Toronto's Sherbourne Health Centre, which also deals with recent immigrants, gay and transgendered people, has been entirely electronic since opening, according to its senior networks and systems administrator, George Pinto. Its records are managed by Canada's Clinicare software product.



The wireless project will ensure a continuity of care and will also allow for cost savings, said Pinto, as ?you don't have to schlep paper around.? Duplications of efforts are also greatly reduced. ?The information is in the system, there to see,? said Pinto.

Many hospitals are making the move toward using EMRs, according to Michael Martineau, director of the Branham Group, a market research and strategic consulting firm for IT vendors. ?But once you move into the community, it's still largely paper-based systems,? he said. In spite of this, Martineau said, he does sense a major shift ahead ?to put technology into the hands of the individuals-physicians-who have been taking care of us our whole lives.?

This will be especially key in the years ahead as Canada suffers a health care practitioner shortage, forcing more people to turn to clinics and use multiple doctors. ?Sharing paper records (between physicians) is problematic,? said Martineau.

The mobile health buses used to utilize the old standard of the separate paper-based chart system until a two years ago, when it was, in fact, the 40 or so volunteer nurses who came forward to take the technology into their hands -- they requested that the mobile health buses be outfitted with EMR access capability. ?This EMR deployment was very much driven by the end users. They know it's the best tool to provide the best care,? said Pinto.

There are two laptops per bus; Bell Mobility's EVDO supplies the wireless that allows the nurses to connect back to the EMRs at the Centre via Microsoft Terminal Server. The Centre is planning for an upgrade to Citrix soon for their remote accessing needs.

Funding for this initiative will come from a recently announced $900,000 investment from e-health advocacy non-profit Canada Health Infoway. ?This will connect (the clinic, the mobile health buses, and the infirmary), improve the existing connections, and outfit the infirmary,? said Pinto. The infirmary will boast a wide array of IT options to improve care, including VOIP and WiFi, along with tablets for providers and mobile thin clients. Pinto said, ?It's fluid, so (the data) is wherever they're needed.?

Clinicare is a system that works best in a primary care facility, said Pinto, so the Centre needs a new EMR program that caters to an acute care facility for the infirmary; it is in the final stages of choosing a new system. The next step after that will entail using the Centre's internal resources to develop some software (by either doing it in-house or hiring a third-party developer) to create the links between Clinicare and the new program. The linkups between the clinic, buses, and infirmary, and the infirmary itself should be operational by fall.

This continuity of care could also ease the load on hospitals and health facilities, according to Martineau. The majority of problems that people seek medical treatment for fall under chronic conditions; disadvantaged populations, like the ones that the Centre primarily helps, are often especially at risk for chronic diseases like diabetes, respiratory ailments, and cardiovascular problems. These put a great strain on health facilities and care practitioners. ?You need to keep track of the elements of the disease,? according to Martineau, who said that the EMRs allow for easy tracking of symptoms and warning signs, along with features that aid in preventative measures, such as automated reminders of when certain patients are due for a check-up or symptom check-in.

?That way, you can treat them effectively and at the right time, rather than them becoming really ill and having to go to the hospital,? he said.