Wednesday, December 19, 2007

A Closer View of E-health

When transforming the hospital experience through an enterprise e-health initiative—the greater the convenience a portal offers, the greater the benefits to the organization.

Dealing with a cocktail of changing market dynamics — health consumerism, retail health services, Google health, community benefit, "co-opetition" with physicians, patient safety, pay-for-performance and regulatory pressures — hospitals nationwide are beginning to formulate their strategic plan to tackle these market drivers while delivering on their mission. Savvy health care executives know that the experience their community, patients, physicians and employees have with the organization directly impacts their competitiveness and ultimate success.

Today's information-driven society is changing health care (for good or bad we'll save for another discussion) forever. Consumer expectations are more demanding of our institutions, where access to timely, relevant information is a clear market differentiator. Hospitals that embrace these changing dynamics will thrive in the coming years.

As hospitals begin addressing these new challenges, many are turning to e-health as their foundation for creating a positive, differentiated experience. It's certainly not the only answer, but key to engaging and interacting with an information-driven constituency.

Shifting processes to the Internet
By leveraging the power of the global network to fundamentally transform how they interact with their constituencies — consumers, patients, physicians and employees — and shifting business processes to the Internet, organizations can differentiate themselves in their local hospital market.

Smart, progressive organizations that invest in their constituents' overall experience with the organization will find that their investment will more than pay off in improved patient and physician satisfaction, more effective community advocacy, increased downstream revenue, better employee collaboration and clinical excellence. The investment also will strengthen their ties to consumers, patients and patients. In the past, for example, hospitals built office space within or near their hospital to forge relationships with physicians. Smart organizations will continue to use that tactic, but they also will use Web portals to supplement their physician recruitment and retention initiatives.

Hospitals currently are deploying Web portals that enable doctors to access and direct patient data remotely, sparing them a road trip to the hospital or forcing them to make clinical decisions without the benefit of all the information they need because the patient's paper record is unavailable. Given the choice of selecting a hospital that helps them practice more efficiently versus one that doesn't, physicians will go with the former.

Innovative hospitals also are delivering information online to help patients take better care of themselves and schedule appointments, making it more convenient for existing and prospective patients to interact with and access their services.

Like the banking and travel industries, the health care industry will shift most of its non-clinical business processes to the Internet because it will improve their efficiency. For instance, a hospital that enables patients to find answers to their questions online may find that it needs only 10 customer service representatives to staff its call center instead of 20 or 30 employees.

Portal progress
Given the extraordinary value that the Internet offers, consumers expect everyone with whom they interact to be online. This means that the first exposure a hospital's constituents have to a health care organization will be through its Web site. Thus, it's imperative that the organization strive to make the consumer's first experience a positive one; the organization may not get a second chance if that visitor has a poor experience.

The greater the convenience a portal offers, the greater the benefit to the organization. To help enterprises plan and benchmark progress in their e-health strategy, MEDSEEK developed a model, adapted to the hospital market from Gartner portal research, composed of the following five levels:
Level 1. The hospital or system offers static brochures.
Level 2. Through a Web site, the hospital extends some interactivity.
Level 3. The hospital starts using its site to drive changes in business processes. These include online pre-registration, appointment scheduling, payer transactions and administrative functions. The site also enables physicians to interact via secure messaging with consumers and lets consumers search for disease management and self-care activities.
Level 4. The organization creates new business opportunities and moves a majority of its current business functions online.
Level 5. The portal features advanced collaboration between the hospital and the community, with enhanced integration of capabilities among all hospital departments. Interactions between the hospital and the portal user feel uniquely personalized.

Hospital approaches vary
Hospitals and health care networks understand the need to move toward Level 5 and are actively doing so. These include Edward Hospital & Health Services. In 2006, the Naperville, Ill.-based health system implemented a portal, gearing it toward a non-traditional health care experience to reflect its brand positioning and community identity.

"Our corporate brand — 'For people who don't like hospitals' — is about connecting with our patients, physicians and visitors in ways that reduce the inconvenience and stress typically associated with hospitals. We challenge the status quo, and our market research confirms that the community feels we do things differently here," said Cheryl Eck, director of e-health at Edward Hospital.

"Compared to our past Web site experience, we are not only offering much more flexibility for the community to interact with the hospital, but also to meet people with similar interests and health concerns," Eck noted.

Like Edward Hospital, Munroe Regional Medical Center in Ocala, Fla. embraced the Internet as the cornerstone to marketing its new Bariatric Center of Excellence. Munroe established a partnership with a leading obesity informational Web site and provided detailed, relevant information about its expertise and experience through its consumer portal. Every marketing "call to action" channeled prospects to the hospital's Web site and a dedicated effort developed thought leadership that motivated prospects to take action.

As a result, monthly referrals to the Bariatric Center jumped 50 percent to 60 procedures per month. With each procedure contributing $4,000 in net operating income, the effort contributed approximately $960,000 to net profitability per annum. Hospital executives and physicians were ecstatic with the results — and even more surprised to learn they were pulling patients from as far away as Missouri and other non-traditional service areas.

Approximately a decade ago, Henry Ford Health System (HFHS) in Detroit launched its first enterprise Web site. Like most corporate Web sites of its time, it was a largely a static branding exercise. Since then, HFHS has regularly enhanced the content, functionality and usability of this site so that it is now offers rich patient and physician experience on a highly scalable portal platform. Introduced in 2000, Henry Ford's "MyHealth" patient portal has become an extension of its patient management and clinical systems environment. It began with 100 requests for appointments a month and grew to its current level of around 10,000 a month. MyHealth is now one of the largest patient portals in the country, with 200,000 patients enrolled.

In August 2006, HFHS launched "eVisits" — a Web-based system within the MyHealth portal for conducting virtual consultations with physicians. Plans are to extend eVisits to all primary care physicians by May 2008 and to execute a 3-year quality outcomes research project through the portal. Through and MyHealth, HFHS is achieving its corporate mission of being a leader in the e-health space. HFHS has an evolving portfolio of Web-based solutions that support and enhance its administrative and clinical workflows.

Some hospitals, such as East Jefferson General Hospital in Metairie, La., are seeking to secure a competitive advantage by implementing portals catering to provider needs. "The home page is certainly dynamic and inviting, but what's going on behind the scenes is perhaps even more powerful," said Don Chenoweth, formerly the hospital's CIO and now a senior vice president with Phoenix Health Systems, an IT outsourcing and consulting firm.

"In designing the Web site, we decided that we wanted to attract every qualified physician in the area to get privileges at East Jefferson," Chenoweth explained. "More providers equal more revenue and a greater range of services that we can provide to the community." One key aspect of this goal was loading the Web site with standard forms, such as patient-referral paperwork, that nurses in physician offices can download and securely e-mail to hospital departments.

"The site contains some 300 PDF forms, all indexed, and always the most current version. That's huge," Chenoweth said. "To get physicians working from the hospital, you have to give them the functionality and make things easy for them."

Not an option
In the increasingly competitive landscape of health care, organizations have no choice but to deploy and execute initiatives to improve care, promote patient safety, and enhance the overall experience that patients and physicians have with the organization. It's not a luxury, but an essential part of doing business in today's economy.

Enterprise e-health can play a vital role in helping hospitals achieve their mission and goals by enabling them to engage and interact more meaningfully and cost-effectively with patients, physicians, employees and consumers.

This article was written by Peter Kuhn and originally published by ADVANCE for Health Information Executives (Vol. 11 •Issue 12 • Page 33.) Peter Kuhn is the President of MEDSEEK, a provider of enterprise e-health solutions with 600-plus hospital clients across North America.

Wednesday, December 12, 2007

IT Executives Tout Technology To Transform U.S. Health Care

Representatives of three major IT firms said that consumer technologies could transform U.S. health care and its delivery, Government Health IT reports. The IT executives spoke at a National Cancer Institute-sponsored symposium, called "The Future: Consumer Health Information Technology."

Adam Bosworth, former director of Google Health, said failure to leverage IT has hampered the dissemination of medical research, stunted the growth of evidence-based medicine and focused doctors on sickness rather than keeping patients healthy.

He added that IT could have an immediate impact if the health care model was altered to give patients ownership of their medical data and allow researchers to more easily test new protocols.

Bill Crounse, Microsoft's worldwide health director, said that among advanced nations, the use of health IT in the U.S. ranks among the "worst of the worst."

The United Kingdom spends 10 times as much as the U.S. on health IT, according to Bradford Hesse, chief of the Health Communication and Informatics Research Branch at the National Cancer Institute.

Bern Shen, chief health care strategist at Intel Digital Health, predicted that technology-enabled health care could move from hospitals and medical centers to the home similar to how computing evolved from mainframes to personal computers.

All the panelists agreed that the Internet in recent years has empowered health care users (Pulley, Government Health IT, 12/11).

Friday, November 30, 2007

IT Could Cut Canada's Health Care Costs by About $7B Annually

November 13, 2007 | Creation of Canadian electronic health records (EHR) system could save billions in costs annually. President of Canada Health Infoway predicts huge reduction in need for diagnostic tests, fewer days in hospital.

Richard Alvarez, President of Canada Health Infoway, the country's planned health information sharing program -- said that more effective information management through the use of IT could reduce national health care costs by $6 billion to $7 billion Canadian, or about $6.24 billion to $7.29 billion, annually, Charlottetown Guardian reports.

The savings would come from reducing hospitalizations based on unnecessary drug interactions and a reduction in duplicate diagnostic tests, the Guardian reports.

The Canadian federal government plans to invest $1.6 billion Canadian, or about $1.66 billion, into Health Infoway and leverage another $1.6 billion Canadian, or about $1.66 billion, from provincial and territorial governments.

"This is a $10 billion (Canadian) project all told by the time it is completed and we expect that to happen over the next 10 years," Alvarez said.

Alvarez said the nationwide health IT program will "start with hospitals, then pharmacies and community clinics, and probably the last to come on board will be family doctors' offices" (Original article from Charlottetown Guardian, 11/13).

U.S. Poll: Most Adults Say EHR Benefits Outweigh Privacy Risks

Nearly two-thirds of U.S. adults believe that the benefits of electronic health records outweigh the privacy risks, according to a new Wall Street Journal Online/Harris Interactive poll, the Wall Street Journal reports.

Three-quarters of the survey's 2,153 respondents said they agree that patients would receive better care if doctors and researchers were able to share information more easily through electronic systems. Similarly, 63% said that using EHRs could reduce medical errors, and 55% said EHR sharing could reduce health care costs. However, about 25% of respondents said they are unsure if EHRs can provide these benefits.

The survey, which was conducted between Nov. 12 and 14, also found that about 25% of respondents said they currently use some form of EHR. Of those, 23% said the EHR is maintained by their physician, while 2% said they created and maintain their own personal health record on their computer. Fifty-six percent of respondents said they do not have an EHR, while 17% said they are unsure if they have an EHR.

The poll indicates that privacy concerns still remain among health care consumers. Half of those surveyed said EHRs make patient privacy more difficult to ensure, down from 61% in 2006. Twenty-five percent of those surveyed said EHRs would not make it more difficult to ensure patients' privacy, while another 25% said they were unsure.

November 29, 2007 from iHealthbeat

Thursday, November 29, 2007

eHealth Leaders | Mississauga Hospitals sharing patient records

Over the past years, several hospitals, and commercial vendors have announced personal health record projects. Few of these are widely deployed, and few are fully integrated into ambulatory or legacy hospital-based electronic record systems. The earliest adopters of personal health records have many lessons learned that can inform these new initiatives.

Today’s Health information technologies allow for comprehensive management of medical information and its secure exchange between health care consumers and providers. Widespread adoption of information technology is now commonly regarded as a pathway to improving health care and patient outcomes. Because of these technologies, people everywhere are increasingly benefiting from web-based information technology, and savvy web-users are finding the outdated information systems traditionally associated with delivering healthcare nonsensical.

Antiquated IT systems and processes combined with poor information flow are increasingly resulting in systemic under-use, and misuse of healthcare services. Add to this the pressure from the full spectrum of consumers, payers, and policy makers—and all eyes are on the sources of wasted resources, operational inefficiencies, and unsafe care.

The resulting call for a significant restructuring of our Canadian healthcare system is coming from the highest levels of government, demanding that the industry take advantage of the time, cost, and resource efficiencies promised by healthcare information technology– including electronic health records (EHR) and web-based information exchange. To put the fundamentals in place in Canada will conservatively cost between $10-billion and $12-billion, or about $300 for every Canadian citizen, according to a study by consulting firm Booz Allen Hamilton Inc. However, returns would be enormous, amounting to about $6-billion a year, in the form of improved quality of care, better safety and greater productivity.

Light at the end of the tunnel
Advances in health information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels.

Most would agree that achieving our Canadian goals requires fresh approaches to health system design, including amongst other things, extending the relationships between physicians and patients (and the tools to help patients be active participants in their own care.) This path improves public health one individual at a time, by building partnerships between health care consumers and providers across the country. However, in order to accomplish this, an honest discussion is required regarding the current standards for system design, evaluation, reimbursement, and usability.

Somehow, hospital leadership must enable their organizations to evolve while protecting the financial stability of their institution and the well-being of the patients. This includes providing the modern tools, training, and support to move forward and evolve their health delivery platform. This can be accomplished incrementally by growing the universal understanding of viable, effective technologies---and more importantly sharing our successes and failures as an industry.

There is no longer any choice about joining the eHealth revolution. It is becoming the rule, not the exception—and it is gaining momentum everywhere. A proven eHealth portal solution not only leverages, enhances, and augments existing IT investments, but also simultaneously evolves information delivery platforms towards a more open, vendor-neutral, patient-centric environment. Moreover, it is not meant to replace any legacy systems, rather reside “on top of” or in collaboration with any/all existing systems.

eHealth Leaders
The Credit Valley Hospital, William Olser Health Centre, and Halton Healthcare Services in Mississauga, Ontario today are sharing patient data through a Web-based electronic healthcare record (EHR) viewer, ensuring all three sites can securely share all patient records—regardless of legacy IT systems or vendors. This extended ability to share patient records promises to have a dramatic effect on improving patient safety and operational efficiency by reducing redundant treatments and medical errors.

The Credit Valley Hospital is the latest Canadian hospital to implement Agfa HealthCare’s IMPAX® Clinical Dashboard™ eHealth portal solution (powered by MEDSEEK®). Deployed in just over 90 days, the Dashboard™ extends vendor-neutral, enterprise-wide IT system interoperability between the three disparate hospitals. Today, users have the ability to easily access critical patient information from any PC, handheld, PDA, or tablet PC with Internet access. Data can be retrieved from any of the three facilities – whether it resides at William Osler Health Centre’s two sites (Etobicoke and Brampton) or the three sites of Halton Healthcare Services (Oakville, Milton, Georgetown). The portal solution has the ability to serve the nearly one million residents currently living in Mississauga, Brampton, Halton Hills, and Oakville.

“Due to the regional programs at The Credit Valley Hospital, it’s critical that all departments are able to share data amongst providers and partners, while providing a complete, up-to-date patient medical record,” said Dan Germain, vice president, CFO and CIO, The Credit Valley Hospital. “Agfa’s solution integrates all patient clinical data with the other healthcare facilities in the region, facilitating LHIN-wide, province-wide and even nation-wide data-sharing.”

Building on this first stage in a long-term eHealth portal strategy, The Credit Valley Hospital plans to eventually extend a patient portal with dynamic transactional functionality to its regional constituents, promising to have a dramatic effect on wait-times and patient safety, while significantly reducing costs and redundancies, such as test duplications due to missing or unavailable information.

“Connecting The Credit Valley Hospital, William Olser Health Centre, and Halton Healthcare Services is a great achievement for the Mississauga region. It is the first step to enhancing patient care, and creating a national EHR platform consistent with Canada Health InfoWay’s EHR Blueprint. Agfa’s proven federated portal model is a ‘win-win’ situation for hospitals – simple in premise, and deployed at a fraction of the time and cost of competitors, with immediate return on investment,” said Dieter Pagani, director of Agfa HealthCare’s enterprise solutions group. “These hospitals are truly eHealth leaders in Ontario, and have taken a quantum-leap towards eliminating the traditional barriers associated with sharing data.”

According to their website, Agfa HealthCare’s Enterprise eHealth solutions, including the IMPAX Clinical Dashboard, extend interoperability, process automation, and workflow connectivity for clinical and business functions across multi-departments and communities of users, both inside and outside the hospital. Agfa Enterprise’s eHealth solutions are also “customized for each hospital’s and user’s needs, and built on a complimentary core foundation that is web-based, scalable, extensible and focused on delivering fast return on investment. “

Adopting a federated (Horizontal) architecture
The federated (Horizontal) architecture demonstrated in the examples above, promises to fundamentally alter the healthcare landscape for every constituent, while simultaneously leveraging all legacy investment with quality and cost advantages not typically seen in healthcare.

To remain competitive, hospitals will soon have no real choice but to further transform their delivery platform. Organizations unable or unwilling to keep up are in danger of losing their competitive edge. The trick is to survive the transformation without multi-restarts, multi-level failures and multi-millions wasted. The potential to succeed however has never been clearer.

The good news is that a proven model is apparently available that delivers rapid, convenient access to any and all lifetime patient medical information from anywhere, regardless of when and where the care was delivered. Such a system is easily deployed, satisfies the need for immediate cost effectiveness (ROI), and dramatically increases productivity. Ultimately, such a platform creates a healthcare environment that provides both patients and providers with improved outcomes and higher satisfaction (while paving the foundation to a national EHR.)

Credit Valley Physicians REACH the Electronic Health Highway
Abstract:Mississauga, ON) A recent partnership between The Credit Valley Hospital (CVH), Halton Healthcare Services (HHS) and William Osler Health Centre (WOHC) means that patient safety, satisfaction and technology will be enhanced at these three organizations. William Osler Health Centre and Halton Healthcare Services recently welcomed The Credit Valley Hospital to the REACH portal. The collaboration between six physical hospital sites in Peel and Halton regions means all of their clinicians have instant access to patient health information stored electronically at any of the hospitals through a secure network called REACH -- Rapid Electronic Access to Clinical Health information.

The electronic health information portal allows authorized clinicians access to their patients' information through a secure web browser inside and outside of the hospital environment. This means lab and diagnostic test results, images, transcriptions and progress reports written at one hospital can be viewed immediately by a physician treating the patient at a subsequent visit at one of the other five facilities. Patients move between facilities for different diagnostic tests and procedures that are not necessarily performed at all facilities.
Credit Valley's patient information - health record, lab and diagnostic test results and images, transcriptions and progress reports can be easily viewed and updated with new information.

"Integrating our system with William Osler Health Centre and Halton Healthcare Services will reduce the duplication of tests and by doing so, reduce healthcare costs." says Dan Germain, Credit Valley vice president and e-Health lead for the Mississauga Halton Local Health Integration Network. "What's most important is the benefit to patients, especially in emergency situations when access to comprehensive patient information is critical."

Dr. Paul Philbrook, CVH chief of Family Medicine and current Chair of the Central West - Mississauga Halton Community Family Medicine / Public Health Network of Physicians. He and his colleagues championed the idea of allowing affiliated physicians the opportunity to access their patient records across all local hospital sites. He says "the REACH portal is a welcome advancement of access to patient information and integration locally. This will enhance patient care and safety."

"Shared access to the electronic health record is one of the most important collaborations between healthcare providers in a LHIN environment," according to Mississauga Halton LHIN CEO Bill MacLeod. Central West LHIN CEO, Mimi Lowi-Young concurs noting, "the REACH portal contains virtually all of the on-line data contained within the three hospitals and six sites for a population in excess of one million inhabitants."

The REACH web portal provides access to over 90,000 inpatient stays and 1,050,000 outpatient visits for the fiscal year ended March 31, 2007. Patient stays and visits from all three hospitals are consolidated into one web portal view for use by authorized clinicians.

The electronic health information is only a keystroke away after the clinician logs into the secure REACH network with his user identity and password. There the clinician will see a "dashboard" of patient information options to view the patient as "admitted, attending or referring" and then choosing the pertinent information fields.

Unlike traditional web portals, this dashboard is able to access clinical data from disparate systems through one unified view, enabling easy review of patients' records, lab results, cardiology images, diagnostic (PACS) images, transcriptions and progress reports. Because the ehealth record will show the patient's entire health history, important information such as medication allergies will be revealed even if the patient inadvertently forgets to mention the allergy at the time of a visit to one of the five other health facilities currently on the REACH network.

"That's especially important," says Germain, "as we move toward the integration of health information from across and between all providers within the province's Local Health Integration Networks (LHIN)." Germain is the e-Health Lead for the Mississauga Halton Local Health Integration Network.

William Osler Health Centre and Halton Healthcare Services initiated the electronic highway between their facilities more than a year ago when the Georgetown site moved from within William Osler's cluster of facilities to become part of Halton Healthcare Services. It was important for continuity of care that the patient information stored electronically on Osler's computer system became available to Halton Healthcare providers as well.

For More Information Contact:Dan Germain, CFO and CIO, The Credit Valley Hospital. Original story posted on Longwoods eLetter (December 4, 2007.)

Friday, November 16, 2007

Rebooting Canadian Healthcare using eHealth Portals

by Dan Germain, VP, Chief Financial and Information Officer, The Credit Valley Hospital as published in Canadian Healthcare Technology Magazine | Vol.12, No. 8 | Nov/Dec 2007.

According to recent statistics from the Canadian Institute for Health Information, as many as 24,000 Canadians die each year from adverse events like surgical errors, patients receiving the wrong medication, and hospital-acquired infections. As the practice of medicine today is inherently dependent upon healthcare technology, the accountability and sustainability of our healthcare system depends on the ability of healthcare practitioners to find ways of gaining efficiencies and increasing effectiveness in every aspect of their daily activities.

All levels of government across Canada are experiencing pressures today to cut healthcare delivery costs, while increasing the level patient safety and care. With this demand for managed care, technology is quickly evolving to meet new and more complex requirements, with significant benefits to medicine and healthcare overall. As Charles Darwin so aptly identified: “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” In the past, the acquisition of technology was viewed as the answer in and of itself. Decisions about technology and usage were typically driven by the question of how to improve the effectiveness of what hospitals were already doing. However, today’s information systems should be viewed as a vehicle to transform current hospital processes into what they could and should be doing.

At the same time, there is a demonstrated understanding for the need to update technology systems in order to extend a national electronic health record (EHR) in Canada. Healthcare stakeholders agree that technology is critical to facilitating necessary information-sharing across disciplines and venues. Driven by Canadian Health Infoway, this movement embraces the need to evolve healthcare informatics toward a more open, standards-based, patient-centric model that brings together all imperatives: clinical, administrative, financial, managerial, and human resources.

With the information-sharing capabilities provided today by a rapidly expanding number of new technologies, Canadian healthcare organizations can leverage a crucial tool-set to support informed medical decisions at the point of care. To this end, healthcare providers and vendors both agree that a consistent, standardized way to share information between healthcare stakeholders can overcome the barriers to attaining an EHR.

One destination; Many paths
When any healthcare organization sets out to extend a ‘cradle-to-the-grave’ EHR – readily accessible via the Internet and linked to clinical protocols and guidelines — most people picture only one scenario. In this scenario, a user enters a patient query into one computer system, and that query goes to one source where all the patient information has been stored in a single “centralized” database, or vertical architecture. The system searches one database and returns the queried information to the user. The problem with this scenario, is that information is not best accessed in this manner as the required patient data resides somewhere in a disparate system.

However, this is not the only option. Instead of duplicating that patient data in a new centralized system, the healthcare organization could leave the existing data in place. Then, when the user enters a query about a patient, the system logically gathers the appropriate patient data from wherever it is stored. This approach is called a “federated” database model and employs a horizontal architecture. Anyone who uses the Internet takes the delivery of content from multiple systems for granted. Almost every Web page is automatically assembled from multiple sources, and employs a federated database model. One simply clicks a button and data is retrieved from disparate databases and servers.

By definition, a federated database is a collection of data stored on multiple autonomous computing systems connected by a network that is intuitively presented to users as one integrated database. Additionally, using a federated portal approach allows bandwidth, hardware, administration, and other infrastructure costs to be distributed over time, keeping pace with the development and deployment of the facility. This can significantly reduce networking and system-interfacing costs and opens up a number of added functional possibilities by extending data to the organization’s value chain delivering clear, tangible benefits for your short and long term needs. Compared to a centralized portal, today’s federated architecture can achieve equivalent or better results, at a fraction of the cost and time.

Follow the leaders
The Credit Valley Hospital ( is a vibrant community hospital providing leadership in the delivery of primary, secondary, and tertiary health care services to the people of Mississauga, Ontario and the surrounding LHIN-6 region. Serving more than 5,400 visitors daily, The Credit Valley Hospital (CVH) has provided patients with access to cutting-edge medical research, programs and treatment since 1985, recently opened a new Ambulatory Care Wing that offers both systemic (chemotherapy) as well as radiation therapy as a regional Cancer Centre. By 2011, CVH will have completed another expansion adding 145 new inpatient beds to the community. . As such, it’s not surprisingly to imagine that the 2,700 staff and nearly 400 physicians generate and store a significant amount of disparate data.

CVH recently implemented a MEDSEEK Web solution which facilitates various healthcare organizations to support vendor-neutral and enterprise-wide system interoperability. Due to the regional programs at CVH, it was critical that all departments were able to share data amongst its providers. The goal was to be able to provide the same information sharing capabilities among various healthcare facilities, nation-wide, as well as reduce redundancies like test duplications due to missing or unavailable information. After implementing the federated portal, CVH saw an immediate improvement in both patient flow and medical care throughout the hospital. Today, patient-data is immediately available from any computer with Internet access, whether the disparate data actually resides at the two sites (Etobicoke and Brampton) of William Osler Health Centre ( or at the three sites (Oakville, Milton, Georgetown) of Halton Healthcare ( The population served by these portals exceeds one million people residing in Mississauga, Brampton, Halton Hills, and Oakville.

Agfa Healthcare’s Clinical Dashboard™ (powered by MEDSEEK) is the only proven federated portal model in the country that addressed CVH’s unique pain points in an efficient and cost-effective manner. The portal met the organizations rigorous selection criteria by offering superior software and services, clinical integration experience, and the ability to expand to future enterprise eHealth solutions. The combination of ease of use, real-time data access and enhanced clinical functionality enhances patient care and clinical excellence, while extending a virtual EHR. In addition, the solution was implemented in only 90 days – at a fraction of the cost for a centralized portal solution – which was vital.

Jeff Lamb, Executive Vice President of Sales at MEDSEEK confirms those sentiments: Enhanced integration functionality throughout a medical enterprise yields immediate operational efficiencies including reduced paperwork, improved communications, better workflow management, and stronger relationships among clinicians, patients and the community. For CVH specifically, having connectivity to William Osler and Halton Healthcare facilities, the portal provides a virtual medical record of all patient data across multiple LHINs. This not only improves physician efficiencies but also contributes to enhanced patient safety and care.

The federated portal solution evolves Canada’s healthcare delivery toward a more open, standards-based, patient-centric model, at a fraction of the time and cost of the centralized portal approach. CVH expects this solution to significantly reduce surgical and medication errors while making lives easier for staff. Additionally, as CVH expands its portal solution to support PDAs, the portal will become even more valuable as patients will be able to ask their physician specific questions and have results available immediately. Ultimately, however, the biggest winner is the Canadian patient and taxpayer.

There’s no argument about the need for a better way to access information, reduce medical errors and increase the quality of patient care, and that technology plays a critical role in making this happen. However, using technology the way it’s always been used is not the best approach for the kind of radical change needed. Through examples like CVH, it’s clear that interconnectivity and information-sharing between hospitals, LHINs, and even across provinces is a reality, and can significantly benefit from a new, “federated” way of thinking.

Wednesday, November 07, 2007

One Patient, One Record’ system ready for take-off in New Brunswick

The province of New Brunswick announced in September that it will invest $35.9 million over the next three years to establish a province-wide electronic health record system.

Canada Health Infoway will contribute $18.2 million to the project, with the remaining $17.7 million coming from the province.

The money will be used to put the essential building blocks in place for the ‘One Patient, One Record’ (OPOR) system. The core components, as announced, will consist of:

• an Interoperable Electronic Health Record. The Interoperable Electronic Health Record is considered a foundation piece for the One Patient One Record (OPOR) system. It will provide the infrastructure and functionality required to link, capture, store and view relevant patient information.

• a Client Registry. The Client Registry system is essentially the one-patient component of the OPOR system. With this system, each patient will have a unique provincial identifier that will tie together patient information from various clinical systems.

• a Provider Registry. The Provider Registry system will contain information on healthcare providers in the province.

• and a Provincial Diagnostic Imaging Repository. The Provincial Diagnostic Imaging Repository will consolidate a patient’s diagnostic imaging reports and images for procedures such as X-rays, CT scans, ultrasounds and MRIs, into a provincial repository.

The Department of Health has signed agreements with Initiate Systems Inc. for a Client Registry solution ($1.9 million over two years) and Orion Health for the Interoperable Electronic Health Record and Provider Registry systems ($4 million over three years).

A third contract awarded to xwave for system integration and maintenance services is worth $5.6 million over three years. The contract to create a diagnostic imaging repository has been awarded to Agfa Inc., in the amount of $9 million over two years.

Change management and training programs will also account for a large measure of the investment. And as Canada’s only officially bilingual province, New Brunswick is committed to developing solutions that work in both English and French.

“These systems are key building blocks along the journey to a complete electronic health record that will ultimately link all patient information from across the healthcare system – from hospitals, from your family doctor, from your local pharmacy and elsewhere,” said Mike Murphy, New Brunswick’s health minister.

In terms of architecture, the province doesn’t intend to pioneer new technologies or methodologies; instead, it wants to implement time-tested solutions that have a track record.

It’s hewing closely to Infoway’s standards and solutions, and it has watched carefully as other jurisdictions – Alberta and British Columbia, in particular – have gotten their own province-wide programs off the ground.

“We’re not the first to do this, but we’re going to catch up quickly to the other provinces,” said Gordon Gilman, assistant deputy minister for corporate services. “We’re a small province, which makes things easier in many ways. We think we can catch up to the others in two or three years.”

Many of New Brunswick’s hospitals are already sophisticated users of electronic health records. However, the OPOR system will provide a large measure of interoperability between the hospital systems, which are provided by many different vendors and often lack an ability to talk to one another.

The electronic health record from Orion will act as a kind of umbrella solution, accepting information from all systems and providing a viewer to healthcare providers across the province.

Carole Sharp, assistant director for projects, corporate services, at the New Brunswick government, said that a central repository will be established, housing patient data from disparate sources that will result in a comprehensive single record for each person in the province.

Healthcare organizations will keep ownership of their data, but some of it will be sent to the repository. “That will allow doctors and nurses across the province to use a viewer to see an integrated record,” she said. Sharp noted that not all data will be sent to the central repository, only that which doctors, nurses and other healthcare professionals consider to be essential.

For its part, xwave will provide system-integrator services, tying together the various solutions so that disparate systems mesh in the repository viewer.

“xwave has over 30 years experience in building healthcare systems,” said Paula Hatty, account executive with the company. “We’ve created client registries and we’ve played a key role in developing the patient wait time system in Ontario.”

Gary Folker, managing director of clinical management systems at xwave, commented that the company is well-versed in interoperability issues and Infoway’s blueprint for the design and construction of healthcare systems.

“We’re also experienced in project management, and we’re well-positioned to keep things on time and to deliver the best solution.”

Gilman commented that in addition to the four core projects, New Brunswick has also embarked on a Prescription Drug Monitoring Program, which will collect pharmaceutical prescription information at the point of dispensing – that is, at the province’s pharmacies.

The program will track dispensing of some six or seven drugs – such as oxycontin – that have been sources of concern in New Brunswick and other provinces. “We’re going to monitor selected drugs that appear to be problematic,” said Gilman. “We’ll likely share information with addiction services and police forces.”

The province has completed an RFP for the Prescription Drug Monitoring Program, and expects to select a vendor before the end of the year.

Moreover, New Brunswick will be implementing a full-scale pharmaceutical monitoring program, which will deliver information to health service providers at the point of care.

It will track the drug history of patients, provide physicians with drug interaction information and allergy warnings, in a bid to improve patient safety and the effectiveness of therapies.

Gilman noted that New Brunswick is currently in the planning stages of the project, and that planning is being conducted in conjunction with the province of Nova Scotia. “They’re developing the same kind of system, so why not do the planning together?,” Gilman commented.

He observed that it’s much easier to bring experts to the Maritimes for meetings once, rather than to request visits to different Atlantic provinces on separate occasions. While the One Patient One Record project is, for the most part, starting with large organizations such as hospitals, the long-range plan is to include all healthcare providers, such as doctors’ offices and clinics.

“The ultimate goal is to connect all sources of patient information,” said Gilman. “That includes public health, mental health services, doctors’ offices and others.” That will require additional investments in new systems. Indeed, the province estimates it will need to invest some $250 million in eHealth over the next 10 years.

By Jerry Zeidenberg, as published in Canadian Healthcare Technology Magazine, Nov.2007)

If everyone agrees, then why can’t I see my record?

In late May of this year, a large percentage of the health and medical informatics community in Canada met in Quebec City for the 2007 eHealth Conference. One regular feature of this annual conference is the Great Debate. This year the debate centered on the question “should patients have unfettered access to their health information?” I was very fortunate to be invited to be one of the debaters – on the pro side.

Before the debate even took place, the audience, of about 800 attendees, were asked whether they agreed or disagreed with the debate question. It was estimated at the time that approximately 90-95 percent of the delegates responded in favour – yes, patients should have access to their health information! And this was before the debate even started.

If so many people agree, then why can’t I see my record today? What is the hold-up? What is stopping us from moving ahead in a direction where there is overwhelming support – and this support is coming from healthcare professionals?

These are great questions that have been asked before, and we know that the answers are not that straight-forward. One major reason is seemingly banal, but overpowering: our delivery system has not accepted the idea of patient access to their own medical records.

I know, how can this be? Is this not in direct contradiction to what was stated in the preceding paragraphs? Well, yes and no.

In the abstract, yes it makes perfect sense that patients should have full access to all of their health information. In an era where consumers are becoming more involved in most every other aspects of their lives, it is reasonable to assume that the same consumers would want the same powers and freedom while managing their healthcare.

However, dealing with one patient at a time, considering the very nature of the contents of a PHR (patient or personal health record), addressing issues surrounding relevancy and privacy, the acceptance of full patient access is not as readily forthcoming. More specifically, the resistance is not, for the most part, technology-based but rather driven by a health system infrastructure and culture that cannot change… at least the way it is structured today. In other words, the system will not change until a number of issues are addressed. Below, I outline three.

First, the healthcare culture, certainly when it comes to dealing with patients, has been operating for generations with a paternalistic view. The consensus is that most patients cannot be trusted to manage their own care.

To some degree, this perspective is warranted. Further, some patients appear to even go out of their way to provide evidence in order to support this thinking. Smoking is one obvious case where there is widespread poor health management by patients.

However, it must be emphasized that this is not the case for all patients. There are many patients with chronic illness who truly want to be more actively involved and empowered. I know that, as a patient, I want to know all the facts no matter how tough they may be to deal with; sometimes understanding the situation does indeed make it easier to accept.

Second, the reimbursement structure within the Canadian healthcare system does not motivate doctors (certainly not general practitioners) to provide medical records access to their patients. While doctors most assuredly want their patients to be informed, so as to improve their health outcomes, in the end, there really is no reason to spend much time or effort, not to mention funds, to provide this access.

In fact, one could argue, that the system today actually promotes and reinforces an environment of face-to-face, one-to-one, healthcare information delivery (as opposed to electronic communication) by creating a simple payment formula – fee for service (i.e., see a patient, submit a claim).

If patients get access to information through electronic means, there will be fewer patient visits – no ifs, ands or buts! That is one of the major benefits of IT – fewer visits, lower costs overall. While it is true that the benefits of eHealth go well beyond the financial (i.e., patient safety, increased efficiencies), this is still an important consideration that needs to be addressed. In the end, what would motivate a clinician to earn less money?

Third, it is not yet an accepted fact that patients having access to their own health information improves their health outcomes. The research is still going on “in the labs”, but each month there is more and more evidence demonstrating that the empowered patient is healthier.

So, where does that leave us? It would appear that no matter how much IT development has taken place, or how much system interoperability is created or informatics training is done, I won’t get to see my record until:

1. The overall system appreciates the role of the patient as an individual and as a key stakeholder who must become active in healthcare system management.

2. The financial framework begins to motivate clinicians to support patients’ migration to feasible access of their own health information.

3. More research is funded to prove the hypothesis that informed patients are healthier.

By Kevin Leonard, PhD (as published in Canadian Healthcare Technology Magazine, Nov. 2007)

Kevin Leonard, MBA, PhD, CMA, is an Associate Professor, Faculty of Medicine, University of Toronto.

Thursday, September 27, 2007

BEYOND GOOD INTENTIONS: Accelerating the Electronic Health Record in Canada

Summary of Main Themes and Insights from a Policy Conference Held on June 11-13, 2006 in Montebello QC.

An Electronic Health Record (EHR) is a secure and private lifetime record of an individual’s key health history and care. It creates significant value, providing a longitudinal view of clinical information. The record is available electronically to authorized health care providers and the individual anywhere and anytime in the support of care. This record is designed to facilitate the sharing of data – across the continuum of care, across healthcare delivery organizations and across geographical areas.

Healthcare is the world’s most information intensive industry. Every day this industry produces massive volumes of data, which, properly used, can improve clinical practice and outcomes, guide planning and resource allocation, and enhance accountability. Electronic health information is fundamental to better health care. There will be no quantum leap forward in health care quality and efficiency without high quality, user-friendly health information compiled and delivered electronically.

The eHealth revolution is also the key to enhanced protection of privacy. Only in an electronic world is it possible to ensure that identifiable patient records are accessible to providers on a need-to-know basis. Access to all or parts of an EHR can be protected, and the identities of those who have looked at an EHR are known. Such protection is impossible with paper records, particularly in hospitals and other institutions.

Building a first-rate health information system may have as great an effect on 21st century health care as Medicare did in the 1960s and 1970s. But we have a long way to go to realize its potential. Canada’s health care system still manages information with old technologies and practices, some of which literally originated in the 19th century (94% of physician visits in Canada involve paper records; most prescriptions are handwritten). The production of information has grown exponentially, but the capacity to process, analyze, and deploy it to good effect has not kept pace. We have been, by international standards, cautious in our approach and limited in our ambition. As the title of the conference implies, our intentions are good. The challenge is moving beyond good intentions to pan-Canadian implementation.

The task of building an information network that patients, providers, managers, and policy-makers can use to improve decision-making at all levels is daunting. The health information agenda competes with innumerable other claims on resources. The payoff from investments in health information may be years away, while waiting lists are on the front page of today’s newspaper. Neither the public nor providers put better health information and tools high on top of their priority lists. Nor is implementation risk-free: Perfection is unattainable, cost estimates are notoriously unstable, and failures are inevitable.

On the surface then, there are many reasons to adopt a wait-and-see attitude and proceed incrementally. Yet the evidence is increasingly clear that the health care system is not as safe as we once thought it to be, is less efficient than we should expect and less evidence-based than should be acceptable. It is implausible to anticipate major improvements on these dimensions in the absence of electronic health information at various levels.

Most health information conferences are held by, and for, those who have already embraced the eHealth revolution and are immersed in the technical details. The challenge is not to convince the enthusiasts – the many champions and early adopters who have promoted the cause of an EHR as an essential part of contemporary practice. It is to enlist the support of senior-level decision-makers who set overall policy and hold the purse strings, and for whom the EHR is not necessarily a top-of mind issue. Canada Health Infoway and the Health Council of Canada recognized that securing an EHR for every Canadian depends on persuading top-level decision-makers of its importance and providing them with a realistic account of what it will take to put it in place.

These realities created a need for a conference pitched at just the right level for senior decision makers --- including Ministers and Deputy Ministers of Health and Finance, CEOs and VPs of regional health authorities and major organizations, and senior health information executives. These leaders, it was assumed, would want the unvarnished truth about what an EHR could accomplish the challenges of implementation and the experiences of various jurisdictions. They would want the opportunity to ask tough questions. Above all, they would want to know whether and how the EHR would help the recipients and providers of care.

Canada Health Infoway’s mandate is to provide a fully interoperable EHR for 50% of Canadians by 2009. The Health Council of Canada has called for 100% coverage by 2010. Newfoundland anticipates a fully functional, province-wide EHR by 2009. The Premier of Alberta has promised an EHR for every Albertan by 2008. Based on performance to date, these are enormously ambitious and, perhaps, unachievable goals. But the sense of urgency has been upgraded; in the words of one presenter, that urgency has to be spread beyond the converted to a wider constituency.

The sponsoring agencies spent a year planning the conference. The first hurdle was to attract the decision-makers; in this, the conference succeeded. The second was to assemble an international caliber program that would inspire the audience to stay through an intensive day and a half, and to engage with presenters and each other. They stayed, and they engaged. The third was to create a forum for frank and open dialogue. This we achieved by having all parties involved in all sessions, and promising to create a record of the proceedings that focused on substance and meaningful exchanges rather than on who said what in what context.

This summary is not a verbatim record of proceedings, but an analytic review of main themes and how the experiences and perspectives recounted at the conference apply to concrete issues in Canadian health care. The three questions uppermost in most decision-makers’ minds are:
o How does the EHR improve quality, efficiency, and overall patient care?
o What scale of investment is needed to make the EHR a reality for all Canadians?
o What are the implementation challenges, and what strategies have proven most successful?

A. Impact on Patient Care
A dominant theme throughout the conference was the impact of the EHR on patient care. Among the benefits cited were:
o Improved communication between providers, and between providers and patients. In Denmark and New Zealand in particular, the flow of information has grown exponentially.
o In New Zealand and England, the implementation of the EHR among various professions has created momentum for working in teams. The EHR has been a catalyst for accelerating this key element of health care innovation widely supported at the policy level throughout the world.
o Patient empowerment. In Denmark, people have access to their EHR. They can review information such as laboratory results and prescriptions to improve self-care – particularly important for chronic disease management. They can see which providers have viewed their records, which allows them to monitor privacy.
o Improved adherence to preventive measures. The literature suggests that electronically generated reminders for screening and follow-up increases adherence by 10% to 15%.
o Improved delivery of recommended care for various conditions. The Vanguard group in Boston delivered recommended care about 60% of the time in a baseline study. This improved to over 90% by combining team-based practice with the EHR.
o Nation-wide implementation of the EHR in the US, including e-prescribing with decision support tools built in, could reduce adverse drug events by two million annually, preventing 190,000 hospitalizations.
o According to the literature, introducing the EHR into the ICU reduces ICU mortality by 46% to 68%; complications by 44% to 50%; and overall hospital mortality by 30% to 33%.
o The use of e-prescribing in Denmark has reduced the medication problem rate from 33% to 14%, and laboratory systems have reduced tube labeling errors from 18% to 2%.
o Dr. Alan Ausford, an Edmonton physician and champion of the EHR, illustrated how on a typical day, e-health improves care and changes management of up to 20% of his patients in many ways, from ensuring medications are appropriate to respecting their end-of-life treatment choices.
o A major touted benefit of the EHR is chronic disease management (CDM). Some believe the benefits have already been demonstrated and there is consensus that the EHR is a necessary, but perhaps not sufficient, tool to improve CDM.
o There are some risks inherent in poorly adopted EHR technology. If decision support tools interrupt providers too frequently, the flow of care can be disrupted. Implementing systems too rapidly without attention to detail can cause unintended delays in the early stages of the transition.

B. Costs and Return on Investment
It is notoriously difficult to produce valid international comparisons of the amount of money invested in e-health in general, and the development of the EHR in particular. The IT infrastructure has many components, including fibre-optics and satellite networks, centralized and distributed servers, other hardware, software, upgrading and maintenance, technical support, etc. Some costs are fixed, others are variable. Both formal and informal training costs are difficult to estimate.

Many costs are shared, or borne by end users and not computed in jurisdiction totals. The most comprehensive and transparent data are likely those from England. The total investment since 2002 is an estimated $11.5 billion US; projected 10 year costs are $22.7 billion. Other major industries spend about 4% to 5% or more on information system development and support; the current estimated level in Canada is about 1.5%.

There is more published information available on the return on investment, albeit often in limited settings. Among the estimates shared by presenters were:
o The Booz Allen Hamilton study in Canada estimated savings of $6 billion annually with a fully developed EHR, which would cost about $1 billion a year for 10 years to implement.
o There are US estimates of $3 in benefits for every $1 spent on e-health in primary care.
o Nationwide these savings could translate to $44 billion annually.
o The Ontario Telehealth Network saved $5.2 million in travel grants alone in 2005-06, with 20 million kilometers of travel avoided.
o In Edmonton, the use of the telephone and fax for exchanging laboratory and other information plummeted as use of the computerized portals increased. In Denmark, the information systems have saved 50 minutes a day per family doctor, and reduced telephone contact between doctors and hospitals by 66%.
o Evaluations of telehealth home care and chronic disease management programs have shown among users of the services:
o 34% to 40% fewer emergency room visits
o Over 32% fewer hospitalizations and up to 60% fewer hospital days
o 47% reduction in long term care admissions.
o New Zealand anticipates fewer referrals to specialists because of better communications, with better capacity to control costs.

C. Implementation Stages and Strategies
Implementation is at varying stages around the world. At the national level, New Zealand and Denmark appear to have the greatest penetration, with 80% and more of family doctors using an EHR in their practices. The office-centred record is, again to varying degrees, linkable to external systems such as laboratory, imaging, and drugs. In Denmark, at least one county boasts 100% electronic access to hospital discharge letters; referrals to specialists; lab results; billings; prescribing; home care; and pharmacies.

No jurisdiction has achieved a fully automated, comprehensive EHR for its entire population. Hence, there are no definitively proven strategies for problem-free implementation. However, a number of insights emerged from the conference, including:
o The transition period is invariably difficult. The initial preferences of users (e.g., text-based rather than structured data entry) may change over time. Flexibility is therefore essential.
o Moving to an EHR in its fullest form is not just a technical innovation; it is a cultural transformation. Change management is vital, and failure to build in processes for effecting the transformation will reduce both uptake and impact. In the words of one presenter, all of us – providers and managers in particular – need to complete the transition from resistance to electronic information (historical position) to acceptance (current position) to addiction (cannot function without it).
o Implementation takes time, but can be accelerated once adoption and proven successes have reached a critical mass, or tipping point. At these stages, policy can drive faster change, for example, by making certain resources available only through electronic portals.
o The data elements are the core of any system, and spending time and resources on standardizing definitions and usage will go a long way toward creating information systems that yield valid and reliable measures of quality and performance.
o There will be far greater acceptance of provider-level IT if workflow is modified accordingly to gain improvements.
o Creating secure networks for communicating information in any form has proven to be hugely appealing to providers in almost every country. E-mail use grows very rapidly and is an effective vehicle for introducing providers to the world of electronic information.
o It is very important to structure contracts so that risks are appropriately shared, and purchasers do not pay for systems that do not work. The National Health Service in Britain (NHS) has taken a firm stance, and although it incurred delays because it changed a principal vendor, it did not take a huge financial hit.
o Leadership at all levels is crucial. Clinician leadership is essential but cannot be effective in isolation. There must be commitment from Boards and CEOs, the government, and the various sectors.
o Helping family doctors use the data generated by the EHR to analyze and improve their own practices will increase uptake. In Denmark, the counties fund data consultants who visit each practice one to two times each year to troubleshoot and help produce usable quality oriented information on treatment patterns, etc.
o If providers perceive “early wins” in the process, they will be more likely to invest their own money and agree to standards.
o Some strategies to enhance adoption among providers include clinical stories, peer-to-peer training, demonstration clinics, mentorship, and protected time.
o Giving patient’s access to their EHR is the wave of the future. Experience to date in Denmark and the US has been uniformly positive. If the patient is to be at the centre of the system, the patient has to be included in the information network and given the capacity to contribute to and use the EHR, and to communicate with the care team.

D. Lessons for Canada
Canada has five main priorities in health care:
1. Reduced wait times, not only in high profile areas such as hip and knee replacements and cancer care, but also in access to primary and specialty care as well as underserved areas such as mental health;
2. Primary health care, with interdisciplinary teams providing comprehensive, convenient care with an increased emphasis on health promotion and prevention;
3. Enhanced patient safety in the community and institutions;
4. Improved quality of care, particularly for people with chronic conditions; and
5. Improved efficiency and better value for money.

Both implicitly and explicitly, the conference addressed all of these priorities and provided evidence and observations on how the EHR could contribute to addressing them. The following table applies the themes more directly to the Canadian context – a consolidation of what we know (with varying degrees of certainty) about the potential of full-fledged implementation. As the EHR becomes richer, with more elements and connectivity, the potential impact grows. In some areas, there is already solid evidence that the benefits can be realized. In others, the logical case appears persuasive, but there is a need for stronger empirical evidence.

The EHR by itself cannot guarantee improved performance. The culture must also change, and all health system stakeholders, including users of services, must be inclined and trained to convert the potential of health information into concrete improvements in quality and efficiency. The benefits of the EHR grow over time as providers in particular exploit its potential to enhance communications, improve safety and quality by using decision support tools, expand the network of trusted colleagues, and generate valid performance measures and comparisons. In other words, however indifferent the initial reaction and despite the inevitable pain of the transition phase, over time the human and capital investment generates a high rate of return. No one ever goes back to the pre-EHR world once exposed.

View the original posting.

Wednesday, September 19, 2007

National Clinician eHealth Support Network | A peer-to-peer initiative launched to Share e-health Experiences

Physicians, nurses and pharmacists from across Canada who are considering using e-health will soon benefit from the expertise of a network of colleagues, experienced in e-health, who will provide mentorship and help navigate barriers.

Clinicians (physicians, nurses and pharmacists) from nine provinces came together on September 15 to launch the Clinician eHealth Support Network: A peer-to-peer initiative, a group of health care providers who will provide hands-on support to colleagues in their respective jurisdictions to help them address challenges and uncover the opportunities and efficiencies that are associated with e-health.

"With more and more clinicians recognizing there are benefits emerging as a result of the use of e-health, the Clinician eHealth Support Network will connect peers to help answer questions and share experiences from a perspective they can relate to," said Richard Alvarez, President and CEO of Canada Health Infoway, the federally funded, independent not-for-profit organization which invests with public sector partners to accelerate electronic health records across Canada. "I commend the clinicians whose e-health leadership will benefit their peers by transferring the knowledge they've acquired. These peer leaders are paving the way for increased use of e-health among clinicians throughout Canada."

Members of the Clinician eHealth Support Network: A peer-to-peer initiative will support their clinician colleagues who are contemplating the use of electronic health record solutions by providing:
• Individual demonstrations of electronic health records technology
• Ongoing support and mentoring
• Assistance in goal setting, prioritizing
• Support offered on-site and remotely.

More information on the National Clinician eHealth Support Network.

Original Post from Canada Health Infoway | September 19, 2007, Toronto

Thinking Systems Corporation Releases Plug-in for Philips iSite PACS

St. Petersburg, FL (November 20, 2006)  - For Immediate Release

Thinking Systems Corporation, recognized as one of the nation’s most innovative medical imaging software developers and for its broad product portfolio that supports the spectrum of modalities, today announced the company’s release of its new plug-in for Philips/Stentor’s iSite PACS.

This plug-in was independently developed utilizing iSite’s open API (Application Interface). The new offering will provide comprehensive 3rd party PACS solutions to iSite users for all modalities, including PET/SPECT-CT fusion, nuclear cardiology processing and quantification analysis, general nuclear medicine processing and review, PET cardiac analysis, PET brain analysis, 3D/MPR, calcium scoring, cardiac CTA, orthopedic templating, echocardiography, general ultrasound, cardiac catheterization and angiography. The integrated platform enables enterprise-wide access to these modalities with cutting edge clinical applications.

“What makes this plug-in different from a generic iSite plug-in is that instead of being a passive plug-in, Thinking Systems provides comprehensive solutions, from interfacing to modality scanners, data conversion, data verification, HIS/RIS validation, data distribution, to image fusion, image reconstruction and quantification analysis,” said Xiaoyi Wang, president and co-chairman, Thinking Systems Corporation.           

“Key to this plug-in is Thinking Systems’ ModalityBrokerTM, which bridges the modalities to iSite and powers Thinking Systems’ cutting edge clinical applications that can be invoked by both iSite Radiology and iSite Enterprise.”

THINKING SYSTEMS solutions are installed at over twenty sites across Canada and are proudly distributed by Alliance Distribution Network (ADN) Canada. For more information please contact your local ADN Canada sales consultant Toll-Free in Canada at 877-434-5311 or e-mail.  

Note: Any / all product names mentioned in this document may be trademarks or registered trademarks of their respective companies and are hereby acknowledged.

Monday, September 10, 2007

Province of Ontario | Local Health Integration Network (LHIN) Map

For more information about a LHIN, please choose the appropriate link below.
1. Erie St. Clair
2. South West
3. Waterloo Wellington
4. Hamilton Niagara Haldimand Brant
5. Central West
6. Mississauga Halton
7. Toronto Central
8. Central
9. Central East
10. South East
11. Champlain
12. North Simcoe Muskoka
13. North East
14. North West

For additional information please visit Ontario's Local Health Integration Network (LHIN) web site.

Cross-Canada eHealth race well underway | N.B. may be first to have linked medical records

FREDERICTON - By the end of 2009, all hospitals will be linked to 'one patient one record' system, with doctors and pharmacies joining later and positioning New Brunswick to be the first in the country to reconcile its medical records process.

Health Minister Mike Murphy announced on Friday that his department signed contracts for four major pieces of the province's e-health record system. He said the programs New Brunswick purchased are used successfully in other provinces. And while some other provinces are ahead in aspects of e-health, not one has all hospitals linked through a one patient one record system.

Don Sweete, the Atlantic Canada executive regional director for Canada Health Infoway, said New Brunswick's 2009 deadline is realistic. There are several provinces racing towards the 2009 target, he said, but it is difficult to say who will achieve the coveted system first.

"All provinces have made tremendous progress in moving forward with the interoperable electronic health programs," Sweete said. "New Brunswick's no different."

The system, which will be in place within three years, is expected to cost $36 million. The province will contribute $17.7 million, while Canada Health Infoway, a non-for-profit organization dedicated to develop health information systems, will pay the rest. Murphy said the contracts cover the basics of his e-health strategy, and will give hospitals across the province immediate access to any patient's extensive medical history.

"It is not the full e-health initiative that I have spoken at length of," Murphy said. "That is going to take several years more."

The long-term plan is to link all health care providers - from doctors' offices and pharmacies - to the hospital system. The entire strategy, yet to be thoroughly defined by the government, is expected to cost a quarter-billion dollars over the next 10 years. Murphy said the strategy is more efficient and will eventually save the system money.

"There will be far fewer clinical errors made by health care professionals with regard to drugs and allergies," he said.

Initiate Systems Inc. will provide a client registry for $1.9 million over two years. Orion Health signed a three-year agreement worth $4 million for a provider registry and the Interoperable Electronic Health Record system, which makes it possible to link, capture, store and view patient information in a central database. System integration and maintenance services costing $5.6 million over three years will be handled by xwave. Agfa Healthcare Inc. will receive $9 million over two years to create its Diagnostic Imaging Repository, used to consolidate images from X-rays and ultrasounds to MRIs and CT scans.

The independent Canada Health Infoway is funding all provinces and helping them to strategize and establish e-health systems. Sweete said the organization is 100 per cent behind the approach New Brunswick has taken.

Gary Folker, Xwave managing director of business development for health care, said the province has a well thought out and aggressive mandate.
"There's a lot of work that needs to be done to accomplish this," Folker said, adding that the province is well positioned to succeed.

Murphy said the province's "dead-last" standing in the country for an e-health strategy it has held up until a few months ago can be turned into an advantage.
"We have a road map now - we know where it's working and not working," he said. "By the end of 2009 we may very well be the first Canadian province to have all of our hospitals hooked up one patient one record."

But while New Brunswick is trying to the finish first in the country, Murphy said it will also establish the best privacy laws to accompany the system.
The government is working on those laws, and Murphy hopes they will be in place no later than spring.

"The legislation has to be developed hand-in-hand with these foundational pieces," Murphy said.

"If you don't have the proper mechanisms in place and the proper laws in place, then theoretically someone could push a button and see everything in your health care record. And that's never going to happen in New Brunswick."

MEGHAN CUMBY | FOR THE TELEGRAPH-JOURNAL | Published Saturday September 8th, 2007 | Appeared on page A1

Friday, September 07, 2007

New Brunswick | Tenders awarded for key components to e-health strategy

September 7, 2007, FREDERICTON (CNB) - Contracts have been signed for four major pieces in the province's e-health strategy, Health Minister Mike Murphy announced today. The systems are an Interoperable Electronic Health Record, a Client Registry, a Provider Registry and a Provincial Diagnostic Imaging Repository.

"These systems are key building blocks along the journey to a complete electronic health record that will ultimately link all patient information from across the health care system - from hospitals, from your family doctor, from your local pharmacy and elsewhere," Murphy said. "With this information, authorized health care providers will have access to individuals' health records to provide them with the care they need, when they need it."

"The progress we are celebrating today on the e-health front is a major step forward in the modernization of New Brunswick's health care system," said Richard Alvarez, president and CEO of Canada Health Infoway. "Information is central to quality health care. Today's announcement is about making that vital information quickly accessible to clinicians so they can get on with the job of caring for their patients."

The Interoperable Electronic Health Record is considered a foundational piece for the One Patient One Record (OPOR) system. It will provide the infrastructure and functionality required to link, capture, store and view relevant patient information.

The Client Registry system is essentially the one-patient component of the OPOR system. With this system, each patient will have a unique provincial identifier that will tie together patient information from various clinical systems.

The Provider Registry system will contain information on health care providers in the province.

The Provincial Diagnostic Imaging Repository will consolidate a patient's diagnostic imaging reports and images for procedures such as X-rays, CT scans, ultrasounds and MRIs, into a provincial repository. Once completed, the diagnostic imaging information will be retained for the life of a patient, will be available provincewide in a standardized format for the use of authorized clinicians, and will be stored in a centralized system with appropriate back-up.

Murphy said that the Department of Health has signed agreements with Initiate Systems Inc. for their Client Registry solution ($1.9 million over two years) and Orion Health for the Interoperable Electronic Health Record and Provider Registry systems ($4 million over three years). A third contract awarded to xwave for system integration and maintenance services is worth $5.6 million over three years. The contract to create a Diagnostic Imaging Repository has been awarded to Agfa Healthcare Inc., in the amount of $9 million over two years.

"What we are witnessing now is a new era unfolding for health care in our province," Murphy said. "The implementation of the OPOR system will revitalize our health system by improving access to vital clinical information which will aid in better clinical decision-making, and result in improved care for New Brunswickers."

The OPOR system will be implemented over a three-year period at a total cost of $35.9 million. New Brunswick has partnered with Canada Health Infoway, which is contributing $18.2 million to the project, with the remaining $17.7 million coming from the province. In total, it is estimated that New Brunswick needs to invest a quarter of a billion dollars over the next decade in electronic information and computer technology to improve the delivery and management of health care in the province.

About Canada Health Infoway (Infoway)
Canada Health Infoway is a federally funded, not-for-profit organization created to facilitate the development of electronic health information systems across the country. It works with provinces and territories to invest in electronic health projects, which support safer, more efficient health care delivery. These private and secure systems fully respect patient confidentiality, and provide health care professionals with immediate access to complete and accurate patient information, enabling better decisions about diagnosis and treatment. The result is a sustainable health care system offering improved quality, accessibility, productivity and cost savings.

View the original post by Canada Health InfoWay.

Thursday, September 06, 2007

Hamilton Health connecting around the world

Hamilton Health Sciences' orthopedic surgeon Dr. Justin deBeer was halfway around the world in Taipei, Taiwan but wanted to be able to keep tabs on his patients back in Canada. What in the past would have been a next to impossible proposition was actually done quickly and easily thanks to ClinicalConnect – a web-based portal for physicians that brings together data from three of the hospital’s most commonly used clinical software systems in an electronic health record format.

Hamilton Health Sciences worked with Medseek to design and implement the "ClinicalConnect" portal, but also engaged physicians from a variety of disciplines to offer input and drive the creation of the final product. Since Meditech is the most widely used information system at Hamilton Health Sciences, it was the first to be merged into the ClinicalConnect environment. ClinicalConnect offers a user-friendly view of the Meditech information, which ranges from admission information to lab results, and allows physicians to view the information simply by signing on to ClinicalConnect.

The next step involved adding views of patient records, stored in a system called Sovera. Currently the charts are scanned and merely displayed through ClinicalConnect, however, the portal does allow physicians to view the information and also indicates the number of chart deficiencies that need to be resolved. By the end of this year, physicians will be able to access Sovera directly through ClinicalConnect, which will enable them to interact with patient information in real time and directly resolve any chart deficiencies. In the future, physicians will have the option to e-edit and e-sign Meditech-based charts in the portal, and the updates will be passed back to the Meditech system. When this feature is available in the portal, it will also be available via PDAs.

Adding PACS to the system proved to be a tremendous enhancement, since it enables physicians to view X-rays from the same system that houses other clinical information about their patients. And by signing on to one system, physicians can access and interact with all of this information. They can also customize their views and pick and choose which information they want to see and when.

“Our ClinicalConnect portal gives physicians and other clinicians secure, real-time access to electronic patient records. Whether they are at the hospital or elsewhere, our physicians can quickly access all clinical reports, lab results, PACS images, pharmacy medication lists and much more,” said Dale Anderson, information and communications technology manager of projects and e-Health solutions at Hamilton Health Sciences.

As Hamilton Health Sciences expands the wireless network within its four sites, ClinicalConnect will become even more valuable. Already, some physicians have been piloting wireless applications of the system on PDAs in certain areas of the hospital. They’ve got access to all available patient information when they are seeing the patient. Patients are also able to ask questions about particular tests and procedures when they are with their doctor and do not have to wait for results to be retrieved from another computer or system.

The remote access to patient information through ClinicalConnect enables healthcare providers him to use remote Internet access to call up the patient’s information, including X-ray images and blood work, to check up on patients.

View a (Flash-based) overview of Hamilton Health Sciences "ClinicConnect” solution.

Originally published in Canadian Healthcare Technology, April 2007

Alberta’s Telestroke Program | Technology to improve stroke care to remote areas

Canadians living in rural and remote areas of Alberta will have better access to stroke diagnosis and treatment services through an investment of close to $1.1 million from Canada Health Infoway in the province-wide network that links stroke specialists and patients.

The Telestroke program will provide funding to participating health regions to expand the use of videoconferencing technology and other specialized equipment to enable direct medical consultation without the need to have the health professional and patient in the same place.

"Our Telestroke program has already demonstrated many examples of faster diagnosis and treatment, as well as improved outcomes for stroke patients in rural Alberta," said Dave Hancock, Minister of Health and Wellness. "This investment will build on our strong Telehealth network that bridges the physical distance between patients and specialist services."

The Telestroke program supports the Alberta Provincial Stroke Strategy, which is a collaborative partnership between government, regional health authorities and the Alberta Heart and Stroke Foundation to reduce the rate of strokes and improve acute treatment, rehabilitation care and outcomes for patients.

"Alberta's Telestroke program is one of many revolutionary initiatives that are modernizing patient care across Canada," said Richard Alvarez, President and CEO of Canada Health Infoway, a not-for-profit organization which invests with public sector partners to accelerate electronic health records across Canada. "This project will provide patients with quick access to stroke diagnosis and treatment closer to home, resulting in improved outcomes and increased efficiency."

Improving stroke care supports Premier Ed Stelmach's plan to improve Albertans' quality of life. Other priorities for the government are to: govern with integrity and transparency, manage growth pressures, build a stronger Alberta and provide safe and secure communities.

For more information, please visit Alberta's Telestroke Program website

Friday, August 31, 2007

100% Paperless Healthcare and the EHR

Whether your hospital is in Toronto or 100 Mile House, Cape Breton or Restigouche—one thing’s for sure. No matter how “wired” your healthcare facility is, you’ll still find lots of paper forms and processes. Paper is endemic in Canadian hospitals and clinics, even in those with fairly robust enterprise information systems. Paper is still used for staff scheduling, HR processes, reporting, transfers, discharges, and all kinds of other workflow-related tasks. There are a number of valid reason why this is.

Many Healthcare Informatics (CIS/HIS) vendors could extend an existing (standards-based) platform to support a fully-automated, (fully paperless) digitized-workflow---but often the perceived aggravation, delays, and high costs associated with modification (and integration) simply doesn’t justify the effort, or more importantly, the required ROI.

Specialized software can solve some of the smaller problems, but adding additional applications in an already crowded and complex arena of applications (that don’t talk to one another) can further compound issues. The biggest problem with any paper-based workflow is that it is static, and therefore cannot be shared beyond the physical limitations of the department.

This directly impacts our goal of a Canada-wide electronic health record (EHR), as existing patient information cannot readily be made available when and where it is needed. Clinicians and administrators need access to this patient data to enable the most informed decisions around patient care (regardless of geographic location) and to optimize operational performance. Most would agree that significant improvements are required in the area of clinical information acquisition, storage, retrieval, sharing, and especially presentation. An important first step is simply to get all existing data into the hands of clinicians and other health care professionals, as informed decisions can help save money and—more importantly, help save patient lives. Ultimately any (and all) patient health records, whether in an Acute Care, clinic, laboratory or General Practitioner (GP) setting, will need to be available digitally in a standardized and regulated format.