Wednesday, August 13, 2008
In 2005, the Ontario government decided to transfer the operation of Georgetown Hospital from William Osler Health Centre to Halton Healthcare Services. During the transition, historical clinical data was left on the Osler system, and after the transfer, many of the physicians remained at Georgetown and still provided service to Osler. In order to provide clinicians with access to patient data from both organizations, a “provider portal” was deemed the best approach to meet the clinical data sharing needs of physicians and clinicians.
The IT staff from Halton and Osler worked together to identify available vendor solutions, and during the request for proposals process, three other hospitals — Credit Valley Hospital, Trillium Health Centre and Headwaters Health Care — became involved in the evaluation because it was felt they might join the network later. In 2006, Credit Valley acquired a licence for the provider portal; Trillium and Headwaters followed in 2008.
In a presentation at the eHealth Summit, Dan Germain, vice-president, CFO and CIO at Credit Valley, explained how the Rapid Electronic Access to Clinical Health Information (REACH) system was deployed. The REACH provider portal (provided by Medseek) is a web-based Portal solution that consolidates clinical patient data from disparate vendor systems (in real-time) into a unified, patient-centric view regardless of site location.
Currently, the REACH portal allows viewing of allergies and alerts, laboratory results, pharmacy medications, pathology reports, radiology images and reports, ECG tracings, clinical orders, clinical documentation, scanned paper records, rounding reports, and other clinical data. It’s developed on a federated data model, where data is stored at each entity. The REACH server consolidates the clinical data in real time, presenting it to the user in a web browser in milliseconds. It's similar to a Health Information Access Layer (HIAL.)
The REACH portal also employs an Enterprise Master Patient Index (EMPI.) However, once access is granted to use the Ontario EMPI, REACH will interface to that application. The Credit Valley Hospital's IT team was impressed by the speed with which this application was deployed, Germain said. Implementation was accomplished over a few months, and in the words of users, testing was similar to a systems upgrade. Since the application is very intuitive, users required little if any training.
Before deployment at CVH, a privacy impact assessment was performed. The only significant recommendation was to mandate the use of a pass-code keyfob for remote access via the Internet. Since patient-specific data is only stored once, responsibility for data security and integrity remains with each host hospital.
By the spring of this year, William Osler, Halton and Credit Valley were using the provider portal extensively. Every month, hundreds of physicians and clinicians log onto REACH, one-third of whom are users looking at their patients that have been seen at other facilities. There are now over 9,000 views per month. As well as integrating into the Ontario HIAL and EMPI, Germain said future plans for this initiative include additional clinical content such as operating room systems and realtime physiological wave-form monitoring. REACH is also to extend a Patient Portal providing patient's range of other self-care services directly accessible online.
By Richard Pizzi, Associate Editor 08/12/08
Canada's electronic health record projects increased by 12 percent last year and have quadrupled since 2004, according to Richard Alvarez, president and CEO of Canada Health Infoway.
"Canadians want their medical information available electronically to the clinicians who care for them and that's starting to happen in communities across Canada," said Alvarez.
“Collaboration among governments is at an all-time high and with continued federal funding, we are well on our way to providing every Canadian with an electronic health record by 2016."
Canada Health Infoway is an independent, not-for-profit organization funded by the Canadian government. It jointly invests with every province and territory to accelerate the development and adoption of EHR projects in Canada.
Infoway approved $311.5 million in new EHR investments in 2007-08, bringing the total cumulative value of its investments to $1.457 billion, or 89 percent of Infoway's $1.6 billion in capitalization by the Canadian government. The investment brings the total number of projects underway to 254, representing a four-fold increase from the 53 projects that were underway in 2004.
"The electronic health record projects the government of Canada is investing in are coming alive (and) bringing tangible results," said Tony Clement, Canada's federal minister of health.
Clement noted, for example, that in Nova Scotia, a shared diagnostic imaging program provides digital images of X-rays, MRIs, CT scans and ultrasounds to authorized healthcare providers. He said patients in Canada's remote northern communities are connected with healthcare professionals in urban centers through telehealth, and electronic medical records are generating results in the face of growing clinician shortages and administrative demands.
Alvarez said he's seeing steady progress in all Infoway-funded electronic health record programs including registries, diagnostic imaging and laboratory and drug programs. He said Infoway would continue to target investments in "replicable solutions that support health system transformation, such as telehealth and public health surveillance."
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