A matter of life and death

Death is a strong motivator.

In part because of the death of a critically ill woman in 1988, Ontario hospitals now participate in an extranet-based bed and resource registry system.

“Back in 1988, there was an awful lot of publicity about a lady who had become very ill in Midland, (Ont.,) and her doctor was calling all over trying to find a bed, and she died,” said Shelley Moneta, manager of the Internet-based Ontario CritiCall program, an emergency patient referral system housed at Hamilton Health Sciences Corp. in Hamilton, Ont.

“That (death) gave everybody the impetus needed to get a bed referral system started,” Moneta said.

Between 1988 and 1992, several urban centres around the province set up their own patient transfer systems. As available technology improved, Moneta said, it became inefficient to have multiple systems running separately.

In late 1995 and early 1996, proposals were made for a province-wide registry of hospital beds and resources. Later in 1996, Hamilton and Thunder Bay, Ont., hospitals were tested on the newly developing system.

“Every year, it’s been expanded to include more and more hospitals and resource information. Right now, it tracks bed availability, ICU status, emergency department status, neonatal intensive care status, physicians on call, contact information, and the traffic in the ER for about 126 hospitals,” with all other Ontario hospitals to follow in the next several months, according to a provincial government edict, Moneta said.

She said while several years ago some hospitals worried about bringing Internet access into the buildings — they were usually concerned about security or employees using the Internet inappropriately — these days the other hospitals are quite willing to buy into the program since it has proven effective over the years.

Hospital staff such as ward clerks or charge nurses use a Web browser to log on over the Internet with a user name and password that Moneta said can be defined with multiple levels of security.

“There’s no patient demographics on there whatsoever, but we do use SSL (Secure Socket Layer) security as well as multiple levels of privilege assigned to user levels…I could set up a user that could only see hospitals within their own community or their community plus Ottawa, or something like that,” Moneta said.

System security also allows for defining what fields can be modified by particular users.

“So an admitting clerk at McMaster (Hospital Campus) would be able to update her own bed availability but would not be able to update the bed availability for the Ottawa hospital, and she might not even be able to see the bed availability for Ottawa unless she had a reason to need that,” whereas managers would have extended system privileges, Moneta explained.

ER staff update their emergency status information as it changes between three status indicators: normal, redirect and critical care bypass. Telecommunications staff at each hospital keep the system informed of which physicians are on call, what their area of speciality is, and the doctors’ pager and telephone numbers.

Physicians themselves do not generally use the system directly, but rather they call a 1-800 number and rely on a CritiCall representative to check the system for current resources. Updates to the system are also automatically sent to ambulance dispatchers.

Each hospital is responsible for finding its own Internet access. Moneta said while different areas of the province have different issues in terms of ISP availability and reliability, there is sufficient competition among ISPs to ensure the hospitals are kept happy with their connection services. If a hospital should go off-line for any reason, they only need call the CritiCall number and have the representative update the information on the hospital’s behalf.

“We have a redundant Internet link, so as far as the server’s concerned, we’re pretty safe there. But we also are mirroring the server in Ottawa in the fall, so from our point of view the registry will never be down,” Moneta said.

Furthermore, she said the system was started in 1996 with new code using four-digit dates so there is no anticipated year 2000 problem.

The system was designed by Rincon Technologies from Dundas, Ont. Paul Errygers, an Internet specialist with Rincon, said the 1996 start meant working without the Internet application tools that are now taken for granted.

“We started from scratch and we did a lot of work banging our heads against the wall to get this working. Then as time has gone by, we have been able to use Cach