Canadian e-Health and Web 2.0

Healthcare systems are undergoing a series of complex transformations.  Consumers are demanding better services and information that enables provider transparency and a more personalized service delivery model.  This shift in healthcare has already begun, whether or not healthcare delivery organizations are ready to respond or not.  We are quickly moving away from the traditional models of medicine and towards a patient-centric model with the intent to deliver more efficient care, whilst simultaneously improving patient outcomes.  The advent of new web 2.0 eHealth technologies is proving a powerful catalyst and today’s savvy consumers (patients) are demanding that the often slow-moving healthcare industry act in response to their evolving needs.

With close to 70% of the Canadian Population  online — it stems to reason that most people prefer to investigate their health concerns online before visiting a Physician.  Moreover, these same people report that what they find online influences their treatment decisions.  The increasing expectations of consumers is a clear reflection of wider societal changes that have been evolving for a number of years, however, the pace of these trends has recently accelerated.  In particular, the ability to articulate and communicate (1:1) individual preferences and demands has been made far easier with advancing web technologies. Such tools, for example, have enabled even novice internet users to create and edit content online.  It’s clear; 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.  

Patient Empowerment

Empowering patients to take more control over their health extends to those actions individuals and take for themselves, their children, their families and others to stay fit and maintain good physical and mental health; meet social and psychological needs; prevent illness or accidents; care for minor ailments and long-term conditions; and maintain health and well being after an acute illness or discharge from hospital.    This “Self-care” is also one of the key building blocks for patient-centric healthcare delivery, and research shows that supporting self-care improves health outcomes, increases patient satisfaction, and reduces the increasing administrative burden.

This (r)evolution is also driven by things like the increased adoption of online services via broadband and mobile devices; the enhanced ability to connect with individuals in other social networks; the continuing ease in submitting content online; and the growing participation of users with similar interests in online communities.  People are flocking to online communities to share personal health experiences as well as learn from others with similar experiences or conditions.   Patient feedback on treatments and providers for example, has begun to develop into an online system that generates transparency in the health system.

Today’s web-savvy patients are using web tools to take responsibility for managing their own health status and care-path rather than always relying on experts or the 'doctor knows best' assumption. This self-service (self-care) trend effectively bridges the gap between caregivers and patients – before, during, and after the hospital stay and has far-reaching implications.

Heightened Transparency and Accountability

One of the central components of healthcare delivery (and public health at large) is information.  The use eHealth (ICT) technologies related to gathering and retrieving patient data is already important and will only become more important in the future. Millions of dollars are spent each year in Canada on patients with chronic diseases who do not receive the recommended care designed to keep their conditions under control.  

New web 2.0 consumer tools and service models for chronic conditions are taking shape and the trend toward measurement of clinical outcomes is increasing and irreversible.   As both regulatory agencies and consumers insist today on measuring the quality of care across a wide variety of clinical areas, “best-practice” treatment models emerge.  This follows the growing awareness that quality equals affordability and that the best way to control long-term costs is to provide higher quality care today.   

The Electronic Health Record (EHR)

Technology can be intimidating, however Practitioners recognize today that the use of a comprehensive, transferrable EHR promises to protect patients from preventable errors such as medication mistakes, surgical complications, and much more.   It’s proven that extending care delivery stakeholders access to timely, evidence-based and expert information enables more efficient and better-informed decisions.   A US-based 2008 New England Journal of Medicine survey found that “82 percent of those using such electronic records said they improved the quality of clinical decisions, 86 percent said they helped in avoiding medication errors, and 85 percent said they improved the delivery of preventative care.” 

Whether the goal is to heighten prevention, detection, integration, or extend patients self-management, the advent of new web 2.0 eHealth technologies is shifting the healthcare delivery paradigm to focus on connecting individuals rather than infrastructure – putting patients (and clinicians) at the centre of new models of connectivity for improved communication and collaboration.  The future has a way of arriving unannounced. 

May the dreams of our past be the reality of our future. 

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 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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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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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.

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

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

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

Canadian Regional e-Health/EHR Authorities

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Manitoba




Western Health Information Collaborative (BC, Alberta, Saskatchewan, Manitoba, Yukon, NWT, and Nunavut)


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Canada Health Infoway