Happy Holidays from all of us at ADN Canada Inc.

We look forward to working with you in the year to come. We wish you a very happy holiday season and a new year filled with peace and prosperity.  Best Wishes, ADN Canada

Digirad 2017 RSNA Booth: North - Hall B: 8323

If you are attending the 2017 RSNA please stop by the Digirad booth located at booth # 8323 North Hall 

Digirad Installs 4th Digirad ERGO Nuclear Camera in Toronto Hospital

Digirad ERGO

The Digirad Ergo's purpose is multi-purpose but it's compact, lightweight, portable, and design make it perfect for First Pass Nuclear Cardiac Studies.

Ergo™ Advantage:

• Solid-state technology enables superior positional flexibility and high-quality imaging.
• Versatile Its large field-of-view (12.2” x 15.6”) makes Ergo effective for a wide range of procedures.
• Portable The lightweight design and portable base make it easy to take Ergo from room to room or into various departments.
• Patient-friendly A sleek, open design makes it convenient to image patients sitting up or lying down.
• Effective Six easy-to-change, high-performance collimator options enable outstanding image contrast and clarity for a wide range of procedures.

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Since 1999, ADN Canada has sourced and introduced ‘best-of-breed’ diagnostic imaging innovation to the Canadian health care market from around the world. From the world’s first commercial solid-state Nuclear Gamma Camera, to KLAS® highest rated Cardiovascular Picture Archiving and Communication (PACS) System. ADN Medical Provides Solutions for Visionaries.  For more information please visit our website or contact us directly.

DIGIRAD’S NEXT-GENERATION EARTH AND SPACE SCIENCE MISSIONS

An X-Ray Spectrometer using state-of-the-art detector technology will be launched this year on the Clark spacecraft, one of two missions to be flown as part of the Small Spacecraft Technology Initiative. Under SSTI, NASA funded the development of “Clark,” a high technology demonstration satellite to provide 3-m resolution panchromatic and 15-m resolution multispectral images, as well as collect atmospheric constituent and cosmic x-ray data. The 690-Ib. satellite, to be launched in early 1997, will be in a 476 km, circular, sun-synchronous polar orbit.

The primary objective of this mission is to demonstrate new technologies for small spacecraft. In keeping with this philosophy, we use two new types of semiconductor X-ray detectors, both operating near room temperature: avalanche photodiodes and cadmiumzinc-telluride detectors. The main purpose of flying these detectors is to test them in a space environment so that they can be used with confidence on future space missions. Measurements of solar flare and gamma-ray burst X-ray emissions will also be made as well as atmospheric constituent and cosmic x-ray data.  Digirad will measure these emissions.

To assist, Digirad developed a new class of solid-state detector arrays with microelectronics readout circuitry for two-dimensional imaging of x-ray and gamma ray fields in support of next-generation Earth and space science mission requirements.   The approach uses cadmium zinc telluride (CZT), a new room temperature detector material first developed by Digirad. Recent results show that CZT detector arrays can exhibit high detection efficiencies and superior energy resolution from below 1 kev to above 600 kev. CZT detectors are robust and lightweight; and can be patterned in a variety of array structures, with pixel dimensions to well below 100 m.

The innovation of producing CZT imagers suitable for space meets the needs of NASA small missions initiatives. 

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For more information in Canada on Digirad's solid-state technology for advanced Nuclear Imaging, please contact your local ADN Canada sales consultant Toll-Free in Canada at 1-877-434-5311 or via e-mail.  Note: Any / all product names mentioned in this document may be trademarks or registered trademarks of their respective companies and are hereby acknowledged.

THE FUTURE OF OSTEOPOROSIS DIAGNOSIS - OSTEOCORE 3™

View Ostercore Brochure 

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ABOUT Alliance Distribution Network (ADN) Canada

With over ten years in business in Canada and over twenty PACS sites installed, Alliance Distribution Network (ADN) distributes KLAS Award winning Thinking Systems PACS and RIS solutions across Canada, as well as both Digirad, Medi-Link, Esaote, and UltraSPECT respectively.   For additional information please contact ADN directly Toll-free at 1-877-434-5311 or via email  Alternatively, please feel free to join the discussion on our new Facebook Page.

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. 

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)

The Healthcare Enterprise | Making a case for eHealth Investment

Many healthcare executives look at technology as a cost of doing business. However, investment in strategically chosen technology can enhance revenue while lowering operational costs. Labour, as an example, is the most expensive and valuable resource in a hospital. Therefore, any measurable improvement in the use and efficiency of labour can improve a hospital’s bottom line considerably.

Whether business office staff processing claims information, nurses performing patient assessments, or physicians diagnosing and treating patients, with the current disarray of disparate information databases (and wireless and remote technologies;) users are constantly striving to gather the information required in order to perform and optimize their job function. Strategic implementation of new Technology can significantly improve efficiency in:
• Clinical Operations (ex: Nursing, Physicians and ER)
• Financial Operations (ex: Contract Management, Administration and Registration and Accounts Payables and Material Management)
• IT Operations (ex: Training, Help desk, Network, etc.)

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CLINICAL OPERATIONS
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1. Nursing:
This is the primary area for patient care improvement and enhanced patient revenue. All aspects of technology must perform smoothly – and be transparent to the end user – or nursing will not use it for patient care. When this area is not supported by IT effectively, nurses and other clinicians will revert to paper as the only reliable way to record information regarding patient interventions and notes on the patient’s status. When this happens it significantly lengthens the process, potentially up to two hours per patient per shift. Furthermore it results in duplicate processes and redundant data capture – so much so the caregiver spends too much time managing the clerical tasks, and the patient care process is inhibited. Accurate and timely charging for patient procedures, tests and supplies do not always occur resulting in lost revenue for the hospital. The key technology elements that must all be operating effectively are:
• Robust Clinical Application System including Case Management and Scheduling
• System reliability (99.9% availability)
• System performance (instant response time)
• Easy to use and accessible system devices (e.g., wireless, PDA’s, tablets, printers, etc.)

2. Physicians:
Physicians’ have two main concerns
• time to see patients and
• the timely availability of accurate patient information.

Therefore, creating a way for physicians – no matter where they may be – to continuously receive updated information on their patients addresses both of their primary concerns. Providing this technology is a key contributor to recruiting and retaining satisfied physicians, as well as providing high-quality patient care. The key technology elements that must all be operating effectively are:
• Physician-oriented presentation of patient results information
• Easy-to-Use computerized physician order entry system
• Online access to patient’s diagnostic x-ray and ultrasound information (PACS)
• System reliability
• System performance
• Support for multiple input and output devices (e.g., wireless, PDA’s, tablets, printers, etc.) from in-hospital as well as remote locations
• Integration to their office practice management and EMR systems

3. EMR:
The ultimate goal of most healthcare organizations is a paperless electronic medical record to improve the efficiency and effectiveness of the enterprise workflow process and enhance the revenue generation process. Healthcare management understands, at a conceptual level, that having an automated digital hospital would improve the entire patient care workflow process, and thus, patient satisfaction and staff productivity. The successful automation of previously paper-based processes requires a robust IT infrastructure, and careful planning among all the affected stakeholders.

4. PACS:
A PACS system not only has proven to produce positive bottom-line results, but also is often considered a necessary precursor to the EMR. A wise investment that often pays for itself within 3-5 years, it allows the “reading” of images from all modalities from a workstation that is either in the hospital, or in a remote office. The biggest benefit however is the ability to transmit and view the image to wherever it is needed, and removes all of the barriers to access that exist with traditional film. To achieve all the available benefits, the network bandwidth must be in place to support very large image files, and again, careful planning among all the affected stakeholders is critical to a successful implementation.

5. ER:
Increasingly hospitals are realizing that their ER is a major entry point for patients and should not be overlooked as a revenue source. Providing comprehensive computerized systems that are optimized for the ER’s workflow are mandatory if the hospital desires to realize the potential benefits available. The key technology elements that must all be operating effectively are:
• Emergency Room Patient Tracking System
• System reliability
• System performance
• Easy to access and use input and output devices (e.g., wireless, PDA’s, tablets, printers, etc.)
• Seamless Integration to a hospital’s Master Patient Index to retrieve patient information and provide billing data
• Integration with the EMR to maintain a comprehensive clinical record.

6. Laboratory:
Laboratory orders are processed promptly because of the need of the patient. However, in a paper-based environment, charges can be overlooked because of the multiple steps required to process a patient chart and the extra work involved in capturing charges. A comprehensive Laboratory Information System (LIS) that is fully integrated with the HIS will alleviate this problem, as well as improve the overall efficiency and effectiveness of the Laboratory staff. The key technology elements that must all be operating effectively are:
• Robust Laboratory Information System including integration with all laboratory instruments
• Integration with hospital’s EMR and/or order entry system
• Integration with any external reference laboratory used to enable a complete view of patient’s lab results
• System reliability
• System performance

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FINANCIAL OPERATIONS:
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The key to strategic gains in the Financial/Administrative area is to invest in the newest technology that enables business processes to function more efficiently, and ensures the most accurate billing practices for the organization. Even small procedural changes can create more effective billing and substantially improve the bottom line. Likewise, the implementation of comprehensive scheduling systems can improve turnaround times and help ensure the optimal use of expensive fixed assets throughout the hospital. Other areas suitable for increased investment are described below.

1. Contract Management:
Many hospital billing operations submit claims based upon the personal knowledge of staff billers. Billers often overlook minute and incremental charge optimization opportunities simply because of the volume of bills and claims that must be generated and submitted. The computerization of code optimization and the underpayment analysis of payer reimbursement will have an ongoing and profound impact on a hospital’s bottom line. Whereas these billers are very knowledgeable, their true value is in the management and adjudication of claims denials. The loss of revenue per claim may be small, yet the total volume of claims equates to a substantial loss. Computerization of the claims submission and denial process quickly pays for itself and can immediately increase the hospital’s cash. The key technology elements that must all be operating seamlessly:
• Contract Management Application System
• System reliability (minimal downtime)
• System performance (immediate response time)
• Adequate storage (retrieve discharged patient’s complete information)
• Electronic interface to primary payors
• Integration with hospital’s patient accounting system

Hospitals will vary on the impact of automating these areas of operation. The cumulative effect can be quite surprising. As PriceWaterhouseCoopers and HIMSS analytics reported in their study of cardiac care in 36 hospitals in March 2005, there was an “85% reduction in medical errors and a 65% reduction in inappropriate denials from payors…” in the hospitals studied.

2. Admissions and registration:
This area requires system speed and a reduction in the complexity of screen layouts. There is typically a lot of turnover in this area. Yet Admissions is the first location for revenue enhancement and the primary source of errors and inaccurate data for billers to deal with claims denials. The key technology elements that must all be operating effectively are:
• Comprehensive admission-discharge-transfer system
• Integration with payors to confirm patient coverage
• Integration with patient scheduling system
• System reliability (no downtime)
• System performance (immediate response time)
• Easy to access and use input and output devices

3. Accounts Payable/Materials Management:
The goal of automating the replenishment of the hospital supplies (using just-in-time processes), while taking maximum advantage of the hospital’s contracts, in an effective and efficient process, has a significant impact on the hospital’s profitability. Accurate, ongoing, and continuous inventory, minimal loss of stock, and maximum chargeability are the key components. Taking advantage of discounts by being able to pay vendor’s invoices within the discount can benefit the hospital’s bottom line. The key technology elements that must all be operating
effectively are:
• Comprehensive Accounts Payable System
• Comprehensive Materials Management System
• Integration between Accounts Payable and Materials Management
• System performance (immediate response time)
• Easy to access and use
• Adequate storage

4. Barcoding:
It has been shown that barcoding data at the bedside, from the pharmacy, and through materials management reduces medical errors tremendously, as well as, improves the automation of input of data into the patient chart. It holds the ability to speed and integrate the purchasing, distribution, administration, charting, and billing for pharmaceutical and other supplies. An effective barcoding strategy not only provides more accurate and timely information, but also saves time and improves the work lives of clinicians, managers, and staffers by making things run more smoothly and simply. To realize the full benefits of a barcoding implementation, attention must be paid to the workflow changes necessary to get maximum returns. When combined with supply chain automation, the entire process of acquiring the correct supplies, packaged and correctly prepared for patient delivery, are made available to the care-giver when needed – and the documentation for billing, inventory reordering, and the patient chart, is captured as a by-product of the patient care process.

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IT OPERATIONS:
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The common thread in improving IT Operations in healthcare is to achieve maximum leverage of the staff resources to implement and support an ever-increasing array of emerging hardware and applications. Through continual centralization of the environment, more ROI is squeezed out of fixed assets and the staff becomes more efficient by giving them the tools to do their job more effectively. Whether it’s server administration, network management, application support, or user provisioning, the innovative investment in the IT infrastructure can improve service levels and ensure optimum utilization of expensive staff resources. Practical examples include:

1. Training:
As the general workflow process is automated, the need for personnel to understand how to use the tools at hand becomes paramount. Training is needed in two distinct areas; the IT staff and the users:
• The IT staff must be trained to understand how to use the servers, switches, software and network to maximize the users’ capabilities. Each IT staff member has a “multiplier effect” upon the user community’s effectiveness. Most should therefore be certified in their area of expertise.
• The automation process is for the benefit of the user and the organization. Therefore, the user must be trained in the optimal usage of the system and the tasks they perform. This means that an ongoing training program should be implemented to ensure employees are accomplished on the system(s) they use and fully understand the implication of their actions when using automated systems to perform their jobs.

2. Help Desk/ Service Level Management:
IT departments may have a phone number for users to call in case of need, however most facilities do not have an automated structured process to monitor
technology, diagnose problems, administer support, and measure performance by automated reporting. It is imperative to be able to understand the source of help desk calls in order to properly plan for the improvements needed to improve customer service.

3. Network:
The network is the nervous system of an organization’s information flow. There are a number of components of a network that must be able to transport data at a guaranteed minimum volume.

4. Switches, bridges, and routers:
The switches, bridges and routers are the devices that route data from one part of the network to another. Considering that a fully automated healthcare workflow process will have a minimum of 25 major applications that will route data for 30 departments, the switches need to be configured to handle the volume of traffic anticipated.

5. Backplane:
A backplane acts as a “traffic cop” for the data that comes from all of the different switches within the network. Therefore, it must handle the accumulated burstable volume of the network. For a fully integrated and automated workflow process, a backplane may need to burst to 4 Gigabytes/sec. of volume.

6. Network Management Software:
Many of the major network vendors have the ability to continuously “ping” the network through a technology called SNMP. This allows IT to proactively monitor the “health” status of switches, PCs and servers. The same software now also keeps an inventory of hardware and software, as well as version control, so that the network can now distribute patches, updates, and fixes to the users quickly. Finally, most of these network vendors now have integrated help desk and service level management automation into their support process. Therefore, IT can now receive a request for assistance, log it, prioritize it, and escalate it automatically. They can then diagnose and fix (either remotely or by the system dispatching a person) user’s hardware and software. Finally, the IT tools can then print out a report that shows the amount of time systems were up for the month, how many service calls were responded to by prioritized need, who was serviced and when, as well as the outcome of that service call.

7. Wireless and Remote Capabilities:
Wireless PDAs, tablet PCs, smartphones and laptops are transforming the way information is gathered and processed. Systems can now be structured so that physicians may plug their device into the hospital system and be uploaded with what happened to their patients overnight. Additionally, caregivers and hospital staff can now work from home.

8. VoIP:
Currently the dual networks and dual support staffs to run a network and a PBX system are costly. Time and again, the return on investment (ROI) to move the phone system onto the network, department by department over a period of time, has shown to be a good investment. There is no charge for moves, adds and changes (MACs) now, the administration of two systems can be handled internally by one group, and future cabling costs are minimized.

9. Cabling:
Cabling is an infrastructure issue and often its importance is overlooked. But, it is foundation of the information highway for a hospital. In addition, as hospitals are adding increasing computerization, cabling installed two years ago may soon be outdated. Cabling should be an integral part of a hospital’s computer plan.

10. Standardization:
Standardization means that the technical components of servers, switches, and PCs should have the same memory, cache, and storage. The reason for this is that servicing a few standards reduces the complexity of support, which has shown time and again to be the best way to reduce the cost of operations.

11. Servers:
Most servers are currently purchased as individual standalone machines. This creates two problems: first, it means that each server is a single point of failure for its own data and there is no failover capability from one server to another; and second, the storage usage of each machine is usually less than 50% of capability. Therefore, the architecture of servers should be configured into a storage array network (SAN) of blade servers configured to backup each other.

Conclusion:
The implementation and continued automation of the healthcare workflow process is analogous to building a house. All departments run their own operation, but are interconnected and dependent upon each other to provide a complete workflow environment. The foundation of said “digital house” however, is the technological infrastructure. Any weak points in the infrastructure will create bottlenecks in the workflow process. The demand for quick and accurate patient information in hospitals is continuously on the increase. Hospitals have to improve their technological infrastructure in order to meet the needs of caregivers and to enhance their revenue. Healthcare workflow process improvement will take time to accomplish in a coordinated, synergistic manner that will improve patient care and hospital revenue.

Patient Destiny: Consumers must have access to their health records

By Kevin J. Leonard and David Wiljer

Just as customers accessing their information have reduced banking industry costs, it is a general assumption that the same will hold true in healthcare. As more patients bypass the “hands-on” personal method and obtain information for themselves, it is estimated that great savings will be gained, and consequently, a tremendous amount of strain will be removed from the system.

However, very seldom is patient information (e.g., the specific results of diagnostic tests) ever shared with the patient. As a result, it is very difficult for patients to enter a dialogue with their doctors about treatment, because the healthcare provider is the only one with the information. One truism seems to be constantly ignored: It is impossible for patients to manage their health without the requisite information! This is not just a passing fad or part of a catchy slogan, but rather a conclusion that is based on a number of logical premises, outlined as follows:

Times have changed: This may not appear to be all that insightful, at first glance, but this premise contains very important building blocks. We are no longer in an era where businesses and governments tell people what to do and when. The rise in consumerism has created the demand from the public for better information and better service. The public wants information in the way they want it, when they want it. We have rapidly progressed through the Information Age into a “Knowledge Era”. Information that is meaningless to consumers has no value. In the next 20 years, the industries that will be successful will be the ones that can take advantage of technology and deliver pertinent information, which is “targeted knowledge” channeled down to the individual consumer.

Patients are at the centre of healthcare: We have seen many Hospital Mission statements echoing this same message – changing to patient-centered care. However, this ‘mantra’ has not been firmly understood or appreciated. Without the patient, there is no need for healthcare professionals. The patient is the one constant throughout all of the healthcare system.

What patients do want, and will demand, is better information about the system, about who does what services, and about how well they perform these services. Answers to these questions will allow consumers to make informed decisions surrounding their care.

Patients want access to their own patient information – and they want to be able to understand what it is that they are reading. In particular, they want to know more about their illness or disease, and they want information on treatment options and success rates. Often, they would like to get in touch with other patients to exchange experiences and to get advice. After all, it is only when they interact with other patients that they get real information about what they are going, or will go, through.

Ultimately, patients are the decision makers: When patients are faced with difficult healthcare questions, they seek advice – from their doctors, other health professionals, and their own personal network. Even though the physician will provide the best medical support, ultimately, it is the patient who has to decide whether they want this drug treatment or that surgery.

It is understood that not all patients may have the maturity or cognitive ability to comprehend the decisions that they have to make. Many caregivers have used this argument to withhold information; but, in actuality, this rebuttal only applies to a small percentage – perhaps, to 20 percent of our population. The remaining 80 percent have the ability and the right to make their own decisions. What they lack is the medical background in order to facilitate all the information and to process it in order to make an informed choice.

It is our belief that in the healthcare system of the future, we will see physicians (and other professionals) act as advisors to patients, rather than the old model, where patients are told what to do. Gone will be the day where patients will feel that they are not free to question facts or to seek options.

Decision-makers need information: It is well understood in information theory, and in the decision analysis literature, that decision-makers need information to assist in making any decision. It then becomes clear that we must get the critical information to the patient in order for them to make informed decisions. This means that the focal point of the healthcare system of the future must be on the patient record, since that is the only point where all the data reside. In order to move the data and information around efficiently, it is obvious as well that this record will have to be in an electronic form.

Conclusion: Patients must be able to access their health records and other patient information if they are to make informed and effective decisions about their health management. Consequently, it is impossible for patients to manage their health without this requisite information!
Access to records improves satisfaction for lung transplant patients
Over 40 percent of patients have at least one chronic illness, accounting for nearly two thirds of all medical expenditures. Because of their long timeframe and high attendant costs over time, chronic illnesses lend themselves to electronically mediated self-management tools. Prototypes of web-based, patient-centered Information and Decision Support Tools have been demonstrated to improve self-management of illness and enhance understanding of the complications of poorly controlled disease. Patients living with chronic illness are also more likely to use health information than their healthier counterparts, although each chronic illness has specific, recognizable challenges for affected patients in symptom comprehension, information management, task fulfillment and social interaction.

It is our hypothesis that leadership will come from these chronically ill patients (either individually or within a group) by demanding better access to health system and service information. In recent research, we interviewed patients on a number of “access to information” issues. Unfortunately, asking patients (or computer end-users or stakeholders) what information they would like to receive is not efficacious due to the fact that end-users are normally not well versed in “system options”.

What stakeholders are very good at, however, is identifying functionality they would “like to have” at the moment that they experience it. As a result, we have engaged different groups of patients suffering from a chronic condition. In this instance, we present results on post-lung transplant patients in both passive (survey interview) and active (simulation) environments to elicit their needs and wants. (This group was analyzed due to accessibility, however, it is believed that many of the findings are applicable across a number of illnesses or chronic conditions.)

Almost two-thirds of these lung transplant patients (63 percent) had seen some portion of their medical record (most commonly blood work or X-ray results) and a similar percentage believed a personal medical record would help them manage their personal healthcare. The most common reason respondents wanted access to their medical chart was to enhance their understanding of their medical condition. This desire to have further access to personal medical information was expressed despite a comprehensive patient education program provided by the transplant program, and despite the fact a high degree of patients felt they were provided with an adequate degree of information upon discharge from hospital. As a whole, this group appears to have a high level of interest in their medical information and can be described as active participants in their care.

The patients were then asked what they believe would be the most valuable aspect of having access to their medical information. Respondents were encouraged to check all that apply:

• 57 percent of patients believe that access to their medical information would help enhance their understanding of their medical condition.

• 13 percent of patients indicated that access to their medical information would help ensure the information was available to their family doctor.

• 13 percent of patients felt access to this information was important in case of an emergency.

Further, over 60 percent of patients believe that having access to information about the medical care that they receive would help in managing their healthcare while at home. The difference in the phrasing of each question may illustrate the importance patients’ place on information necessary for self-management over information about their hospital stay. Sixty percent of patients believe that if they were provided with their medical record, they themselves and their family physician would use it the most. Related to the use of the patient’s medical record, 73 percent of respondents did not have any concerns about a family physician, family members or other medical specialists having access to their record.

Patients were also given the chance to choose what type of information from the hospital they would find useful to help manage their care at home The most popular choice was the lab test and results (67 percent) followed by a summary of their medical history, medication information (history and current), contact information (specialists and emergency contacts) and blood pressure/ temperature charts. Family and personal history and height/weight charts were not strongly endorsed. Only 17 percent of all respondents felt the inclusion of an allergy history was necessary in their personal health record. Given a choice, 63 percent of patients would want this information as a paper copy. Other preferences included CD (13 percent), secure Internet (13 percent), and other storage device (10 percent). Forty-seven percent of respondents indicated that they would find it useful to have the entire lung transplant manual in an electronic format.

The survey indicates that lung transplant patients are interested in accessing their personal health information to support their health management. At the time of the survey, well over half of the sample group was connected to the Internet and according to the literature, it can be expected they are accessing health information through that medium. This desire stems from increased self-reliance in the management of personal health and the desire to take a more active role in the medical decision-making process. While the effect that this information may have on patient health outcomes is not clear, access to personal health information is associated with improved patient satisfaction. As patients move to a more self-reliant role in the management of their health, the demand for personalized information will only increase.

Conclusions: We must begin to put pressure on the system to support patients in gaining access to their own health information. As presented herein, this is needed and soon will be demanded. Ultimately, this inevitability has been framed by the term Patient Destiny, where patients are actively involved in all healthcare decision-making. This is an infeasible proposition in a paper-based system, which means we must move to more Electronic Health Records or EHRs. Since patient access to individual healthcare provider organizations’ health record systems appears to be almost as unviable, due to limitations in data format, unique patient identifiers and system constraints, one appealing approach is to follow the path whereby patients interface with their health-related information across the many providers in a Web 2.0 environment.

A web-based patient interface between consumers and the health system could help patients search for quality information and link them to resources that address their needs. In detail, the benefits for the consumers could be as follows:

• Obtain quality health information, quickly and efficiently, based on personal and contextual needs;

• Access an up-to-date consumer health directory with listings and satisfaction ratings of trusted healthcare providers in Canada and elsewhere;

• Connect with like-minded users to share health experiences, knowledge and resources;

• Allow consumers to use monitoring tools to manage active lifestyles and primary healthcare conditions such as blood pressure, weight and high sugars;

• Provide a pathway to their own health information and expectations; and

• Design a reward system for their investment in health, well-being and where health-conscience behaviour is rewarded within a ‘point collection’ system.

In essence, a health sector-wide strategy of patient awareness and education is now required. All consumers of healthcare – the healthy and the ill – need to be presented with a forum for a comprehensive discussion on healthcare, one that deals with the trends of rising consumerism and greater expectations relating to information access and delivery. We must promote an “effective and coordinated consumerism” perspective within healthcare. Hopefully, this will provide an incentive to all consumers to become more involved in their own care and health management and to demand more from health providers.

Kevin J. Leonard is Associate Professor in the Dept of Health Policy, Management & Evaluation, University of Toronto.

David Wiljer is Director, Knowledge Management and Innovation, at Princess Margaret Hospital, University Health Network, Toronto.