Common Pulse Newsline March 2007
March 14, 2007

MARCH  2007

World-First Health Care Online Event a Success


Canada Health Infoway approach praised in Pakistan, India:
“Can we copy Infoway internationally?”


  • 200 online healthcare registrants participate in real-time “Co-Web
  • Experts in Toronto, Delhi and Karachi compare global strengths
  • Challenges in health care demographics, crises of drug abuse, rise of digital care
  • Partners are now adding new healthcare topics for coming collaborations – See the list at the end if you have a topic for global cooperation, or if you wish to sponsor a webinar.



Special Thanks for the success of the webinar goes to our facilitators and sponsors:

The Honourable Sinclair Stevens, President, Commonwealth Advantage
Dr. Alex Jadad, Chair and Founder, Centre for Global e-Health Innovation
Luis Saffie, Centre for Global e-Health Innovation
Irfan Valliani, Centre for Global e-Health Innovation
Mick Majid, President, Cyglera
Neil Appalsamy
Dawn Van Dam, President, Health Connexions
Nabarun Chaudhuri, President, Aithent Canada
Ghalia Naseer, VP Corporate Relations, Si3
Dr. Fowzia Siddiqui, National Institute of Child Care, Aga Khan University
J. Paul Haynes, CEO, Medshare
Barry Gander, EVP, Commonwealth Advantage



Tuesday February 6th marked the birth of a new kind of event, the “Co-Web”  -- a real-time face-to-face global collaboration of experts.  “CommonPulse”, dedicated to breaking down global silos for one-third of the world’s population, shared the best practices in technology and services so that costs are lowered, adoption cycles are shortened and more people are treated with better results.


HOST:  The Honourable Sinclair Stevens
President, the Commonwealth Advantage

“We are commencing a journey this evening that I hope will lead to the creation of a Commonwealth Council of Collaboration to further better health care for mankind.”

US Canada Health Care
  • We have created this online CO-WEB which we call Common Pulse.  A CO-WEB is our term for a “Collaborative Web”  --  something new on the global scale. 
  • We could not have done this five years ago.  Today, however, there are 160-million Internet users in the Commonwealth, and we can reach out to healthcare providers in every field.
  • We will become a focus of co-operation for all in the Commonwealth who seek to deliver better health care to our 2 billion people  -  one-third (1/3) of the world’s population.
  • The Commonwealth is in a unique position to take our knowledge of universal health care to other areas of the world.  The United Kingdom can be our bridge to Europe while India and Pakistan will lead us to China, Asia and the Middle East.
  • We will help the community literally  stay  alive  in the coming years, as we mutually explore the burning topics that need to be resolved in health care.
  • Together, we Commonwealth nations can help improve health care for a truly ailing nation  -   the United States.

Click Here for Mr. Steven’s Full Remarks


KEYNOTE:  Richard Alvarez
President, Canada Health Infoway

“The opportunity for Canada from the Commonwealth is to have high quality, low cost solutions, providing revenue growth and diversification”

  • Canada Health Infoway has helped break down the silos in Canada, in part by overcoming the diffusion of healthcare treatment.
  • Canada’s First Ministers of Health created Infoway, to develop Electronic Healthcare Records (EHR) which follow patients through their diagnosis and treatment.
  • For both Infoway and the Commonwealth, the key is collaboration around a shared vision.
  • Infoway has more than 200 projects on-stream, valued at almost $900-million, in sectors such as Registries,
    Diagnostic Imaging, Drug and Lab Info Systems, Tele-health, Interoperable HER, and Innovation and Adoption.
  • Healthcare in Canada is a $142-billion business, with 70% of the funding being done by the Public Sector.
  • Canada can offer the Commonwealth safe, high quality, low-cost solutions to help mitigate demand and cost pressures, especially in IT support, data processing, claims management and medical transcriptions.
  • Canada can also offer health system governance, organization and delivery expertise; leadership in facilities design & construction, capital financing; healthcare IT; education & Training; and Tele-medicine.
  • Infoway’s experience can directly help the Commonwealth: a federated system of 53 states, shared governance, shared vision and strategy, collaboration for success, and leveraged business opportunities.


Click Here for Mr. Alvarez’ Presentation



Dr. Alex Jadad
Chair and Founder, Centre for Global e-Health Innovation

‘We have several billion web sites around the world, and we should collectively manage our knowledge within the Commonwealth”

  • The power of Web 2.0 does not reside in any one server, individual or organization.  Instead, it operates by allowing individual users to interact and affect its behaviour in a bottom-up approach.
  • We need to develop joint educational and certification programs, so we can exchange across geographical boundaries.
  • The Web of Collaboration has to include interoperability…a global Commonwealth system.  The goal would be to join forces to create a true person-centric health system.
  • The need is for the right tools and equipment so that we can efficiently capture digital images, displays, and samples.
  • The Good news is that digital health is now international  --  India for example has made headway in Radiography.  Global companies will set up shops to diffuse Best Practices.  The human touch is important but automation is required


Click Here for Dr. Jadad’s Paper


Dr. Shafiq Qaadri
Ministry of Health Promotion

“The diseases of First World countries are the diseases of excess, whereas the diseases of other areas are the diseases of insufficiency”

  • The global burden of health care and its stratification, we must partner across institutions, provides and countries.  In Ontario, we have 60,000 civil servants handling health care, and it is hard to provide coordination.
  • We have re-introduced exercise and healthy food to our students across Ontario, to give them the good habits they will need later in life.
  • This group can act as a resource for issues like infection control and environmental quality.
  • A Conference call  “Canada & India ICT” is going to be held in March 2007 in India; Dr. Qaadri and Minister Smitherman will go to India to attend.
  • Dr. Qaadri Gave a detailed insight to the situation in India and Pakistan


Dawn Van Dam
Health Connexions

“We need to figure out how physicians and patients can change what they’re doing today -- to improve their health outcomes tomorrow.”

  • Huge demographic shifts are driving the need for change; ten years from now, Senior Citizens will outnumber children in Canada
  • Physicians need a structured approach to asking the right questions to screen patients.
  • With the right kind of patient screening, we can compare real-world cases with benchmarks, so we can find out how to improve the practice of medicine.  Through these medical audits, we can gather the data --  then, self-reflection can lead to improvements in medical practice.
  • If we can engage the patient more in the process, we can get better medical diagnoses and enhanced long-term results.
  • 40% of patients do not take the prescriptions required for their treatment.  Patient communication plans need to be strengthened, involving parents, spouses, pharmacists, doctors, chiropractors and so on.
  • REMEDY® is a patient communication management software tool offered through Health Connexions that helps patients manage their own health.  It’s available for any disease state.  In the example for allergy sufferers, by broadcasting pollution counts, the weather and pollen levels, this provides the patient with much-need relevant information.  Then Remedy provides a convenient record-keeping system for prescriptions and monitoring of patient compliance.  Go to site
  • Key to success: “Patient’s needs and preferences must be looked into first.”



Mick Majid

“There has been an alarming rise in the misuse of prescription drugs today; new users of prescription drugs have overtaken new users of marijuana”

  • Toronto Centre for Addiction found that as many as 11% of individuals reported prescription drugs as part of their substance abuse problem
  • 1993 statistics – Drug abuse amounts to $ 25 Billion.
  • Prescription drugs are responsible for about 40% of drug abuse nationwide according to American Medical Association.
  • Narcotics and Controlled Prescription drugs will be the most abused drugs within the next two to five years, according to reports and surveys by various health care groups and federal government
  • Total economic cost of Narcotic and prescription drugs is huge and tremendous strain on the Health Care cost
  • Modes of abuse of drugs through –
    • Dr. shopping
    • Fraudulent prescriptions
    • Pharmacy shopping
    • Pharmacy theft
    • Over prescribing
  • Non medical use of drugs
    • Medication and Prescription
    • Reconciling
  • Current measures of control are subject to consistent, systemic deficiencies and inefficiencies.
  • A process of “One to One Pharmacy” and “One to One MD” could help with the solution
  • Goals of the solution –
    • Assist prescribers & pharmacists with real time information for best professional practice
    • Curb abuse; improve system for those in true need
    • Reduces social impacts of abuse and fiscal costs
    • Tracking and reporting mechanism that is REAL TIME
  • Cyglera’s One to One Pharmacy and One to One MD will have immediate impact to significantly curtail the illegal procurement of narcotics through the deficiencies and inefficiencies of the existing control measures.


Bill Hutchison
Chairman, i-Waterfront Advisory Board

“We are setting a record with this round-the-world webinar, and we are trying in Toronto to create the world’s best connected community, in a living high-bandwidth laboratory.”

  • The Toronto Waterfront Revitalization Commission is working on a new community of 100,000 people who are connected by a broadband system 100,000 times faster than anything we are used to.
  • We want to put a 10-gigabit/second connection to businesses, at a reasonable price.
  • We intend to create a cluster of digital media companies in downtown Toronto, and we are working with world leaders like Dr. Jadad.
  • Emphasis on e-Application of Technology for healthcare like Entertainment sector and Governments. Touched upon following related topics:
    • High speed communication
    • E-health
    • E-education
    • Digital media components
    • Digital democracy
    • Creating a living laboratory.
    • Remote monitoring (E.g. remote dialysis)
  • We need to work out how we can collaborate with other Commonwealth communities like Delhi and Karachi --  and we can start with a collaborative ‘sister cities’ network.





By 2050 India will have the largest population in the world, with a work force much younger than the U.S. or Europe.  It promises to have one of the highest sustained economic growth rates.  Its strata of educated professionals includes a computer-literate cadre that will soon outnumber all of the other computer operators in the rest of the world put together.  It is making major “made in India” strides in innovative health care solutions.


Host: Nabarun Chaudhuri,
Aithent Canada


Moderator: Arshiya Sethi
Editor and Journalist

“Our countries, with their shared heritage, can offer their strengths to the world.  One of India’s health programs alone reaches more than 500 million people, and could be of great benefit in developing nations.”

  • Healthcare is a very low priority in India and Pakistan.  Defence spending is much higher.  No Government-sponsored programs exist. Salaries are not good. Not much money goes to the poorest of the poor.


  • India is an exporter of its medical skills. India provides HR to the world.  The most eminent surgeons in the U.S. are Indian.
  • India will be able to reduce its demands on health care once it puts in place basic sanitation.


  • The quality of water and food is uncertain. Health awareness levels have to be increased, yet an attitude block exists.
  • But if you can make a break-through in India, the market size is phenomenal. 


  • Canada could be a key part of the solution if it could make equipment or supply equipment manufacturers.
  • India has an international presence in Pharma.


  • India is seeing the highest increase in annual salaries, because Indians are returning.


Dr. Yash Paul Bhatia
CEO, Astron Hospital and Healthcare Consultants; Chairman, Accreditation Committee, National Accreditation Board for Hospitals

“The cost of developing a drug will go down dramatically if it is “trialed” in India. The whole world is a new global village, with an exchange of knowledge driving across the globe and providing a learning environment.”

  • New drugs can be developed more quickly if they are trialed in India.  The time has come for India to be considered one of top medical resources of the world.


  • The system in India is maturing rapidly, with trained professionals who can provide first-class service  --  but we need tens of thousands of additional people, and we mush become part of the global research community.
  • The primary Healthcare system is the backbone of the system, and gets a major part of the funding from the public sector.  But the money goes mostly to those who could probably afford the care.  The allocation of public funds needs to be put more into primary care for those who need it.  Funding coordination is needed.


  • The Cancer Institute developed because our previous approach was not sustainable.  We had to build up a non-public sector solution.  It could be a not-for-profit solution, or P3.
  • “The Way Forward” for India could see it build on its strengths: clinical trials; technical manpower, including excellent IT support; and low cost of research. 



Ms Usha Bhasin
Senior Director and Head of Development Communication Division, Doordarshan TV

“Over 70% of the people in India get their information from TV, and our Health Club program is transforming the lives of 550-million people  --  the largest reach in the world.”


  • The Kalyani Club is India’s longest-running TV program.  It is participatory, interactive and collaborative.
  • We have to go deep into the hearts and minds of the people.  When you see the never-ending queues of patients, you realize that a TV campaign can help people begin their treatment process.


  • Local languages and dialect radio production is the key.  Minute-to-minute planning is done centrally, but productions are done in the field, so people can participate.  It is interactive in that it is done in many formats, with songs, dialogue, magazines etc.  Entertainment lessens fatigue of repetition.  It is interactive in that the doctors are brought to the village, and responses are recorded and broadcast.  Other methods include letters and phone-ins to specialists in the studio.
  • Wide-ranging social action has been stimulated.  For example, the recent floods saw the mobilization of the Clubs.  Members have created an eagerness to improve themselves.  It gets over the attitude that ‘the government will fix things’.



Dr. Amar P.S. Chahal
Velos Medical Informatics, California


“We want to see connected worlds with high quality and a mixed delivery system that includes public-private partnerships.”


  • Velos gives administrators a clinical research centre, and they are all connected.  Individual investigators can runt heir won trials, joined by a virtual connection.  Using the Internet, we get one common look-and-fell across the globe.
  • “Virtualization” can be exploited by the Commonwealth.  The U.S. is extremely fragmented.  The Canadian/Indian system allows people to be tracked; it is a marriage made in heaven.  We can mix and match systems across the Commonwealth.


  • This can be good for servicing large Pharma companies as well as individual doctors.
  • We have given physicians networks for running studies and protocols.  We have no restrictions on the licence. Give a Global desk-top to the investigator.






The Islamic world is growing fast in demographic terms, and Karachi offers the Commonwealth gateway to this important portion of the world community.  Pakistan’s economy is driving forward with double-digit growth, as more enterprises are sold to the Private Sector.  Pakistan’s Aga Khan University Hospital is one of the world’s most advanced institutions, and is run as a P3 organization.


Host: Ghalia Naseer,
Vice President, Si3


Moderator: Dr. Fowzia Siddiqui,
Neurophysiology and Epilepsy (Harvard) and National Institute of Child Care, Aga Khan University Hospital, Karachi


“Pakistan offers strengths in telemedicine, and in international collaboration on clinical trials.  We have used our digital expertise to collaborate online with our colleagues in Alberta, Canada.”

  • Pakistan has outreach programs in the media, similar to those in India.


  • We are fighting against a cultural mind-set that illnesses are caused by supernatural agencies, and we’re educating the people about proper healthcare prevention and treatment habits.
  • Advancement in technology, especially in neural imaging & diagnostics --  such as MRT-based procedures  --  have made previously inoperable conditions curable


  • We don’t have enough experts in neuro-diagnosis, though cardio expertise is available.
  • Patient education is now expected and building slowly.  Educated patients can help with medication compliance.


  • Countless implications come from the application of new technology in all fields.  New software makes MRI more powerful, and makes the brain patterns easier to diagnose.  One can see the motions of the muscles.
  • The new technology helps eliminates trial-and error, and lowers cost.


  • We are involved in Internet-based epilepsy teleconferences with Alberta, where experts present cases and compare techniques.
  • Lower costs make treatment more accessible.


Dr. Shoaib Sobani
CEO, Medical Informatics (Pvt Ltd)

“Sharing mutual strengths in technology can be a wonderful way to bridge East and West.  Outsourcing is one of the greatest miracles of the century in helping the masses.”

  • A lack of resources in the U.S., plus the higher cost, are moving work to the East.


  • We are able to provide a much more cost-effective environment. We are training people for expanded work, to turn out more resources for the increasing work.  It is an HR-intense type of work.  There is no lack of work; it is a matter of how much we can handle.
  • This will continue, as we see more work coming.  People are very pleased with our work, as it is done very fast.


  • We can harness technology through outsourcing to make the world more efficient.
  • Confidentiality is an important aspect of outsourcing, and Pakistan is following international guidelines.


  • There are ten medical universities in Pakistan, creating a pool of specialists.  Many ex=pats are also returning, bringing their knowledge back.
  • Pakistan is strong in medical imaging over the Internet, plus medical transcription and coding.


  • Pakistan has a number of medical boards that certify professionals to international standards.


Dr. Anwar Naqvi
Assistant Director, Sindh Institute of Urology & Transplantation (SIUT)

“Molecular diagnostics can be a growth field for Pakistan.  SIUT uses it for hepatitis and dialysis diagnosis, and screening programs.”

  • We need to develop a forum where all the people working in this area can centralize their findings and share knowledge. 
  • We need to use the global community to learn from each other. 


  • We have had 6-7 pilot projects, and now we need to get together both within and outside of Pakistan.  But because money is restricted, people are not cooperating.



Dr. Shariq Khoja
Assistant Professor, Dept of Community Health Sciences and Medical Director’s Office,  Aga Khan University Hospital

“The key to providing the best healthcare is to generate evidence for results, so we are relying on the most effective tools.”


  • The quality of rural health care is poor.  Rural doctors can’t update their education, and no system of accountability exists.  There is no information exchange, so we don’t know if we are looking at the right technologies to meet our needs.
  • It is time to link our primary health care sector to national hospitals and internationally; we need to explore these options.


  • We have a strength in EHR programs, and need to network our expertise more widely.
  • The changes in IT in this part of the world are astounding, and are changing the expectations of the people, especially in rural areas.  They expect better care.  They don’t know exactly how it will work, but they have access to TV information and are demanding quality care.


  • Healthcare providers are expected to provide more, and develop better programs. Tele-health is an answer. Tele-health can allow NGOs and villagers can take a better lead in their own development.
  • The greatest risk is that projects are not evidence-based; they need to know how things work and how to best move ahead.  For example, mobile phones are ubiquitous, but can they be used for tele-health?  A proper research component is needed.


  • Most of the tele-health networks rely on government funding.  For a broader implementation, there is a need for more involvement from the communities and companies.



Canadian Strengths

Healthcare Governance & Management

Ops planning & performance optimization

Health Infomatics

Health Services accreditation

Facilities Design & Construction
- project management, capital financing

Healthcare IT

  • communications standards
  • HER architectural solution
  • Project management
  • End-user change management

Education & Training


  • Tele-monitoring
  • Tele-triage
  • Doctor-by-phone
  • Robotics
  • Remote disease management

Breaking Down Silos

  • federated model, 53 states
  • shared governance & vision
  • collaboration for success
  • leveraged business models

Patient Portal





International Strengths

Satellite connectivity for Telemedicine in remote fields

Generation and distribution of patient records through Telemedicine

New technologies that would provide an instant messaging distribution network

RFID in healthcare (asset management / locator services for patients / resources)

Telemedicine for a patient's perspective - make it simple and easy

Role of wireless and mobility in Telemedicine

Legal liability issues - as in "do we need regionally licensed people to monitor patients in Ontario", for instance - or can this be done through a call center?


Please send comments or suggestions to:
Barry Gander, EVP, Commonwealth Advantage