Dr. Adam Cwinn, head of the Emergency Medicine department at the Ottawa Hospital General Campus, utilizes technology to make his job more efficientBlair Gable/The Globe and Mail
Desmond Entwistle lay in a hospital bed, his temperature soaring, as life and death swirled around him.
He had been admitted to a Montreal hospital while undergoing painful treatment for acute leukemia when, one day in December of 2004, he was simply forgotten about for 18 hours.
When staff took his temperature and realized he had likely picked up an infection, they plunged a needle into him, according to his son. They failed to notice the MedicAlert bracelet clasped around his father's wrist, which said that he was allergic to penicillin. He went into severe toxic shock and died six days later.
"They pumped him full of penicillin and killed him," his son, Darren Entwistle, the chief executive officer of Telus Corp., said in an interview.
Four years earlier, driven by a hard business case, Mr. Entwistle began steering the Vancouver-based telecommunications giant into a major bet that it can help fix the sort of problem that would later contribute to his father's death.
Canada's health records system, based largely on paper and bracelets, is "arcane," he says, and in bringing it into the 21st century there is the opportunity for both profit and social good.
One can see the early result of the Telus plan at work in the emergency room of The Ottawa Hospital.
On a late afternoon recently, veteran physician Adam Cwinn could be found brushing his fingers across the glass surface of an iPad to zoom in on a chest X-ray.
The hospital plans to order 3,000 iPads by the middle of next year. Behind this move is Telus, which is providing the wireless network and has aggregated the hospital's databases on Telus software.
As its rivals buy up media properties in multi-billion-dollar blockbuster acquisitions, Telus is quietly hoping that medical institutions across the country are ready to follow The Ottawa Hospital's lead and dive into a new era of advanced health care technology. That would mean a surge in profit from a division that has annual revenues of about $400-million.
The move, industry watchers say, has relatively little risk for such a potentially huge payoff: It puts Telus in the lead position ahead of the intense strain that baby boomers will inflict upon this country's already-struggling and outdated health care system, at precisely the time when advanced technology such as tablets can finally offer a viable solution. There are just two small problems: Doctors often resist change and the whole thing is dependent on the political will to implement electronic solutions at a time of tight budgets and electronic health scandals.
"This is going to be the challenge that defines our lifetime," Mr. Entwistle says. "We have a ton of antiquated technology out there."
Before he got his iPad, Dr. Cwinn said, he spent way too much time checking printed charts, darting from patients' bedsides to desk-bound PCs and walking around the hospital to see what his staff were up to and which beds were empty.
Staring down at the chest X-ray, he says, "You wouldn't make a diagnosis with this, but for interacting with patients, it's excellent." With a giant flat screen TV above a hub of computers, he can also keep better track of his department's physicians and instantly see the number of free beds available, even at the hospital's other campuses.
He can also access crucial information right at a patient's bedside. Turning to the iPad, he pushes on an "allergies" tab. A list pops up.
Mr. Entwistle, in a later interview, says, "I wish they had that sort of technology when my father was ill."
And this is just the sexy, high-tech veneer; the much more crucial changes are happening elsewhere, with the hospital's vast databases merging into one flow of information for the first time.
For many businesses, this type of technology isn't revolutionary. But hospitals are renowned for being reluctant to change. For that reason, Dale Potter, The Ottawa Hospital's chief information officer, was hired from the private sector two years ago to shift the large institution onto a new path.
"Health care [has]got to change," Mr. Potter says. In 2008, he polled key staff members on the amount of information they needed that was available electronically; the answer was 30 per cent, meaning fully 70 per cent of the crucial knowledge they required was being scrawled on slips of paper or printed out of a machine.
A year later, after an ambitious digitization process aided by Telus's software, hospital staff said that 100 per cent of the information they needed was in the hospital's system. And that's when Mr. Potter came across a group of medical residents printing and handing out information from the hospital's system before they went on their rounds.
"A lab result could have come in the middle of [printing]that, and they would have missed it," Mr. Potter says. "I was almost ashamed."
Hence the iPads - fully functional computers that can move with doctors on their rounds. Tablets, of course, are nothing new, either to the private sector or to hospitals. The Ottawa Hospital already has a variety of out-of-favour tablets in a "morgue" in the institution's basement, abandoned after doctors found the devices lacking. But with the iPad, Research In Motion Ltd.'s new PlayBook tablet, and devices looming from Samsung Electronics Co. Ltd. and Dell Inc., the tablet market may finally be an option for medicine after years of clunky, unintuitive devices.
"It's taken a while for institutions to be ready for mobility within their walls," says Marc Filion, chief operating officer of Telus's health solutions unit. "I've been talking to CFOs and CIOs across the country - and they're saying, 'Just go ahead and do it.'"
And with the baby boom generation about to crush into Canada's health care system, upping the annual cost of health care to about $240-billion a year by 2020 from $160-billion now, that technological revolution has come just in time. Medical institutions are desperately seeking ways to maximize their time and cut costs. And Canada is very far behind: Only about 50 per cent of the country's health records are digital, compared with nearly 100 per cent in the United Kingdom, according to Telus.
"The will to do it is much stronger than it was 15 years ago," says Michael Carter, a professor and director of the University of Toronto's Centre for Research in Healthcare Engineering. "Implementation of IT in health care is really 15 years behind other service industries. But they're coming around, so Telus may be right."
But one of the problems stalling the process is that doctors are largely non-compliant, Mr. Carter says. In smaller institutions or individual offices, doctors have to be offered financial incentives to automate and digitize their health records. Often, they will scribble out notes, then make nurses or assistants enter the information into a computer.
Telus's push into the health sector began 10 years ago, but really took shape in 2007 with the $763-million acquisition of Emergis, a Montreal-based health technology company. The company's main product, Oacis, pulls information from a hospital's various, disparate data bases - from patient histories and current prescriptions to bed databases - and aggregates them. It can share information between multiple institutions in an area, so patients of one hospital can have doctors in another hospital access their records. The company's hope is that it will soon be doing this across entire provinces, if not the country.
"I don't get why the digitization of society hasn't gone like a wildfire through the health care sector," Mr. Entwistle says. "It's an investment that's born out of necessity. We have to drive it. If we don't, the economics are only going to become more daunting."
And this is just the start. Telus is pushing beyond institutions to developing apps for young kids suffering from illnesses to help manage their conditions. It's also moving into the home, where Mr. Entwistle envisions parents becoming more active participants in their own health. Nurses, he says, could take smart phone pictures of wounds and e-mail them to specialists, who could make recommendations. Tele-medicine, where diagnoses can be done by high-definition video, would increase with the expansion of advanced wireless networks into the most remote Canadian and aboriginal communities.
National Bank Financial Inc. telecom analyst Greg MacDonald said the approach has less risk than the some other telecom strategies, such as owning media properties. "You're improving the quality of the product [health care]and cutting costs - it's the biggest no-brainer I've ever seen," Mr. MacDonald said.
The biggest problem, of course, is politics. The unending scandals at Ontario's eHealth initiative and the multiple privacy-related scandals in Britain - in one case, someone lost two discs containing the personal information of more than 25 million people - have soured many people on expensive technology investments in health care. There is the added concern, within hospitals, that any dollar going to technology is one dollar not going towards treating patients, Mr. Carter says, and that those investments are frivolous, with the potential to be squandered.
"I can't do anything about the machinations that take place at a political level because I'm a businessperson, not a politician," Mr. Entwistle says. "No one thinks this is a bad idea … I can tell you right now that moving information electronically - which, I can tell you, is core to Telus's business - is much more expeditious than moving information on a manual basis. I don't think that particular point is in dispute."
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HEALTH CARE TECH
Telemedicine
Already in use in B.C. and in dealing with overseas disasters, this is basically video-conferencing between medical specialists and patients in remote areas. It can help serve communities that may not have certain specialists, and is revolutionizing the possibilities for diagnosis.
Databases
Hospitals often have patient databases that are inaccessible to other institutions or to patients at home. By aggregating information within a region, within a province, or across Canada, it may be possible to cut down on medical errors by sharing data.
Handheld devices
Can allow doctors to pull up crucial information at a patient's bedside rather than being confined to a desktop computer, perhaps minimizing medical errors. Mobile devices of various stripes could help phase out paper-based equipment. Nurses at Ottawa Hospital seem to prefer smaller devices because larger tablets are cumbersome to carry on their rounds.
Patient portals
Patients, and parents, can take a more active role in their own health care by using personal Web portals giving access to their medical history and other health information.
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BY THE NUMBERS
$400-million
Annual revenues from Telus's health care division
5 million
Number of people already part of Telus's digital health-records technology division
$800-million
Amount Telus has invested in the division over the past three years.
25
Number of hospitals in the Greater Toronto Area.
20
Number of separate data centres, as well as more than 20 separate patient-record systems, in the GTA.
2
Number of systems Telus believes GTA's institutions need (as well as one backup)