Wednesday, December 17, 2008

KLAS announces top-performing Healthcare IT software and services vendors for 2008

The 2008 Top 20 Best in KLAS Awards lists top Healthcare IT vendors in a number of software categories (view Top 20,) as well as several professional services categories.

KLAS Founder and Chairman Kent Gale said more than 1,500 interviews were conducted. Gale added that KLAS is developing new categories and refining others based on the comments received during the interview process. The company has added cardiology as a category, he pointed out, while it is working on designations for RFID assets and labor and delivery and others.

As the Clinical Portal category is relatively new, KLAS does not yet extend a “Best in KLAS” rating, however MEDSEEK is the Category Leader for Clinical Portals in the recent report. (View Report)

"Since 1998, the Top 20 Best in KLAS Awards report has been shining a light on the performance of vendors throughout the healthcare industry," said KLAS President Adam Gale in a press release. "Today the objective of the report remains the same: To help healthcare providers make informed decisions, whether they're looking to buy technology, review a current vendor, validate an operational decision or determine the right products to remain after a merger."

View Original Article

Friday, December 12, 2008

Top 50 Health 2.0 Blogs

It’s clear the Internet is transforming how we practice medicine, biomedical research, and empowering health care stakeholders. While we have seen many new concepts and terms appear and disappear, the term “Web 2.0” is increasingly being discussed.

Recent advances in web technologies and user interfaces has greatly changed the design and pervasiveness of Web applications, and in many cases actually transformed the way users interact with them. As eloquently argued by Mandl and colleagues in the New England Journal of Medicine, these developments represent “tectonic shifts in the health information economy” with far-reaching consequences for patient involvement, as the gravity shifts away from health care providers as the sole custodian of medical data.

Health 2.0 embraces the idea of bringing health care into the community of physicians, patients, and those in the health care industry together with technology and the Internet to provide the best possible health care environment.

What better way for the various parts of this community to share their thoughts and communicate ideas than through their blogs? From corporate blogs to blogs that are a part of social networks to individual blogs touching on technology or health care policy, these blogs will help bring you into the community, provide information and resources, and may perhaps help you find your voice as well.

From popular medical websites such as WebMD and Healthline to Health 2.0 sites like Organized Wisdom, these blogs bring you health information on a variety of topics.

1. WebMD Community Blogs. This trusted source of medical advice offers blogs ranging from ADHD to men's health to urology. Select one or more topics to learn the latest in that field.

2. Mayo Clinic Blogs and Podcasts. Stay on top of subjects such as pregnancy, stopping smoking, nutrition and more with the blogs and podcasts available at this site.

3. Healthline Health Matters . Read the blogs available through Healthline here. Topics include cancer treatment, reproduction, teen health, nutrition, and much more.

4. MedlinePlus Health News. Click through the daily news updates on this government-sponsored site or sign up for the RSS feeds to have the news delivered straight to you.

5. ENURGI. This company works to connect families, patients, and health care givers. The blog provides updates about the company as well as helpful advice on topics such as checking references for caregivers and exercise and health.

6. The Revolution Manifesto. RevolutionHealth offers a community resource to find information about health and wellness, illness, and connecting with others. Their blog highlights important health care issues and how those issues affect changes within the company.

7. HealthNex. From IBM employees concerned with health care innovations that help the global community, this blog brings topics such as e-records, health policy, and technology to Health 2.0 readers.

8. The Health Wisdom Blog. From Organized Wisdom, the site that gives you information on your health with WisdomCards, be sure to follow this blog for updates on the latest 2.0 tools.

9. NeoTool Healthcare IT Blog. From NeoTool, a hospital systems integration software, this blog offers the latest IT trends with a focus on hospitals in particular as well as information about the NeoTool software as well.

10. SharpBrains Blog. This blog keeps you updated on the latest brain health news and research. Don't miss their Medicine 2.0 blog carnival where they offer the best of the blogs offering 2.0 information.

Medical social networking sites offer lots of information on their blogs, usually with the angle of reader-based research. Check out these blogs written by highly informed patients and medical professionals alike.

11. The Value of Openness. From PatientsLikeMe, this blog brings the best of patient-led research to you. Recent posts have touched on young-onset Parkinson's, MS, and genetics discrimination.

12. Doctor Blogs at Daily Strength. From Daily Strength, these physicians share their knowledge on topics ranging from why men don't seek health care treatment to high school sports to the five stages of grief.

13. PeoplesMD Blog. Get the latest on both social networking and health issues--especially as they have to do with one another--on this blog from PeoplesMD.

14. Trusera Blog. Trusera is a social network of patients who are sharing their health experiences. The blog brings you updates in the world of health care as well as updates on Trusera itself.

15. change: healthcare. This social networking site allows patients to compare and support each other on health care topics such as illness, prescription drugs, and many other health care topics. The blog keeps you updated on health care news such as how to spot an online medical scam or whether or not you should get married for health care benefits.

16. HealthCareVox. Not actually a part of any one social networking site, this blog focuses specifically on how social networking plays into the world of health care and technology. Recent topics have included the success of specific online communities and a global study on social technology.

17. PsychCentral Blogs. PsychCentral, an online psychology community, offers this blog to keep you updated on the latest in the field of psychology such as face recognition and the relationship to social culture and non-drug approaches to treating ADHD.

18. The SoberCircle Guy's Blog. The official blog of SoberCircle, you can find posts about both social networking and the 2.0 technology used to create a supportive and healthy environment.

19. New Media Medicine Blogs. Read the blogs from physicians, med students, and pre-med students from this social networking sites for doctors. Sponsored by a university in New Zealand, these blogs definitely have a distinctive feel separate from similar U.S. blogs.

From the latest in health 2.0 tools to a listing of current medical blogs, these 2.0 blogs will keep you current and in the know.

20. Health 2.0 Blog. A blog written by leaders in the health 2.0 movement, these posts will keep you abreast of all the latest trends and technologies occurring in the health care world.

21. The Health Care Blog. A sister site to health 2.0 Blog, this blog expands coverage in its posts to include not only the 2.0 aspect, but also the latest news and inside happenings in the health care industry.

22. The Doctor Weighs In. Five physicians post on this health care blog that frequently features plenty of health 2.0 topics such as the future of health 2.0 tools.

23. Diabetes Mine. This comprehensive site detailing all aspects of managing diabetes offers a blog with a strong focus on the 2.0 aspects of online technology and community connection.

24. Medical 2.0. Written by a pediatrician and health 2.0 guru, this blog offers great tips and resources for enhancing your health and medical 2.0 library.

25. Frankie Speaking Frankly. This blogger from the U.K. brings you interesting posts about the world of health and medical 2.0. As the creator of MedWorm with a strong interest in medical research, her experience in the field is sure to provide great insight to the current and future trends of health 2.0.

26. Web 2.0 and Medicine. Find reviews and updates on the latest web 2.0 tools that affect the field of medicine on this blog written by a physician with a strong interest in the progress of health 2.0.

27. Medgadget. This hugely popular blog provides the latest in medical technology both on and off the Internet.

28. Clinical Cases and Images--Blog. This blog brings the world of medicine together through their informative and interesting blog. Get the latest news, interesting blogs, and newest technologies here.

29. ScienceRoll. This medical student with a strong interest in web 2.0 technology writes about the intersection of these two fields in his blog.

30. Informaticopia. Blogging about the world of eHealth around the world, this blogger is based in the U.K., but also touches on health 2.0 in Canada and the U.S. as well.

31. Medlogs. For a listing of medical blogs, this news aggregator brings the latest medical blogs to you in one spot. Read through the most current blog list or browse through the categories of blogs on the left-hand menu.

Health 2.0 is inextricably linked to technology, so read about how technology and health care affect each other in these blogs.

32. Health Populi. Written by a health economist, this blog looks at how health care and technology intersect. Recent posts include health care debt trends and the economic impact on health insurance, medical treatment, and prescription drug use.

33. iHealthBeat. Actually more of a journal than a blog, this site offers updates on Monday through Friday on how technology affects the health care industry. A part of the California HealthCare Foundation, some of the news is a bit more geared to California and the west coast.

34. HIStalk. This Health IT blog serves primarily as a news aggregator for all the HIS inside industry scoops, but it also provides reader-written posts about the industry.

35. The Healthcare IT Guy. Written by a CEO of a health care IT company, this blog offers plenty of reviews for great health 2.0 sites as well as updates about health care as it pertains to technology.

36. eHealth. Blogging on the nuances of eHealth, health 2.0, and medicine 2.0, this writer discusses the various aspects of technology and health care systems.

37. Neil Versel's Healthcare IT Blog. Read about podcasting, blogging, open source, privacy and more as these aspects of technology pertain to the health care industry.

38. Future of Health IT. This news aggregator blog lets you know the latest news on IT trends and happenings as they relate to the health care industry.

39. The Healthcare Information Systems Blog. While currently undergoing a re-focusing of direction, this blog generally examines health care and its association with technology innovation.

40. Efficient This site offers the latest on technology, best practices, and lifehacks. Stay on top of what technology your physician has available in her field.

41. Kidney Notes. Not necessarily just focusing on kidneys, this blog offers a good mix of medical technology news, funny journal articles, and other random fun-ness. Medical professionals and laypeople alike will enjoy reading this blog.

42. Combining medical librarianship and Internet technology, this blog offers great 2.0 tools and tips for those in the health care industry.

43. Laika's MedLibLog. Another blog heavy on the medical library end of health 2.0 and written by a Dutch medical information specialist, this blog offers topics such as WikiMindMap, Dutch medical blogs, and more.

The current state of health care in America just begs for health 2.0 intervention with communities and technology working to make a change for the better. These blogs let you know how the struggle to improve the system is going.

44. Kathleen's Blog: Second Opinion. A part of CodeBlueNow!, the founder writes this blog with inspirational and thought-provoking calls to arms for those working to make a change in health care policies.

45. Crossover Health. This blog is a great example of the Renaissance nature of health 2.0 as it strives to find a way to make policy changes through inclusion of physicians, patients, and policy makers as they incorporate aspects of technology and finance to improve health care for all.

46. Health Care For All. This non-profit works to create a better health care system through creating a consumer-centered system, and their blog provides the latest developments in their pursuit of better quality care.

47. A Scanner Brightly. This blogger is going about making changes in policy by bringing more medical transparency to the field. As a supporter of this movement, you will find topics comparing U.S. healthcare to other countries and examinations of current transparency policies.

48. Amateur Economists. While not strictly a health blog, the economic topics here frequently touch on health care policy and how economics affects changes. This blog is geared towards those who are not well-versed in economics, but want to understand the implications on current events.

49. Health Care Law Blog. This lawyer blogs about the intersection of health care, the law, and technology. Topics frequently touch on electronic health care records, social networks as they pertain to health care, privacy, and more.

50. HealthBlawg. Lawyer David Harlow writes about health care, technology, the law, and health care policy on his blog.

Published on Wednesday September 17th , 2008 | Read original article

Thursday, December 11, 2008

Global Perspective: Australia’s Electronic Health Record (EHR) Resources

Coalition for eHealth Australia
The Coalition for eHealth was formed to improve the strength and coherence of the voice from those with expertise in eHealth. View Members of the Coalition for eHealth.

The National E-Health Transition Authority (NEHTA) published specifications for both messaging and connectivity architecture which underpin the approach to e-health communications for NEHTA’s ePathology, eDischarge Summary, eReferral and eMedications Management. Strategic policy alignment takes a strong focus on the monitoring and analysis of trends and technology, in order to drive the Australian Governments' e-Health agenda. Read Specifications.

Australian Health Ministers Advisory Council (AHMAC).
In early 2008, Australian Health Ministers, through the Australian Health Ministers' Advisory Council, commissioned Deloitte to develop a strategic framework and plan to guide national coordination and collaboration in E-Health. Read Summary.

HealthConnect Australia Archive

National E-Health Transition Authority (NEHTA) Privacy Blueprint for the Individual Electronic Health Record
The Consumers Health Forum's National E-Health Transition Authority (NEHTA) Privacy Blueprint for the Individual Electronic Health Record considers a range of key issues including governance, audit functionality, sensitivity labels, what controls individuals have over information on the Individual EHR, and secondary uses.

e-Health is a Valuable Tool
As the e-health movement continues to gain momentum across Australia, consumers are playing a greater part in driving the e-health direction to meet consumer needs.

Keeping Consumer e-Health Transparent
Ethics is central to the culture of health provision in Australia; however, when it comes to looking at e-health things can get a bit clouded. This article looks at just one aspect of e-Health and consumer sponsored (and run) websites.

e-Health and the Quality Use of Medicines - Getting Better All the Time
Computers have revolutionized the way pharmacists work, delivering many improvements to consumers. However, e-Health offers ongoing opportunities.

e-Health - A Consumer's View
There are benefits and drawbacks with the development and implementation of e-Health systems, but with consumer involvement, concerns can be addressed

e-Health for Consumers - Practical Strategies
The e-Health strategies were developed out of the CHF 2005-06 Electronic Health Records project for maintaining a high level of well-informed consumer participation and input in the development and implementation of e-Health systems. The strategies also reinforce the need to consider important issues for consumers, such as privacy, governance, and shared decision-making between health providers and consumers, to ensure these issues remain on the e-Health development agenda.

Tuesday, December 09, 2008

Global Perspective: NHS Scotland’s e-Health Strategy

The potential of information technology to support improved healthcare is recognized across the world. There are many approaches to delivering this potential; Scotland is building an approach that best fits the needs of NHS Scotland.

In Scotland, the e-Health Strategy is setting a course which focuses on improved healthcare more than technology. It also seeks to build on the significant progress we have already made to move to progressively stronger and more integrated support for the provision of care. The e-Health Strategy targets the key priorities set for health while also looking to build the wider vision of more integrated care and the use of information to promote better, more efficient and safer care for patients.

Read NHS SCOTLAND’s eHealth Strategy.

Monday, December 08, 2008

Electronic Health (e-Health) Resources

Online e-Health Literature Catalogue
(Departmental Library, Health Canada)
+ A fully searchable catalogue providing access to more than 4 000 full text reports, papers, periodicals, and journal articles from Canada, the United States, Australia, the United Kingdom and Europe. Topics include telehealth and telemedicine, protection of personal health information, electronic health records, legislation, standards, and major current health policy documents which have an impact on the use of ICTs in health.

Health Technology Assessment (HTA) Database
(NHS Centre for Reviews and Dissemination, University of York, United Kingdom in collaboration with International Network of Agencies for Health Technology Asssessment (INAHTA.))
+ Includes technology assessment publications related to projects being conducted by members of INAHTA. Note: Many of the publications records links to original papers or executive summaries.

Telemedicine Bibliographic Database
(Telemedicine Information Exchange, Portland, Oregon, U.S.A).
+ Bibliographic database which provides access to citations of articles on telemedicine, many with abstracts; frequent updates. Note: Contains over 12,000 article citations with many available for online purchase and delivery.

CanadianEMR Roundtable Forum Podcast- The Convergence of EMR and EHR

The Convergence of EMR and EHR Podcast
Where are we now? Where are we going? The Convergence of EMR and EHR in Canada. Featuring Panelists: Sam Marafioti, Dr. Steve Edworthy, Dr. Stephen McLaren, and Mary Atkinson.

Listen to the Podcast (Length: 34:44.) Visit CanadianEMR Online.

Friday, December 05, 2008

4th Annual Canadian Health Informatics Awards

The 4th Annual Canadian Health Informatics Awards Gala, held on November 19, 2008 at the Sheraton Centre in Toronto, celebrated the outstanding achievements and excellence in the Canadian Health Informatics Community. ITAC Health (formerly CHITTA, Health Division of ITAC) and COACH: Canada’s Health Informatics Association co-hosted the gala.

Congratulations to:

The Gala celebrated the following outstanding achievements:

Winner: Telus Health Solutions

Winner: Agfa HealthCare

Winner: Xwave Healthcare & Cancer Care Ontario


Winner: Agfa HealthCare

Winner: Ormed Information Systems




The Information Technology Association of Canada (ITAC) is the voice of the Canadian information and communications technologies (ICT) industry. ITAC represents a diverse ICT community spanning telecommunications and internet services, ICT consulting services, hardware, microelectronics, software and electronic content. ITAC's community of companies accounts for more than 70 per cent of the 572,000 jobs, $140.5 billion in revenue, $6.0 billion in R&D investment, $31.4 billion in exports and $11.4 billion in capital expenditures that the ICT industry contributes annually to the Canadian economy. ITAC is a prominent advocate for the expansion of Canada's innovative capacity and for stronger productivity across all sectors through the strategic use of technology.

To view a list of ITAC Members click here.


White Paper: The Critical Role of Integrated Patient Information in the Delivery of High Quality Healthcare

Find out how an SOA-based solution for HIE and interoperability can provide both caregivers and applications with comprehensive and accurate integrated patient information that facilitates the delivery of high quality healthcare. Download the White Paper.

The Promise of eHealth 2.0 | Clinical Portal Technology

The past few years have been busy ones for those involved with automation of processes within the healthcare industry.

As a result of these efforts, 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 systems and processes combined with poor information flow are increasingly resulting in 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 call for a significant restructuring of our 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/ medical records (EHR/EMR) and web-based information exchange.

To put the fundamentals in place requires investment; however, returns would be enormous in the form of improved quality of care, better safety and greater productivity.

Healthcare executives today have a unique challenge in responding to the e-Health call to arms, as even new systems may also create inefficiencies and added risk to patients if not utilized properly. Somehow, leaders must enable their organizations to evolve while simultaneously protecting the financial stability of the institution and the well being of the patients. This includes providing the modern tools, training and support required to move forward and evolve their health delivery platform.

This can be accomplished incrementally by growing the universal understanding of viable, effective web 2.0 e-Health technologies and sharing successes and failures as an industry. There is no longer any choice about joining the e-Health revolution. It is becoming the rule, not the exception—and it’s gaining momentum everywhere.

We are quickly moving away from the traditional models of medicine and towards a patient-centric model with the intent to deliver more efficient care, whilst simultaneously improving patient outcomes. This is why tools have been introduced to help realize the promise of e-Health. A proven portal solution not only leverages, enhances, and augments existing IT investments, but also evolves information delivery platforms towards a more open, vendor-neutral, patient-centric environment.

According to Frost & Sullivan, increasing integration is creating the need for a single point of contact to healthcare IT (HIT) systems, which in turn, is driving the e-Health market.

Today's health systems are tangled, highly fragmented networks that often waste a great number of resources by duplicating efforts, leaving unaccountable gaps, and failing to build on the strengths of our health professionals and clinical expertise. With an aging population, extended wait times, and chronic conditions reaching epidemic proportions, our healthcare system will not survive without radical change. e-Health, the application of web-based information technology to healthcare, can profoundly change the way the business of healthcare is conducted— making it safer, more affordable, and significantly more efficient.

However, transforming traditional modes of delivering care will require Health Care Organizations (HCO) to take advantage of the enormous potential offered by information technology in far more complex ways. Previously, e-Health was stalled by interoperability issues and a lack of workflow-driven, secure information exchange. Today however, progressive technology and innovative solutions are enabling unprecedented advancements.

The relatively brief history of Health Information Technology (HIT) has taught organizations the high costs of failure, which has caused Health Care Organizations to prudently proceed with guarded optimism. Although there is recognition of the benefits of e-Health, when combined with a market already crowded with HIT vendors attempting to help HCO’s realize a return on investment (ROI,) it becomes increasingly difficult to identify a vendor with a meaningful track record. As such, the majority of Health Care Organizations have been watching the progress of vanguard organizations before they commit their time and money.

Waiting to join the e-Health movement has its own disadvantages. Besides prolonging current inefficiencies, laggard organizations may miss an important window of opportunity, and the benefits of adopting e-Health strategies are too great to ignore. For HCO’s determined to take advantage of the current Infoway driven EHR environment, the next imperative action is to outline an appropriate technical platform for their e-Health strategy.

Fundamentally, organizations are seeking a platform that allows the seamless delivery of information across the continuum of healthcare and multiple locations. Fortunately, this objective can be met without cost prohibitive, universal replacement of existing HIT. Moving forward with a proven e-Health portal communications strategy can bind the information technology of disparate facilities and stakeholders into an interactive user community using advanced, but proven, web portal technologies.

From the user perspective, a web portal is technology that allows an individual or user community to gain convenient access to a broad range of information and services through their web browser.

Most HCO’s serve a variety of stakeholder communities, including providers, payers, patients, employees, and consumers. Each of these stakeholder communities benefits from a portal that is targeted specifically to meet their needs, aggregating information of value for them and allowing them to communicate freely with the host organization and each other.

For the hosting HCO, a portal is an integration tool that incorporates service and data management applications with workflows and business processes to present a unified, personalized, and streamlined gateway to their enterprise for its stakeholders. The HCO establishes a portal strategy to offer timely access to real-time information resulting in better customer service that is accessible from a single point of entry, regardless of which system generates the information or where the information resides.

While a provider portal, patient portal, employee portal, and a consumer portal each appear independent of the other, they are clearly interrelated. Since healthcare consumers may be patients, employees, or even providers, their needs will overlap. Therefore, each stakeholder may require access to the others’ data as well as additional common data sources.

A portal solution can serve to aggregate information stored in disparate, incompatible systems using a Service-Oriented Architecture (SOA). SOA describes a product architecture that allows tight integration with underlying applications, without requiring system interoperability. This also allows users to access software functions independent of the underlying platform and/or programming language.

It permits services to be rolled into larger applications that can be incorporated into portals, without locking the enterprise into a specific vendor. While the SOA concept has been around for quite some time, emerging standards-based integration technologies like Web services and XML have recently made it practical. The benefit for your healthcare organization is clear – a SOA enables eHealth while protecting the enterprise’s investment in legacy software. As organizations search for viable tactical path to leverage a Service-Oriented Architecture, many can use portal products as a first step.

By empowering patients, providing rapid, real-time data access, greater efficiency, and increased patient/physician collaboration, everyone benefits. Although eHealth applications serve the needs of many different stakeholders, there are four major stakeholder groups, which illustrate the value of this solution: patients, physicians, consumers and employees.

In spite of the differences in type and format of information and services each group requires, there is significant overlap and common desire for:
+ A more positive physician/patient experience between clinicians and patients
+ A more satisfying and effective clinical experience for patients and caregivers
+ A more transparent technology experience for all of the stake holders, but particularly the care givers and IT staff, easy to use and easy to maintain
+ Better IT cost control to make the CIO and CFO’s job of keeping costs down easier
+ More referrals and admits because of streamlining and efficiency improvements that expand a facility’s capacity
+ Brand advancement, fulfilling the goals of the marketing department and CEO of improving community awareness and market position
+ Better recruiting retention because of more effective use of staff time and skills, and easier access to human resources and other employee information
+ Improved operations for administrators and clinicians, building on existing skills and significantly reducing unnecessary mundane tasks.

However, while many vendors offer partial solutions, few offer a comprehensive portal communication solution.

Legacy HIS/CIS vendors offer applications targeting information access and management, and while they improve the physician/patient experience and provide operational efficiencies, the needs of the other stakeholders are not addressed.

Traditional web vendors, on the other hand, tend to focus on content management systems that excel at promoting an organization’s brand but leave the needs clinical and operations stakeholders unpreserved.

Somewhat more comprehensive, electronic medical record (EMR/EHR) vendors offer vital elements of the big picture solution, but cannot accomplish the complete transformation that browser-based systems promise.


The Gartner Group identified five levels of eHealth development using Portals, the elements that comprise them, and what it takes to move from one level to the next (see figure 1).

Health Care Organizations continue to significantly use portal products to build and deploy a variety of customer, citizen, partner and employee facing enterprise portals.

Portals have evolved through four generations of technology and are embarking on their fifth generation. In the beginning, eHealth bore relatively simple websites that provided new levels of information accessibility to healthcare consumers.

As the technology evolved to Level 2, searchable directories and more interactive features were added, providing dynamic new options for HCO marketing and administration departments. It was possible to promote classes and services, help people find reliable current health information and appropriate specialists, make human resources information readily available to employees, and collect and manage data using the Internet.

Since Generation 2, portals have leveraged service-oriented (SOA) capabilities. Generation 2 portals provided a rudimentary method of composite application assembly known as inter-portlet communication. Organizations can use inter-portlet communication to build composite applications by linking portlet’s related to a specific business process. This type of composite application is referred to as "on the glass" because the integration is at the presentation layer rather than deep in the business logic. This integration approach is effective for user-driven processes, and advanced enterprise portals use inter-portlet communication extensively.

Level 3 applications required a broader revolution within healthcare from paper to electronic medical records, which was reliant on emerging data standards and the willingness of HCO’s to empower their users with more control and access.

Generation 3 portals enabled systems to handle basic web services. These portal products could consume web services. The addition of workflow, which is a feature of most portal products, introduced a new way to orchestrate composite applications.

Over time, the experiences of the early adopters and results of pilot projects generated sufficient results to compel cautious HCO’s to pursue the promise of eHealth. With Level 3 adoption no longer stalled by technological limitations and the pervasive wait-and-see mentality, the next wave in eHealth is cresting.

Transformational web portals will offer business process management with workflow automation, alerts, and reminders, integration with patient records, medical device uploads and a host of other equally exciting advances. Together, unified data resources and user interaction will radically alter best-practices for patient care and healthcare efficiency.

As far back as February 2006, a survey of healthcare CIO’s ranked the area for which they would be most likely to offer increased functionality via their web presence. Offering patients the ability to schedule appointments through their website was most frequently identified, followed by utilizing a physician portal link and providing consumer health information. However, only a handful of the CIO’s report that their website is used to offer patients secures and authenticated access to medical records.

On the cutting edge of eHealth, vanguard organizations are evaluating the appropriate technical platform for Level 4 applications. With Generation 4, portals started to leverage advanced web services. This included the ability to provide web services, as well as consume them. It also supported the first web services standard for portlets, Web Services for Remote Portlets (WSRP), which enables one portal to consume a portlet from a different portal, using web services protocols. Thus, portal pages could include local and remote portlets, all supporting a single set of processes.

Generation 5 is emerging (see figure 1). Advanced features include support for business process management (BPM), service-oriented applications (SOBAs) and orchestration, critical features to support advanced composite applications. Business Process Execution Language will become the standard orchestration language for portal products and will extend beyond the capabilities of their current workflow features.

A portal strategy should be built on a stable, secure framework, offer single sign-on, single-patient/single-view access to all information using a coherent system of portals — simultaneously serving the needs of the wide variety of stakeholders.

A comprehensive portal communications solution should include broad-based applications through:
+ Flexible, easy-to-use web content management tools for rapid application development by both non-technical staff and programmers
+ Interoperability between incompatible legacy HIS systems, and real-time data access
+ Secure communication allowing patients and providers to communicate conveniently
+ Integrated third party applications for additional functionality.

Current, partial solutions can be made whole with interpretable portals through which all healthcare stakeholders will exchange information and engage the enterprise regardless of geographical location. Enterprise portals are intended to consolidate and streamline a vast array of information from multiple sources into a single screen. Portal technology enables different IT systems and software applications to communicate, to exchange data accurately, effectively, securely and consistently, and to use the information that has been exchanged, making the most out of your investments.

With billions being invested in the migration from paper to electronic records, rapid ROI is a determining factor on the minds of executives and administrators concerned about their bottom line. Speedy, enterprise-wide adoption is critical for any eHealth initiative to realize the full benefits of their investment.

Delays and patchwork systems negatively impact the organizations’ ROI. Still, adoption continues to be spotty, despite incentives. In part, the gradual adoption curve can be ascribed to common complaints of HIT; accompanying workflow and systems integrations require process changes that can be intimidating. Reengineering the way work is done presents challenges that extend far beyond use of the technology. Changing the enterprise culture and convincing busy professionals to adopt and learn new systems are essential but challenging components.

A study conducted back in 2001 found 121 administrators and physicians working for HCOs agreed that in order to remain competitive, providers must move toward interactive consumer web self-service capabilities (e.g. scheduling services, pre-registering for services and bill payment) and online Physician patient communication. However, the reluctance to proceed was tied predominantly to a lack of funding followed by a lack of commitment, fear, politics and other intangibles that must be overcome if an organization is to be able to achieve the advanced website functionality. These findings were reiterated in the 2006 HIMSS CIO Leadership survey, which found that for the sixth consecutive year, respondents identified a lack of adequate financial support for IT as the most significant barrier to a successful implementation of IT at their organization.

Certainly, ROI is an important factor in any healthcare IT acquisition. A prudent capital investment is measured by its contribution to the sustained financial strength of the organization. However, the use of capital assets for eHealth objectives cannot be measured solely on the balance sheet. When capital investment improves clinical outcomes, reduces preventable medical errors, and eliminates common sources of waste, the return is evident in healthier patients.

The fragmentation of legacy HIT systems causes interoperability issues that can undermine an organization’s confidence in their ability to successfully implement a comprehensively integrated web solution. The data systems needed for an outpatient setting require a different level of sophistication than those that regulate admissions, discharges, and transfers within in a large hospital. Each system is defined by unique vendor standards, some of them decades old. These hurdles make a seamless, rapid data sharing format seem out of reach. However, integration can be tackled with the latest web technology.

Using a “virtual electronic health record” (EHR) model, any HCO can connect underlying systems rapidly and cost effectively to deliver views of clinical information through secure, single sign-on, web-browser technology. The virtual EMR is dependent on a decentralized, federated data model. Using this architecture allows HCOs to leverage legacy HIS/CIS investments, avoiding the ongoing maintenance of an expensive Central Data Repository (CDR).

A federated data model eliminates system integration hassles and overcomes patient identification challenges with master patient indexing logarithms. It seamlessly integrates disparate clinical and census data, transforming fragmented data into a clean and concise dashboard of information.

For example, a Clinical Portal can present admitting, attending, and referring Physicians with real-time access to all of their patients’ clinical information across multiple sites and when combined with systems such as computerized physician order entry (CPOE), provides the ability to input patient order entry and review via a web-browser. Additionally, online continuing medical education (CME), calendars, scheduling, clinical trial information, grand rounds, physician newsletters, and other relevant clinical content may all be presented in a customizable view for each user.

The biggest concern for busy Physicians is the time and energy required to transfer data and learn new systems. They are understandably reluctant to spend time away from patient-facing activities to address administrative business. To reduce training time, leading eHealth solution providers devote considerable resources to researching and designing intuitive applications that build on existing user experiences best practices.

Additionally, a federated data-model eliminates the need for Clinicians to learn underlying applications for checking labs or reviewing films, for example, as the GUI they use does not require any understanding of the host IT system, only to view the relevant clinical data that resides on it.

Understandably, HCOs, Physicians and Clinicians are sensitive to their responsibility to protect confidential patient information and may see rapid, real-time online access to vital information as a threat to privacy. Understandably adequate security measures and an architectural design must be engineered to allow an organization to implement eHealth applications with demonstrable compliance with regulations and respect for the patients’ rights. Todays web 2.0 eHealth technologies including authentication protocols and CAPTCHA, encryption of secure messages, automatic audit trails of information access, controlled workflow and secure servers guard patient information from unauthorized access.

e-Health is certainly no longer in its infancy, yet sustained concerns about implementing new technology is understandable. It’s a real challenge for most organizations to create a tactical plan to ensure that their web capabilities support current corporate objectives.

It is far more difficult for HCOs to devise a long term plan that serves the evolving needs of the organization, adapts to technological advances, and meets new societal demands. The pressure to deliver on high-priced projects adds gravity to the matter. The initial expenses are just a small piece of the overall financial commitment an HCO makes in the transition to eHealth, and the failure rate for EHR implementations is estimated at 30 to 50 percent. False starts and implementation time-line overruns are too costly for most HCO's to risk.

To overcome these barriers, part of doing it right the first time requires research to learn from organizations that have been successful in their own eHealth initiatives. Over the past decade, a wide variety of HCOs have achieved eHealth success, from early-adopting visionaries constantly striving for better ways to engage their stakeholders, to more cautious pragmatists waiting for proven solutions to their online needs.

In the 2006 HIMSS CIO Survey, lack of staffing resources was identified as the second most common barrier to IT adoption. Time and resource efficiencies enabled by eHealth have been demonstrated to pay for themselves in as little as a year. Fewer chart pulls and phone calls, speedier access to accurate information, lower record maintenance, and staffing costs, and revenue enhancements together create a synergy of efficiency—that more than compensates for the up-front investments.

For example, reducing the need for just one administrator/ trainer can save significant financial resources. One estimate based on a 40 hour work week over 50 weeks, and an average annual salary of $50,000, suggests that reducing one full time trainer can yield a savings of $61,000 USD a year. The architecture and design of today’s eHealth products are focused on allowing nontechnical users the maximum flexibility to manage their websites and portals. Additionally, intuitive design reduces the need for training and results in an immediate cost saving.

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.

However, the potential to succeed has never been clearer. A proven, cost effective model is available that delivers rapid, convenient access to any and all historical patient medical information from anywhere, regardless of when and where the care was delivered. Such a system is easily deployed, satisfies the need for cost effectiveness (ROI), dramatically increases productivity, efficiency, and makes the best use of existing resources. Ultimately, such a platform creates a healthcare environment that provides both patients and providers with improved outcomes and higher satisfaction.

Portals will allow transactions (and information) to flow rapidly and seamlessly over the web, but first the groundwork must be laid. Thankfully, proven technology exists to help healthcare organizations transition smoothly from one level of eHealth to the next at a fraction of the time and cost of competing models. Ultimately, confidence in proven solutions will embolden the willingness of responsible managers to move forward with and capitalize upon the promise of e-Health.


TELUS named 2008 Canadian Health Company of the Year

ITAC Award presented for excellence in corporate initiatives, customer satisfaction and exceptional quality of service

Toronto, ON, November 21, 2008 — On the heels of a significant announcement around its continued commitment to the healthcare sector, the newly branded TELUS Health Solutions has been named the 2008 Canadian Health Company of the Year by the Information Technology Association of Canada (ITAC).

The award, presented at a gala event in Toronto, honours TELUS as a distinguished for-profit healthcare information technology company that has demonstrated excellence in the Canadian health informatics industry within the past 12 months. TELUS was nominated as a private sector company that has excelled in corporate initiatives and client satisfaction, delivering exceptional quality of service.

“It is a tremendous honour for the TELUS team to be named Health Company of the Year by ITAC,” said Joe Natale, president, TELUS Business Solutions. “The transformation of healthcare in Canada is a huge undertaking that will take the collaboration of all key stakeholders - government, healthcare providers and business. At TELUS, we are committed to taking a leadership role in healthcare transformation through leveraging innovation and the strength of our people.”

The award was presented on behalf of ITAC Health, formerly the Canadian Healthcare Information Technology Trade Association (CHITTA), and was specifically focused on the successful implementation of TELUS iScheduler and Call Centre Anywhere at CritiCall Ontario, a 24-hour-a-day emergency referral service for physicians across the province of Ontario.

"The TELUS solution will allow CritiCall to invoke the entire circle of care anywhere and anytime, regardless of physician or patient location," said Kris Bailey, executive director of CritiCall Ontario.

“Without a doubt, IT has the potential not only to save lives by providing doctors, nurses and other healthcare workers access to essential information, but to lower the overall cost of healthcare,” said François Côté, president, TELUS Health Solutions. “We are proud that TELUS Health is at the forefront of the eHealth movement, and couldn’t be happier about the acknowledgement of our leadership through this distinguished award.”

TELUS Health Solutions has years of expertise in successfully implementing healthcare applications and information communication technology processes through industry leading solutions and consulting services to customers in Canada and around the world. It is backed by more than 1,500 TELUS Health Solutions team members including healthcare professionals. For more information, please visit

About ITAC Health
Representing more than 120 Canadian ICT companies that are actively involved in the health sector, ITAC Health is the healthcare division of ITAC, the Information Technology Association of Canada. Our mandate is to provide our members with access to public and private leaders of the healthcare industry, provide access to information and collaboration opportunities, and provide a consolidated voice for the industry when interacting with local and international governments in the promotion and governance of our industry. As a consolidated, single voice, members help influence the Canadian healthcare ICT market through active participation in our standing committees and various working groups.

TELUS (TSX: T, T.A; NYSE: TU) is a leading national telecommunications company in Canada, with $9.5 billion of annual revenue and 11.5 million customer connections including 6 million wireless subscribers, 4.3 million wireline network access lines and 1.2 million Internet subscribers. TELUS provides a wide range of communications products and services including data, Internet protocol (IP), voice, entertainment and video. In support of our philosophy to give where we live, TELUS, our team members and retirees have contributed $113 million to charitable and not-for-profit organizations and volunteered more than 2.1 million hours of service to local communities since 2000. For more information about TELUS, please visit

Thursday, December 04, 2008

Telus to invest $100M in Electronic Health Records (EHR)

Telus Corp. announced Tuesday (18 Nov 2008) it will spend $100 million over three years on its Emergis division, now known as Telus Health Solutions. Burnaby, B.C.-based Telus acquired Longueuil, Quebec-based Emergis for $763 million last year. The company’s products include claims management, electronic health records and pharmacy management.

Read original article.

TELUS (TSX: T, T.A; NYSE: TU) is a national telecommunications company in Canada that provides a wide range of communications products and services including data, Internet protocol (IP), voice, entertainment and video. The company is based in Burnaby, British Columbia.

Courtyard Group | Status of Electronic Health Records (EHR) adoption in Canada


With offices in the UK, US, and Canada, the Courtyard Group is an international healthcare consultancy company whose mandate is to transform healthcare by enabling clients to achieve sustainable outcomes. Courtyard has done a number of notable projects across Canada including working on Ontario’s Wait Time Management Strategy.


How Often Do U.S. Physicians Go Online for Clinical Information?

Fifty-eight percent of U.S. physicians surveyed said they go online for clinical information at least two times per day, according to a new Epocrates survey.

Fifteen percent of physicians reported going online for clinical information once per day, while 22% reported going online for clinical information several times a week. Three percent of physicians surveyed said they go online for clinical data weekly, while 2% said they go online for clinical information monthly.

More than three out of four respondents said they go online for clinical information more often now than they did a year ago, according to the survey.

Forty-eight percent of physician respondents said they go online for clinical information most frequently during patient consultations, compared with 37% who said they most frequently look up clinical information between patient visits. Ten percent of doctors said they go online for clinical information after work, while 3% said they find clinical information online during their lunch breaks and 2% said they go online for clinical data before work.

Results are based on a survey of 501 physicians who have used the Epocrates Online product at least three times and have logged on within the past 60 days.

Source: Epocrates, "Epocrates Online Physician User Survey"
Read original article.

Eventually, Information Technology (IT) May Make Practice of Medicine More Satisfying

Almost every plan to improve health care -- from members of Congress, insurers, employers and President-elect Barack Obama -- contends that new IT, including electronic health records, electronic prescribing and telemedicine, will save time and money.

But will health Information Technology (IT) make practicing medicine more satisfying?

Eventually, but it's going to take a while, and it won't be easy or inexpensive, according to a representative of the Healthcare Information and Management Systems Society and the president of The Physicians' Foundation, which recently released a national survey measuring doctors' opinions about the profession.

The Physicians' Foundation survey indicates widespread frustration among primary care physicians. They feel overworked and nearly half of them plan to cut back on the number of patients they see or quit medicine entirely, according to the survey.

Neither John Maese, chair of the HIMSS Ambulatory Care Steering Committee and president of Quality Physician Services in Brooklyn, N.Y., nor Lou Goodman, president of The Physicians' Foundation, see health IT as a panacea for all that ails the medical profession, but both agree it can be a valuable tool.

Goodman, however, is worried there soon may not be enough primary care physicians, regardless of new technology.

"Going into this project we generally knew about the shortage of physicians," Goodman said, adding, "What we didn't know is how much worse it could get over the next few years. The bottom line is that the person you've known as your family doctor could be getting ready to disappear -- and there might not be a replacement."

Initial Investment of Time and Money
Maese said that health IT can help make the practice of medicine more rewarding but that it takes an initial investment of time and money.

"Initially, technology slows you down," Maese said, adding, "So in the face of declining reimbursement that requires you to see more patients per hour, it can be very frustrating to start up with technology."

Maese said, "Younger physicians who have grown up with a computer find it easier to transition to technology." He added, "Older physicians who do not have that experience initially have to carve out time to learn basic computer skills and then the new software."

In its survey, mailed to 270,000 primary care doctors and 50,000 specialists, The Physicians' Foundation asked, "Have you already implemented an electronic health record?" Among the almost 12,000 responses, 72% answered "no" and 28% answered "yes."

"Time, money, personnel and expertise are the major barriers to widespread adoption of technology in medical practice," Goodman said.

Of those who said they had not moved to EHRs, 77% cited lack of money, 69% cited lack of expertise or other resources and 61% cited lack of time.

Although the survey did not specifically address physicians' opinions of health IT, Goodman said his sense is that most physicians look forward to the advancement it represents.

"I think many physicians are very interested in adopting new technology and many have already taken the next step," Goodman said.

"There is great interest and continued excitement over the potential improvements technology holds. [Health IT] is clearly on the front burner in the early discussions in the Obama cabinet as part of its proposed health system reform efforts," Goodman noted.

The Physicians' Foundation was founded in 2003 as part of a settlement in an anti-racketeering lawsuit involving insurers, physicians and medical societies. The foundation conducts research and acts as an advocate for physicians and physicians groups.

More Seed Money Needed
Maese and Goodman said increasing payments to help offset investment costs for technology would help make technology spread more rapidly.
"We believe that the large initial investment in technology without the concomitant adjustment in payment rates makes it very difficult for private practice to install an [EHR]," Goodman said, adding, "Even large group practices have seen challenges with questions of interoperability and the significant outlays of time and money required to get a system up and running."

Maese agrees. "There needs to be increased financial support for the EMR, the initial purchase and the ongoing maintenance of the EMR," Maese said, adding, "Currently, small practices, where most health care is delivered, do not have the economic ability to purchase the hardware, the software as well as the additional expense of electrical wiring upgrades and high speed Internet access to make an [EHR] work."

Five Ways Information Technology (IT) Can Help
Once the initial learning curve is negotiated and hardware and software are in place and working, Maese lists the following five ways new technology can make a physician's life more satisfying:

• "The computer may not save them time but there is a feeling that there is a higher quality of care rendered and better patient safety. This is very satisfying to the physician."

• "Reduction of the hassle factor. You are able to deal with insurance or formulary issues at the point of care so you do not have to go back after the patient has left the office and redo the request for a medication or a service."

• "Improved time management or flexible time management. Electronic medical records that can be accessed from home gives the physician more flexibility. The physician can attend meetings and events without having to go back to the office to complete medical records or carry charts back and forth to have them completed."

• "Better access to care for patients in an emergency. Electronic records can be accessed from anywhere."

• "More family time. Once the physician has completed seeing all the patients, the physician can go home, see the family and complete chart documentation remotely. In addition, follow-up care, checking diagnostic tests and X-rays can be done at home, which again allows the physician flexibility to spend more time with the family, which helps increase overall lifestyle satisfaction."

by George Lauer, iHealthBeat Features Editor
Read Original Article.

Wednesday, December 03, 2008

New Brunswick’s Task Force on Personal Health Information (PHIFT)

Co-chaired by Jean-Guy Finn and Kevin Malone, the Province of New Brunswick’s Task Force on Personal Health Information (PHIFT) was created in May 2008 to consult with New Brunswicker’s and advise the minister on new legislation to regulate the collection, use and disclosure of personal health information.

In October, 2007 New Brunswick’s PHI Task Force released a report entitled Balancing Privacy Rights and Access Requirements. The recommendations in the report strike a good balance between the protection of personal health information (PHI) and the need to use this information appropriately in order to improve patient care and, secondarily, better manage the health care system.

PHIFT Mandate
Co-chair Bios
Personal Health Info

Consultation Guide
Task Force Report

Tuesday, December 02, 2008

Sarah Kramer, President and CEO of eHealth Ontario Outlines Health Strategy

Sarah Kramer, President and CEO of eHealth Ontario spoke about the future of eHealth in Ontario at HealthAchieve 2008.

She focused on Ontario’s eHealth strategy, its system transformation goals and how the government’s goals will be implemented. In her words,the overall emphasis of eHealth in Ontario is to deliver clear, measurable, transparent results … that improve patient care quality and safety. Click here for the full text of her speech.

eHealth Ontario is the marriage of the Ministry of Health and Long-Term Care’s e-Health Program and the province’s Smart Systems for Health Agency (SSHA) under one banner.

Three key e-health priorities have been identified for the next few years including a Diabetes Registry, an e-health portal to centralize health information on an easily accessible web site, and e-prescribing which will eliminate hand written prescriptions and reduce medication errors.

The ultimate goal of the e-health strategy is to create an electronic health record (EHR) for all Ontarians by 2015. An electronic health record will provide patients and providers with the ability to access, share and use health information. It will improve health care delivery, increase patient safety, reduce ER wait times and create a more effective health care system.

* eHealth Ontario will work with the Office of the Information and Privacy Commissioner/Ontario to ensure the protection of personal health information;
* The Ontario government created SSHA in 2003 to improve patient care through a variety of initiatives, including network hosting and secure e-mail.

Province of Nova Scotia: Electronic Health Record (EHR) Initiatives

Many of the IM projects underway, such as the Nova Scotia Hospital Information System (NShIS), the Picture Archiving and Communications System (PACS), and the primary health care information management program are helping to move us closer to our goal of a portable electronic health record (EHR) for all Nova Scotians.

* Nova Scotia Hospital Information System
* Picture Archiving and Communications System
* Primary Health Care Information Management Program

Newfoundland and Labrador's Electronic Health Record (EHR) Resources

The Centre for Health Information collaborates with Newfoundland and Labrador's health system to ensure quality health information is available for health care, system-wide planning, research, and policy development. Through this collaboration, the Centre has fostered expertise in health information systems development and management, applied health research, data quality and collection, education, and personal information protection.

The Health Information Network (HIN) Division manages the development of infrastructure for secure electronic health records. It is responsible for the management of the HIN that currently connects all health authorities, and in the future will connect other health system stakeholders in the province. Several collaborative projects are currently underway at the Centre which will assist in the development of the HIN and will support person-specific electronic health records, including: the Unique Personal Identifier/Client Registry; the Pharmacy Network; Primary Health Care Information Management System; Diagnostic Imaging/Picture Archiving and Communications System; Laboratory System; and Telehealth.
Read latest news.

- UPI/Client Registry
- Provider Registry
- Pharmacy Network
- Primary Health Care
- Diagnostic Imaging
- Lab System
- Telehealth
- Background Documents
- EHR Links

Monday, December 01, 2008

Province of Manitoba | Provincial Electronic Health Record (EHR) Resources

Manitoba eHealth Vision
The Manitoba eHealth Program will facilitate the improvement and enablement of healthcare delivery transformation through the use of information and communication technology. Manitoba eHealth offers a single integrated organization capable of providing province-wide solutions under the direction of the Manitoba eHealth Board.

Manitoba eHealth Mandate:
• Begin the process for integrating health care systems across regions and care-sectors
• Improve and expand health care services by managing information and communication technology as a single organization capable of achieving economies-of-scale, province-wide
• Improve the efficiency and effectiveness of Information and Communications Technology (ICT) services by leveraging the benefits of a centralized delivery model.

Through a coordinated provincial approach, Manitoba eHealth is working with health care professionals to plan, design and build the necessary systems that will lead to a provincial Electronic Health Record (EHR).

Projects in Progress
Emergency Department Information System (EDIS)
Hospital Information System Project (HISP)
Provincial HISP / Long Term Care Planning
Interoperable Electronic Health Record (iEHR)
Provincial Client Registry
Provincial Lab Information System
Provincial Radiology Information System / Picture Archiving and Communications Systems (RIS / PACS)
Utilization Management System (UM System)

Projects Completed
Clinical Supply Chain Information System (CSCIS)
Lab Information System (LIS) – Winnipeg Region
Primary Data Centre (PDC)
Security Planning
Sterile Instrument Tracking System (SITS)
Surgical Information Management System (SIMS)

Province of Saskatchewan | Provincial Electronic Health Record (EHR) Resources

Saskatchewan Health Information Network (SHIN) manages the development of a province-wide health information network in Saskatchewan. SHIN is funded by Saskatchewan Health and managed by Health Information Solutions Centre (HISC) personnel.

The key roles of SHIN are:
1. To provide information management and technology services to regional health authorities and other health service providers and delivery agencies within Saskatchewan;
2. To deliver the mandate of an Electronic Health Record for Saskatchewan citizens; and,
3. To support health sector initiatives, provide a province wide health information network and securely, centrally hosted health care applications in the HISC data centre.

Electronic Health Record Blueprint
iEHR/Lab Results Repository
Pharmaceutical Information Program
PIP Patient Brochure
Provider Registry System
Public Health Surveillance
RIS-PACS-Archive (Diagnostic Imaging)
Shared Client Index (Client Registry)
Integrated Clinical System

Saturday, November 29, 2008


FOCUS: Ontario's ailing e-health initiative: If e-health is so good, why is it so slow in coming at UHN?

FEATURES: University Health Network’s (UHN) Centre for Global eHealth Innovation’s Kevin Leonard, and former UHN CEO Tom Closson.

The entire TV program can viewed here.

Thursday, November 27, 2008

EHR SPOTLIGHT | British Columbia

The provincial government has outlined several goals and strategies related to health information management in British Columbia:
• Develop a comprehensive Technology Plan. This will help health professionals deliver faster, more effective treatment to patients through new information technology and telemedicine.
• Build a unified, universal and cost-effective health services information network that will improve care and reduce costs.
• Enhance information privacy rights.

Defines how health information management can help achieve British Columbia’s health system's goals and objectives over the next five years.

An overview on how the Province of British Columbia intends on using the secure sharing of integrated health information (EHR) to improve patient care, reduce duplication of services, and enhance management and planning for health service delivery.

Wednesday, November 26, 2008

Differentiating between Single Sign-on (SSO), Enterprise Single Sign-on (ESSO), ESSO with Context, and Clinical Portals.

So you eventually want an EHR.
What’s the best path?
Depends on the goals.

The Evolving Landscape
Healthcare delivery organizations, departments, and stakeholders across the continuum of care use a wide variety of IT systems for storing clinical information that are rarely integrated. This disparate data can result in time-consuming and painstaking efforts to obtain a patient’s complete medical record.

Today, Healthcare organizations have a vested interest in creating an infrastructure that delivers integrated patient information. Not only is the outcome of care improved when caregivers have complete, usable data, but additional benefits are immediately acquired. These benefits include improved operational efficiency, easier compliance with regulatory requirements, a reduced need for investment in IT systems and implementation, the ability to measure and manage quality of care and participate in research, and much more.

Information systems available to healthcare organizations until now have not been able to fully to deliver these benefits. This is primarily due to IT systems lacking a common or standardized method of representing clinical data (nomenclature, terminology, coding systems, etc.). In addition, the high degree of specialization demanded by clinical practices, as well as the tendency of healthcare organizations to adopt a best of breed approach for IT systems implementation, has increased the level of diversity and disparity of data. Consequently healthcare organizations have been forced to settle for basic, limited levels or integration of their clinical applications.

Single Sign-on (SSO) and Enterprise Single Sign-on (ESSO)
Although Single Sign-On (SSO) technology dates back with some vendors to 1996, adoption has been slow. Within the past two years, interest and deployment in this technology have increased, and the solution has blossomed into more than a security solution. This technology is primarily supported by Healthcare delivery organizations to assist their IT departments in their administrative duties.

In its simplest form, Enterprise Single sign-on (ESSO) is an access management mechanism whereby a single action of user authentication and authorization can permit a user (via batch credential provisioning) to access all applications with access permission, without the need to enter multiple passwords. In the Healthcare reality, an ESSO solution by definition can reduce administrative burden, extend access to multiple applications, and increase productivity and user satisfaction.

Imagine ESSO like a Windows Desktop environment. Once logged on, users have access to any/all applications (i.e. MS Word, Excel, PowerPoint, etc.) simply by double-clicking the icon on the desktop. When the application is launched from the desktop, users naturally do not need to sign-in again. However, users still need to navigate through multiple applications, pages, and disparate data to find the clinical information they’re looking for. In a client-server environment, this is further compounded by the time required to launch the application and search for the specific patient’s clinical information. In today’s ESSO reality, to have a comprehensive view of a patient’s clinical data would effectively require launching all the associated applications and searching through disparate data individually. While the user may not need to sign-on to access the systems, it’s clear this isn’t intuitive, nor time or cost effective.

ESSO and Context Management
A conversation about SSO would not be complete without talking about context management. Some may have the impression that investing in a SSO solution means the combination of functionality afforded by both SSO and context management. Providers have expressed problems when their constituency did not understand what they were buying if they were not getting both.

Context management automatically synchronizes multiple applications in response to a single user gesture directed at any application using readily identifiable information such as a particular patient, encounter or observation. Put simply, if using multiple applications simultaneously, a Patient-search on one system can trigger a similar search in other systems. This allows for the user to access each disparate database in context. This technology is primarily supported by Healthcare delivery organizations to assist their IT departments in their administrative duties. When combined with ESSO, Context Management can extend user authentication, patient search, and allow access to multiple vendors’ native applications. More sophisticated implementations can extend context sharing at the encounter level and/or in a bidirectional manner. However, users still require the user to navigate through multiple native applications and pages to find the detailed clinical information they’re looking for. Not ideal but significantly more value than simple (E)SSO.

The premise of ESSO with Context Management implies by definition that ALL users need access to the same finite and highly detailed clinical data found in the specific department or best-of-breed system. Most would agree that the meticulous and detailed needs of those using a Lab system, for example, in the Lab environment, would be significantly different than the data needs of someone in the ER trying to access a Patients Lab results to ensure there is not a conflict. In this model, stakeholders have access to the disparate data via the native application. One of the challenges with this model is that Physicians and Clinicians have to learn and navigate through multiple (departmental or “best-of-breed”) applications to get the patient data they require.

Although steps have been made to try and optimize this delivery model, the question remains. Is this as intuitive and streamlined as it could be? Can it expand outside of a single hospital? Eventually, won’t vendors selling (E)SSO with context realize that stakeholders don’t need access to ALL the clinical information available to do their job more effectively, they need access to the clinical data that is relevant to their specific role. Each clinical stakeholder has different needs.

This author contends that the next wave of (E)SSO with context solutions will add a presentation layer to the offering such that the user is presented only with the clinical data required (versus just access to the clinical data.) However, in the context (no pun intended) of not having any access to any clinical information at the point of care, being able to access the native departmental or best-of-breed application via (E)SSO is still a quantum leap for care delivery. In the face of evolving needs and reducing resources, many opt for this path as any solution is better than no solution.

Clinical Portals
This type of solution involves the creation of a customizable user interface that can work with information from different vendors and sources. Portals are designed for the clinical end-user directly at the point of care and offer the ability to manipulate the way information is presented, in most cases regardless of the legacy vendor. They typically involve a bottom layer that is responsible for aggregation of information, and a top layer in which the information is intuitively presented to the caregiver.

For example, portals can display data any number of ways from different sources in a hierarchical structure or simple “tabbed” environment. Think of a Portal solution (results-wise anyway) as the same integration results as an (E)SSO with context solution, however served up in a customizable web-based offering where the user is presented ONLY the clinical data required (versus just access to said clinical data.)

Unlike ESSO with Context, Portals call data directly from the databases where the legacy data resides, not a duplicate of the original transaction on a repository. This ensures data is queried in real-time, eliminates the need for a centralized data repository (CDR) and associated brokers and can also provide advantages in areas such as flexibility, scalability, availability, and even security to a limited extent, because information remains where it is created and each organization is free to administer its resources as it sees fit.

Moreover, Portals by definition offer unfettered use of the information. Because information is only handled in the presentation tier, the type and depth of data manipulation, cross-reference and analysis are unlimited and can be customized by user. This is primarily because, even though Portals are easy for Hospital IT departments to maintain, administer, and manage---they were originally designed to meet the clinical stakeholder’s unique needs.

One of the strongest differentiators for Portals is the fact that Clinicians and Physicians don’t have to learn multiple (departmental or “best-of-breed”) applications to get the clinical data they require. Users only need their respective departmental solution, and a portal to aggregate all other relevant data. Today’s Portals can accomplish everything a (E)SSO with context can all on a future-ready, scalable, standards-based platform. Although (seemingly) diametrically opposed paths, both ESSO with context and Portal paths can by definition provide a comprehensive, transferrable EHR. The differences are in time to implement and cost.

Future Proof
The realistic and “future proof” way to achieve an actual, real-time picture of a patient’s medical history is with a solution that provides interoperability – creating a unified patient record from the various sources holding patient data, no matter where they are located, or in which format. Any solution implemented must also accomplish this while adhering to privacy and security policies as well as auditing requirements of the organization/s and relevant regulating authorities. Moreover, the solution must be able to resolve issues of identity (name with/without middle initial, married/maiden names, etc.--aka MPI) and to deal with situations in which one patient may have more than one registered identity within and across multiple information systems.

So whether starting from fresh, or currently on a (E)SSO-with-context path and looking for a presentation layer (or EHR/EMR Viewer,) clinical stakeholders need intuitive, customized and streamlined access to relevant patient data. The true benefits of interoperability will only be realized when the integrated patient information is used not only by means of having it presented to the caregiver via a portal of some sort but rather by leveraging the data as a key clinical asset and using it to meet the needs of quality, compliance and management initiatives. The challenges that most organizations deal with in their quest to execute these initiatives mainly revolve around dealing with the lack of access to the broad set of medical data required for successful implementation. A robust interoperability solution holds the key to unlocking this information and turning such initiatives into a reality.

While any given EHR solution theoretically may be achieved via multiple paths, the ultimate vision is to create a single, unified patient record based on data from different information systems, formats, sites and if needed even across organizations, enabling the data to be integrated, analyzed and used – without affecting the systems in which information is stored.