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.

Monday, August 27, 2007

What the @#$% is an Azyxxi?

There’s been a lot of scuttlebut around Microsoft's acquisition of a technology (and company) known as Azyxxi from MedStar Health in Washington, D.C. To clarify, Azyxxi (according to their website) is "a unified health enterprise platform that helps improve cross-organizational access and insight to clinical, administrative, and financial data."

What Pain Points Azyxxi will address in Healthcare IT?
o Improvements are needed in clinical information acquisition, storage, retrieval, sharing, and presentation—an important goal in any health care strategy.
o As we move toward the future, an important first step is simply to get all existing data into the hands of clinicians and other health care professionals.
o In today's hospital enterprise, already-existing information may not readily be available when and where it is needed.
o Best-of-breed systems lack integration, creating an environment in which information is hard to access and harder to aggregate for optimal value.
o Clinicians and administrators need access to data that enables the most informed decisions around patient care and operational performance.

The Microsoft Azyxxi solution
Health care professionals could benefit from the ability to quickly pull this data into a consolidated and customized view, to help enable informed decisions and peak performance. Azyxxi focuses on improving clinical information acquisition, storage, retrieval, sharing, and presentation. Azyxxi sits across most current best-of-breed systems in the hospital. It aggregates patient data so that clinicians can get an instant picture of the data in the hospital's systems. There's no waiting for archived information. Azyxxi aggregates relevant data for one, nearly instantaneous, view. Healthcare workers can maximize the value of information to help make the most informed decisions. Informed decisions can help save your business money and—most importantly—help save patient lives.

A hospital or health system typically has a configuration of best-of-breed IT systems that operate independently of each other. One system controls imaging, another manages emergency room systems, yet another addresses operating room management and the list goes on. Azyxxi sits across most current best-of-breed systems in the hospital and aggregates patient data so that clinicians can get an instant picture of the data in the hospital's systems at any time. The information is viewed and analyzed according to the individual needs of the user. Azyxxi customizes the results to help enable the most informed decisions and best patient care.

Existing IT State
You have hard-working, disparate information systems that cannot coordinate to feed you an integrated view of results. This results in frustrated clinicians and administrators who may not have access to all the data they need. Traditional enterprise-wide health IT systems have evolved from transactional systems. In these systems data is organized and locked in strings that have been created to resolve a specific transaction request. System requests are slowed down by the inability to search on individual data components, as the search request must move through all the transaction codes in the system to identify the relevant data pieces—an inefficient process in a business that may depend on timely decisions to help save patient lives.

Why Microsoft Azyxxi is different?
It's seemingly built on a federated-database model similar to MEDSEEK. Your clinicians and administrators need integrated and customized views and analysis of clinical, financial and administrative data. Azyxxi was developed as a solution to data storage and search issues, integrating across multiple best-of-breed health IT systems. It does not replace them.

Results for your health organization
Data is divided into multiple components, clearly identifiable within each transaction. This means the data can be re-organized into multiple buckets to answer a wide variety of queries. Search is fast because it does not require scrolling through thousands of transactions to source the data. Detailed queries and analysis become easier the more you use Azyxxi, as you increase your potential to leverage existing criteria sets and views.

Azyxxi's flexible federated architecture means that it can be customized any number of ways, depending on the user's needs. Much like competitor Medseek's "eConnect" platform, views and workflows can be optimized over time as workflows evolve, making it increasingly valuable the more that it is used. For more information on Microsofts Azyxxi solution, please visit:

Sunday, August 26, 2007

Age and culture as impediments to the adoption of healthcare IT

by Bill Crounse, MD | Worldwide Health Director, Microsoft

A friend sent me a link to an article written for by senior editor, Kate Evans-Corriea. Ms. Evans-Corriea's article entitled "Age Does Matter" reflects on what she says was a common theme at Gartner's recent Symposium ITxpo. That theme is perhaps best captured in a quote from Gartner analyst, Tom Bittman, who says, "It's not the technology; It's not the process that's holding us back. It's the culture".

As I read the article, I couldn't help but think about a conversation I had just had with a colleague who currently serves as a hospital CIO. He expressed to me his total frustration with hospital culture and healthcare providers. In fact, he is so frustrated that after ten years on the job he is looking for another position; this time likely in another industry.

His hospital had recently purchased a very advanced surgical management system that included anesthesia scheduling and work-flow automation. The anesthesiologists at first welcomed these new tools, although one of the docs had initially pushed back because he had designed his own solution that he thought was a lot better than the vendor solution selected by the hospital. Even so, after a few weeks using the new system, several of the older and most influential members of the anesthesia group simply proclaimed that they didn’t like what the hospital had purchased and would be going back to using their old paper processes. And, as my colleague noted, "that was that".

A similar scenario had recently played out in the radiology department. The mammography unit was asked to start using the hospital's digital PACS system. They prepared the docs for the fact that their productivity could initially fall by as much as 30 percent until they got used to the new tools and work-flow. The docs agreed to give it a try, but as soon as their productivity actually did take a nose-dive, they rebelled and refused to use the new system. I know what you may be thinking. Screw the doctors! Tell them they have no choice but to use the new systems. As a doctor and a former hospital VP/CIO and CMIO, I know it's not that easy. Those doctors are the life blood of the hospital. It took years to recruit the physicians who run the mammography unit. And the anesthesiologists? They along with their powerful surgeon allies are responsible for most of the hospital’s profit margin.

The CIO also told me about his hospital's struggle to implement an electronic charting system in nursing. He said the VP of Nursing gives the initiative good lip service, but her first in command is a 50 year old nurse who has never worked anywhere else, and there’s a lot of passive-aggressive behavior going on in the rank and file. Since the nurses are all employees, you might think administrators could just lay down the law and mandate the use of the nursing documentation system. But you would be na├»ve to think that. The average age of nurses working at the hospital, especially as managers and unit leads, is 50-plus. There’s a huge nursing shortage with lots of vacancies in posted positions. They have a powerful union. It’s hard to tell them what to do.

I share this because it is so typical of the culture in healthcare, and not only here in America. It speaks volumes on the issue that Gartner is drawing to our attention; it isn’t so much about the technology as it is about the culture, and the need for more carefully orchestrated change management. Of course some of these hassles will resolve as the “dinosaurs” retire. But based on what Gartner is saying the age and culture issue won't go away. Instead of “why must I use this computer instead of my paper” the argument will become “why must I use this (fill in the blank) instead of my computer"?

Posted by Bill Crounse, MD | Worldwide Health Director, Microsoft

Wednesday, August 22, 2007

Carrots or sticks | Making a case for heightened government involvement in EHR

As confirmed in Frost & Sullivan's 2005 Analysis of the Canadian Healthcare IT Markets, Canada has a national health service which provides hospital care and other medical services to the entire population and is publicly financed. The health service is highly decentralised, with the management and delivery of health services being the responsibility of the provincial and territorial governments, which have jurisdiction over 97% of the nation’s hospitals.

The provinces and territories operate health insurance plans which are obliged to conform to the principles of the Canada Health Act and are collectively known as Medicare. The government responsibilities for healthcare delivery include:

• Setting national standards for health
• Oversee the implementation of the ‘Canada Health Act’
• Provide funding to Provinces
• Promote health protection, disease prevention & health promotion

Provincial/ Territorial
• Managing and delivering health services
• Planning, financing and evaluating the provision of hospital care,
physician and healthcare services

In order to promote healthcare IT, some provinces have set in motion various plans to reform the healthcare IT infrastructure at the primary care level. Ontario’s Primary Care IT Strategy is being implemented to assist primary care physicians with the adoption and implementation of IT in their practices. This involves a dual approach to the procurement of Clinical Management Systems (CMS)—Application Service Provider (ASP) Solutions and Local Solutions.

Over 95% of Canadian Hospitals are Public, Non-profit Entities. The provincial and federal government hospitals account for over 95% of all beds. Private hospitals account for only 4% of all beds, the vast majority of which are in Quebec. Public hospitals operate as not-for-profit organisations with their own governing boards, which have control over day-to-day decisions and allocations of resources. However, boards must stay within annual operating budgets negotiated with their local healthcare commission on an annual basis. All hospitals in Yukon are federally managed.

There has been an increase in Outpatient Care in Acute Hospitals and Hospital Day Surgery Programmes also. Increasingly, fewer patients are hospitalised overnight and those that are admitted to in-patient facilities are generally admitted for shorter periods of time. There is also increasing pressure to reform from an institutional to a community-based model.

The problem is the number of Canadian Hospitals still acting alone (as IT-fifetoms) in their continued procurement of CIS/HIS/IT platforms that are not scalable or standards-based. This is most relevant related to our quest for a national EHR.

To compound issues, significant differences exist across Canadian Provinces on the local, regional and national level in terms of per capita spending on (and inputs to) healthcare systems. However, quality, accessibility, and sustainability of care are also limited because best practices are not freely shared. What results are small, politically charged, competing fifetoms. Action at a national/ federal level would be indispensable, as the lack of accountability ensures higher integration costs. To wit, Canadian Healthcare delivery organizations require much stronger, mandated guidelines on eHealth interoperability. It is difficult and highly inefficient to continue with Hospital Networks (and their numerous stakeholders) working in isolation to improve their healthcare systems---AS eventually all entities will need to be integrated to achieve a national EHR.

The current state of most Clinical Information Systems' (CIS) across Canada, as an example, is draconian in comparison to what is available using today's technologies. Especially from an operational efficiencies standpoint. In fairness, a.>the primary/ acute care HIS/CIS platform across the country is 10-15 years old on average, and b.> Canada Health Infoway's Funding Timeline has replacement funding for primary CIS (tentatively) forthcoming Q3-2009 (and procurement of new systems will likely be delayed until this time, if only to capitalize on this Government compensation.)

Canada Health Infoway, has successfully promoted eHealth standards and guidelines, however, using incentives to progress interjurisdictional cooperation between neighbouring healthcare providers---is akin to herding cats. Simply moderating the procurement process hasn't had the effect it might have.

The difference between the "carrot" (subsidizing standardized IT procurement,)and the "stick" (mandating connectivity standards) would hopefully ensure Vendors either adhered to a standardized level of connectivity, or they would not be allowed to sell in Canada. This act alone could eliminate 50% of the total cost (and at least 40% of the time)to our achieving a national EHR.

The importance of interjurisdictional cooperation in Canadian healthcare cannot be understated in terms of cost to the taxpayer. In order to cut the red tape related to the use of shared health services, it is imperative that an electronic systems standard be established of patient identification. Secondarily, there must be heightened support to introduce mandatory eHealth and telemedicine services (telemedicine, teleconsultation, laboratory services, shared medical imagery (teleradiology),eBilling, ePharmacy, federated eHealth Portals, and sharing of standardized protocols.)

To a growing extent, standardized eHealth contributes to fairer health services across geographical and social boundaries, as well as helping to reduce (or at least limit) the growing costs of the healthcare. Services would not create extra financial burden, as it would depend on voluntary basis of services provider and would present another alternative to the existing system. eHealth by definition requires the sharing of patient identifiable data when and where necessary. When the processing of such personal data relates to a person's health, processing is particularly sensitive and therefore requires special protection. In the eHealth context, the processing of personal data in health systems across multiple jurisdictions varies significantly due to their specifics and the diverse legacy platforms currently in place. It is therefore important to consider whether the Canadian government (Health Canada) should mandate national guidelines (rather than only incentivizing decisions through Canada Health Infoway.) Manadated cooperation between regional and Provincial stakeholders provides, as an example, a framework for greater legal certainty and accoutability of eHealth products and vendors (and services liability within the context of existing product liability legislation. )

Although interoperability is not a goal in itself, since Canadian healthcare delivery organizations (at all levels) are now directing their health policies to subscribe to a new paradigm of common visions, and common values, a definitive focus are now required for eHealth interoperability. In the context of Canada’s (taxpayer-funded) public healthcare system, Canada Health Infoway’s ‘incentivized’ funding methodology has only managed to add a layer of broad standardization, which clearly doesn’t go far enough. The wasteful management and misaligned allocation of funds, while intended to evolve Canada to a national EHR, unfortunately will require strong Federal guidelines and enforcement to protect taxpayer interests. The only thing more blatent than the misappropriation of healthcare dollars in Canada, is the lack of any ROI accountability.

Without a mandated, standardized (versus incentivized) interoperability framework, our Canadian healthcare system is so rife with misappropriation of healthcare funds (by people of relatively high social or economic status) to make money for themselves or to further the aims of their organization---taxpayers will pay twice (2:1) as much to achieve our objectives of a National EHR. If history has proven anything, it’s that without a formal audit process or investigative arm regulating Canadian taxpayer dollars invested in Healthcare---only the illusion of objectivity is provided. Behind the scenes, the spoils are being pilfered so flagrantly it would make Imelda Marcos blush. No Federal watch-dog, no accountability.

Monday, August 20, 2007

The Healthcare Enterprise | Making a case for eHealth Investment

Many healthcare executives look at technology as a cost of doing business. However, investment in strategically chosen technology can enhance revenue while lowering operational costs. Labour, as an example, is the most expensive and valuable resource in a hospital. Therefore, any measurable improvement in the use and efficiency of labour can improve a hospital’s bottom line considerably.

Whether business office staff processing claims information, nurses performing patient assessments, or physicians diagnosing and treating patients, with the current disarray of disparate information databases (and wireless and remote technologies;) users are constantly striving to gather the information required in order to perform and optimize their job function. Strategic implementation of new Technology can significantly improve efficiency in:
• Clinical Operations (ex: Nursing, Physicians and ER)
• Financial Operations (ex: Contract Management, Administration and Registration and Accounts Payables and Material Management)
• IT Operations (ex: Training, Help desk, Network, etc.)

1. Nursing:
This is the primary area for patient care improvement and enhanced patient revenue. All aspects of technology must perform smoothly – and be transparent to the end user – or nursing will not use it for patient care. When this area is not supported by IT effectively, nurses and other clinicians will revert to paper as the only reliable way to record information regarding patient interventions and notes on the patient’s status. When this happens it significantly lengthens the process, potentially up to two hours per patient per shift. Furthermore it results in duplicate processes and redundant data capture – so much so the caregiver spends too much time managing the clerical tasks, and the patient care process is inhibited. Accurate and timely charging for patient procedures, tests and supplies do not always occur resulting in lost revenue for the hospital. The key technology elements that must all be operating effectively are:
• Robust Clinical Application System including Case Management and Scheduling
• System reliability (99.9% availability)
• System performance (instant response time)
• Easy to use and accessible system devices (e.g., wireless, PDA’s, tablets, printers, etc.)

2. Physicians:
Physicians’ have two main concerns
• time to see patients and
• the timely availability of accurate patient information.

Therefore, creating a way for physicians – no matter where they may be – to continuously receive updated information on their patients addresses both of their primary concerns. Providing this technology is a key contributor to recruiting and retaining satisfied physicians, as well as providing high-quality patient care. The key technology elements that must all be operating effectively are:
• Physician-oriented presentation of patient results information
• Easy-to-Use computerized physician order entry system
• Online access to patient’s diagnostic x-ray and ultrasound information (PACS)
• System reliability
• System performance
• Support for multiple input and output devices (e.g., wireless, PDA’s, tablets, printers, etc.) from in-hospital as well as remote locations
• Integration to their office practice management and EMR systems

3. EMR:
The ultimate goal of most healthcare organizations is a paperless electronic medical record to improve the efficiency and effectiveness of the enterprise workflow process and enhance the revenue generation process. Healthcare management understands, at a conceptual level, that having an automated digital hospital would improve the entire patient care workflow process, and thus, patient satisfaction and staff productivity. The successful automation of previously paper-based processes requires a robust IT infrastructure, and careful planning among all the affected stakeholders.

4. PACS:
A PACS system not only has proven to produce positive bottom-line results, but also is often considered a necessary precursor to the EMR. A wise investment that often pays for itself within 3-5 years, it allows the “reading” of images from all modalities from a workstation that is either in the hospital, or in a remote office. The biggest benefit however is the ability to transmit and view the image to wherever it is needed, and removes all of the barriers to access that exist with traditional film. To achieve all the available benefits, the network bandwidth must be in place to support very large image files, and again, careful planning among all the affected stakeholders is critical to a successful implementation.

5. ER:
Increasingly hospitals are realizing that their ER is a major entry point for patients and should not be overlooked as a revenue source. Providing comprehensive computerized systems that are optimized for the ER’s workflow are mandatory if the hospital desires to realize the potential benefits available. The key technology elements that must all be operating effectively are:
• Emergency Room Patient Tracking System
• System reliability
• System performance
• Easy to access and use input and output devices (e.g., wireless, PDA’s, tablets, printers, etc.)
• Seamless Integration to a hospital’s Master Patient Index to retrieve patient information and provide billing data
• Integration with the EMR to maintain a comprehensive clinical record.

6. Laboratory:
Laboratory orders are processed promptly because of the need of the patient. However, in a paper-based environment, charges can be overlooked because of the multiple steps required to process a patient chart and the extra work involved in capturing charges. A comprehensive Laboratory Information System (LIS) that is fully integrated with the HIS will alleviate this problem, as well as improve the overall efficiency and effectiveness of the Laboratory staff. The key technology elements that must all be operating effectively are:
• Robust Laboratory Information System including integration with all laboratory instruments
• Integration with hospital’s EMR and/or order entry system
• Integration with any external reference laboratory used to enable a complete view of patient’s lab results
• System reliability
• System performance

The key to strategic gains in the Financial/Administrative area is to invest in the newest technology that enables business processes to function more efficiently, and ensures the most accurate billing practices for the organization. Even small procedural changes can create more effective billing and substantially improve the bottom line. Likewise, the implementation of comprehensive scheduling systems can improve turnaround times and help ensure the optimal use of expensive fixed assets throughout the hospital. Other areas suitable for increased investment are described below.

1. Contract Management:
Many hospital billing operations submit claims based upon the personal knowledge of staff billers. Billers often overlook minute and incremental charge optimization opportunities simply because of the volume of bills and claims that must be generated and submitted. The computerization of code optimization and the underpayment analysis of payer reimbursement will have an ongoing and profound impact on a hospital’s bottom line. Whereas these billers are very knowledgeable, their true value is in the management and adjudication of claims denials. The loss of revenue per claim may be small, yet the total volume of claims equates to a substantial loss. Computerization of the claims submission and denial process quickly pays for itself and can immediately increase the hospital’s cash. The key technology elements that must all be operating seamlessly:
• Contract Management Application System
• System reliability (minimal downtime)
• System performance (immediate response time)
• Adequate storage (retrieve discharged patient’s complete information)
• Electronic interface to primary payors
• Integration with hospital’s patient accounting system

Hospitals will vary on the impact of automating these areas of operation. The cumulative effect can be quite surprising. As PriceWaterhouseCoopers and HIMSS analytics reported in their study of cardiac care in 36 hospitals in March 2005, there was an “85% reduction in medical errors and a 65% reduction in inappropriate denials from payors…” in the hospitals studied.

2. Admissions and registration:
This area requires system speed and a reduction in the complexity of screen layouts. There is typically a lot of turnover in this area. Yet Admissions is the first location for revenue enhancement and the primary source of errors and inaccurate data for billers to deal with claims denials. The key technology elements that must all be operating effectively are:
• Comprehensive admission-discharge-transfer system
• Integration with payors to confirm patient coverage
• Integration with patient scheduling system
• System reliability (no downtime)
• System performance (immediate response time)
• Easy to access and use input and output devices

3. Accounts Payable/Materials Management:
The goal of automating the replenishment of the hospital supplies (using just-in-time processes), while taking maximum advantage of the hospital’s contracts, in an effective and efficient process, has a significant impact on the hospital’s profitability. Accurate, ongoing, and continuous inventory, minimal loss of stock, and maximum chargeability are the key components. Taking advantage of discounts by being able to pay vendor’s invoices within the discount can benefit the hospital’s bottom line. The key technology elements that must all be operating
effectively are:
• Comprehensive Accounts Payable System
• Comprehensive Materials Management System
• Integration between Accounts Payable and Materials Management
• System performance (immediate response time)
• Easy to access and use
• Adequate storage

4. Barcoding:
It has been shown that barcoding data at the bedside, from the pharmacy, and through materials management reduces medical errors tremendously, as well as, improves the automation of input of data into the patient chart. It holds the ability to speed and integrate the purchasing, distribution, administration, charting, and billing for pharmaceutical and other supplies. An effective barcoding strategy not only provides more accurate and timely information, but also saves time and improves the work lives of clinicians, managers, and staffers by making things run more smoothly and simply. To realize the full benefits of a barcoding implementation, attention must be paid to the workflow changes necessary to get maximum returns. When combined with supply chain automation, the entire process of acquiring the correct supplies, packaged and correctly prepared for patient delivery, are made available to the care-giver when needed – and the documentation for billing, inventory reordering, and the patient chart, is captured as a by-product of the patient care process.

The common thread in improving IT Operations in healthcare is to achieve maximum leverage of the staff resources to implement and support an ever-increasing array of emerging hardware and applications. Through continual centralization of the environment, more ROI is squeezed out of fixed assets and the staff becomes more efficient by giving them the tools to do their job more effectively. Whether it’s server administration, network management, application support, or user provisioning, the innovative investment in the IT infrastructure can improve service levels and ensure optimum utilization of expensive staff resources. Practical examples include:

1. Training:
As the general workflow process is automated, the need for personnel to understand how to use the tools at hand becomes paramount. Training is needed in two distinct areas; the IT staff and the users:
• The IT staff must be trained to understand how to use the servers, switches, software and network to maximize the users’ capabilities. Each IT staff member has a “multiplier effect” upon the user community’s effectiveness. Most should therefore be certified in their area of expertise.
• The automation process is for the benefit of the user and the organization. Therefore, the user must be trained in the optimal usage of the system and the tasks they perform. This means that an ongoing training program should be implemented to ensure employees are accomplished on the system(s) they use and fully understand the implication of their actions when using automated systems to perform their jobs.

2. Help Desk/ Service Level Management:
IT departments may have a phone number for users to call in case of need, however most facilities do not have an automated structured process to monitor
technology, diagnose problems, administer support, and measure performance by automated reporting. It is imperative to be able to understand the source of help desk calls in order to properly plan for the improvements needed to improve customer service.

3. Network:
The network is the nervous system of an organization’s information flow. There are a number of components of a network that must be able to transport data at a guaranteed minimum volume.

4. Switches, bridges, and routers:
The switches, bridges and routers are the devices that route data from one part of the network to another. Considering that a fully automated healthcare workflow process will have a minimum of 25 major applications that will route data for 30 departments, the switches need to be configured to handle the volume of traffic anticipated.

5. Backplane:
A backplane acts as a “traffic cop” for the data that comes from all of the different switches within the network. Therefore, it must handle the accumulated burstable volume of the network. For a fully integrated and automated workflow process, a backplane may need to burst to 4 Gigabytes/sec. of volume.

6. Network Management Software:
Many of the major network vendors have the ability to continuously “ping” the network through a technology called SNMP. This allows IT to proactively monitor the “health” status of switches, PCs and servers. The same software now also keeps an inventory of hardware and software, as well as version control, so that the network can now distribute patches, updates, and fixes to the users quickly. Finally, most of these network vendors now have integrated help desk and service level management automation into their support process. Therefore, IT can now receive a request for assistance, log it, prioritize it, and escalate it automatically. They can then diagnose and fix (either remotely or by the system dispatching a person) user’s hardware and software. Finally, the IT tools can then print out a report that shows the amount of time systems were up for the month, how many service calls were responded to by prioritized need, who was serviced and when, as well as the outcome of that service call.

7. Wireless and Remote Capabilities:
Wireless PDAs, tablet PCs, smartphones and laptops are transforming the way information is gathered and processed. Systems can now be structured so that physicians may plug their device into the hospital system and be uploaded with what happened to their patients overnight. Additionally, caregivers and hospital staff can now work from home.

8. VoIP:
Currently the dual networks and dual support staffs to run a network and a PBX system are costly. Time and again, the return on investment (ROI) to move the phone system onto the network, department by department over a period of time, has shown to be a good investment. There is no charge for moves, adds and changes (MACs) now, the administration of two systems can be handled internally by one group, and future cabling costs are minimized.

9. Cabling:
Cabling is an infrastructure issue and often its importance is overlooked. But, it is foundation of the information highway for a hospital. In addition, as hospitals are adding increasing computerization, cabling installed two years ago may soon be outdated. Cabling should be an integral part of a hospital’s computer plan.

10. Standardization:
Standardization means that the technical components of servers, switches, and PCs should have the same memory, cache, and storage. The reason for this is that servicing a few standards reduces the complexity of support, which has shown time and again to be the best way to reduce the cost of operations.

11. Servers:
Most servers are currently purchased as individual standalone machines. This creates two problems: first, it means that each server is a single point of failure for its own data and there is no failover capability from one server to another; and second, the storage usage of each machine is usually less than 50% of capability. Therefore, the architecture of servers should be configured into a storage array network (SAN) of blade servers configured to backup each other.

The implementation and continued automation of the healthcare workflow process is analogous to building a house. All departments run their own operation, but are interconnected and dependent upon each other to provide a complete workflow environment. The foundation of said “digital house” however, is the technological infrastructure. Any weak points in the infrastructure will create bottlenecks in the workflow process. The demand for quick and accurate patient information in hospitals is continuously on the increase. Hospitals have to improve their technological infrastructure in order to meet the needs of caregivers and to enhance their revenue. Healthcare workflow process improvement will take time to accomplish in a coordinated, synergistic manner that will improve patient care and hospital revenue.

Saturday, August 18, 2007

Forging ahead: The electronic Child Health Network (eCHN)

The electronic Child Health Network (eCHN) provides services to enable Health Information Custodians, such as hospitals, to use electronic means to share personal health information with other [Canadian] Health Information Custodians.

Stated Mission
To be the preferred enabler of electronic health data and information for providers of maternal, newborn and child health care in Ontario and Canada.

Stated Vision
eCHN's vision is that electronic health information in Ontario and Canada should be a universal system that is inter-operable, comprehensive, accessible, flexible and available in a secure and controlled environment.

There are two primary eCHN offerings: PROFOR and HiNET.

PROFOR is a password protected professional development website for health care providers. Through PROFOR, health care professionals have access to the following types of information:
o Professional presentations and discussions including rounds for medical, nursing and other professional services.
o Educational material that can be printed from PROFOR and given to parents and children for their reference after their office or hospital visit.
o Pharmacy information, including the Sick Kids Pharmacy Formulary of Drugs.

Benefits of PROFOR
o Provides the latest information on many paediatric topics as provided by leading experts.
o Provides educational material that may be used as resource material for parents or patients.
o Provides the current Sick Kids formulary as a reference.
o Assists health care professionals in obtaining credits for continuing education.
o Permits health care professionals to benefit from educational presentations even when they are unable to be present at then time.

Read more about PROFOR at

Access to PROFOR: Health care professionals interested in accessing PROFOR can send their name, professional affiliation and email address to
Note: A password and user ID will be issued. There is no charge for accessing PROFOR.

HiNet is a secure system in which a child's medical records are available electronically to health care providers when and where they are required. This information includes laboratory results, doctor's notes, xrays, visit information and personal information such as age, address and phone number. HiNet uses the latest security technology and all information remains private within eCHN. HiNet is available only to pre-authorized health care providers. Patient participation is voluntary and written parental consent may be required. Although the decision not to participate will not affect the care delivered to any child, there are substantial benefits to having a child's health data on the network. These include faster access to patient records, more complete information available to health care providers and a reduction in duplicate X- rays and diagnostic tests.

Benefits of HiNET
o Health care professionals have instant access to the most current patient information.
o Information is available when and where it is required.
o HiNet reduces the opportunities for lost or unavailable records.
o The need to repeat tests completed recently may be reduced.
o The requirement for the patient to travel may be reduced.
o Facilitates delivering better, safer and more timely health care.
o Helps clinicians use their time more effectively by spending less time on paperwork and more time on providing care.
o Sharing health information improves continuity of care.

Read more about HiNET at

Download a HiNET brochure (English/French available) at
Health care organizations and professionals interested in obtaining access to HiNet should contact eCHN by telephone at 416-813-8807 or via e-mail at

To view current eCHN Members please visit

All content as per eCHN website

Friday, August 17, 2007

Health Canada | eHealth Thesaurus

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Doctor Google and Doctor Microsoft; if not them, who?

via HealthBlog on Aug 14, 2007

Bill Crounse, MD Worldwide Health Director Microsoft

The Internet is abuzz today following a New York Times article by Steve Lohr about Microsoft's and Google's designs to change the game in healthcare. Readers who follow this Blog will understand very well where I come down on all of this. As a country, maintaining the status quo in our broken healthcare system (which really isn't a system at all) just isn't a viable option. We spend about twice as much money per capita on health than any other nation on earth, yet the US ranks far behind other countries in many of the ways we measure the overall health status of a population.

Do I think that some kind of universal, government-run healthcare fix is the answer to all of our problems? Absolutely not! One of the things I have learned as I have traveled around the world these past few years is that providing timely, cost-effective, equitable healthcare for an entire population of people is challenging no matter what payment system is in place. Healthcare is expensive and it doesn't matter whether the payor is government (we pay), employers (we pay) or private citizens (again, we pay); many of the miracles of modern healthcare have become so expensive and so out of the reach for people of ordinary means, there's just not enough money in any system to apply them universally and equally to every citizen. Therefore, healthcare always has been and always will be rationed in some way.

So, if how we pay for healthcare has flaws no matter what system is in place, we must find better ways and better systems to deliver more affordable and accessible care. I've taken a few hits for my positive stance on retail clinics, home health, patient self-service, physician-patient e-mail, personal tele-health services, and other modalities to provide health information and medical services in ways besides those that our current "system" provides. Many of my physician colleagues are on a war path against retail clinics. They are calling every state legislator and pulling out every tool in their regulatory armamentarium in an attempt squash the movement, but they will ultimately fail.

Prohibition doesn't work. Retail clinics will thrive or falter based on the quality of services they provide and the value that their customers perceive. The whole reason this movement has gained a foothold is because medical professionals haven't been listening to their patients. Patients want healthcare to behave like other industries. It really doesn't matter who's paying the bill. We are all paying the bill, and we expect more than we have been getting considering how BIG that bill has become.

Doing something about this will take more than coming up with new ways to pay for healthcare as it is presently delivered. We need new care delivery models, staffing models, business models, and a bevy of contemporary information and communication technologies to truly revolutionize American medicine. Neither Google, nor Microsoft nor any of the other companies mentioned in Lohr's article can be your doctor, nor should they be. But these companies can and should help us with the technologies that will be needed to change the game. If not Microsoft or Google, then who?

Thursday, August 16, 2007

Google preparing ehealth portal initiative

Google is planning a product that it hopes will overhaul the way patients, doctors, vendors and pharmaceutical companies manage their medical information online. Dubbed the Google Health Scrapbook, the product is in developmental stages now and there is no certainty that it will be launched. Google executives met last week with their counterparts at WebMD in New York to pull them in as a partner for the new online service. They plan to pitch the product to other potential partners in the coming weeks.

The plan, as it stands now, calls for there to be four different directories for each different type of user. The prospect of listing a separate directory for medical devices seems to have been scrapped. Users will be able to log in with their own account information and do things such as add a new medical provider, check their medical records or pay their bills.

The product would also provide information about hospitals such as the frequency that a hospital performs a specific type of procedure or which hospitals perform which procedures most often.

Aside from WebMD, Google is hoping to partner with Intuit on the product. Intuit currently offers consumers a software program that helps them keep track of their medical expenses. The company has already met with the CEO of AllScripts LLC, Glen Tullman, and representatives of Epic Systems Corp., which has signed a non-disclosure agreement.

Involved in the project is Missy Krasner, a project manager who joined Google earlier this year. She was previously a top official in the Office of the National Coordinator for Health Information Technology. Adam Bosworth is rumored to be the one directing the company's overall health initiatives.

Google observers who have been expecting a major Google Health initiative to be announced in May were surprised that the company’s health-related release was Google Co-op. Google Co-op is a social search product focused around vertical areas such as health, autos and travel. Its health directory allows users to bookmark interesting pages and add them into the directory, which can then be viewed by others. It also allows users to subscribe to feeds from a variety of sources such as WebMD and the Mayo Clinic.

A Google press official declined to comment specifically on their plans. The press official released this statement: "Health has been an area of interest at Google for some time. We have been doing a variety of research in the health area, including how to improve the quality of health-related search results. Google Co-op is one reflection of that. We continue to look for more ways to benefit our users in the area of health, but we do not have any products to announce at this time. As part of our efforts, we work with many companies in formal and informal ways.”

If the company’s Google Health Scrapbook launches, its health information offering will immediately go far beyond what is currently available to its users via Google Co-op.

Google's Personal Health Record Initiative

The social-networking revolution is coming to health care, at the same time that new Internet technologies and software programs are making it easier than ever for consumers to find timely, personalized health information online. Patients who once connected mainly through email discussion groups and chat rooms are building more sophisticated virtual communities that enable them to share information about treatment and coping and build a personal network of friends. At the same time, traditional Web sites that once offered cumbersome pages of static data are developing blogs, podcasts, and customized search engines to deliver the most relevant and timely information on health topics.

Google Health, codename “Weaver”, is Google’s planned personal health information storage program. Google’s Vice President of Engineering Adam Bosworth lobbies for the program for quite a while now. Adam said the current US health care system is challenged when it comes to “supporting caregivers and communicating between different medical organizations.” Adam went on to say that people “need the medical information that is out there and available to be organized and made accessible to all ... Health information should be easier to access and organize, especially in ways that make it as simple as possible to find the information that is most relevant to a specific patient’s needs.” Adam adds that this – making information accessible – happens to be along Google’s mission.

The New York Times today writes that “about 20 percent of the [US] patient population have computerized records – rather than paper ones – and the Bush administration has pushed the health care industry to speed up the switch to electronic formats. But these records still tend to be controlled by doctors, hospitals or insurers. A patient moves to another state, for example, but the record usually stays.” But, the NYT continues, initiatives like the one by Google “would give much more control to individuals, a trend many health experts see as inevitable.” A prototype of Google Health has now been shown “to health professionals and advisers,” the NYT reports.

To find out just what you might be able to see in a future Google Health service, take a look at these screenshots from Google’s prototype which have been sent in here. As prototypes go, certain approaches of the program may change, and the specific interface may or may not be kept like this in a final release. “We’ll make mistakes and it will be a long-range march,” the NYT quotes Adam Bosworth.

To see more Screenshots of Google's new Personal Health record initiative, please visit

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