University app could become SARS screening standard

An “”e-screening”” wireless solution developed by Queen’s University during Toronto’s outbreak of severe acute respiratory syndrome (SARS) has piqued the attention of health-care professionals as far away as Australia, according

to one of its Kingston, Ont.-based creators.

David Goldstein, medical director of the Queen’s University Anesthesiology Informatics Laboratory (QUAIL), said Wednesday the homegrown application has also attracted the interest of staff at the Atlanta-based Centers for Disease Control and Prevention. Meanwhile, the e-screening solution has already been deployed in over 22 Ontario hospitals and is now being made available to all of the province’s healthcare institutions, he said.

“”This shows that all solutions for hospitals don’t have to be dealt with by IBM, Compaq or HP,”” Goldstein said of the wireless application that was first announced last May in the Canadian Medical Association Journal. “”Given the latitude and the finances, a hospital’s own IT department could come up with better solutions faster to respond to the needs of the users, which are the clinicians and the patients.””

Goldstain was at the University of Ottawa’s health sciences facility to talk about QUAIL’s progress in adapting IT solutions to the health-care field. He recalled the time that QUAIL’s research team stayed awake for 72 hours to come up with a more efficient way of screening for SARS among those people entering and exiting Kingston General Hospital, including patients, family members and staff.

“”We created this solution to track (people) using radio frequency computers, a back-end data base and screening bar codes,”” said Goldstein.

When the SARS outbreak first hit southern Ontario, Kingston General received a questionnaire from the Ontario Ministry of Health to be distributed to, and filled out by, hospital entrants.

The object was to track the signs and symptoms of possible SARS cases. But the form took two to five minutes to fill out. The only way of monitoring the paper-based system was to go through the hundreds of thousands of forms manually.

“”For surveillance, you can’t go through 35,000 pieces of paper every other day and expect to be able to track people,”” he said. “”The first two days, we had lineups around two city blocks. Our CEO and our staff were getting anxious.””

The team at QUAIL developed an electronic Web-based SARS screening tool that would have several advantages, said Goldstein. The tool consisted of a front-end, touch-screen interface for entrants and a back-end database accessible to hospital staff. For entrants, it meant 30 seconds instead of several minutes. For staff, it meant an effective tracking method.

Significantly, the Web-based tool was developed for laptops or personal computers using bar-codes and wireless technology. For barcodes, QUAIL used hospital personnel, research and medical school lists to generate unique bar codes for each employee that were applied to hospital ID badges and adapted to an automated scanning device. The screening tool was made accessible through a secure encrypted wired local area network (LAN) that consisted of a PC plugged into the hospital information network or an encrypted secure wireless network.

The technology has easily been adapted to the security and confidentiality needs of patients as well, said Goldstein.

Mike Rimmer, QUAIL’s director of technology, added the research team has implemented “”role-based”” access to patient records.

“”It’s not enough that you’re a physician, you have to have a clinical expectation,”” he said. “”The clinical role you replay determines the level of access to patient records.””

Rimmer suggested the access system is a pre-emptive response to the expected changes in Canada’s federal privacy legislation beginning in 2004. The changes are widely believed to increase privacy protection and make privacy law more complex.

“”We’re not quite sure what to expect,”” he said. “”So we’re expecting the worst.””

During the SARS crisis, the University of Guelph said it was using a similar combination of handhelds and database to screen for the disease, while the B.C. government has funded a team to search for a cure using knowledge management applications.

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