Dr. Glen Geiger, Medical Director & Chief Clinical Information Officer, Information Services, The Ottawa Hospital
Feature
Mobile technology takes
The Ottawa Hospital further
on its journey toward excellence
T
he Ottawa Hospital’s recent foray
into mobile computing technology
with the Apple iPad® has allowed
physicians to revitalize bedside patient rounds and direct care activities.
Like other hospitals in the western world,
The Ottawa Hospital has seen unprecedented growth in technology over the past four
decades; CT and MRI scanners, automated
medication infusion pumps, and non-invasive blood pressure cuffs, to name just a
few. The paradox of modern healthcare is
that despite this proliferation in technology,
clinicians across the western world continue to use manual care-delivery processes,
largely driven by paper forms, handwritten
documentation, FAX machines, and pagers.
While other industries have put information
technology directly in the hands of frontline
workers, healthcare has lagged behind in the
transformation of direct patient care, preferring instead to leverage technology only
within isolated islands such as medical imaging or the hospital lab. This has resulted in
the cumbersome, bureaucratic, unresponsive
system with which citizens are very familiar.
In a world where your order at Tim Horton’s is entered into a computer to move it to
a recipient ten feet away, doctors continue to
rely on paper forms and the mail system to
request diagnostic testing from remote facilities. The internet allows the average citizen
to find services in seconds, while family doctors and other primary care providers have no
directory of specialists in their area to help
them refer patients for tertiary care. Within
hospitals, medication orders and diagnostic
testing requests are written on carbon forms
and transcribed multiple times before they
can be executed, with all the attendant potential for error this entails. At The Ottawa
Hospital, computer workstations provide access to patient results at the nursing station
and in physician offices but, until recently,
access to information at the patient bedside
required the medical team to recopy the results or print them from the computer system
in order to carry them.
Volume 18/Issue 3 Fall 2011
When the Apple iPad® became available
last year, The Ottawa Hospital launched an
initiative to configure a clinical application
that would make patient information available on this mobile platform. By November,
the developer’s efforts had borne fruit and
the first version of the Clinical Mobile Application was put into production in a pilot
project with the Division of General Internal
Medicine. The first version allowed Staff
Physicians and Residents to review patient
lab results, diagnostic imaging reports, and
transcribed documents at the patient bedside.
‘handle’ on their care when they received information right at the bedside. The patients
felt more in control when they were given
the facts directly, rather than filtered by delay
and physician recall.
Since the initial pilot, the development
team has enhanced the Clinical Mobile App
with a PACS viewer that allows medical images to be displayed. As the saying goes, “a
picture is worth a thousand words”, and for
patients and their families, being able to see
their own x-ray makes it easier to understand
the diagnosis and treatment plan.
The paradox of modern healthcare is that despite this proliferation
in technology, clinicians across the western world continue to use
manual care-delivery processes, largely driven by paper forms, handwritten documentation, FAX machines, and pagers.
The application also provided access to information resources such as the hospital formulary, e-CPS, and the hospital’s collection
of online journals and e-texts.
The results were dramatic. Clinicians recognized the value of the new tool immediately. Having up-to-date patient information
available anywhere, anytime, enabled better
patient care decisions. Reports began to filter
in describing how much easier it was to look
after patients. Care teams that had been doing
‘rounds’ from a workstation-equipped conference room began to do bedside rounds again
because they could easily carry the information with them. Physicians took to showing
results directly to their patients. Anecdotal
feedback described how family members of
critically ill patients were better able to understand their loved one’s condition when
they were shown the information for themselves. At the end of the pilot, the Residents
moving out of the pilot area and onto new rotations, refused to give their iPads back and
were the envy of their colleagues.
Direct interviews with patients confirmed
that they, too, felt that the team had a better
The privacy of patient information has
been of paramount concern throughout this
project. Physicians are reminded of the importance of maintaining patient confidentiality during commissioning and a reminder
message appears during login. The Clinical
Mobile Application is secured by two levels of user passwords and the application
does not retain any patient information in
its memory. The technical support team also
has the ability to erase iPads remotely in the
event of loss.
Following the success of the pilot, The
Ottawa Hospital IS Governance Committee approved the purchase of a further 1,800
iPad 2’s, for deployment to physicians and
residents, and clinicians are ‘lining up’ to
receive theirs. The next phase of application
development will include the ability to order
x-rays and lab tests directly from the patient
bedside. Physicians and residents have already confirmed that this would enhance
their use of the application and would make
electronic ordering easier.
Feature continued on page 6
5
Karim Bhaloo, BSc, MLT, OSMT District 5 Director
Feature
Freedom of Information
and Ontario hospitals
O
n October 20, 2010, the Ontario Government introduced
the Broader Public Service Accountability Act, 2010 (BPSAA)
which received Royal Assent on December
8, 2010. The Act introduced new rules and
accountability standards not only for the
broader public sector organizations, but
also for Local Health Integration Networks
(LHINs) and hospitals. Also known as Bill
122, the Act, among other things, brings
Ontario hospitals under the umbrella of the
Freedom of Information and Protection of
Privacy Act (FIPPA).
Even though FIPPA will apply to all public or private hospitals effective January 1,
2012, only records that came into the custody or control of the medical facility on or
after January 1, 2007 will be subject to the
Act. According to the Act, a record means
“any record of information however recorded, whether in printed form, on film, by electronic means or otherwise, and includes:
a) correspondence, a memorandum, a book,
a plan, a map, a drawing, a diagram, a
pictorial or graphic work, a photograph,
a film, a microfilm, a sound recording,
a videotape, a machine readable record,
any other documentary material, regardless of physical form or characteristics,
and any copy thereof, and
b) subject to the regulations, any record that is
capable of being produced from a machine
readable record under the control of an institution by means of computer hardware
Feature continued from page 5
In the long term, The Ottawa Hospital’s
mobile strategy includes expanding the use
of the device to more clinicians and the use
of inter-provider messaging to enhance communication between different members of
the care team.
The Ottawa Hospital is in discussion with
their speech recognition vendor to deliver
this technology on iPads. This will complement the current offering of ‘real time’ voice
6
and software or any other information
storage equipment and technical expertise normally used by the institution.”
public to access them depends on the hospital’s capacity to demonstrate the exemption.
Some of the exemptions include:
Under FIPPA, citizens of Ontario will
have the right to request access to these records unless they are either excluded or exempt. Under the Personal Health Information
Protection Act (PHIPA), a citizen can access
records about him or herself only. However,
under FIPPA anyone can access any records
that are under the control of or held by the
hospital, public or private, on any issue subject to certain exclusions. Some of these exclusions as set out in the Act include:
1. Proprietary information such as requests
for proposals.
2. Employment records.
3. Information prepared by or for in-house
legal department.
4. Information produced by the Board or a
committee of the Board during a meeting that “a statute authorizes holding the
meeting in the absence of the public and
the subject-matter of the meeting is a
draft of a by-law, resolution or legislation
or litigation or possible litigation.”
1. Ecclesiastical records of a church or religious organization that is affiliated with
an educational institution or a hospital.
2. Records that relate to the operations of a
hospital foundation.
3. Administrative records of a member of
a health profession listed in Schedule 1
to the Regulated Health Professions Act,
1991 that relate to the member’s personal
practice.
4. Records relating to charitable donations
made to a hospital.
5. Records relating to the provision of abortion services.
6. Personal health information as defined in
PHIPA.
The introduction of FIPPA marks a major
change for hospitals in Ontario. In order for
these institutions to be compliant with the
legislation on January 1, 2012, they must
change and or introduce policies and procedures to manage requests made under the
legislation. ❖
References:
Ministry of Health and Long-Term Care.
(2011). The Broader Public Sector Accountability Act, 2010. Accessed on July 6, 2011 at
http://www.health.gov.on.ca/en/legislation/
bpsa/fippa.aspx
Certain records can be exempt under FIPPA but the public can still request access to
such records under FIPPA. The ability of the
Pessione, H & Hawkins, P.J. (2011). Application of Freedom of Information to Ontario
Hospitals. Hospital News, p.29.
recognition, currently available through PC
workstations and will allow physicians to
create text documents, anywhere, anytime.
Electronic medication ordering is a longterm project that will leverage the hospital’s
investment in both the PC-based Electronic
Medical Record, and its counterpart, the Clinical Mobile Application. Direct entry of medication orders is part of a change in medication
workflow, considered essential to preventing medication errors and ensuring patient
safety. By the time this functionality becomes
available, clinicians will already be very familiar with the use of the mobile device for
less critical types of electronic ordering.
Speech recognition, electronic ordering,
online information resources and mobile access to the Electronic Medical Record, are
all part of a cultural shift that is transforming
healthcare and TOH is proud to be leading
the way. ❖
Photo of Dr. Geiger courtesy of Chrissie
DeCurtis Cloutier, The Ottawa Hospital
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