CANADIAN'S AND THE RUSE OF HEALTHCARE 2.0

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

The task of building an information network that patients, providers, managers, and policy-makers can use to improve decision-making at all levels is truly daunting (and the health information “agenda” competes with innumerable other claims on resources.)

That said, Canada’s Healthcare Informatics arena is rapidly changing, primarily due to growing public and private investment in Electronic Health Information Systems (EHIS). At the same time, a recent economic study (November 2009) identifies a serious need for increased labor and skills amongst Canadian Health Information (HI) and Health Information Management (HIM) professionals over the next five years. To compound further, there are fears in both the private and public sector that the successful implementation of EHIS systems is potentially jeopardized due to lack of qualified human resources. Add to this - - issues around Canada Health Infoway Funding, a limited and flawed EHR blueprint, Federal and Provincial politics, lobbying, posturing, competition, and (yes) corruption - - and it’s easy to see how a feast or famine (all or nothing) environment has been established.

From a consumer standpoint in Canada, advancing patient care has also unfortunately been tied directly to those vendors that have the bandwidth to extend a provincial or national solution (even if those platforms are antiquated and in many cases not standardized). This discussion (and subsequent funding) is entirely based on resources, and while absolutely a relevant conversation - - in practice - - has only left Canadian’s with a sub-par platform and an increased tax-burden.

So, while increasing evidence (and PR buzz) attempts to illuminate progress in extending a Canada-wide EHIS - - it’s really only proven to be lip service. As political pressures mount, huge contracts are extended to vendors who are in many cases no more equipped to deliver an integrated EHIS than a local start-up.

The best example one might extend related to the state-of-the-union of Canadian EHIS is from the “Wizard of Oz”.  One might think that it’s only a matter of time before Canadian citizens get wise to the kick-back’s, cost over-run’s, deception, and general systemic corruption in Canadian EHIS. Let’s not even get started on the role of “Consultants” in all of this. The unfortunate challenge is that, unless one is deeply entrenched in this sector for a number of years - - most investigations are only typically scratching the surface.

Neither the Canadian Government nor any of its elected bodies have yet to even get close to the real issues (and savvy multi-national vendors are well aware of this and capitalizing on it.) When Canadians finally pull back the metaphorical ‘curtain’ to see the ‘Wizard’ pulling furiously on ropes and levers - - to attempt to evidence progress - - they’re going to wonder whose hand was on the wheel?  Just take a look at the long, detailed (and growing) list of Federal and Provincial resources (i.e. dollars) allocated to accomplishing specific EHIS tasks that are never completed or even accounted for.

To be continued...

Province of Ontario: Ex-eHealth Chair quits ... again

August 14, 2009 | The STAR | QUEEN'S PARK BUREAU

Hudson's resignation from health ministry comes as PM wades into spending scandal. Premier Dalton McGuinty's go-to man in reducing health-care wait times has left the government – less than two months after being replaced as chairman of the scandal-ridden eHealth Ontario.

Acclaimed neurosurgeon Dr. Alan Hudson last week resigned from his full-time, $292,653-a-year job leading the province's efforts to reduce delays in cancer and cataract surgery, diagnostic imaging, cardiac procedures and hip and knee replacements. Reached on vacation with his family, Hudson said in an interview that he consulted Health Minister David Caplan and others before deciding to step down last Friday after five years in the job.

"Everyone wanted me to stay on, but I am not going to stay on until I die," said the 71-year-old Order of Canada recipient. "It is time for me to do other things – play with my grandchildren, do some travelling."

The news, first reported on thestar.com, came as Prime Minister Stephen Harper yesterday waded into the eHealth spending imbroglio – in which consultants who were paid as much as $3,000 a day raised public ire by expensing tea and Choco Bites cookies – with a caustic rebuke of McGuinty for costly delays in creating electronic health records for Ontarians.

"The federal government had in its budget considerable funds available for the (Canada) Health Infoway, for the expansion and pushing forward of the project to make health records in this country electronic, so I obviously would encourage the provincial government to get on with rectifying the problems in that area."

Senior provincial officials countered that the federal government has not yet given Ontario the cash for electronic health records. Because he was on contract, Hudson will not receive a golden handshake like the $317,000 given to departed eHealth chief executive Sarah Kramer, who finally broke her silence yesterday with an acerbic statement slamming the media and health ministry bureaucrats.

"There's no severance," said Terry Sullivan, chief executive of Cancer Care Ontario, where the wait times offices are headquartered. He noted Hudson was rattled by the eHealth experience, which became a major political headache for McGuinty, prompting him to clamp down on untendered contracts to consultants and the meals and treats they expense to taxpayers.

"He was distressed and troubled by the whole experience. ... I assume that was part of his calculus," Sullivan said of Hudson, crediting him for the innovative wait-times system that began tracking treatment times with an eye to improving them. A replacement for Hudson on the wait-times file has not been determined, but Sullivan urged the government to do so, noting that general surgeries will eventually be added to the list.

Hudson's departure is a further blow to McGuinty's Liberals in the wake of the eHealth debacle, in which revelations of spending abuses have continued to emerge – including an estimated $25,000 spent on writing and tweaking a speech for Kramer. She left the agency in June amid furor over executive perks, big bonuses and untendered contracts that total at least $16 million of taxpayers money. Kramer's 448-word statement issued yesterday appears to have been triggered by McGuinty's declaration Wednesday that it was a "mistake" to put her in the job.

She defended eHealth's hiring of (overtly) highly paid consultants, saying she had to take over a "moribund and deeply troubled and dysfunctional organization." While she acknowledged the expense was "not negligible," she deemed it an "essential investment" in speeding progress to creating electronic health records.

"As with any major change, our efforts were met with strong, intractable resistance and outright hostility in some quarters, including within the Ministry of Health and a few other vested interests in the health care sector," Kramer wrote, also blaming "sensationalized media coverage." She did not respond to requests for an interview.

Hudson defended Kramer's performance, saying she did the best she could to bring electronic health records to the masses. "She is not a dreadful person," he told the Star.
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Province of Ontario fires eHealth boss Sarah Kramer over spending scandal

As identified in this publication on March 30th, 2009 (related to eHealth Ontario),"If it doesn’t work the first (second or third) time---rebrand and start over. Taxpayers have short memories." So let's be clear... what is being identified today by the National Post as an 'Important step to restore public confidence'---is really the forth time the Province has gone through this step. When will we ever learn?

There's a name for those who do the same thing over and over again and expect different results. Apparently that name is the Ontario Government---as yet another scandal over lavish spending at eHealth Ontario has claimed the career of a top public servant.

The provincial government said yesterday it was revoking Sarah Kramer's appointment as president of the agency in charge of creating electronic health records. Ms. Kramer has been dogged by reports that she has been involved in questionable procurement practices where large contracts -- totalling $5-million -- were awarded without tenders from September, 2008, to January, 2009.

The contracts revealed a tangle of relationships between many senior eHealth officials, including Ms. Kramer, board chairman Dr. Alan Hudson and their former colleagues and associates.

Ontario Health Minister David Caplan said yesterday he was revoking Ms. Kramer's appointment after "many valid concerns have been raised regarding eHealth Ontario."

Calls for Ms. Kramer's resignation had been growing as opposition members accused Mr. Caplan of endorsing the lavish and questionable spending at eHealth Ontario through his inaction. Conservative party researchers obtained details of the contracts through Freedom of Information requests.

Ron Sapsford, Deputy Minister of Health and Long Term Care, will now serve as acting president and chief executive officer of eHealth Ontario.

Mr. Caplan said he asked the board of eHealth to "launch a third-party review of the agency, overseen by a government auditor," and asked for a prompt review by the Auditor-General.

Mr. Caplan said the move was "an important step to restore public confidence in the agency and its mandate of modernizing our health care system."

However, replacing the head of eHealth does not end the scandal for the Liberal government, opposition critics said.

Bob Runicman, the Progressive Conservative party leader, said Mr. Caplan himself needed to step down and suggested Ms. Kramer should repay some of her compensation.

"A so-called resignation on a Sunday afternoon that is clearly designed to avoid public scrutiny is simply not acceptable," Mr. Runciman said in a written statement. "The buck stops with Health Minister Caplan. He needs to quit now, and stop taking the easy way out by assuming he's off the hook with Ms. Kramer gone. If he won't leave on his own, the Premier should show him the door."

He also said Ms. Kramer needs to do more than step down.

"In these especially tough economic times, when taxpayers don't get value for their hard-earned money, it should be paid back," he said.

"We expect the Minister to reveal today the exact amount of Ms. Kramer's compensation package, and whether or not she has been asked to pay back any of her lucrative salary, hefty bonus and extravagant expenses."

Ms. Kramer will get $317,000 in severance pay, but will forego the bonus and benefits stipulated in her contract. According to Caplan spokesman Steve Irwin, Ms. Kramer will be required to pay back some of that money if she gets another job in the next 10 months.

The contracts engaged by eHealth Ontario have been under increasing scrutiny.

Three contracts totalling nearly $2-million, for example, were awarded to Courtyard Group, whose founding partner, Michael Guerriere, worked closely with Dr. Hudson for years. Mr. Guerriere's wife, Miyo Yamashita, was the beneficiary of a four-month, $268,000 contract, as managing partner of Anzen Consulting Inc.

Conservatives released documents last week showing Ms. Yamashita, who as a partner at Anzen was responsible for developing a communications and media strategy, billed eight hours (at $300 per hour) for tasks that included sending herself e-mails and calling herself to ask follow-up questions.

The documents also show a senior vice-president, Donna Strating, was expensing $3 snacks and even cheaper soft drinks even as she earned $2,700 per day.

Other reports indicate Ms. Kramer listed an Accenture Inc. executive as a reference when applying for the full-time CEO job. Accenture benefited from three single-sourced contracts worth $1.3-million, two while Ms. Kramer was advising the board but not yet hired and a third shortly after she was hired in November.

GOOGLE HEALTH ACCUSED OF INACCURACY IN ELECTRONIC MEDICAL RECORDS

Google Health, Google's health care IT solution, has been taken to task by physicians who say the billing information it uses for some patients' electronic medical records can give an inaccurate picture of their health conditions. Since rolling out in Feb. 2008, Google Health has been positioned as competition for Microsoft's health care IT offerings, as well as sites such as WebMD.

Google is encountering protests from users who say the information its Google Health beta Website presents has the potential to be inaccurate when it comes to electronic medical records. Much of the online traffic over the issue has stemmed from one particular case, that of kidney cancer survivor Dave deBronkart, who transferred his medical records from Beth Israel Deaconess Medical Center to Google Health, only to find that the latter had taken information from his billing records to incorrectly state that he had chronic lung disease and other conditions.

"I've been discussing this with the docs in the back room here, and they quickly figured out what was going on before I confirmed it: The system transmitted insurance billing codes to Google Health, not doctors' diagnoses," deBronkart wrote on his personal blog on April 4. "And as those in the know are well aware, in our system today, insurance billing codes bear no resemblance to reality."

He also wrote, "I suspect processes for data integrity in health care are largely absent, by ordinary business standards. I suspect there are few, if any, processes in place to prevent wrong data from entering the system, or tracking down the cause when things do go awry." deBronkart took care to say the post was not "a slam on Google Health."

However, the story reached the Boston Globe on April 13 under the title "Electronic Health Records Raise Doubt." The article quotes deBronkart's primary physician, Dr. Daniel Sands, as saying the information from billing records, incorporated into Google Health, should never be used clinically.

When contacted by eWEEK, a Google spokesperson referred to the Globe article's quoting of Dr. Roni Zeiger, product manager for Google Health, as saying having such information available online will benefit users in the long term as the solution's accuracy improves.

"That's something I think we could do better on," the article quotes Zeiger as saying with regard to whether Google Health indicates the source of data for each diagnosis.

A number of online pundits have stated that physicians and other health care providers should be concerned about the importing of insurance billing records into Google Health precisely because of this lack of accuracy. Google has not posted a response on its blogs yet. 

Google upgraded Google Health in March 2009 to allow users to share medical records and other personal health information with doctors and trusted contacts. The announcement was greeted with skepticism by some users, who voiced privacy concerns.

That same month, Google unveiled that it was participating in a pilot program with the CMS (Centers for Medicare & Medicaid Services) that would let Medicare beneficiaries in Arizona and Utah import their Medicare claims data into Google Health. First introduced in February 2008, Google Health allows Google to share competitive space with Microsoft's health care IT offerings, as well as Websites such as WebMD.

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PROVINCE OF ONTARIO UNVEILS YET ANOTHER ELECTRONIC HEALTH DATA PLAN

March 30th, 2009
If it doesn’t work the first (second or third) time---rebrand and start over. Taxpayers have short memories.

To this end, Ontario has unveiled another round; a $2.1 billion strategy that hopes to give every diabetic patient in the province an electronic health record by 2012. Apparently the original $650 million was required to ensure the "right people" are working on the initiative.

The "eHealth Ontario" initiative will also connect doctors, patients and pharmacists electronically to better manage the flow, safety and effectiveness of prescription drugs and cut wait times at Ontario hospitals, the head of the group developing the program says.

"There is a very clear line between investing in information and information technology in these three areas and seeing improvements from a patient perspective," says Sarah Kramer, president of eHealth Ontario.

The 53-page strategy aims to have 65 per cent of the province's primary physicians and two-thirds of their patients hooked up to the electronic medical data by April 2012. The eHealth agency was formed last September after a previous costly and controversial program failed to produce viable health record plans.

The original program, called Smart Systems, had been created in 2002, employed 300 people and wasted $650 million as part of its mandate to electronically link and support Ontario's 150,000 health-care providers. But a 2007 operational review found it was riddled with delays, lacked any accountability and its privacy policies were incomplete.

When the new, restructured and rebranded agency was formed, the province brought in Dr. Alan Hudson - head of Ontario's drive to shorten wait times in key areas. Hudson, who is chair of eHealth Ontario, quickly created a new board of directors filled with Bay Street notables.

Conservative health critic Elizabeth Witmer called Ontario's record on eHealth extremely poor. "(The government) has already invested half-a-billion dollars and we have seen NO results," she said. One might think there would be greater accountability. Or any!? In an attempt to prove, if you throw enough money at something it looks like progress, the new agency says its goal is to have enrolled 100 per cent of physicians and all of their patients by 2015. It also would like to see 65 per cent of medication orders filled electronically in three years with 35 per cent of physicians ordering drugs via secure, electronic prescriptions.

Key to the program, Kramer says, is the enrollment of as many as 800,000 diabetes patients in the province into the electronic record system. Currently, Kramer says, only half of diabetics receive the kind of basic, preventative checkups that can keep them out of hospital by catching common complications of the disease before they cause acute harm. The plan will implement a tracking system that will allow physicians and patients to follow care and alert them when any of those signal examinations are due or have been missed.Both physicians and patients will be able to access this information through the use of passwords.
On the pharmacy side, Kramer says the electronic triangle the strategy will form between patient, doctor and pharmacist will cut back significantly on the frequent mistakes that accompany prescription drug use.

Kramer says the strategy will cut wait times most significantly by keeping diabetics out of hospital. Once the infrastructure and training are in place, it will be easier to bring other diseases into the electronic system. The money, approved by the provincial cabinet in May 2008, will also fund such programs as Ontario Telemedicine Network, which provides over-the-phone medical advice to hundreds of people annually. Dennis Darby, head of the Ontario Pharmacists' Association, welcomed the new strategy. "It certainly will allow pharmacists to provide better patient care," he says.


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HAMILTON HEALTH SCIENCES (HHS) WINS MEDSEEK’s 2009 eHEALTH EXCELLENCE AWARD

MEDSEEK recognizes HHS for its outstanding web portal vision, innovation, performance and achievement.

BIRMINGHAM, Ala.--(BUSINESS WIRE)--MEDSEEK, the leading provider of enterprise portal connectivity solutions, announced today that Hamilton Health Sciences (HHS) won MEDSEEK’s 2009 eHealth Excellence Award for outstanding vision, innovation and performance in using web portal technology to enhance care delivery, information access and service. The award was presented to Dale Anderson, HHS’ manager of projects and eHealth solutions, at MEDSEEK’s 9th Annual eHealth Client Congress in Tampa, Fla., on Feb. 25, 2009.

Hamilton Health Sciences is one of the most comprehensive health care systems in Canada. Its six hospitals and cancer facility are licensed for more than 900 beds and serve more than 2.3 million residents of Hamilton and central south and central west Ontario. Through its affiliation with McMaster University's Faculty of Health Sciences, HHS offers some of the most innovative treatments and talented medical professionals in Canada.

“MEDSEEK is pleased to recognize HHS for the exceptional efforts it has made to provide safe, high quality care as well provide a total user experience throughout the entire healthcare system,“ said Peter Kuhn, MEDSEEK’s CEO. “We are excited to acknowledge the impact our portal solutions have had across HHS’ enterprise and among its physicians, patients and employee constituencies.”

Over the past 4 years, more than 2,700 HHS clinicians have registered to access its patients’ electronic medical records in real time via a portal called ClinicalConnect. Through this portal, clinicians have access to a unified, single view of a patient’s clinical reports, laboratory results, medication lists, images and other data stored in disparate clinical systems. These systems include a hospital information solution from MEDITECH, picture archiving and communication system from GE Healthcare as well as a health information management application from Sovera Document Imaging.

In 2007, HHS redesigned its consumer portal to make it easier and more convenient for patients and visitors to access health information and interact with the organization. The consumer portal provides greater emphasis on patient education and included an upgrade of the existing infrastructure to make the site more stable and reliable for end users.

HHS, which is the largest employer in Hamilton, has also implemented an employee portal to disseminate and streamline communication with its more than 10,000 employees, improving efficiency, productivity, job satisfaction and staff retention. Employees are using the portal to access staff directory, schedules, internal job postings, training and more, helping HHS’ human resources department operate more efficiently.

“We are honored to be recognized by MEDSEEK for excellence in the use of eHealth to improve patient care, safety and operational efficiencies,” said HHS’ Anderson. “We chose to partner with MEDSEEK for its unparalleled insight into healthcare technology innovations and best practices, and its focus on the user experience which has truly transformed and streamlined our ability to provide quality patient care.” Although ClinicalConnect began at Hamilton Health Sciences, it is now being extended and adopted by the Local Health Integration Network or region to interconnect other hospitals, community healthcare agencies and healthcare providers.

About Hamilton Health Sciences
Hamilton Health Sciences is a family of six unique hospitals and a cancer centre, serving more than 2.3 million residents of Hamilton and central west Ontario. Hamilton Health Sciences is the second largest hospital group in Ontario and serves as a regional referral centre for burns, trauma, cardiac, stroke, neurosurgery, pediatrics, digestive diseases, high-risk obstetrics, cancer, orthopedics and rehabilitation services. With a staff of approximately 10,000, the hospital is the largest employer in Hamilton, Ontario. As an academic teaching hospital with more than 900 beds and an affiliation with McMaster University and Mohawk College, Hamilton Health Sciences is committed to providing exemplary health care for the people and communities we serve and advancing excellence in education and health research.

About MEDSEEK
For more information, visit www.medseek.com or call 888-MEDSEEK.

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WAL-MART TO SELL LOW-COST ELECTRONIC HEALTH RECORD SYSTEMS in the US

It seems everybody wants in on the action. Known for its low-cost food, clothing and appliances, Wal-Mart soon will be offering reasonably priced electronic health record systems.

In a story apparently leaked to the New York Times earlier this week, the big box store will join forces this spring with Dell computers and eClinicalWorks, a provider of healthcare information technology, to offer low-cost EHR systems to physicians, The New York Times reports. Systems are expected to only cost $25,000 for the first physician and $10,000 for additional physicians in a particular (non-acute care) practice.

What's included? Dell is offering its laptops and tablet PCs for physicians to use. eClinicalWorks will provide its electronic health record and practice management software. eClinicalWorks is an Internet-based service that also allows physicians to manage billing and registration online. Dell will install the hardware, while eClinicalWorks will be responsible for installing its software on the PCs, as well as for training and maintenance of the system.

A $19 billion healthcare information technology initiative in the recent stimulus package would provide physicians more than $40,000 over several years for implementation of EHRs, according to the Times.

A former Bush administration healthcare IT official told the Times that such low-cost EHR systems from Wal-Mart could be a "game changer" in the industry's efforts to spur adoption of the technology. Long-term care is working with the rest of healthcare to contribute its portion to the development of an electronic health record system. Bush had set a goal of 2014 for the establishment of such a system.

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Vendor Profile: DIGIRAD CORPORATION

After numerous grants from the Department of Defense, the National Cancer Institute and the U.S. Department of Energy, in 2000, DIGIRAD CORPORATION notably brought the first commercial solid-state gamma camera for nuclear medicine to the market.

Today, publically-listed DIGIRAD CORPORATION provides advanced cardiovascular imaging services solutions and solid-state nuclear medicine imaging products to nearly 1,000 clients worldwide. Notably said to be a “textbook example of how a company paid close attention to market conditions and was able to carve out a unique product opportunity. DIGIRAD's proprietary technology is based on solid-state semiconductor technology, which was developed in-house and originally used in defense technology applications.”
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More about DIGIRAD.
Note: DIGIRAD is distributed in Canada by ADN Canada (www.adn-nichemedical.com)

VENDOR PROFILE: Thinking Systems Corporation

KLAS® Award Winning THINKING SYSTEMS CORPORATION is the developer of ThinkingPACS™ and ThinkingRIS™ ---a comprehensive imaging suite (that includes an advanced Nuclear and Cardiology toolset) and extends well beyond traditional radiology modalities such as CT, MRI, DR and CR.)

Imagine an enterprise-wide, multi-disciplinary, integrated, vendor-neutral (web-based) imaging solution using one database. Thinking Systems seamlessly manage and store nuclear medicine, PET, echo cardiology and Cath lab images; supporting image registration and even fusion among multimodalities (i.e. PET, SPECT, CT, MR, etc.,) including image quantitative analysis (for cardiac and brain studies) and orthopedic templating. Providing truly customized implementations, Thinking Systems translates the power of its versatile product portfolio and expertise into highly effective solutions tailor-made for each installation.

THINKING SYSTEMS solutions are installed worldwide in leading hospitals, research institutes, imaging centers, and doctor’s offices, including US notables like Yale, Mass General, Univ. of Miami, and Kettering Medical Center.

In Canada, THINKING SYSTEMS are utilized by the Humber River Regional Hospital. Mount Sinai Hospital (MSH,) Women’s College Hospital (WCH,) Toronto Western Hospital, Toronto General Hospital, Princess Margaret Hospital (PMH,) the University Health Network (UHN,) and a number of clinic sites.

Intuitive. Intelligent. Innovation. | Thinking Systems

More about Thinking Systems Corporation. Note: In Canada, Thinking Systems solutions are provided by ADN Canada (www.adn-nichemedical.com)

CALL FOR SUBMISSIONS

ACUMEME is seeking articles, commentary and ideas on the state of electronic health records (EHR) and e-Health 2.0 in Canada. Have something to say? Here’s your sounding board. Anonymity assured. E-mail us at acumeme@yahoo.com.

Government of Canada Supports Electronic Health Record System that Will Save Time and Lives

Wed., Feb. 11, 2009 | OTTAWA, ONTARIO
The Honorable Leona Aglukkaq, Minister of Health, today announced that the Government of Canada, through its Economic Action Plan, is continuing to support the creation of health information systems designed to benefit Canadians by saving time and lives, while also creating economic stimulus.

Support from Budget 2009 will assist Canada Health Infoway in implementing electronic health records. It will also speed up the implementation of electronic medical record systems for physicians, as well as connect hospitals, pharmacies and community care facilities.

"An electronic health record system will improve the safety and accountability of the overall health-care system," said Minister Aglukkaq. "It will save time and lives by reducing duplication, improving the management of chronic disease, improving access to care and boosting productivity. This will result in a positive contribution to Canada's economy, including the creation of thousands of sustainable, knowledge-based jobs throughout Canada."

Many other countries are following Canada's adoption of electronic health records, which give health-care providers a complete picture of their patients' health history and help them to provide better care. Electronic health records will also help to reduce wait times by speeding the flow of information through the system, eliminating duplicate or unnecessary tests, and reducing hospital stays due to adverse drug events. Automated alerts and reminders will help to reduce medication errors and remind health-care providers of necessary tests or vaccinations.

Funding of $500 million announced today is in addition to $400 million in support provided to Canada Health Infoway in Budget 2007. This brings the Government of Canada's total commitment to this initiative to $2.1 billion. Since its inception, Infoway and its provincial and territorial partners have made good progress in making electronic health records a reality in Canada. Across the country, increasing numbers of Canadians and health-care providers are gaining access to health information through secure electronic systems.

"The Government of Canada's continued investment in the development of electronic health record systems across Canada will result in continued modernization of the health-care system, with tangible results for Canadians in every corner of the country," said Richard Alvarez, President and CEO, Canada Health Infoway. "In addition to benefiting the health system, electronic health records are also reducing operating costs and stimulating the economy by creating thousands of jobs."

Canada Health Infoway is an independent, not-for-profit corporation established in 2001 to accelerate the development of health information and communication technologies such as electronic health records (EHR's), telehealth, and public health surveillance systems on a pan-Canadian basis. Its members are the 14 federal, provincial and territorial Deputy Ministers of Health.

See Health Canada News Releases

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Canada Health Infoway Launches new Canadian e-Health Certification

The government-funded organization works to accelerate the adoption of electronic health records in Canada. Its new e-health certification aims to make consumer health vendors bake more security, privacy and interoperability features into their applications.

Canada Health Infoway is launching a new certification service for vendors who create consumer e-health applications. The non-profit organization hopes its new e-Health Certification Service will encourage health IT vendors to take advantage of the considerable progress Canada has made in setting standards and deploying interoperable electronic health records. With interest in consumer health products continuing to grow, ensuring these solutions work well with technologies used to store Canadian health data is essential.

These products can help individuals organize their health information and gather medical records from doctors, hospitals and pharmacies. It can also help doctors keep up-to-date on changes to your digital health records.

“The key word is interoperability and this should be the driving force for technology solutions in all sectors,” John Reid, president and CEO of the Canadian Advanced Technology Alliance (CATA Alliance), said. “In the health care sector, you want solutions and information to be portable from one geography to the other and that’s the whole idea behind these standards.”

Bernard Courtois, president and CEO of the Information Technology Association of Canada (ITAC), also applauded the national standard and said it could boost the confidence of the market considerably.

“It’s a sign that electronic health is making progress and reaching the consumer world, not just the health care system world,” he said. “Canadians will realize that e-health is something they can’t do without in a modern health care system.”

In addition to better interoperability, organizations investing in certified e-health solutions can also expect a high degree of confidence that the products they buy meet stringent security standards. When applying for certification, a vendor will need to fill out a self-assessment form on how well their product meets Infoway’s standards. After passing this stage, vendors will have to “provide an overview of their privacy policy” and “demonstrate very specific test scripts through their applications,” according to Shelagh Maloney, Infoway’s executive director of external liaison.

“Our ultimate goal is that buyers of these systems, especially the health organizations, will make it a mandatory requirement in their buying process to purchase consumer health platforms certified by Infoway,” she said.

Maloney, however, did not want to comment on the specific costs vendors can expect to pay for going through the certification process. Courtois said that whatever the costs might be, they need to be affordable in order to allow smaller companies a chance at becoming certified.

Traditionally, the problem with certifications is that there’s just too many of them, he added, “if you have to obtain multiple health certifications, it can waste lots of time and money, and really doesn’t provide much help for the buyers,” Courtois said. “This makes things tougher for smaller companies, but it’s also an expense for larger companies and it would be naïve to think that the cost doesn’t get factored back into when they sell the application.”

Reid added that by creating cost-effective – but also well-respected – national standard, vendors can truly differentiate themselves and improve the e-health application market.

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White Paper | Electronic Health Information: The Key to Evidence-Based Medicine and Improved Patient Care.

Sponsored by: BEA/Oracle8/ OCT 08.

This (U.S.-based) Government Insights White Paper provides background information on the healthcare industry in the United States and the challenges and opportunities associated with leveraging technology and electronic health information to promote more effective care delivery across a broader patient community.

This paper also highlights two case studies that demonstrate how technology can serve as a key component of effective healthcare by creating the data framework for evidence-based medicine (EBM).

DOWNLOAD WHITE PAPER

Global Snapshot: National and Regional Electronic Health Projects

Global Perspective: Electronic Health Records (EHR)

HIMSS Global Enterprise Task Force (GEFT) investigates implementation of EHR’s in 15 countries around the world.

Recognizing common threads that affect all Electronic Health Records (EHR) implementations in 15 countries, the Global Enterprise Task Force of the Healthcare Information and Management Systems Society (HIMSS) has released “Electronic Health Records: A Global Perspective.”

The extensive study reviewed healthcare IT progress in Europe, Asia Pacific, Middle East and North America. A 16-member task force looked at various EHR components within each country, including, security, quality, financing sources and barriers to adoption. The 119-page report presents findings on EHR implementation by country. Each chapter features an overview of the country’s electronic health record status followed by a review of achievements, barriers and recommendations in the different areas.

DOWNLOAD REPORT (.pdf)

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The HIMSS Global Enterprise Task Force (GEFT), formed in 2006 under the HIMSS Enterprise Information Steering Committee, includes industry leaders from around the world who provide expert analysis from a local perspective. The work group plans to update and expand the report in future editions and calls on interested health IT experts throughout the world to contribute. Contact the HIMSS Europe office at europe@himss.org for more information on participation.

About HIMSS.

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Global Perspective: China’s “Green Book” and Personal Health Record’s

PHR: Is There an Easier Way? The Chinese “Green Book” achieves some goals currently unattained in the U.S.

Perhaps this will be the year Personal Health Records (PHRs) will catch on with the public and begin realizing their potential. There is certainly no shortage of products available. Nor is there a shortage of approaches to the technology, level/type of information stored and sophistication of tools. Surveys indicate PHR's are gaining the interest of the American health care consumer and suggest that large-scale usage cannot be too far off. Nonetheless, the PHR still has the lowest adoption rate of any major EHR function in hospitals and physician offices.

Are we over-complicating the concept of the PHR? After all, patients have always been the primary source of information about their personal illnesses and injuries, but now that we are starting to utilize technology, create laws, and develop policies and procedures about such information, we may actually be creating problems. Perhaps we could learn a lesson from China — where a simple, yet remarkably effective (in some ways,) version of the PHR is in widespread use.

The Green Book
Patients visiting many of China's public hospitals for outpatient care receive a "green book" that constitutes their ambulatory patient record. During the course of a patient visit, the doctor enters clinical notes such as patient complaint, test results, diagnosis and prescribed medications. All notes are handwritten.

At the conclusion of the visit, the physician gives the 'Green Book' back to the patient or other responsible party. When the patient returns for treatment or medication refill, he/she must bring the 'green book', which the physician uses to maintain continuity of care. Neither the hospital nor the physician keeps a copy of these ambulatory records; the patient receives the sole copy.

A number of concerns seemingly make this approach unworkable in the U.S., such as the risk of losing the record, the potential for unauthorized changes to it, legibility issues and the need for a legal business record. But despite its shortcomings, the 'Green Book' achieves some goals currently unattained in the U.S.:

Portability: So long as the patient brings their 'Green Book' to the visit, it can be shared with any provider without hassle or delay.

Interoperability: Could U.S. interoperability issues really be a euphemism for "I don't want to do it?" Are we making it too hard by trying to be perfect?

Patient Accountability: The responsibility for preserving, protecting and presenting the record belongs to the patient. The U.S. is not advocating that the health care system place such responsibility and accountability entirely on the patient, but maybe sharing would be beneficial?

General Standards: The standards for use, format and content are high-level, achievable and appear to be well-accepted.

Physician Acceptance: It appears that virtually all caregivers who are supposed to use the green book actually accept it. The temptation for individuals to replace it with something they like better appears to have been resisted.

The Chinese are not drowning in worthy options. The green book PHR concept is simple, especially in comparison to American high-tech options. However, sometimes our technology becomes as much a barrier as a solution and large-scale PHR adoption will not occur in the U.S. until the outlined goals are achieved using technology as an enabler.

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Original Article by Michael R. Cohen, CPHIT, CPEHR, FHIMSS, and Margret Amatayakul, RHIA, CHPS, FHIMSS.

Health Care in Canada Report (HCIC 2008)

Health Care in Canada 2008 (HCIC 2008) is the ninth in a series of annual reports on Canada's health care system by the Canadian Institute for Health Information (CIHI.)

The Health Care in Canada (HCIC 2008) Report provides a review of key analytic work undertaken at CIHI that highlights CIHI's health care research priorities (access, quality of care, health human resources, funding/costs, etc.). Also included in this report is a review of seminal national and international health care research as it maps onto these health care priorities. HCIC 2008 is a tool for health care researchers, persons involved in strategic decision-making in health care, the media and Canadians in general to identify current priorities in health care.

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About CIHI
The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.