019. The guideline is designed to enhance care for all Canadians with Parkinson disease and: â&#x20AC;˘ is based on the best published evidence â&#x20AC;˘ involves expert consensus when there is a lack of evidence â&#x20AC;˘ offers practical clinical advice â&#x20AC;˘ takes into account patient choice and informed decision-making. â&#x20AC;˘ Is relevant to the Canadian healthcare system. The updated guideline provides a comprehensive review of this complex disease focusing on communication, diagnosis and progression, treatment and non-motor features, as well as a new section on palliative care. For your free download of the guideline & the summary infographic, visit www.parkinsoncliniH calguidelines.ca â&#x2013;

Careers

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Social Worker â&#x20AC;˘ Full Time RESIDENT/FAMILY CENTERED CARE Located in the Oakridge area of Vancouver, B.C., Louis Brier Home and Hospital is an â&#x20AC;&#x153;Exemplary Statusâ&#x20AC;? accredited long-term care facility situated next to the Weinberg Residence (Assisted Living Suites and Multi-Level Care, both Private Pay). Our Mission is to provide exemplary resident and family-centered care for seniors through innovation, education, research, partnerships and collaboration through the contributions of staff, volunteers, funding partners and donors with a focus on quality and safety, all guided by Jewish heritage. Our vision is to be a center of excellence for elders providing innovative and outstanding care consistent with Jewish values and traditions. We live by our Values - CHAI (Hebrew word for LIFE): Caring, Health, Safety and Wellness, Accountability, and Integrity. Resident and employee safety is a priority and a responsibility shared by everyone at LBHH/WR, and as such, the requirement to continuously improve quality and safety is inherent in all aspects of this position. The Social Worker is an integral member of the interdisciplinary team, and provides input and support to problem solving and decision-making concerning resident issues and concerns. Social worker services are delivered to residents (and families) at Louis Brier Home and Hospital and at Weinberg Residence ďŹ ve days per week from 8AM to 7PM and on Sundays from 10AM to 6PM (a two-week rotational schedule). Two Full-Time Social Workers provide services within the framework of an elderly, predominantly-Jewish community with diverse ethnic and cultural experiences. To apply for this position please forward your covering letter and resume to our Human Resources Department at www.hospitalnews.com

Qualifications Master of Social Work Degree from an accredited university including or supplemented by coursework in Gerontology, registration with the BC College of Social Workers, and two years of social support services experience.

careers@louisbrier.com NOVEMBER 2019 HOSPITAL NEWS 45

NEWS

Leveraging AI and Machine Learning

to advance interoperability in Canadian healthcare

By Wilson To and Patrick Combes bring us closer to delivering on the promise of patient-centered medicine.

avigating the health care system, is often a complex journey involving multiple physicians from hospitals, clinics, and general practices. At each junction, healthcare providers collect data that serve as pieces in a patient’s medical puzzle. When all of that data can be shared at each point, the puzzle is complete and practitioners can better diagnose, care for, and treat that patient. However, a lack of interoperability inhibits the sharing of data across providers, meaning pieces of the puzzle can go unseen and potentially impact patient health.

AN OPPORTUNITY TO TRANSFORM THE INDUSTRY

THE CHALLENGE OF ACHIEVING INTEROPERABILITY True interoperability requires two parts: syntactic and semantic. Syntactic interoperability requires a common structure so that data can be exchanged and interpreted between health information technology (IT) systems, while semantic interoperability requires a common language so that the meaning of data is transferred along with the data itself. This combination supports data fluidity. But for this to work, organizations must look to technologies like artificial intelligence (AI) and machine learning (ML) to apply across that data to shift the industry from a fee-for-service – where government agencies reimburse healthcare providers based on the number of services they provide or procedures ordered, to a value-based model that puts focus back on the patient. The industry has started to make significant strides toward reducing barriers to interoperability. For example, industry guidelines and resources like the Fast Healthcare Interoperability Resources (FHIR) have helped to set a standard, but there is still more work to be done. Among the biggest barriers in Canada right now is the fact there are significant variations in the way data is shared, read, and understood across healthcare systems, which can result

A LACK OF INTEROPERABILITY INHIBITS THE SHARING OF DATA ACROSS PROVIDERS, MEANING PIECES OF THE PUZZLE CAN GO UNSEEN AND POTENTIALLY IMPACT PATIENT HEALTH. in information being siloed and overlooked or misinterpreted. For example, a doctor may know that a diagnosis of dropsy or edema may be indicative of congestive heart failure, however a computer alone may not be able to draw that parallel. Without syntactic and semantic interoperability, that diagnosis runs the risk of getting lost in translation when shared digitally with multiple health providers.

BRINGING INSIGHT TO THE EXAM ROOM WITH THE HELP OF AI AND ML – WHAT’S NEXT? Advanced technologies like AI and ML can help health care organizations achieve both syntactic and semantic interoperability. For example, Vancouver General Hospital (VGH) and University of British Columbia (UBC) researchers are using advanced technologies from Amazon Web Ser-

vices to create their own machine learning models that can triage x-rays to provide a better healthcare experience. For example, imagine a patient comes into the hospital with symptoms of pneumonia. The doctor can take an x-ray, which is then analyzed by an ML model trained that interprets the image for the indication of infection. The algorithm can then determine the priority for that study to be seen by a radiologist. The result? The patient in need can be prioritized to be evaluated more quickly and put on a treatment plan in less time than would have ordinarily taken to capture, assess, and diagnose. With healthcare data that is interoperable, hospitals are poised to leverage AI to complement the complete clinical record to deliver care more effectively and efficiently. More importantly, it can breakdown silos – using technology to evaluate scans will help to create a standard that can

As technology creates more data across healthcare organizations, AI and ML will be essential to help take that data and create the shared structure and meaning necessary to achieve interoperability. As an example, one U.S. supplier of health information technology solutions is deploying interoperability solutions that pull together anonymized patient data into longitudinal records that can be developed along with physician correlations. Coupled with other unstructured data, this supplier uses the data to power machine learning models and algorithms that help with earlier detection of congestive heart failure. As healthcare organizations take the necessary steps toward syntactic and semantic interoperability, the industry will be able to use data to place renewed focus on patient care. In practice, one of the available digital platforms, stores and analyses 15 petabytes of patient data from 390 million imaging studies, medical records and patient inputs – adding as much as one petabyte of new data each month. With machine learning applied to this data, the company can identify at-risk patients, deliver definitive diagnoses and develop evidence-based treatment plans to drive meaningful patient results. That orchestration and execution of data is the definition of valuable patient-focused care – and the future of what we see for interoperability drive by AI and ML in Canada. With access to the right information at the right time that informs the right care, health practitioners will have access to all pieces of a patient’s medical puzzle – and that will bring meaningful improvement not only in care decisions, but in patient’s lives. ■ H

Wilson To is Global Healthcare Business Development lead and Patrick Combes is Global Healthcare IT Lead at AWS. 46 HOSPITAL NEWS NOVEMBER 2019

www.hospitalnews.com

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