Google Health beta -- What's really new and different?

May 23, 2008 | Google Health beta -- What's really new and different?
By David Kibbe

From his role as Director of Health IT for the AAFP, co-creator of the CCR and with his involvement behind the "NDA firewall" with the Google Health team, David Kibbe probably has a better vision than most about what's new and different with Google Health. And he is indeed optimistic.

Much of the discussion about Google Health beta's recent launch as an online PHR or healthURL seems to me to miss the point about what is really new and different. Here's how I see it:

1) Computability. What Google Health does that no other platform is yet capable of doing is to make personal health data both transportable AND computable. Right now, this is the news. By supporting a subset of the Continuity of Care Record (CCR) standard for both inbound and outbound clinical messages, Google Health beta makes it possible for machines to accept, read, and interpret one's health data. It is one thing to store health data on the Web as a pdf or Word text file, for example one's immunizations or lab results, where they can be viewed. It is a giant leap forward to make the data both human and machine readable, so that they can be acted upon in some intelligent way by a remote server, kept up-to-date, and improved upon in terms of accuracy and relevance. That is what the CCR xml subset supported within Google Health beta achieves for the consumer that is really new and different; this is what HealthVault and Dossia are to date missing.

Right now, those web services are only mildly useful and sort of "toyish" -- allowing the user to create a meds calendar and get email reminders (ePillBox), or setting up preferences for health and medical news searches (MyDailyApple), or suggesting alternative medications to the ones you now take (SafeMed). But disruptive innovations are often considered simplistic and compared to toys when they first emerge (remember the first Apple computer?) and there is no stopping these developers and these partner companies from making their services more intelligent, more useful, and more convenient to the consumer. Which brings me to ....

2) Rapid design evolution. Google Health beta has established a robust and growing community of programmers and developers eager to attach their widgets, services, and full-scale apps to the Google Health beta juggernaut. Most of the public doesn't see this activity, because it is hidden behind the Google NDA that the developers have to sign, swearing themselves to secrecy about what's going on at Google Health. But it is an enthusiastic, really smart, and tirelessly innovative group of people who have been attracted to the Google Health platform. They are going to help Google's engineers rapidly evolve the design of Google Health over the next few months and years, in ways that are completely impossible to predict, depending mainly on how fast Google Health's operators are willing to move. Design creates value, and value causes infrastructure to change. Modularization of the entire EHR and PHR space may now be possible.

While I recognize that most of the commentary about Google Health beta and Microsoft HealthVault will concentrate on privacy concerns, barriers to data entry, and questions about whether mainstream health data sources will participate or not, I think the disruptive potential has already been unleashed. Watch what happens as the Google Health platform modules and component services grow and start to interact with one another. Read original article.

The Emergence of the Patient Portal

It stems to reason that most people would prefer to investigate their health concerns online before visiting a Physician. Studies indicate that these same people report that what they find online influences their treatment decisions. What’s clear that today’s patients are becoming better informed and more web savvy; increasingly seeking services that allow them to take an active role in managing their health.

As the healthcare industry shifts its focus to Electronic Medical (Health) Records, many forward thinking practices are asking vendors about “Patient Portals.” A portal can be thought of as a gateway or door (in the form of a web interface) to related sets of data, content, and web services. Some well known portals include Google (www.google.com), MSN (www.msn.com) and Yahoo (www.yahoo.com) search sites.

A Patient Portal extends Patients the power to customize their own HealthCare experience and communicate easily, safely and securely over the Internet with Clinical stakeholders. Providers grant patients access (with a secure username and password) to information through a web connection.

Patients Portals extend:
- Convenient 24/7 access to their physicians and clinicians through a single, secure online channel
- Access to moderated clinical data (e.g. labs and diagnostic results,)
- Access to relevant health information, personalized care instructions and disease management
- Ability to request prescription refills and renewals
- Access to maintain their own Personal Health Record (PHR) and Profile
- Ability to pre-Register and make, cancel or reschedule appointments
- Ability to pay their bill online
- Online Referral Requests/Office Visits
- Access to your organizations relevant classes and events
- Ability to make, cancel or reschedule appointments

Patient Portals even integrate with legacy Clinical, Financial, and EHR systems and is completely scalable, evolving with your organization. Providers can better communicate with their own patients. The attending Physician doctor can easily communicate with patients’ other attending physicians without the potential delay of traditional mail or phone messages. Data is exchanged in a PIPEDA (Personal Information Protection and Electronic Documents Act) /HIPAA (Health Insurance Portability and Accountability Act) (www.hipaa.org) compliant and secure fashion.

As exponentially more and more physicians adopt Electronic Health Medical Records they begin to realize the potential benefits of a Patient Portal. All too often doctors spend time with patients discussing symptoms, illnesses, and providing medical advice for which they routinely do not bill for. Why? Perhaps a fast paced office with a waiting room of patients and falling behind in the day’s schedule; too many things to remember beyond the “Chief Complaint.” This may be only one potential reason for under coding and subsequent under billing that many doctors say is routine. The doctor’s note in it’s entirety and the professional manner in which it is ultimately written, documented and adhered to, is the prize.

The patient can log on to a HIPAA/ PIPEDA compliant and secure web site and complete much of their pertinent information on-line prior to their in-person visit. The patient’s data is encrypted. The practice can be sure that HIPAA/PIPEDA standards are being met.

Once a Hospital or Physician’s practice has made the conversion from traditional paper charting to the EMR/EHR world, it becomes much easier to add a Patient Portal. The one simple truth however, related to eHealth Portals, is that if the underlying disparate clinical data cannot be accessed and consolidated, an eHealth platform cannot be extended to the patient. An example of a Patient Portal Vendor that both accesses and consolidates underlying disparate clinical data to extend a customized experience back to the Patient is Medseek.

The Hospital/Practice is the ultimate authority regarding how much data is conveyed to the patient. The patient does not have access to the doctor’s records at any time. The patient only sees what the doctor wants them to see. The physician note remains protected. The office staff enjoys the benefits of the patient portal too. The days of sending the patient a registration packet and hoping it’s complete before the office visit are gone forever. Staff no longer has to wait while the patient fills in all the necessary information. The patient fills out the paper work in the luxury of their own home. For patients that do not have access to an internet-enabled computer, a touch screen kiosk can be set up in the lobby away from wandering eyes.

New functionality is being added to patient portals. Some EMR/EHR vendors that support Patient Portal even have multilingual versions with automatic translation built in. Through a quality Patient Portal, the capability exists for test results to be viewed by the patient. Note: This is not to be confused with the newest health care product release by Microsoft: the Microsoft Health Vault (Announced October 5, 2007). This product allows an individual a Personal (self-regulated) Health Record (PHR) to store their own person health documents in a secure online vault.

A web presence is important. A Hospital or Physician practice is a business. Like most businesses, a quality web site becomes your “store front” to a prospective patient. Acceptance of technology in healthcare is a growing trend. Many practices post educational information on their practice web site as a service to their patients. This information does not replace a doctor’s care but serves as a valuable resource to the patient. Consumers are demanding automation and web services in all facets of daily life. The health care practitioner needs to provide these types of services to remain competitive in today’s health care market.

So, whether the ultimate goal is enhance the patient experience, build or strengthen community, enhance staff loyalty and retention, or improve clinical decisions and outcomes---Patient Portal's bridge the gap between Caregivers and Patients— before, during, and after the hospital stay.

B.C. upgrades PharmaNet to advance electronic health care

Victoria, B.C., March 10, 2008 - B.C. is enhancing PharmaNet as the next step in implementing electronic health records by investing $14.2 million in its eDrug project, Health Minister George Abbott announced today.

"Upgrading PharmaNet will help us further improve patient safety and better protect patients from medication errors that occur in a paper-based system," said Abbott. "With the new PharmaNet, physicians and pharmacists will be able to track patient medications between acute care and community settings and provide greater accuracy in the PharmaNet medication profiles."

PharmaNet is internationally recognized as a world-class secure electronic network that protects patient safety. It protects patients from potentially dangerous medication errors, duplications and dangerous combinations of different medications. It records all prescriptions dispensed at B.C. community pharmacies in a central database and checks for interactions.

eDrug is one of seven eHealth projects underway in British Columbia that will use advanced information technology to deliver needed health information instantly to authorized health professionals in B.C. The eDrug project, in addition to delivering the new PharmaNet-eRx system, will:

Provide online tools so physicians and pharmacists can offer affordable, best-practice therapies;
• Provide greater accuracy in the PharmaNet medication profiles by recording both dispensing by the pharmacists, and pickup of the prescription by the patient;
• Reduce administrative time in submitting PharmaCare Special Authority requests;
• Strengthen the privacy and security features of PharmaNet; and
• Over time, enable physicians to prescribe online.

"Pharmacists welcome upgrades to PharmaNet that will improve patient care," said Marshall Moleschi, Registrar of the College of Pharmacists of BC. "Updating PharmaNet has the potential to improve patient safety by reducing adverse drug events, avoid treatment delays and call backs leading to more effective and efficient care delivery."

Funding for B.C.'s eDrug program comes from the Province and Canada Health Infoway, a federally-funded, not-for-profit organization that is leading the development and adoption of electronic health records across Canada. Infoway is contributing $8.8 million and the Province is contributing $5.4 million of the $14.2 million agreement.

"PharmaNet has been one of Canada's leading e-health initiatives for more than a decade," said Richard Alvarez, president and CEO of Canada Health Infoway. "By connecting physicians and pharmacists, the new PharmaNet-eRx system will help reduce medication-related adverse events, increase patient safety and result in better health outcomes for patients throughout British Columbia."

Currently MAXIMUS BC and Systems Xcellence Inc. (SXC) maintain PharmaNet for the Ministry of Health's Pharmaceutical Services Division. The enhancements to PharmaNet are in a Change Order to the existing Master Services Agreement for an additional $14.2 million. The Change Order will see MAXIMUS BC configure and install a new SXC application as well as integration of this product with other eHealth components.

"This is major improvement to the already world-class PharmaNet system," said MAXIMUS BC president Duff Lang. "Improving information access for pharmacists and the public will truly deliver on the eHealth vision and will enable us to continue our quality service on behalf of the province."

All patient information will be protected by privacy measures that are among the strongest in Canada. The personal health information in PharmaNet and other components of a new electronic health record will comply with applicable privacy protective legislation, including the Province's Freedom of Information and Protection of Privacy Act, the Personal Information Privacy Act, the Pharmacists, Pharmacy Operations and Drug Scheduling Act and provisions of the Health Act that govern the use of information for health-related purposes. In addition, access to patient information will be restricted to only those having legal authority and a clear need to access the information.

Canada Health Infoway is leading the development and implementation of electronic health projects across Canada. Infoway works with provinces and territories to invest in electronic health projects, which support safer, more efficient health care delivery. Fully respecting patient confidentiality, these private and secure systems provide health care professionals with immediate access to complete and accurate patient information, enabling better decisions about diagnosis and treatment. The result is a sustainable health care system offering improved quality, accessibility, productivity and cost savings.

View Original Press Release

Google to store patients' health records

Google Inc. will begin storing the medical records of a few thousand people as it tests a long-awaited health service that's likely to raise more concerns about the volume of sensitive information entrusted to the internet search leader. The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google's new service, which won't be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that's also required to use other Google services such as e-mail and personalized search tools. Google views its expansion into health records management as a logical extension because its search engine already processes millions of requests from people trying to find more information about an injury, illness or recommended treatment.

But the health venture also will provide more fodder for privacy watchdogs who believe Google already knows too much about the interests and habits of its users as its computers log their search requests and store their e-mail discussions.

Prodded by the criticism, Google last year introduced a new system that purges people's search records after 18 months. In a show of its privacy commitment, Google also successfully rebuffed the U.S. Justice Department's demand to examine millions of its users' search requests in a court battle two years ago.

Pilot project has uncertain timetableThe Mountain View-based company hasn't specified a timetable for unveiling the health service, which has been the source of much speculation for the past two years. Marissa Mayer, the Google executive overseeing the health project, has previously said the service would debut in 2008.

Contacted Wednesday, a Google spokesman declined to elaborate on its plans. The Associated Press learned about the pilot project from the Cleveland Clinic, a not-for-profit medical cente founded 87 years ago. The clinic already keeps the personal health records of more than 120,000 patients on its own online service called MyChart. Patients who transfer the information to Google would still be able to get the data quickly even if they were no longer being treated by the Cleveland Clinic.

"We believe patients should be able to easily access and manage their own health information," Mayer said in a statement supplied by the Cleveland Clinic. The Cleveland Clinic decided to work with Google "to create a more efficient and effective national health care system," said C. Martin Harris, the medical centre's chief information officer.

Google isn't the first high-tech heavyweight to set up an online filing cabinet in an effort to make it easier for people to get their medical records after they change doctors or health insurance plans.

Health services go online
Rival Microsoft Corp. last year introduced a similar service called HealthVault, and AOL co-founder Steve Case is backing Revolution Health, which also offers online tools for managing personal health histories.

The third-party services are troublesome because they aren't covered by the Health Insurance Portability and Accountability Act, or HIPPA, said Pam Dixon, executive director of the World Privacy Forum, which just issued a cautionary report on the topic.

Passed in 1996, HIPPA established strict standards that classify medical information as a privileged communication between a doctor and patient. Among other things, the law requires a doctor to notify a patient when subpoenaed for a medical record. That means a patient who agrees to transfer medical records to an external health service run by Google or Microsoft could be unwittingly making it easier for the government or some other legal adversary to obtain the information, Dixon said. If the medical records aren't protected by HIPPA, the information conceivably also could be used for marketing purposes.

Google, which runs the internet's most lucrative ad network, typically bases its marketing messages on search requests and the content on web pages and e-mail contained in its computers. It's not clear how Google intends to make money from its health service. The company sometimes introduces new products without ads just to give people more reason to visit its website, betting the increased traffic will boost its profits in the long run.

View Original CBC News Article © The Canadian Press, 2008

Mississauga's William Osler Health Centre goes high-tech with patients' records

The Brampton Guardian | Monday December 24 2007 | PETER CRISCIONE

BRAMPTON - William Osler Health Centre (WOHC) is among three hospital sites in southern Ontario equipped with the ability to share patient data through a new web-based electronic healthcare record (EHR) viewer.

Agfa HealthCare, a leading provider of IT-enabled clinical workflow and diagnostic imaging solutions, unveiled recently new technology (their Clinical Dashboard platform) that allow's users to easily access critical patient information from any personal computer, handheld, or tablet PC with Internet access. For instance, data at WOHC's Etobicoke and Brampton sites can be retrieved and shared with Halton Healthcare Services (Oakville, Milton, Georgetown) and Credit Valley Hospital in Mississauga.

This eHealth portal (EHR Viewer) solution serves the nearly one million residents living in the communities of Brampton, Etobicoke and Georgetown.

"Agfa's proven federated portal model is a 'win-win' situation for hospitals - simple in premise, and deployed at a fraction of the time and cost of competitors, with immediate return on investment," said Dieter Pagani, director of Agfa HealthCare's Enterprise Solutions Group. "These hospitals are truly eHealth leaders in Ontario, and have taken a quantum-leap towards eliminating the traditional barriers associated with sharing data." Company officials say this vendor-agnostic technology promises to fundementally alter the Canadian healthcare landscape.

Agfa HealthCare's eHealth solutions are customized to meet the needs of each hospital and their unique stakeholders, "and built on a complimentary core foundation that is web-based, scalable, extensible and focused on delivering fast return on investment." The new technology ensures all three sites (including Credit Valley Hospital and Halton Health) can securely share all patient records---regardless of IT systems or vendors.

"This makes us trailblazers," said Judy Middleton, Chief Information Officer for WOHC. "If a physician has a patient at Osler, and the patient says 'I've been at Oakville or I've been at Credit Valley', then all the information from their visits will be accessible by the physician. So in terms of expediting treatment and care, you have much more information (at your disposal)."

Middleton said other hospitals in the Central West Local Health Integration Network (LHIN,) of which WOHC is a part of, are taking steps to adopt this innovative technology. In achieving this level of interoperability, William Osler will be able to reduce duplication and errors, while increasing the level of accuracy of information in terms of diagnosis, Middleton said.

---
[Original Article]

William Osler Health Centre’s Clinical Portal (EHR Viewer) Sets Connectivity Standard in Ontario

This article reprinted with permission from Medseek's eHealth Success Stories

In 2005, the Ontario Ministry of Health and Long-Term Care required William Osler Health Centre to transfer one of its hospitals to the Mississauga-Halton Local Health Integration Network (LHIN). Osler Health needed to provide physicians with real-time access to clinical information so that the continuity of care would not be disrupted during the transfer period and beyond. The most cost-effective and least complex solution was to build and deploy a clinical portal, and Osler turned to MEDSEEK due to the company’s reputation for reliability and service. Osler’s trust in MEDSEEK was extended when it rolled out their Rapid Electronic Access to Clinical Health information (R.E.A.C.H.) eHealth Portal in 2006.

The REACH eHealth Portal (EHR Viewer) has been extremely well received by physicians, in large part because the health system made sure to enlist their assistance and support from the start.

"From a quality perspective, more clinicians are using it and it is allowing them to access all the information they need to make patient care decisions faster, which ultimately affect clinical outcomes for the better," - Elizabeth Nemeth, RN, BScN, MN, project manager of the REACH and MD-Net portals

“A CIO can develop the vision, but if he or she doesn’t have physician and clinician champions along the way that vision is all for naught,” said Judy Middleton, chief information officer at Osler. “It’s really important to involve key individuals and end-users. They will let you know whether you are heading in the right direction and whether the information you’re providing is useful and meaningful to them. At the end of the day that’s what’s important.”

Although the divestiture provided the immediate spark that led Osler to launch a portal, the health system, one of the largest in Ontario, had been considering using a portal as a strategic tool to improve patient care and foster closer ties with physicians, patients, consumers and employees.

"It was part of the overall vision of the organization to provide access anywhere anytime to patient information over the Web,” Middleton said. “The master plan was already there and the Ministry of Health provided the impetus for us to make it happen sooner rather than later.”

Portals Improve Data Flow and Clinical Outcomes
Since its debut, REACH has been so successful that it led Osler to expand access in October 2007 to all nurses and allied health personnel. “From a quality perspective, more clinicians are using it and it is allowing them to access all the information they need to make patient care decisions faster, which ultimately affect clinical outcomes for the better,” said Elizabeth Nemeth, RN, BScN, MN, project manager of the R.E.A.C.H. and MD-Net portals at William Osler.

Due to its strategic nature and clinical impact, R.E.A.C.H. was expanded to the Peel and Halton regions, and just this past fall William Osler Health Centre welcomed clinicians at Credit Valley Hospital to the REACH portal. The successful collaboration between six physical hospital sites means all of their clinical stakeholders have instant access to patient health information stored electronically at any of the hospitals---regardless of legacy vendor platform.

"It was part of the overall vision of the organization to provide access anywhere anytime to patient information over the Web," - Judy Middleton, chief information officer at William Osler

The R.E.A.C.H. eHealth portal network provided federated access to over 90,000 inpatient stays and 1,050,000 outpatient visits for the fiscal year ended March 31, 2007. Patient stays and visits from all hospitals are consolidated into one, intuitive Web portal.

The REACH initiative (EHR "Viewer" based on Canada Health Infoway's designation) allows authorized users secure access to longitudinal patients information via a secure web-browser, whether inside and outside of the native hospital environment. This means records are both transferable and comprehensive. As patients move between regional facilities for different diagnostic tests and procedures, data like lab and diagnostic test results, images, transcriptions and progress reports written at one hospital can be viewed immediately by a physician treating the patient, on a subsequent visit, at any of the associated REACH facilities.

William Osler Health also plans to extend regional stakeholders a patient portal in the near future. While the organization’s Web site currently only extends minimal patient self-services (e.g.online bill payment,) the planned patient portal will offer patient stakeholders a richer menu of services such as online access to laboratory and test results, online appointment scheduling, and much more. Creating this portal, however, is particularly challenging because William Osler serves one of the most ethnically diverse populations in Canada.

“We are proceeding carefully because we want to be culturally sensitive and make sure that we do this right,” Middleton stated. “With each portal, we try to create a similar look and feel so the portals don’t look very different from each other but still meet the unique needs of the various end-users.”

"William Osler’s positive experience with REACH has also attracted the attention of the Province of Ontario's Ministry of Health. The Ministry is weighing whether other local health integration networks (LHIN's) in the Province should use it as a model for electronically exchanging information within their individual organization", Middleton said.

[Original article]

A Closer View of E-health

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

eHealth Leaders | Mississauga Hospitals sharing patient records

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

100% Paperless Healthcare and the EHR

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

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

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

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