Alberta Cancer Board counting on VoIP

“Unify, simplify, fortify,” is the new mantra at the Alberta Cancer Board.

The phrase points to three key benefits the Board expects once its new Voice over IP (VoIP) infrastructure is rolled out by the end of the year.

The VoIP system is designed to seamlessly integrate multiple interfaces, minimize complexities and bolster the security of ACB’s wide area network infrastructure.

It is also expected to boost productivity of IT staff as well as physicians attached to the Board. Infrastructure consolidation will be the first and most obvious fallout. “In the past we’ve had two sets of cabling – for the telephone and the network,” said Shivan Boodoo, project manager, Information Systems at ACB. “With the VoIP deployment, we will eliminate one set and route voice calls over the Board’s wide area network instead of a telephone line.”

Savings from this alone could be significant – and would include long-distance cost reductions, as every call routed over the wide area network would be a like a local call. And consolidation doesn’t just cover infrastructure and cabling – it also extends to end user devices.

With the move to VoIP, ACB physicians will have a single appliance on their desks – a Cisco 7970 IP phone – serving as a telephone and a dictation device. “So they won’t have to grapple with multiple appliances and multiple user interfaces,” said Boodoo. “Most importantly,” he said, “VoIP positions the Board to harness new and innovative tools and technologies.”

One of these is a new clinical documentation system ACB plans to roll out once its VoIP infrastructure is up and running. Based on technology from Milpitas, Calif.-based Vianeta Communications, the new Web-based system will unify and automate every aspect of Health Information Management at ACB – from dictation, transcription and speech recognition to chart completion and distribution.

The Vianeta system is likely to boost physician efficiency at ACB facilities by as much as 25 per cent, enhance transcription speed, accuracy and flexibility, and reduce IT costs. “It will also be intuitive and much easier to use,” predicted Boodoo.

Boodoo noted that the Cisco phone will let doctors log on, punch in a patient’s ID and pull up relevant information on the phone’s display within moments. When doctors activate the device’s dictation function, the phone display disappears and is immediately replaced by a dictation interface with touch screen controls for functions like stop, play, skip back and forward. Boodoo said the approximately 100 physicians attached to the Board frequently move around between major facilities, associate offices and remote clinics. “Now they won’t need to carry a Dictaphone or dial into anything.”

The project manager has no regrets about replacing the Board’s existing dictation infrastructure, which has triggered more disk drive failures and crashes than he cares to remember. (After a crash, it would typically take several attempts and a great deal of time to get the system up and running again).

And system failures were not the only challenge. Replacement parts for the aging Dictaphone and Lanier systems were hard to come by and, when obtained, very expensive to maintain. “Dictation quality was bad,” said Boodoo. “Transcriptionists couldn’t understand recordings and the system was generally quite erratic.”

Before the year is through, however, all these problems will be no more than an unpleasant memory.

With the much anticipated launch of the new Vianeta-based system, the ACB is gearing up for dramatic improvements in availability – not to mention data quality, access and usability. All this is not just wishful thinking. Three Alberta Health Regions that standardized on Vianeta early last year are already reaping these rewards.

For hundreds of physicians at the David Thompson, Palliser and Chinook Health Regions, the new Vianeta system has proved a clear winner. “Cost and availability were the main drivers behind these three deployments,” according to Ralph Aceves, vice-president of field operations at Vianeta. Aceves said aged legacy dictation equipment at the three regions was difficult to maintain. “Every upgrade was painful and expensive as the regions’ proprietary hardware could not integrate with other systems. Limited storage capacity made it impractical to archive dictations for more than five days. Some physicians dictated into microcassettes, causing workflow problems and creating a separate management load for supervisors.”

Aceves said three components in the Vianeta arsenal have helped resolve these challenges conclusively: Adaptable digital dictation and speech recognition products, a workflow management server (WMS), and a multi-channel distribution capability. All these elements, he said, work seamlessly together, providing hospital administrators, physicians and other stakeholders with complete and easy access to patient information. “The dictation products integrate well with the WMS hardware, so hospitals can configure workflow efficiently, while multi-channel distribution offers a choice of delivery modes: online, print or fax.”

Once workflow rules are set up in the WMS the entire process is automated. “Report delivery is a snap,” said Aceves. “No longer are reports physically carried to multiple clinics, departments or hospital floors. Once transcribed, they are transmitted electronically to physicians for editing and signing, and signed reports become part of an electronic medical record. All that happens without any human intervention.” With the success of the David Thompson, Palliser and Chinook projects, excitement at the ACB – about its own forthcoming deployment – is running high. “Automation and standardization,” are two focus areas at the Board.

Automation is seen as the high road to better transcription and distribution processes. A single standardized dictation system across four regions is expected to significantly improve the efficiency of the physicians working at the Board’s numerous facilities. “Our doctors often move from one region to another,” said Boodoo. “Now when that happens, they won’t need to learn an entirely new set of commands and controls, as all regional systems will have the same specifications.”

According to Aceves, another efficiency booster is the system’s Web interface that enables the physician to access transcribed reports from any location, edit them online, sign them electronically and distribute them to appropriate stakeholders – all without loading any software on his or her local PC. “Internet access and a standard Web browser is all that’s needed.” Aceves said the system enables proxy signatures to be set up in a few seconds.

“Doctors going on vacation, for instance, could assign someone else to sign on their behalf for a specified time period. The substitute then automatically starts getting that doctor’s reports. When the specified time elapses, the proxy expires.”

Even niftier capabilities are expected when the transition to IP telephony is completed by the end of this year. The Vianeta system supports both analog and digital technology, so the dictation system can be integrated into the network without an analog gateway.

According to Aceves, the VoIP implementation will also enhance security. “Everything will be secured through an IP backbone, there’s no danger of any leaks from the PBX side of things.” Vianeta’s success in Alberta has prompted the company to enter into discussions with other Canadian provinces.

Joaquim P. Menezes ( is assistant editor of CIO Government Review.

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