Hospital News 2015 June Edition

INSIDEEthics .................................................. 17

Nursing Pulse .....................................19

Safe Medication .................................23

From the CEO's desk ..........................24

Evidence Matters ...............................25

FOCUS IN THIS ISSUEHEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING/ONCOLOGY:Programs and initiatives that are transforming care and contributing to an effective, accountable and sustainable system. Innovations in electronic/digital process in health-care, including mHealth. A look at medical imaging techniques for diagnosis, treatment and prevention of diseases. Approaches to cancer diagnosis and treatment.JUNE 2015 | VOLUME 28 ISSUE 6 | www.hospitalnews.com

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2 Focus HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING/ONCOLOGY

raditionally, homecare, like other parts of healthcare, is focused on conducting specifi c tasks within a limited time-

frame. Many of our clients had come to expect their homecare provider to arrive by a certain time, carry out a variety of pre-determined tasks, and leave within a certain period of time. Yet what we didn’t know was whether this was an acceptable arrangement for our clients – did this pro-vide a good experience? When we asked our clients, they actually told us that we could do better.

Five years ago, Ontario’s 14 Community Care Access Centres (CCACs) and their Service Provider Organizations (SPOs), implemented a common approach to sur-veying clients and caregivers about their experience with homecare. The survey’s earliest results showed that Toronto Cen-tral CCAC and our contracted SPOs had a lower client experience rating than the provincial average. Furthermore, of all of our services, personal support services were rated the lowest. Feedback analysis showed us that while our clients expected us to be competent at providing care, they wanted us to provide their care with em-pathy, courtesy and respect. They wanted us to listen and understand what was most

important to them. Ultimately, communi-cation with our clients was identifi ed to be the single most important factor driving our client’s experience.

We understood that this was not about giving our staff scripts for having better conversations; it was much more about changing behaviours and culture.

The leadership of the Toronto Central CCAC met with the leadership teams of our SPOs to better understand the survey data. We investigated worldwide best prac-tices in patient-centred care, we commit-ted to a shared approach, and we devel-

oped a plan that would change the nature of homecare delivery. The core of that plan involved using open-ended questions to engage clients in conversations with our care providers and to implement care de-livery that was more fl exible and respon-sive. We changed the conversation.

“Changing the Conversation” is a phi-losophy that focuses on asking clients what is most important to them. Instead of fol-lowing a list of clinical tasks, our front-line teams listen to what our clients and care-givers have to say and then deliver care ac-cordingly. At the end of our home visits,

we also ask our clients if there is anything else that we can do for them. These two simple questions tell us a lot about what’s going on in the lives of our clients and caregivers: fundamentally, we are recogniz-ing that our clients are in the best position to know what they need, and their needs are not static.

Four years ago, we implemented a four-month test of change that included 50 clients from our palliative care program, three Toronto Central CCAC Care Co-ordinators, 90 Personal Support Workers (PSWs), and six PSW supervisors from two SPOs. As with any new initiative, there were concerns about unintended negative consequences. PSWs worried that veering from assigned tasks would lead to unrea-sonable expectations: more housekeeping than health care duties; more work in less time. Our care coordination staff was simi-larly worried that health care dollars might end up being used on non-health care ac-tivities. We were concerned about poten-tial resource pressures due to higher vol-umes of services required to accommodate ‘new’ requests from clients and families.

The results surprised us. Not only did Changing the Conversation dramatically improve the experiences of our clients, who said through surveys that they felt “more cared for” by our frontline teams, but frontline providers themselves also felt more satisfi ed with their roles. One of the two SPOs in the pilot evaluated their results separately and found that they had a 50 per cent drop in service complaints from clients within weeks. What’s more, only one per cent of client requests were not normally part of a PSW’s role. Some of those particular requests included sim-ply sitting and talking with the client for a few minutes, underscoring the importance of the social aspect of homecare.

The success of our small test led to the rollout of Changing the Conversation across all personal support for homecare, and subsequently to all of our services, in-cluding nursing, therapy services, and care coordination. The more fl exible, conversa-tion-focused approach is now used with all client population groups and demograph-ics, including across the Toronto Central CCAC and all of our 22 service provider partners. Toronto Central CCAC’s client experience results have moved from lowest in the province to the provincial average in just three years.

Through this work, Toronto Central CCAC is doing our best to deliver what is most important to our clients while sup-porting them to live the fullest and health-iest lives possible. This approach to care is refl ective of our commitment to delivering on our vision of ‘outstanding care – ev-ery person, every day’. Although it seems common sense that empathy, courtesy, and respect go a long way when caring for cli-ents – changing lives starts with changing culture. ■H

Anne Wojtak is the Co-Executive Sponsor of the ‘Changing the Conversation’ initiative and the Chief Performance Offi cer and Senior Director of Performance Improvement and Outcomes at Toronto Central CCAC.

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Ultimately, communication with our clients was identifi ed to be the single most important factor driving our client’s experience.

Changing the homecare client experience by changing the conversation

Requests included simply sitting and talking with the client for a few minutes, underscoring the importance of the social aspect of homecare.

JUNE 2015 HOSPITAL NEWSwww.hospitalnews.com

3 In Brief

There are major differences across Ontario’s long-term care homes in the percentage of residents who are being prescribed antipsychotic medications, ac-cording to Looking for Balance, a report from Health Quality Ontario (HQO), the provincial advisor on health care quality.

In some long-term care homes, no resi-dents over age 65 are being prescribed an-tipsychotic medications, while in others, up to two-thirds of the residents are being prescribed the drugs. The report notes that some of the variation across the province could be due to the fact that some homes specialize in treating people with severe mental illness or advanced dementia. But it is unlikely this factor alone explains the breadth of these differences.

Antipsychotic medications are often prescribed to control symptoms of psycho-sis, and to manage agitated and aggres-sive behaviours associated with dementia, such as hitting or yelling, which can put residents – or those around them – at risk.

But the use of these drugs must be weighed against their side effects, which include a higher risk of falls, symptoms that affect quality of life (like sleeping all day), and possibly a small increased risk of death.

“Because of the side effects, there is a lot of debate right now in Ontario and across Canada about how best to prescribe an-tipsychotic medications,” says Dr. Joshua Tepper, President and CEO of HQO. “The variation underscores the importance of carefully considering these medications for each person living in long-term care homes, so that only those residents who would most benefit are using them.”

Although there is variation from one home to the next, the report found that overall there was slightly less use of these medications in long-term care homes than there was four years ago. The percentage of residents being prescribed antipsychotic medications in Ontario has decreased from 32 per cent in 2010 to 29 per cent in 2013. ■H

Canadians face wait times of over 460 days in order to get access to new, poten-tially lifesaving medicines in public drug plans, according to a new IMS Brogan re-port commissioned by Rx&D. Overall, the report ranks Canada 16 out of 18 similar OECD countries.

“It’s unimaginable to know that, in 2014, only 23 per cent of 141 Health Canada-approved new medicines were in-cluded in public plans, ranking Canada 17 out of 18 on this front,” says Brett Skinner, Rx&D Executive Director, Health and Economic Policy.

The 2015 Access to New Medicines in Public Drug Plans: Canada and Compa-rable Countries report finds Canada seri-ously lagging compared to other similar OECD countries in terms of public drug plan reimbursement.

“More and more, public drug plans in Canada are making new medicines avail-able only on a conditional, case-by-case basis – resulting in more administration,

longer wait times for patients before be-ginning treatment, increased paperwork for physicians; and most importantly, no guarantee that patients will receive cov-erage. These new treatments are being developed to improve health outcomes, to cure diseases and to help Canadians better live with chronic conditions,” says Rx&D President Russell Williams. “We all lose out if Canadians can’t get access to these new treatments – from the very real costs of sickness on families, to increased hospitalization rates and even lost produc-tivity.”

“My wife died of a very rare incurable cancer. Her life was extended more than 15 months, with generally good quality, by two drugs that are widely known to be ef-fective. She received them on a compas-sionate basis – free – from drug companies before they were approved by Health Can-ada. Each drug costs many thousands per month. Had these drugs been approved for use, our provincial drug plan would not

have covered them. Paying for such treat-ments can cause severe emotional and financial hardship for families, and even bankrupt them,” says John-Peter Bradford, who was present at Rx&D’s report launch.

The report notes that: • In Canada, 29 per cent of cancer medi-cines were covered in public drug plans across provinces comprising at least 80 per cent of the eligible national public drug plan population, ranking Canada in 16th place of 18 countries. • Canadian public drug plans placed re-imbursement conditions on 90 per cent of new medicines when measured across provinces comprising 80 per cent of the eligible national public drug plan popula-tion. • In Canada, 20 per cent of new biologic medicines were reimbursed in public drug plans across provinces comprising at least 80 per cent of the eligible national public drug plan population, putting Canada in 17th place of 18 countries. ■H

behind similar countries on access to new medicines

New work by the Douglas Mental Health University Institute computa-tional neuroscientist Mallar Chakravarty, PhD, and in collaboration with research-ers at the Centre for Addiction and Men-tal Health (CAMH) challenges the long-held belief that a larger hippocampus is directly linked to improved memory func-tion.

The size of the hippocampus, an impor-tant structure in the brain’s memory cir-cuit, is typically measured as one method to determine the integrity of the memory circuit. However, the shape of this struc-

ture is often neglected. Using a novel algorithmic technique to map the hippo-campus, Dr. Chakravarty, Assistant Pro-fessor, Department of Psychiatry at Mc-Gill University, is shedding new light on its shape. The algorithm developed by the team identifies individuals with different-ly shaped hippocampi. In fact, the study has found that while stereotypic shapes exist for this structure, individuals with a broader hippocampus tend to perform better on various tests that assess memory. In the study, these shape differences were better predictors of memory function than

the bulk volume of the hippocampus. Improving our understanding of the

geometry of different structures may have significant implications in understanding neuropsychiatric disorders, such as Al-zheimer’s disease, where memory func-tion is significantly compromised. Given the aging demographics of Quebec and Canada, uncovering clues on how to im-prove memory function, one of the main impairments reported (even in healthy ag-ing), will be critical to relieving the over-whelming burden our health care system currently faces. ■H

Canadians laggingAntipsychotic medication use during

pregnancy does not put women at addi-tional risk of developing gestational diabe-tes, hypertensive disorders or major blood clots that obstruct circulation, according to a new study led by researchers at Women’s College Hospital and the Institute for Clin-ical Evaluative Sciences (ICES).

The study, published in BMJ, is the largest to date to examine possible links between newer antipsychotic medications – such as quetiapine, olanzapine and ris-peridone and medical conditions that often develop during pregnancy or with use of older antipsychotic drug medications.

Antipsychotic drugs are a range of medi-cations that are used for some types of mental distress or disorder - mainly schizo-phrenia and manic depression (bipolar dis-order). They can also be used to help se-vere anxiety or depression.

The study compared a group of 1,021 pregnant women who took antipsychot-ics during pregnancy to a group of 1,021 pregnant women of similar of age, income, mental health status and health care uti-lization who did not take antipsychotics. The researchers found: • There were no significant differences in risk for gestational diabetes, gestational hy-pertensive disorders or venous thromboem-bolism between women who had taken an-tipsychotic medications during pregnancy and those who had not. • There were no significant differences in risk for preterm delivery, extremely low birth weights or extremely high birth weights in infants born to women who had taken antipsychotic medications during pregnancy and those who had not. • Women who used antipsychotic medica-tions during pregnancy were more likely to require labour induction compared to women who did not take an antipsychotic drugs while pregnant. ■H

Antipsychotic drug use in pregnant women poses minimal risk

Antipsychotic drug usevaries widely across ontario long term care homes

Memory and the hippocampus: size may not matter as much

HOSPITAL NEWS JUNE 2015 www.hospitalnews.com

4

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Cindy Woods, Senior Communications OfficerThe Scarborough Hospital, Barb Mildon, RN, PHD, CHE , CCHN(C)VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

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like Stephen Fletcher. Our brief encounters, typically in airports or the occasional public event, are always

friendly and cordial. It is hard not to ad-mire him. Despite quadriplegia, he has found the strength and determination to serve his country as a Member of Parlia-ment, at various times holding appoint-ments as Minister of State (Democratic Reform), Minister of State (Transport); and currently, as a member of the Trea-sury Board Cabinet Committee. As of late, Mr. Fletcher has been focusing his formidable energy on promoting physi-cian-hastened death. It appears many share his perspective, with public opin-ion and legislative reform starting to turn his way. Just last month, the Supreme Court of Canada overturned the prohi-bition against assisted suicide.

According to a recent IPSOS Reid poll, nearly 70 per cent of Canadians support the availability of death hasten-ing alternatives for people living with signifi cant disabilities that might impair their quality of life. In other words, Ca-nadians fi nd it inconceivable to imag-ine themselves confi ned to a body that even remotely approximates the one Mr. Fletcher now permanently resides in. While the majority of Canadians ad-mire him, at some level I suspect they are afraid of the abject vulnerably his life proves is possible within the repertoire of human experience. This fear is so deeply seated that they imagine themselves preferring death. For anyone wondering why physician-hastened death makes disabled people feel vulnerable, wonder no more.

Human beings are not good at pre-dicting how they will react in circum-stances that have yet to unfold. While Mr. Fletcher argues that death should sometimes trump disability, studies of people who become disabled due to spi-nal injuries, head trauma or strokes, offer a strikingly different perspective. Just un-der ten per cent of these patients become suicidal and the majority relinquish their wish to die within a year or two. In his biography, What Do You Do If You Don’t

Die?, Mr. Fletcher recounts suicidal thoughts that lingered long after his catastrophic accident. He says that had doctor-assisted suicide been an option af-ter his 1996 car accident, he would have considered signing up and checking out. Thankfully it was not. His recovery took determination and strength, but such is the stuff that Stephen Fletcher is made of. It also took the support of family and friends, the unwavering commitment of

medical professionals and it took time. Those of us working in healthcare un-

derstand that life-altering illness, trauma or anticipation of death can sometimes sap will to live. In those instances, health care providers are called upon to commit time; time to manage distress, provide unwavering support and to assuage fear that patients might be abandoned to their hopelessness and despair. That is the es-sence of how medicine has traditionally responded to suffering. Stopping time by way of arranging the patient’s death has never been part of that response. In light of the decision by the Supreme Court, we must now contemplate Canada’s fu-ture euthanologists. What professional designation will they require? What dis-ciplines will they be drawn from? What training will they receive? What ethical and practice guidelines will they abide by? And what judicial oversight will they submit to?

Mr. Fletcher and I, along with Pro-fessor Margaret Somerville, spoke at a recent forum on euthanasia and as-sisted suicide. Mr. Fletcher said he did

not want to die drowning in his phlegm and in pain. I assured him, on behalf of Canada’s palliative care community that we would not let that happen. He said that he did not want to be reliant on ma-chines to keep him alive. I told him that competent Canadians, under our current laws, are entitled to refuse or discontinue treatment, including life-sustaining mea-sures. He described autonomy as a core Canadian value. I reminded him that au-tonomy has its limits, particularly when it causes others to feel more vulnerable and implicates the physician’s role in re-sponse to suffering.

Mr. Fletcher says he has received sup-portive letters from across the country from people who fear what dying will look like. With too few Canadians hav-ing access to palliative care, little won-der that people are afraid. Offering the option to have their physician end their lives feels akin to confronting home-lessness by eliminating guardrails from bridges. Nonetheless Mr. Fletcher feels that safeguards, such as a ‘cooling off’ period to establish that a request to die is sincere, not coerced and sustained are possible. If so many in your circumstance change their mind, I asked him, do we now require a two-year waiting period? His response was, “maybe”.

To be fair, perhaps Mr. Fletcher has not contemplated these particular com-plexities. He may not have considered how asking physicians to stop time could undermine their most powerful response to suffering. His voice has become an im-portant one in how we conceive of dis-ability, death and dying and no doubt is one that all Canadians anxiously await to hear.

(Mr. Fletcher was provided the op-portunity to respond to this editorial; he declined to do so). ■H

Dr. Harvey Max Chochinov holds the only Canada Research Chair in Palliative Care. He is the Director of the Manitoba Palliative Care Unit, CancerCare Manitoba, and Distinguished Professor, University of Manitoba

IDr. Harvey Max Chochinov

According to a recent IPSOS Reid poll, nearly 70 per cent of Canadians support the availability of death hastening alternatives for people living with signifi cant disabilities that might impair their quality of life.

The Fletcher Effect


5 HEALTH CARE TRANSFORMATION/EHEALTH/MOBILE HEALTH/MEDICAL IMAGING/ONCOLOGY Focus

iriam Porter of Toronto has always considered herself a private person. But the night before she had preventive

surgery to remove her fallopian tubes and ovaries, she decided it was time to share her story. Inspired by a host of friends who have chosen to “go public” to raise aware-ness of ovarian cancer, she wrote about her love for her son and her desire to be with him as he grows up.

Over the past few years, Porter learned that ovarian cancer is often hereditary and that she had a high risk for both breast and ovarian cancer. Four relatives had breast cancer and she is also an Ashkenazi Jew, a group with a higher than usual proportion of carriers.

Research has proven that there is a strong link between BRCA1 and BRCA2 genetic mutations and ovarian cancer. There are likely other genetic elements as researchers probe the human genome fur-ther. If a fi rst-degree relative – a mother, sister, daughter – has been diagnosed with ovarian cancer, the risk of developing can-cer is much higher than for the general public. The statistics are clear. Carriers of a BRCA1/2 genetic mutation have up to a 40 per cent chance of developing cancer compared to only two per cent for the gen-eral population.

Historically, only about 23 per cent of women with ovarian cancer went for ge-netic testing. But as Dr. Marcus Bernar-dini, gynecologic oncologist at Princess Margaret Cancer Centre, says, “That is far too low. We believe there are between 10 and 15,000 families in Ontario who may be at risk and not know it.”

So Dr. Bernardini and his team of re-searchers and genetic counsellors have developed the Prevent Ovarian Cancer program to identify more women with a BRCA1/2 mutation and provide them with the counselling they need to make decisions about preventing ovarian cancer.

The Prevent Ovarian Cancer program is looking for women 18 years or older living in Ontario who have a fi rst-degree relative

(mother, daughter, sister) diagnosed with high grade serous cancer.

Researchers on the Prevent Ovarian Cancer program will be collecting some of this new information for research purpos-es. Using the www.preventovariancancer.ca website, participants will be asked to:• Give permission to access the pathology

report for the fi rst-degree relative with ovarian cancer;

• Fill in a family history questionnaire;• Provide a blood sample for genetic

testing;• Complete fi ve psychosocial question-

naires;• And undertake pre/post-genetic coun-

selling.

The good news is that women can par-ticipate wherever they live. Blood sam-ples can be provided at any Life Labs fa-cility and genetic counselling is available by phone or face-to-face in most areas of the province.

Because the program is in its very early stages, there is funding for 500 partici-pants. If you know someone whose moth-er, sister or daughter has been diagnosed with ovarian cancer, don’t delay. Tell them about www.preventovariancancer.ca to see if they may be eligible to par-ticipate in the Prevent Ovarian Cancer program.

For women like Miriam Porter, Ange-lina Jolie and many, many more, having

the knowledge of their genetic status is powerful. Porter says, “I believe it is bet-ter to do something than nothing at all…What I do know is that we all have the power to surround ourselves with life-saving information. I will no longer re-main silent.”

For more information on the Prevent Ovarian Cancer program, visit www.preventovariancancer.ca or contact the program’s voice messaging system at 1-866-330-0180 or email [email protected] ■H

Cyndy De Giusti provides communications support for the Prevent Ovarian Cancer program.

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Some members of the Prevent Ovarian Cancer team at Princess Margaret Hospital. (inset) Miriam Porter went public with her story to raise awareness of ovarian cancer.

Looking for the answers to ovarian cancer



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they ask us.When the doctors don’t know,

OPSEU’s Health Professionals,an important part of Ontario’s health care team

hether they come to the hospi-tal with the fl u, broken bones, or a head injury – patients at William Osler Health System’s

(Osler) Emergency Departments (ED) are now able to take charge of their health like never before. A new mobile app called Os-ler Outpatient is empowering patients by making it easier for them to manage their after-care once they leave the hospital.

Osler Outpatient allows patients to more actively participate in their discharge from hospital by replacing traditional pa-per discharge instructions with an app that patients can access anywhere and any-time. Other features of the app include a calendar function that allows patients to set alerts and reminders for medication, appointments, or important milestones in their recovery; customizable options that allow patients to tailor a care plan based on their discharge instructions; and Fre-quently Asked Questions to help patients decide whether they should seek medical care after discharge.

“We are excited that this app is now available to our patients and families, and about the positive impact it can make as part of their care experience,” says Susan deRyk, Vice President, Patient Experience, Communications and Strategy at Osler. “With its user-friendly features, Osler Out-

patient, is making it much easier for pa-tients to be proactive and to manage their care confi dently and effectively once they return home after their stay in hospital.

Unveiled on May 26 before a crowd at Osler’s Brampton Civic Hospital, Os-ler Outpatient was the winning app that emerged from Osler’s National Student App Contest. The competition was held last November as a hackathon-style event, which attracted teams of high school, un-dergrad and graduate students. The teams were given 48-hours to develop an innova-tive Android mobile app to help improve

the patient experience at Osler hospitals. A team of four graduate students from

the University of Toronto – Cory Blumen-feld, Victor Chen, Haley Liu, and Jerry Tang – won the contest and then worked closely with patients, physicians and staff to fi ne-tune the app to ensure it is patient-focused and best suits the diverse health care needs of those Osler serves.

“It has been my team’s goal to build a comprehensive app that improves the quality of care provided to patients at Osler,” says Zach Fisch, a member who joined the team after the contest ended to

assist with development and testing. “We think that providing patients with as much information as they need to feel au-tonomous in the health care process is really important.”

Osler’s new app also aims to boast posi-tive results for the hospital. As one of the largest community hospitals in Canada, as well as one of the busiest emergency de-partments in the country, Osler anticipates that empowering patients through this app may help reduce unnecessary hospital re-admissions.

“As people begin to rely increasingly on information provided through their mobile devices, we recognize that we have an un-precedented opportunity to help patients and families better navigate their care experience while they are with us,” says deRyk. “We are looking forward to seeing how this app can help transform the ex-perience for our patients and families, and bring innovative, patient-inspired care to our community, through technology.”

The team of students was presented with a cheque for $10,000, compliments of contest sponsor, Fieldpoint Service Ap-plications Inc. – a software management company based in Oakville, Ontario.

Osler Outpatient can be downloaded on Google Play. ■H

Donna Harris is a Strategic Communications Partner, William Osler Health System.

New app empowers patients by making self-management easyBy Donna Harris

W

A new mobile app called Osler Outpatient is empowering patients by making it easier for them to manage their after-care once they leave the hospital.



or decades health care pro-fessionals have known about the power of human touch in people’s lives. Physically,

touch can relieve pain and stress, it can reduce blood pressure and even boost our immune systems. But its impact men-tally is just as important, conveying to another person that they are not alone is especially powerful for those suffering from chronic diseases such as cancer and chronic kidney disease (CKD). Amongst feelings of anxiety and stress, it is true that human touch can provide comfort and ease suffering.

On April 23, 2015, Cancer Care Ontar-io and the Ontario Renal Network hosted the ninth annual Human Touch Awards, an event that celebrates the many com-mitted professionals and volunteers across our cancer and kidney care systems who go the extra mile to help ease the pain and

suffering of others and provide exemplary patient care. This year, those recognized included eight individuals and one team of front-line cancer and renal health care providers, professionals and volunteers. A selection committee, which included rep-resentatives from Cancer Care Ontario, the Ontario Renal Network, Canadian Cancer Society, the Kidney Foundtion of Ontario, regional cancer centres and pa-tients, focused on nominees’ level of excel-lence, compassion, leadership and overall improvement of the patient experience, when selecting the award recipients.

“Compassion is an integral component of care that this year’s award recipients provide to patients every day,” says Mi-chael Sherar, President and CEO, Cancer Care Ontario, “They not only exemplify and inspire excellence in patient-centred care; they also enrich the patient and fam-ily experience through their incredible commitment, untiring dedication and sin-cere emotional support.”

The Human Touch Awards were cre-ated to emphasize the importance of in-tegrating empathy and compassion into a patient’s overall experience because it truly impacts their well-being. A diagno-sis of cancer or advanced chronic kidney disease is life-changing, with both physi-cal and emotional implications. Thus, it is essential that patients are treated not only for the physical symptoms of their disease but for the emotional ones as well. Winners and nominees recognize that this emotional support plays a signifi cant role in a patient’s well-being and is an impor-tant facet of person-centred care.

This year’s winners exemplify the im-pact of the human touch. One example is volunteer Marjorie Brewster who has volunteered in Pediatrics for the last 26 years, currently in the Paediatrics Oncol-

ogy Clinic at Southlake Regional Health Centre. Brewster’s outstanding commit-ment to “her children” has brought joy to the lives of so many children undergo-ing treatment for cancer along with their families. She personally purchases and do-nates a toy to every child that visits the Paediatric Oncology Clinic at Southlake Regional Health Centre to help transform an otherwise scary event into a little bit of magic for children and parents alike. Volunteer Randall Russell is another great example – a CKD patient himself – he works tirelessly to build awareness about what it means to live with the disease, from sharing thoughtful ideas and practi-cal advice as a patient advisor for The Ot-tawa Hospital’s Renal Program to partici-pating in a collaborative project with the Ontario Renal Network and the Canadian Foundation for Healthcare Improvement, where he spent countless hours with team

members to develop a decision-coaching video to improve the skills of health care professionals coaching patients through decisional confl ict. These are just two of our winners, each with their own inspir-ing stories of dedication to improving the patient experience.

These exceptional health care profes-sionals, providers and volunteers from across the province have changed the lives of countless patients for the better. It is their relentless compassion that makes them stand out and bring to life the notion of person-centred care.

To read more about these and other 2015 winners, please visit www.cancer-care.on.ca/humantouch3 and www.renal-network.on.ca/humantouch3. ■H

Jayani Perera is a Senior Public Relations Advisor at Cancer Care Ontario.

Recognizing the compassion of individuals who embody person-centred careBy Jayani Perera

Physically, touch can relieve pain and stress, it can reduce blood pressure and even boost our immune systems. But its impact mentally is just as important, conveying to another person that they are not alone is especially powerful for those suffering from chronic diseases such as cancer and chronic kidney disease (CKD).

(left) Marjorie Brewster accepts her Human Touch Award from Cancer Care Ontario. (right) Randall Russell accepts his Human Touch Award from the Ontario Renal Network.

Cancer care system: • Marjorie Brewster, Volunteer, Paediatric Oncology Clinic, Southlake Regional Health Centre• Jennifer Lounsbury, Acute Nurse Adult Nurse Practitioner Outpatient Oncology, Grand River Regional Cancer Centre• Karen Biggs, Registered Dietician, Juravinski Cancer Centre• Screen for Life Mobile Cancer Screening Coach Team, Juravinski Cancer Centre: Carrie Claxton, Elisabeth Silverthorne, Joanna Hakenberg, Leslea Boyle, Anne Hixon, Emma Catacchio, Karen Todd, Georgina Martin, Brenda Lumsden-Johanson, Cathy Chaput, Elizabeth Vandesompele and Alyssa Higginson

Kidney care system:• Michael McCormick, Volunteer, Chronic Kidney Disease Program - St. Michael’s Hospital, The Kidney Foundation of Canada - Ontario Branch and the Ontario Renal Network• Randall Russell, Volunteer, Chronic Kidney Disease Program and Nephrology Patient Family Advisory Committee - The Ottawa Hospital• Connie Twolan, Clinical Director - Regional Nephrology Program and Regional Director - Champlain LHIN • Julie Ann Lawrence, Nurse Practitioner, Kidney Care Centre – London Health Sciences Centre• Shirley Pulkkinen, Renal Program Social Worker, Algoma Regional Renal Program -Sault Area Hospital

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ecky Quinlan can’t say enough about the benefi ts of connect-2care, Holland Bloorview’s new online tool that gives par-

ents and kids access to their health care record and the tools to manage their care.

“My son Jack is pretty complex and seen

in seven different departments,” Becky ex-plains. “Now I can go online to see a list of all of his appointments and what’s pend-ing, and it keeps me more organized.”

Holland Bloorview, Canada’s largest children’s rehabilitation hospital is one of the fi rst children’s hospitals in North

America to offer an online portal to fami-lies and it is one of the most comprehen-sive in the country.

Kids and families are able to access their Holland Bloorview health care in-formation, including visit history, clinical notes, test results and details about up-coming appointments.

“This information belongs in the hands of our clients and families,” says Keith Adamson, Senior Director of Collabora-tive Practice. “connect2care is years in the making and it speaks to our deep com-mitment to client and family-centered care and ensuring that families have the information they need to make in-formed decisions.”

In just four months over 400 clients and families have enrolled.

Becky loves having Jack’s clinical re-ports at her fi ngertips. “Before I’d take a ton of notes at every appointment but now I can access that information in real time. I can also print out reports and take them with me to show other specialists.”

Generously supported by Canada Health Infoway, connect2care was born through a true partnership with families. It was developed based on feedback from parents and kids and is part of a research study at the Bloorview Research Institute to see how it can be improved over time.

Clinicians across the hospital have been documenting electronically for the last few years, making the transition to the online portal a smooth one.

Later this spring Holland Bloorview will launch a series of updates aimed at making it more mobile friendly, adding features that allow clients to request and cancel appointments and message their clinicians online.

Becky is excited about new features that will be added soon. “In the past when I had a simple question it might result in a cou-ple of weeks of phone tag to get an answer. I’d phone and talk to the nurse, and the nurse has to talk to the doctor, but some of the specialists aren’t at the hospital ev-ery day. With two-way messaging I’ll be able to type my question in and wait for a direct response.”

Becky is a family-centred care special-ist at Holland Bloorview who is helping to sign families up for the service. “I think it empowers us as patients and families to have our information at our fi ngertips.” ■H

Jennifer Obeid is Manager of Communications at Holland Bloorview Kids Rehabilitation Hospital.

to manage their child’s care onlineBy Jennifer Obeid

B

Holland Bloorview, Canada’s largest children’s rehabilitation hospital is one of the fi rst children’s hospitals in North America to offer an online portal to families

hen compared with other provinces and international jurisdictions, cancer survival rates in Ontario are among

the highest in the world. The Cancer Quality Council of On-

tario (CQCO) released the results of its 11th Cancer System Quality Index (CSQI) on May 20, 2015 and highlighted that among selected countries with simi-lar socio-economic status and health care systems, Ontario had the highest relative survival ratio for cancer of the colon and rectum and also had a high ranking for both prostate and lung cancer survival.

Established in 2002, the CQCO is an arm’s length advisory group that provides guidance to Cancer Care Ontario and the Ministry of Health and Long-Term Care (MOHLTC) in their efforts to im-prove the quality of cancer care in the province. The CQCO is composed of healthcare providers, cancer survivors, family members and experts in the areas of oncology, health system policy, perfor-mance measurement, health services re-search and health care governance.

The CSQI is an interactive web-based public reporting tool that tracks On-tario’s progress towards better outcomes in cancer care and highlights where the province can advance the quality and performance of care. It is one of the most comprehensive tools of its kind world-wide in terms of its breadth of measure-ment, jurisdictional comparisons and international benchmarks. The CSQI measures the provincial cancer system through a set of indicators which evolve year over year. Indicators are retired when performance reaches or surpasses targets, or when there is a more accurate way to measure the system.

Overall, this year’s results show that Ontario’s cancer system is performing very well when compared with other ju-

risdictions nationally and internationally. This success can be attributed to a solid infrastructure based on evidence and the willingness to strive for excellence and constant improvement.

“In Ontario, we have very high stan-dards for cancer care. The strength of our system can be attributed to our will-ingness to collaborate around common goals and to our ongoing dedication to providing the best care possible,” says Dr. Eric Hoskins, Minister of Health and Long-Term Care. “CSQI plays an impor-tant role by helping guide the health care community as it plans practical improve-ments that have a positive impact.”

Due to strong partnerships throughout the entire health system and government investment, wait times have also im-proved signifi cantly since the launch of the Wait Times Strategy in 2004. To bet-ter understand wait times from a patient perspective, CSQI looks to measure wait times spanning the entire patient journey beginning with when a person becomes symptomatic right through to treatment.

“Results from this year’s CSQI dem-onstrate that Ontarians can continue to be confi dent in their cancer system,” says Michael Sherar, President and CEO, Cancer Care Ontario. “We will use the 2015 results to continue to drive ex-

cellence through the many initiatives already underway across the cancer journey.”

The CSQI 2015 includes 34 indicators spanning the cancer journey from screen-ing to end-of-life care and survivorship. Each indicator is a specifi c measurement of progress against one of seven dimen-sions of quality – each established to help us focus our efforts in improving the can-cer system.

Below is a summary of some of this year’s CSQI results. From highest to low-est, the ratings are Very Good, Good, Fair, Poor and Incomplete. • Enhancing patient and provider safety

– this year’s rating is good• Ensuring cancer services are effective –

this year’s rating is good• Improved access for Ontarians – this

year’s rating is good • Providing care that is responsive to pa-

tient needs – this year’s rating is fair• Ensuring equity – this year’s rating is

fair• Improved integration – this year’s rat-

ing is fair• Greater effi ciency – this year’s rating is

incomplete dataIn addition, the CSQI 2015 presents

cancer system performance within each of Ontario’s 14 Local Health Integration Networks (LHINs) and presents a snap-shot view of how each LHIN is doing in terms of all indicators across CSQI. This year’s Index also includes international comparators as we move towards regular benchmarking against international best practice.

For more information about the CSQI 2015 and to view this year’s interactive release, please visit www.csqi.on.ca. ■H

Virginia McLaughlin is the Chair of the Cancer Quality Council of Ontario (CQCO).

Cancer survival rates in Ontario among highest in the worldBy Virginia McLaughlin

W

Overall, this year’s results show that Ontario’s cancer system is performing very well when compared with other jurisdictions nationally and internationally.

Becky Quinlan is thrilled to use connect2care to manage her son Jack’s Holland Bloorview’s appointments and reference his health care record.

My son Jack p

n

Many of Holland Bloorview’s families carry around paper copies of their kid’s health-care records collected from countless clinic appointments. The hospital’s new online portal, connect2care, eliminates the need.

Giving families the information they need



Soft contact insert docking into patient eye

Free-floating capsulotomies


BETTERCompeting patient interface technologies can be messy or inconvenient. The proprietary LenSx® Laser with SoftFit™ Patient Interface technology:• Is designed for both cataract and corneal work• Facilitates free-floating capsulotomies• Reduces IOP rise (16 mmHg increase over baseline)1 and laser time (33% faster)2

• Simplifies docking even with deep-set or small eyes• Fixates the eye, eliminating the need to tape down the patient’s head

© 2013 Novartis 5/14 SU141123


1. ER13 - 098 - SoftFit™ Patient Interface - IOP Assessment. Alcon data on file.2. LenSx® Laser systems have undergone continuous improvement since launch to reduce both laser time and procedure time. Alcon data on file.



any of the greatest risks to quality take place as patients move through different parts of the health system – across

care settings and various health care pro-fessionals. During these ‘hand-offs’, pa-tients are arguably at their most vulnera-ble and need to rely on providers for clear communication and care coordination so that they can feel safe and secure. Health systems themselves are also at their most vulnerable – with no widespread author-ity to oversee patient transitions, both pa-tient and provider must depend on many individual components coming together in a near seamless fashion. When clear care coordination happens, the opportu-nity for quality care is great.

Care coordination and communication between providers and patients (aged 55 and older) is the focus of the latest re-port released by Health Quality Ontario (HQO), the provincial advisor on health care quality. As a family doctor, who also serves as the president and CEO of HQO, this report takes on a special meaning for me in my ongoing efforts to improve the quality of the care delivered in my own family practice as well as working in a large emergency department.

Experiencing Integrated Care explores how well health care is being integrated in Ontario, compared to the other provinces and 10 other countries, using informa-tion from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults.

Ontario performs among the best across Canada and on an international scale in certain areas of integrated care, such as providers informing patients whom to contact should a question arise about their condition after a hospital stay, and in primary care providers coordinating follow-up care with specialists and other health care providers.

Ninety per cent of Ontarians surveyed, who had a hospital stay in the past two years, said they knew who to call if a question came up about their treatment. Internationally Ontario was on par with other top-performing countries when it came to hospitals making arrangements for follow-up care, with 81 per cent of Ontarians surveyed saying they left the hospital feeling confi dent of the next steps to take with their care.

These numbers are important because this portion of the population often relies on the health system more than others. Of those Ontarians participating in the survey, eight out of 10 reported at least one chronic condition, including more than half (54 per cent) with two or more chronic conditions. Nearly two-thirds of

the respondents had seen two or more doctors in the previous year; and more than half (59 per cent) saw or needed to see a specialist in the previous two years. At each of these interactions, care coor-dination and communication were vital – but as our report shows, they didn’t always take place.

The province’s providers still need to improve in the way they share informa-tion and communicate with patients and other health care professionals.

In the survey, 75 per cent of respon-dents who had been hospitalized said they received written information about what to do and the symptoms to watch for when they returned home – as compared to 89 per cent and 87 per cent of respondents in the United States and New Zealand. That

means a quarter of respondents reported leaving the hospital without important written information.

In addition, 10 per cent of Ontario re-spondents said specialist doctors did not have basic medical information or test results at an appointment. Compare that number to France’s results, where just three per cent said there was a time in the past two years when their specialist did not have information, or in the Nether-lands, where fi ve per cent reported that same challenge.

Of course, these are just a few of the revealing statistics captured within the report. It’s easy to provide a litany of data like this, but what is more important is how we use this data to fuel change. It’s evident that hospitals and primary care

providers in Ontario are committed to creating better experiences for patients – and we’ve already seen great progress in this respect. But by measuring ourselves against the performance of others in other jurisdictions – whether they are provinces right here in Canada or countries around the world – we know we can do more to improve care where it really matters.

Creating an integrated system takes all of us. I hope data like this will inspire and guide you. How will you improve care co-ordination and communication for your patients? ■H

Dr. Tepper is the President and CEO of Health Quality Ontario, the provincial advisor on the quality of healthcare in Ontario and a physician.

How do Ontarians experience integrated care?By Dr. Joshua Tepper

M

Many of the greatest risks to quality take place as patients move through different parts of the health system – across care settings and various health care professionals.

new Two-Day Chemotherapy Model at Trillium Health Partners (THP) is provid-ing patients with a more

personalized treatment plan, leading to higher quality care and a better patient experience.

In early 2014, Cancer Care Ontario recognized THP for achieving the short-est cancer wait times in the province. Shortly thereafter, the Two-Day Chemo-therapy Model was implemented with the goal of reducing wait times even further, improving patient fl ow and above all, im-proving patient satisfaction.

Traditionally, patients only had the op-tion of one-day chemotherapy treatment, which meant a patient would have to go through blood tests, oncologist appoint-ments and chemotherapy all in one day. This process meant long days for patients, who often spent lengthy periods of time waiting in between appointments.

Under the Two-Day Chemotherapy Model, patients have three appointments over two days. On the fi rst day, patients have their blood work done and meet with their oncologist. Based on the re-sults of these appointments, the second day is dedicated to chemotherapy treat-ment. Patients spend less time waiting for appointments and have more fl exibility to schedule their daily lives around their treatment.

Ross has been undergoing chemother-apy treatment at THP for the past two years.

“In my fi rst year of treatment I was on the one-day chemotherapy model. My treatments were four hours long, which made for a very long day,” says Ross.

The two-day model empowers patients to be more involved in their treatment plan by providing them with choices about how and when they receive treat-

ment. Ross says the two-day model suits him much better. “On the two-day model I feel more in control of my treatment. There is more certainty. After I get my blood results, I know whether or not I will have chemotherapy the next day,” says Ross.

Now marking its one-year anniversary, the two-day model has signifi cantly re-duced oncology patient wait times for pa-tients on both the one-day and two-day models. Patients on the two-day model saw wait times decrease by 77 minutes for blood work and appointments with their oncologist, and 25 minutes for chemo-therapy treatment. Overall, all patients undergoing chemotherapy treatment have seen wait times reduced by nearly 90 minutes.

“Truly patient-centred care requires building programs and treatments around the patient – taking into account patient needs both inside the hospital and be-yond its walls,” says Dr. Craig McFadyen, Chief and Medical Director, Trillium Health Partners and Regional Vice-Pres-ident, Mississauga Halton/Central West Regional Cancer Program. “The two-day model gives patients easy and timely ac-cess to high quality care.”

Staff see fi rst-hand the improvements

the two-day model has made to the pa-tient treatment plan and fl ow of the clin-ic. “The two-day model is a step forward for our clinic,” adds Cindy Burzycki a registered nurse in THP’s oncology pro-gram. “It is time-saving for the patient and effi cient for staff. Nurses are not rushed and can spend quality time with each patient.”

THP is a recognized leader in provid-ing comprehensive world-class cancer care treatment. To continue to deliver exceptional patient care, THP will open a new clinic for cancer patients in 2015 to provide direct access to urgent care for patients requiring follow-up treat-ment, avoiding visits to the emergency department and admissions to hospital. The new clinic will provide patients with convenient access to the specialists they need without having to wait in the emer-gency department or be admitted to a hospital bed.

Through compassion, excellence and courage, Trillium Health Partners is pav-ing the way for a new kind of health care within its community and beyond. ■H

Lauren Hayes is a Communications Coordinator at Trillium Health Partners.

By Lauren Hayes

A

Rethinking chemotherapy treatment

Nurses Roy Ostil (left) and Sandra Azan-Hyman (right) care for patient Mike Koyanagi during a Two-Day Chemotherapy appointment.

New chemotherapy model improves patient satisfaction



Simpler docking – patient’s head does not need to be taped down


FASTER1

Designed to minimize procedure time for faster patient throughput from start to finish:• Laser time of 30-45 seconds,* minimizing laser time to the eye• Surgeon-selectable patient flow into and out of the OR• Compatible with a range of surgical beds• Simpler and easier patient docking2

© 2013 Novartis 5/14 SU141125


*Based on typical laser treatment parameter for cataract surgery.1. LenSx® Laser systems have undergone continuous improvement since launch to reduce both laser time and procedure time. Alcon data on file.2. Multicenter prospective clinical study (n=882 eyes). Alcon data on file.



Bedsores, also called pressure ulcers, are injuries to the skin and underlying tis-sue that are usually caused by lengthy and unrelieved pressure on the skin. They are painful for patients, can lead to serious infections, and cost the Canadian health care system approximately $3.5 billion a year, according to some experts.

For patients with limited mobility – in-cluding elderly patients confi ned to a bed and people with spinal cord injuries who use a wheelchair – pressure ulcers pose a serious health concern.

Common approaches to prevention in-clude having caregivers regularly turn pa-tients and the use of specialized mattresses,

but a new type of electric underwear could help eliminate these painful injuries.

The underwear sends electrical puls-es for 10 seconds every 10 minutes to areas of the body where bedsores oc-cur (e.g., the buttocks and hips). The pulses mimic regular body movements that prevent constant pressure and help prevent bedsores.

The underwear, developed by the Proj-ect SMART team at Alberta Innovates Health Solutions, is not yet approved for sale in Canada, but in a recent experimen-tal phase 2 study none of the 48 people who used the specialized underwear devel-oped bedsores.

Top 10 ListWhat’s on the 2015

ith so many emerging drugs, medical devices, and procedures coming to market, how can health professionals, administrators, and patients identify the ones that could truly have a signifi cant impact in Canada? That’s where the Canadian Network for Environmental Scan-ning in Health (CNESH) comes in. For the second consecutive year CNESH, along with a

panel of clinical experts, have been working to identify which new and emerging health technologies hold the greatest promise to improve both the lives of patients and the delivery of healthcare.

The 2015 Top 10 New and Emerging Health Technology Watch List includes fi ve emerging drugs and fi ve innovative medical devices.

“Every day we read sensational stories about the promise of new health technologies and wonder if they will really make a difference to our health or the health care system,” says Rosmin Esmail, Chair of CNESH and Director of Health Technology Assessment and Adoption at Alberta Health Services. “But CNESH cuts through the hype and creates a list, based on evidence, which can help decision-makers plan for the future when it comes to new and emerging technologies.”

Health technologies were identifi ed through a public call for nominations and the committee followed a rigorous prioritization process to arrive at the fi nal list of 10 technologies.

So, what innovations should we be watching for in 2015?

W

Nivolumab for melanomaImmunotherapy, considered by many

to be a breakthrough in cancer care, is a treatment that works by stimulating the body’s natural immune system to fi ght the cancer. Nivolumab is emerging as an important new immunotherapy treatment for melanoma.

Melanoma is the most dangerous form of skin cancer and is one of the most fre-quently occurring cancers in Canada.

When the cancer is diagnosed early, it can be cured by surgical removal. But if it spreads to other parts of the body, surgery may not be enough and treatment focuses on chemotherapy, radiation therapy, and immunotherapy to control the cancer.

Nivolumab is used to treat patients with inoperable or metastatic melanoma. It works by blocking a protein called “pro-grammed cell death 1” (PD-1). PD-1 hides cancer cells and prevents them from

being killed by the body’s immune system.In a recent study, the cancer disappear-

ance rate was signifi cantly higher with nivolumab (7.6%) than with dacarbazine (1%), a type of chemotherapy drug, and the one-year mortality rate was 58 per cent lower in patients treated with nivolumab compared with those treated with chemotherapy.

Nivolumab is not yet available in Cana-da. In December 2014 the FDA approved the drug for advanced melanoma.

Mammograms are widely used in breast cancer screening, but they are less useful for telling normal tissue apart from cancer-ous tissue in women with dense breasts.

A new type of imaging system may of-fer more useful information when used in combination with mammography in women with dense breasts or when mam-mography results don’t agree with physical fi ndings (e.g., when a lump can be felt).

A breast-specifi c gamma camera is used to scan the breast tissue, but before the scan patients receive an injectable drug called a “tracer.” More of the tracer is ab-sorbed by cancerous cells than by normal cells, so the breast cancer typically appears as darker spots in comparison with images of normal tissue.

This type of molecular breast imaging has shown moderately better performance in identifying cancer in women with dense breasts when used in combination with mammography compared with MRI. It is also generally a more comfortable proce-dure and image data are received within fi ve to 10 minutes of the procedure.

Molecular breast imaging

Electrically stimulated underwear for pressure ulcers

Andexanet Alfa for Bleeding Episodes

An anticoagulant, often called a blood thinner, is a medication that is widely pre-scribed to help treat or prevent blood clots in the veins, arteries, lungs, or heart. For years warfarin has been the mainstay of an-ticoagulant therapy but three new oral an-ticoagulants are now available in Canada.

While these new drugs offer practical benefi ts, there is no treatment available to rapidly reverse the anticoagulant effect – something critically important to patients taking these drugs who may need emer-gency surgery or experience serious bleed-ing complications.

However, andexanet alfa (PRT064445) is a new treatment developed as an anti-dote to the new oral anticoagulants. The drug works by blocking the anticoagula-tion effect of the drugs and restoring the normal process that allows bleeding to stop.

The development of this drug is widely seen as an important innovation in the management of patients who are taking new oral anticoagulants. In the United States the Food and Drug Administra-tion (FDA) designated the drug a ‘break-through therapy’ and ongoing studies con-tinue to evaluate its safety and effi cacy.

“Every day we read sensational stories about the promise of new health technologies and wonder if they will really make a difference to our health or the health care system”



By Andrea Tiwari

Continued on page 16

OF GAME-CHANGINGHEALTH TECHNOLOGIES?

Pediatric vision scanner for common eye disorders in pre-school children

Almost half a million Canadians live with heart failure, a disabling condition where their heart isn’t strong enough to pump blood as well as it should. The dis-ease is a leading cause of death in Canada and is on the rise, as more patients survive heart attacks and live with chronic condi-tions that affect the heart such as diabetes or high blood pressure.

The standard treatment for heart failure has not changed in some time. It involves treatment with a combination of drugs and the goal is to improve symptoms and pre-vent the disease from progressing.

Medication LCZ696 is a new treatment that combines valsartan, an existing drug, with sacubitril, a new drug that works on a different pathway to increase naturally

occurring molecules in the body that de-crease blood pressure and the amount of work the heart needs to do. By combining the two drugs, the treatment helps manage heart failure in a way that could not be done by just giving sacubitril alone.

In a phase 3 clinical trial, patients with heart failure who received medi-cation LCZ696 were found to be 20 per cent less likely to die from heart-related problems than those who re-ceived standard therapy. They were also hospitalized less for worsening heart failure compared to people on standard therapy. In March 2015 Health Canada granted the drug priority review due to its potential to offer signifi cant clinical benefi t.

Multidrug-resistant organisms (MDROs) are bacteria that are resistant to a variety of antimicrobial drugs, severely limiting treatment options. They are one of the biggest issues facing public health around the world.

The available treatment options in-clude broad-spectrum antibiotics, but resistance to some medications in this class has already been reported in medi-cal literature.

Eravacycline is a new antimicrobial medication from the tetracycline class of drugs that can be given intravenously or

via pill. In clinical studies, it has shown antimicrobial activity against a wide range of bacteria, including those that are resis-tant to currently available antibiotics. It also seems to be effective at treating infec-tions that are hard to treat with other new antibiotics.

Eravacycline can be given as a single treatment even before the diagnosis in acute life-threatening infections. And, because patients can switch from injection to pill form when they are clinically stable, it has the potential to reduce the length of hospital stays and the associated costs.

Eravacycline antibiotic for multidrug-resistant infections

Medication LCZ696 for heart failure

Two of the most common vision disor-ders in preschool children are strabismus (misaligned eyes) and amblyopia (lazy eyes). Early diagnosis is key to correcting them, but if left undiagnosed they can af-fect a child’s development and even lead to vision loss.

Unfortunately, these vision disorders can be hard to diagnose using the screen-ing tools available in a family doctor’s of-fi ce and access to specialized screening programs varies greatly across Canada.

A new portable, hand-held pediatric vi-sion scanner that quickly and accurately

detects these disorders may signifi cantly improve diagnosis. The device works by giv-ing a “pass” or “refer” response, letting clini-cians know if children should be referred for further testing or treatment. The device is easy to use in a regular offi ce setting.

One published study showed that the vision scanner is better at diagnosing these eye disorders in young children than physi-cal exams or another automated device. The scanner could also lower testing costs because results can be interpreted by non-specialists and make eye exams for chil-dren more accessible.



Remote monitoring of cardiac devices

More than 200,000 Canadians with heart conditions have a pacemaker or im-plantable cardioverter-defi brillator implant-ed inside their bodies to help manage their disease. But did you know that these medi-cal devices also record data about how the heart is working? This vital information can then be used to inform treatment decisions.

Today, most patients with implanted heart devices visit a medical clinic for follow up by a heart specialist, where information from the device is transferred to a computer and any adjustments can be made.

However, it is now possible for infor-mation from these cardiac devices to be monitored remotely and transferred from home to a heath care professional. A data transfer machine in the home receives in-formation from the device and sends it to a central database, which then forwards the information to the clinician.

Remote monitoring technology has improved dramatically over the past few years and offers several advantages to pa-tients and the health system. Physicians can be quickly alerted to problem with the heart device, meaning treatment de-cisions or adjustments can be made soon-er. And remote monitoring could lead to fewer clinic visits, because information from the device is regularly sent to the health care team from home.

While some remote monitoring pro-grams for cardiac devices currently exist across Canada, the technology has not been widely adopted yet and is still consid-ered an emerging innovation.

Every year approximately 30,000 Cana-dians are hospitalized due to sepsis, and more than one-third will die.

Sepsis is a serious, full-body response to an infection and it happens when toxins, produced by bacteria or other types of in-fection, that are released into the blood-stream and cause cells to release substanc-es that initiate infl ammation throughout the body. The infl ammation can cause ex-tremely low blood pressure and tiny clots in the bloodstream which, if left untreated, can severely damage vital organs and lead to death. Toraymyxin is an external blood

purifi cation medical device that removes the endotoxin that causes sepsis from the bloodstream.

The device works with a machine that draws blood out of a vein, purifi es it of en-dotoxins, and delivers the purifi ed blood back to the patient.

When compared with standard treat-ments, toraymyxin has been shown to reduce the 28-day mortality rate by more than 50 per cent. And studies have shown toraymyxin can improve blood flow and significantly lower rates of organ damage.

Secukinumab for psoriasisPsoriasis is a chronic, infl ammatory skin

disease that causes itchy patches of thick, scaly, red skin and affects nearly one million Canadians. The disease can be long-lasting, with symptoms disappearing and reappear-ing regularly. For some it causes minor dis-comfort, but for others it limits daily activi-ties and greatly affects self-esteem.

The standard treatments for psoriasis include creams and ointments, photother-apy (also called light therapy), and oral or injected medications. The choice of treat-ment depends on how severe the psoriasis is, treatment cost, and patient preference.

Secukinumab is a new injectable drug that treats moderate to severe psoriasis. It is part of a group of drugs called biologics, which are effective at controlling symptoms with fewer serious side effects. In two re-cent studies, patients receiving secukinum-ab had better results and symptoms that decrease more quickly compared to people treated with another biologic drug.

In March 2015 Health Canada ap-proved secukinumab for the treatment of moderate to severe psoriasis for adults who are candidates for systemic therapy or phototherapy.

For more details about each of the health technologies included on the 2015 Top 10 New and Emerging Health Tech-nology Watch List and a description of the methodology used to create the list, visit www.cadth.ca/cnesh. CADTH serves as the secretariat for CNESH. ■H

Andrea Tiwari is a Communications Of-fi cer at CADTH.

Game-Changing Health Technologies

Toraymyxin for sepsis

Continued from page 15


S P E C I A L P U L L O U T S H O W G U I D ES P E C I AC I A


M A Y 3 1–J U N E 3, 2 0 1 5E2

v

www.e-healthconference.com

SUNDAY MAY 31, 2015

07:45 - 16:00 CNIA/ONIG Pre-Conference Symposium 205 A-D

08:00 - 18:00 Registration Open North Lobby09:00 - 16:00 COACH Clinician Forum 201 A-D09:00 - 11:00 CPHIMS Exam 203 CD11:00 - 13:00 Lunch 206 A-D12:00 - 13:00 CA Exam 203 CD13:00 - 16:15 CIHI Symposium 202 AB13:30 - 16:00 Canada Health Infoway Workshop 202 CD

13:30 - 16:00 Canadian Institutes of Health Research (CIHR) Workshop 203 AB

14:00 - 16:00 COACH eHIP Symposium 203 CD

16:30 - 17:30 President’s Reception By Invitation Only Exhibit Hall B

17:30 - 19:00 Welcome Reception Exhibit Hall B

19:00 - 21:00 Hacking Health Design Challenge – Opening Reception 206 A-D

MONDAY JUNE 1, 201506:00 - 17:30 Registration Open North Lobby06:30 - 07:30 Fun Run North Lobby07:15 - 08:15 Sponsor Breakfast Symposia Lobby level rooms

08:00 - 21:00 Hacking Health Design Challenge – Hack! Exhibit Hall B

08:30 - 10:00Conference Opening and Keynote Address: Kerry Munro Exhibit Hall A

10:00 - 18:30 Exhibit Hall Open Exhibit Hall B10:00 - 10:30 Break Exhibit Hall B10:30 - 11:30 Sponsor Symposia Lobby level rooms11:30 - 12:30 Lunch Exhibit Hall B12:30 - 13:30 Dedicated Exhibit Hall Time Exhibit Hall B13:30 - 15:00 Concurrent Sessions Lobby level rooms15:00 - 15:30 Break Exhibit Hall B15:30 - 17:00 Concurrent Sessions Lobby level rooms17:00 - 18:30 Exhibit Reception Exhibit Hall B17:30 - 19:30 CNIA Annual General Meeting 205 C

TUESDAY JUNE 2, 201507:00 - 19:00 Registration Open North Lobby07:30 - 08:45 Academic Forum 205 AB

07:30 - 08:45 COACH EHR Governance Community of Interest Breakfast 103 A

07:30 - 08:30 CIHI Info Session 206 E

08:00 - 12:00 Hacking Health Design Challenge – Judging Presentations Exhibit Hall B

08:30 - 09:30Plenary Session: One person, one picture Exhibit Hall A

09:30 - 17:00 Exhibit Hall Open Exhibit Hall B09:30 - 11:00 Break Exhibit Hall B09:30 - 10:45 COACH Annual General Meeting 201 AB10:00 - 11:00 Sponsor Symposia Lobby level rooms11:00 - 12:30 Concurrent Sessions Lobby level rooms12:30 - 13:30 Lunch Exhibit Hall B

13:30 - 14:30Hacking Health Design Challenge – Demo Finale Exhibit Floor Closed

Exhibit Hall A

14:30 - 16:00 Concurrent Sessions Lobby level rooms

16:00 - 17:00 Hacking Health Design Challenge – Awards Presentation Exhibit Hall B

16:00 - 17:00 Pre-Gala Reception Exhibit Hall B18:15 - 23:00 CHIA Gala Exhibit Hall A

WEDNESDAY JUNE 3, 201508:00 - 13:00 Registration Open North Lobby08:30 - 12:00 ITAC Annual General Meeting 206 E08:30 - 10:00 Concurrent Sessions Lobby level rooms10:00 - 10:30 Break Lobby Level10:30 - 12:00 Concurrent Sessions Lobby level rooms

12:00 - 14:00 Lunch and Keynote Address: Dr. Samantha Nutt Exhibit Hall A

*Program subject to change


E3 M A Y 3 1–J U N E 3, 2 0 1 5

Making Connections

APP is sponsored by

eHealth Series 2015

The Ontario Hospital Association (OHA) is pleased to present the new eHealth Series 2015 which includes both in-person conferences and live webcast events on a variety of eHealth topics.

Following are the first four events in this series:

eHealth 101 Monday, June 8, 2015

Advancing Towards a Paperless Patient RecordTuesday, June 16, 2015

Getting Board Members on Board with Health Care Information SystemsTuesday, June 16, 2015

Doing CPOE Right: Patient-Centred Design and Evidence-Based CultureTuesday, September 29, 2015

To register, learn more and stay updated on future eHealth Series programs,

visit www.oha.com/ehealthseries.

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The result is highly relevant content, delivered by subject-matter experts – keeping you on the leading edge of health care issues, trends and thinking.

To learn more, or to register now, go to www.oha.com/conferences.


M A Y 3 1–J U N E 3, 2 0 1 5E4

Kerry Munro – Digital Leader, Social Marketing Expert & Former COO@kerrymunrois■ Monday, June 1 ■ 8:30am–10:00am■ Conference Opening and Keynote

Address

“Help, I’ve fallen and I can’t reach my iPhone”

Kerry Munro is a dynamic, results ori-ented leader with deep knowledge and proven success in Omni-Channel, ecom-merce and digital. He delivers break-through performance and shareholder value via transformational change and the creation of extraordinary consumer and commercial experiences. Kerry possesses the strategic vision and leadership required to transform businesses that face disrup-tion due to changing market or technol-ogy dynamics, particularly in the areas of Omni channel, digital intermediation and customer experience.

In less than 4 years he took Yahoo Can-ada from a fl oundering business and cata-pulted it into the fastest growing and best performing business unit in Yahoo world-wide, growing revenues from under $5M to $200M USD and creating long standing consumer relationships with over 19 mil-lion Canadians monthly. In a hyper-com-petitive industry where Canadians spend more time online than anywhere in the world, he lead the market through his deep

understanding of how to connect consum-ers to brands by leveraging the power of the internet, mobile and social media.

Dr. Samantha Nutt– Global Humanitarian, Founder of War Child Canada & Bestselling Author@SamanthaNutt ■ Wednesday, June 3■ 12:00pm–2:00pm

Lunch and Closing Keynote Address

Samantha Nutt is an award-winning humanitarian, bestselling author and ac-claimed public speaker. A medical doctor and a founder of the renowned interna-tional humanitarian organization War Child, Dr. Nutt has worked with children

and their families at the frontline of many of the world’s major crises – from Iraq to Afghanistan, Somalia to the Democratic Republic of Congo, and Sierra Leone to Darfur, Sudan. A leading authority on current affairs, war, international aid and foreign policy, Dr Nutt is one of the most intrepid and recognized voices in the hu-manitarian arena and is amongst the most sought-after public speakers in North America. With a career that has spanned more than two decades and dozens of confl ict zones, her international work has benefi ted hundreds of thousands of war-affected children globally.

Dr. Nutt was named one of Canada’s 25 Transformational Canadians by The Globe and Mail, and has been recog-nized as a Young Global Leader by the World Economic Forum. Time Maga-zine has featured her as one of Canada’s Five Leading Activists. In July 2011,

Dr. Nutt was appointed to the Order of Canada, Canada’s highest civilian hon-our, for her contributions to improving the plight of young people in the world’s worst conflict zones. ■H

■ Tuesday, June 2, 2015■ 8:30 AM to 9:30 AM

One Person, one picture: The value of standardized and interoperable data

This plenary session will highlight the value of using standardized tools such as the interRAI suite of assessment in-struments at the point of care to support decisions for direct clinical care, organi-zational program planning, resource allo-cation, and health care policy.

The interRAI assessment instruments collect and generate interoperable data across the continuum of care through the use of standardized common lan-guage. The key is to collect data once at the point of care and use the same infor-mation for managing the care of an in-dividual and for to managing the health care system.

Come and learn more about the imple-mentation of interRAI assessment instru-ments in Canada and other countries.

Moderator: Nadine Henningsen, Executive Director, Canadian Home Care Association

Our Panelists

John Hirdes, PhD FCAHS, CanadaDr. Hirdes is a professor and chair of

the Ontario Home Care Research and Knowledge Exchange at the School of Public Health and Health Systems, Uni-versity of Waterloo, Ontario, Canada. He is the senior Canadian Fellow and a board member of interRAI. He chairs the interRAI Network of Excellence in Mental Health (iNEMH) and the inter-RAI Network of Canada, a collaborative network of researchers and graduate stu-dents from across Canada.

Anja Declercq, PhD, BelgiumDr. Declercq has a degree in applied

economics and in sociology, and a PhD in social sciences.

She is currently a professor in the Fac-ulty of Social Sciences of the Katholieke Universiteit Leuven in Belgium and proj-ect manager at Lucas, an interdisciplinary research institute of that same university. Her research mainly focuses on care for elderly people in terms of innovation and quality improvement.

Andrew Downes, New ZealandA Physiotherapist by background, An-

drew worked in neuro-rehabilitation for most of his 12 years in clinical practice. During the past 16 years Andrew has been involved in a number of large clini-cal change management projects that have all included a major healthcare IT component. He is currently the manager of the National interRAI Software Ser-vice for New Zealand. This services pro-vides access to a national clinical assess-ment system, interRAI, which is used by several thousand clinicians from several hundred health care providers across the acute, community, primary and residen-tial care sectors in New Zealand. ■H

Keynote speakers

Plenary Panel Session

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E5 M A Y 3 1–J U N E 3, 2 0 1 5

here is no longer any question about the value that electronic information technology repre-sents for health care systems

around the world. And while the ability to gather, store, manage and share patient information is driving health system trans-formation everywhere, ensuring that clini-cians have the right data and information when and where they need to use it is now critical if patients are to receive the best possible care.

In recent years, Canadian health leaders have implemented numerous digital health strategies that have greatly increased clini-cians’ electronic access to information. The problem now, as President, Cerner Canada Jim Shave explains, is that the fl ow of infor-mation is still too often one-to-one and isn’t fl owing ftreely between all clinicians and organizations that gather information. That broader fl ow, or interoperability, represents the next frontier in Canadian healthcare.

“Clinical interoperability happens when patient information can move freely be-tween competing systems without organi-zational, vendor or geographic barriers,” says Shave. “In Canada, the industry needs to mobilize and fi nd new ways to get clini-cal information fl owing more easily.”

Dr. Peter Rossos, CMIO and staff gastro-enterologist at UHN noted in a presenta-tion to the House of Commons Standing Committee on Health in 2012 “To better leverage economies of scale, we can con-solidate, upgrade, and replace systems, and

we can improve connectivity and interop-erability between existing systems.”

Trevor Hodge, Executive Vice-President of Canada Health Infoway, echoes the need for clinical interoperability, which he sees as the starting point in fully realizing the value of digital health.

“Interoperability is just the means to an end,” says Hodge. “The end is advanced clinical use of information, and better, safer, patient care. And there is no doubt, whatsoever, that the road to advanced use of information and better care lies through clinical interoperability.”

With that end in mind, the Pan-Ca-nadian Clinical Interoperability Steering Committee, composed of clinicians, health and e-health program leaders, vendors and other stakeholders was formed in 2014. Co-chaired by Rossos and Hodge, the commit-tee developed a strategy to accelerate clini-cal interoperability in Canada, and have just released an Action Plan, which they call a roadmap to implementing that strategy.

While the plan will be updated in re-sponse to changing circumstances and increased understanding, the overarching goal, which is to improve the quality of patient care through the effective sharing of clinical information among health care organizations, clinicians and their patients will remain constant.

The Action Plan establishes three initial priorities: Medication Management, Com-municable Disease Management, and Co-ordination of Care.

The fi rst of these, medication manage-ment, is intended to increase patient safety

by reducing the number of preventable med-ication errors focused specifi cally on e-pre-scribing and electronic hospital medication reconciliation. Signifi cant work has been done in these two areas over the past 10 years in Canada, and the Action Plan aims to build on this work. Over the next few months, the Interoperability Steering Com-mittee will coordinate briefi ngs and other ac-tivities in order to engage stakeholders and mobilize the industry to move forward.

The second Action Plan priority is communicable disease management. The initial focus here is on immunization, spe-cifi cally interoperability among physician offi ce EMRs, public health immunization systems, and possibly community pharma-cy systems. A great many clinicians and e-health professionals have already ex-pressed interest in immunization interop-erability projects, and working groups are being established to examine clinical requirements for sharing information, as well as standards and protocols to support the sharing of immunization information between EMRs and across systems.

The third priority is coordination of care. While much of the early work will focus on establishing a common agreement on what properly constitutes coordination of care, e-referral is one area in which good work is currently being done, and this holds real promise in terms of shortening wait times, reducing oversights, and improving the pa-tient experience.

Dr. Rossos says the Action Plan’s initial priorities are a great fi rst step, and notes that strategic directions and initiatives must be established, implemented and sus-tained by the Canadian health industry. On behalf of the Clinical Interoperability Steering Committee, Rossos and Hodge are asking clinicians, health and e-health leaders, as well as vendors and other stake-holders to visit the Canada Health Infoway InfoCentral website to learn more about the Action Plan and provide feedback on the Plan’s fi rst priorities. Based on cur-rent needs, future requirements and work achieved to date, the timing is perfect for a collaborative move towards national clini-cal interoperability.

Hodge concludes, “This plan is a road-map for work we are all going to do to-gether. We have 77,000 physicians, 360,000 nurses, 38,000 pharmacists, and one million allied health professionals, all serving 35 million Canadians. If we are going to make the best use of the clinical information we have been so good at collecting, in order to deliver the best possible care, we all need to be pulling in the same direction.” ■H

Colin Gray is a freelance writer in Toronto.

By Colin Gray

Connecting for interoperabilityT

“Clinical interoperability happens when patient information can move freely between competing systems without organizational, vendor or geographic barriers”

telushealth.comTELUS Talks Health newsletter. Leading insights. Provocative thinking.Subscribe now at telushealth.com/signup

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M A Y 3 1–J U N E 3, 2 0 1 5E6

acking Health has partnered with the Ontario Telemedi-cine Network (OTN), Can-ada’s Health Informatics

Association, Canada Health Infoway, and the Canadian Institute for Health Information to deliver an eight week design challenge culminating in a demo showcase and prizes to be awarded at the National e-Health Conference May 31-June 2nd, 2015.

The event began with a kick-off at the MaRS Centre March 30th, where Dr. Ed Brown, CEO of OTN, announced chal-lenges and priorities for participants to work on. Participants then began co-de-veloping solutions with a design jam facili-tated by Usability Matters.

Teams then went virtual for eight weeks.

Four meetups were hosted (one every two weeks) with exciting keynotes to keep teams engaged and motivated.

Finally, teams will convene at the National e-Health Conference hosted

by Canada’s Health Informatics Asso-ciation, Canada Health Infoway, and the Canadian Institute for Health Informa-tion. Starting with an evening reception on May 31st, and followed by 48 hours

of fi nal tweaking, validation, and testing, the teams will then partake in a demo competition in which they are judged and scrutinized, with winners announced shortly after. ■H

Hacking Health Design ChallengeH

Sunday May 31th, 5-9pmDuring the Sunday night reception,

teams will give a 5 minute pitch to their progress to date and network with confer-ence attendees.

Monday June 1st, 8am-9pmMentors and digital health experts will

visit teams fi rst thing in the morning, of-fer feedback, and suggest ways to improve their prototypes. Teams will then spend the next 24 hours modifying, improving, test-

ing, validating and tuning their prototypes in preparation for the demo competition.

Tuesday June 2nd, 8am-5pmAll hacking stops at 12pm. After lunch,

the demo competition begins. Teams will be evaluated by an expert panel of judges.

The awards presentation and winners will be announced after judges deliberate, ex-pected between 4-5pm.

“Hosting the Hacking Health Design Challenge at Canada’s largest eHealth conference enables the participating

teams to co-develop, validate, test, and form important partnerships with key stakeholders in the digital health commu-nity. We have fantastic partners on-board that are committing to take the developed solutions and prototypes to citizens and patients, moving these projects forward long after the challenge concludes. This is a great opportunity to see the ground-breaking solutions that design, tech, en-trepreneurial and healthcare communi-ties can build together.” – Hadi Salah, co-founder of Hacking Health.

is key to developing and maintaining a thriving health care system across geographical boundaries

health care system is necessary to deliver high quality care under

It’s all about and providing

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Learn about Agfa HealthCare at www.agfahealthcare.com

Agfa HealthCare’s Enterprise imaging solution is a universal imaging platform that supports integrated care across the department, enterprise and region. It brings together patient images from multiple sources across the entire healthcare system in one consolidated view. The Enterprise Imaging portfolio improves collaboration across disciplines, reduces costs and increases operational efficiency.

Enterprise ImagingNo image left behind!


E7 M A Y 3 1–J U N E 3, 2 0 1 5

Imagine your INTEGRATED, OPTIMIZED, EFFICIENT health system.

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Around the world, hospitals are preparing for a future that incorporates regional healthcare. With ever increasing demands for efficiency and cost savings, collaboration and consolidation along the care continuum are key to ensuring that patient care quality remains the number one priority. Agfa HealthCare’s regional imaging offering includes a single platform, including VNA technology to store images and a zero-footprint viewer technology to view images. This workflow centric approach to manage internal and external sharing of images and reports facilitates exchange of data between systems. It connects caregivers providing both clinical and diagnostic access to images across a community or region. As a leading provider of integrated IT systems and state-of-the-art imaging solutions for hospitals, Agfa HealthCare has the experience and solutions to support you on your journey to a regional healthcare model

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M A Y 3 1–J U N E 3, 2 0 1 5E8

T.F.H.C. T.F.H.C.

T STAIRS

OPEN

EXIT STAIRS

OPEN

FHC

FHC

FHC

309 ShowOffice

308 ShowOffice

SHOWCASE&

THEATRES

HACKATHON

CommunicationsCafé

eposter Rooms

Meeting Room

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17 Ehtics

ringing more care into the cor-rections system makes simple sense when one looks at the incidence of mental health

issues among prison populations. That said, some people may think offenders are not being held accountable for their actions because they are ‘not criminally responsible’ (NCR). Certain high profi le media stories might lead one feeling a ‘moral yuck’ if you believe that this status of ‘NCR’ can be used as a way of avoid-ing the penal system. In fact, these people are managed through the forensic system – there is, though, a clear determination that they need treatment as much as or more than detention.

This raises broader ideas of the pur-poses of corrections systems. Are they meant to be punitive? Are they meant to ‘correct’? Can recovery (one form of ‘correction’) potentially lead to redemp-tion? From where does that possibility of redemption come – the legal system, or the general public? Perhaps in our ideal system and society, people with emerging mental health issues would have enough earlier support to keep them well and nev-er involved with the justice system.

Until then, a three way partnership is able to bring more active care to some people within the corrections system. Working with the Ministry of Community Safety and Correctional Services and the Ministry of Health and Long-Term Care, CAMH’s Forensic Early Intervention Ser-vice (FEIS) will enhance the voluntary

mental health services for individuals in the Toronto South Detention Centre. These people have mental illness which may make them unfi t to stand trial (UST) or who may have a legitimate defense of NCR available to them.

The new remand centre in Mimico in-cludes a 26-bed unit for people with acute mental health needs. If an initial screen-ing for mental health issues is positive, a referral to FEIS can then bring about tri-age, assessment and treatment.

The goals of FEIS include improv-ing safety for staff and inmates, reducing backlogs in the courts due to concerns about an inmate’s fi tness to stand trial and improving inmates’ chances of rehabilita-tion, thereby decreasing the likelihood of reoffending.

FEIS makes use of CAMH’s lengthy ex-perience in assessing and providing care and supports to individuals whose mental illness has led them to encountering the

criminal justice system. It also extends the service in a manner aimed at more timely access to treatment and rehabilitation in order to successfully reintegrate individu-als back into the community. Ultimately, the goal is to enable people currently en-meshed in the forensic system to live their lives as well as possible – UST or NCR or not.

In addition, the FEIS teams are de-veloping an ‘integrated care pathway’ to guide their work. This consistent interdis-ciplinary plan of care is designed to help clients with specifi c conditions or symp-toms to progress by providing detailed guidance for each stage of care. This also enables evaluation across many clients over a time period – offering the evidence to validate and improve practice and re-covery outcomes.

Working toward these goals of recov-ery and reintegration within a corrections context is not at all a matter of leniency, but rather a recognition of illness (and in some circumstances, exacerbating social conditions) which can produce criminal behavior but which can also be managed - preventing more of the same in the future.

FEIS is one piece of a larger matrix of forensic mental health care across Canada and elsewhere, including formal profes-sional health care as well as less formal support from other sources - often involv-ing the arts. These include ‘Postcards from the County’ based at the Pittsburgh Insti-tution near Kingston, Ontario; Zoe Boek-binder’s Prison Music Project inspired

by Johnny Cash’s Folsom Prison Blues concert and a variety of ‘Shakespeare in prison’ projects around the world.

These projects all work toward some-thing that is a grand ethical aspiration - embracing ‘gravity and grace’ simultane-ously. That phrase comes from Simone Weil - an early 20th century writer. She was not specifi cally referring to forensic rehabilitation, but those three words cap-ture the great moral challenge of seeing people with criminal histories as people with multiple dimensions - and very dif-ferent possible futures.

Moving past instinctive ‘yuck’ feelings can take effort. Finding ways to see others in multiple dimensions is often a central element of ethical reasoning. In foren-sic mental healthcare, the gravity is very great. But the mustering of grace remains an essential in all realms of care. Innova-tions like FEIS and evidence based path-ways of care help support clients and staff to achieve such aspirations. Clear infor-mation can help the open-minded public, too, see these aspirations as valid, valu-able and virtuous. ■H

Kevin Reel, MSc, OT Reg. (Ont.) is an Ethicist at The Centre for Addiction and Mental Health (CAMH), an Assistant Professor and Associate Graduate Faculty Member, Department of Occupational Science and Occupational Therapy Associate Graduate Faculty Member, Institute of Medical Science, University of Toronto.

More care for clients within the corrections systemBy Kevin Reel

B

Working toward these goals of recovery and reintegration within a corrections context is not at all a matter of leniency, but rather a recognition of illness.



Windsor Regional Hospital nurse took the top prize at an international competi-tion where mobile “apps”

for the health care sector are designed and developed.

Kaitlyn Sheehan, an RN in the cardiac catheterization lab at the hospital’s Ouel-lette campus, was the “Overall Judges Favourite” recipient at Hacking Health Windsor Detroit for the app she concep-tualized called “Stent Tracker.” It’s a Web-based app that allows patients to store their cardiac stent information, manage their medication list, schedule reminders to take important medications, and pro-vide an educational tool on heart health after a coronary angioplasty. With an app, all this information can be synced on a mo-bile device, rather than a patient card or pamphlet that could easily get lost.

The idea by Kaitlyn, who also works at the Cardiothoracic ICU at Harper Univer-sity Hospital at the DMC in Detroit, was so good that it was also judged as the app with the “Highest Potential for Adoption.”

Kaitlyn came up with the idea herself, and assembled a team to help her design a prototype for the app, which will be further developed this year.

“It was so exciting,” Kaitlyn says of the fi rst annual Windsor-Detroit competition. “It had an amazing team – programmers, med students and myself – to create an app that can really help our patients.”

About 200 people participated in the 1st annual Hacking Health Windsor De-troit at TechTown Detroit on May 1-3, which teamed up health care profession-als – doctors, nurses, pharmacists and hospital admins – with professionals from the IT sector–programmers, designers – to design mobile applications for the health care sector.

Hacking Health “hackathons” take place around the world, and are designed to improve healthcare through collabora-tion between health care professionals and technology creators.

More information about Hacking Health can be found at www.hackinghealth.ca. ■H

Steve Erwin is Manager, Government and Community Relations, Corporate Communications, Windsor Regional Hospital.

Nurse wins top award for mobile app designBy Steve Erwin

A

Kaitlyn Sheehan conceptualized the app “Stent Tracker.”

orth York General Hospital (NYGH) is the fi rst hospital in Canada to use Radio Frequen-cy Identifi cation (RFID) as a

medication management solution, signifi -cantly improving accuracy and effi ciency within its pharmacy operations, and ulti-mately improving patient safety.

In a quality study, NYGH registered pharmacy technicians were able to achieve 100 per cent accuracy in restocking medi-cation trays using MEPS Real-Time Inc.’s Intelliguard® Kit and Tray Management System. The system uses advanced RFID technology to automate the process of restocking medication trays, which elimi-nates the potential of human error and reduces restocking time.

“Our goal was to improve patient safety by reducing the risk of medication errors in the restocking process,” says Edith Rolko, Director of Pharmacy and Infec-tion Prevention and Control at NYGH. “The results from the quality study dem-onstrated not only can we reduce the risk of medication errors with an automatic re-stocking system, we can virtually eliminate the risk all together. Using the data col-lected from the quality study, which mea-sured error rates in the restocking process with and without an automated system, it is estimated the automated Intelliguard® Kit and Tray Management System will prevent over 2500 medication tray errors annually.”

How it works: A small RFID tag is placed on the medi-

cation containers. Each RFID tag contains product information such as manufactur-er, medication name, drug identifi cation number, lot number and expiration date.

When medication trays are returned to the pharmacy to replenish drugs that have been used or removed, each tray is placed in the Intelliguard® Kit and Tray Manage-ment Workstation. The system will scan

all the remaining RFID tagged items, com-pare them against the tray’s assigned drugs and quantities. It then generates a list of consumed, expired or soon-to-expire med-ications to be replaced in only a matter of seconds.

The pharmacy technician will then refi ll the tray according to the list. As a last safety measure, each replenished tray is placed back in the workstation and scanned once again to ensure all restocked medications and quantities are correct. A fi nal report is printed and sent to the pa-tient care area with the refi lled tray.

Before the automated system was in place, NYGH pharmacy technicians man-ually checked every medication in the trays. It took 8.5 minutes to review 78 to 138 medications in a single tray. With the new Intelliguard® Kit and Tray Manage-ment Workstation, restocking medication trays only takes 4.1 minutes, less than half the time.

“The automated restocking process ensures patient care areas have the right drugs, in the right doses, at the right time,” says Rolko. “Manual medication checking was incredibly labour intensive and time consuming, and there was always a risk of human error. Since we began working with

the automated system in October 2014, we have saved over 592 hours and eliminated the risk of error in the restocking process.”

Today, with the time saving realized, NYGH pharmacy technicians can offer daily medication tray refi lls with more ac-curacy for high users like the anesthesiolo-gists. The Department of Anesthesia was one of the fi rst areas to trial the system and recognized the advantages.

“The RFID tags have signifi cantly im-proved the work fl ow between the Depart-ment of Anesthesia and the pharmacy,” says Dr. Richard Bowry, Chief of Anes-thesia at NYGH. “In the past, medication trays were restocked three times a week, and we would often need to call the phar-macy to deliver additional medications. With this new automated system, the trays are restocked daily so the anesthesia team can be confi dent the medications required to do their work are available.”

Rolko explains one of the reasons NYGH chose the MEPS Real-Time Inc.’s system was because of the small tag sizes, which was especially important to the anasthesiology team. The RFID tags are about 1 by 2 centimeters in size and do not interfere with the actual medication labels.

“The quality study conducted with North York General Hospital confi rms the clear and distinct benefi ts of using an RFID-based medication management so-lution to eliminate medication errors in tray exchanges and increase staff effi ciency within the hospital pharmacy,” said Shariq Hussain, CEO, MEPS Real-Time, Inc. “Our Intelliguard® Kit and Tray Manage-ment System provides a fast, accurate, reli-able and easy-to-use solution for managing tray restocking so clinicians have access to critical medications when and where they are needed throughout the hospital.” ■H

Priscilla Hsu is a Communications Offi cer at North York General Hospital.

Using RFID technology to reduce medication errors By Priscilla Hsu

North York General Hospital (NYGH) is the fi rst hospital in Canada to use Radio Frequency Identifi cation (RFID) as a medication management solution, signifi cantly improving accuracy and effi ciency within its pharmacy operations.

Debbie Pereira, Pharmacy Technician at NYGH, using the Intelliguard® Kit and Tray Management to scan a medication tray.

N


19 Nursing Pulse

OSGOODEPROFESSIONAL DEVELOPMENT CONTINUING LEGAL EDUCATION

Priority Service Code: 15-99HN

To Register: www.osgoodepd.ca Or Call: 416.597.9724 or 1.888.923.3394 Or E-mail: [email protected]

Legal Risk Management for Nurses in 2015June 17, 2015Live & Online

Critical Legal Issues in Documentation and Charting for NursesJune 18, 2015Live

2015 Guide to Legal Risk Management in Long-Term CareSeptember 28, 2015Live & Online

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comprehensive approach is needed to ensure there is an adequate supply of nurses to look after the health and well-

being of people living in rural, remote and northern regions of the province.

That’s a key fi nding of a provincial task force launched by the Registered Nurses’ Association of Ontario (RNAO) and co-chaired by David McNeil, Vice President Patient Services, Clinical Transformation and Chief Nursing Executive at Health Sci-ences North, and Louise Paquette, Chief Executive Offi cer of the North East Local Health Integration Network (LHIN).

The two long-time northern residents released RNAO’s report on May 11 in Sud-bury. Coming Together, Moving Forward: Building the Next Chapter of Ontario’s Rural, Remote and Northern Nursing Workforce sheds light on why it’s diffi -cult to retain and recruit nurses, and pro-poses 23 recommendations that will help stem a shortage of nurses working in these communities.

RNAO launched the task force – com-posed of more than a dozen experts in the health fi eld – in April 2014 with a mandate to come up with strategies to help build a more sustainable nursing workforce for ru-ral, remote and northern areas of the prov-ince. The consultation process included examining evidence, scanning what other jurisdictions and professions have done, and listening to hundreds of registered nurses (RN), nurse practitioners (NP), reg-istered practical nurses (RPN), and nursing students.

“Without a doubt, nurses play a pivotal role in our health system. And the particu-lar challenge we uncovered was the need to improve access to care, because nurses pro-vide the hands-on care patients require,” says Paquette, adding that she is confi dent the recommendations will help attract and retain nurses.

Among the recommendations:• Invest and support strategies that will re-sult in 70 per cent of nurses working full time• Address compensation inequities be-tween community and hospital sectors • Develop a framework, practice standards and education pathways that support an expanded scope of practice in rural, re-

mote and northern sectors, including RN prescribing • Improve access to nursing education by bringing it closer to home and supporting First Nations, Inuit, Métis and Franco-phone persons to become nurses• Develop partnerships to support the travel and accommodation needs of nurs-ing students seeking placements in rural, remote or northern settings• Provide funding for nursing orientation programs for newly hired nurses to rural, remote or northern communities• Relieve short-term staffi ng gaps through organizational partnerships instead of rely-ing on temp agencies and overtime to back-fi ll vacation/leave• Create and support access to dedicated continuing education that recognizes the unique nature of rural nursing practice

Co-chair David McNeil, who is also a past-president of RNAO, has experience working in a remote nursing station. He says the report is timely and can remedy recent concerns highlighted by the Auditor General of Canada. Earlier this month, Au-ditor General Michael Ferguson released a review of health services in dozens of First Nations communities in Ontario and Man-itoba. “A number of our recommendations deal directly with concerns about scope of practice, education and training and we are certain the recommendations put forth by the task force will improve quality of care in remote regions where First Nations, Inuit and Metis populations live,” McNeil says. “Nurses and others have been inspired by the association’s decision to focus on rural, remote and northern nursing challenges.”

RNAO CEO Doris Grinspun commend-ed Paquette, McNeil and the rest of the members of the task force for their work. A collaborative effort from all levels of government, health organizations, associa-tions, educators, and community partners is needed, she says, and so the task force has proposed leaders and stakeholders to guide the implementation of each of the report’s recommendations.

“The task force has acknowledged that a shared responsibility is needed to address the historical gap in nursing services in our rural, remote and northern communities, and the time to begin taking action is now,” Grinspun says. “This way, we can ensure swift implementation of the solutions we propose to make sure we are doing all we can to meet the unique care needs of peo-ple who live in these communities.”

To read the task force report, visit www.RNAO.ca/RuralRemote ■H

Marion Zych is director of communications for the Registered Nurses’ Association of Ontario (RNAO), the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario.

Recommendations to retain and recruit nurses in rural, remote and northern communitiesBy Marion Zych

A comprehensive approach is needed to ensure there is an adequate supply of nurses to look after the health and wellbeing of people living in rural, remote and northern regions of the province.

David McNeil, VP Clinical Programs and Chief Nursing Executive at Health Sciences North (left), and Louise Paquette, CEO of the North East LHIN, co-chaired RNAO’s task force that released recommendations for Coming Together, Moving Forward: Building the Next Chapter of Ontario’s Rural, Remote and Northern Nursing Workforce.

A



he Juravinski Cancer Cen-tre in Hamilton, Ontario has been exploring new terrain in the concept of ‘mobile’ health

with the introduction of the Screen for Life Mobile Cancer Screening Coach. Roughly the size of a Greyhound bus, the cancer screening coach is fully equipped with a state-of-the-art digital mammography ma-chine and supported by allied health pro-fessionals trained to perform Pap tests and provide cancer screening consultations. Fecal Occult Blood Test (FOBT) kits, the at-home test for colorectal cancer screen-ing, are also available to patients who meet the eligibility criteria.

The introduction of the cancer screen-ing coach represents a shift in the model of cancer care services delivery – where health services are brought directly to people where they live, to facilitate access to care.

Since it’s launch in June 2013, the can-cer screening coach’s focus has been on engaging the under/never screened popu-

lation of women 50 – 74 years of age who may face cultural, social and/ or other bar-riers that make it diffi cult for them to par-ticipate in screening. Initially stationed for a couple months at a time at community centres located in priority areas in lower Hamilton, the cancer screening coach now operates on a rotating schedule, mak-ing regular visits to over 20 different sites across the lower city. In May 2015, the coach was also launched at Six Nations in Oshweken to make cancer screening more accessible to First Nations people.

“Regular cancer screening can detect cancer at an early stage before symptoms develop, or detect changes that lead to cancer,” says Dr. Ralph Meyer, president, Juravinski Cancer Centre and regional vice president, Cancer Care Ontario. “This is why we are reaching out to women and men in their communities to ensure they have equal access to care. The can-cer screening coach is an innovative way to bring much needed services closer to home, especially for people who may oth-erwise not be screened for breast, cervical or colorectal cancer.”

Catherine Murray credits the cancer screening coach for saving her life. At the age of 54, Catherine had never received a mammogram even though she was eligible for the Ontario Breast Screening Program when she turned 50. There were other competing priorities, such as ensuring her utility bills could be paid, which brought her to the North Hamilton Community Health Centre, where the Coach had been stationed.

It was on this fateful trip that Catherine met Carrie Claxton, a medical radiology technologist who performs mammography on the Coach, who invited her to visit the state-of-the-art facility on wheels. Agree-ing to breast screening, Catherine never expected that a test done on a bus would eventually lead to a diagnosis of breast cancer.

“I would never have found the tumour which was the size of a peach if I hadn’t re-ceived a mammogram on the Coach,” says Catherine. “I am extremely grateful to the people on the bus for helping me to fi nd the cancer early enough that it’s treatable. To a certain extent, they saved my life.”

Catherine’s praise of the cancer screen-ing coach team is well warranted as their commitment to person-centred care and community engagement has made a sig-nifi cant impact on the communities the coach has served. For the past three years since the cancer screening coach hit the road, team members have actively dem-onstrated leadership in social advocacy and participatory action by reaching out to people at food banks, seniors groups, yoga classes and bingo forums. The team, which includes nurse navigators, medical radiology technologists, clerks, a health promotion specialist, a Primary Care Medical Lead and Regional Primary Care Aboriginal Cancer Physician Lead, has been resilient and resourceful in leading change by creating a positive environ-ment that embraces diversity and equal-ity in a non-judgmental way for people who may be otherwise wary of getting screened.

“Trust is fundamental in any patient/caregiver relationship, but no more so than when it comes to caring for people who have rarely or never been screened for cancer,” says Dr. Meyer. “The team’s compassionate approach has not only made remarkable contributions but has helped to ensure the success of a new and innovative patient-care model.”

In April 2015, the cancer screening coach team was recognized with a Human Touch Award from Cancer Care Ontario for providing exceptional care.

Features of the Coach include:• a full fi eld digital mammography suite• an exam room for pap screening• two change rooms• wheelchair accessibility• running water• two back-up generators• shoreline availability• Wi-Fi to support information systems and communications ■H

Vel Snoukphonh is a Public Relations Specialist at Hamilton Health Sciences.

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Screen for Life Coach brings cancer screening closer to homeBy Vel Snoukphonh

T

Cancer Screening Coach Team and community partners work together in priority areas in Hamilton to facilitate access to cancer screening.Coach.

Carrie Claxton, medical radiation technologist assists a client with mammography on the Screen for Life Coach.

The introduction of the cancer screening coach represents a shift in the model of cancer care services delivery – where health services are brought directly to people where they live, to facilitate access to care.



obody told my grandmother she was dying of cancer — not the doctors, not my father, not me. In the late 1960s, a termi-

nal disease was kept from a patient. And so that poor, beloved woman died terrifi ed of what was happening to her body.

Death and disease were not discussed in those days. We went along with our doc-tor’s decisions, even avoiding his (and it usually was a he) offi ce in case he was keeping from us something that could be potentially fatal.

Welcome to the Swinging Sixties. Much has changed since then but we still have a long way to go to create an environment in which the patient is no longer simply the recipient of the munifi cence of highly edu-cated, highly skilled medical professionals.

My children call me RoboMom after two new knee joints and two new lenses to replace my clouded ones. However I am more than the sum of my mechanical bits and pieces. I’m a survivor of multiple post-operative infections, months spent in hospital, and weeks at home receiving an-tibiotics intravenously.

In my year-long journey I discovered that I have a right to take part in decisions about how my body is treated. To discuss treatment options intelligently with my health care providers. To make informed decisions about what is best for me. And I have learned that I am also responsible, to the best of my ability, to take care of my health.

I became involved in a pilot project in Nova Scotia in which patients and doctors freely exchange medical records through a secure online site. It has been an enrich-ing experience and I’ve spoken about it at a few health conferences. It has also led me to become a voice for patient-centred care. How to include patients in decision-making from universal access to digital health records to requesting second opin-ions without fear of being blackballed by the medical profession. It’s about working with doctors and nurses and other health care providers to maximize care and limit costs in an overburdened health care sys-tem in Canada.

Recently I began doing volunteer work in the day unit of the oncology department. As I offer tea, juice, cookies and a friendly smile to those receiving chemotherapy, I sometimes observe doctors discussing treatment options with patients and their families. That did not happen to me just three years ago while I was hospitalized. Perhaps because it was a different environ-ment but doctors did rounds at 6 a.m. as I groggily came to after heavy medication, leaving me in no position to ask questions. Only fl oor nurses, with access to the doc-tors’ notes, could interpret for my family and me what was wrong with me and what was being done to help me heal.

I notice other changes too. My family doctor went on a local radio call-in pro-gram to detail her ideas for a “Triple Aim” approach to general practice which, to quote her, will focus on “improving patient and health care practitioner satisfaction, improving individual and health of the population and that all we do is sustain-able (money, resources, human workforce, etc.).” Now that it refreshing.

Still there are areas of healthcare that could be improved to allow the patient more say in his/her care. One I want to explore is the relationship between ortho-

paedic surgeons and physiotherapists. The ward therapists in hospital do work closely with surgeons but once released I was on my own to fi nd help in private clinics. I chose, through the recommendation of a friend, not a medical professional, an ex-cellent practice that offers strength train-ing to help with post-operative healing. But when I asked if my therapist commu-nicates with surgeons, he said not really. Surgeons are too busy and other than mes-sages passed to him via patients, he has no real contact. Maybe it is time for each to speak and each to listen — perhaps

even listen to a patient with experience of both.

We have come a long way from the late 1960s when my Grandmother huddled in a hospital bed, zonked out on drugs for pain, and trembled in fear about what was happening to her. But there is still some distance to go.

I welcome comments and may be reached at [email protected]. ■H

Alexa Thompson is a freelance writer with an interest in patient-centred healthcare.

VS.

YOUR ADVANTAGE, in and out of the courtroom.

www.thomsonrogers.com

A patient’s perspectiveBy Alexa Thompson

N

We still have a long way to go to create an environment in which the patient is no longer simply the recipient of the munifi cence of highly educated, highly skilled medical professionals.



urgical patients at Rouge Val-ley are healing more quickly thanks to our physicians, staff and the use of new technology.

Both Rouge Valley Health System (RVHS) hospital campuses, Rouge Valley Centenary (RVC) and Rouge Valley Ajax and Pickering (RVAP), each now have a new portable X-ray machine. Known as a mini C-arm, this diagnostic equipment creates an X-ray picture producing a live and continuous X-ray image for surgeons during procedures to aid in the diagno-sis and repair of feet, hand, wrist, and fi nger injuries.

The surgeons of Rouge Valley are taking full advantage of this new tool in use since last month to streamline care and ensure more immediate feedback on the success of procedures for patients.

“Because it’s portable and produces very low levels of radiation, I can use the mini C-arm in the operating room during delicate trauma or reconstructive surgeries for fi ngers, hands and feet,” says Dr. Allan Eckhaus, a plastic surgeon at RVHS. “The images it provides allow me to perform very precise surgeries with few complications, smaller incisions and quicker healing.”

The mini C-arm works in much the same way the larger C-arm X-ray machine works, used at RVHS most often during hip replacement surgery. However, unlike the larger one, the smaller and portable version is being used in a number of different ways.

Dr. Peter Hayashida, chief of surgery at RVAP, explains that the mini C-arm is faster and more versatile.

“It has been used for closed reduction of fractures of the hand and wrist, it has been used for removal of foreign bodies (metallic) and diagnosis of hand and wrist fractures,” says Dr. Hayashida. “This new piece of equipment allows us to treat pa-tients with these problems faster and with fewer steps involved. It simplifi es the treat-ment algorithm.”

Some of the foreign bodies they treat this way include needles, metal, and leaded glass. As a relatively common injury, it is an important use for the machine. In the past at RVHS, patients with these types of inju-ries either had to wait for the C-arm to be removed from the operating room or wait to actually have a procedure completed in an operating room.

Now, patients can be treated in an am-bulatory setting, such as the fracture clinic or emergency, in a timelier fashion, so they are not relying on another piece of equip-ment that is constantly in use. The mini C-arm also gives the doctor the ability to see the effect of their work in real time.

The information received from the mini C-arm can provide confi rmation of a frac-ture allowing the surgeon to set the frac-ture without surgery or to immobilize the fracture using stainless steel pins.

Explains Dr. Eckhaus: “It allows doctors to set fractures with the live feedback of the X-ray to check the accuracy of the po-sition of the bones.”

As a surgeon, Dr. Hayashida has used the mini C-arm in the operating room. He

says: “The orthopedic surgeons have also been using it (as well as the plastic sur-geons) and fi nd it is a simpler and faster way of making a diagnosis and expediting treatment for our patients.” The result is that patients rarely have to wait as they would have in the past.

Renate Ilse, program director of sur-gery, endoscopy and central processing at RVHS, says, “The biggest service improve-ment is around access to care. Instead of

having to wait for diagnostic imaging, something that can take 30 to 60 minutes, or even more if a diagnostic imaging tech-nician is called away for an emergency, the surgeon can examine and set the fracture immediately. Both the plastic surgeons and orthopedic surgeons are very enthusiastic about the machine.”

The initial expected usage for the mini C-arms is predicted to be more than 200 cases annually at RVAP, and more than 1,000 cases annually at RVC.

Although the mini C-arm is proving its value, the purchase of the machine would not have occurred if not for generous do-nors to the Rouge Valley Health System Foundation. Through fundraising events over the course of the year, the RVHS Foundation raised the funds needed to pur-chase the two machines.

The highest-profi le fundraiser for the C-arm was the RVHS Foundation’s annual Gala, held in March. Visit www.myrou-gevalley.ca to see how donors were edu-cated about the need for the mini C-arm through a Game of Thrones spoof, which debuted at the Gala, starring Rouge Val-ley’s medical staff.

Dr. Hayashida says, “We would like to thank all the donors who supported the purchase of this important piece of equipment.” ■H

Dave Stell is Manager, Communications and Government Relations at the RVHS Foundation.

New portable x-ray provides better care for surgical patients By By Dave Stell

S

Dr. Peter Hayashida manipulates the mini C-arm for a procedure in which a fi shing hook was removed from the patient’s hand. Registered practical nurse Mike Alfermann looks on.

Known as a mini C-arm, this diagnostic equipment creates an X-ray picture producing a live and continuous X-ray image for surgeons during procedures

“Do you do that laparoscopically?”Many traditional open surgeries for cancer treatment are now performed using a laparoscope for a minimally invasive approach. Sunnybrook leads the way.By Natalie Chung-Sayers

ary Abbott returned home just two days after she had lapa-roscopic surgery to remove a cancerous tumour from her

colon that was then resected.

Diagnosed in her mid-forties with colorectal cancer, she hoped that the surgical treatment would not involve a long recovery.

“The cancer diagnosis and the surgery are just the fi rst part of your journey. It was important to me that you’re not knocked fi rst from surgery; that I could regain feel-ing fi t and healthy, and to get my energy back to prepare for the next challenge of my treatment: the chemotherapy,” says Mary.

Instead of traditional open surgery involving a large incision, Dr. Shady Ashamalla, a surgical oncologist special-izing in minimally invasive procedures for gastrointestinal cancers at Sunny-brook’s Odette Cancer Centre, made only a few small incisions. Through ports placed through the incisions, and using a laparoscope (tiny video camera) to see, he operates within the abdomen, skillfully maneuvering long, thin surgi-cal instruments to remove the tumour without perforating any areas of the body and then to reconnect the two ends of the healthy colon.

“We strive to reduce the surgical foot-print in every procedure while ensuring

we achieve the same oncological effect, or removal of all of the cancer – an ap-proach that translates into better quality of life for patients,” says Dr. Ashamalla who completed advanced fellowships in both Minimally Invasive Surgery (MIS) and Surgical Oncology as part of his training.

A smaller surgical footprint allows for less complications including a shorter stay in the hospital and improved re-covery time. Recalls Mary, “I’ve had C-sections for both my children. Recovery from this surgery was way easier.”

A study published in April 2015 in the New England Journal of Medicine re-ports that laparoscopic surgery is as safe and effective as open surgery for patients with rectal cancer that has not spread to nearby tissues (no metastases). The Colorectal Cancer Laparoscopic or Open Resection (COLOR) II is a large, ran-domized trial conducted in 30 centres in eight countries that looked at outcomes (disease-free survival, the occurrence of distant metastases) of 1,103 patients with rectal cancer, from January 2004 to May 2010, with a three year follow-up.

M

Continued on page 31Dr. Shady Ashamalla. Photo credit: Doug Nicholson


23 Safe Medication

s a folate analogue, metho-trexate exhibits cytotoxic ef-fects through its interference of DNA synthesis, replication

and repair. These effects result in an over-all poor safety profi le, with potential toxici-ties involving multiple organ systems. The heightened risk of harm associated with its use in error is the basis behind metho-trexate’s presence on ISMP’s List of High-Alert Medications (https://www.ismp.org/tools/highalertmedicationLists.asp). The scenario above illustrates one example where a medication incident involving methotrexate had the potential to cause serious patient harm.

Prescribed for medical conditions in and out of oncology, it is not uncommon to see methotrexate in community and hospital settings. Regardless of practice site, the risk of error when handling the medication is precipitated by several factors, including methotrexate’s varying indications, dos-age regimens, strengths and formulations. For instance, while methotrexate may be taken as a once weekly dose in rheumatoid arthritis, the medication is taken on pre-defi ned days of each cycle in most cancers.

To examine medication incidents in the community related to methotrexate,

the Institute for Safe Medication Prac-tices Canada (ISMP Canada) performed a multi-incident analysis to identify con-tributing factors from reported incidents. Voluntary reports of medication incidents were extracted from the Community Phar-macy Incident Reporting (CPhIR) pro-gram, a database designed by ISMP Cana-

da with support from the Ontario Ministry of Health and Long-Term Care.

After evaluation of 137 medication in-cidents, each were categorized into three themes based on shared characteristics. The themes were further divided into 3 – 4 subthemes (see Table 1).

The results of the analysis demonstrated

three key areas for which system-based solutions may be implemented to reduce error when dealing with methotrexate. These include:1. Standardization of prescribing practices (ex. pre-defi ned order sets)2. Implementation of safeguards in the community pharmacy (ex. independent double checks)3. Fostering a culture of patient-centered care (ex. patient education and follow-up)

Overall, it is important to remember that while methotrexate is indicated in a broad range of medical conditions, the medication poses signifi cant harm to pa-tient safety when handled in error. This applies to all stages of the medication-use process, with the probability of error in-creased when contributing factors are pres-ent. It is therefore ISMP Canada’s ongoing initiative to advocate for the reporting, sharing and learning from incident reports – ultimately allowing for continuous qual-ity improvement in medication safety. ■H

Melody Truong is a BScPhm-PharmD Candidate at the Leslie Dan Faculty of Pharmacy, University of Toronto; Certina Ho is a Project Lead at the Institute for Safe Medication Practices Canada.

A focus on high-alert drugs: Methotrexate medication incidentsBy Melody Truong and Certina Ho

A

“A set of blister packages were prepared for a patient. The methotrexate tablets, intended as a once weekly dose, were dispensed as once daily dosing. The error was found after the patient had taken two extra doses.”

Associated Medications(Medication incidents were related to the association of methotrexate with other drugs.)

Dosing Complexities(Medication incidents were related to the complexities involving methotrex-ate’s varying indications, dosing regi-mens, strengths and formulations.)

Medication-Use Process(Medication incidents were related to the involvement of methotrexate with-in the stages of the medication-use process.)

Drug InteractionsLook-alike/Sound-alike Drug NamesConcomitant Drugs

Calculation ErrorFrequency ErrorParenteral RouteMulti-Medication Compliance Aids

PrescribingOrder EntryPreparation/Dispensing

Table 1: Themes and subthemes of the methotrexate multi-incident analysis

THEMES SUBTHEMES

(Note: Some drugs may be concurrently prescribed with methotrexate. For example, folic acid and methotrexate are commonly prescribed together to reduce toxicity.)

(Note: Compliance aids present with additional intricacies that may facilitate medication errors, independent of the handling of methotrexate.)


24 From the CEO's Desk

nowledge sharing is a vital component of a strong health care system. That’s why at Accreditation Canada, we

help organizations get the word out when they’ve created solutions they can share with others. We call these solutions Leading Prac-tices, and they have a proven positive impact on health care delivery, quality, and patient safety. Our Leading Practices Database includes nearly 1,000 innova-tive and effective practices available to anyone with internet access.

Here’s how our database works: Health care organizations from across Canada submit a potential Leading Practice elec-tronically, and a committee of external reviewers (including health care experts and Accreditation Canada surveyors and staff) evaluate it against a set of criteria

to determine whether it should be ac-cepted. The turnaround time from sub-mission to decision is approximately six weeks.

Criteria for evaluating Leading Practices:1. Is it innovative and creative? 2. Is it client–or family-centred? 3. Has it been evaluated? 4. Does it demonstrate the intended

results?5. It is sustainable?6. Can it be adapted/adopted by other

organizations?Successful submissions are published

in English and French in our Database. These health care solutions cover varied aspects of the care continuum, including risk management, service delivery, edu-cation and training, patient and client

safety, governance, and quality improve-ment initiatives.

As a major proponent of improving the quality of healthcare and social services organizations in Canada, we want to make sure we help organizations across the country make the most of their les-sons learned. A searchable, online da-tabase is an excellent and simple way to make this happen. We encourage you to go to accreditation.ca/leading-practices and consider submitting your organiza-tion’s innovative practices for review and potential inclusion on our database. Leading Practices are tangible ways for organizations to help each other trans-form care and contribute to an effective, accountable, and sustainable system. ■H

Jil Beardmore is Writer/Editor at Accreditation Canada.

ll of us in the health care sec-tor work hard every day to ensure that we are meeting the needs of the patients and

families we serve. At Hamilton Health Sci-ences (HHS), this mission of service and caring is our North Star – something we always look to for direction and focus.

Fulfi lling that mission can be very challenging given the pace of change in healthcare. The demands on our services are growing and changing. The patients we see are living longer, and often have more complex conditions. They also frequently have higher expectations for their health care experience than in years past. And while technological breakthroughs are offering new treatments and new hope, they often come with a steep price – high tech tools are expensive. When it comes to “bricks and mortar”, our facilities are aging. All of this at a time when funding for hospitals is fl at or shrinking as govern-ments struggle to balance budgets and re-align priorities.

Like many of our peers, we are com-mitted to overcoming these challenges in a positive and proactive way. But fi nding solutions will require the creative energies and intellectual horsepower of everyone who cares about and relies upon our or-ganization.

With this in mind, HHS has launched a long-term visioning initiative called Our Healthy Future. We are working with pa-

tients, families and communities, to imag-ine the future of the delivery of care at HHS. We intend to determine what ser-vices our community will need and want from HHS in the future and how we will deliver those services. Beyond being a plan for the future of our clinical care, Our Healthy Future will be very helpful for planning new facilities that HHS may require beyond the next 10 years or longer, and how we’ll work with our community partners to create a more seamless health care system.

We began this process with research and

discovery. Many of our staff, physicians and volunteers have been involved in groups that are analyzing our programs and ser-vices, and looking at population data. At the same time, we conducted a series of community workshops and an online en-gagement website (ourhealthyfuture.ca), where people from across our region could tell us what they value most when it comes to health care services. To date, we’ve held nine community workshops, and we’ve also visited our local Farmer’s Market and other community venues/events to engage with community members and provide

them with the opportunity to submit their input.

I’ve had the pleasure of participating in these community events, where I’ve con-nected with many fellow community mem-bers whose stories and ideas both validate and challenge the work we do as health care providers. I am sure these individu-als represent the views of many Canadians. Their stories are testimonies to the general understanding that, while there are many things we’re doing right as a hospital sys-tem, there are also many opportunities for improvement. Some stories are positive, others constructive. But the one common thread that’s become clear to me through-out this process is that we live in a region, and a country, where people are incredibly invested in their health care system. We all have ideas about what could be improved, and we’ve all had experiences – or know someone who has – that have impacted how we think and feel about the care that’s available to us.

We’ve reached a fork in the road where all of us involved in the health care system need to make important decisions about what the system will look like in the future. It’s a challenging but exciting time to be working in this sector. It’s our opportunity to collaborate with the people we serve to shape a healthier future for Canadians. ■H

Rob MacIsaac is President & CEO, Hamilton Health Sciences.

Planning our healthy futureBy Rob MacIsaac

A

Rob MacIsaac is President & CEO, Hamilton Health Sciences.

E-sharing for better healthBy Jil Beardmore

K

We live in a region, and a country, where people are incredibly invested in their health care system.

The Hospital for Sick Children (SickKids) submitted a Leading Practice in June of 2013 for its Daily Continuous Improvement Program (Daily CIP). The program helps managers and supervisors engage staff in continuous improvement activities and increase organizational performance. It includes daily risk-identifi cation and mitigation discussions between Managers and Clinical Support Nurses, improvement huddles with all staff members, and monthly reviews of a unit-level scorecard and associated plan-do-study-act work.

To date, the Daily CIP has resulted in increased staff engagement scores; over 2,600 staff-initiated improvements, including 80 large improvement initiatives; and improved performance in areas particular to each unit (e.g., medication reconciliation rates, discharge timing, hand-hygiene compliance).

For more details about this initiative, search Daily Continuous Improvement Program in the Leading Practices Database. You can also contact [email protected] or [email protected] about the program.

CSSS Pointe-de-l’Île in Québec submitted a Leading Practice in 2013 about its end-of-life care program. The program was created with input from residents, their families, and employees and addresses wide-ranging aspects of end-of-life care.

Volunteers receive appropriate training, and a care kit is made available to residents and families.

The kit includes items like soft sheets and clothing for the resident. Loved ones are periodically provided with coffee and refreshments in a non-intrusive manner. Three books are also provided—one that explains the physical process of passing to the family/loved ones, one for volunteers, and one in which caregivers and loved ones can write out their thoughts. The post-mortem

process has also been revised to better address everyone’s needs and wishes.

Over 150 residents and their families have benefi tted from this unique program, which prioritizes dignity and comfort. This Leading Practice is available using the search term humanitude. You can also contact [email protected] for more information.

Leading Practice: End-of-life care

Leading Practice:Sickkids’ Daily Continuous Improvement Program


25 Evidence Matters

ressure ulcers, or bedsores, are a serious health problem for many patients. For those with reduced mobility or sensation

– such as patients who spend long periods of time in a bed or wheelchair – the risk of developing pressure ulcers is high. And once developed, not only are they painful and debilitating, but they can also lead to local infection, sepsis – and even death.

The prevalence of pressure ulcers in Canadian health care settings is estimat-ed to be about 26 per cent, and individu-als with spinal cord injuries are particu-larly affected. More than 85 per cent of individuals with spinal cord injuries will develop a pressure ulcer at least once during their lifetime. Other patients at risk include elderly residents in nursing homes, individuals in long-term care, and anyone with limited mobility in a bed or wheelchair.

Pressure ulcers can be diffi cult to treat and take a long time to heal. Severe pres-sure ulcers can take months or years to treat and can require surgery. So, it’s bet-ter to prevent them before they happen. Prevention traditionally involves encour-aging patients to move around or change their body position on a regular basis, or frequently repositioning them if they can’t move by themselves. Because this can be labour intensive for caregivers, devices to help prevent pressure ulcers have been developed, such as specialized beds and mattresses and, very recently, Smart-e-Pants.

Smart-e-Pants are underpants – similar to bike shorts – that contain electrodes to deliver 10 seconds of electrical stimula-tion every 10 minutes to a patient’s but-tock muscles. This stimulation is designed to prevent pressure ulcers by mimicking the subconscious fi dgeting and shifts in body position of someone without mobil-ity issues. The technology is still under-going clinical trials and isn’t yet commer-cially available.

Prior to the development of Smart-e-Pants, electrical stimulation using elec-trodes placed directly on a patient’s skin which has been used as a treatment for pressure ulcers since the 1960s was in-vestigated for preventing pressure ulcers. In a study of electrical stimulation for pressure ulcer prevention, which involved patients with spinal cord injuries, all par-ticipants experienced a reduction in the pressure that leads to pressure ulcers. Al-though, electrical stimulation appears to be effective, the time-consuming nature of placing and re-placing the electrodes led medical technology innovators to begin exploring the idea of placing the electrodes in an undergarment. Smart-e-Pants were born.

CADTH – an independent, evi-dence-based health technology agency – is continually scanning the horizon for emerging drugs, medical devices, and pro-cedures likely to have a signifi cant impact on patient care and the health care sys-tem. In a recent horizon scanning bulle-tin – Smart-e-Pants: Using Intermittent

Electrical Stimulation to Prevent Pressure Ulcers – CADTH reviewed the available evidence on the effectiveness of this new technology. As one would expect for a newer device, when searching the litera-ture on Smart-e-Pants, CADTH found only short-term, small, and non-random-ized trials – however, the early evidence is encouraging. According to comments by patients with spinal cord injuries in an early clinical trial of Smart-e-Pants, the underpants are easy to use. Some patients reported additional benefi ts, such as re-

duced pain, decreased spasticity, reduced fl uid retention in the legs, and stronger muscle contractions.

A study of the safety and feasibility of Smart-e-Pants looked primarily at the de-mands on caregivers. The patients in this study were all at risk of developing deep tissue injuries – a severe type of pressure ulcer – and were in acute and tertiary re-habilitation hospitals, in long-term care facilities, or receiving home care. Most caregivers in the study gave the technolo-gy positive reviews, and both patients and

caregivers were satisfi ed with the amount of time it took to put on and remove the underpants. In addition, patients said they experienced very little or no irrita-tion, distraction, or discomfort from the electrical stimulation or from the un-derpants themselves. Although it wasn’t a main outcome of interest, none of the patients developed a pressure ulcer dur-ing the course of the study – which lasted four weeks or, in the case of hospital pa-tients, until discharge.

While early research indicates that Smart-e-Pants relieve pressure and are safe and easy to use – particularly in in-dividuals with limited mobility in beds or wheelchairs – the studies completed so far haven’t measured their effectiveness for preventing pressure ulcers. However, there is a research study currently under-way that aims to measure the effective-ness of Smart-e-Pants, a technology that could prove to be an important advance in pressure ulcer prevention.

If you’d like to read CADTH’s hori-zon scanning bulletin on Smart-e-Pants – or access other bulletins on a variety of medical technologies not yet avail-able or widely used in Canada – visit the CADTH website: www.cadth.ca/environ-mental-scanning.

To learn more about CADTH, visit www.cadth.ca, follow us on Twitter: @CADTH_ACMTS, or talk to our Liai-son Offi cer in your region: www.cadth.ca/contact-us/liaison-offi cers. ■H

Barbara Greenwood Dufour is a Knowledge Mobilization Offi cer at CADTH.

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Smart-e-Pants for preventing pressure ulcers:

A stimulating idea

The prevalence of pressure ulcers in Canadian health care settings is estimated to be about 26 per cent, and individuals with spinal cord injuries are particularly affected.



arse Harman has had eight appointments with Royal Vic-toria Regional Health Cen-tre (RVH) oncologist Dr.

Bryn Pressnail, but has only seen him in person twice.

That’s just fi ne with him.No slight against Dr. Pressnail, Harman

just hates to travel. The thought of hav-ing to drive to Barrie from Muskoka for his medical appointments was adding stress to an already stressful situation.

Instead, Harman, 60, is able to meet with the Barrie oncologist without leaving his hometown of Huntsville. He does this through the Ontario Telemedicine Net-work (OTN). Telemedicine uses two-way video-conferencing and accompanying diagnostic equipment to provide medical consultation.

“That’s huge for me,” says Harman, who was diagnosed with lung cancer in Decem-ber. “I live 10 minutes away from my local hospital. I come here and have my visits with Dr. Pressnail through telemedicine and then head home. I’m done in less than 40 minutes. It would take me an hour and half just to get to Barrie. That’s one way and providing the weather isn’t too bad.”

Often the weather is bad and in the summer the traffi c can be brutal. Last year Environment Canada issued 44 severe weather warnings in Simcoe-Muskoka and on long weekends over 125,000 cars snarl traffi c on Highway 400.

“It is a big relief for us,” says Holly Chantler, Harman’s wife. “It’s so stressful having to drive to Barrie – we know be-cause we had to do it for three days in a row for the fi rst appointments. We were so stressed out. It was snowy and stormy. You just never know what kind of weather you will hit on the way there or back. Tele-medicine alleviated the unknown of travel and weather. When you are dealing with cancer there are enough unknowns – this just eliminates one of them.”

Last year at RVH, 2,600 patient “visits” took place via telemedicine. This amounts to more than 700 clinic hours and saves patients more than 400,000 km of travel. “Telemedicine is so patient friendly. Some-times, at fi rst, they are a little nervous be-cause it is new and they are not used to be-ing on television, but after the fi rst session it is like we are both in the same room to-gether,” says Dr. Pressnail. “Telemedicine saves my patients travel time, provides them care close to home, and for many, it reduces the fi nancial burden of gas, park-ing and meals they would have to face if travelling for these appointments. What is good for my patients is good for me.”

Dr. Pressnail has been such an avid sup-porter of telemedicine that he is among the fi rst to receive a Champion of Tele-medicine Award from the Ontario Tele-medicine Network. He is recognized for his leadership in the development, test-ing and implementation of telemedicine which continues to improve care for his patients every day.

“Dr. Pressnail has been an amazing ad-vocate for his patients throughout his en-tire career. He was one of the fi rst physi-cians to champion this new technology because he could see that it would have a huge, positive impact in the lives of his patients. And he was right,” says Lindsey Crawford, RVH vice-president, Patient Programs and regional vice-president, Cancer Care Ontario.

Dr. Pressnail began holding telemedi-cine appointments in 2011, but only in limited numbers. Now it is a daily routine for 20 cancer doctors (radiation oncolo-gists, medical oncologists and gynecologi-cal oncologists) at RVH’s Simcoe Mus-koka Regional Cancer Centre (SMRCC) to see at least three patients every day via telemedicine.

If OTN didn’t present Dr. Pressnail with

an award for such leadership, you can bet Carse Harman would have. “The only problem I have with this service is that it has saved me so much time I don’t know what to do with myself. There’s only so many soap operas I can watch,” laughed Harman. ■HDonna Danyluk works in Corporate Communications at Royal Victoria Regional Health Centre (RVH) in Barrie.

Telemedicine cuts travel time and enhances careBy Donna Danyluk

C

Dr. Bryn Pressnail, oncologist at RVH’s Simcoe Muskoka Regional Cancer Centre (SMRCC) has been such an avid supporter of telemedicine that he is among the fi rst to receive a Champion of Telemedicine Award from the Ontario Telemedicine Network.

Last year at Royal Victoria Regional Health Centre, 2,600 patient “visits” took place via telemedicine. This amounts to more than 700 clinic hours and saves patients more than 400,000 km of travel.

Smartphones help to improve the patient experience at home

ecently, many home care or-ganizations have jumped on to the mobile information highway as a way of connect-

ing workers out in the community with their administrative support staff back in the offi ce. While improved connectiv-ity and instant access to visit informa-tion/confi rmation are defi nite pluses, for VHA Home HealthCare – a not-for-prof-it agency that admits over 85,000 home and community care “clients” (a term often used in community health instead of “patients”) annually – signifi cant im-provements to the personal support pa-

tient experience were an even more valu-able offshoot.

“The introduction of mobile tech-nology,” says VHA CEO and President, Carol Annett, “aligns perfectly with our strategic priorities of being more attuned to client needs, more connected both internally and with our partners, and by providing more inspired solutions, which is really about our short and long-term goal to invest in valuable client-centred technology.”

The interface was thoughtfully de-signed, tested and adjusted and includes a section for Personal Support Work-

ers (PSWs) to add client preferences. “VHA’s PSWs are quick to add insights to this section,” says Joy Klopp, director of contracts, quality and risk management.

“Notes like , ‘client likes to take a walk after dinner,’ or ‘client prefers a warm glass of milk before bed’ are inputted so that, if the regular worker is not there, or there is a new PSW coming on board, they already know coming in what’s most important. These may seem like small details, but evidence suggests these ‘little things’ can have a signifi cant impact on the client experience,” she adds.

By Pamela Stoikopoulos

R




he health care system in Ontar-io rarely functions as a seamless and coordinated service experi-ence for patients. This is espe-

cially true for the high user segment of the population. Therefore, Health Links across Ontario face what can at times seem like an insurmountable challenge – how to simul-taneously bend the curve of both outcomes and costs associated with high users. Yet, this challenge can and is being addressed in Chatham-Kent.

Under the leadership of Chatham-Kent Health Alliance (CKHA), the Chatham-Kent Health Link (CKHL) is changing the game for high users. In fact, today this group of providers boldly suggests that be-ing a patient identifi ed as a high user by the CKHL is actually an advantage.

That certainly was not the case a year ago when the system was fragmented and poorly coordinated. However, through in-novation, collaboration, patient engage-ment and real accountability, the CKHL is seeing the patient’s journey transform within months.

“It seems so simple yet we’ve historically lacked the tools to turn data into knowl-edge and the collaboration framework to mobilize new, responsive approaches to care,” explains Nancy Snobelen, Co-Chair of the CKHL and Director of Partnerships & System Integration, CKHA. “The truth is that we didn’t understand that standard-ization is not the solution for high users, rather they require rapid, individualized re-sponses for their frequent or intense system utilization. By addressing this issue rather than leveraging traditional care pathways, we get to the root of the problem and have the opportunity to truly affect change.”

Simply put, the local health care system is being turned on its head – it’s dynamic, exhilarating and inspiring. In Chatham-Kent, providers are re-envisioning how Ontario’s health care system can focus on the patient experience through measure-able coordinated care.

Together, the 14 partner organizations are sharing responsibility to lead or sup-port six different streams of activity that are shaping a new direction for service delivery across the continuum. The streams refl ect six common problems the CKHL providers face:1. Notifi cation to the Community Care Access Centre when one of their clients is hospitalized.2. Duplicate or absent medication recon-ciliation.3. Duplicate or unused community resources.4. Standardized and individualized clinical processes supported by best practice.5. Real-time patient identifi cation, tracking and monitoring.6. Ownership for communication, care planning documentation and data sharing.

And impressively, they have implement-ed solutions to all six challenges. Through a combination of high tech and low tech solutions they now understand in real-time who and where the high user patients are as well as when and what they need. Ad-mittedly, if the CKHL provided a list of its lessons learned, all the usual factors would be present so what made the difference for this community?

Matt Snyder, Chief Transformation Of-fi cer for TransForm Shared Service Orga-nization, who was an integral part of the CKHL phase one journey offers this expla-nation, “The Chatham-Kent Health Link set out clear priorities, created foundational structures and built a legacy of benefi cial technology solutions in its fi rst phase, all of which were critical. But, more so than any-where else, we’re seeing committed leader-ship at all levels and particularly, at the clin-ical adoption level.” The priority projects have positioned this community to leverage a set of dynamic tools, some of which are fi rsts in Ontario, which when couple with defi ned roles among providers with strong and lasting relationships has created im-pressive patient outcomes.

One dynamic tool that is setting the CKHL apart from its peers is the use of MediaMed’s Global Performance Solution or Med-GPS. This tool, which responds to the challenge of identifi cation, tracking and monitoring of high user patients, combined with an innovative clinical process helps the group to identify and stratify patients in real-time. Moreover, it has turned existing data into real-time knowledge that allows the providers to quickly mobilize and adapt their care plans to meet the patients’ cur-rent or emerging needs. In one instance, the number of Emergency Department vis-its for one patient went from 35 down to eight visits annually. A stunning 77 per cent decrease due to a more coordinated plan.

It has not been a straight road or an easy journey but it has been a critical les-son in what innovation looks and feels like to those leading change. A key lesson has been to expect and learn from failures along the way by being ready to continually implement small changes. “This is diffi cult in a health system and it’s easy to feel over-whelmed by the magnitude of the change

required. So it’s been an evolution in learn-ing to recognize that these lessons are pow-erful tools in reshaping our approach and achieving rapid results,” says Denise Wad-dick, Co-Chair CKHL and Executive Di-rector of Thamesview Family Health Team. “This would not have been possible were it not for the stable partnerships in our com-munity; without the collective desire to put agency interests aside and to fundamen-tally consider a new way forward for our

patients. We believe that we are poised for the next level of collaboration. We have the right partners, the right tools, for the right patient care. Watch us; we will continue to put Chatham-Kent on the map as we move into our second phase of our Health Link journey.” ■HZoja Holman is Director, Communications & Organizational Development, Chatham-Kent Health Alliance.

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A Health Link success storyBy Zoja Holman

T

At their Monday morning meeting, Lisa Richardson, CKHA Health Links Care Manager (R), shows Nancy Snobelen Co-chair, Chatham-Kent Health Link (L), that the Med-GPS system is showing two high users are currently in the hospital. This real-time monitoring of the Health Link patient cohort allows Lisa to identify, locate (ED or inpatient) and then reach out to these individuals before they leave CKHA.

Simply put, the local health care system is being turned on its head – it’s dynamic, exhilarating and inspiring.



new partnership between the Canadian Association of Neu-rophysiological Monitoring (CANM) and The Michener

Institute for Applied Health Sciences will improve the outcomes for patients having high-risk surgery and potentially save the health care system millions of dollars each year.

CANM has partnered with the Mi-chener Institute to develop a Graduate Certifi cate Program in Intraoperative Neurophysiological Monitoring (IONM) that launched in September 2014.

IONM is a growing allied health care profession that is vital to the protection of patients undergoing high-risk surgeries such as neurosurgery and spinal deformity correction. IONM practitioners continu-ously assess the patient’s nervous system in real time to alert the surgeon of evolv-ing problems, allowing for rapid interven-tion. Timely IONM feedback is a powerful tool that can improve surgical outcomes and prevent devastating post-operative outcomes, including paralysis.

Using IONM during spine surgery can reduce the incidence of permanent neu-rological injury by up to three per cent. Given that the economic burden of a trau-matic spinal cord injury in Canada ranges from $1.47 million (incomplete paraple-gia) to $3.03 million (complete quadri-plegia) over a patient’s lifetime, this rep-resents a tremendous cost savings to this country’s health care system because more than 10,000 Canadians undergo spine sur-gery each year. In other words, IONM has the potential to save our health care sys-tem many millions of dollars in addition to preventing an immeasurable amount of

human suffering each and every year. The cost-benefi t to using IONM in procedures that put the nervous system at risk also helps health care decision-makers, who are under increasing pressure to deliver high quality, economically sustainable healthcare.

“The new certifi cate program in IONM offered by CANM and Michener will be the fi rst of its kind in Canada and, to our knowledge, the world,” says Laura Holmes, President of CANM.

“By offering the two-year post-graduate certifi cate program online, we are able to increase accessibility to students across Canada and internationally. Since our or-ganization has recognized and embraced the urgent need for both a professional ed-

ucation program and a national accredita-tion exam leading to eligibility for practice in Canada, a partnership with Michener is integral to meeting the IONM needs of patients in the Canadian health care system.”

“One of Michener’s core strengths is our ability to respond quickly to emerg-ing health education needs through the development of partnerships that bring clinical and educational solutions togeth-er in creative ways,” says Michener’s CEO Maureen Adamson.

“This partnership with CANM provides us a unique opportunity to advance the quality and accreditation of intraoperative neurophysiological monitoring not just in Ontario, but across the country.”

IONM has been around for approxi-mately 30 years but regulations and stan-dards of education and practice have only recently been introduced. However, the creation of the Canadian Association of Neurophysiological Monitoring (CANM) in 2008 launched tremendous momentum in the development of IONM as an inde-pendent allied health care profession in Canada. And while IONM may be one of the newer allied health care professions to come of age in Canada, recent evidence and improvements in technology have resulted in an increased demand for its services among vascular, orthopedic and neurosurgeons. This is good news for both patients and the Canadian health care system as a whole.

“As a group of children’s spine sur-geons, the Canadian Paediatric Spine Study Group is extremely excited about the recent agreement between CANM and The Michener Institute for an educa-tion program to train IONM professionals in Canada, as they are now an essential part of our surgical team,” says Dr. Ron El-Hawary, Chief of Paediatric Orthopedics IWK Health Centre and past-President of the Canadian Paediatric Spine Society (CPSS).

“This ground-breaking program will allow the training of new, well quali-fi ed IONM professionals in Canada, and should ultimately provide optimal care for Canadian children who require surgery for spinal deformities.”

For more information, please visit www.canm.ca. ■HFor course and/or registration details visit Michener.ca/ce Registration now open for Fall 2015.

New partnership prevents suffering and saves money By Susan Morris

A

Intraoperative Neurophysiological Monitoring is a growing allied health care profession that is vital to the protection of patients undergoing high-risk surgeries such as neurosurgery and spinal deformity correction.

Canada’s Academic Health Science NetworksBy Tina Saryeddine and Kate Monfette

ust a few days before the re-lease of the federal budget, leaders from across Canada’s Academic Health Sciences

Networks (AHSNs) met in Ottawa for a two-day Symposium. “AHSNs may not be a familiar term for everyone, but these entities, which comprise health care or-ganizations, faculties of medicines and the range of stakeholders needed to inte-grate patient care, training and research, are critical to our capacity to transform health systems and overcome the hurdles of disability and disease,” says Bill Tholl, President & CEO of HealthCareCAN.

The 2014 AHSN Symposium was at-tended by over 70 leaders, ranging from deans of medicine to health care CEOs, clinicians, administrators, vice presidents of health research and others. Themed “Innovations in Academic Health Care: Collaborating to Compete”, it focused on fi ve key questions.

The fi rst question was about how Can-ada’s AHSN’s collaborate to compete and brand our country globally. Dr. Peter Singer, President & CEO of Grand Chal-

lenges Canada, an organization which funds Canadian undertakings to improve health internationally, talked about the number of Canadian innovations that are making a difference in develop-ing countries.

Grand Challenges Canada has sup-ported 230 innovative global health proj-ects totalling $42M in Canada, largely in academic health science networks and related companies.

Examples of innovations funded by Grand Challenges Canada included an app that allows blood oxygen testing, which allows for life saving tests at a frac-tion of the cost of regular devices, and a cooking device that is being used to re-duce the risk of anemia.

“The faculties of medicine of Canada – from professors to researchers; students to trainees, are all vested in the success of academic health science networks – it is within these networks that they bring the promise of training, research and ed-ucation to patient care. It is within these settings that the promise of the profes-sion can be brought to life today and for

future generations”, says Dr. Genevieve Moineau, President & CEO of the As-sociation of Faculties of Medicine of Canada.

As such, a second key question dis-cussed at the Symposium related to the effect of time and place on the challenges facing these organizations. To this end, Dr. Peter Pisters, President & CEO of University Health Network; Ms. Dianne Doyle, President & CEO of Providence Healthcare; Dr. Gavin Stewart, Dean of Medicine at the University of British Co-lumbia; and Ms. Tracy Kitch, President & CEO of IWK Health Centre offered their collective conclusions: Context matters, but many issues seem to transcend time and place when it comes to sustaining health research in academic settings.

The third key question of the sympo-sium related to the role of federal funding for AHSNs. This was highlighted in pre-sentations from Dr. Alain Beaudet, Presi-dent and CEO of the Canadian Institutes of Health Research (Canada’s premier federal health research granting agency) and Dr. Gilles Patry, President & CEO of

the Canada Foundation for Innovation (CFI), which funds research and inno-vation related infrastructure. Academic health science leaders in Canada require adequate and sustainable federal support for both of these organizations.

The April 21st federal budget brought some welcome relief in terms of addition-al funding for CFI ($4.33B for 10 years starting in fi scal year 2017-18). Howev-er, there is no increase planned for the CIHR budget until 2016-17.

The mixed results of the federal budget for academic health sciences networks highlighted the importance of the fourth question discussed at the Summit, which was to take stock of the status of a nine-point action plan for the sustainability of health research. This action plan was developed at the previous (2014) Sympo-sium. It focused on ensuring that we have the leadership capacity to ensure that the winning conditions for health research are achieved nationally and that we have the right policy and funding conditions for the research endeavour.

J




Educational & Industry Events

To list your event, send information to “[email protected]”.

We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “[email protected]”

To see even more healthcare industry events, please visit our website

www.hospitalnews.com/events

June 8, 2015 eHealth 101 In-Person Live Webcast, Toronto Website: www.oha.com

June 11-12, 2015 National Conference On Dementia Care Toronto, ON Website: www.insightinfo.com/national-conference-dementia-care/

June 12-13, 2015 Computed Tomography at the Heart of Integrated Diagnostic Imaging - International CT Symposium 2015 Montreal, Quebec Website: www.toshiba-medical.ca

June 14-17, 2015 IPAC Canada 2015 National Education Conference Victoria Conference Centre, Victoria BC Website: www.ipac-canada.org

June 16, 2015 Advancing Towards a Paperless Patient Record In-Person Live Webcast, Toronto Website: www.oha.com

June 16, 2015 Getting Board Members on Board with Health Care Information In-Person Live Webcast, Toronto Website: www.oha.com

June 18, 2015 MedEdge Summit 2015 York Region Richmond Hill Centre for the Performing Arts, Ontario Website: www.businessrichmondhill.ca

June 19, 2015 Women in Leadership Toronto, Ontario Website: www.oha.com

June 22-23, 2015 Health Canada Regulatory Reforms Toronto, Ontario Website: www.pharmaregulatory.ca

September 13-15, 2015 Canadian Association of Environmental Management Over the Top for Clean conference and Trade Show Scotia Bank Conference Centre, Niagara Falls Ontario

September 15-16, 2015 National Elder Friendly Hospital Conference Marriott Bloor Yorkville, Toronto Website: www.healthcareconferences.ca

September 29, 2015 Doing CPOE Right: Patient-Centred Design and Evidence-Based Culture In-Person Live Webcast, Toronto Website: www.oha.com

September 30-October 1, 2015 3rd Annual National Forum on Patient Experience Toronto, Ontario Website: www.patientexperiencesummit.com

ccording to the Canadian In-stitute for Health Information, Canada spent $211 billion on healthcare in 2013, 11.2 per

cent of GDP. Health care costs are a grow-ing concern in Canada and around the world. Nurses are the largest group of Ca-nadian health care professionals, and have the potential to improve Canadian health care while keeping costs in line.

Many of the reasons for cost concerns in Canada are the same as in other countries. One important factor in rising costs is the aging population. According to Employ-ment and Social Development Canada, an estimated 5 million Canadians were 65 years of age or older in 2011. The number of elderly is expected to reach 10.4 million by 2036. Elders utilize more health care services and suffer more chronic condi-tions than younger populations, so the cost impact of this demographic trend is considerable.

Another reason for cost concerns is the increasing expense of technology. While improved technologies such as telemedi-cine, genomics and new pharmaceuticals can save lives, these developments can be expensive. Technology costs contribute to the rising hospital costs in Canada, as in other parts of the world.

Aging populations and improvements in technology are factors in rising health costs that nurses cannot change. However, nurses can take steps to help curb exces-sive costs while maintaining high qual-ity patient care. Here are some examples of how nurses can help improve the bottom line:

Cost awareness and cost control. Nurses traditionally give care without thinking about the costs involved. It’s important for nurses to learn about how health care

is fi nanced in their hospital or clinic, and what the costs of care are for proce-dures, lab tests and other services. Nurse managers can involve their nursing staff in reviewing and controlling the nurs-ing unit budget. Nurses can keep up with changes in health policy by advancing their education or becoming active in professional organizations.• Reducing waste. Medical supplies and linen services pose increasing costs in health care settings. Wasteful practices such as hoarding supplies do not improve patient care, but they will impact the bud-get. Nurses are at the front line of patient care and are often the key decision makers in the use of patient care supplies. Nurses therefore play an important part in reduc-ing waste, which can help the environ-ment as well as the fi nancial health of the clinical setting. • Improving effi ciency. Labor expenses represent the largest portion of costs in many clinical settings. Reducing absentee-ism and unnecessary overtime expenses improves the effi ciency of nurses and better controls costs. Another area for effi ciency is improving patient fl ow. For example, getting patients discharged on schedule from a medical-surgical hospital unit frees up beds so admissions from the emergency or intensive care departments can be received. Timely transfers and ad-missions help reduce patient complications and improve the overall quality of care. Nurses are critical team members in man-aging effi ciency in health care settings.It’s important for nurses to realize that they’re part of the overall health care fi -nancial system. Nurses have important roles to play as they make decisions about patient care. It’s not just that the health care budget affects nurses and nursing care. Nurses and nursing care affect the Canadian health care budget. ■H

Susan J. Penner, adjunct faculty, School of Nursing and Health Professions, University of San Francisco, California USA and author of Economics and Financial Management for Nurses and Nurse Leaders, 2nd ed. New York: Springer Publishing Company, 2013.

Why nurses need to start thinking about a hospital’s fi nancesBy Susan J. Penner

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Nurses can take steps to help curb excessive costs while maintaining high quality patient care.

The last question of the event focused on the role of the private sector in realiz-ing our potential in the life and health sci-ences research arena. A panel discussion featured Canada’s medical device com-panies (MEDEC), research based phar-maceutical companies (Rx&D), and bio-technology companies, (BIOTECanada). Presidents & CEOs of respective national associations shared their insights into how to build a better business case for conduct-ing research in Canada. While the nature of AHSNs and private sector companies are different, in many respects we share the same overall goals around growing the health research enterprise. The discussion highlighted the importance of collaborat-

ing between the private and public sectors to compete effectively globally.

This was the fourth annual AHSN Symposium, which is co-hosted by Health-CareCAN, the national voice of health care organizations in Canada and the As-sociation of Faculties of Medicine of Can-ada. Photos and presentations, as well as the referenced action plan, are available at www.ahsn.ca ■H

Tina Saryeddine, Executive Director, Research & Innovation, HealthCareCAN and Kate Monfette, Manager Marketing, Communications and Media Relations for the Association of Faculties of Medicine of Canada.

Continued from page 28Health sciences network



welve years ago when I started working as a clinical pharma-cist at Trillium Health Centre, technology was far from what

it is today. Smartphones were nonexistent and an app was something you ordered at a restaurant. The Internet was not as ubiquitous and useful. Medical websites were just starting to appear. Despite that, some of those sites were quite useful in clinical practice. When such websites were discovered, it was like discovering hidden treasures that must be protected. It was common practice to email website links to oneself or each other, scribble them on pieces of paper, or bookmark them on the Web browser.

When there were fewer websites, this practice was suffi cient to keep track of use-ful medical sites. However, with passing time, the number of useful clinical web-sites grew exponentially. Needless to say, the pieces of paper could get lost and book-marking was not always effective when us-ing different computers.

A solution was needed to organize these useful resources in one common place to be accessed from anywhere, regardless of the kind of browser or computer used. That was when www.rphworld.com was conceived. It was to be a gateway website based on the same concept as that of Ya-hoo, where links of clinical websites were organized under different categories. Each link in this site’s repository would have a short description of what could be found in the corresponding website. RPhWorld was shared amongst colleagues and friends and over the Internet. It has been found to be quite useful in clinical practice in locat-ing necessary resources to solve daily issues such as screening multiple medications for possible drug interactions etc.

As more and more links were added to RPhWorld, the site became rather clumsy. A simple category system was no longer practical to allow users quick access to de-

sired websites. This is because with large numbers of sites, categories had to be di-vided further into sub categories and even sub-sub categories. The solution was to add a search functionality to RPhWorld to help locate the desired link quickly. But even this did not prove suffi cient in locat-ing the desired resources, as the search function was only searching the descrip-tion of the sites, not their contents.

Another solution had to be implement-ed to deep-search into each of the sites in the repository and fi nd articles that would help in clinical decision making. That was when Google Custom Search was used for such purpose, resulting in much improved search capabilities. RPhWorld was now able to search deeply into thousands of websites to fi nd matching articles, not just

descriptions of websites. In addition, af-ter extensive manipulation and tweaking, the search engine was made to be able to assume that the person doing the search was a pharmacist, thereby returning re-sults that are useful to a pharmacist, such as clinical guidelines, continuing educa-tion, drug therapies etc. The search re-sults were noticeably much more relevant for pharmacists than those obtained using traditional Google.

The feedback for this new search func-tionality was overwhelmingly positive. Tens of thousands more useful and trusted medical websites were added to the search engine. The search engine was further de-veloped to include modules for physicians, one for the general public, and eventually one for nurses and allied health. This was

when a new URL was needed to house this new search engine, and it was to be iMe-disearch.com.

iMedisearch has the same benefi ts as a traditional Google search engine – deep search and fast responses. But that’s where the similarities end. Firstly, iMedisearch only searches from reputable medical web-sites (manually selected based on strict accepted criteria), in contrast to Google, which delivers results from any site, leav-ing users the responsibility of determining which sites are reputable.

Secondly, iMedisearch caters search results to different categories of search-ers – general public, physicians, pharma-cists, nurses, and allied health. This leads to more relevant results for the user. For example, a doctor would not be inter-ested in medical articles written for a lay person. For nurses, searching for a disease condition would bring up articles on nurs-ing care of such patients. And therapists would be served with articles related to therapies and rehabs for the same medical condition used in the search query.

iMedisearch went online in 2008. In 2013, it was featured in a health policy textbook – “Advancing Medical Practice through Technology” – and a medical textbook by the Association of Physicians of India titled “The API Textbook of Medi-cine”. Recently, the Times of India recom-mended using it to search for reliable med-ical information on the Internet.

iMedisearch is available at www.imedis-earch.com and as a BlackBerry 10 app. A Mobile version of the search engine is also available at the same URL. iMedisearch searches from over 80,000 reputable medi-cal websites including UptoDate and is an especially helpful tool to search for clinical guidelines, continuing education, disease and treatment information. ■H

Hong Kao is a clinical pharmacist from Ontario.

iMedisearch: The story of a medical search engine from OntarioBy Hong Kao

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The organization began piloting Mo-bilityPlus – the name of the project which capitalizes on the BlackBerry 10 platform and is supported by Telus and GoldCare – in 2013 and completed its rollout in 2014. Currently, there are over 1,100 workers on Mobility Plus at VHA , a majority of whom are Personal Support Workers. A smaller number of shift nurses are also using the smartphones and application to support care in the community.

“We’ve spent a lot of time studying the impact of the introduction of Mobility Plus,” notes Chief Financial Offi cer and Vice President of Operations Support, Jennifer Blum. “Missed visits have been slashed by 50 per cent, while we’ve re-duced unconfi rmed visits (where PSWs fail to “check in” with the offi ce to show they’ve arrived at a client’s home) by an astounding 85 per cent. At the end of the day improved fl ow of information all around – between client and PSW and the PSW and the offi ce – lets us remain

more focused on the quality of care we’re providing and spend less time on admin-istration. It’s a win-win all around.” She adds that the instant access to the offi ce via BlackBerry means staff can instantly send client requests or a schedule change on the spot. They can also call clients to let them know if they’re running late because of heavy traffi c or a transit shut-down. “It really empowers our employees to make a difference,” says Blum.

At fi rst, many PSWs were wary of the idea of using smartphones. Previous surveying of the workforce showed only

about 50 per cent of workers were com-fortable using the internet. But compre-hensive training, the intuitive nature of mobile technology and enhanced com-munication have converted even the most skeptical of PSWs. VHA PSW Na-hida Mohamed says, “It’s the best deci-sion the company has made to commu-nicate!”

Felister Mburu, a PSW coach for the or-ganization notes, “MobilityPlus improves the quality of care I’m able to give and makes the old way seem old-fashioned. You don’t have to keep calling the offi ce

for addresses or messages or ask some-one to speak slower because you can’t understand them. When you’re driving, GPS takes you where you want. There’s no confusion – you have the apartment, the entry code, the street, the client, you have everything you want. I love it!”

While the project was challenging, the insights and information gathered during the implementation process will undoubtedly help VHA as it continues to roll out of other point-of-care tech-nology in the community including a wound-care management system for its nurses and charting solutions for VHA’s rehabilitation service providers. “Though each application is different,” adds Blum, “they all share the common goal of im-proving care. And ultimately that has a huge impact on the client experience.” ■H

Pamela Stoikopoulos is Communications Manager at VHA Home HealthCare.

Continued from page 26Smartphones help improve the patient experience at home

“The introduction of mobile technology aligns perfectly with our strategic priorities of being more attuned to client needs, more connected both internally and with our partners, and by providing more inspired solutions.”



NCLEX RN ReviewRPN Exam Prep Class (CPNRE)Personal Support Worker (PSW) 26 Weeks-$1999Location: Toronto School Of Health 245 Fairview Mall Drive, Suite 723 Toronto, ON M2J 4T1 Tel: 416-800-8281

www.TorontoSchoolofHealth.com

RN-RPN-PSW

rain tumour surgery has un-dergone signifi cant changes in recent years thanks to new and improved tracking and imaging

technologies. Now, ultrasound imaging can be used in real time to detect brain shift and improve surgical outcomes for operat-ing room teams and their patients.

Every day, 27 Canadians are diagnosed with a brain tumour according to the Brain Tumour Foundation of Canada, ranging from malignant cancer to benign cysts. When surgery is required, one particular challenge in removing brain tumours is a phenomenon known as brain shift. This happens when the brain moves within the cranium once a surgeon has made a hole in the skull. Depending on the patient, and the length of the procedure in question, brain shift can be relatively signifi cant.

During operations, surgeons rely on so-phisticated navigation and tracking systems to locate tumours that may not be visible to the naked eye because they are either too small or located in a diffi cult-to-see area. These navigation systems typically rely on MRI or CT-scan data that was gathered prior to surgery when the pressure in the brain was normal. As a result, these images do not refl ect any potential brain shift.

Not having access to real-time images can lead to a number of potential issues.

Portions of a tumour may be left behind, leading to additional treatment, such as chemotherapy or a second surgery. In worst case scenarios, the surgeon may actually re-move healthy tissue, potentially leading to impairments that could have been avoided.

Intraoperative MRI technology – in which surgery is performed using real-time MRI imaging without the need to move the patient – has been a major milestone in advancing brain tumour removal. This technology is rarely available, however,

largely because costs for purchasing and in-stallation can run from $3 million and up. Currently, it is only available in a limited number of top medical facilities around the world.

Luckily, surgeons now have access to an effective and more affordable option with innovations such as the Stealth® Navi-gated Ultrasound. This add-on module for the widely-used StealthSation® platform allows surgeons to plug a guided ultrasound probe into a navigation system to look for

tumours during surgery. This real-time, intraoperative ultrasound imaging can be combined with preoperative imaging in or-der to more accurately detect the extent of brain shift during surgery and assess the ac-curacy of the surgical procedure.

Unlike intraoperative MRI systems, guided ultrasound probes are relatively in-expensive devices ($50,000 to $60,000). They can be widely used in cranial neu-rosurgery procedures in which a surgeon needs to asses brain shift or lesion bound-aries. These include various forms of brain cancer (astrocytoma, glioblastoma multi-forme, mixed glioma, oligodendroglioma, large fl aps/deep resections), as well as signifi cant changes in blood and cerebral spine fl uids, edema (swelling), tissue re-moval, and hemorrhages.

There have been a number of clinical tri-als of ultrasound-linked navigation systems for brain tumour surgery that have reported noticeably improved accuracy rates in tu-mour removal. One study concluded that navigation using 3D ultrasound is a “ver-satile, useful and reliable intraoperative imaging tool in resection of brain tumours, especially in resource-constrained settings where intraoperative MRI is not available”.

While ultrasound-linked navigation is in fact a familiar concept to many in the fi eld, adoption has been slow in Canada, largely because of technology compatibility issues with existing navigation solutions. The majority of hospitals have not adopted this technology for that very reason.

With Health Canada’s recent licens-ing of the Stealth® Navigated Ultrasound system (fully compatible with the widely used StealthStation® S7® or i7™ system, which have been used in Canada for over a decade), this is no longer a barrier to adop-tion. The Stealth® Navigation Ultrasound system has been approved for use in the U.S. since October 2012.

Not only is this an affordable option, de-ployment can usually be completed within two hours. Experience to date outside of Canada shows that surgeons are profi cient in using the technology after fi ve to 10 training cases.

With Canadian access to affordable, easy-to-deploy solutions, ultrasound-linked navigation is poised to play a signifi cant role in improving brain tumour removal outcomes moving forward. ■H

Daniel Giacinti is Marketing Manager, Neurosurgery for Medtronic Canada

Real-time ultrasound helps see brain shiftBy Daniel Giacinti

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This new technology allows for real-time monitoring of brain shift during brain tumour removal surgery.

These researchers had previously re-ported on short-term outcomes in Lancet Oncology in March 2013 with an inter-pretation that laparoscopic surgery in patients with rectal cancer resulted in similar surgical safety, resection margins, and completeness of resection com-pared to that of open surgery. There was less blood loss for patients who under-went laparoscopic surgery; hospital stay was shorter, though the procedure was longer (on average four hours versus three hours).

“My procedure was on a Wednesday. I went home that Friday. It felt pretty good moving around. Some of my friends visited shortly after I returned home and asked with concern if I should be in bed resting,” Mary recalls.

“My thinking is that if there’s a less in-vasive option that is as safe, and you’ve got a skilled surgeon: why would any-one not do laparoscopic surgery,” says Mary, who specifi cally sought out Dr. Ashamalla. “He had the expertise I was looking for, for my treatment – skilled in gastrointestinal matters, in gastrointes-tinal cancers and a leader in minimally invasive surgery.”

Dr. Ashamalla is also an assistant pro-fessor and surgeon educator in the De-partment of Surgery at University of To-ronto. In his educator role, his research is focused on introducing more inter-active teaching techniques for surgical residents. At the Sunnybrook Canadian Simulation Centre, Dr. Ashamalla con-tinues to implement advanced simula-tion technologies such as three-dimen-sional virtual reality and box simulator training for laparoscopy, into surgical education residency programs.

With his unique training, he also continues to break new ground, for ex-ample, by performing multi-visceral lap-aroscopic surgery for locally advanced adherent colorectal cancers that require multiple organ removal. This is a novel approach that Sunnybrook is leading in development, implementation and dissemination.

Two and a half weeks after her sur-gery, Mary was on her way to a hiking vacation. As she boarded the fl ight to

her destination, she asked a fellow pas-senger to help her place her bag in the overhead compartment. Mary remarked that she had recently undergone sur-gery, but because she was moving with ease, he looked at her oddly and asked, “Where?” Mary replied with confi -dence, “I wouldn’t lie about something like that!” ■HNatalie Chung-Sayers is a Communications Advisor at Sunnybrook Health Sciences Centre.

Photo credit: Doug Nicholson

Sunnybrook’s Live Tweet of a right hemicolectomy surgery done laparascopically.

Continued from page 22

“Do you do that laparoscopically?



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Hospital News 2015 June Edition